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 Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 410 and 416
[CMS-1517-F]
RIN 0938-AO73
 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
 ACTION: Final rule.
 SUMMARY: This final rule revises the Medicare ambulatory surgical center (ASC) payment system to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). This final rule establishes the ASC list of covered surgical procedures, identifies covered ancillary services under the revised ASC payment system, and sets forth the amounts and factors that will be used to determine the ASC payment rates for calendar year (CY) 2008. The changes to the ASC payment system and ratesetting methodology in this final rule are applicable to services furnished on or after January 1, 2008.
 DATES: *Effective Date:*
                             This final rule is effective on January 1, 2008.
 FOR FURTHER INFORMATION, CONTACT: Alberta Dwivedi, (410) 786-0378. Dana Burley, (410) 786-0378.


SUPPLEMENTARY INFORMATION: 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 This Final Rule AHA American Hospital Association AMA American Medical Association APC Ambulatory payment classification ASC Ambulatory surgical center BESS [Medicare] Part B Extract Summary System CAH Critical access hospital CBSA Core-Based Statistical Area CMS Centers for Medicare & Medicaid Services CPI-U Consumer Price Index for All Urban Consumers CPT [Physicians'] Current Procedural Terminology, Fourth Edition, 2007, copyrighted by the American Medical Association. CPT® is a trademark of the American Medical Association. CY Calendar year DRA Deficit Reduction Act of 2005, Public Law 109-171 FY Federal fiscal year GAO Government Accountability Office HCPCS Healthcare Common Procedure Coding System HOPD Hospital outpatient department HQA Hospital Quality Alliance IOL Intraocular lens IPPS [Hospital] Inpatient prospective payment system MAC Medicare administrative contractor MedPAC Medicare Payment Advisory Commission MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-173 MPFS Medicare Physician Fee Schedule MSA Metropolitan Statistical Area NTIOL New technology intraocular lens OCE Outpatient Code Editor OMB Office of Management and Budget OPPS [Hospital] Outpatient prospective payment system PM Program memorandum PPAC Practicing Physicians Advisory Council PPS Prospective payment system PRA Paperwork Reduction Act of 1995 RFA Regulatory Flexibility Act RVU Relative value unit To assist readers in referencing sections contained in this document, we are providing the following table of contents: Table of Contents I. Background A. Legislative and Regulatory History B. ASC Payment Method C. Provisions of Public Law 108-173 (MMA) D. Issuance of Proposed Rule E. Changes to the ASC List for CY 2007 II. Revisions to the ASC Payment System Effective January 1, 2008 A. General B. Factors Considered in the Development of the Revised ASC Payment System C. Rulemaking for the Revised ASC Payment System in CY 2008 III. Covered Surgical Procedures Paid in ASCs On or After January 1, 2008 A. Payable Procedures 1. Definition of Surgical Procedure 2. Procedures Excluded From Payment Under the Revised ASC Payment System a. Significant Safety Risk b. Overnight Stay B. Treatment of Unlisted Procedure Codes and Procedures That Are Not Paid Separately Under the OPPS C. Treatment of Office-Based Procedures D. Specific Surgical Procedures Excluded From Payment Under the Revised ASC Payment System IV. Ratesetting Methodology for the Revised ASC Payment System A. Overview of Current ASC Payment System B. ASC Relative Payment Weights Based on APC Groups and Relative Payment Weights Established Under the OPPS C. Packaging Policy 1. General Policy 2. Policies for Specific Items and Services a. Radiology Services b. Brachytherapy Sources c. Drugs and Biologicals d. Implantable Devices With Pass-Through Status Under the OPPS e. Implantable Devices Without Pass-Through Status Under the OPPS D. Payment for Corneal Tissue Under the Revised ASC Payment System E. Payment for Office-Based Procedures F. Payment Policies for Multiple and Interrupted Procedures 1. Multiple Procedure Discounting Policy 2. Interrupted Procedure Policies G. Geographic Adjustment H. Adjustment for Inflation I. Beneficiary Coinsurance J. Phase-In of Full Implementation of Payment Rates Calculated Under the Revised ASC Payment System Methodology V. Calculation of ASC Conversion Factor and ASC Payment Rates for CY 2008 A. Overview B. Budget Neutrality Requirement C. Calculation of the ASC Payment Rates for CY 2008 1. Proposed Method for Calculation of the ASC Payment Rates for CY 2008 in the August 2006 Proposed Rule a. Estimated Medicare Program Payments (Excluding Beneficiary Coinsurnace) Under the Current ASC Payment System in the August 2006 Proposed Rule b. Estimated Medicare Program Payments (Excluding Beneficiary Coinsurance) Under the Proposed Revised ASC Payment System in the August 2006 Proposed Rule c. Calculation of the Proposed CY 2008 Budget Neutrality Adjustment in the August 2006 Proposed Rule d. Application of the Budget Neutrality Adjustment To Determine the Proposed CY 2008 ASC Conversion Factor in the August 2006 Proposed Rule e. Calculation of the Proposed CY 2008 ASC Payment Rates Under the Revised ASC Payment System in the August 2006 Proposed Rule f. Calculation of the Proposed CY 2008 ASC Payment Rates Under the Transition in the August 2006 Proposed Rule 2. Alternative Option for Calculating the Proposed Budget Neutrality Adjustment in the August 2006 Proposed Rule a. Estimated Medicare Program Payments (Excluding Beneficiary Coinsurance) 
                            ( print page 42471)
                            Under the Existing ASC Payment System in the August 2006 Proposed Rule b. Estimated Medicare Program Payments (Excluding Beneficiary Coinsurance) Under the Proposed Revised ASC Payment System in the August 2006 Proposed Rule c. Calculation of the Proposed CY 2008 Budget Neutrality Adjustment in the August 2006 Proposed Rule d. Discussion of the Alternative Calculation of the Budget Neutrality Adjustment 3. Calculation of the Estimated CY 2008 Budget Neutrality Adjustment According to the Final Policy 4. Final Calculation of the Estimated ASC Payment Rates for CY 2008 a. Estimated CY 2008 Medicare Program Payments (Excluding Beneficiary Coinsurance) Under the Existing ASC Payment System b. Estimated Medicare Program Payments (Excluding Beneficiary Coinsurance) Under the Revised ASC Payment System c. Calculation of the Final Estimated CY 2008 Budget Neutrality Adjustment d. Calculation of the Final Estimated CY 2008 ASC Payment Rates D. Calculation of the ASC Payment Rates for CY 2009 and Future Years 1. Updating the ASC Relative Payment Weights 2. Updating the ASC Conversion Factor E. Annual Updates VI. Information in Addenda Related to the Revised CY 2008 ASC Payment System VII. ASC Regulatory Changes A. Regulatory Changes That Were Finalized in the CY 2007 OPPS/ASC Final Rule With Comment Period B. Regulatory Changes Included in This Final Rule VIII. Files Available to the Public Via the Internet IX. Collection of Information Requirements X. Regulatory Impact Analysis A. Overall Impact 1. Executive Order 12866 2. Regulatory Flexibility Act 3. Small Rural Hospitals 4. Unfunded Mandates 5. Federalism B. Effects of the Revisions to the ASC Payment System for CY 2008 1. Alternatives Considered 2. Limitations of Our Analysis 3. Estimated Effects of This Final Rule on ASCs 4. Estimated Effects of This Final Rule on Beneficiaries 5. Conclusion 6. Accounting Statement C. Executive Order 12866 Regulation Text Addendum AA.—Illustrative ASC Covered Surgical Procedures for CY 2008 (Including Surgical Procedures for Which Payment Is Packaged) Addendum BB.—Illustrative ASC Covered Ancillary Services Integral to Covered Surgical Procedures for CY 2008 (Including Ancillary Services for Which Payment Is Packaged) Addendum DD1.—Illustrative ASC Payment Indicators I. Background A. Legislative and Regulatory History Section 1832(a)(2)(F)(i) of the Social Security Act (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 specified by the Secretary that are performed in an ambulatory surgical center (ASC). To participate in the Medicare program as an ASC, a facility must meet the standards specified in section 1832(a)(2)(F)(i) of the Act, which are implemented in 42 CFR Part 416, Subpart B and Subpart C of our regulations. The regulations at 42 CFR 416, Subpart B set forth general conditions and requirements for ASCs, and the regulations at Subpart C provide 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 1833(i)(1)(A) of the Act requires the Secretary to specify surgical procedures that, although appropriately performed in an inpatient hospital setting, also can be performed safely on an ambulatory basis in an ASC, critical access hospital (CAH), or a hospital outpatient department (HOPD). The report accompanying the legislation explained that 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 on 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. Medicare only allows payment to ASCs for procedures that are specified on the ASC list. Section 626(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 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 5103 of the Deficit Reduction Act of 2005 (DRA), Public Law 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. Section 1833(i)(2) of the Act provides that 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 payment amount under the hospital outpatient prospective payment system (OPPS) 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 implemented in this final rule. In the November 24, 2006 final rule with comment period for the CY 2007 OPPS and ASC payment systems (71 FR 67960), we addressed the changes in payment to ASCs mandated by section 5103 of Public Law 109-171 and finalized § 416.1(a)(5) of the regulations to implement this provision. (Hereinafter, the November 24, 2006 final rule with comment period is referred to as the CY 2007 OPPS/ASC final rule with comment period.) We also addressed additions to and deletions from the ASC list of covered surgical procedures that were implemented on January 1, 2007. In addition, we made changes in the process to review payment adjustments for insertion of new technology intraocular lenses (NTIOLs) under section 1833(i)(2)(A)(iii) of the Act. Section 416.65(a) of the regulations specifies general standards for procedures on the ASC list. ASC procedures are those surgical and other medical 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 postoperative 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 
                        ( print page 42472)
                        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 can be found in the June 12, 1998 proposed rule (63 FR 32291). 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), May 4, 2005 (70 FR 23690), and in the CY 2007 OPPS/ASC final rule with comment period (71 FR 67960). 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 the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes. These annual coding updates have been implemented through program instructions to the carriers that process ASC claims. (We note that Medicare Part B carriers are transitioning to Medicare Administrative Contractors (MACs) through 2011, as described in a final rule with comment period published in the 
                        **Federal Register**
                         on November 24, 2006 (71 FR 68229).) We last issued program instructions to update the list only to conform to CPT and HCPCS coding changes on December 20, 2006, via Transmittal 1134, Change Request 5211. This transmittal can be found on the CMS Web site at: 
                        *http://www.cms.hhs.gov/​Transmittals/​*). B. ASC Payment Method On August 23, 2006, we proposed in the 
                        **Federal Register**
                         (71 FR 49635) a revised payment system for ASCs to be implemented effective January 1, 2008, in accordance with section 626(b) of Public Law 108-173, including revisions to the ratesetting methodology and the applicable ASC regulations to incorporate the requirements and payments for ASC services under the revised ASC payment system. We also proposed a new “exclusionary” approach for revising the ASC list of covered surgical procedures beginning CY 2008. We proposed to evaluate surgical procedures to identify those that could pose a significant safety risk or that would be expected to require an overnight stay when performed in ASCs, and that would, therefore, be excluded from Medicare payment under the revised ASC payment system. Using that exclusionary method, we developed a list of surgical procedures that we believed were safe for Medicare beneficiaries in ASCs and that were appropriate for Medicare payment. We proposed to adopt an exclusionary approach for identifying surgical procedures that were appropriate for payment under the revised ASC payment system, and the result of that process was a proposed list of surgical procedures for which separate payment would be made. We refer to that list of payable procedures hereinafter as the ASC “list of covered surgical procedures.” 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 (MPFS). The August 2006 OPPS/ASC proposed rule addressed the second element, payment for the cost of items and services furnished by the facility. Under the current ASC 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 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. Rept. No. 96-1479, at 134-35 (1980)). As stated earlier, to establish those reasonable estimated allowances for services furnished prior to implementation of the revised ASC payment system, section 626(b)(1) of Public Law 108-73 amended section 1833(i)(2)(A)(i) of the Act that required us to take into account the audited costs incurred by ASCs to perform a procedure in accordance with a survey. Further, beginning January 1, 2007, and prior to implementation of a revised ASC payment system, in accordance with section 5103 of Pub. L. 109-171, no ASC standard overhead amount may be greater than the OPPS payment rate for a given service for that year. Except for screening colonoscopies and flexible sigmoidoscopies, payment for ASC 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 overhead amount. As required by section 1834(d) of the Act and implemented in regulations at 42 CFR 410.152(i), the amount paid by Medicare must be 75 percent of the fee schedule payment amount for screening colonoscopies and flexible sigmoidoscopies. 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, a CAH, or an HOPD 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, Public Law 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) that belong to 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 on June 16, 1999, in the 
                        **Federal Register**
                         (64 FR 32198). We proposed changes to the NTIOL request for review process in the CY 2007 OPPS/ASC proposed rule published in the 
                        **Federal Register**
                         on August 23, 2006 (71 FR 49631 through 49635) and finalized changes to that process in the CY 2007 OPPS/ASC final rule with comment period (71 FR 68175 through 68181). C. Provisions of Public Law 108-173 (MMA) Section 626(a) of Public Law 108-173 (MMA) 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 (CPI-U) (U.S. city average) if the Secretary has not otherwise updated the amounts under the revised ASC payment system. As amended by Pub. L. 108-173, section 1833(i)(2)(C) of the Act 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 (FY) basis beginning with FY 1986 through FY 2005 and on a 
                        ( print page 42473)
                        calendar year (CY) basis beginning with CY 2006. Section 626(a) of Public Law 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. Section 626(a) of Public Law 108-173 also requires that the CPI-U adjustment factor equal zero percent in FY 2005, the last quarter of CY 2005, and each calendar year from CY 2006 through CY 2009. Section 626(b) of Public Law 108-173 repealed 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 added section 1833(i)(2)(D) of the Act. Section 1833(i)(2)(D)(iii) of the Act 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 Government Accountability Office (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 Public Law 109-171 beginning January 1, 2007, as we described in sections XVII.A.1. and XVII.E. of the preamble to the CY 2007 OPPS/ASC final rule with comment period (71 FR 68165 and 68174, respectively). 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 Public Law 108-173 added a conforming amendment to section 1833(a)(1) of the Act, which provides 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 under the revised ASC payment system. D. Issuance of Proposed Rule As stated earlier, in the August 23, 2006 
                        **Federal Register**
                         (71 FR 49635), we proposed to implement revisions to the ASC payment system so that the revised system is first effective on January 1, 2008. In addition, we set forth an analysis of the impact that the proposed revised ASC payment system would have on affected entities and Medicare beneficiaries. We received over 8,900 pieces of correspondence in response to our August 23, 2006 proposal for the revised ASC payment system, which included some comments recommending various changes to how CMS pays for ASC services and processes ASC claims that we did not propose in the August 23, 2006 
                        **Federal Register**
                        . While we read those comments with interest, we generally do not address them, nor have we made any changes in this final rule based on them. We summarize the numerous comments and recommendations that are pertinent to what we proposed, and we respond to them in the appropriate sections of this final rule. E. Changes to the ASC List for CY 2007 As part of the CY 2007 OPPS/ASC final rule with comment period, we finalized additions to and deletions from the ASC list of covered surgical procedures, effective January 1, 2007 (71 FR 68166). We did not change the criteria for adding or deleting items from the ASC list effective January 1, 2007. However, in the August 2006 proposed rule (71 FR 49628), we discussed changes to the criteria in the context of developing the proposed revised ASC payment system to be effective January 1, 2008. The changes to the criteria that we proposed resulted in the proposed addition for CY 2008 of many procedures that do not meet the current criteria for addition to the list. II. Revisions to the ASC Payment System Effective January 1, 2008 A. General As we discussed earlier, generally, there are two primary elements in the total cost of performing a surgical procedure: (a) The cost of the physician's professional services for performing the procedure; and (b) 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 MPFS. The latter is covered by a Medicare benefit enacted in 1980 that authorized payment of a fee to ASCs for services furnished in connection with performing certain surgical procedures. Section 1833(i)(1) of the Act requires us to specify surgical procedures that are appropriately and safely performed on an ambulatory basis in an ASC. Moreover, we are required 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 of covered surgical procedures 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 performed under the present ASC payment system. In CY 2007, Medicare only allows payment to ASCs for procedures on the ASC list of covered surgical procedures. Except for screening colonoscopy services, 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 overhead amount. As discussed earlier, under section 626(b) of Public Law 108-173, Congress mandated implementation of a revised payment system for ASC surgical services by no later than January 1, 2008. Public Law 108-173 set forth several requirements for the revised payment system, but did not amend those provisions of the statute pertaining to the ASC list. As we proposed in the August 2006 proposed rule (71 FR 49635), in this final rule, we address two components of the ASC payment system that will go into effect January 1, 2008. First, we are establishing the ASC list of covered surgical procedures for which an ASC may receive Medicare payment for facility services under the revised ASC payment system, as well as those covered ancillary services that may be separately paid if they are provided integral to a covered surgical procedure. Second, we are specifying the method we will use to set payment rates for ASC services furnished in association with covered surgical procedures. In this final rule, we also specify the regulatory changes that we are making to 42 CFR Parts 410 and 416 to incorporate the rules governing ASC payments that will be applicable beginning in CY 2008. 
                        ( print page 42474) B. Factors Considered in the Development of the Revised ASC Payment System 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 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 revised payment system, as well as developing a process to allow special payment for new technology. We 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 revised payment system. We appreciate the thoughtful suggestions that were presented. We considered the concerns and issues brought to our attention, the proposals for revising the ASC list of covered surgical procedures, and the suggested methods by which we could set ASC payment rates in developing the policies in this final rule. In the August 23, 2006 
                        **Federal Register**
                         (71 FR 49506), we proposed the policies for the revised ASC payment system to be effective beginning in CY 2008. In response to those proposed policies, we received over 8,900 pieces of correspondence from the public that we are addressing in this final rule. Subsequent to publication of the August 2006 proposed rule for the revised ASC payment system, the GAO published the statutorily mandated report entitled, “Medicare: Payment for Ambulatory Surgical Centers Should Be Based on the Hospital Outpatient Payment System” (GAO-07-86) on November 30, 2006. We considered the report's methodology, findings, and recommendations in the development of this CY 2008 final rule for the revised ASC payment system. The GAO methodology, results, and recommendations are summarized below. The GAO was directed to conduct a study comparing the relative costs of procedures furnished in ASCs to those furnished in HOPDs paid under the OPPS, including examining the accuracy of the ambulatory payment classifications (APC) with respect to surgical procedures furnished in ASCs. Section 626(d) of Pub. L. 108-173 indicated that the report should include recommendations on the following matters: 1. Appropriateness of using groups of covered services and relative weights established for the OPPS as the basis of payment for ASCs. 2. If the OPPS relative weights are appropriate for this purpose, whether the ASC payments should be based on a uniform percentage of the payment rates or weights under the OPPS, or should vary, or the weights should be revised based on specific procedures or types of services. 3. Whether a geographic adjustment should be used for ASC payment and, if so, the labor and nonlabor shares of such payment. To compare the relative costs of procedures performed in ASCs and HOPDs, the GAO first compiled information on ASCs’ costs and the surgical procedures performed. It conducted a survey of 600 randomly selected ASCs from the universe of all ASCs to obtain their CY 2004 cost and procedure data. The GAO received 397 responses from facilities and, through data reliability testing, determined that data from 290 responding facilities were sufficiently reliable and geographically representative of ASCs. Furthermore, to compare the delivery of surgical procedures and their relative costs between ASC and HOPD settings, the GAO analyzed OPPS claims data from CY 2003. It also interviewed officials at CMS, representatives from ASC industry organizations and physician specialty societies, and representatives from nine ASCs. In order to allocate ASCs’ total costs among the individual procedures they performed, the GAO developed a specific methodology to allocate the portion of an ASC's costs accounted for by each procedure. It constructed a relative weight scale for Medicare's covered ASC procedures that captured the general variation in resources associated with performing different procedures. Primarily, it used data that CMS collects for the purpose of setting the practice expense component of physician payment rates, supplemented by information from specialty societies and physicians who work for CMS for those procedures for which CMS had no data on the resources used. To calculate per-procedure costs based upon data gathered through its survey of ASCs, the GAO deducted costs that Medicare considers unallowable, that is, advertising and entertainment costs. In addition, it also removed costs for services that Medicare pays for separately, such as physician and nonphysician practitioner services. The remaining facility costs were then divided into direct and indirect costs. The GAO defined direct costs as those associated with the clinical staff, equipment, and supplies utilized during the procedure. Indirect costs included all remaining costs. Next, to allocate each facility's direct costs across the procedures it performed, the GAO applied its relative weight scale. It allocated indirect costs equally across all procedures performed by the facility. For each procedure performed by a responding ASC facility, it summed the allocated direct and indirect costs to determine a total cost for the procedure.  To obtain a per-procedure cost across all ASCs, the GAO arrayed the calculated costs for all ASCs performing that procedure and identified the median cost. To compare per-procedure costs for ASCs and HOPDs, the GAO obtained the list of OPPS APCs and their assigned procedures, along with the OPPS median cost of each procedure and its related APC group. It then calculated a ratio between each procedure's ASC median cost as determined by the survey and the median cost of the procedure's corresponding APC group under the OPPS, referred to as the ASC-to-APC cost ratio. It calculated a corresponding ratio between each ASC procedure's median cost under the OPPS and the median cost of the procedure's APC group using CMS data, referred to as the OPPS-to-APC cost ratio. In order to evaluate the difference in procedure costs between the two settings, the GAO compared the ASC-to-APC cost ratio to the OPPS-to-APC cost ratio. Next, to assess how well the relative costs of procedures in the OPPS, defined by their assignment to APC groups, reflect the relative costs of procedures in the ASC setting, it evaluated the distribution of both the ASC-to-APC cost ratios and the OPPS-to-APC cost ratios. The GAO also analyzed Medicare claims data for the top 20 procedures with the highest Medicare ASC claims volume in CY 2004 to examine the delivery of additional services with 
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                        surgical procedures in ASCs and HOPDs. Last, to calculate the percentage of labor-related costs among the responding ASCs, for each ASC, the GAO divided total labor costs by total costs and then determined the range of the percentage of labor-related costs among all of the ASCs between the 25th and the 75th percentile, as well as the mean and median percentage of labor-related costs. Based on its extensive analyses, the GAO determined that the APC groups in the OPPS accurately reflect the relative costs of the procedures performed in ASCs. GAO's analysis of the cost ratios showed that the ASC-to-APC cost ratios were more tightly distributed around their median cost ratio than were the OPPS-to-APC cost ratios. These patterns demonstrated that the APC groups reflect the relative costs of procedures performed by ASCs and, therefore, that the APC groups could be used as the basis for an ASC payment system. The GAO determined, in fact, that there was less variation in the ASC setting between individual procedures' costs and the costs of their assigned APC groups than there is in the HOPD setting. It concluded that, as a group, the costs of procedures performed in ASCs have a relatively consistent relationship with the costs of the APC groups to which they would be assigned under the OPPS. The GAO's analysis also found that procedures in the ASC setting had substantially lower costs than those same procedures in the HOPD. While ASC costs for individual procedures varied, in general, the median costs for procedures were lower in ASCs, relative to the median costs of their APC groups, than the median costs for the same procedures in the HOPD setting. The median cost ratio among all ASC procedures was 0.39 (0.84 when weighted by Medicare volume based on CY 2004 claims), whereas the median cost ratio among all OPPS procedures was 1.04. The GAO found many similarities in the additional items and services provided by ASCs and HOPDs for the top 20 ASC procedures. However, of these additional items and services, few resulted in additional payment in one setting but not the other. HOPDs were paid for some of the related services separately, while in the ASC setting, other Part B suppliers billed Medicare and received payment for many of the related services. Finally, in its analysis of labor-related costs, the GAO determined that the mean labor-related proportion of costs was 50 percent. The range of the labor-related costs for the middle 50 percent of responding ASCs was 43 percent to 57 percent of total costs. Based on its findings from the study, the GAO recommended that CMS implement a payment system for procedures performed in ASCs based on the OPPS, taking into account the lower relative costs of procedures performed in ASCs compared to HOPDs in determining ASC payment rates. *Comment:*
                         A number of commenters noted that, by the close of the public comment period for the August 2006 proposed rule for the revised ASC payment system, the GAO had not yet provided recommendations regarding ASC payment in a report to Congress that it was required to submit by January 1, 2005. Some commenters recommended that, although CMS was directed to take into account these recommendations in implementing the revised ASC payment system, should the GAO's recommendations be provided before publication of the final rule establishing the policies of the revised ASC payment system, CMS should not take them into consideration, given the public's inability to provide input to CMS during the comment period regarding the GAO's methodology, findings, and recommendations. Other commenters recommended that, if the GAO Report was forthcoming shortly, CMS should provide another opportunity for public comment prior to finalizing the policies of the revised ASC payment system in order to allow the public to provide CMS with their perspectives on those recommendations. *Response:*
                         As described earlier, the GAO published its report (GAO-07-86) on November 30, 2006. In accordance with section 1833(i)(2)(D)(i) of the Act, we did take into account the recommendations made in the GAO Report in developing the final policies for the revised ASC payment system. The GAO's findings and recommendations are summarized above, and its specific recommendations are further discussed in the particular sections of this final rule that address the related topics. We appreciate the public's interest in providing us with detailed input regarding the revised ASC payment system from a variety of perspectives. In regard to the commenters' recommendation for a second opportunity for public comment prior to finalizing the policies of the revised ASC payment system after the GAO Report was published, we note that the GAO's recommendations are in complete accord with our August 2006 proposal for the revised ASC payment system. Therefore, we are not providing another opportunity for public comment prior to finalizing the policies of the revised ASC payment system, because the proposed revised system is fully consistent with the recommendations of the GAO Report and we already provided a 90-day comment period regarding our proposal for CY 2008. We believe that the comment period for the August 2006 proposed rule provided the public with ample opportunity to comment on the policies that were recommended by the GAO. The considerable operational changes required to implement the revised ASC payment system necessitate significant lead time that would not be possible if we were to provide another comment period prior to finalizing the policies. We also believe that our consideration of the recent GAO study, as well as other available information regarding HOPD and ASC costs and payments, in addition to our prior discussions with stakeholders and the many public comments on the proposed rule, provide us with the necessary breadth and depth of information and viewpoints to finalize our payment policies for the revised ASC payment system in this final rule. At its December 2006 meeting, the Practicing Physicians Advisory Council (PPAC) made two recommendations to CMS regarding the final rule for the revised ASC payment system. First, the PPAC recommended that CMS establish a process to consult with national medical specialty societies and the ASC community to develop and adopt a systematic and adaptable means of fairly reimbursing ASCs for all safe and appropriate services, allowing for changes in technology and current day practice. Second, the PPAC recommended that CMS apply any payment policies uniformly to both ASCs and HOPDs, as appropriate. We have considered the GAO Report, in addition to the recommendations of the PPAC, all public comments received on the proposed rule, and other concerns and issues brought to our attention by interested parties over the past several years, in developing this final rule for the CY 2008 revised ASC payment system. Specific policies are discussed, comments summarized and responses provided, and policies finalized in subsequent sections of this final rule. C. Rulemaking for the Revised ASC Payment System in CY 2008 In response to comments submitted timely regarding the proposals set forth in the proposed rule for the revised ASC payment system published on August 23, 2006, this final rule establishes the final policies and regulations of the 
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                        revised ASC payment system for initial implementation in CY 2008. All tables included in this final rule listing HCPCS codes subject to pertinent final policies of the revised ASC payment system, as well as estimated payment rates, are illustrative only, based on CY 2007 HCPCS codes and final CY 2007 OPPS and MPFS information, with application of the most current update estimates for CY 2008. The information in the Addenda to this final rule is also only illustrative, to provide examples of the results of applying the final policies of the revised ASC payment system, based on the most recent information available for CY 2007. As further discussed in sections V.E. and VI. of this final rule, we will propose the CY 2008 relative payment weights, payment amounts, specific HCPCS codes to which the final policies of the revised ASC payment system would apply, and other pertinent ratesetting information for the CY 2008 revised ASC payment system in the proposed OPPS/ASC rule to update the payment systems for CY 2008 to be issued in mid-summer of CY 2007. We will then publish final relative payment weights, payment amounts, specific CY 2008 HCPCS codes to which the final policies will apply, and other pertinent ratesetting information for the CY 2008 revised ASC payment system in the final OPPS/ASC rule to update the payment systems for CY 2008. The ASC payment system treatment of new CY 2008 HCPCS codes published in the CY 2008 OPPS/ASC final rule will provide interim determinations, open to public comment on that final rule, and we will respond to comments about those determinations in the OPPS/ASC final rule for CY 2009. III. Covered Surgical Procedures Paid in ASCs On or After January 1, 2008 A. Payable Procedures In its March 2004 Report to the Congress, the Medicare Payment Advisory Commission (MedPAC) recommended replacing the current “inclusive” list of procedures, which are the only surgical procedures for which Medicare allows payment to an ASC, with an “exclusionary” list. That is, rather than limiting payment to ASCs to a list of procedures that CMS specifies, Medicare would allow payment to ASCs 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 eligibility for Medicare ASC payment. 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 of covered surgical procedures, are probably no longer clinically relevant. In the August 2006 proposed rule for the revised ASC payment system, we noted that we had 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 for payment under the revised ASC payment system. We agreed that adoption of a policy similar to 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, in the August 2006 proposed rule (71 FR 49636), we proposed that, under the revised ASC payment system for services furnished on or after January 1, 2008, Medicare would allow payment to ASCs for any surgical procedure performed in an ASC, except those surgical procedures that we determine are not payable under the ASC benefit. Further, we proposed to establish beneficiary safety and the expected need for an overnight stay as the principal clinical considerations and decisive factors in determining whether ASC payment would be allowed for a particular surgical procedure. As discussed in section XVIII.B.2. of the preamble of the proposed rule, we also proposed to exclude from separate payment under the revised ASC payment system those surgical procedures that are on the OPPS inpatient list, that are not eligible for separate payment under the OPPS, and that are CPT surgical unlisted procedure codes. We discuss below the criteria that we proposed 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. 1. Definition of Surgical Procedure In order to delineate the scope of procedures that constitute “outpatient surgical procedures” in the August 2006 proposed rule, we first proposed to clarify what we considered to be a “surgical” procedure. Under the existing ASC payment system, we define a surgical procedure as any procedure described within the range of Category I CPT codes that the CPT Editorial Panel of the American Medical Association (AMA) defines as “surgery” (CPT codes 10000 through 69999). Under the revised payment system, we proposed to continue to define surgery using that standard. The CPT Editorial Panel is responsible for maintaining the CPT nomenclature, with authority to revise, update, or modify the CPT codes. A larger body of CPT advisors, the CPT Advisory Committee, supports the work of the CPT Editorial Panel. Members of the CPT Editorial Panel include individuals nominated by physician and hospital associations and insurers, providing for diverse specialty input. In addition, in the August 2006 proposed rule for the revised ASC payment system, we proposed to include within the scope of surgical procedures payable in an ASC those procedures that are described by Level II HCPCS codes or by Category III CPT codes that directly crosswalk to or are clinically similar to procedures in the CPT surgical range. We proposed to include all three types of codes in our definition of surgical procedures because they all may be eligible for separate payment under the OPPS and, to the extent it is reasonable to do so, we proposed that the revised ASC payment system parallel the OPPS in its policies. In the August 2006 proposed rule, we provided an example of a Level II HCPCS code that we believe represents a procedure that could be safely and appropriately performed in an ASC, specifically HCPCS code G0297 (Insertion of single chamber pacing cardioverter-defibrillator pulse generator). We developed this Level II HCPCS code for use in the OPPS because CPT code 33240 (Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator), which describes the surgical insertion of a cardioverter-defibrillator pulse generator, does not distinguish insertion of a single chamber cardioverter-defibrillator generator from insertion of a dual chamber cardioverter-defibrillator generator. Under the OPPS, 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 Level II HCPCS codes to permit HOPDs to more accurately report the resources required when these surgical procedures are performed. In instances such as this, when a Level II HCPCS code is 
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                        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 proposed to allow payment for the Level II HCPCS code under the proposed revised ASC payment system. We proposed not to allow ASC payment for Level II HCPCS codes or Category III CPT codes that describe services that fall outside the scope of, that is, that do not correspond to, surgical procedures described by CPT codes 10000 through 69999. We recognized in the proposed rule that continuing to use this definition of surgery would exclude from ASC payment 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 believed that continuing to rely on the CPT definition of surgery would be administratively straightforward, logically related to the categorization of services by physician experts who both establish the codes and perform the procedures, and consistent with our proposal to allow ASC payment for all outpatient surgical procedures. Given the number of other changes that we expected to implement as part of the revised payment system, along with the significant expansion of ASC covered surgical procedures that we proposed, we explained that we believed 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 MPFS and the OPPS. During the development of the August 2006 proposed rule, we reviewed thousands of CPT codes in the surgical range (CPT codes 10000 through 69999), and we proposed to not exclude from payment over 750 surgical procedures previously excluded, in addition to providing ASC payment for the more than 2,500 CPT codes on the CY 2007 ASC list of covered surgical procedures. However, we are cognizant of the dynamic nature of ambulatory surgery, which has resulted in a dramatic shift of services from the inpatient setting to the outpatient setting over the past two decades. Therefore, in the proposed rule, we solicited comments regarding other services that are invasive and “surgery-like,” which could safely and appropriately be performed in 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 were interested in considering commenters' views regarding what constitutes a “surgical” procedure. We received many public comments about our August 2006 proposal to define the surgical procedures for which we would make payment to ASCs as those falling within the surgical code range specified by the CPT Editorial Panel. *Comment:*
                         While, in general, hospital associations and device manufacturers supported the proposal to maintain the definition of a surgical procedure used under the existing ASC payment system, many ASC industry representatives provided a broad range of suggestions about how the definition should be expanded. Some of the commenters requested that CMS place no limit on the procedures that would be payable in ASCs because there is no such limit on Medicare payments to HOPDs. Other commenters suggested a more limited expansion of procedures eligible for payment under the revised ASC payment system. These commenters specifically recommended that CMS expand its definition of a surgical procedure to include: (a) Medical procedures that are invasive and require general anesthesia or that are specifically designated as intraoperative procedures; (b) X-ray, fluoroscopy, and ultrasound procedures that require insertion of a needle, catheter, tube, or probe via a natural orifice or through the skin; (c) Radiology procedures integral to performance of nonradiologic procedures, performed either during or immediately following the surgical procedure; and (d) Level II HCPCS and Category III CPT codes that describe procedures that crosswalk directly or are clinically similar to those listed in suggestions (a) through (c) above. *Response:*
                         We have given consideration to the many recommendations of the commenters. In general, we continue to believe it is appropriate to provide payments to ASCs for the resources associated with performing those services that are surgical procedures as defined by the CPT Editorial Panel. From the Panel's broad experience in regularly addressing the complex issues associated with new and emerging health care technologies, as well as the difficulties encountered with obsolete procedures, we believe its members are well-positioned to maintain and refine the existing coding taxonomy, which defines certain procedures as surgery, to appropriately reflect medical practice in an evolving health care delivery system. In addition, we believe that our proposal to pay for surgical procedures in ASCs that are reported by Level II HCPCS and Category III CPT codes that directly crosswalk or are clinically similar to procedures in the surgical range of CPT codes that are payable in ASCs is consistent with our definition of surgery according to the CPT surgical code range, while providing ASC payment for some procedures that have not yet been categorized by the CPT Editorial Panel or for which Medicare recognizes alternative HCPCS codes for payment. Although we are not changing our definition of surgery as suggested by commenters, we did review procedures that are coded by specific Level II HCPCS or Category III CPT codes that were identified by commenters as surgical procedures that should be payable in ASCs. We assessed those procedures using the same final criteria discussed in section III.A.2. of this final rule that we used to evaluate all surgical procedures for their safety or the expected need for an overnight stay in making decisions about their exclusion from ASC payment. As we proposed, we also evaluated the codes in the context of whether they directly crosswalk or are clinically similar to procedures in the CPT surgical range that we have determined do not pose a significant safety risk or for which an overnight stay is not expected when performed in ASCs. As a result of that review, 14 additional Level II HCPCS codes and 15 Category III CPT codes beyond those we proposed for CY 2008 payment will be payable as covered surgical procedures when performed in ASCs beginning in CY 2008. Furthermore, as discussed in section IV. of this final rule, although we are not expanding our definition of surgical procedures, we will provide separate ASC payment for a number of covered ancillary services when they are furnished on the same day as a covered surgical procedure and are integral to the performance of that procedure in the ASC setting. Those services include certain radiology procedures, such as some fluoroscopy and ultrasound services, that some commenters recommended we define as surgical procedures for addition to the ASC list of covered surgical procedures. *Comment:*
                         Several commenters expressed concern regarding CMS' proposed exclusion from ASC payment of all procedures described within the range of Category I CPT codes defined as “radiology” in accordance with the CPT Editorial Panel designation. The commenters asserted that regulations regarding the Federal physician self-referral prohibition (section 1877 of the Act) exclude interventional and 
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                        intraoperative radiology services from the definition of “radiology” services subject to the law's self-referral prohibition, and that CMS should, therefore, treat those services as surgical services that are eligible for payment as covered surgical procedures under the revised ASC payment system. They believed that interventional radiology and intraoperative radiology services that require insertion of a needle, catheter, tube, probe, or similar device are appropriately considered surgical in nature for purposes of ASC payment. *Response:*
                         The commenters' statements with respect to the treatment of interventional radiology procedures under the physician self-referral regulations seem overly broad. The physician self-referral regulations provide that the following services (which may include some, but not all, interventional radiology procedures) are not “radiology and certain other imaging services” for purposes of section 1877 of the Act: (i) X-ray, fluoroscopy, or ultrasound procedures that require the insertion of a needle, catheter, tube, or probe through the skin or into a body orifice; and (ii) radiology procedures that are integral to the performance of a nonradiological medical procedure and performed either during the nonradiological medical procedure or immediately following the nonradiological medical procedure when necessary to confirm placement of an item inserted during the nonradiological medical procedure. We do not believe that Medicare's exclusion of specific services from the definition of “radiology and certain other imaging services” for purposes of the physician self-referral prohibition should result in such services being considered “surgical services” for purposes of the revised ASC payment system. Further, as we explain above, we believe that the characterization of procedures as surgery for purposes of their performance in ASCs is best left to the expertise of the CPT Editorial Panel. We do not believe that services designated as radiology services by the CPT Editorial Panel are appropriately classified as covered surgical procedures in ASCs, facilities that specialize in the delivery of ambulatory surgical services. However, as discussed further in section IV.C.2. of this final rule, we do believe that it is appropriate to provide separate ASC payment for certain ancillary services that are integral to the covered surgical procedures. Thus, we will provide separate payment to ASCs under the revised payment system for radiology services that are integral to the performance of an ASC covered surgical procedure when that radiology procedure is one of those for which separate payment is made under the OPPS. That is, separate payment will be made for covered ancillary radiology services integral to covered surgical procedures that are provided in the ASC immediately before, during, or immediately following the surgical procedure. After consideration of the public comments we received, we are finalizing our proposal to define surgery as those procedures described by CPT codes within the surgical range of 10000 through 69999, without modification. In addition, we are including within our definition of a covered surgical procedure payable in the ASC setting those Level II HCPCS codes or Category III CPT codes that directly crosswalk or are clinically similar to procedures in the CPT surgical range that we have determined do not pose a significant safety risk, that we would not expect to require an overnight stay when performed in ASCs, and that are separately paid under the OPPS. An illustrative list of covered surgical procedures under the revised ASC payment system, including Category I and Category III CPT codes and Level II HCPCS codes, can be found in Addendum AA to this final rule. An illustrative list of radiology services and other covered ancillary services that are eligible for separate ASC payment when provided integral to an ASC covered surgical procedure on the same day is located in Addendum BB to this final rule. 2. Procedures Excluded From Payment Under the Revised ASC Payment System As stated above, in the August 2006 proposed rule for the revised ASC payment system, we proposed to allow payment to ASCs for all procedures described by CPT codes within the surgical range of 10000 through 69999, or by Level II HCPCS codes or Category III CPT codes that directly crosswalk or are clinically similar to procedures in the CPT surgical range, that do not pose a significant safety risk to Medicare beneficiaries and that are not expected to require an overnight stay. Having established what we consider to be 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 we expect would require an overnight stay within the bounds of prevailing medical practice. We discuss in the next section how we proposed to identify procedures that could pose a significant safety risk. a. Significant Safety Risk First, we proposed to exclude from ASC payment any procedure that is included on the current OPPS inpatient list, that is, those procedures designated as requiring inpatient care under § 419.22(n). (See Addendum E to the CY 2007 OPPS/ASC final rule with comment period (71 FR 68385 through 68398).) The procedures included on that list are typically performed in the hospital inpatient 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 believed that any procedure for which we did not allow payment in the hospital outpatient setting due to safety concerns would not be safe to perform in an ASC. Second, we proposed to exclude from ASC payment procedures that the CY 2005 Part B Extract Summary System (BESS) data indicated were performed 80 percent or more of the time in the hospital inpatient setting, even if those procedures were not included on the OPPS inpatient list. We selected an 80-percent threshold because we believed that an 80-percent level of inpatient performance was a fair indicator that a procedure is most appropriately performed on an inpatient basis and, as such, would pose a significant safety risk for Medicare beneficiaries if performed in an ASC. We believed that procedures with inpatient utilization frequencies above the proposed threshold were complex and were likely to require a longer and more intensive level of care postoperatively than what is provided in a typical ASC. We also believed 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 proposed to retain some of the specific criteria for evaluating safety risks that are listed in § 416.65(b)(3) of our existing regulations. Procedures that involve major blood vessels, major or prolonged 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 proposed to exclude from ASC payment surgical procedures that may be expected to involve any of these characteristics, based on evaluation by our medical advisors. We noted that most of the procedures that our medical advisors identified as involving any of the characteristics listed in § 416.65(b)(3) also require overnight or 
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                        inpatient stays, reinforcing our belief that they should be excluded from ASC payment. Finally, we proposed not to continue applying under the proposed revised system the current time-based, prescriptive criteria at §§ 416.65(b)(1) and (b)(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 believed these criteria were no longer clinically appropriate for purposes of defining a significant safety risk for surgical procedures. We indicated that, in light of the proposed changes for evaluating procedures to identify those that pose a significant safety risk for beneficiaries when performed in ASCs, we believed 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 believed 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 did not seem relevant within the context of the proposal only to exclude from ASC payment under the revised payment system those surgical procedures that pose a safety risk or are expected to require an overnight stay. We would expect the types of surgical 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 stay. We proposed to add new Subpart F to 42 CFR Part 416 to reflect coverage, scope, and payment for ASC services under the revised payment system. Included in the changes would be new § 416.166 to reflect the changes that we proposed 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 surgical procedures beginning January 1, 2008. To set the provisions that are applicable to our existing ASC payment system apart from those that would apply to the revised ASC payment system, as we proposed, in the CY 2007 OPPS/ASC final rule with comment period, we revised the section headings of Subparts D and E of Part 416 to clearly denote the provisions that govern covered surgical procedures furnished before January 1, 2008. We also added §§ 416.76 and 416.121 to clearly denote the effective dates of Subparts D and E (71 FR 68226). *Comment:*
                         Commenters provided many recommendations regarding the proposed criteria for evaluating which procedures should be excluded from the ASC list of covered surgical procedures that varied greatly. At one end of the spectrum, some commenters recommended that CMS only exclude from ASC payment those procedures that are included on the “inpatient list” used under the OPPS. They believed that all procedures not on the OPPS inpatient list are safe for performance in ASCs and that, by the specification of their payable status under the OPPS, they do not require an overnight stay. Some commenters suggested that CMS create the ASC exclusionary list by individually reviewing surgical procedures based upon data that demonstrate the risks, complications, and overall safety of a given procedure, rather than attempting to specifically apply the standards of the proposed criteria. They believed that health outcomes databases, including the National Surgical Quality Improvement Project and patient and device registries, could provide further information to refine an initial safety assessment based on the proposed criteria when certain procedures were identified as needing further consideration and evaluation. The commenters recommended this flexible and specific approach to allow for full consideration of the surgical aspects of each procedure, in order to make an appropriate determination regarding its safety for ASC performance. The commenters believed CMS could work with surgical professional associations and external surgical experts to facilitate a smooth and efficient clinical review process. In contrast, other commenters recommended that CMS implement more stringent review criteria than our criteria under the existing payment system for evaluating which procedures are unsafe for performance in ASCs. They believed that beneficiary safety could be better protected if CMS would adopt review criteria that would exclude more procedures from ASC performance than those criteria currently in place, while maintaining the existing limitations on operating and recovery room times. *Response:*
                         We believe that both ends of the spectrum of public comments are inconsistent with our goal of only excluding those procedures from ASC payment that are unsafe for performance in ASCs or are expected to require an overnight stay. We agree with the perspective of most commenters that procedures on the OPPS inpatient list should also be excluded from ASC payment. However, while we strongly disagree with the contention by some commenters that all procedures performed in HOPDs are appropriate for performance in ASCs, we also believe that instituting criteria that are more restrictive than those currently in place would be inappropriate, because we do not have safety concerns regarding procedures that are already included on the ASC list of covered surgical procedures. Typically, HOPDs are able to provide much higher acuity care than ASCs. ASCs have neither patient safety standards consistent with those in place for hospitals, nor are they required to have the trained staff and equipment needed to provide the breadth and intensity of care that hospitals are required to maintain. According to current CMS standards, hospitals must meet numerous documentation, infection prevention, and patient assessment requirements that are not applied to ASCs. Therefore, there are some procedures that we believe may be appropriately provided in the HOPD setting that are unsafe for performance in ASCs. Thus, we are not adopting a final policy to exclude only those surgical procedures on the OPPS inpatient list from ASC payment under the revised payment system. Nonetheless, as stated in our August 2006 proposal and consistent with MedPAC recommendations, we are committed to revising the ASC list of covered surgical procedures so that it excludes only those surgical procedures that pose significant safety risks to beneficiaries or that are expected to require an overnight stay. We believe that adoption of a policy similar to that recommended by MedPAC would serve both to protect beneficiary safety and increase beneficiary access to surgical procedures in appropriate clinical settings. We also believe that this approach is most consistent with the PPAC's recommendation that we provide payment under the revised ASC payment system for all safe and appropriate services. Thus, we do not believe that it would be appropriate to implement more restrictive criteria for evaluating procedures for exclusion from ASC payment or even to maintain all of the current criteria that we use under the existing payment system to evaluate the appropriateness of including procedures on the ASC list. We continue to believe the current limitations on operating room and recovery room times for ASC procedures 
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                        are no longer clinically relevant to assessing the safety risk of surgical procedures. Our comprehensive review of all surgical procedures has convinced us that there are procedures in addition to those included on the CY 2007 ASC list of covered surgical procedures that may be safely performed in ASCs, and that increasing the number and types of procedures for which Medicare provides ASC payment is appropriate. Regarding our proposed overall approach to evaluating procedures for exclusion from the ASC list of covered surgical procedures, we believe that our evaluation process is generally consistent with the approach advised by some commenters that we apply the proposed criteria as part of an initial safety assessment, and then conduct procedure-specific analyses of possible risks and complications of individual procedures based on available data. In preparing the proposal for the revised ASC payment system, we reviewed each surgical procedure that is separately payable under the OPPS and not already on the CY 2007 ASC list and with inpatient utilization of less than 80 percent against the proposed safety and overnight stay criteria and identified a subset of procedures for further assessment if we had concerns about their potential safety risk. We then used all of the information available to us to arrive at a preliminary determination regarding each procedure's suitability for payment in the ASC setting. These preliminary determinations constituted our proposed treatment of the procedures under the revised ASC payment system, and the status of the codes was open to public comment in the August 2006 proposed rule. We received detailed information and recommendations from many commenters, including hospitals, ASCs, device manufacturers, and physician specialty organizations, as well as physician experts, regarding the proposed treatment of many surgical procedure codes. Summaries of these comments and our responses follow later in this section of this final rule. *Comment:*
                         A number of commenters expressed concerns about the safety implications of a greatly expanded list of surgical procedures to be performed in ASCs. They advocated implementation of specific additional measures for tightening and strengthening the criteria we proposed to use to evaluate the potential for beneficiary risk associated with surgical procedures. Included in the commenters' numerous recommendations were the following comments: (1) Make no changes to the current criteria until the ASC Conditions for Coverage are revised to ensure that patient protections comparable to those in place in hospitals are in place in ASCs. (2) Apply the existing and proposed criterion to exclude procedures from the ASC list that involve major blood vessels, by adopting a specific list of blood vessels that CMS defines as major blood vessels, in order to provide more certainty about which procedures would be excluded. Some commenters recommended that CMS adopt the definition of a major blood vessel advanced in a medical textbook, 
                        *Essentials of Anatomy & Physiology,*
                         6th Edition, by Seeley, Stephens and Tate. For procedures that involve blood vessels defined by Seeley, et al., as major, but that are already being performed safely in ASCs (for example, CPT code 36870, Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft (includes mechanical thrombus extraction and intra-graft thrombolysis)), the commenters suggested that CMS retain them as ASC covered surgical procedures, thereby allowing their continued payment when performed in ASCs. (3) Apply the existing and proposed criterion to exclude from ASC payment those procedures requiring major or prolonged invasion of body cavities, by defining “prolonged” invasion as referring to any procedure in which the patient is under anesthesia for 90 minutes or longer, and expand the definition of body cavity to include major blood vessels. (4) Exclude from ASC payment procedures that commonly require systemic thrombolytic therapy. Some commenters recommended that CMS exclude procedures that involve blood vessels that, if occluded, would require inpatient lytic therapy, while other commenters recommended more generally that CMS exclude procedures that may result in a patient's need for lytic therapy. Lytic or inpatient thrombolytic therapy as used in this context both refer to systemic thrombolytic therapy. (5) Disallow procedures that require puncturing of the femoral vessels for access. Some commenters recommended that this exclusion be for procedures accessing either the femoral artery or the femoral vein, while other commenters would have limited the exclusion to only those procedures requiring femoral arterial access. (6) Implement a quantitative measure (greater than or equal to 15 percent of total blood volume) to define the existing and proposed criterion to exclude from the list procedures that generally result in extensive blood loss. (7) Use a 50-percent inpatient threshold for excluding procedures from the ASC list instead of the proposed 80-percent threshold. While some commenters recommended lowering the proposed threshold for exclusion of procedures from the ASC list from 80 percent to 50 percent, several other commenters suggested that CMS should not apply a specific numerical threshold of inpatient utilization at all to its evaluation of procedure safety. They noted that this could have the unintended effect of automatically excluding some procedures from ASC payment simply because of limited data indicating their performance slightly more than 80 percent of the time in the inpatient setting, while data for clinically similar codes reflected inpatient performance slightly less than the 80-percent threshold. Instead, these commenters recommended that we evaluate each surgical procedure with respect to the other proposed criteria, based on the clinical characteristics of the procedure itself. The group of commenters recommending establishment of a lower threshold of 50 percent believed that this modified standard would better enable us to identify procedures that are typically clinically complex and have a higher risk of complications and extensive postoperative care. They suggested that setting the threshold at 50 percent would ensure that procedures performed the majority of time in the inpatient setting would be excluded from ASC payment. (8) Require that patients be assessed for comorbidities and anesthesia risk using the American Society of Anesthesiologists’ tool, and those patients who are high risk, such as patients over age 85 or with morbid obesity, should be required to go to hospital settings for surgical procedures. (9) Identify and implement outcome and process measures to assess aspects of quality across care settings, including ASCs. To develop those measures, some commenters suggested that CMS work closely with the Hospital Quality Alliance (HQA) and the Ambulatory Quality Alliance (AQA) (formerly both organizations were known as the AQA). The HQA has already begun to include the measures of care used in the Surgical Care Improvement Project, and some commenters believed that the goal of preventing complications in the care of surgical patients provides an appropriate starting point for determining the correct measures for assessing important aspects of the safety 
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                        and quality of all types of ambulatory surgery. *Response:*
                         We appreciate the commenters’ concerns regarding beneficiary safety and gave consideration to each of the individual recommendations listed above. We respond to each of these individually as follows: (1) 
                        *Maintain the current procedure review criteria until after the ASC Conditions for Coverage are revised.* We do not believe that postponing revisions to our review criteria until after the ASC Conditions for Coverage are revised is warranted. We cannot predict when those revisions will be issued, and we are confident that the criteria we will use to evaluate procedures for exclusion from the list of covered surgical procedures under the revised ASC payment system are appropriate and serve to protect beneficiary safety in the current environment. (2) 
                        *Specifically adopt a defined list of “major blood vessels*.” As we stated earlier, we believe it is important to maintain flexibility in our review of procedures for safe performance in the ASC setting, consistent with our past practice regarding this criterion. As noted by commenters requesting a specific definition of this criterion, there are some procedures already on the ASC list that are being safely performed in ASCs and that involve vessels that would be defined as major according to the recommendations of some commenters. We do not agree with these commenters that it would be logical or clinically consistent for us to adopt a specific definition of major blood vessels to evaluate procedures for exclusion from ASC payment, yet still continue to provide ASC payment for procedures that would otherwise be excluded, except for their history of safe performance in ASCs. We believe the involvement of major blood vessels is best considered in the context of the clinical characteristics of individual procedures, as recommended by other commenters, and see no need to adopt a defined list of major blood vessels. (3) 
                        *Define prolonged invasion of a body cavity as any procedure in which the patient is under anesthesia for 90 minutes or longer, and expand the definition of body cavity to include major blood vessels.* We do not believe that considering major blood vessels to be included in the definition of a body cavity is clinically sensible, based on the general medical understanding of the terms. In addition, we already have a separate safety review criterion regarding major blood vessels, and we believe that evaluation of the safety of procedures involving major blood vessels will continue to be appropriately assessed using that criterion. We also do not believe that prolonged invasion should be defined as anesthesia for 90 minutes or longer. There are surgical procedures that require more than 90 minutes that do not invade a major body cavity at all, and maintaining that time-based restriction would be contrary to the recommendations of MedPAC and current clinical practice. We believe the criterion regarding major or prolonged invasion of body cavities is most appropriately evaluated through a flexible review approach, consistent with our past practice, in which we consider the criterion and its relationship to each specific surgical procedure. Therefore, we are not expanding the current criterion regarding invasion of a body cavity to include the length of time the beneficiary will be under anesthesia or to incorporate major blood vessels. (4) 
                        *Exclude from ASC payment procedures that commonly require systemic thrombolytic therapy.* We agree with the commenters that systemic thrombolytic therapy is unsafe for performance in ASCs. Systemic thrombolytic therapy involves significant clinical risks and is not an appropriate procedure for initiation in ASCs if its use is anticipated. We have historically considered in our clinical evaluation of the safety of procedures for performance in ASCs the likely need for systemic thrombolytic therapy in association with a surgical procedure, but we have never previously made that an explicit safety review criterion. We agree with the commenters that it should be a specific criterion for evaluation of procedure safety. Therefore, we are making it explicit that the final criteria used to evaluate the safety of procedures for performance in ASCs at § 416.166(c)(5) include the criterion that covered surgical procedures may not be of a type where systemic thrombolytic therapy would commonly be required. (5) 
                        *Exclude procedures that require use of the femoral vessels for access.* We do not agree with some commenters' position that excluding all procedures that involve the femoral vessels is reasonable or necessary to ensure the patient safety of surgical procedures performed in ASCs. Other commenters stated that there are instances in which the performance of procedures may require use of femoral vessels due to the beneficiary's particular physical condition. For example, a beneficiary who has experienced prolonged exposure to vascular sclerosing agents (such as chemotherapy) or has been on hemodialysis for many years may not have upper body peripheral blood vessels that are adequate even to support the basic intravenous access required during any surgical procedure performed under general anesthesia. In such a case, the surgeon may need to use the femoral vein just to provide routine intravenous access during surgery. In other cases, the use of the femoral vessels may be required for certain surgical procedures. For instance, the femoral blood vessels may be accessed to create an arteriovenous fistula for hemodialysis using a graft, as described by CPT code 36825 (Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); autogenous graft) or CPT code 36830 (Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); nonautogenous graft (e.g., biological collagen, thermoplastic graft)). Both of these procedures that may directly involve the femoral vessels have been on the list of covered ASC procedures since before July 2000, and we have no concerns about their safe performance in ASCs. We do not believe that it makes clinical sense to prohibit use of the femoral vessels in ASC procedures, knowing that they may be needed in any number of situations and that femoral access has been safely achieved in ASCs for years. We believe that our process for clinical review of individual procedures, during which our medical advisors consider the specific performance characteristics of a particular surgical procedure, is the most appropriate method for ensuring that procedures that pose a significant safety risk are excluded from ASC payment. As evidenced by the history of safe performance in ASCs of some procedures that utilize femoral access, we agree with the commenters who believe that it is the specific surgical procedure, rather than the method of vascular access, that must be fully evaluated to assess a procedure's safety in ASCs. (6) 
                        *Adopt a quantitative definition of “extensive blood loss*.” We do not believe that the recommendation by some commenters that we revise the criteria used to evaluate procedures for exclusion from the ASC list by quantifying extensive blood loss is necessary or advisable. The existing and proposed criterion related to blood loss requires exclusion of procedures that “generally result in extensive blood loss” (42 CFR 416.65(b)(3)(i) and 42 CFR 416.166(c)(1), 
                        ( print page 42482)
                        respectively), and we have historically evaluated this criterion in considering surgical procedures for ASC payment. We do not believe that identifying a specific amount of blood loss that is considered by some to be “extensive” would improve our clinical review regarding procedural safety. For most surgical procedures, specific estimates of expected blood loss are not available, and we do not believe that a discussion of whether or not a procedure generally results in a loss of 14 percent versus 16 percent of a beneficiary's blood volume would be clinically meaningful and contribute to our ability to evaluate a surgical procedure's potential for safe performance in ASCs. (7) 
                        *Adopt a 50-percent inpatient utilization threshold for exclusion of procedures from the ASC list.* We reexamined our proposal to exclude all procedures from ASC payment that are performed in the inpatient setting 80 percent or more of the time. Although the recommendations of some commenters advocated using a lower threshold to exclude more procedures from ASC payment, we confirmed that using any relatively arbitrary threshold resulted in unintended inconsistencies in the treatment of clinically similar procedures. There were several instances in which one procedure in a clinical family would be excluded from ASC payment based on its inpatient utilization of just slightly over 80 percent, whereas our clinical review of other members of the family indicated that those procedures were safe for performance in ASCs, with inpatient utilization of slightly less than 80 percent. For example, we proposed to exclude CPT codes 33207 (Insertion or replacement of permanent pacemaker with transvenous electrode(s); ventricular) and 33208 (Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular) from ASC payment under the revised payment system because the inpatient utilization for those procedures was higher than 80 percent and, therefore, we did not specifically review the procedures to assess their clinical safety or need for an overnight stay before proposing to exclude them. We did not propose to exclude CPT code 33206 (Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial), the other procedure in the same family of codes as CPT codes 33207 and 33208, because the inpatient utilization for that procedure was somewhat lower than 80 percent, and our clinical review, based on the other safety and overnight stay criteria proposed for the revised ASC payment system, led to our belief that it was appropriate for performance in ASCs. When we performed a clinical review of CPT codes 33207 and 33208 in order to respond to public comments, we determined that CPT codes 33207 and 33208 do not pose a significant risk to beneficiary safety and are not expected to require an overnight stay, so they are appropriate for performance in ASCs, along with CPT code 33206. Therefore, we have removed both CPT codes 33207 and 33208 from the list of excluded procedures for the revised ASC payment system. We are also, as proposed, not excluding CPT code 33206 from eligibility for ASC payment. This more flexible approach, without application of a specific inpatient utilization threshold, allows us to treat the individual members of the same family of procedures consistently as a clinically coherent group, while considering them in the context of our final safety and overnight stay criteria for the revised ASC payment system. We also identified a number of surgical procedures with high Medicare inpatient utilization because, most of the time, the procedures are performed with other surgical procedures for beneficiaries who are hospital inpatients. Thus, although the data reflect high inpatient utilization, the procedures themselves are not unsafe for ASC performance, nor do they typically require an overnight stay. Specifically, commenters argued that the high inpatient utilization of CPT code 64447 (Injection, anesthetic agent; femoral nerve, single) was due to its frequent use during inpatient surgical procedures, whereas the injection may also be performed safely in ASCs on its own as an ambulatory pain management intervention. They believed that using the inpatient utilization as the basis for the exclusion of this procedure from ASC payment was unfair because we should evaluate the procedure itself specifically based upon its clinical characteristics, rather than based upon utilization data which could be misleading with respect to the procedure's potential for safe performance in the ASC setting. Our clinical review of CPT code 64447, in response to comments, convinced us that it would clearly not pose a significant safety risk or be expected to require an overnight stay when performed in ASCs and should not be excluded from the list of covered surgical procedures under the revised ASC payment system. Therefore, we concluded that, in the cases of CPT codes 33207, 33208, and 64447, the utilization data alone could not be relied upon to support a decision to exclude these procedures from ASC payment and, as evidenced by our proposed list of excluded procedures, there were many procedures paid under the OPPS that were not performed more than 80 percent of the time on an inpatient basis but that were proposed for exclusion from ASC payment because of their safety risk or expected need for an overnight stay. Therefore, for this final rule, we evaluated each of the procedures that we had proposed for exclusion from ASC payment based on inpatient utilization of 80 percent or more and made separate determinations about the safety and need for an overnight stay for each of those procedures using all available information, as we did for all other procedures in the surgical range of the CPT code set. Thus, while we proposed an 80-percent inpatient utilization threshold as one criterion for excluding surgical procedures from ASC payment, we now believe that we will reach more appropriate, clinically consistent decisions regarding procedures for exclusion from ASC payment by not adopting any specific numerical threshold for inpatient utilization that would automatically exclude surgical procedures from ASC payment. Rather than institute a definite threshold for inpatient utilization, we will examine all the clinical information regarding a surgical procedure, including its inpatient utilization, to determine whether or not a procedure would pose a significant risk to beneficiary safety or would be expected to require an overnight stay if performed in an ASC. We will not make final our proposal to exclude procedures from the ASC list of covered surgical procedures based solely on their inpatient utilization of 80 percent or more. (8) 
                        *Require beneficiary assessment of individual surgical risk and do not permit high risk patients to receive ASC services.* We do not believe that it would be appropriate to accept the commenters' recommendation that patients with certain specified demographic characteristics or comorbidities be automatically excluded from being considered for surgery within an ASC. The recommendation would require ASCs to deny services to individual beneficiaries who are found, based on an appraisal through a specific assessment tool, to have a high level of risk. Section 416.2 defines an ASC as providing surgical services to patients not requiring hospitalization. Thus, ASCs must ensure that each patient is assessed for relevant risk factors by the physician prior to performing the 
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                        surgical procedure, in order to screen out patients who are likely to require hospitalization in connection with the planned procedure. We require physicians to make these assessments as a part of their decisions regarding where to perform a surgical procedure for specific Medicare beneficiaries, prior to referring them to facilities for those surgical procedures. The ASC Conditions for Coverage specifically state in § 416.42(a) that “a physician must examine the patient immediately before surgery to evaluate the risk of anesthesia and of the procedure to be performed.” In addition, we protect Medicare beneficiary safety through our process of excluding procedures from ASC payment that pose a significant safety risk for the typical Medicare patient. In summary, we do not believe that it is necessary or appropriate for CMS to mandate that ASCs use a specific assessment tool in conducting these required beneficiary assessments. (9) 
                        *Identify and implement outcome and process measures in ASCs to assess quality of care.* We will take into consideration for future action the recommendation by some commenters that we identify and implement outcome and process measures to assess aspects of quality of care across settings, including ASCs, taking into consideration our final policy for the CY 2009 OPPS that will require hospitals to meet quality reporting standards to receive the full OPPS update (71 FR 68189). We agree that this could be an appropriate next step and is consistent with CMS” policies being implemented in other beneficiary care settings. In fact, section 109(b) of the Medicare Improvements and Extension Act under Division B of the Tax Relief and Health Care Act of 2006, Public Law 109-432, enacted on December 20, 2006, specifies that the Secretary may require that in order to receive the full annual payment update, ASCs must report data on selected measures of quality. The provisions for ASC services are to apply in a manner similar to which they apply to hospital outpatient services, effective January 1, 2009. After considering the public comments received, we are finalizing our proposal, with modification, to exclude from ASC payment all surgical procedures that could pose a significant safety risk to Medicare beneficiaries or are expected to require an overnight stay. The criteria to be used to identify procedures that could pose a significant safety risk when performed in an ASC include those surgical procedures that: generally result in extensive blood loss; require major or prolonged invasion of body cavities; directly involve major blood vessels; are emergent or life-threatening in nature; commonly require systemic thrombolytic therapy; are designated as requiring inpatient care under § 419.22(n); can only be reported using a CPT unlisted surgical procedure code (see section III.B. of this final rule for further discussion); or are otherwise excluded under § 411.15. We are not adopting the specific 80-percent inpatient utilization threshold that we proposed for exclusion of surgical procedures from ASC payment. The final revised policy regarding covered surgical procedures is set forth in § 416.166 of this final rule, effective January 1, 2008. b. Overnight Stay A longstanding criterion for determining which procedures are appropriate for inclusion on the ASC list of covered surgical procedures 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 postoperative recovery room or short-term (not overnight) convalescent room.” Under § 416.65(b)(1)(ii), we have historically considered procedures that require more than 4 hours of recovery or convalescent time to be inappropriately performed in the ASC. We have heard many differing opinions of what constitutes an “overnight” stay, ranging from “more than 24 hours” to time spent in recovery after sunset. After deliberation and consideration of several options, in the August 2006 proposed rule for the revised ASC payment system, we proposed to exclude from ASC payment any procedure for which prevailing medical practice dictates that the beneficiary would typically be expected to require active medical monitoring and care at midnight following the procedure (hereinafter “overnight stay”). During the development of the August 2006 proposed rule, our clinical staff evaluated each surgical procedure using available claims and physician pricing data, as well as their 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 proposed 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 services for which Medicare makes payment. The expectation is that surgical procedures performed in 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 defining measure of “overnight stay.” We proposed to add the requirement that procedures will typically not be expected to require active medical monitoring and care at midnight following the procedure to proposed new § 416.166(c)(5). *Comment:*
                         Some commenters recommended that CMS use “less than 24 hours” as the definition of an overnight stay. Several of the commenters stated that the same 24-hour postoperative recovery standard that applies in HOPDs should apply in ASCs. One commenter stated that CMS' definition of overnight stay related to survey and certification for ASCs is a planned stay of over 24 hours and, that conversely, when the “length of stay is less than 24 hours, it is not considered an overnight stay.” Further, several commenters noted that a number of States allow ASCs to perform procedures that require stays of up to 23 or 24 hours. One commenter group argued that the terms “ambulatory” and “outpatient” surgery describe the same kind of care, and that the same 24-hour postoperative recovery standard should apply in both ASC and HOPD settings. Some commenters suggested that, if CMS allowed all procedures that are performed in HOPDs to be performed in ASCs, no specific definition of overnight stay would be required because any procedure paid under the OPPS would be presumed to require no overnight stay and that the same assumption should be applied to ASCs. A number of other commenters agreed with our proposal that procedures requiring an overnight stay should not be performed in an ASC and specifically endorsed our definition of overnight stay. They also believed that the proposed definition is consistent with other accepted definitions and standards of the term. Several commenters believed that our proposal, if adopted, would require ASCs performing and billing covered surgical procedures to transfer patients to other facilities if the recovery of 
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                        individual patients extended beyond midnight on the day of the procedure, in order to receive payment under the revised ASC payment system. Other commenters expressed concern that procedures performed later in the day in ASCs would be treated differently for purposes of ASC payment than those procedures that were performed in the morning, in terms of allowing for adequate recovery time. *Response:*
                         We want to clarify our proposal to use the expected need for medical monitoring at midnight following the performance of a procedure as a consideration in determining whether a surgical procedure should be excluded from ASC payment. Our proposal does not affect the distinct care ASCs may provide in individual cases at various times of the day, nor does it alter the ASC payment for covered surgical procedures and covered ancillary services. As we explained in the August 2006 proposed rule, we proposed to exclude surgical procedures from ASC payment only based on their expected need for an overnight stay or the risk they pose to beneficiary safety. We identified the need for medical monitoring at midnight as a clinical measure that was meaningful to our clinical staff and advisors in their assessment, on a procedure-by-procedure basis, of the expected postoperative needs of the typical Medicare beneficiary, in order to determine whether a procedure was likely to require an overnight stay. We agree with some commenters that the criteria currently in place under the existing ASC payment system that limit covered surgical services to those that do not generally exceed a total of 90 minutes operating time and a total of 4 hours of recovery or convalescent time are both outdated and inconsistent with the proposed policy to base exclusion on the need for an overnight stay. We also agree with the commenters who recognized that the proposed revised measure to facilitate identification of those procedures requiring an overnight stay is considerably less restrictive than the current criteria and, at the same time, the use of midnight as a reference point is clinically meaningful and adequate to ensure beneficiary safety. As stated above, a beneficiary'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, as defined at § 416.2, ASC means “any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization.” Thus, ASCs are not certified by Medicare to provide overnight care, and there is longstanding policy to exclude from coverage in ASCs those surgical procedures that require overnight stays, as evidenced by our existing criterion at § 416.65(b)(1)(ii) that requires CMS to limit covered surgical procedures to those that do not generally exceed a total of 4 hours of recovery time following surgery. The expectation is that a beneficiary undergoing a procedure in an ASC will recover from anesthesia and return home on the same day that he or she reported to the ASC for a scheduled procedure. This expectation is inconsistent with a 24-hour postoperative recovery period as recommended by some commenters. The commenters’ comparisons of ASCs to HOPDs are not persuasive for many reasons. Most importantly among these is the fact that HOPDs, unlike ASCs, have medical and nursing staff on duty 24 hours a day and all of the resources of the hospital to support the care requirements of beneficiaries in that setting. After consideration of the public comments we received, we continue to believe that it is appropriate to exclude from ASC payment any procedure for which standard medical practice dictates that the beneficiary would typically be expected to require active medical monitoring and care at midnight following the procedure. Therefore, we are finalizing, with editorial modification to include this requirement in the general standards for covered surgical procedures at § 416.166(b), our proposal to exclude these surgical procedures from ASC payment. B. Treatment of Unlisted Procedure Codes and Procedures That Are Not Paid Separately Under the OPPS 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 covered surgical 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 procedures reported by unlisted CPT codes is made only at the discretion of the contractor under the MPFS. Because of concerns about the potential for safety risks when procedures that may only be reported with unlisted procedure CPT codes are performed, in the August 2006 proposed rule for the revised ASC payment system, we proposed to continue excluding CPT unlisted surgical procedure codes from ASC payment. 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, major or prolonged invasion of body cavities, or extensive blood loss, or was emergent or life-threatening in nature. 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 whose payments are packaged under the OPPS. Packaged CPT codes under the OPPS are identified by status indicator “N” in Addendum B of the CY 2007 OPPS/ASC final rule with comment period (71 FR 68283 through 68384), and their OPPS payment is provided through payment for other separately payable services. We made this proposal for two reasons. First, we would not be able to establish an ASC payment rate for packaged surgical procedures using the same method we proposed 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, ASCs, just like hospitals, would receive payment for these packaged surgical procedures because their costs would already be included in the APC relative payment weights upon which the ASC payment rates would be based. *Comment:*
                         A few commenters recommended that CMS not exclude all unlisted CPT codes from ASC payment as proposed. Some commenters believed that, because Medicare makes facility payments for unlisted CPT codes under the OPPS, CMS should provide the same treatment in ASCs. Other commenters suggested that, for groups of related CPT codes in which all codes but the related unlisted code are provided payment in ASCs, CMS should also include the unlisted code on the ASC list of covered surgical procedures. For example, all of the specific CPT codes in the surgical hysteroscopy 
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                        subsection of CPT (CPT codes 58558 through 58578) are currently on the ASC list. One commenter contended that because CMS had already determined that all of those specific hysteroscopy procedures are safe for performance in ASCs, the related unlisted hysteroscopy procedure (CPT code 58579, Unlisted hysteroscopy procedure, uterus) should also be deemed to pose no significant safety risk or require an overnight stay. *Response:*
                         We appreciate the commenters' examples of unlisted codes in families where all of the other procedures in the CPT subsection are not excluded from ASC payment, in support of their recommendation that the related unlisted procedure code should be treated comparably. However, the fact remains that we do not know what specific procedure would be represented by an unlisted code. Our charge requires us to evaluate each surgical procedure for potential safety risk and the expected need for overnight monitoring and to exclude such procedures from ASC payment. It is not possible to evaluate procedures that would be reported by unlisted CPT codes according to these criteria. We continue to believe that because our final policy under the revised ASC payment system excludes from ASC payment those procedures that pose a significant safety risk in ASCs or would be expected to require an overnight stay, it would not be appropriate to provide ASC payment for unlisted CPT codes in the surgical range, even if payment may be provided under the OPPS. As discussed earlier, ASCs do not possess the breadth and intensity of services that hospitals must maintain to care for patients of higher acuity, and we would have no way of knowing what specific procedures reported by unlisted CPT codes were provided to patients, in order to ensure that they are safe for ASC performance. Therefore, we are finalizing in § 416.166(c)(7) our proposal, without modification, to exclude from ASC payment under the revised ASC payment system all procedures reported by unlisted surgical procedure codes. *Comment:*
                         A few commenters expressed concern that payments for certain surgical services that are packaged under the OPPS are frequently paid through the OPPS payments for more comprehensive services that we had proposed to define as nonsurgical because they are not classified by CPT within the surgical range of codes. Therefore, these packaged surgical services would not be paid under the revised ASC payment system. They pointed out that when ASCs perform these packaged surgical services as part of providing a more comprehensive nonsurgical service, the ASC would receive no payment for the surgical service. To illustrate the problem, commenters provided examples of the surgical codes that typically receive packaged payment under the OPPS through payment for radiology services. The minor packaged surgical procedures included numerous injection and catheter placement procedures in the surgical range of CPT codes that generally accompany radiology services for purposes of injecting contrast or facilitating another nonsurgical intervention. These commenters recommended that CMS expand the definition of surgical procedures to include invasive radiology services that have a surgical component, including those radiology procedures that are performed in association with a surgical procedure proposed for packaged payment under the revised ASC payment system, to enable ASCs to receive payment for the comprehensive service, including both the radiology service and the minor surgical procedure. Alternatively, several other commenters supported our proposal to package payment under the revised ASC payment system for the minor surgical procedures for which payment is also packaged under the OPPS, rather than paying for them separately. *Response:*
                         We continue to believe that packaging payment for those surgical services that are packaged under the OPPS is appropriate under the revised ASC payment system. This policy is aligned with the recommendation of the PPAC to apply payment policies uniformly in the ASC and HOPD settings. It also maintains comparable payment bundles under the OPPS and the revised ASC payment system for these services, consistent with the recommendation of MedPAC to maintain consistent payment bundles under both payment systems. Packaged surgical services are minor procedures and are usually reported with a more comprehensive procedure that may itself be nonsurgical and, therefore, excluded from payment under the revised ASC payment system. See section III.A.1. of this final rule for a further discussion of the definition of surgical procedure under the revised ASC payment system. We believe that payment for these minor surgical procedures would be appropriately packaged into payment for comprehensive surgical procedures that are separately paid in the ASC setting, when those minor surgical procedures are provided in support of the comprehensive surgical procedures. In the circumstances referred to by the commenters, the minor surgical procedures are performed in support of comprehensive nonsurgical services and payment for the minor surgical procedures is packaged into payment for the nonsurgical services under the OPPS. Although the packaged procedures are surgical according to our definition for the revised ASC payment system, we do not believe it is reasonable or appropriate to assign a different packaging status for these procedures under the revised ASC payment system than is assigned under the OPPS. The minor surgical procedures are not separately paid in the OPPS and, thus, are not eligible for separate payment under the revised ASC payment system. In addition, if the procedures are only performed in conjunction with major services not payable in ASCs, Medicare also will make no packaged payment for these minor surgical procedures. As we discuss further in section III.A. of this final rule, Medicare pays ASCs for the performance of ambulatory surgical procedures, not for providing nonsurgical services. We do not agree that we should define surgical procedures under the revised ASC payment system to include other types of services, such as radiology services, just because they are provided in association with a minor surgical procedure in the CPT surgical range of codes. Instead, we continue to believe that the other types of services, including radiology services, are not appropriate for performance in ASCs unless they are integral to covered surgical procedures. We see no rationale for considering comprehensive radiology services to be integral to the minor surgical procedures. After considering all public comments received, we are finalizing, without modification, our proposal to provide packaged payment under the revised ASC payment system for all surgical procedures packaged under the OPPS for the same calendar year. Therefore, we will exclude these surgical procedures from separate payment in the ASC setting under the revised payment system, and they will not be included on the ASC list of covered surgical procedures. We believe that this approach will provide appropriate packaged payment for minor surgical procedures provided in association with significant ASC covered surgical procedures. When these minor surgical procedures are performed in support of comprehensive nonsurgical procedures, they are not appropriate for ASC payment because the more comprehensive service is not a surgical 
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                        procedure paid under the revised ASC payment system. HCPCS codes for surgical procedures for which payment will be packaged under the revised ASC payment system are identified in Addendum AA to this final rule with payment indicator “N1” (Packaged service/item; no separate payment made). C. Treatment of Office-Based Procedures According to the general standard in § 416.65(a)(2) of the existing regulations, procedures that “are commonly performed, or that may be safely performed, in physicians' offices” are excluded from the ASC list of covered surgical procedures. We did not propose to continue to apply this provision under the revised ASC payment system. Rather, in the August 2006 proposed rule for the revised ASC payment system, we proposed to allow ASC payment for surgical procedures that are commonly and safely performed in the office setting. We reasoned that the types of procedures performed in physicians' offices would neither pose a significant safety risk nor require an overnight stay when performed in an ASC. However, we expressed concerns that allowing payment for office-based procedures under the ASC benefit could create an incentive for physicians inappropriately to convert their offices into ASCs or to move all their office surgery to an ASC. To address this concern, we proposed to limit payment for office-based procedures to neutralize any such incentive (see section IV.E. of this final rule). We also proposed in new § 416.171(d) to set forth rules governing the payment of office-based procedures in ASCs. We specifically invited comment regarding the effect on the Medicare program, and on practice patterns for ambulatory surgery generally, of our proposal to allow ASC payment for office-based procedures that historically have been excluded from the ASC list of covered surgical procedures. As we discussed in the August 2006 proposed rule, we proposed to limit payment for office-based procedures in ASCs in an attempt to mitigate potentially inappropriate migration of services from the physician office setting to the ASC. Alternatively, we acknowledged that we could entirely exclude office-based procedures or procedures that require relatively inexpensive resources to perform from the ASC list of covered surgical procedures. *Comment:*
                         Many commenters supported our proposal to not exclude from ASC payment those procedures that are performed most of the time in the physician's office setting. Numerous commenters requested that the payment rate for those procedures be set at a percentage of the OPPS amount, applying the same payment methodology under the revised ASC payment system as for all other surgical procedures not excluded from ASC payment. The commenters believed that the proposed treatment of office-based procedures is unfair because, when any of those procedures would be performed in the ASC setting, that facility site would be necessary due to an individual beneficiary's need for the higher acuity care setting. Therefore, the commenters concluded that the same level of payment, in relationship to OPPS payment for those procedures, should be made for office-based procedures as for other covered ASC procedures that are not office-based. Furthermore, commenters contended that there would be very little change in surgical practice patterns under the revised ASC payment system, and that procedures currently performed predominantly in physicians' offices would not move to ASC settings as a result of our proposal to provide payment for those procedures in ASCs. *Response:*
                         We appreciate the commenters' support for our proposal to not exclude office-based surgical procedures from ASC payment under the revised ASC payment system. Based on both our final definition of surgical procedures and our final safety and overnight stay criteria to be used in evaluating procedures for exclusion from ASC payment, we see no reason to exclude surgical procedures that are currently commonly performed in physicians' offices from payment under the revised ASC payment system. We believe there are a variety of reasons that may contribute to the choice of a particular care setting for the treatment of an individual beneficiary, including the patient's surgical risk, the geographic location of the beneficiary and physician, individual physician practice patterns and preferences, the availability of specialty ASCs, and others. We do not believe that individuals receiving surgical procedures in ASCs routinely require care that is of such greater acuity than care provided in the office-based setting that the facility resources are significantly and systematically increased when those procedures that are primarily office-based are performed occasionally in ASCs. While it may be true that some more acute cases are treated in ASCs rather than in physicians' offices, we continue to believe that the structure of payments should not provide a financial incentive for treatment in the ASC facility setting. Furthermore, this policy is consistent with the averaging principle that is common to all prospective payment systems; payment is based on the resources that are required to treat the typical case, and payment for the treatment of a specific Medicare beneficiary may, therefore, be higher than the costs of treating less severe cases but lower than the costs of treating more acute cases. We believe that including these office-based procedures on the ASC list of covered surgical procedures will ensure Medicare beneficiary access to these services in the most appropriate ambulatory or outpatient setting. Our final payment policy for these procedures, along with public comments and our responses, is discussed in section IV.E. of this final rule, and the related payment rules are set forth in § 416.171(d). After considering the public comments received, we are finalizing our proposal, without modification, to provide payment under the revised ASC payment system for surgical procedures that are currently performed predominantly in physicians' offices and that may be safety performed in ASCs, without requiring an overnight stay. D. Specific Surgical Procedures Excluded From Payment under the Revised ASC Payment System In Tables 44 and 45 of the August 2006 proposed rule (71 FR 49640 through 49646), we listed the HCPCS codes and short descriptors for surgical procedures that, in addition to those that comprised the OPPS inpatient list in Addendum E to the August 2006 proposed rule, we proposed to exclude from ASC payment on or after January 1, 2008, because they pose a significant safety risk or are expected to require an overnight stay. Table 44 included those surgical procedures proposed for exclusion from payment because at least 80 percent of Medicare cases are performed on an inpatient basis, while Table 45 listed those surgical procedures proposed for exclusion from payment because they require an overnight stay. In section III.A.2. of this final rule, we discuss our final rationale for excluding surgical procedures from ASC payment. We note that because our final policy, as discussed above, for the revised ASC payment system does not automatically exclude from payment those procedures for which at least 80 percent of Medicare cases are performed on an inpatient basis, all procedures listed in Table 44 of the August 2006 
                        ( print page 42487)
                        proposed rule were reviewed again for this final rule as described below, in the context of our final exclusionary patient safety and overnight stay criteria. For many of the procedures listed in Table 45 of the August 2006 proposed rule, 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 of the August 2006 proposed rule, we defaulted to the one characteristic that is common to all of the codes listed. That is, we believed that, at a minimum, prevailing medical practice would dictate the provision of overnight care following each of the procedures listed in Table 45 of the August 2006 proposed rule. We acknowledged that we had to exercise a degree of clinical judgment in identifying those procedures that we proposed to exclude from ASC payment. Therefore, we solicited comments on the appropriateness of excluding the procedures in Table 45 from payment under the revised payment system. We requested that commenters who disagreed with a specific procedure's proposed exclusion from payment submit clinical evidence that demonstrates that the criteria we proposed in proposed new § 416.166 of the regulations are not factors when the procedure is performed in the majority of cases. We asked that commenters also provide data to support any assertion that the preponderance of Medicare beneficiaries upon whom the procedure is performed would not be expected to require overnight care or monitoring following the surgery. We noted in the proposed rule that simply asserting that the procedure could be safely performed in an ASC, without providing corroborative evidence and data, would not furnish us with sufficient information upon which to make an informed decision. *Comment:*
                         Several commenters requested that, if CMS decided not to adopt less than 24 hours as its definition of an overnight stay, CMS should revise the list of proposed excluded procedures that were included in Table 45 of the August 2006 proposed rule on the basis of their overnight stay requirement. The commenters disagreed with CMS' determinations that all of those procedures required at least active medical monitoring at midnight following the procedure. Many commenters provided specific recommendations regarding surgical services that they believed should not be excluded from payment under the revised ASC payment system. In addition, several commenters identified a number of procedures not on the OPPS inpatient list that CMS proposed to exclude from ASC payment but that were not displayed in Table 44 or Table 45 of the proposed rule and for which CMS provided no rationale for their exclusion. *Response:*
                         In response to these procedure-specific comments and to those comments that reflected the belief that all procedures not on the OPPS inpatient list should be payable under the revised ASC payment system, we reviewed a subset of all of the surgical procedures that we proposed to exclude from payment under the revised ASC payment system, identified as described below. This included reassessing the treatment of those codes that were proposed to be excluded but were inadvertently left out of Table 44 or Table 45 in the August 2006 proposed rule. To conduct this comprehensive review, we identified all codes within the surgical range of CPT codes that met all of the following criteria: (1) Not proposed for the CY 2008 list of ASC covered surgical procedures (Addendum BB to the August 2006 proposed rule); (2) not included on the CY 2007 OPPS inpatient list; (3) not packaged under the OPPS; (4) not CPT unlisted surgical procedure codes; and (5) recognized for separate payment under the OPPS. Elimination of all CPT codes not meeting these criteria yielded about 750 procedures designated for a second review by our medical advisors, in order to finalize their treatment under the CY 2008 revised ASC payment system. Our clinical staff evaluated each of those procedures using all available claims and physician pricing data, as well as their clinical judgment and the public comments, to determine which procedures would be expected to require monitoring at midnight of the day on which the surgical procedure was performed or that otherwise would pose a significant safety risk to the typical Medicare beneficiary. Table 2 below, which provides an illustrative list of all surgical procedures excluded from ASC payment under the revised ASC payment system, reflects the final outcome of that comprehensive review process. In all, we are not excluding 17 of the procedures that we had initially proposed for exclusion from payment under the revised ASC payment system. The procedures for which we made a different final determination than our proposal regarding the appropriateness of their performance in ASCs include procedures from virtually all specialty areas within the surgical range, from dermatology to gastroenterology to ophthalmology. In addition, we reviewed all Category III CPT codes and Level II HCPCS codes in the context of the public comments and our final policy for the revised ASC payment system and concluded that 29 of these codes, in addition to those HCPCS codes on the CY 2007 ASC list of covered procedures, are appropriate for performance in ASCs under the revised payment system. *Comment:*
                         A number of commenters requested that CMS exclude additional procedures from the ASC list of covered surgical procedures. Specifically, several commenters requested that CMS exclude the procedures listed in Table 1 below, because they believed that they pose significant safety risks to beneficiaries when performed in ASCs. They stated that all of the procedures listed in Table 1 would violate at least one of the proposed procedure review criteria by involving major blood vessels or prolonged invasion of body cavities. Further, one commenter suggested that some of the procedures (as listed, CPT codes 35473 through 37650) should be excluded, because they involve femoral access and could require thrombolytic therapy. Table 1.—Specific Procedures That Commenters Requested Be Excluded From ASC Payment
HCPCS code
Short descriptor21215
Lower jaw bone graft.32002
Treatment of collapsed lung.33206
Insertion of heart pacemaker.33214
Upgrade of pacemaker system.33215
Reposition pacing-defib lead.33216
Insert lead pace-defib, one.33217
Insert lead pace-defib, dual.33218
Repair lead pace-defib, once.33220
Repair lead pace-defib, dual.33222
Revise pocket, pacemaker.33223
Revise pocket, pacing-defib.33224
Insert pacing lead & connect.33225
L ventric pacing lead add-on.33226
Reposition L ventric lead.33234
Removal of pacemaker system.35473
Repair arterial blockage.35474
Repair arterial blockage.35475
Repair arterial blockage (non-dialysis).35476
Repair venous blockage (non-dialysis).35492
Artherectomy, perc.35761
Exploration of artery/vein.37205
Transcath IV stent, perc.37206
Transcath IV stent/perc addl.37250
IV U.S. first vessel add-on.37251
IV U.S. each add vessel add-on.37650
Revision of major vein.40700
Repair cleft lip/nasal.40701
Repair cleft lip/nasal.42200
Reconstruct cleft palate.42205
Reconstruct cleft palate.42210
Reconstruct cleft palate.( print page 42488)42215
Reconstruct cleft palate.42220
Reconstruct cleft palate.G0297
Insrt 1 chamb dfib pulse generator.
 *Response:*
                         We appreciate the commenters' concerns and conducted a comprehensive review of each of the procedures presented. We agree with the commenters that the procedures reported by CPT codes 35475 (Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or braches, each vessel); 37205 (Transcatheter placement of an intravascular stent(s), (except coronary, carotid, and vertebral vessel), percutaneous; initial vessel); and 37206 (Transcatheter placement of an intravascular stent(s), (except coronary, carotid, and vertebral vessel), each additional vessel) should be excluded from the ASC list of covered surgical procedures because they could pose a significant safety risk to beneficiaries in ASCs. We did not include CPT code 35475 in our proposed list of covered surgical procedures under the revised ASC payment system because we, like the commenters, believe that it poses a safety risk for beneficiaries if performed in ASCs. Although we did propose to add CPT codes 37205 and 37206 to the ASC list for CY 2007, we did not finalize that proposal for CY 2007 in response to comments and continue to agree with commenters that those procedures would likely require an overnight stay. With regard to the remaining procedures, three of them, specifically CPT codes 33222 (Revision or relocation of skin pocket for pacemaker); 33223 (Revision of skin pocket for single or dual chamber pacing cardioverter-defibrillator); and 37650 (Ligation of femoral vein), are on the current ASC list of covered surgical procedures and have been safely performed in ASCs for some time. We do not believe that they represent a significant safety risk or are likely to require an overnight stay. We did not propose to exclude any of the remaining procedures in Table 1 from the list of procedures for which ASCs may receive payment under the revised payment system because, based on our clinical review, we did not find that the procedures would be expected to require an overnight stay or pose a significant risk to beneficiary safety when performed in ASCs. Our review for this final rule, in consideration of the comments, did not alter our final opinion on the appropriate treatment of these other codes. Therefore, we are finalizing our proposal, with modification, regarding specific surgical procedures that are excluded from ASC payment under the revised ASC payment system. Table 2 provides an illustrative list of CPT codes that are payable under the OPPS but that are excluded from the ASC list of covered surgical procedures. This illustrative list does not include those procedures that are on the OPPS inpatient list, packaged under the OPPS, or only reportable by CPT unlisted surgical procedure codes. All of the procedures listed in Table 2 are excluded from the list of covered surgical procedures for which Medicare will provide ASC payment under the revised ASC payment system because we believe, based on our review of each procedure's clinical characteristics, utilization data reflected in physician claims, and prevailing medical practice as reflected in the valuation of the services by the AMA/Specialty Society Relative Value Scale Update Committee (RUC), and consideration of the judgment of our medical advisors and all public comments to the proposed rule, that these surgical procedures pose a significant risk to beneficiary safety or are expected to require an overnight stay. In this final rule, we are finalizing the addition of 793 new surgical procedures to the ASC list of covered surgical procedures for CY 2008, while we are excluding those procedures listed in Table 2 from ASC payment for CY 2008. This list will be updated for the CY 2008 revised ASC payment system through the CY 2008 OPPS/ASC annual rulemaking cycle. Table 2.—Illustrative List of Surgical Procedures Payable Under the OPPS (Not on the OPPS Inpatient List, Not Packaged Under the OPPS and Not Designated as CPT Unlisted Codes) That Are Excluded From ASC Payment Because They Pose a Significant Safety Risk or Are Expected to Require an Overnight Stay
HCPCS code
Short descriptor15170
Acell graft trunk/arms/legs.15171
Acell graft t/arm/leg add-on.15175
Acellular graft, f/n/hf/g.15176
Acell graft, f/n/hf/g add-on.19260
Removal of chest wall lesion.19307
Mast, mod rad.20100
Explore wound, neck.20101
Explore wound, chest.20102
Explore wound, abdomen.21049
Excis uppr jaw cyst w/repair.21175
Reconstruct orbit/forehead.21195
Reconst lwr jaw w/o fixation.21261
Revise eye sockets.21263
Revise eye sockets.21408
Treat eye socket fracture.21470
Treat lower jaw fracture.21742
Repair stern/nuss w/o scope.21743
Repair sternum/nuss w/scope.22100.
Remove part of neck vertebra.22101
Remove part, thorax vertebra.22222
Revision of thorax spine.22526
Idet, single level.22527
Idet, 1 or more levels.22612
Lumbar spine fusion.22614
Spine fusion, extra segment.22851
Apply spine prosth device.23470
Reconstruct shoulder joint.24150
Extensive humerus surgery.24151
Extensive humerus surgery.24935
Revision of amputation.25170
Extensive forearm surgery.26037
Decompress fingers/hand.27216
Treat pelvic ring fracture.27235
Treat thigh fracture.27412
Autochondrocyte implant knee.27415
Osteochondral knee allograft.27446
Revision of knee joint.27475
Surgery to stop leg growth.27524
Treat kneecap fracture.28360
Reconstruct cleft foot.29866
Autgrft implnt, knee w/scope.29867
Allgrft implnt, knee w/scope.29868
Meniscal trnspl, knee w/scpe.31292
Nasal/sinus endoscopy, surg.31293
Nasal/sinus endoscopy, surg.31294
Nasal/sinus endoscopy, surg.31600
Incision of windpipe.31601
Incision of windpipe.31610
Incision of windpipe.31785
Remove windpipe lesion.32005
Treat lung lining chemically.32020
Insertion of chest tube.32201
Drain, percut, lung lesion.32601
Thoracoscopy, diagnostic.32602
Thoracoscopy, diagnostic.32603
Thoracoscopy, diagnostic.32604
Thoracoscopy, diagnostic.32605
Thoracoscopy, diagnostic.32606
Thoracoscopy, diagnostic.32998
Perq rf ablate tx, pul tumor.33244
Remove eltrd, transven.34101
Removal of artery clot.34111
Removal of arm artery clot.34201
Removal of artery clot.34203
Removal of leg artery clot.( print page 42489)34421
Removal of vein clot.34471
Removal of vein clot.34490
Removal of vein clot.34501
Repair valve, femoral vein.34510
Transposition of vein valve.34520
Cross-over vein graft.34530
Leg vein fusion.35011
Repair defect of artery.35180
Repair blood vessel lesion.35184
Repair blood vessel lesion.35190
Repair blood vessel lesion.35201
Repair blood vessel lesion.35206
Repair blood vessel lesion.35226
Repair blood vessel lesion.35231
Repair blood vessel lesion.35236
Repair blood vessel lesion.35256
Repair blood vessel lesion.35261
Repair blood vessel lesion.35266
Repair blood vessel lesion.35286
Repair blood vessel lesion.35321
Rechanneling of artery.35458
Repair arterial blockage.35459
Repair arterial blockage.35460
Repair venous blockage.35470
Repair arterial blockage.35471
Repair arterial blockage.35472
Repair arterial blockage.35475
Repair arterial blockage.35484
Atherectomy, open.35485
Atherectomy, open.35490
Atherectomy, percutaneous.35491
Atherectomy, percutaneous.35493
Atherectomy, percutaneous.35494
Atherectomy, percutaneous.35495
Atherectomy, percutaneous.35500
Harvest vein for bypass.35685
Bypass graft patency/patch.35686
Bypass graft/av fist patency.35860
Explore limb vessels.35879
Revise graft w/vein.35881
Revise graft w/vein.35883
Revise graft w/nonauto graft.35884
Revise graft w/vein.35903
Excision, graft, extremity.36838
Dist revas ligation, hemo.37183
Remove hepatic shunt (tips).37195
Thrombolytic therapy, stroke.37201
Transcatheter therapy infuse.37202
Transcatheter therapy infuse.37204
Transcatheter occlusion.37205
Transcath iv stent, precut.37206
Transcath iv stent/perc addl.37207
Transcath iv stent, open.37208
Transcath iv stent/open addl.37209
Change iv cath at thromb tx.37210
Embolization uterine fibroid.37565
Ligation of neck vein.37600
Ligation of neck artery.37605
Ligation of neck artery.37606
Ligation of neck artery.37615
Ligation of neck artery.37620
Revision of major vein.38120
Laparoscopy, splenectomy.38240
Bone marrow/stem transplant.38720
Removal of lymph nodes, neck.39400
Visualization of chest.42225
Reconstruct cleft palate.42227
Lengthening of palate.42842
Extensive surgery of throat.42844
Extensive surgery of throat.43020
Incision of esophagus.43130
Removal of esophagus pouch.43280
Laparoscopy, fundoplasty.43510
Surgical opening of stomach.43647
Lap impl electrode, antrum.43648
Lap revise/remv eltrd antrum.43651
Laparoscopy, vagus nerve43652
Laparoscopy, vagus nerve.43752
Nasal/orogastric w/stent.43830
Place gastrostomy tube.43831
Place gastrostomy tube.44180
Lap, enterolysis.44186
Lap, jejunostomy.44206
Lap part colectomy w/stoma.44207
Lcolectomy/coloproctostomy.44208
Lcolectomy/coloproctostomy.44213
Lap, mobil splenic fl add-on.44500
Intro, gastrointestinal tube.44901
Drain app abscess, precut.44970
Laparoscopy, appendectomy.45541
Correct rectal prolapse.47011
Percut drain, liver lesion.47370
Laparo ablate liver tumor rf.47371
Laparo ablate liver cryosurg.47490
Incision of gallbladder.48511
Drain pancreatic pseudocyst.49021
Drain abdominal abscess.49041
Drain, percut, abdom abscess.49061
Drain, percut, retroper absc.49200
Removal of abdominal lesion.49323
Laparo drain lymphocele.49324
Lap insertion perm ip cath.49325
Lap revision perm ip cath.49326
Lap w/omentopexy add-on.49435
Insert subq exten to ip cath.49436
Embedded ip cath exit-site.49491
Rpr hern preemie reduce.49492
Rpr ing hern premie, blocked.50020
Renal abscess, open drain.50021
Renal abscess, percut drain.50080
Removal of kidney stone.50081
Removal of kidney stone.50541
Laparo ablate renal cyst.50542
Laparo ablate renal mass.50543
Laparo partial nephrectomy.50544
Laparoscopy, pyeloplasty.50945
Laparoscopy, ureterolithotomy.51990
Laparo urethral suspension.53500
Urethrlys, transvag w/ scope.57106
Remove vagina wall, partial.57107
Remove vagina tissue, part.57109
Vaginectomy partial w/nodes.57120
Closure of vagina.57282
Colpopexy, extraperitoneal.57283
Colpopexy, intraperitoneal.57284
Repair paravaginal defect.57292
Construct vagina with graft.57295
Change vaginal graft.57310
Repair urethrovaginal lesion.57330
Repair bladder-vagina lesion.57335
Repair vagina.57425
Laparoscopy, surg, colpopexy.57555
Remove cervix/repair vagina.58260
Vaginal hysterectomy.58262
Vag hyst including t/o.58263
Vag hyst w/t/o & vag repair.58270
Vag hyst w/enterocele repair.58290
Vag hyst complex.58291
Vag hyst incl t/o, complex.58292
Vag hyst t/o & repair, compl.58294
Vag hyst w/enterocele, compl.58541
Lsh, uterus 250 g or less.58542
Lsh w/t/o ut 250 g or less.58543
Lsh uterus above 250 g.58544
Lsh w/t/o uterus above 250 g.58553
Laparo-vag hyst, complex.58554
Laparo-vag hyst w/t/o, compl.58770
Create new tubal opening.58823
Drain pelvic abscess, precut.58920
Partial removal of ovary(s).58925
Removal of ovarian cyst(s).59030
Fetal scalp blood sample.59074
Fetal fluid drainage w/us.59409
Obstetrical care.59612
Vbac delivery only.60210
Partial thyroid excision.60212
Partial thyroid excision.60220
Partial removal of thyroid.60225
Partial removal of thyroid.60240
Removal of thyroid.60252
Removal of thyroid.60260
Repeat thyroid surgery.60500
Explore parathyroid glands.60502
Re-explore parathyroids.60512
Autotransplant parathyroid.60520
Removal of thymus gland.61623
Endovasc tempory vessel occl.61626
Transcath occlusion, non-cns.61720
Incise skull/brain surgery.62000
Treat skull fracture.62160
Neuroendoscopy add-on.62351
Implant spinal canal cath.63001
Removal of spinal lamina.63003
Removal of spinal lamina.63005
Removal of spinal lamina.63011
Removal of spinal lamina.63012
Removal of spinal lamina.( print page 42490)63015
Removal of spinal lamina.63016
Removal of spinal lamina.63017
Removal of spinal lamina.63020
Neck spine disk surgery.63030
Low back disk surgery.63035
Spinal disk surgery add-on.63040
Laminotomy, single cervical.63042
Laminotomy, single lumbar.63045
Removal of spinal lamina.63046
Removal of spinal lamina.63047
Removal of spinal lamina.63048
Remove spinal lamina add-on.63055
Decompress spinal cord.63056
Decompress spinal cord.63057
Decompress spine cord add-on.63064
Decompress spinal cord.63066
Decompress spine cord add-on.63075
Neck spine disk surgery.63741
Install spinal shunt.64448
Nblock inj fem, cont inf.64449
Nblock inj, lumbar plexus.64804
Remove sympathetic nerves.64910
Nerve repair w/allograft.64911
Neurorraphy w/vein autograft.69725
Release facial nerve.69955
Release facial nerve.69960
Release inner ear canal.
 IV. Ratesetting Methodology for the Revised ASC Payment System A. Overview of Current ASC Payment System 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 also can be safely performed in an ASC and to review and update the list of procedures paid under the ASC payment system at least every 2 years. Under the existing ASC 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. We refer readers to section I.B. of this final rule for further history regarding the establishment of standard overhead amounts for ASC payment. The standard overhead amounts under the existing ASC payment system for procedures on the ASC list of covered surgical procedures 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 payment system are explained in the February 8, 1990 
                        **Federal Register**
                         (55 FR 4526). The existing ASC payment system consists of 9 standard overhead amounts ranging from $333 to $1,339, based on the data collected in the 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 are included in active NTIOL classes. Medicare also makes separate payment for implantable prosthetic devices and implantable durable medical equipment (DME) that are surgically inserted at an ASC under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule. Payment for all other facility services that are directly related to performing a surgical procedure is packaged into the prospectively determined ASC payment for the covered surgical procedure. Section 5103 of Public Law 109-171 requires us to substitute the OPPS payment amount for the ASC standard overhead amount for surgical procedures performed in an ASC on or after January 1, 2007, but prior to the revised ASC payment system, when the ASC standard overhead amount exceeds the OPPS payment amount for the procedure in that year. In Addendum AA to the CY 2007 OPPS/ASC final rule with comment period (71 FR 68243 through 68283), we identify the HCPCS codes on the CY 2007 ASC list for which the CY 2007 ASC payments are capped at the OPPS payment amounts in accordance with the provisions of section 5103 of Public Law 109-171, based on a comparison of the final CY 2007 OPPS payment rates and the ASC standard overhead amounts that are effective in CY 2007. Except for screening flexible sigmoidoscopy and screening colonoscopy services, payment for ASC 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. As required by section 1834(d) of the Act, the coinsurance for screening flexible sigmoidoscopies and colonoscopies is 25 percent and the amounts paid by Medicare must be 75 percent of the standard fee. Medicare currently accounts for geographic wage variations when calculating individual ASC payments by applying the relevant inpatient prospective payment system (IPPS) wage index values and localities that were established under the IPPS prior to implementation of the new Core Based Statistical Areas (CBSAs) issued by the Office of Management and Budget (OMB) in June 2003 to 34.45 percent of the national ASC standard overhead amount. The 1986 ASC survey data are the basis for attributing 34.45 percent of ASC facility costs to labor costs. Section 1833(i)(2)(C) of the Act requires the Secretary to update ASC payment rates using the CPI-U (U.S. city average) (CPI-U) if the Secretary has not otherwise updated the amounts under the revised ASC payment system. As amended by Public Law 108-173, section 1833(i)(2)(C) of the Act provides 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. Public Law 108-173 further amended section 1833(i)(2)(C) of the Act to require us in FY 2004, beginning April 1, 2004, to increase ASC payment rates using the CPI-U as estimated for the 12-month period ending March 31, 2003, minus 3.0 percentage points. Public Law 108-173 also requires that the CPI-U adjustment factor equal zero percent in FY 2005, the last quarter of CY 2005, and each of CYs 2006 through 2009. Section 141(b) of the Social Security Act Amendments of 1994, Public Law 103-432, requires us to establish a process for considering requests for review of the appropriateness of the payment amount provided under section 1833(i)(2)(A)(iii) of the Act for IOLs to ensure that the ASC payment for the insertion procedure is reasonable and related to the cost of acquiring a lens that belongs to a class of NTIOLs. In the CY 2007 OPPS/ASC proposed rule that was published August 23, 2006 (71 FR 49631 through 49635), we proposed changes to the process for recognizing IOLs as belonging to a new NTIOL class. In the subsequent CY 2007 OPPS/ASC final rule with comment period (71 FR 68175 through 68181), we finalized the proposed changes to that process, beginning with requests for review for establishing new NTIOL classes for CY 2008 payment. The revised ASC payment system that we are finalizing in this rule will implement requirements set forth in section 626 of Public Law 108-173. The 
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                        revised payment system mandated by section 626(d) of Public Law 108-173 requires us to take into account recommendations in a report to Congress prepared by the GAO. As mentioned earlier, that report (GAO-07-86) was published on November 30, 2006. Its methodology, findings, and recommendations are summarized in section II.B. of this final rule. Specific ASC payment system issues considered in the GAO Report are discussed in the individual sections below under the related topic areas. B. ASC Relative Payment Weights Based on APC Groups and Relative Payment Weights Established Under the OPPS As we stated in the August 2006 proposed rule for the revised ASC payment system (71 FR 49647), we considered several strategies and methodologies for setting ASC payment rates under a revised payment system. These options included requiring ASCs to submit modified cost reports as a basis for establishing ASC costs, expanding the number and payment range of the current ASC payment groups, basing payments to ASCs on the relative weights for surgical services established under the MPFS, basing payments to ASCs on the relative weights for surgical services established under the Medicare OPPS, as suggested in Public Law 108-173, or basing 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 reviewing the advantages and disadvantages of each of these approaches, in the August 2006 proposed rule we proposed, within the parameters of section 626 of Public Law 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 in 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 Public Law 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 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 all services furnished in connection with outpatient surgical procedures. Third, Public Law 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 that, of the 150 highest volume surgical procedures furnished in HOPDs, 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 CMS sets payments and determines what is payable under the ASC benefit. We explained in the August 2006 proposed rule that the OPPS payment rates are based on relative payment weights, which are updated annually based on the most recent year of hospital outpatient claims data and hospitals' latest Medicare cost reports. 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 Advisory Panel on Ambulatory Payment Classification Groups (APC Panel) and as a result of comments received during the OPPS annual rulemaking cycles. Moreover, we believed that the APC groups had matured with respect to their clinical and resource homogeneity, and the relativity in resource utilization among APCs containing surgical procedures had stabilized. Thus, we concluded in the proposed rule that the APC groups and their relative weights were reasonable and appropriate models for grouping outpatient surgical procedures and determining the relativity of the ASC payment weights under the revised payment system. For example, whether performed in an HOPD or in an ASC, we believed the time and facility resources required to perform a routine laparoscopic hernia repair described by CPT code 49650 (Laparoscopy, surgical; repair initial inguinal hernia), with a CY 2007 OPPS relative payment weight of 43.5488, were approximately 5 times higher than those required to perform a diagnostic colonoscopy described by CPT code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)), with a CY 2007 OPPS relative payment weight of 8.7686. Thus, we believed that the relative payment weights established under the OPPS for procedures performed in the hospital outpatient setting reasonably reflected the relative facility resources required for such procedures and did so with sufficient coherence to be applicable to other ambulatory sites of service. Taking all these factors into account, we proposed 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 proposed to establish provisions in proposed new Subpart F, §§ 416.167 and 416.171, to reflect these proposed changes for calculating the ASC payment rates beginning January 1, 2008. As further discussed in section II.B. of this final rule, on November 30, 2006, the GAO published the report mandated by section 626(d) of Public Law 108-173 (GAO-07-86), where it determined that the APC groups of the OPPS accurately reflect the relative costs of procedures performed in ASCs. It concluded that the APC groups in the OPPS reflect the relative costs of surgical procedures performed in ASCs in the same way that they reflect the relative costs of the same procedures when they are performed in HOPDs. Therefore, the GAO recommended that the APC groups could be applied to procedures performed in ASCs, and the OPPS could be used as the basis for an ASC payment system, thereby eliminating the need for ASC surveys and providing for an annual revision of the ASC payment groups. At its December 2006 meeting, the PPAC recommended that CMS apply any payment policies uniformly to both 
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                        ASCs and HOPDs as appropriate, confirming its belief that the OPPS and the revised ASC payment system could be closely linked. We received a number of comments on our proposal to use the OPPS relative payment weights as the basis for establishing relative payment weights under the revised ASC payment system. A summary of the comments and our responses follow. *Comment:*
                         Many commenters agreed that using the OPPS APCs as a “grouper” and the APC relative payment weights to establish ASC payment rates for surgical procedures paid under the revised ASC payment system is appropriate because a significant number of surgical procedures furnished in the hospital outpatient setting are also performed in ASCs. Some commenters argued that because ASCs provide many similar procedures that are also performed in HOPDs and often utilize the same equipment, supplies, and clinical labor in performing these procedures, the relative costs of performing the procedures should be similar, if not identical, in both settings. Moreover, the commenters generally agreed that creating an ASC payment system that parallels the OPPS would promote transparency across sites of service in the area of outpatient surgery and would also promote greater alignment and coordination between the OPPS and the revised ASC payment system, including providing for the annual updating of payment weights in the ASC payment system. Some commenters requested that CMS apply different conversion factors to the OPPS relative payment weights for specific types of procedures to calculate their ASC payment rates, because they suggested that the OPPS relativity was not correct for some services provided in single specialty ASCs (for example, gastroenterology and pain management procedures). They believed that the OPPS APC weights, based on all hospital services rather than just surgical services, may be flawed and that additional analyses of relative hospital and ASC costs are needed. They recommended that CMS develop firm data on the differences between hospital outpatient and ASC costs and the magnitude of those differences for numerous services before finalizing significant changes in ASC payments for procedures. One commenter specifically discussed a study commissioned by MedPAC in which RAND found that no single outpatient surgical setting, ASCs or HOPDs, had consistently higher rates of patient characteristics that would be expected to increase facility costs. Analyses by another commenter found that among a subset of gastrointestinal (GI) procedures, the majority of surgical CPT codes describing those procedures received OPPS payments that were less than hospitals' median costs for the individual procedures. *Response:*
                         We appreciate the commenters' general support for basing the revised ASC payment system relative weights on the OPPS APC groups and their relative weights. As discussed in detail in section II.B. of this final rule, in its November 2006 report on ASC payment, the GAO found that the APC groups in the OPPS accurately reflect the relative costs of procedures performed in ASCs. The GAO analyses also demonstrated that there is less variation in the ASC setting between individual procedures’ costs and the costs of their assigned APC groups than there is in the HOPD setting, and that when compared to the median cost of the same APC group, procedures performed in ASCs had substantially lower costs than those same procedures performed in HOPDs. The GAO findings were based upon data for all procedures performed in ASCs in CY 2004, as reported by those ASCs responding to the GAO survey. In view of the GAO's confirmation that the APC groups accurately reflect the relative costs of these procedures performed in ASCs in the same way that they reflect the relative costs of the same procedures when they are performed in HOPDs, substantiating a key assumption underlying our proposal for the revised ASC payment system, we do not believe there is a compelling rationale for using different ASC conversion factors to develop payment rates for various procedures under the revised ASC payment system. Applying more than one ASC conversion factor to different procedures would imply that we believe the OPPS APC payment weight relativity is not applicable to the ASC setting, contrary to our proposal and the GAO study results. APCs currently serve as a “grouper” for the OPPS and, as such, the payment for any given procedure under the OPPS does not specifically reflect the cost of that procedure in any one facility. Instead, the APC relative payment weights under the OPPS are developed based on the median cost of all single claims for all procedures assigned to each APC. Prospectively established APC payment rates provide an averaging effect on OPPS payments for individual services. With the significant expansion of covered surgical procedures eligible for ASC payment that we are finalizing in this final rule for the revised ASC payment system as discussed in section III. of this final rule, in many cases where one service in an APC is an ASC procedure, most of the other procedures assigned to the same APC will also be paid in the ASC setting. Thus, under the revised payment system, ASCs generally will have the potential to provide a mix of individual services assigned to those APCs that is similar to the mix of OPPS procedures attributable to certain APCs and, in many cases, all of the procedures assigned to certain APCs under the OPPS will also be ASC covered surgical procedures. We believe this uniform approach under the revised ASC payment system is fully consistent with the recommendation of the PPAC that we apply payment policies consistently to both ASCs and HOPDs, as appropriate. It also generally treats procedures performed in ASCs consistently for purposes of developing ASC payment rates under the revised ASC payment system, in accordance with the PPAC recommendation that we adopt a systematic and adaptable means of fairly reimbursing ASCs for their services. While information provided by the commenters clearly demonstrated that some specific groups of procedures would experience a significant decrease in payment under the revised ASC payment system as compared with the existing payment structure, we are not convinced that the information we received contradicts the premise of our proposal and the GAO findings that the relativity of costs observed in HOPDs could appropriately be used as the basis for the relative payment weights in the revised ASC payment system. We also continue to see no clinical basis that would support the differential relativity of costs for various procedures performed in the ASC or HOPD settings. While applying a single conversion factor to the OPPS relative weights may result in decreases to ASC payments for some services commonly provided in single specialty ASCs, we also believe that this approach should result in facilities receiving more appropriate payments for ASC services in general, where those payments more accurately reflect the facility resources required for their performance. As discussed further in section IV.J. of this final rule, our final policy of a 4-year transition to phase in the revised ASC payment system should mitigate the potential disruption in care that could be associated with significant increases or decreases in payments for specific surgical procedures under the revised payment system. Individual ASCs will have a longer period of time to evaluate and potentially modify the breadth of 
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                        surgical procedures they provide based on the expanded list of covered surgical procedures and the final policies of the revised ASC payment system. Further, our final ASC policies for payment of device=intensive procedures and covered ancillary services that more closely align the ASC and OPPS systems may moderate the magnitude of differences between current ASC payments and those under the revised payment system for individual surgical procedures. We do not believe that it would be appropriate to modulate changes in payment under the revised system by differentially adjusting the payment weights or the conversion factor for various types of services because, consistent with the GAO recommendation, we believe the OPPS relative payment weights upon which the revised ASC payment system is based appropriately reflect the relativity in ASC resource costs associated with different surgical procedures. We believe that the final payment policies for the revised payment system result in appropriate and equitable payments, and thus, we see no rationale for applying adjustments that are counter to the principles of a prospective payment system. After considering the public comments received, we are finalizing our proposal, without modification, to establish the relative payment weights under the revised ASC payment system for most covered surgical procedures based on their OPPS APC relative payment weights for the same calendar year, with application of a single ASC conversion factor to determine the national unadjusted ASC payment rates, as set forth in §§ 416.167 and 416.171. Several exceptions to this general policy are discussed elsewhere in this final rule, specifically in sections IV.C. and IV.E. of this preamble. C. Packaging Policy 1. General Policy 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 payment the payment for a bundle of direct and indirect costs incurred by the facility to perform the surgical 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. CMS currently applies different rules under the ASC payment system and the OPPS 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, CMS 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, CMS pays separately for some of these items and services, in addition to paying for the surgical procedure. ASCs currently receive separate payment for prosthetic implants and implantable DME, as well as additional payment for NTIOLs. Laboratory services, physicians' services, and x-ray or diagnostic procedures may also be paid separately under other Medicare Part B fee schedules. Conversely, under the OPPS, payment for prosthetic implants and implantable DME is packaged into the OPPS payment for the surgical procedure performed to insert the implants. Payments for IOLs, anesthesia materials, and implantable surgical supplies, such as stents, mesh, guidewires, pins, and catheters, are packaged into the associated surgical procedure payment under both the OPPS and the ASC payment system. In developing the August 2006 proposed rule for the revised ASC payment system, we considered several packaging options. First, we considered making no change to the current policy regarding items and services for which payment is packaged into the ASC payment. That is, we would continue under the revised ASC payment system to package into the ASC payment all services listed at existing § 416.61(a). In addition, we would continue to pay separately, sometimes 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 Diagnostic Laboratory Fee Schedule); physician services (MPFS); and x-ray or diagnostic procedures other than those directly related to performance of the surgical procedure (MPFS). We also considered proposing to apply the OPPS packaging rules to the ASC payment system and to pay under the revised ASC payment 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 covered surgical procedure would not be packaged into the ASC payment 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 has 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, in the August 2006 proposed rule for the revised ASC payment system, we proposed a third option (71 FR 49648). That is, we proposed to continue the current policy of packaging payment for all direct and indirect costs incurred by the facility to perform a covered surgical procedure into the ASC payment for the 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 were proposed for packaging into the ASC surgical procedure payment as listed in proposed § 416.164(a). Proposed § 416.164(a) addressed the services for which payment was proposed to be included in the ASC payment for the covered surgical procedures, and proposed § 416.164(b) addressed those services that were proposed 
                        *not*
                         to be included in the ASC payment for the covered surgical procedures. In addition, we proposed to cease making separate payment for implantable prosthetic devices and implantable DME inserted surgically in an ASC. Instead, under the revised payment system, we proposed to package payment for implantable prosthetic devices and implantable DME when they are surgically inserted into the ASC payment for the associated covered surgical procedure, as we do under the OPPS. However, we proposed to continue excluding from ASC payment for covered surgical procedures the other services addressed in § 416.164(b). That is, payment for items and services for which payment is currently made under other Part B fee schedules, with the exception of implantable prosthetic devices and implantable DME, would 
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                        not be included in the ASC payment for the surgical procedure. Payment for items and services, such as physicians' professional services; 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 DME for use in the patient's home would not be included in the ASC payment for the covered surgical procedure. We proposed this third option for a number of reasons. First, in the August 2006 proposed rule, we explained that this approach to packaging is most consistent with the principles of a prospective payment system. Second, we noted that 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, in the August 2006 proposed rule, we concluded that we did 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 services payment under the existing payment system, reduce incentives for cost-efficient delivery of services in ASCs, and increase the complexity of the revised ASC payment system. Moreover, after 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 HOPD, 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. We sought comments in the August 2006 proposed rule (71 FR 49648) from ASC clinical and administrative staff, and from physicians who perform surgeries in 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 specifically requested 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. At its December 2006 meeting, the PPAC recommended that CMS apply any payment policies uniformly to ASCs under the revised ASC payment system and HOPDs under the OPPS. In the GAO Report (GAO-07-86) published on November 30, 2006, based upon its study of the 20 most frequently performed ASC procedures in CY 2004, the GAO found that many additional services were billed with surgical procedures in both the ASC and HOPD settings, but few resulted in an additional payment in one setting but not the other. In general, HOPDs were paid separately for some of the related additional services they billed with the procedures and, in the ASC setting, other Part B suppliers usually billed Medicare for those services and received payment for them. Multiple surgical procedures performed in one session were typically paid separately in both settings, occurring in similar proportions of cases and subject to the same 50-percent reduction policy for the procedure with the lower payment rate. Laboratory services were paid under the OPPS according to the Clinical Diagnostic Laboratory Fee Schedule (CLFS) rates and were billed by another Medicare Part B supplier when provided in the context of a surgical procedure performed in an ASC. Similarly, some radiology services were paid separately under the OPPS, but when those radiology services were performed with procedures provided in the ASC setting, those services generally were furnished and billed by another Part B supplier. Anesthesia services in both settings were usually billed by another Part B supplier. While individual drugs were billed under the OPPS for most procedures, the GAO found that none of those individual drugs were separately payable in the HOPD setting, just as their payment was packaged in ASCs. Thus, the GAO concluded that there were many similarities in the additional services billed in the ASC or HOPD settings with the top 20 ASC procedures. Furthermore, the GAO found that, in the context of the existing ASC payment system, CMS generally made separate payment for similar additional services in both settings, although sometimes to other Part B suppliers than to the ASCs themselves. We also note that we proposed, consistent with section 141(b) of the Social Security Act Amendments of 1994, Public Law 103-432, to continue to provide adjustment to payment amounts for NTIOLs under the revised ASC payment system as set forth in Subpart G that we finalized in the CY 2007 OPPS/ASC final rule with comment period. We received numerous comments on our proposed packaging policies for the revised ASC payment system. The commenters submitted many suggestions regarding the various approaches that they believed CMS should follow when finalizing the packaging policies for certain items and services under the revised ASC payment system. A summary of the comments and our responses follow. *Comment:*
                         In general, many of the commenters agreed with CMS' proposal to continue to package under the revised ASC payment system payment for various items and services that are currently packaged under the OPPS and the existing ASC payment system. They recommended that CMS adopt its proposal to provide packaged payment for the costs of many items and services that are directly related to the provision of surgical procedures, such as facility overhead, operating and recovery room use, nursing and technician services, administrative and housekeeping items and services, appliances and equipment, materials for anesthesia, IOLs, surgical dressings, supplies, splints, and casts. They acknowledged that the statute requires that payment to ASCs for IOLs (other than NTIOLs which receive a supplemental payment) must be packaged into the ASC payment for IOL insertion procedures. In addition, the commenters agreed that CMS should continue to exclude from payment as part of the ASC payment for covered surgical procedures some items and services that are paid under other Part B fee schedules, specifically the professional services of physicians and nonphysician practitioners paid under the MFPS and laboratory services paid under the CLFS. Further, the commenters agreed that CMS should continue to provide additional payment for NTIOLs. The commenters who supported continued packaging of the items and services described above generally provided those recommendations in the context of their broader recommendation to apply the same packaging policies under the revised ASC payment system as under the 
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                        OPPS, because the proposed payment rates under the revised ASC payment system were based upon the OPPS payment groups. They argued that parallel packaging policies were most consistent with promoting transparency between the two systems and minimizing any payment incentives to shift sites of service for various procedures. They also believed that this approach is the most appropriate, given the proposal to base the rates in the revised ASC payment system on the OPPS relative payment weights, with application of a single conversion factor. The commenters asserted that consistent packaging policies would ensure that some payment was made for the costs of all items and services used by facilities in performing surgical procedures, and that there was no duplicate payment for these items under either the OPPS or the revised ASC payment system. MedPAC supported the proposal to expand the ASC payment bundles in the revised payment system by packaging payment for implantable prosthetics and DME, but recommended that CMS make the payment bundles under the revised ASC payment system and the OPPS even more compatible by expanding the payment bundles in the OPPS. MedPAC noted that different bundling policies under the two payment systems may lead to different relative payment amounts in each setting, even if the base payment rates share the same relative values in both settings. *Response:*
                         We appreciate the commenters' support for continuing to package payment under the revised ASC payment system for those items and services that also receive packaged payment under the OPPS. The commenters' recommendations are consistent with the PPAC recommendation that we apply payment policies uniformly across the two systems. We note that any changes to the OPPS payment bundles are outside the scope of this final rule for the revised ASC payment system. Such changes would have to be proposed and finalized through the OPPS annual rulemaking cycle, and we will keep MedPAC's recommendations in mind for future OPPS updates. As set forth in final § 416.163, payment is made under the revised ASC payment system for ASC services furnished in connection with covered surgical procedures. As set forth in revised § 416.2, ASC services include both facility services, which are defined as items and services that are furnished in connection with a covered surgical procedure performed in an ASC and for which payment is packaged into the ASC payment for the covered surgical procedure, and covered ancillary services, which are defined as those items and services that are integral to a covered surgical procedure and for which separate payment may be made under the revised ASC payment system. After considering all public comments received, we are finalizing, with modification, our proposal to provide packaged payment for ASC facility services into the ASC payment for covered surgical procedures under the revised ASC payment system. That is, we will continue to identify as within the scope of ASC facility services for which payment is packaged into the payment for covered surgical procedures as set forth in final § 416.164(a) the following: nursing, technician, and related services; use of the facility where the surgical procedures are performed; laboratory testing performed under a Clinical Laboratory Improvement Amendments of 1988 (CLIA) certificate of waiver; drugs and biologicals for which separate payment is not allowed under the OPPS; medical and surgical supplies not on pass-through status under the OPPS; equipment; surgical dressings; implanted prosthetic devices and related accessories and supplies not on pass-through status under the OPPS, including IOLs; implanted DME and related accessories and supplies not on pass-through status under the OPPS; splints and casts and related devices; radiology services for which separate payment is not allowed under the OPPS and other diagnostic tests or interpretive services that are integral to a surgical procedure; administrative, recordkeeping, and housekeeping items and services; materials, including supplies and equipment for the administration and monitoring of anesthesia; and supervision of the services of an anesthetist by the operating surgeon. Under the revised ASC payment system, the above items and services fall within the scope of ASC facility services, and we will package payment for them into the ASC payment for the covered surgical procedure in order to promote efficient use of resources. We will continue to provide a payment adjustment for insertion of an IOL approved as belonging to a class of NTIOLs, for the 5-year period of time established for that class, as set forth in Subpart G and new § 416.172(g) for the revised ASC payment system. As a modification to our proposal, under the final policy of the revised ASC payment system, covered ancillary services that are integral to a covered ASC surgical procedure will be allowed separate payment. These covered ancillary services, which are outside of the scope of ASC facility services defined at § 416.2 and described at new § 416.164(a) for which payment is packaged into the ASC payment for covered surgical procedures, are defined at § 416.2 and described at new § 416.164(b) as follows: brachytherapy sources; certain implantable items that have pass-through status under the OPPS; certain items and services that we designate as contractor-priced (payment rate is determined by the Medicare contractor) including, but not limited to, the procurement of corneal tissue; certain drugs and biologicals for which separate payment is allowed under the OPPS; and certain radiology services for which separate payment is allowed under the OPPS. Public comments on the proposed rule and our responses regarding these specific items and services are discussed later in this section. We will consider to be outside the scope of ASC services, as set forth in § 416.164(c), the following items and services, including, but not limited to: physicians' services (including surgical procedures and all preoperative and postoperative services that are performed by a physician); anesthetists' services; radiology services (other than those integral to performance of a covered surgical procedure); diagnostic procedures (other than those directly related to performance of a covered surgical procedure); ambulance services; leg, arm, back, and neck braces other than those that serve the function of a cast or splint; artificial limbs; and nonimplantable prosthetic devices and DME. 2. Policies for Specific Items and Services Although in the August 2006 proposed rule we proposed to package payment for a broad array of items and services under the revised ASC payment system into the ASC payment for a covered surgical procedure as described earlier in this section, we solicited and received many public comments regarding our proposed treatment of those items or services that are directly related to a surgical procedure and that would be paid separately under the OPPS but that were proposed for packaging under the revised ASC payment system. We address those specific comments and provide our responses below. *Comment:*
                         A number of commenters indicated that, if the goal of the revised ASC payment system is to create a payment system that is based on OPPS relative weights and payment rates, then the packaging policy for ASCs should be 
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                        based on the same inclusions as those found under the OPPS. They suggested that following the OPPS payment policies under the revised ASC payment system would promote parity in payments between HOPDs and ASCs and, thereby, eliminate inappropriate incentives to base care decisions on payment considerations. Specifically, a number of commenters were concerned about payment differences that could arise between HOPDs and ASCs when services outside the CPT surgical range were provided in an ASC in conjunction with a covered surgical procedure on the ASC list. They noted that when HOPDs provide some of these services and items, they generally receive separate payment for them. *Response:*
                         Because we received numerous comments on various issues related to the proposed packaging of payment for specific items and services under the revised ASC payment system where the proposed packaging policy differs from the OPPS payment policy, we address them separately in the following sections: a. Radiology Services Under the existing ASC payment system, we define a surgical procedure as any procedure described within the range of Category I CPT codes that the AMA defines as “surgery” (CPT codes 10000-69999). In the August 2006 proposed rule, we indicated that we would continue this standard (71 FR 49636). Because the HCPCS codes that describe radiology services are outside of the CPT surgical range, payment for radiology services that are directly related to surgical procedures has been packaged into the ASC payment for the covered surgical procedure under the existing ASC payment system. The current regulatory definition of an ASC does not allow the ASC and another entity to mix functions and operations in a common space during concurrent or overlapping hours of operation. That is, the two facilities must be separated by time (different hours of operation) or the other entity may operate in the ASC's space when the ASC is not operating in that space. Historically, we have made an exception to this rule when there is a need for imaging services during the course of a covered surgical procedure in progress in an ASC under the existing ASC payment system. In that case, an Independent Diagnostic Testing Facility (IDTF) sharing the space with the ASC (normally at a different time) may conduct the required radiology service outside of its normal business hours, as needed, and receive Medicare payment for those services. Specifically, under the existing ASC payment system if an ASC enrolls in the Medicare program as an IDTF and bills as that supplier when furnishing a radiology service that is reasonable and necessary and directly related to and furnished in conjunction with a covered surgical procedure, the IDTF may bill and receive payment under the MPFS for imaging and guidance services, even though they are being provided during the ASC's designated hours. The GAO Report on ASC payment released on November 30, 2006 confirmed that separate payment is commonly made to another Part B supplier for these radiology services provided in association with surgical procedures in ASCs. Currently, radiology services provided in association with surgical procedures paid under the OPPS are either packaged or paid separately through an OPPS facility payment. We received a number of comments regarding our proposal to package payment for radiology services into payment for their associated surgical procedures under the revised ASC payment system. A summary of the comments and our responses follow. *Comment:*
                         Numerous commenters opposed CMS' proposed policy of packaging payment for radiology services directly related to a surgical procedure into the ASC payment for the associated covered surgical procedure. Some commenters requested that CMS continue to follow the existing practice regarding separate payment for radiology services provided in association with surgical procedures under the current ASC payment system. That is, they recommended that CMS permit continued separate payments for such radiology services to IDTFs if the ASCs are enrolled as IDTFs and bill for the services as that type of supplier. On the other hand, other commenters believed that ASC enrollment as an IDTF supplier was unnecessarily administratively burdensome for those ASCs that only are providing radiology services necessary for the safe provision of surgical procedures. These commenters requested that CMS adopt the OPPS payment policy for radiology services under the revised ASC payment system, which either provides separate payment or packages their payment into the OPPS payment for the surgical procedure associated with the radiology services. They indicated that following the OPPS payment policy under the revised ASC payment system would promote parity in payments between HOPDs and ASCs, especially because the relative payment weights used in both payment systems were linked. In contrast, MedPAC recommended that CMS address the potentially inconsistent payment policies by creating larger payment bundles under the OPPS, consistent with CMS' proposal to package payment for radiology services directly related to a surgical procedure under the revised ASC payment system. *Response:*
                         We believe that appropriate radiology services may be necessary for the safe performance of covered surgical procedures that are provided to Medicare beneficiaries in ASCs, and we realize that under the current system, payments for many of these services are made to other Part B suppliers even though the radiology services are integral to the surgical procedures provided by ASCs. We have come to believe that the most prudent method for providing accurate payment for the ancillary radiology services that are integral to, and required for the successful performance of, covered surgical procedures is to provide separate payment for certain radiology services under our final policy for the revised ASC payment system. Payment for the costs of radiology services that are separately paid under the OPPS is not included in the OPPS payment weights upon which the revised ASC payment system is based so, under our proposal, ASCs may not have received the most appropriate payment for the costs of these associated radiology services. We will, therefore, provide separate payment to ASCs for certain ancillary radiology services when they are integral to the performance of a covered surgical procedure billed by the ASC on the same day, provided that separate payment for the radiology service would be made under the OPPS. We specify that a radiology service is integral to the performance of a covered surgical procedure if it is required for the successful performance of the surgery and is performed in the ASC immediately preceding, during, or immediately following the covered surgical procedure. Based on our analysis of the OPPS data, we believe that, in most cases, a radiology service that is separately payable under the OPPS that is performed in the ASC on the same day as a covered surgical procedure will be provided integral to a covered surgical procedure, and the ASC will be able to receive separate payment for the service as a covered ancillary service. The separate ASC payments for these radiology services will be made at the lower of: (1) The amount calculated according to the standard methodology of the revised ASC payment system; or (2) the MPFS nonfacility practice expense amount for the service (specifically, for the 
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                        technical component (TC) if the service's HCPCS code is assigned a TC under the MPFS). This is similar to our final payment policy for covered office-based surgical procedures added to the ASC list in CY 2008 or later years. Payment for the costs of the facility resources associated with the radiology service would have been made to IDTFs under the existing ASC payment system at the MPFS nonfacility practice expense amount. Therefore, we believe the revised payment system beginning January 1, 2008, will both ensure appropriate and equitable payment for covered ancillary radiology services integral to covered surgical procedures and not provide a payment incentive for migration of services from physicians' offices or IDTFs to ASCs. This final policy will not encourage the proliferation of ASCs enrolling as IDTF suppliers, a practice which could lead to even greater future increases in the volume of diagnostic imaging services than those recently observed for such services to Medicare beneficiaries. CMS defines an IDTF in § 410.33 as an entity independent of a hospital or physician's office in which diagnostic tests are performed by licensed or certified nonphysician personnel under appropriate physician supervision. ASCs are distinct entities that operate exclusively for the purpose of providing surgical services to patients not requiring hospitalization (§ 416.2). As discussed earlier, an ASC that is also enrolled as an IDTF must maintain separate, exclusive hours of operation from those of the IDTF, and there may be no overlap in the hours of operation of the two entities. In order to bill for diagnostic tests, the IDTF must be enrolled as such with Medicare and meet specific requirements regarding its structure, ownership and, operation as set forth in § 410.33. As stated in § 416.49, an ASC is responsible for obtaining radiologic services from a Medicare approved facility to meet the needs of its patients and, as confirmed by the GAO in its report released on November 30, 2006, many ASCs currently provide those radiology services in association with covered surgical procedures through other Part B suppliers, specifically IDTFs. Under the revised payment system, there is no incentive for ASCs that provide only those radiology services that are integral to the performance of covered surgical procedures to also enroll as IDTFs. In contrast to current policy, under the revised system, payment will be made to the ASC for radiology services that are furnished integral to a covered surgical procedure. Payment will no longer be permitted to IDTFs for covered ancillary radiology services furnished integral to covered surgical procedures in ASCs. Because ASCs are distinct entities that operate exclusively to provide ambulatory surgical services, we would not expect that IDTFs sharing space with ASCs would be billing for any services for a patient receiving those services in an ASC on the date of a covered surgical procedure because all such services would be integral to the surgical procedure. Under the final policy, only the ASC can receive payment for the facility resources required to provide the ancillary radiology services. IDTFs would not be able to bill for radiology services integral to the performance of a covered surgical procedure, an existing practice which commenters claimed is unnecessarily administratively burdensome because it requires ASCs that are only providing radiology services related to the safe performance of surgical procedures also to enroll as IDTF suppliers under Medicare. As of January 1, 2008, we are no longer permitting the exception that has allowed billing by IDTFs for required radiology services provided in ASCs during the course of covered ASC surgical procedures. We are also not allowing any other suppliers to bill for the technical component of radiology services provided in ASCs that are integral to the performance of an ASC covered surgical procedure. Only ASCs will receive separate payment for the technical component of those radiology services that are separately payable under the OPPS to ensure that no duplicate payment is made. This policy will ensure that packaged or separate payment is made to ASCs for all radiology services integral to the performance of covered surgical procedures, thereby providing appropriate payment to ASCs for those radiology services that are essential to the delivery of safe, high quality surgical care. In summary, under the revised ASC payment system, we are adopting the OPPS payment status for radiology services and will pay separately, at the lower of the amount developed according to the standard methodology of the revised ASC payment system or the MPFS nonfacility practice expense amount, for ancillary radiology services designated as separately payable under the OPPS when those radiology services are integral to the performance of a covered surgical procedure provided on the same day and billed by the ASC. Similarly, we will package payment for those services that are designated as packaged under the OPPS into the payment for the covered surgical procedure. The separate national, unadjusted ASC payment for a covered ancillary radiology service would be based either upon the OPPS payment weight for the APC group of the radiology service, with application of the uniform ASC conversion factor, or upon the MPFS nonfacility practice expense relative value units (RVUs) for the service. Payment under the revised ASC payment system for these covered ancillary radiology services would be subject to geographic adjustment, like payment for covered surgical procedures. IDTFs would no longer be able to receive payment for ancillary radiology services that are integral to the performance of a covered surgical procedure for which the ASC is billing Medicare. This policy is consistent with the PPAC's request for uniform payment policies across the OPPS and the revised ASC payment system and is responsive to MedPAC's concern about creating different payment bundles for ASCs and HOPDs. Because the packaging status of radiology services under the revised ASC payment system will parallel their treatment under the OPPS, any changes to the packaging of radiology services under the OPPS that would alter the OPPS payment bundles would also occur under the revised ASC payment system. Therefore, we believe that this approach is fully consistent with the recommendations of MedPAC and the PPAC in applying payment policies consistently to both ASCs and HOPDs. Radiology services include all Category I CPT codes in the radiology range established by CPT, from 70000 to 79999, and Category III CPT codes and Level II HCPCS codes that describe radiology services that crosswalk or are clinically similar to procedures in the radiology range established by CPT. This revised ASC payment system policy for each calendar year will apply to all radiology services that are separately payable under the OPPS in that same calendar year. An illustrative listing that includes all radiology services that are separately payable under the CY 2007 OPPS, which will be proposed for updating and then finalized in the CY 2008 OPPS/ASC proposed and final rules, respectively, can be found in Addendum BB to this final rule. Covered ancillary radiology services are assigned to payment indicator “Z2” (Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight) or “Z3” (Radiology service paid separately when provided integral to a 
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                        surgical procedure on ASC list; payment based on MPFS nonfacility PE RVUs). ASC payment rates for these radiology services will be determined according to the standard methodology of the revised ASC payment system as discussed further in section V. of this final rule, or according to the MPFS nonfacility practice expense amount, whichever payment amount is lower. This final policy is set forth in §§ 416.171(d) and 416.167(b)(3). After consideration of all public comments received, we are finalizing a policy to provide separate payment under the revised ASC payment system for those ancillary radiology services separately paid under the OPPS that are integral to the performance of covered surgical procedures for which the ASC bills Medicare. This final policy contrasts with our proposal which would have provided packaged payment for all ancillary radiology services. Instead, under the revised ASC payment system, we will provide separate payment for those ancillary radiology services that are separately paid under the OPPS when they are provided on the same day as, and integral to, the performance of a covered surgical procedure in an ASC. Payment for ancillary radiology services that are packaged under the OPPS will be packaged under the revised ASC payment system, and these services are identified in Addendum BB to this final rule with payment indicator “N1” (Packaged service/item; no separate payment made). Separately paid radiology services are considered to be covered ancillary services. ASC payment for these radiology services will not be subject to the 4-year transition (see section IV.J. of this final rule) because the services have never received separate payment under the existing ASC payment system. The 4-year transition applies only to those services that receive separate payment under the existing CY 2007 ASC payment system. We also are revising proposed § 416.164(a) and (b) to reflect this final policy. b. Brachytherapy Sources As we stated in the August 2006 proposed rule, under the existing ASC payment system, a single payment is made to an ASC for all facility services furnished by the ASC in connection with a covered surgical procedure. However, a number of services and related items covered under Medicare may be furnished in an ASC, where these items and services are not considered to be facility services and, therefore, are not paid through the ASC payment for the covered surgical procedure. These items and related services may be covered and paid to other Part B suppliers, such as physicians. Such is sometimes the case with payment for brachytherapy sources implanted in ASCs, where the needles and catheters to implant the sources are implanted during surgical procedures that are on the ASC list. Under the existing ASC payment system, while payment is not made for brachytherapy sources to ASCs, these sources may be separately paid at contractor-priced rates by Medicare contractors under the MPFS to physicians who may also be billing the CPT codes for application of the brachytherapy sources in ASCs. Contractor-priced rates are those payment rates for certain items or services that are individually established by each Medicare contractor for payment of claims submitted to them. Brachytherapy source application codes, which are included in the radiology section of the CPT code book, are not on the existing ASC list because they do not fall within the CPT surgical range and, therefore, are not defined as surgery for purposes of ASC payment. While we did not explicitly discuss payment for brachytherapy sources in the August 2006 proposed rule, we received a number of comments regarding payment for brachytherapy sources under the revised ASC payment system. A summary of the comments and our responses follow. *Comment:*
                         Several commenters suggested that CMS pay separately for brachytherapy sources under the revised ASC payment system when they are implanted in ASCs. Other commenters recommended that CMS continue to pay separately under the MPFS for brachytherapy sources provided in ASCs. The commenters requested that CMS allow separate payment for brachytherapy sources to facilitate the treatment of cancer patients who have brachytherapy sources implanted in ASCs. As an example, they described a closely related sequence of procedures performed in the ASC setting for the brachytherapy treatment of patients with prostate cancer, including the placement of needles and catheters, reported with a CPT code on the ASC list; the application of brachytherapy sources, reported with a CPT code not on the ASC list; and the provision of numerous brachytherapy sources, reported with specific Level II HCPCS codes in the OPPS setting. The commenters noted that it would be appropriate to implant brachytherapy sources in ASCs for the treatment of prostate cancer, because the surgical procedure to insert the required needles and catheters is currently on the ASC list and, in the case of prostate cancer in particular, patients must have the sources implanted in the same session where the needles or catheters are placed. The commenters pointed out that each of these related items and services is separately paid under the OPPS, so the base OPPS payment weights for the surgical needle and catheter placement procedures do not provide payment for the brachytherapy source application or the sources themselves. They noted that all of these individual procedures and items are required to provide the full brachytherapy treatment. *Response:*
                         Based on the comments received and our review of the issue, we have concluded that the most appropriate policy under the revised ASC payment system is to provide separate payment to ASCs for the brachytherapy sources as covered ancillary services implanted in conjunction with covered surgical procedures billed by ASCs. Further, as evidenced by our decisions regarding payment for other covered ancillary services under the CY 2008 revised ASC payment system, our intention is to maintain consistent payment and packaging policies across HOPD and ASC settings for covered ancillary services that are integral to covered surgical procedures performed in ASCs. Therefore, consistent with our policy to pay separately for some drugs, biologicals, and radiology services as covered ancillary services, we also believe that adopting a payment policy consistent with the OPPS for payment of brachytherapy sources is reasonable and appropriate to ensure that the comprehensive brachytherapy service can be provided by ASCs. The application of the brachytherapy sources is integrally related to the surgical procedures for insertion of brachytherapy needles and catheters, which are appropriate for performance in ASCs. There is a statutory requirement that the OPPS establish separate payment groups for brachytherapy sources related to their number, radioisotope, and radioactive intensity, as well as for stranded and non-stranded sources as of July 1, 2007, OPPS procedure payments do not include payment for brachytherapy sources. We agree with both MedPAC and the PPAC that consistent payment bundles between the two payment systems are desirable. Therefore, under the revised ASC payment system, we will pay ASCs separately for brachytherapy sources when they are provided in association with a surgical 
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                        procedure not excluded from ASC payment and billed by the ASC on the same day. The ASC brachytherapy source payment rate for a given calendar year will be the same as the OPPS payment rate for that year or, if specific OPPS prospective payment rates are unavailable, ASC payments for brachytherapy sources will be contractor-priced. The ASC brachytherapy source payment rate will be established at its OPPS payment rate, without application of the ASC budget neutrality adjustment factor to the OPPS conversion factor. In addition, consistent with the payment of brachytherapy sources under the OPPS, the ASC payment rates for brachytherapy sources will not be adjusted for geographic wage differences. Because brachytherapy sources are implantable devices with relatively fixed costs for which we would not expect efficiencies that would permit ASCs to acquire them at lower costs than HOPDs, we believe it is most appropriate to pay for the brachytherapy sources at the same rates as the OPPS if possible. A list of brachytherapy sources recognized under the CY 2007 OPPS, for which payment according to the statute is made at charges reduced to cost under the CY 2007 OPPS, is included in Table 3 below, as well as in Addendum BB to this final rule, specifically those codes assigned to payment indicator “H7” (Brachytherapy source paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced). An updated list will be proposed and finalized for CY 2008 in the CY 2008 OPPS/ASC proposed and final rules, respectively, as will the CY 2008 OPPS payment rates for brachytherapy sources. We also may establish new brachytherapy source HCPCS codes, revise the existing HCPCS codes, or both, for separate payment on a quarterly basis under the revised ASC payment system, as we currently do under the OPPS, in order to keep the two payment systems aligned. In addition, we note that the CPT codes for the application of brachytherapy sources are radiology services in the radiology range of Category I CPT codes, so they would also be separately paid in ASCs under the revised ASC payment system if provided in association with a covered surgical procedure, as described in section IV.C.2.a. of this final rule. Table 3.—Brachytherapy Sources Paid Separately Under the CY 2007 OPPS as of April 1, 2007
HCPCS code
Long descriptorA9527
Iodine I-125, sodium iodide solution, therapeutic, per millicurie.C1716
Brachytherapy source, Gold-198, per source.C1717
Brachytherapy source, High Dose Rate Iridium-192, per source.C1718
Brachytherapy source, Iodine-125, per source.C1719
Brachytherapy source, Non-High Dose Rate Iridium-192, per source.C1720
Brachytherapy source, Palladium-103, per source.C2616
Brachytherapy source, Yttrium-90, per source.C2633
Brachytherapy source, Cesium-131, per source.C2634
Brachytherapy source, High Activity, Iodine-125, greater than 1.01 mCi (NIST), per source.C2635
Brachytherapy source, High Activity, Palladium-103, greater than 2.2 mCi (NIST), per source.C2636
Brachytherapy linear source, Palladium-103, per 1MM.C2637
Brachytherapy source, Ytterbium-169, per source.
 After consideration of all public comments received, we are finalizing a policy to provide separate payment under the revised ASC payment system for ancillary brachytherapy sources implanted in association with the performance of a covered surgical procedure that is billed by the ASC to Medicare. Under our proposal, no payment would have been made to ASCs for the implantation of brachytherapy sources in conjunction with covered surgical procedures, although payment could have been made to other Part B suppliers. Under this final policy, ASC payment for brachytherapy sources as covered ancillary services in a calendar year will be made at the OPPS rates for that same year, or if OPPS rates are unavailable, ASC payment will be made at contractor-priced rates. Payment rates for brachytherapy sources will not be developed through application of the uniform ASC conversion factor, and they will not be subject to the geographic adjustment. Accordingly, we are revising proposed § 416.164(a) and (b) to reflect this final policy. We would also caution that we expect ASCs to follow all Federal, State, and local safety requirements regarding the proper handling and disposal of these radioactive substances. ASCs that cannot comply with those guidelines should not provide brachytherapy services. ASC policies for the proper handling and disposal of brachytherapy sources also should include accommodations for the appropriate disposal of sources that were not implanted. c. Drugs and Biologicals In the August 2006 proposed rule, we indicated that under the existing ASC payment system, payment for all drugs and biologicals (whether packaged or separately payable under the OPPS) is packaged into the ASC payment for the covered surgical procedure. We proposed to continue that policy under the revised ASC payment system. Under the OPPS, CMS pays separately for all pass-through drugs and biologicals, while nonpass-through drugs and biologicals are either packaged or paid separately under the OPPS, depending on whether or not their cost is equal to or less than $55 per day or exceeds $55 per day, respectively, for CY 2007. We received a number of comments on our proposal to package payment for all drugs and biologicals into the payment for their associated surgical procedures under the revised ASC payment system. A summary of the comments and our responses follow. *Comment:*
                         While the commenters generally agreed with CMS’ proposal to package payment for inexpensive drugs into the ASC payment for the covered surgical procedure under the revised ASC payment system consistent with current practice, many commenters objected to CMS’ proposed packaging of payment for expensive drugs and biologicals and urged CMS to pay separately for them. Moreover, several commenters requested that CMS adopt the OPPS payment policies for both pass-through and nonpass-through drugs and biologicals under the revised ASC payment system. They indicated that following the OPPS payment policies under the revised ASC payment system would promote parity in 
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                        payments between HOPDs and ASCs and, thereby, eliminate inappropriate incentives to base care decisions on payment considerations. Specifically, a number of commenters were concerned about payment differences that could arise between HOPDs and ASCs when items were provided in an ASC in conjunction with a covered surgical procedure on the ASC list. They noted that when HOPDs provide pass-through and many nonpass-through drugs and biologicals, they generally receive separate payment for these items; therefore, the base OPPS payment rates contain no payment for these drugs and biologicals. Several commenters expressed particular concern regarding CMS’ proposal to package payment for expensive biologicals into the associated surgical procedure's ASC payment. These commenters cited surgical procedures for the application of skin substitutes, newly proposed as additions for ASC payment in CY 2008, as examples of relatively inexpensive surgical procedures that require the use of costly biologicals, for which separate payment is made under the OPPS. They argued that the additions of the procedures to the ASC list would not provide meaningful access to those services in ASCs, given that the relatively low procedure payments proposed for the revised ASC payment system included no payment for those necessary biologicals. The commenters further added that not paying separately for expensive drugs and biologicals in ASCs could result in a shift of services from ASCs to HOPDs or physicians’ offices, where they are separately paid, even though ASCs could be the most appropriate clinical setting for care. Some commenters suggested that CMS select specific drugs and biologicals for separate payment under the revised ASC payment system based on specific criteria such as their cost, required use, or association with specific surgical procedures not excluded from ASC payment. *Response:*
                         After considering all the comments related to payment for drugs and biologicals, we agree with the commenters that the revised ASC payment system should provide separate payment for relatively costly drugs and biologicals that are integral to covered surgical procedures that are billed by ASCs and whose payments are not packaged into the base OPPS payment rates. Therefore, effective January 1, 2008, we will pay separately for all OPPS pass-through and nonpass-through drugs and biologicals that are separately paid under the OPPS, when they are provided in association with a covered surgical procedure that is billed by the ASC to Medicare. Based on the November 30, 2006 GAO Report on ASC payment, we recognize that historically common ASC procedures generally used drugs that are packaged under the OPPS, but we believe that the significant expansion of the procedures eligible for payment under the revised ASC payment system, in addition to evolving surgical practice, may necessitate the use of different drugs and biologicals in ASCs in the future. To ensure appropriate access to all surgical procedures that are safe for performance in ASCs, we believe it is prudent under the revised ASC payment system to provide separate payment in the ASC setting for drugs and biologicals that are integral to covered surgical procedures for which the ASC is billing, when the costs of those drugs and biologicals were not included in developing the base procedure payment weights under the OPPS. We do not believe it would be appropriate to select only a subset of these drugs and biologicals that are separately payable under the OPPS because we do not see a clear rationale for doing so. We specify that a drug or biological is integral to the performance of a covered surgical procedure if it is required for the successful performance of the surgery and is provided in the ASC immediately preceding, during, or immediately following the covered surgical procedure. Based on our analysis of OPPS data, we believe that, in most cases, a drug or biological that is separately payable under the OPPS that is provided in an ASC on the same day as a covered surgical procedure will be provided as integral to the covered surgical procedure, and the ASC will be able to receive separate payment for the drug or biological as a covered ancillary service. The payments for separately payable drugs and biologicals under the revised ASC payment system for a calendar year will be equal to the payment rates developed according to the payment methodology used in the OPPS for that same year, without the application of the ASC budget neutrality adjustment to the OPPS conversion factor. Because OPPS payment for separately paid drugs and biologicals is provided at the average hospital acquisition cost and is not based upon the application of the OPPS conversion factor to relative payment weights, we believe the OPPS rates should also reflect the typical acquisition cost of these products in the ASC facility setting as well. The OPPS currently relies on the average sales price (ASP) methodology to establish payment rates for many separately paid drugs and biologicals, and ASP data are based upon manufacturers’ reports of all drug sales, including those to different types of facilities and physicians’ offices. The ASP methodology is also utilized to establish the physician's office payment for drugs and biologicals. Therefore, we believe that aligning the ASC payment methodology with the OPPS payment for these covered ancillary services is a consistent and logical approach to setting their ASC payment rates, and we will not apply the ASC budget neutrality adjustment to establish the ASC payment rates. Comparable to their treatment under the OPPS, the ASC payment for separately paid drugs and biologicals will also not be subject to the geographic wage adjustment. In addition, ASC payment for drugs and biologicals that are not separately payable under the OPPS will be packaged into the payments for the covered surgical procedures with which they are administered, consistent with the current OPPS payment methodology. As noted above, under the CY 2007 OPPS, payment for separately payable nonpass-through drugs and biologicals is made according to the ASP methodology, and is generally equal to the ASP plus 6 percent in CY 2007, the same as the physician's office payment. Payment for pass-through drugs and biologicals is set at the rate under the Competitive Acquisition Program (CAP) for Part B drugs or, if the drug is not included in the CAP, at the rate established by the ASP methodology and generally equal to the ASP plus 6 percent. A list of the drugs and biologicals that are separately paid under the CY 2007 OPPS, along with their payment rates as of April 1, 2007, is included in Addendum BB to this final rule, specifically those codes assigned to payment indicator “K2” (Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate). Drugs and biologicals for which payment is packaged under the CY 2007 OPPS are also listed in Addendum BB, where they are assigned to payment indicator “N1” (Packaged service/item; no separate payment made). The CY 2008 payment status and payment rates for drugs and biologicals will be proposed and finalized in the CY 2008 OPPS/ASC proposed and final rules, respectively. We also may establish new HCPCS codes for separately payable drugs and plan to update payment rates for drugs and biologicals based on new ASP information on a quarterly basis under 
                        ( print page 42501)
                        the revised ASC payment system, as we currently do under the OPPS, in order to keep the two payment systems aligned. This final policy is consistent with the recommendation of the PPAC and the comments of MedPAC to align the payment bundles under the OPPS and ASC payment systems. In summary, after consideration of all public comments received, we are finalizing a policy to provide separate payment under the revised ASC payment system for drugs and biologicals that are separately paid under the OPPS, when those items are integral to the performance of a covered surgical procedure for which the ASC is billing. We proposed to provide packaged payment for all drugs and biologicals under the revised ASC payment system through the ASC payment for the covered surgical procedure. In contrast, this final policy will provide separate payment for those drugs and biologicals that are separately paid under the OPPS, when those items are provided on the same day as and integral to the performance of a covered surgical procedure in an ASC. Separate ASC payment for these drugs and biologicals will be made at the OPPS payment rate for the same calendar quarter. ASC payment for those drugs and biologicals that are integral to the performance of a covered surgical procedure and whose payment is packaged under the OPPS will receive packaged payment under the revised ASC payment system. Payment rates for drugs and biologicals will not be developed through application of the uniform ASC conversion factor, and they will not be subject to the geographic adjustment. We also are revising proposed § 416.164(a) and (b) to reflect this final policy. d. Implantable Devices With Pass-Through Status Under the OPPS In the August 2006 proposal for the revised ASC payment system, we proposed to pay for all implantable devices as part of the ASC payment for the covered surgical procedure, thereby packaging payment for all devices except for the additional ASC adjustment for NTIOLs. Under this proposal, payment for devices included in those device categories with pass-through status under the OPPS would also be packaged. In contrast, pass-through status under the OPPS provides payment for a device included in the pass-through device category on a claim-specific basis at the hospital's charges reduced to cost. That is, fiscal intermediaries apply the hospital's overall cost-to-charge ratio from the hospital's last submitted cost report to the submitted charges on the claim and pay the resulting amount on a claim-specific basis. A device offset amount is applied, if appropriate, to take into consideration the predecessor device payment already packaged into the OPPS payment for the associated implantation procedure, in order to ensure no duplicate payment. The predecessor device is the device that would have been used in the procedure if the pass-through device had not been implanted and for which the historical cost is packaged into the payment for the implantation procedure. Under the existing ASC payment system, payment for OPPS designated pass-through devices is either packaged into the ASC payment for the covered surgical procedure or, if the device is implantable DME or an implantable prosthetic, separately paid under the DMEPOS fee schedule, independent from the ASC payment for the associated surgical procedure. We received many comments regarding our proposal to package payment for devices with OPPS pass-through status into payment for their associated surgical procedures under the revised ASC payment system. A summary of the comments and our responses follow. *Comment:*
                         Many commenters encouraged us to expand the OPPS pass-through program to the revised ASC payment system, to provide separate payment for those devices whose payments, in whole or in part, were not packaged into the base OPPS payment weights upon which the revised ASC payment system would be based. These commenters questioned how ASCs would be paid appropriately for devices that are paid separately under the OPPS as pass-through devices at the hospital's charges reduced to cost by the hospital's overall cost-to-charge ratio. The commenters did not believe it would be appropriate to provide payment for devices with pass-through status under the OPPS packaged into the ASC payment for the associated surgical procedure, when there are either no costs associated with those devices packaged into the base OPPS procedure payment weights or inadequate costs associated only with predecessor devices packaged into the base OPPS weights. The commenters added that many of the OPPS designated pass-through devices that are implanted in ASCs are expensive, and their cost would not be adequately reflected in the ASC payment for the covered surgical procedure. They believed that the proposed policy would result in little access to these new technologies in the ASC setting, despite the fact that the associated surgical procedures for their implantation are appropriate for ASC payment. They pointed out that only devices that demonstrate significant clinical improvement are provided pass-through status under the OPPS; hence, Medicare beneficiaries would be unable to receive the most clinically beneficial procedures in ASCs. Several commenters requested that CMS not provide ASC payments for many surgical procedures that use implantable devices, generally for patient safety reasons, whether pass-through devices are used or not. *Response:*
                         While the OPPS pass-through program is a statutory requirement of the OPPS under section 1833(t)(6) of the Act and, therefore, not specifically applicable to the revised ASC payment system, we agree with commenters that similar device payment policies for these devices under the OPPS and the revised ASC payment system are most appropriate to ensure access to procedures implanting these clinically beneficial devices in ASCs. Specifically in the case of OPPS pass-through devices, the costs of the devices are not fully packaged into the OPPS payment weights upon which the revised ASC payment system is based because the devices are separately paid under the OPPS. We agree with commenters that if payments to ASCs for the associated surgical implantation procedures are inadequate to cover the costs of these beneficial devices, then ASCs will not offer the procedures implanting these devices and beneficiary access to these effective devices will thereby be limited to other sites for the services. When we examined the three device categories that currently have pass-through status under the CY 2007 OPPS, specifically C1820 (Generator, neurostimulator (implantable), with rechargeable battery and charging system), C1821 (Interspinous process distraction device (implantable)), and L8690 (Auditory osseointegrated device, includes all internal and external components), we noted that the surgical procedures associated with both C1820 and L8690 are currently payable in the ASC setting. We continue to believe that the procedures associated with these pass-through device categories are safe for ASC performance and, as such, the procedures will be paid under the revised ASC payment system. We remind the public that the list of device categories with pass-through status under the OPPS is updated quarterly, with the addition of new pass-through device categories, if applicable, and that the dates for the expiration of pass-through payment for device categories 
                        ( print page 42502)
                        are proposed and finalized during the OPPS annual rulemaking cycle. Only device categories C1821 and L8690 will continue with pass-through status under the CY 2008 OPPS, but there may be additional device categories established in the future that will have pass-through status during all or a portion of that calendar year. Under the OPPS, claim-specific device pass-through payment is calculated based on the device charge reduced to cost by application of the overall hospital cost-to-charge ratio and, if applicable, the resulting device cost is further subject to a payment reduction (device offset) that is equivalent to the device cost for predecessor devices already included in the APC median cost for the associated surgical procedure. This ensures that the OPPS does not provide duplicate payment for any portion of an implanted device with pass-through status. Of the three device categories currently with pass-through status under the OPPS, only one device category (C1820) has an associated device offset due to the costs of the predecessor nonrechargeable implantable neurostimulators already packaged into the base APC payment weights for neurostimulator implantation procedures. Commenters have persuaded us that, under the revised ASC payment system, it is appropriate to provide separate payment for devices that are included in device categories with pass-through status under the OPPS. A list of the OPPS pass-through device categories as of April 1, 2007 is provided in Table 4 below, and their HCPCS codes are also included in Addendum BB to this final rule, where they are assigned to payment indicator “J7” (OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced). Implantable devices that received packaged payment because they do not have OPPS pass-through status are also listed in Addendum BB to this final rule, where they are assigned to payment indicator “N1” (Packaged service/item; no separate payment made). Table 4.—Active OPPS Pass-Through Device Categories Under the CY 2007 OPPS as of April 1, 2007
HCPCS  code
Long descriptorC1820
Generator, neurostimulator (implantable), with rechargeable battery and charging system.C1821
Interspinous process distraction device (implantable).L8690
Auditory osseointegrated device, includes all internal and external components.
 It is not possible to pay for these devices using the specific OPPS payment methodology, because cost-to-charge ratios are not available for ASCs to convert ASC charges to cost in order to establish a claim-specific device payment. Because these devices are new technology and the number of device categories with pass-through status under the OPPS has been limited over the past several years, we believe that contractor-priced rates are the most appropriate payment methodology for these devices under the revised ASC payment system since there would be little or no OPPS claims data available to establish prospective payment rates for these devices. Therefore, we will pay ASCs separately for devices with pass-through status under the OPPS in that same quarter of the calendar year at contractor-priced rates when they are implanted in ASCs during a covered surgical procedure that is billed by the ASC. As under the OPPS, ASC payment for these devices would not be subject to the geographic wage adjustment, nor would the uniform ASC conversion factor be applied because there is no OPPS payment weight available for these devices and there is little clinical labor associated with the device acquisition by the ASC. The associated nondevice facility resources for the device implantation procedures would be paid through an ASC surgical procedure service payment based upon the payment weight for the nondevice portion of the related OPPS APC payment weight, as described further below with respect to ASC payment for implantable devices without pass-through status under the OPPS. This policy, similar to the device offset policy under the OPPS, would ensure no duplicate device payment by removing, if applicable, the costs of related predecessor devices packaged into the base procedure's OPPS payment weight. Under this policy, we will pay separately in ASCs for new devices that result in significant clinical improvement, consistent with the pass-through policy under the OPPS. This similar treatment of devices included in device categories with OPPS pass-through status under both the OPPS and revised ASC payment systems will help to ensure that beneficiaries have access to the devices in both settings. We believe this approach is fully consistent with the recommendation of the PPAC to apply payment policies uniformly to both ASCs and HOPDs, and with the comments of MedPAC in support of comparable payment bundles in the two systems. As we have stated earlier in this final rule, we are firmly committed to ensuring that outpatient procedures are not limited to certain sites of service and that all surgical procedures that can safely be performed in ASCs and that are not expected to require an overnight stay are on the ASC list of covered surgical procedures so that Medicare beneficiaries have full access to surgical services in all appropriate settings. We believe that paying separately for those devices that are included in device categories with pass-through status under the OPPS and that are implanted during ASC covered surgical procedures under the revised ASC payment system will promote efficient resource use and ensure appropriate access to care. After considering all public comments received, we are finalizing a policy to provide separate payment under the revised ASC payment system for ancillary devices included in device categories with pass-through status under the OPPS in the same quarter of the same calendar year that the devices are implanted during a covered surgical procedure that is billed by the ASC. In contrast with our proposal which would have provided packaged payment for these devices, but consistent with their separate payment under the OPPS, this specific subset of implantable devices will receive separate payment under the revised ASC payment system as covered ancillary services. ASC payment will be made for the devices at contractor-priced rates and will not be subject to geographic wage adjustment, and payment for the associated surgical procedures will be made according to our standard methodology for the revised ASC payment system, based on only the service (nondevice) portion of the procedure's OPPS relative payment weight. Accordingly, we are revising proposed § 416.164(a) and (b) to reflect this final policy. 
                        ( print page 42503) e. Implantable Devices Without Pass-Through Status Under the OPPS Historically, separate payment for implantable DME and prosthetics provided in association with procedures on the ASC list of covered surgical procedures has been made to ASCs on the basis of the DMEPOS fee schedule. Payment for other devices that are not implantable DME or prosthetics, including some nonpass-through devices under the OPPS, has historically been made as part of the ASC payment for the covered surgical procedure because such items have been considered to be supplies. In the August 2006 proposed rule for the revised ASC payment system, we proposed to pay for nonpass-through devices as part of the ASC payment that would be based on the OPPS relative payment weight of the associated surgical procedure, thereby packaging payment for all nonpass-through devices, consistent with their treatment under the OPPS. We also proposed to apply an ASC budget neutrality adjustment of 62 percent to the OPPS conversion factor to calculate the ASC payment rates for all covered surgical services, regardless of the specific nature of the surgical procedures. Therefore, payment for surgical procedures with high device costs, referred to as device-intensive procedures, would be calculated like payment for all other surgical procedures not excluded from ASC payment under the revised payment system. We received many comments on our proposed payment policy for devices without pass-through status under the OPPS. A summary of the comments and our responses follow. *Comment:*
                         Many commenters objected to the packaging of payment for all devices as proposed, principally on the basis that, where the device cost exceeds 62 percent of the APC payment rate, the ASC would not be paid enough to cover the cost of the device, let alone the other service costs of the implantation procedure. Some commenters suggested that CMS continue to pay separately for devices for which it currently pays separately under the DMEPOS fee schedule and provide payment through the ASC payment for only the nondevice portion of the implantation procedure. They recommended that CMS apply the ASC conversion factor only to the nondevice portion of the APC payment weight to calculate the ASC service payment for the implantation procedure. Other commenters believed that CMS should not apply the ASC conversion factor to the device portion of the APC payment, but instead should pass the OPPS payment amount for the device through to the ASC payment system directly because ASCs would be unable to obtain the devices at lower cost than HOPDs. They argued that ASCs would see no efficiencies regarding the fixed device costs, so it would be inappropriate to apply the ASC conversion factor to develop this portion of the ASC procedure payment. These commenters suggested that CMS could then apply the ASC conversion factor to the nondevice portion of the APC payment to develop a service payment, and sum the two partial payments (for the device and the service) to calculate the full ASC payment for these device-intensive procedures under the revised ASC payment system. They concluded that, in this manner, the OPPS and the revised ASC payment system would be aligned, because both systems would provide packaged payment for devices without OPPS pass-through status. Several commenters requested that CMS not provide ASC payments for many procedures that use devices and that are currently paid under the OPPS, generally for patient safety reasons. *Response:*
                         For purposes of the revised ASC payment system, we are defining device-intensive procedures as all those ASC covered surgical procedures in CY 2008 that are assigned to device-dependent APCs under the OPPS, where the APC device cost is greater than 50 percent of the median APC cost. There are 40 such procedures that fall into this group based on their CY 2007 APC assignments, 25 of which are on the CY 2007 ASC list and 15 of which will be newly recognized for ASC payment beginning in CY 2008. They are listed in Tables 5 and 6, respectively, below. These procedures are also identified in Addendum AA to this final rule. Specific payment policies have been applied to device-dependent APCs under the OPPS over the past several years (71 FR 68063 through 68070). There are about 194 OPPS device-dependent procedures, specifically those procedures that are assigned to the 42 OPPS device-dependent APCs under the CY 2007 OPPS, and 89 of these device-dependent procedures are also paid in ASCs in CY 2007. However, only 25 of those 89 procedures are assigned to APCs that have device costs that exceed 50 percent of the APC median costs and would be subject to the payment policy applied to device-intensive procedures under the revised ASC payment system. Thus, as noted above, based on current data, there are 40 device-intensive surgical procedures for which ASC payment will be made in CY 2008. ASC payments for these 40 device-intensive procedures will be made according to the policy described for device-intensive ASC procedures based on their assignments to 19 of the 42 device-dependent APCs under the OPPS for CY 2007. We do not agree with the commenters who believe that many device-intensive procedures are unsafe for performance in ASCs because most of these device-intensive procedures have been on the ASC list of covered surgical procedures for several years and no safety concerns have arisen. In the context of developing this final rule, we have once again reviewed the clinical characteristics of all of these device-intensive procedures based on the public comments and our final policies regarding surgical procedures for exclusion from ASC payment, as discussed in section III.A.2. of this final rule. We continue to believe that many device-intensive procedures are appropriate for performance in ASCs under the final policies of the revised ASC payment system. We also are persuaded that it would be inappropriate to continue to provide separate payment for some implantable prosthetics and DME under the DMEPOS fee schedule by maintaining the practice of the existing ASC payment system. Payment for these devices is already packaged into the base OPPS payment weights, and separate payment for devices under the ASC payment system could essentially pay twice for the device. Separate payment for devices under the revised ASC payment system would also be contrary to MedPAC's support for our proposal to increase the size of the ASC payment bundles and to create comparable payable bundles under the OPPS and the revised ASC payment system. Most importantly, separate payment for certain devices would not provide the incentives for efficiency that would occur through packaging device payment into payment for the associated surgical implantation procedure, because increased packaging through larger payment bundles would encourage ASCs to provide surgical services as cost-effectively as possible. In addition, there are some expensive implantable devices, such as ICDs, which are not currently paid under the DMEPOS fee schedule, but for which we will provide payment for their associated surgical implantation procedures in ASCs beginning in CY 2008. If the separate DMEPOS payment methodology were to be continued, ASCs would be significantly underpaid for such procedures because the device would not be separately paid if it were neither implantable DME nor an implantable prosthetic device. The 
                        ( print page 42504)
                        commenters who recommended continued separate payment for some devices under the DMEPOS fee schedule provided no suggestions for developing the appropriate ASC payment for expensive implantable devices that are neither implantable DME nor implantable prosthetics. We agree with the commenters who are concerned that our standard methodology for the revised ASC payment system that applies a uniform ASC conversion factor to the OPPS relative payment weights could provide inadequate payment for device-intensive procedures under the revised ASC payment system. The estimated budget neutrality adjustment for the revised ASC payment system was 62 percent of the OPPS conversion factor in the proposed rule, and it is currently 67 percent as discussed in section V. of this final rule (the final CY 2008 ASC budget neutrality adjustment will be proposed and finalized through the CY 2008 OPPS/ASC rulemaking cycle). Because of the expected magnitude of the difference between the estimated ASC procedure payments, calculated by application of the ASC conversion factor to the OPPS payment weights under the revised ASC payment system, and the OPPS payment rates for those same procedures, we are particularly concerned that under the revised ASC payment system device-intensive procedures would be underpaid if we paid for them as proposed. We would not expect that ASCs' device costs for expensive devices would differ significantly from the device costs of HOPDs because we do not believe that ASCs would realize more substantial efficiencies in their acquisition of devices in comparison with HOPDs. On the other hand, we believe that ASCs would experience significant efficiencies in comparison with HOPDs when performing the implantation procedures themselves, consistent with the findings of the GAO Report regarding the lower cost of procedures in ASCs in comparison with HOPDs. These lower ASC costs may be attributable to a variety of factors, including lower facility overhead costs due to ASCs' limited operating hours, lack of emergency departments, specialization of ASCs contributing to efficient delivery of services, and the characteristics of different patient populations treated in ASCs versus HOPDs. Therefore, we believe it would be most appropriate under the revised ASC payment system to apply a modified payment methodology to this group of device-intensive services. Accordingly, in developing the ASC payment rates under the revised payment system for device-intensive procedures, we will calculate the device portion of the ASC procedure payment separately from the service portion, in order to provide special consideration for the packaged device costs that are unlikely to vary significantly across different facility settings. Our final payment methodology for device-intensive procedures under the revised ASC payment system is as follows. We will apply the OPPS device offset percentage to the OPPS national unadjusted payment to acquire the device cost included in the OPPS payment rate for a device-intensive ASC covered surgical procedure, which we will then set as equal to the device portion of the national unadjusted ASC payment rate for the procedure. The device offset percentage, which is used under the OPPS to remove the predecessor device cost from the device pass-through payment when a pass-through device is paid at charges reduced to cost, so that the pass-through payment for the device only represents the incremental payment for the new device over the payment for predecessor devices already packaged into the APC payment is our best estimate of the amount of device cost included in an APC payment under the OPPS. We believe that use of the OPPS device offset percentage is appropriate to establish the device amount of payment when device-intensive procedures are furnished in an ASC under the revised ASC payment system. The OPPS device offset percentage is calculated for each OPPS device-dependent APC based upon the most recent year of hospital outpatient claims data available and represents the relative amount of device payment that we believe exists in the total APC payment. The device offset percentage is also applied to reduce the APC payment when a typically expensive device is provided to the hospital without cost or with full credit for the device being replaced and, therefore, the hospital incurs no device cost for implanting the replacement device. For more background on the calculation and use of the device offset percentage, we refer readers to the CY 2007 OPPS/ASC final rule with comment period (71 FR 68077 through 68079). We will then calculate the service portion of the ASC payment for device-intensive procedures by applying the uniform ASC conversion factor as specified in new § 416.171 to the service (nondevice) portion of the OPPS relative payment weight for the device-intensive procedure. Finally, we will sum the ASC device portion and ASC service portion to establish the full payment for the device-intensive procedure under the revised ASC payment system. Tables 5 and 6 include the most current device-intensive procedures that would be subject to this modified payment methodology under the revised ASC payment system. The device-intensive procedure lists for the CY 2008 revised ASC payment system will be proposed and finalized in conjunction with the OPPS treatment of these procedures in the CY 2008 OPPS/ASC proposed and final rules, respectively. The device-intensive procedures in Tables 5 and 6 are listed in Addendum AA to this final rule, where they are assigned to payment indicators “H8” (Device-intensive procedure on ASC list in CY 2007; paid at adjusted rate) and “J8” (Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate), respectively. Table 5.—Illustrative List of Device-Intensive Procedures on the CY 2007 ASC List Subject to the Modified Payment Methodology Under the Revised ASC Payment System Beginning in CY 2008
HCPCS  code
Short descriptor
CY 2007 OPPS  APC
CY 2007 
                                 device-dependent  
                                 APC offset percent33212
Insertion of pulse generator
0090
74.7433213
Insertion of pulse generator
0654
77.3536566
Insert tunneled cv cath
0625
57.5653445
Insert uro/ves nck sphincter
0386
61.1653447
Remove/replace ur sphincter
0386
61.1654401
Insert self-contd prosthesis
0386
61.1654405
Insert multi-comp penis pros
0386
61.1654410
Remove/replace penis prosth
0386
61.16( print page 42505)54416
Remv/repl penis contain pros
0386
61.1655873
Cryoablate prostate
0674
53.7861885
Insrt/redo neurostim 1 array
0039
78.8561886
Implant neurostim arrays
0315
83.1962361
Implant spine infusion pump
0227
80.2762362
Implant spine infusion pump
0227
80.2763650
Implant neuroelectrodes
0040
54.0663685
Insrt/redo spine n generator
0222
77.6564553
Implant neuroelectrodes
0225
79.0464561
Implant neuroelectrodes
0040
54.0664573
Implant neuroelectrodes
0225
79.0464575
Implant neuroelectrodes
0061
60.0664577
Implant neuroelectrodes
0061
60.0664580
Implant neuroelectrodes
0061
60.0664581
Implant neuroelectrodes
0061
60.0664590
Insrt/redo pn/gastr stimul
0222
77.6569930
Implant cochlear device
0259
84.61
 Table 6.—Illustrative List of Device-Intensive Procedures New to the CY 2008 ASC List Subject to the Modified Payment Methodology Under the Revised ASC Payment System Beginning in CY 2008
HCPCS  code
Short descriptor
CY 2007 OPPS APC
CY 2007 
                                 device-dependent  
                                 APC offset percent33206
Insertion of heart pacemaker
0089
77.1133207
Insertion of heart pacemaker
0089
77.1133208
Insertion of heart pacemaker
0655
76.5933214
Upgrade of pacemaker system
0655
76.5933224
Insert pacing lead & connect
0418
87.3233225
Lventric pacing lead add-on
0418
87.3233282
Implant pat-active ht record
0680
76.4063655
Implant neuroelectrodes
0061
60.0664555
Implant neuroelectrodes
0040
54.0664560
Implant neuroelectrodes
0040
54.0664565
Implant neuroelectrodes
0040
54.06G0297
Insert single chamber/cd
0107
90.44G0298
Insert dual chamber/cd
0107
90.44G0299
Inser/repos single icd+leads
0108
89.40G0300
Insert reposit lead dual+gen
0108
89.40
 Table 7 provides an example of how we will calculate the ASC payment for a device-intensive procedure. We use the example of insertion of a cochlear implant, CPT code 69930 (Cochlear device implantation, with or without mastoidectomy), that is included in Table 5 above. For purposes of this illustration, we are using the CY 2007 OPPS/ASC final rule with comment period device offset percentage and payment rate for APC 0259 (Level VI ENT Procedures), the APC to which CPT code 69930 is assigned under the CY 2007 OPPS. We also assume that the ASC budget neutrality adjustment remains at 0.67 under both the first transition year and full implementation scenarios, yielding an ASC conversion factor of $42.543 based on our current estimate of the CY 2008 OPPS conversion factor. The example includes the estimated ASC payment in the first year of the 4-year transition and the estimated payment under full implementation of the revised ASC payment system. Table 7.—Example of Calculation of ASC Payment for a Device-Intensive Covered Surgical Procedure According to the Modified Payment Methodology of the Revised ASC Payment System
First year of 4-year transition
Full implementation of revised 
                                 systemOPPS CY 2007 national unadjusted payment rate
$25,499.72
$25,499.72OPPS CY 2007 device offset percent
84.61%
84.61%OPPS/ASC device portion
$21,575.31 
                                 ($25,499.72 × 0.8461)
$21,575.31 
                                 ($25,499.72 × 0.8461)OPPS service portion
$3,924.41
$3,924.41( print page 42506)OPPS relative payment weight attributable to service (OPPS service portion divided by estimated CY 2008 OPPS conversion factor)
61.8047 
                                 ($3,924.41/63.497)
61.8047 
                                 ($3,924.41/63.497)ASC service portion (OPPS relative payment weight for service portion multiplied by estimated CY 2008 ASC conversion factor)
$2,629.36 
                                 (61.8047 × $42.543)
$2,629.36 
                                 (61.8047 × $42.543)CY 2007 ASC payment (without device payment)
$995
N/AASC service payment  (see following paragraph)
$1,403.59 
                                 (0.25 × $2,629.36) + (0.75 × $995)
$2,629.36Estimated CY 2008 ASC total payment (sum of service payment and device payment)
$22,978.90 
                                 ($1,403.59 + $21,575.31)
$24,204.67 
                                 ($2,629.36 + $21,575.31)
 As discussed further in section IV.J. of this final rule and as shown in the example above, we will apply the transitional blend only to the service portion of the ASC procedure payment. Consistent with their treatment under the OPPS, we will apply the ASC geographic wage adjustment to payment for device-intensive procedures under the revised ASC payment system. *Comment:*
                         Several commenters encouraged CMS to pay the same amount and apply the same payment policies regarding implantable devices in both ASCs and HOPDs. In particular, they recommended that ASCs be paid 100 percent of the portion of the OPPS procedure payment that is device-related, when ASCs perform device-intensive procedures. *Response:*
                         We agree with commenters that providing the same device payment amount for expensive devices under the revised ASC payment system as under the OPPS is appropriate, and our final payment methodology accomplishes that. As we discuss above, we will specifically calculate the amount of OPPS device payment in APCs that contain devices for which the device cost exceeds 50 percent of the APC median cost. We will then add the OPPS device payment amount to the ASC service payment for each device-intensive procedure that is a covered ASC surgical procedure, in order to determine the total payment for the device-intensive procedure when it is performed in an ASC. We also agree that the same payment policies that exist with regard to payment for costly devices under the OPPS should also apply to payment for devices implanted in ASCs. In particular, under the OPPS, beginning on January 1, 2007, when a device is replaced without cost to the hospital or with full credit for the cost of the device being replaced, CMS reduces the APC payment to the hospital by the amount that we estimate represents the cost of the device. The application of this same policy to ASC payment for certain device-intensive procedures is fully consistent with the comments that CMS should pay ASCs for expensive devices in the same manner that they are paid under the OPPS, and with the recommendation of the PPAC that CMS should apply payment policies uniformly under the OPPS and revised ASC payment systems. Therefore, in accordance with the OPPS policy implemented in CY 2007, beginning in CY 2008, we will reduce the amount of payment made to ASCs for device-intensive procedures assigned to certain OPPS APCs in those cases in which the necessary device is furnished without cost to the ASC or the beneficiary, or with a full credit for the cost of the device being replaced. We will provide the same amount of payment reduction that would apply under the OPPS for performance of those procedures under the same circumstances. Specifically, when an ASC performs a procedure that is listed in Table 8 below and the case involves implantation of a no cost or full credit device listed in Table 9, the ASC must report the HCPCS “FB” modifier on the line with the covered surgical procedure code to indicate that a major implantable device in Table 9 was furnished without cost. We expect that this scenario will occur most often in cases in which there is a recall, field action, or other activity that results in the ASC receiving a device from a device manufacturer, for which the facility has no obligation to pay. In these cases, this policy is necessary to be consistent with section 1862(a)(2) of the Act, which excludes from Medicare coverage items and services for which neither the beneficiary nor anyone on the beneficiary's behalf has an obligation to pay. This reduction policy is consistent with the modified payment methodology for device-intensive procedures under the revised ASC payment system that would generally provide the same device-related payment amount in HOPD and ASC settings, both in those cases where the facility bears the cost of the device and those situations where it does not. Tables 8 and 9 list those specific procedures and implantable devices to which the reduction policy applies under the CY 2007 OPPS. The list of device-dependent APCs and their associated procedures and implantable devices to which this policy will apply in CY 2008 will be proposed and finalized in the CY 2008 OPPS/ASC proposed and final rules, respectively. See the CY 2007 OPPS/ASC final rule with comment period (71 FR 68071 through 68077) for further discussion of this policy. When the “FB” modifier is reported with a procedure code that is listed in Table 8, the contractor will reduce the ASC payment for the procedure by the amount of payment that CMS attributed to the device when the ASC payment rate was calculated. The reduction of ASC payment in this circumstance is necessary to pay appropriately for the covered surgical procedure being furnished by the ASC. 
                        ( print page 42507) Table 8.—Illustrative List of Adjustments to Payments for ASC Covered Surgical Procedures in CY 2008 in Cases of Devices Reported Without Cost or for Which Full Credit Is Received
HCPCS  code
Short descriptor
CY 2007 OPPS APC
APC group title
CY 2007 OPPS offset percent61885
Insrt/redo neurostim 1 array
0039
Level I Implantation of Neurostimulator
78.8563650 
                                 64555 
                                 64560 
                                 64561 
                                 64565
Implant neuroelectrodes 
                                 Implant neuroelectrodes.  
                                 Implant neuroelectrodes. 
                                 Implant neuroelectrodes.  
                                 Implant neuroelectrodes.
0040
Percutaneous Implantation of Neurostimulator Electrodes, Excluding Cranial Nerve
54.0663655 
                                 64575 
                                 64577 
                                 64580 
                                 64581
Implant neuroelectrodes 
                                 Implant neuroelectrodes.  
                                 Implant neuroelectrodes.  
                                 Implant neuroelectrodes.  
                                 Implant neuroelectrodes.
0061
Laminectomy or Incision for Implantation of Neurostimulator Electrodes, Excluding Cranial Nerve
60.0633206 
                                 33207
Insertion of heart pacemaker 
                                 Insertion of heart pacemaker.
089
Insertion/Replacement of Permanent Pacemaker and Electrodes
77.1133212
Insertion of pulse generator
0090
Insertion/Replacement of Pacemaker Pulse Generator
74.7433210 
                                 33211 
                                 33216  
                                 33217
Insertion of heart electrode 
                                 Insertion of heart electrode.  
                                 Insert lead pace-defib, one.  
                                 Insert lead pace-defib, dual.
0106
Insertion/Replacement/Repair of Pacemaker and/or Electrodes
41.88G0297 
                                 G0298
Insert single chamber/cd 
                                 Insert dual chamber/cd.
0107
Insertion of Cardioverter-Defibrillator
90.44G0299 
                                 G0300
Inser/repos single icd+leads 
                                 Insert reposit lead dual+gen.
0108
Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads
89.4063685 
                                 64590
Insrt/redo spine n generator 
                                 Insrt/redo perph n generator.
0222
Implantation of Neurological Device
77.6564553 
                                 64573
Implant neuroelectrodes 
                                 Implant neuroelectrodes.
0225
Implantation of Neurostimulator Electrodes, Cranial Nerve
79.0462361 
                                 62362
Implant spine infusion pump
                                 Implant spine infusion pump.
0227
Implantation of Drug Infusion Device
80.2769930
Implant cochlear device
0259
Level VI ENT Procedures
84.6161886
Implant neurostim arrays
0315
Level II Implantation of Neurostimulator
83.1953440 
                                 53444 
                                 54400
Male sling procedure 
                                 Insert tandem cuff. 
                                 Insert semi-rigid prosthesis.
0385
Level I Prosthetic Urological Procedures
46.8653445 
                                 53447 
                                 54401  
                                 54405 
                                 54410 
                                 54416
Insert uro/ves nck sphincter 
                                 Remove/replace ur sphincter.  
                                 Insert self-contd prosthesis.  
                                 Insert multi-comp penis pros.  
                                 Remove/replace penis prosth.  
                                 Remv/repl penis contain pros.
0386
Level II Prosthetic Urological Procedures
61.1633224 
                                 33225
Insert pacing lead & connect 
                                 L ventric pacing lead add-on.
0418
Insertion of Left Ventricular Pacing Elect
87.3233213
Insertion of pulse generator
0654
Insertion/Replacement of a permanent dual chamber pacemaker
77.3533214 
                                 33208
Upgrade of pacemaker system 
                                 Insertion of heart pacemaker.
0655
Insertion/Replacement/Conversion of a permanent dual chamber pacemaker
76.5933282
Implant pat-active ht record
0680
Insertion of Patient Activated Event Recorders
76.40
 Table 9.—Illustrative List of Devices for Which the “FB” Modifier Must Be Reported With the Procedure Code When Furnished Without Cost or for Which Full Credit Is Received
Device
Short descriptorC1721
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.( print page 42508)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.
 After considering all public comments received, while we are finalizing our proposed policy to package payment under the revised ASC payment system for all implantable devices without pass-through status under the OPPS into the ASC payment for the associated surgical implantation procedure, we are adopting a modified methodology to calculate the payment rates for device-intensive procedures under the revised ASC payment system. We proposed to pay for these devices and their associated implantation procedures according to the standard revised ASC payment system methodology, with application of the uniform ASC conversion factor to the applicable OPPS payment weight for the procedure. However, our final payment policy will apply a modified payment methodology to develop the ASC payment rates for device-intensive covered surgical procedures, in order to provide the same payment amount to ASCs for the implantable devices as is made under the OPPS. This methodology will apply to ASC covered surgical procedures that are assigned to device-dependent APCs under the OPPS for the same calendar year, where those APCs have a device cost of greater than 50 percent of the APC cost (device offset percentage greater than 50). While lists of device-intensive procedures under the revised ASC payment system to which this policy would apply based on their CY 2007 OPPS status are included in Tables 5 and 6 of this final rule, the list of ASC procedures subject to this modified payment methodology will be proposed and finalized in the CY 2008 OPPS/ASC proposed and final rules, respectively. We will also reduce the ASC procedure payment for certain device-intensive procedures when the necessary device is furnished to the ASC or the beneficiary at no cost or when a full credit for the device being replaced is provided to the ASC, by the same amount as the OPPS payment reduction for the same calendar year because neither the HOPD nor the ASC incur a device cost for the replaced device in such situations. Accordingly, we are adding new § 416.179 to reflect this payment reduction policy. D. Payment for Corneal Tissue Under the Revised ASC Payment System 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 coinsurance and deductible requirements, and could be paid as an add-on to either the ASC payment 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 corneal 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 summarized 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 acquisition 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 (now MACs) to make separate payment for the costs incurred to procure corneal tissue for transplant at an ASC. In the August 2006 proposed rule to revise the ASC ratesetting methodology and payment rates beginning in CY 2008, we proposed to continue to pay ASCs separately, based on their invoiced costs, for the procurement of corneal tissue (71 FR 49648). We had 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. We noted that, if we were to package payment for the procurement of corneal tissue into the APC payment for corneal transplant procedures, we believed the resulting payment rate would 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. We further proposed in the August 2006 proposed rule to exclude, through proposed new § 416.164(b), the costs of procurement of corneal tissue furnished in an ASC on or after January 1, 2008 from the scope of ASC facility services. We invited comments and submission of data that supported or challenged this proposal to continue paying ASCs separately for corneal tissue on an acquisition cost basis. *Comment:*
                         Several commenters agreed with our proposal to continue to pay separately for the acquisition costs of corneal tissue under the revised ASC payment system, rather than package payment for corneal tissue costs into the payment for the associated corneal transplant procedure. The commenters indicated that this proposed methodology is consistent with the way physicians and HOPDs are currently paid for corneal tissue procurement. They believed that this policy of paying separately for the procurement of corneal tissue has been, and continues to be, the most appropriate payment policy for these services provided in ASC settings, because of the continuing significant variability in the costs of corneal tissue procurement. The commenters further reiterated that packaging these costs should not be considered, because such an option would result in overpayments to certain facilities that have been able to acquire corneal tissue at little or no cost through philanthropic organizations and would undoubtedly result in underpayments to other facilities that paid for the corneal tissue processing, testing, preservation, and transportation costs. *Response:*
                         After consideration of the public comments we received, we are finalizing our proposed CY 2008 ASC corneal tissue procurement payment policy, with modification to clarify that 
                        ( print page 42509)
                        corneal tissue is a covered ancillary service within the scope of ASC services, but not within the scope of ASC facility services. Corneal tissue procurement will be included in the scope of ASC services as a covered ancillary service when it is integral to the performance of an ASC covered surgical procedure, but its payment will not be packaged into the ASC payment for the associated covered surgical procedure. Specifically, under the revised ASC payment system, we will continue to pay ASCs separately, based on their invoiced costs, for the acquisition costs of corneal tissue for transplant in an ASC. The HCPCS code for corneal tissue processing, V2785, is listed in Addendum BB to this final rule, where it is assigned to payment indicator “F4” (Corneal tissue processing; paid at reasonable cost). Accordingly, we are reflecting this final policy in revised proposed §§ 416.164(b)(3) and 416.171(b). E. Payment for Office-Based Procedures 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 of covered surgical procedures. 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 of covered surgical procedures 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 have argued 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 in an ASC or a hospital. Representatives of the ASC industry have contended that unless we made an exception to the criteria that historically governed which procedures comprised the ASC list and allowed 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 asserted in the past that this limitation was 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 the August 2006 proposed rule for the revised ASC payment system and as discussed in section III.A.2. of this final rule, we proposed to expand the ASC list of covered surgical procedures to allow payment for all surgical procedures, except those procedures that pose a significant safety risk or would be expected to 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 proposed not to exclude them from ASC payment under the revised ASC payment system. However, we were concerned that allowing payment to ASCs 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 which we proposed not to exclude from ASC payment beginning in CY 2008 are office-based, that is, they are performed in the physician's office more than 50 percent of the time. The practice expense payment for many of these procedures under the MPFS, when they are performed in the physician's office, would be lower than the payment for the same procedures under the OPPS or under the standard methodology of the revised ASC payment system as proposed. Therefore, we indicated that the proposed ASC payment rates based on the OPPS relative payment weights could result in a significant program cost if these high volume procedures were to shift from the office-based setting to the ASC setting. One reason why we were concerned about the possibility of a sizable shift of office-based procedures to ASCs is the impact that such a shift might 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 that would be made if the revised payment system were not implemented. In the August 2006 proposed rule, we explained that, depending on the methodology for determining the requisite budget neutrality adjustment (71 FR 49657), an influx of high-volume, relatively low cost office-based surgical procedures into the ASC setting under the revised payment system could lower the payment amounts for other procedures made to ASCs due to the constraints of budget neutrality. In other words, we might have had to scale the ASC conversion factor downward in order for estimated aggregate expenditures under the revised system to not exceed what they would have been if the revised 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-based procedures shifting to ASCs. (See section V. of this final rule for a detailed discussion of our proposed and final policies regarding calculation of an ASC conversion factor.) In the August 2006 proposed rule, we explained that 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 properly be based on clinical considerations. Towards that end, we proposed to cap payment for office-based surgical procedures for which ASC payment would be newly allowed under the revised payment system as of January 1, 2008, at the lesser of the MPFS nonfacility practice expense amount or the ASC rate developed according to the standard methodology of the revised ASC payment system. We also proposed to exempt procedures that are on the ASC list as of January 1, 2007, and that meet our criterion for designation as office-based, from the payment limitation proposed for office-based procedures for which ASC payment would be allowed for the first time beginning January 1, 2008. Accordingly, we proposed to incorporate in proposed new § 416.171(e) the payment basis for these office-based procedures beginning January 1, 2008. When we started to identify the codes that we would propose to classify as office-based surgical procedures beginning in CY 2008, we encountered some anomalous cases that required further refinement of our office-based criterion beyond strict application of a 
                        ( print page 42510)
                        50-percent utilization threshold. For example, we identified some CPT codes that met the 50-percent office utilization threshold but for which a nonfacility practice expense amount had not been developed under the MPFS. We proposed to classify as office-based any surgical codes that our physicians’ claims data indicated are performed more than 50 percent of the time in an office setting, even if the codes currently lack a nonfacility practice expense value under the MPFS. We further proposed to cap payment for these procedures, as appropriate, once a nonfacility practice expense amount is established. Until that time, we proposed to calculate payment for these office-based surgical CPT codes using the methodology we proposed for other surgical procedures under the revised ASC payment system. Similarly, until a national nonfacility practice expense amount is established for office-based surgical CPT codes that are contractor-priced (that is, carriers typically determine the payment for a procedure for which there is no calculated national payment) under the MPFS, we proposed to calculate the ASC payment using the same methodology that we proposed 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 OPPS/ASC payment update. In applying the 50-percent threshold, we discovered some apparent contradictions in the BESS data that required us to further refine our definition of office-based procedures. For example, we noted instances in which seemingly similar procedures had inconsistent site-of-service utilization data. The BESS data showed high levels of office utilization for some complex procedures that we expected to be performed relatively infrequently in an office setting, whereas simpler but related procedures showed lower levels of office utilization. Therefore, we undertook another, more detailed level of review and identified groups of surgical CPT 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; 1.1 cm 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's 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, it would seem that the less complex procedures would also have been performed frequently in that site of service. However, the BESS data showed that this was not always the case. 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 were instances in which the less complex procedures within the code group were billed more commonly in an ASC or HOPD, while the more complex procedures within the code group were billed more frequently in the office setting. Therefore, we believed it was prudent to consider the clinical characteristics and utilization data of related CPT codes in determining the codes to be proposed as office-based, to supplement our consideration of data specific to the codes under review. 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's office. However, closer inspection revealed that there was only one case reported for the procedure with a physician's office as the site of service. We were concerned about using such a low volume of procedure claims as the basis for identifying a procedure as office-based. Therefore, we also believed it was wise to consider the volume of claims for procedures in the context of our assessment of their utilization data, to determine those codes to propose as office-based for the revised ASC payment system. Because of the occasional unevenness and inconsistency 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, in our proposed rule, there were some procedures that met the 50-percent office performance threshold when evaluated in isolation from other closely related codes, but that we did not propose to designate as office-based after more specific review. In the August 2006 proposed rule for the revised ASC payment system, we proposed to assess each year, based on the most recent available BESS and other data available to us and detailed clinical review, whether there are additional procedures that we would propose to newly classify as office-based, beginning in the update year. We would solicit comments on the proposed classification of additional codes as office-based as part of the annual OPPS/ASC rulemaking cycle. In addition, we proposed that once we identify a procedure as office-based, that classification could not change in future updates of the ASC payment system. We reasoned 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 proposed as office-based took into account the most recent available volume and utilization data for each individual procedure code and/or, if appropriate, the clinical characteristics, utilization, and volume of related codes. We proposed to apply the office-based designation only to procedures that would no longer be excluded from ASC payment beginning in CY 2008 or later years. Moreover, we proposed to exempt all procedures on the CY 2007 ASC list from application of the office-based classification. We believed that the resulting list accurately reflected Medicare practice patterns and was clinically coherent. The procedures that we proposed to designate as subject to the office-based payment limit were identified in Addendum BB to the proposed rule (71 FR 49845 through 49948). Those procedures for which the CY 2008 payment would be based on the MPFS nonfacility practice expense RVUs according to our analysis for the August 2006 proposed rule were flagged in Addendum BB to that rule. The ASC relative payment weights shown for procedures in Addendum BB to the proposed rule that would be capped by the MPFS nonfacility practice expense RVUs were adjusted to reflect the capped payment amounts. We reminded readers in the August 2006 proposed rule that the ASC payment rates in 
                        ( print page 42511)
                        Addendum BB to that rule were based on the proposed CY 2007 OPPS relative payment weights and the proposed CY 2007 MPFS nonfacility practice expense RVUs. Similarly, the information in Addenda AA and BB to this final rule is also only illustrative, meaning that the Addenda provide examples of the results of applying the final policies of the revised ASC payment system, based on the final information available for CY 2007 and projected CY 2008 updates. As further discussed in sections V.E. and VI. of this final rule, we will propose the CY 2008 relative payment weights, payment amounts, specific HCPCS codes to which the final policies of the revised ASC payment system would apply, and other pertinent ratesetting information for the CY 2008 revised ASC payment system in the proposed OPPS/ASC rule to update the payment systems for CY 2008 to be issued in mid-summer of CY 2007. We will then publish final relative payment weights, payment amounts, specific CY 2008 HCPCS codes to which the final policies will apply, and other pertinent ratesetting information for the CY 2008 revised ASC payment system in the final OPPS/ASC rule to update the payment systems for CY 2008. *Comment:*
                         Several commenters suggested that instituting a cap on payment for office-based surgical procedures would result in payment levels that would make it economically infeasible for many ASCs to perform certain surgical procedures, forcing patients who could be treated safely and more cost effectively in an ASC to go to an HOPD for surgery. Other commenters suggested that there is no empirical evidence that payment of office-based procedures in ASCs would lead to overutilization of ASCs or result in physicians converting their offices into ASCs. The commenters pointed out that, in historical cases where CMS has made exceptions to allow ASC payment for procedures primarily performed in the office, there have not been significant shifts in the sites of service for these procedures. Several commenters suggested that imposing a cap on payment for these procedures would be tantamount to a penalty and an affirmative policy intended to discourage these procedures from performance in the ASC setting. The commenters strongly recommended that the best policy would be to allow physicians to select the site of service they believe is the most clinically appropriate for their patients, especially because sicker patients may require the additional infrastructure and safeguards of an ASC or a HOPD. Other commenters pointed out that CMS' proposal for the revised ASC payment system depends on the use of the relative payment weights for the OPPS that CMS argued in the proposed rule would be expected to reasonably reflect the relativity of ASC resources for surgical procedures. They stated that CMS has no evidence to suggest that the OPPS relativity of payment weights for office-based procedures does not reflect the relative resource use for the performance of these procedures in ASCs and, therefore, application of a payment limitation for these procedures is unwarranted. The commenters also expressed concern that the establishment of a payment cap for office-based procedures would be problematic and detrimental to CMS’ desire to create a setting-neutral payment system. The commenters recommended that CMS exclude this provision from the final rule and pay all procedures using a single ASC conversion factor applied to the applicable OPPS relative payment weight. Several commenters suggested that CMS could follow trends in the sites of service for office-based procedures, and should CMS find significant and unwarranted migration of certain procedures to ASCs, implement the proposed policy at a later date. *Response:*
                         We acknowledge the commenters’ concerns regarding our proposal to cap payments for office-based surgical procedures performed in ASCs. Nevertheless, we continue to believe that capping the payment for office-based surgical procedures performed in ASCs would be the best approach to eliminating differential payment as a factor in site-of-service decisions regarding minor surgical procedures. The combined ASC and physician payment exceeds the single payment the physician would receive for services performed in the office, even with the application of the proposed payment limitation for office-based procedures. Therefore, we are concerned 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. As discussed further in section V. of this final rule, the final policy for the budget neutrality adjustment for the revised ASC payment system which would cap payment for office-based surgical procedures as we proposed takes into account the expected migration of 15 percent of the current office utilization of office-based procedures that will be newly paid in CY 2008 under the revised ASC payment system over the first 4 years of the revised payment system. As commenters observed, a setting-neutral payment system is most consistent with the principle that physicians should be free to make site-of-service decisions on the basis of clinical and quality of care considerations alone. We strongly agree that the health of the patient should be the primary consideration. The proposed cap significantly reduces the payment differential that would otherwise exist when office-based surgical procedures are performed in ASCs and is, thus, more consistent with the principle of site-neutral payment. After consideration of the public comments we received, we are finalizing our proposal under § 416.167(b)(3) and § 416.171(d), without modification, to cap payment for office-based surgical procedures for which ASC payment would first be allowed under the revised payment system beginning in January 1, 2008, or later years at the lesser of the MPFS nonfacility practice expense amount or the ASC rate developed according to the standard methodology of the revised ASC payment system. For those office-based procedures for which there is no available MPFS nonfacility practice expense amount, we will implement the cap, as appropriate, once a MPFS nonfacility practice expense amount is available. Until that time, those procedures that are office-based but for which there is no available MPFS nonfacility practice expense amount available for the comparison will be paid using the standard methodology for calculating ASC payment under the revised ASC payment system. The procedures that we are finalizing as office-based for CY 2008 are identified in Addendum AA to this final rule, assigned to payment indicators of “P2” (Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight); “P3” (Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs); and “R2” (Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight). These payment indicators identify the office-based procedures’ estimated payment status under the CY 2008 revised ASC payment system, based on the final CY 2007 information for the OPPS and the MPFS as discussed above, and their illustrative CY 2008 relative payment weights and payment rates reflect 
                        ( print page 42512)
                        application of the capped payment amounts for those procedures with a payment status indicator of “P3.” We note that the actual proposed and final ASC relative payment weights and payment amounts for CY 2008 will be proposed and finalized through the CY 2008 OPPS/ASC proposed and final rules, respectively. We will continue to monitor the appropriateness of the payment cap for office-based surgical procedures performed in ASCs and explore other opportunities to promote site-neutral payments as we gain experience under the revised ASC payment system. *Comment:*
                         Several commenters expressed concern about the “50-percent rule” we proposed to use to designate which procedures would be considered office-based. One commenter indicated that if a procedure is performed in an office 50 percent of the time, that means half the time the physician has determined that the office is not the appropriate setting for specific patients. Commenters further indicated that clinical circumstances dictate the site of service and not the physician's personal preference, as suggested by the policy proposed for the revised payment system. One commenter stated that surgeons often perform a procedure in the office when anesthesia is not required and perform the same procedure in an ASC when anesthesia is required due to the complexity of individual patient factors. The commenters offered several suggestions for modifying the specific proposal for designating procedures as office-based. In particular, one commenter requested that there be a reasonable, fair, and efficient mechanism for removing a procedure from the office-based list if the typical site of service for a procedure does change for a legitimate clinical reason. Other commenters recommended that CMS consider raising the threshold above 50 percent to a number that shows the clear majority of cases are performed in the physician's office or allow an exemption to the cap for procedures that are performed in ASCs because of the need for anesthesia. Another commenter suggested that CMS could implement this policy through the use of a modifier that indicates the surgeon selected the ASC over the physician's office as the site of service because of the necessity of anesthesia or patient factors, whereupon the payment limitation would not be applied. *Response:*
                         As indicated in our proposed rule, office-based procedures are surgical procedures that the most recent BESS data available indicate are performed more than 50 percent of the time in the physician's office setting. We believe our “50-percent rule” proposed policy is the best option at this point in time. It is our current practice to consider procedures that are performed more than 50 percent of the time in the physician's office setting as office-based procedures, and we will continue to monitor whether the 50-percent threshold is appropriate for this categorization. These office-based procedures, as categorized through application of the “50-percent rule,” are typically procedures that have transitioned from low volume in the office setting and high volume in the facility setting to higher volume in the office setting and lower volume in the facility setting. The 50-percent threshold marks the point in that transition at which a procedure comes to be performed more often in the office. Typically, procedures that come to be performed more frequently in offices than in the facility setting remain primarily office-based once that transition has taken place. Therefore, we continue to believe that the 50-percent threshold is an appropriate, objective measure for determining which procedures ought to be considered office-based. Moreover, a rigorous review of procedures that met the aforementioned threshold took 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. In addition, we conducted a code-by-code analysis to bolster inconclusive data with the clinical judgment of our medical advisors. We will continue 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. However, we note that we proposed that once we identify a procedure as office-based, that classification would not change in future updates of the ASC payment system, except in cases of new codes, where those initial determinations are temporary, as explained further in section V.E. of this final rule. As we have explained above, once a procedure becomes safe enough to be performed in more than 50 percent of cases in the office setting, it is unlikely to revert to a facility setting. The vast majority of procedures designated as office-based under the revised ASC payment system would require only either local anesthesia or at most moderate or “conscious” sedation, that is, sedation to achieve a medically controlled state of depressed consciousness while maintaining the patient's airway, protective reflexes, and ability to respond to stimulation or verbal commands. The use of general anesthesia for the performance of these office-based procedures would be expected to be highly unusual. In those cases where local anesthesia or “conscious” sedation are the typical types of anesthesia used in the performance of certain procedures, the procedure's MPFS nonfacility practice expense amount would have already been valued to include payment for the anesthesia typically used, so appropriate payment would be provided in the ASC setting if the procedure were subject to the office-based payment limitation. However, even when general anesthesia may be required because of uncommon patient-specific considerations, basing a surgical procedure's prospective payment rate on the typical case when anesthesia is not required and the procedure can be performed safely in the office is consistent with the averaging principle that is the basis for all our prospective payment systems, including the revised ASC payment system. Therefore, after considering all comments received, we are finalizing our proposal, without modification, to identify office-based surgical procedures for the revised ASC payment system as those surgical procedures no longer excluded from ASC payment beginning in CY 2008 or later years that are performed more than 50 percent of the time in physicians’ offices, taking into account the most recent available volume and utilization data for each individual procedure code and/or, if appropriate, the clinical characteristics, utilization, and volume of related codes. We will annually assess whether there are additional procedures that we would propose to classify as office-based as part of the annual OPPS/ASC rulemaking cycle. With the exception of new codes for which our determinations would remain preliminary until there are adequate physicians’ claims data available to assess their predominant sites of service as discussed further in section V.E. of this final rule, the classification of a procedure as office-based would not change in future updates of the ASC payment system. Those procedures whose office-based designation for CY 2008 is temporary because they are new codes for which there is not yet adequate physicians’ claims data are flagged with an asterisk (*) in Addendum AA to this final rule. *Comment:*
                         One commenter indicated that code CPT 64555 (Percutaneous implantation of neurostimulator electrodes; peripheral nerve (excludes 
                        ( print page 42513)
                        sacral nerve)), should not be designated as an office-based procedure under the revised ASC payment system because not all of the procedures described by the code can be done in the physician's office. The commenter further stated that payment accuracy should be included as a goal of any new payment system, to avoid site-of-service decisions that are based on financial factors rather than clinical appropriateness. The commenter reasoned that the proposed payment method for procedures similarly identified as office-based would inappropriately impact site-of-service decisions, because it would not be possible to provide the procedures in the ASC setting. Another commenter suggested that CPT code 15340 (Tissue cultured allogeneic skin substitute, first 25 sq cm or less) be removed from the proposed list of office-based procedures so as to ensure appropriate payment for the procedure in the ASC setting and thereby provide Medicare beneficiaries with increased access to the procedure. The commenter noted that this CPT code was new for CY 2006 and, therefore, there were no CY 2005 utilization data available for our review. They also explained that the predecessor CPT code was not performed in the physician's office more than 50 percent of the time, and they did not believe this new code would be determined to be office-based based on the 50-percent threshold when CY 2006 data were available. *Response:*
                         We have identified CPT code 64555, newly proposed for ASC payment beginning in CY 2008, as a device-intensive procedure that is clinically similar to other CPT codes for implantation of neuroelectrodes that are not office-based procedures, although some of the other procedures are ASC covered surgical procedures prior to January 2008. The code is assigned to APC 0040 (Percutaneous Implantation of Neurostimulator Electrodes, Excluding Cranial Nerve) under the CY 2007 OPPS, where other neurostimatulor electrode implantation procedures reside. Therefore, we believe it is most appropriate to remove CPT code 64555 from the list of office-based procedures under the revised ASC payment system, so that it will be paid in the ASC setting according to the modified payment methodology we are adopting for device-intensive procedures. We refer readers to section IV.C.2.e. of this final rule for a detailed discussion of our proposed and final policies regarding ASC payment for procedures with significant device costs. In addition, we note that, while we had also proposed an office-based designation for CPT code 64565 (Percutaneous implantation of neurostimulator electrodes; neuromuscular) beginning with its initial ASC payment in CY 2008, under the OPPS this code is assigned to the same clinical APC as CPT code 64555, which it resembles from both clinical and facility resource perspectives. Therefore, we will also remove CPT code 64565 from the list of office-based procedures for the CY 2008 revised ASC payment system. Following the removal of these two codes from the list of office-based procedures, there are no ASC covered surgical procedures that are both device-intensive and office-based for the CY 2008 revised ASC payment system. With respect to CPT code 15340, as the commenter pointed out, we have no utilization data from CY 2005 available for this procedure to review in developing this final rule. We note that we did not propose to designate the CPT add-on code for an additional area of application, 15341 (Tissue cultured allogeneic skin substitute, each additional 25 sq cm) as office-based under the revised ASC payment system. The proposed ASC treatment of CPT code 15340 was a temporary designation for the new code, subject to change in response to public comments and our examination of utilization data when available. At this time, we have decided to remove this CPT code from the office-based list because, after further review, we believe it is not likely to be performed more than 50 percent of the time in the physician's office setting. However, we will continue to evaluate the appropriateness of this action as new data become available and will annually reassess whether this code, or other procedures newly paid in ASCs in CY 2008 or later years that are not already designated as office-based or for which that classification is temporary, should be proposed as office-based for ASC payment, in the context of each year's OPPS/ASC annual update. We note, specifically, that our treatment of CPT code 15340 in this CY 2008 ASC final rule is not a final determination for CY 2008, because we expect to have CY 2006 utilization data available for the CY 2008 OPPS/ASC proposed rule, where we may propose that additional codes be classified as office-based for the CY 2008 revised ASC payment system. After considering all public comments received, we are finalizing our proposal, with modification, of the office-based list of covered surgical procedures under the CY 2008 revised ASC payment system. At this point, we are removing CPT codes 64555, 64565, and 15340 from the office-based list for the CY 2008 revised ASC payment system. As new data become available, we may propose that additional HCPCS codes newly paid in ASCs in CY 2008 be classified as office-based in the CY 2008 OPPS/ASC proposed rule, and the final CY 2008 ASC list of covered office-based surgical procedures will be published in the CY 2008 OPPS/ASC final rule. F. Payment Policies for Multiple and Interrupted Procedures 1. Multiple Procedure Discounting Policy In the August 2006 proposed rule for the revised ASC payment system, we proposed to mirror the OPPS policy for discounting when a beneficiary has more than one surgical procedure performed on the same day at an ASC facility (71 FR 49651). The current policy for multiple procedure discounting in the ASC, as specified in § 416.120(c)(2)(ii) of our regulations, 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; therefore, 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. Although the ASC 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 methodology. Under the revised ASC payment system in the August 2006 proposed rule, we proposed to package payment for implantable devices into the procedure payment made to the ASC, as under the OPPS. Because we are trying wherever possible to implement parallel payment policies across both systems, we proposed to adopt the OPPS discounting policy that is applied to surgical procedures so that the costs of performing multiple procedures for the implantation of costly devices are taken into account. Thus, payment for the 
                        ( print page 42514)
                        same set of multiple procedures under the OPPS and the ASC payment system would be made using similar packaging and payment rules. For the revised ASC payment system, we proposed in Table 46 of the August 2006 proposed rule (71 FR 49652) a listing of the covered surgical procedures that would be exempt from multiple procedure discounting based on CY 2007 OPPS proposed procedure-specific discounting designations (71 FR 49652 through 49654). These exempt procedures were those surgical procedures proposed for ASC payment in CY 2008 that were also proposed for assignment to a status indicator other than “T” under the CY 2007 OPPS, indicating that a multiple surgical procedure reduction would not apply. We proposed to update this list annually in the OPPS/ASC proposed and final rules, and solicited comments on the list. We also proposed to incorporate our proposed policy on multiple procedure discounting in proposed new § 416.172(e). *Comment:*
                         Several commenters supported our proposal to apply the multiple procedure discounting policy of the OPPS to procedures provided under the revised ASC payment system. The commenters noted that this policy would ensure that payments for ASC covered surgical procedures with high fixed costs are not discounted, and that the full costs of procedures to implant expensive devices are taken into account when these device-intensive procedures are performed in conjunction with other surgical procedures. The commenters also suggested that adopting the OPPS multiple procedure discounting policy would provide parity in payments to both HOPDs and ASCs, as well as minimize any payment incentive to shift services between the two settings because of different policies. They believed that this consistency would result in appropriate and parallel policies for payment of multiple surgical procedures performed in a single operative session in both of these delivery settings where outpatient surgery is commonly performed. *Response:*
                         We appreciate the commenters' support for the proposed ASC multiple procedure discounting policy. Specifically, when more than one covered surgical procedure is provided by an ASC in a single operative session to a Medicare beneficiary, the procedure with the highest ASC payment rate would be paid 100 percent of the ASC payment amount, and ASC payments for any other surgical procedures not expressly exempt from the discounting policy would be reduced by half. Certain ASC covered surgical procedures with relatively high fixed costs would be specifically exempt from the ASC multiple procedure discounting policy, consistent with the current OPPS multiple procedure discounting policy for those surgical procedures assigned to a status indicator other than “T” under the OPPS. We agree with the commenters' general reasoning and further believe that adopting an ASC policy that parallels the OPPS discounting policy would assist in timely and coordinated updates to the multiple procedure discounting status of services payable under both payment systems. *Comment:*
                         Several commenters indicated that CMS inappropriately included only one of three similar CPT codes for the placement of breast brachytherapy catheters (specifically CPT code 19298 (Placement of radiotherapy after loading brachytherapy catheters (multiple tube and button type) into the breast for interstitial radioelement application following (at the time of or subsequent to) partial mastectomy, includes imaging guidance)) on the list of procedures proposed for exemption from multiple procedure discounting, which was provided as Table 46 in the CY 2008 ASC proposed rule (and which has been updated as Table 10 below based on the CY 2007 OPPS final procedure-specific discounting designations). These commenters explained that the general surgical approach and devices required to perform CPT code 19298 are similar to those used to provide CPT code 19296 (Placement of radiotherapy after loading balloon catheter into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy) and CPT code 19297 (Placement of radiotherapy after loading balloon catheter into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; concurrent with partial mastectomy). Moreover, the commenters believed that, because all three CPT codes are assigned to status indicator “S” under the OPPS, indicating that multiple procedure discounting does not apply to payment for their performance in the hospital outpatient setting, all of these codes should also be exempt from multiple procedure discounting under the revised ASC payment system. *Response:*
                         While CPT code 19298 is assigned to status indicator “S” under the CY 2007 OPPS, CPT codes 19296 and 19297 are assigned to status indicator “T” under the OPPS effective January 1, 2007. As discussed in the CY 2007 OPPS final rule with comment period (71 FR 68028), CPT codes 19296 and 19297 were reassigned from New Technology APCs to a clinical APC effective January 1, 2007. Along with their APC reassignments, CPT codes 19296 and 19297 were also reassigned from status indicator “S” to “T” effective January 1, 2007. During the CY 2007 OPPS rulemaking cycle, in considering the public comments and finalizing the new assignments of CPT codes 19296 and 19297 to a clinical APC with status indicator “T,” the implications of the multiple procedure reduction to payment for CPT codes 19296 and 19297 in various clinical scenarios were taken into consideration. Therefore, consistent with our proposed multiple procedure discounting policy for the revised ASC payment system, these two procedures were not included on the proposed list of procedures for exemption from multiple procedure discounting under the revised ASC payment system. Their OPPS payment status of “T” implies that the multiple procedure payment reduction would be appropriate, and the possibility of a 50-percent payment reduction has already specifically been evaluated with respect to the hospital outpatient resources required to perform the procedures. However, because CPT code 19298 is assigned to status indicator “S” under the CY 2007 OPPS, where it remains in its original New Technology APC while additional hospital cost data are being collected, we believe that CPT code 19298 would be appropriately exempted from multiple procedure discounting in both the ASC and HOPD settings, consistent with our overall proposal for discounting under the revised ASC payment system. After considering the public comments we received, we are finalizing our proposed payment policy for multiple surgical procedure discounting under the revised ASC payment system under § 416.172(e) with only editorial modification. We will mirror the OPPS payment policy for discounting when a beneficiary has more than one covered surgical procedure performed in a single operative session in an ASC in CY 2008, by exempting those surgical procedures on the ASC list of covered surgical procedures that are assigned to a status indicator other than “T” under the CY 2008 OPPS from multiple procedure discounting under the revised ASC payment system. The discounting policy of the revised ASC payment system, like 
                        ( print page 42515)
                        the policy of the existing ASC payment system, will apply the multiple procedure reduction if the same procedure is performed bilaterally, consistent with the general discounting policy of the OPPS for payment of surgical procedures that are performed bilaterally. A procedure performed bilaterally in one operative session would be paid at 150 percent of the single procedure payment under the revised ASC payment system. The multiple procedure discounting policy will only apply to ASC payment for covered surgical procedures. ASC payment for covered ancillary services, as discussed further in section IV.C.2. of this final rule, will not be subject to the multiple procedure discount. The specific multiple procedure discounting policy that applies to each ASC covered surgical procedure is identified in Addendum AA to this final rule. Table 10 provides an illustrative summary list of the CY 2007 HCPCS codes on the ASC list of covered surgical procedures for CY 2008, and their respective APCs as of January 1, 2007 under the OPPS, which will be exempt from multiple procedure discounting in ASCs effective January 1, 2008, if no changes are made to their OPPS discounting designation for CY 2008. We will update this list annually in the OPPS/ASC proposed and final rulemaking process, which includes the solicitation of public comments. The CY 2008 list of exemptions will be proposed and finalized for the CY 2008 revised ASC payment system through the OPPS/ASC rulemaking cycle for CY 2008. Table 10.—Illustrative List of Procedures Exempt From Multiple Procedure Discounting Under the Revised ASC Payment System in CY 2008
HCPCS code
Short descriptor
APC11980
Implant hormone pellet(s)
034011981
Insert drug implant device
034011982
Remove drug implant device
034011983
Remove/insert drug implant
034015852
Dressing change not for burn
034015860
Test for blood flow in graft
034019295
Place breast clip, percut
065719298
Place breast rad tube/caths
152420665
Removal of fixation device
034020975
Electrical bone stimulation
034020979
Us bone stimulation
034029010
Application of body cast
042629015
Application of body cast
042629020
Application of body cast
005829025
Application of body cast
005829035
Application of body cast
042629040
Application of body cast
005829044
Application of body cast
042629049
Application of figure eight
005829055
Application of shoulder cast
042629058
Application of shoulder cast
005829065
Application of long arm cast
042629075
Application of forearm cast
042629085
Apply hand/wrist cast
005829086
Apply finger cast
005829105
Apply long arm splint
005829125
Apply forearm splint
005829126
Apply forearm splint
005829130
Application of finger splint
005829131
Application of finger splint
005829200
Strapping of chest
005829220
Strapping of low back
005829240
Strapping of shoulder
005829260
Strapping of elbow or wrist
005829280
Strapping of hand or finger
005829305
Application of hip cast
042629325
Application of hip casts
042629345
Application of long leg cast
042629355
Application of long leg cast
042629358
Apply long leg cast brace
042629365
Application of long leg cast
042629405
Apply short leg cast
042629425
Apply short leg cast
042629435
Apply short leg cast
042629440
Addition of walker to cast
005829445
Apply rigid leg cast
042629450
Application of leg cast
005829505
Application, long leg splint
005829515
Application lower leg splint
005829520
Strapping of hip
005829530
Strapping of knee
005829540
Strapping of ankle and/or ft
005829550
Strapping of toes
005829580
Application of paste boot
005829590
Application of foot splint
005829700
Removal/revision of cast
005829705
Removal/revision of cast
005829710
Removal/revision of cast
042629715
Removal/revision of cast
005829720
Repair of body cast
005829730
Windowing of cast
005829740
Wedging of cast
005829750
Wedging of clubfoot cast
005830300
Remove nasal foreign body
034031500
Insert emergency airway
009431620
Endobronchial us add-on
067033282
Implant pat-active ht record
068036002
Pseudoaneurysm injection trt
026736430
Blood transfusion service
011036440
Bl push transfuse, 2 yr or <
011036450
Bl exchange/transfuse, nb
011036511
Apheresis wbc
011136512
Apheresis rbc
011136513
Apheresis platelets
011136514
Apheresis plasma
011136515
Apheresis, adsorp/reinfuse
011236516
Apheresis, selective
011236522
Photopheresis
011236598
Inj w/fluor, eval cv device
034037250
Iv us first vessel add-on
041637251
Iv us each add vessel add-on
041638205
Harvest allogenic stem cells
011138206
Harvest auto stem cells
011138230
Bone marrow collection
012338241
Bone marrow/stem transplant
012338242
Lymphocyte infuse transplant
011140804
Removal, foreign body, mouth
034042809
Remove pharynx foreign body
034046600
Diagnostic anoscopy
034051701
Insert bladder catheter
034051702
Insert temp bladder cath
034051798
Us urine capacity measure
034053440
Male sling procedure
038553444
Insert tandem cuff
038553445
Insert uro/ves nck sphincter
038653447
Remove/replace ur sphincter
0386( print page 42516)54400
Insert semi-rigid prosthesis
038554401
Insert self-contd prosthesis
038654405
Insert multi-comp penis pros
038654410
Remove/replace penis prosth
038654416
Remv/repl penis contain pros
038661795
Brain surgery using computer
030261885
Insrt/redo neurostim 1 array
003962252
Csf shunt reprogram
069162367
Analyze spine infusion pump
069162368
Analyze spine infusion pump
069163650
Implant neuroelectrodes
004063655
Implant neuroelectrodes
006164553
Implant neuroelectrodes
022564555
Implant neuroelectrodes
004064560
Implant neuroelectrodes
004064561
Implant neuroelectrodes
004064565
Implant neuroelectrodes
004064573
Implant neuroelectrodes
022564575
Implant neuroelectrodes
006164577
Implant neuroelectrodes
006164580
Implant neuroelectrodes
006164581
Implant neuroelectrodes
006165205
Remove foreign body from eye
069865210
Remove foreign body from eye
069865220
Remove foreign body from eye
069865222
Remove foreign body from eye
069865430
Corneal smear
069865450
Treatment of corneal lesion
023167500
Inject/treat eye socket
023167820
Revise eyelashes
069867938
Remove eyelid foreign body
069868040
Treatment of eyelid lesions
069868200
Treat eyelid by injection
023068760
Close tear duct opening
023168761
Close tear duct opening
023168801
Dilate tear duct opening
069868810
Probe nasolacrimal duct
023168840
Explore/irrigate tear ducts
069869200
Clear outer ear canal
034069210
Remove impacted ear wax
0340C9725
Place endorectal app
1507C9726
Rxt breast appl place/remov
1508C9727
Insert palate implants
1510G0104
CA screen; flexi sigmoidscope
0159
 2. Interrupted Procedure Policies When a procedure requiring anesthesia is discontinued after the beneficiary is prepared for the procedure and taken to the room where it is to be performed, but before the administration of anesthesia, ASCs currently report modifier 73 (Discontinued outpatient procedure prior to anesthesia administration) appended to the discontinued procedure and receive 50 percent of the ASC payment for the planned surgical procedure. We believe that ASCs, like hospital outpatient facilities, realize significant savings when procedures for which anesthesia is to be used are discontinued prior to their initiation but after the beneficiary is taken to the procedure room. We believe that savings are recognized for the costs associated with a variety of facility resources, including treatment/operating room time, single use devices, drugs, equipment, supplies, and recovery room time. When a procedure is interrupted after its initiation or the administration of anesthesia, ASCs currently report these cases using modifier 74 (Discontinued outpatient procedure after anesthesia administration) appended to the interrupted procedure, and the full ASC payment for the covered surgical procedure is made. Similar to hospital outpatient procedures that are discontinued after the administration of anesthesia or the initiation of the procedure, in cases where modifier 74 is reported by ASCs, we believe that the facility costs incurred for these discontinued procedures that were initiated to some degree are generally as significant to the ASC as those for a completed procedure, including resources for patient preparation, operating room use, and recovery room care. In the August 2006 proposed rule, we proposed no change to the existing ASC payment policy for procedures reported with modifier 73 or 74 under the revised ASC payment system, and note that the policy under the existing ASC payment system is the same as the OPPS policy in these circumstances. Under the existing ASC payment system, ASCs do not report modifier 52 (Reduced services) for interrupted procedures, because most interrupted covered surgical procedures paid in ASCs would be appropriately reported with modifier 73 or 74 because they generally require anesthesia. Modifier 52 is appended to a service under the OPPS to signify that a service that did not require anesthesia was partially reduced or discontinued at the physician's discretion. Modifier 52 is reported under the OPPS for a variety of types of interrupted services, such as radiology services, and we believe that there are considerable resource savings to the facility under the circumstances where it is reported. Therefore, under the OPPS, we apply a 50 percent reduction to the facility payment for interrupted procedures and services reported with modifier 52. The PPAC recommended that we apply payment policies consistently under the revised ASC payment system and the OPPS. We received a number of public comments recommending consistency of payment policies between the two payment systems. Although not discussed in our proposed rule for the revised ASC payment system, we received comments on the application of the current interrupted procedure policies to the revised ASC payment system and respond to these comments below. *Comment:*
                         Many commenters recommended that we establish consistent payment policies under the OPPS and the revised ASC payment system, because the hospital and ASC facilities provide many of the same services to similar patients. In particular, several commenters compared current payment policies that were similar between the existing ASC payment system and the OPPS, including the payment policy that reduces the payment for interrupted procedures reported with modifier 73 by 50 percent in both payment systems. *Response:*
                         We agree with commenters that consistent policies between the revised ASC payment system and the OPPS are desirable whenever possible, because the revised ASC payment system will be based upon the OPPS relative payment weights. We also note that, with the significant expansion of procedures eligible for ASC payment under the revised ASC payment system, it is possible that some of the additional procedures payable in the ASC setting beginning in CY 2008 may not always require anesthesia. In addition, as further discussed in section IV.C.2. of this final rule, we will be providing separate payment for some ancillary radiology services that are integral to the performance of covered surgical procedures under the revised ASC payment system. Therefore, we believe that the revised ASC payment system should also allow ASCs to report interrupted services not requiring anesthesia with modifier 52, consistent with the OPPS reporting of these services. Because we expect ASCs to utilize fewer facility resources in such situations, similar to ASC procedures where modifier 73 is reported and to 
                        ( print page 42517)
                        HOPDs where modifier 73 or 52 is reported, we believe that it is appropriate to provide the same payment reduction of 50 percent under the revised ASC payment system as under the OPPS when modifier 52 is reported. After considering the public comments received, we are clarifying here the payment policies for interrupted procedures in ASCs. First, procedures requiring anesthesia that are terminated after the patient has been prepared for surgery and taken to the operating room but before the administration of anesthesia will be reported with modifier 73, and the ASC payment for the covered surgical procedure will be reduced by 50 percent. Second, procedures and services not requiring anesthesia that are partially reduced or discontinued at the physician's discretion will be reported with modifier 52, and the ASC payment for the covered surgical procedure or covered ancillary service will be reduced by 50 percent. Third, procedures requiring anesthesia that are terminated after the administration of anesthesia or the initiation of the procedure will be reported with modifier 74, and the full ASC payment for the covered surgical procedure will be provided. We are adding new § 416.172(f) to reflect this final policy. G. Geographic Adjustment Currently, Medicare adjusts 34.45 percent of the national ASC payment rates using wage index values and localities that were established under the hospital IPPS prior to implementation of the new 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 Public Law 108-173. Since 1990, ASC payments have been adjusted for regional wage variations using the IPPS wage index values. As we discussed in the August 2006 proposed rule, we believe that standardization continues to be appropriate in recognition of widely varying labor market costs tied to geographic localities. We also explained in the proposed rule that we believe it is advisable to maintain 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 proposed 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 had not collected new data to identify whether the current labor-related share is correct, the results of a 1994 survey of ASC costs generally supported the current 34.45-percent labor adjustment factor, and we had received no complaints from the ASC community, prior to our proposal, 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, in the proposed rule, we stated our belief that it is reasonable to expect ASCs to have a lower labor adjustment factor than that of hospitals. For example, most OPPS HOPDs are staffed 24 hours per day to provide emergency department services and observation care, and these patterns of operation could lead to relatively higher labor costs for hospital services overall. Therefore, we proposed to continue using 34.45 percent as the labor adjustment factor for regional wage differences under the revised ASC payment system, beginning in CY 2008. We proposed to establish rules governing this proposal in new § 416.172(c). Subsequent to the publication of the August 2006 proposed rule for the revised ASC payment system, the GAO issued the report, “Medicare: Payment for Ambulatory Surgical Centers Should Be Based on the Hospital Outpatient Payment System,” (GAO-07-86), which is discussed in further detail in section II.B. of this final rule. In this report, the GAO determined that based upon the 2004 ASC cost data from a geographically representative group of ASCs received in response to its ASC survey, the mean labor-related proportion of ASC costs was 50 percent. *Comment:*
                         Several commenters agreed with CMS' proposal to use the IPPS pre-reclassification wage index values associated with the June 2003 OMB geographic localities. However, many commenters indicated that the current 34.45-percent labor factor is based on old data and is too low, leading to their recommendation that the 60-percent OPPS labor factor would be more appropriate. Some commenters explained that it was difficult to assess the appropriateness of CMS' proposal in the absence of the GAO Report on the ASC payment system that was directed to address whether a geographic adjustment should be provided for payment of procedures furnished in ASCs and, if so, the labor and nonlabor shares of ASC payment. Other commenters recommended that CMS collect more recent data on the costs of delivering services in the ASC setting or suggested that ASCs be asked to submit cost reports to inform the development of an appropriate, contemporary labor factor reflecting current ASC costs. *Response:*
                         For the reasons stated in the proposed rule and reiterated above, we agree with the commenters that we should use the IPPS pre-reclassification wage index values associated with the June 2003 OMB geographic localities. While we share the concerns of commenters about the age of the survey data used for the current 34.45-percent labor factor, we disagree that it would be appropriate to use the same 60-percent labor factor used under the OPPS. The commenters who indicated a preference for the OPPS labor factor did not address the fact that most OPPS HOPDs are staffed 24 hours per day to provide emergency department services and observation care. Other than their request for parity with the OPPS labor adjustment, they provided no specific data to support the appropriateness of a 60-percent labor factor based on current ASC costs for performing procedures. However, we agree with commenters that the 34.45 labor-related share that we proposed for the revised payment system is likely too low to accurately reflect the current proportion of ASCs' labor costs. The data used to develop the 34.45 labor-related share are 20 years old, and 1994 ASC survey cost data, which have never been used for ASC payment, showed a slightly higher labor-related share of 37.66 percent that we believe was likely reflective of a generally increasing proportion of ASC labor costs. ASCs and HOPDs operate in some of the same communities, using similar clinical staff to perform certain procedures, and ASC staff wages may be comparable to those of hospital staff. However, we have no data to indicate that ASCs and HOPDs have equivalent ratios of labor to nonlabor costs, on average, for all the services each type of facility provides. As discussed above, because ASCs only provide a subset of surgical procedures compared with the wide variety of OPPS services that we expect could be, overall, relatively more labor-intensive than ambulatory surgical procedures specifically, we believe that the most appropriate ASC labor-related share would be lower than the 60 percent used to adjust HOPD payment. The GAO Report determined, on the basis of the 2004 ASC cost data received from a geographically representative group of ASCs in response to its ASC survey, that the mean labor-related 
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                        proportion of costs was 50 percent. In addition, the GAO found that the range of the labor-related costs for the middle 50 percent of ASCs responding to the survey was relatively narrow, at 43 percent to 57 percent of total costs. Therefore, in response to comments about the age of the historical data used for the existing and proposed revised ASC payment system labor factor, in addition to consideration of the GAO's determination based on the most recent ASC survey findings, we reviewed the labor-related share indicated by the 1994 ASC survey cost data and assessed the clinical labor required to provide both ASC and OPPS services, in the context of the full facility resource costs associated with those services. Based on all of those considerations, we believe that it is not necessary to collect additional ASC cost data in order to determine the appropriate labor-related factor for use under the revised ASC payment system and that a 50-percent labor factor for the revised ASC payment system is most appropriate. Fifty percent is significantly higher than the current labor-related share (34.45 percent) that we proposed to maintain but is also lower than the OPPS labor-related share of 60 percent, a differential we believe is appropriate given the broader range of labor-intensive services provided in the HOPD setting. A 50-percent labor-related share is fully consistent with the GAO findings that we believe provide a more accurate representation of the present-day labor-related proportion of ASC costs than the data upon which we currently rely. In the future, if we believe that the collection of additional ASC cost data is important to providing appropriate payment to ASCs and such an activity is administratively feasible, we may consider gathering such information from ASCs. After considering the public comments received, we are finalizing our proposal to apply to ASC payments under the revised ASC payment system the IPPS pre-reclassification wage index values associated with the June 2003 OMB geographic localities, as recognized under the IPPS and OPPS, in order to adjust national ASC payment rates for geographic wage differences under the revised payment system. However, rather than adopting 34.45 percent as the labor adjustment factor as we proposed, we are adopting 50 percent as the labor-related proportion under the revised ASC payment system. The geographic adjustment policy of the revised ASC payment system is set forth in § 416.172(c). H. Adjustment for Inflation As noted above, section 1833(i)(2)(C)(iv) of the Act, as amended by section 626(a) of Public Law 108-173, requires the adjustment of ASC payment 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 payment amounts are to be adjusted by the percentage increase in the CPI-U during years when the ASC payment amounts are not updated. Although we are only required to increase the ASC payment rates by the percentage increase in the CPI-U during years in which we have not updated the ASC payment amounts, we proposed to update the ASC conversion factor annually using the CPI-U. For CY 2008 and CY 2009, the statute requires a zero percent CPI-U increase for ASC services. Beginning in CY 2010, in the August 2006 proposed rule for the revised ASC payment system, we proposed to 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. Accordingly, we proposed to establish rules in proposed new §§ 416.171 and 416.172 to reflect our proposed policy for applying an inflation adjustment under the proposed revised payment system beginning January 1, 2008. (These sections of the proposed regulations also included our proposed policies for calculating a conversion factor and standardizing labor-related costs, respectively, under the proposed revised payment system.) *Comment:*
                         A number of commenters recommended that CMS use the hospital market basket as an update for inflation in the revised ASC payment system. The commenters generally indicated that the hospital market basket more appropriately reflects inflation in the costs of providing surgical services. These commenters pointed out that the CPI-U is a measure of consumer inflation rather than health care provider inflation, and that the hospital market basket was specifically designed to measure the cost of hospital inflation. They concluded that the hospital market basket is, thus, a better proxy for the inflationary pressures faced by ASCs. One commenter presented data indicating that the cost of operating an ASC rose by an average of 13.4 percent between 2003 and 2005 and that, during that same period, the CPI-U fell 36 percent short of meeting these increased costs. Some commenters expressed concern that the use of two different factors to update payments for ASCs and HOPDs would further increase the discrepancies between payments in the two settings. They further suggested that alignment with hospital updates and policies in general would achieve parity and transparency in the market and ensure that facility decisions are made based upon what is best for the patient. Other commenters suggested that CMS develop another method that would more closely approximate the rising cost of operating an ASC if the proposal to base the annual update of the ASC conversion factor on the CPI-U is finalized. *Response:*
                         As we explained in the CY 2007 OPPS/ASC final rule with comment period (71 FR 68003), the OPPS conversion factor is updated annually using the hospital inpatient market basket percentage increase. The statute specifically required us to take into account the recommendations of a GAO Report studying the appropriateness of aligning a revised ASC payment system with the payment rates and relative weights established under the OPPS. However, the statute gives the Secretary broad authority in designing the specific features of the revised system. In particular, the statute gives the Secretary considerable discretion in determining an appropriate update mechanism for the revised ASC payment system. Section 1833(i)(2)(C)(i) of the Act requires that the Secretary update the payment amounts established under the revised system “by the percentage increase in the Consumer Price Index for all urban consumers,” but only if the Secretary has not otherwise “updated amounts established” under the revised system for that year. The statute, therefore, does not mandate the adoption of any particular update mechanism, but it does establish the CPI-U as the default update mechanism in the absence of any other update. In addition, section 1833(i)(2)(C)(iv) of the Act mandates a zero CPI-U adjustment in CY 2008 and CY 2009 for ASCs, the first 2 years under the revised payment system, suggesting that maintaining continuity in the update mechanism under the revised system may be appropriate. Therefore, we proposed, under the revised system beginning in CY 2010, to apply the CPI-U adjustment to update the ASC conversion factor for inflation on an annual basis. While we understand the arguments of commenters in favor of adopting the hospital market basket as the update mechanism under the revised ASC 
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                        payment system, we continue to believe that it is appropriate to adopt the default update mechanism designated by Congress for the revised system. Therefore, we are finalizing our proposal, beginning in CY 2010, to update the 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. At the same time, we recognize that we continue to have flexibility under the statute to employ a different update mechanism under the revised ASC payment system. As one example, we do not intend for the revised ASC payment system to result in additional Medicare expenditures over time. We will be monitoring this issue closely in the coming years. Consequently, we will reconsider the ASC update if expenditures increase inappropriately in future years. Therefore, after consideration of all public comments received, we are finalizing our proposal under § 416.171(a)(2), without modification, to apply the CPI-U to update the ASC conversion factor for inflation on an annual basis under the revised ASC payment system. I. Beneficiary Coinsurance Payment for ASC services is subject to the Medicare Part B deductible and coinsurance requirements. Currently, Medicare pays participating ASCs 80 percent of a prospectively determined standard overhead amount, adjusted for regional wage variations for ASC covered surgical procedures, except for screening colonoscopies. The beneficiary deductible and coinsurance make up the other 20 percent of payment for ASC services, except for screening colonoscopies for which there is no deductible and for which the coinsurance is equal to 25 percent. Section 1834(d) of the Act requires this higher coinsurance for screening colonoscopies and screening flexible sigmoidoscopies. However, only screening colonoscopies are on the CY 2007 ASC list of covered surgical procedures. In addition, effective January 1, 2007, a deductible is no longer applied for colorectal cancer screening tests, including screening flexible sigmoidoscopy and screening colonoscopy procedures performed in ASCs or other settings, as specified in section 1833(b)(8) of the Act (as added by section 5113 of Public Law 109-171). Section 626(c) of Public Law 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. This amendment, however, did not affect section 1834(d) of the Act. Therefore, we proposed to make this change and to continue to maintain the beneficiary deductible and coinsurance at 20 percent under the revised ASC payment system, except for screening colonoscopies and screening flexible sigmoidoscopies (which are both ASC covered surgical procedures in CY 2008) for which the statute requires 25 percent beneficiary coinsurance. In the August 2006 proposed rule for the revised ASC payment system, we proposed to reflect the 20 percent beneficiary coinsurance in proposed new §§ 416.172(b) and (d); however, the proposed regulation text did not address the statutory requirement of 25 percent coinsurance for screening flexible sigmoidoscopies and screening colonoscopies. Consistent with the provisions of section 1834(d) of the Act, we implemented the 25 percent coinsurance requirement for screening colonoscopies (screening flexible sigmoidoscopies are not on the CY 2007 ASC list of covered surgical procedures) in ASCs, effective January 1, 2007, as finalized in § 410.152(i) and discussed in the preamble to the CY 2007 OPPS/ASC final rule with comment period (71 FR 68174). *Comment:*
                         Many commenters supported our proposal to continue to apply the 20 percent coinsurance provision to payment for covered surgical procedures performed in ASCs and paid under the revised ASC payment system. *Response:*
                         We appreciate the comments. The statute requires Medicare to pay 80 percent of the lesser of the actual charge for the service or the amount we determine under the revised payment system, other than for screening colonoscopy and screening flexible sigmoidoscopy procedures. Beneficiary coinsurance will remain at 20 percent for ASC services under the revised ASC payment system, except for screening flexible sigmoidoscopy and screening colonoscopy procedures. The coinsurance for screening colonoscopies and screening flexible sigmoidoscopies will be 25 percent, as required by section 1834(d) of the Act, with no deductible for those services under the revised ASC payment system. This requirement is reflected in our regulations at §§ 416.172(b) and (d). J. Phase-In of Full Implementation of Payment Rates Calculated Under the Revised ASC Payment System Methodology We discussed in section XXVII.D. of the preamble to the August 2006 proposed rule for the revised ASC payment system (71 FR 49690 through 49695), our analysis of the impact that the revised ASC payment system and estimated payment rates 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 wanted 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 caseπmix 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 under Medicare. In the August 2006 proposed rule, we proposed 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 CY 2007 ASC payment rate for a procedure on the CY 2007 ASC list of covered surgical procedures and the final payment rate for that same procedure calculated under the revised payment system methodology described in the proposed rule and reflected in proposed new § 416.171(c). We further proposed that, in CY 2009, we would fully implement the ASC payment rates calculated under the proposed payment methodology, discontinuing the blended transitional payment rates for services furnished beginning January 1, 2009. This was proposed in new § 416.171(d). *Comment:*
                         Several commenters expressed concern that the proposed 2-year transition period would threaten the viability of many ASCs. The commenters indicated that given the size of the payment cuts contemplated under the proposed rule for certain procedures and specialties, especially gastrointestinal, pain management, and ophthalmology services, 1 year would not provide adequate time for ASCs to adjust to the changes and that a 4-year phase-in would allow a more gradual and less disruptive transition to the new payment system. Many commenters urged CMS to implement policies to further address the decrease in payments for procedures whose rates would fall significantly during a 
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                        transition to the new payment system. One commenter suggested that CMS hold harmless procedures that were on the ASC list of covered surgical procedures prior to CY 2008 to prevent significant changes in payments during the transition. Some commenters expressed concern that if CMS revises both the payment system and the geographic localities used for wage adjustment at the same time, providers in certain areas could experience dramatic shifts in payment as a result of the cumulative effect of the wage index and other policy changes that were described in the proposed rule. These commenters encouraged CMS to consider the cumulative effects of the wage index and other policy changes on payments to ASCs under the revised ASC payment system and develop a transitional approach that protects providers from significant reductions in payment. A number of commenters supported the proposed 2-year phase-in of the ASC payment rates based on the final methodology of the revised ASC payment system. The commenters generally believed that the transition period as proposed would provide sufficient notice and time for ASCs to adapt to the revised payment system. Some commenters stated that the proposed transition does not appropriately address payment for device-intensive procedures that implant devices that are paid separately according to the DMEPOS fee schedule under the existing payment system during the transitional year of CY 2008. Some of these commenters urged CMS to devise a strategy that would accelerate full implementation of payment for device-intensive procedures according to the proposed methodology for the revised ASC payment system. Alternatively, other commenters suggested that CMS develop a final transitional policy that does not exclude the payments for implanted devices now paid separately under the DMEPOS fee schedule in calculating the CY 2007 ASC payment contributions to the blended payment rates for device-intensive procedures for CY 2008. *Response:*
                         After consideration of all of these public comments, we agree with the majority of the commenters who indicated that a 2-year transition may provide some ASCs with insufficient time to adapt to the revised payment system. During the transition to the revised system, we believe it is important to maintain appropriate Medicare beneficiary access to ASC services. In addition, we do not believe that the transition should be asymmetrical, meaning that procedures with decreasing payments under the revised payment system should be transitioned differently from those with increasing payments. We also do not believe that the transition should lead to increases or decreases in overall Medicare ASC expenditures. Therefore, in order to provide additional time for ASCs to adapt to the revised payment system and to facilitate Medicare beneficiary access to ambulatory surgical procedures at those ASCs that may not adjust as quickly as others to the revised payment system, we are extending the transition from our proposed 2 years to 4 years for all services on the CY 2007 ASC list of covered surgical procedures, as reflected in § 416.171(c). We believe a transition period of 4 years, comparable to transition periods provided under other payment systems (for example, the recent practice expense changes to the MPFS) and as suggested in comments concerning this issue, will provide a reasonable and balanced approach to implementation that addresses two important objectives, in particular offering sufficient notice and time for ASCs to adapt to the revised payment system and providing more accurate and appropriate ASC payments for covered surgical procedures. The contribution of CY 2007 ASC payment rates to the blended transitional rates will decrease by 25 percentage point increments each year of transitional payment, until CY 2011, when we will fully implement the ASC payment rates calculated under the final methodology of the revised payment system. Procedures new to ASC payment for CY 2008 or later calendar years will receive payments determined according to the final methodology of the revised ASC payment system, as reflected in § 416.171(a), without the need for a transition. ASC covered surgical procedures listed in Addendum AA to this final rule that are subject to the transition are assigned to payment indicators “A2” (Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight) and “H8” (Device-intensive procedure on ASC list in CY 2007; paid at adjusted rate). ASC covered surgical procedures listed in Addendum AA to this final rule that are not subject to the transition are assigned to payment indicators “G2” (Non office-based surgical procedure added to ASC list in CY 2008 or later; payment based on OPPS relative payment weight); “J8” (Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate); “P2” (Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight); “P3” (Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs); and “R2” (Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight). In addition, we agree with commenters who indicated that an adjustment should be made during the transition period for certain procedures that implant devices that are separately payable under the existing ASC payment system. For device-intensive procedures utilizing separately payable devices of significant cost, ideally, we would adjust the CY 2007 base rates for the procedures to appropriately reflect the fact that associated devices may have been separately paid to ASCs in CY 2007 under the DMEPOS fee schedule, but beginning in CY 2008 implantable device payment will be packaged into the ASC payment for the covered surgical procedure under the revised ASC payment system. This would require associating the current separately provided implantable device payments with specific covered surgical procedures, in order to determine an appropriate CY 2007 base payment rate for the transition for each procedure. However, due to the challenges in making these associations, including the common historical practice of payment at contractor-priced rates for some implantable devices that have been reported only under Level II HCPCS unlisted codes under the existing payment system, we cannot accurately allocate those device payments to covered surgical procedures using the ASC data. Under the final methodology of the revised ASC payment system for calculating payment for procedures with significant device costs as discussed in section IV.C.2.e. of this final rule, for device-intensive procedures on the CY 2007 ASC list of covered surgical procedures, we will separately determine both the device payment and service payment portions of the total ASC payment under the revised payment system. We will apply the ASC conversion factor only to the specially calculated OPPS relative payment weight for the service portion, while providing the same packaged payment for the device portion as would be made under the OPPS. That is, we will determine the payment amount attributable to the device, as currently determined under the OPPS, and 
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                        combine that payment amount with the adjusted ASC service payment, resulting in a total “bundled” ASC payment for the device-intensive procedure under the revised ASC payment system. Consistent with that approach, we also will apply our transition policy differentially to those portions of the total ASC payment. While we will not subject the device payment portion of the total ASC payment for the procedure under the revised ASC payment system to the transition policy, we will transition the service payment portion of the total ASC payment for the procedure over the 4-year phase-in period. Device-intensive procedures that are new to the ASC list of covered surgical procedures for CY 2008 or later years will be exempted from any transition period and will be paid at the fully implemented revised ASC payment system rates beginning in CY 2008 or the applicable update year, just like all other new ASC surgical procedures. During each of the transition years, when the CY 2007 ASC payment rate for a device-intensive procedure that did not previously include packaged ASC payment for the implantable device itself is blended with the payment developed under the methodology of the revised ASC payment system that would otherwise package the device payment, the full device payment amount will be paid to ASCs in the transition year, with blended payment determined only for the service portion of the ASC payment, for which a corresponding CY 2007 ASC payment rate exists. This methodology achieves an appropriate payment for costly, implantable devices, because it recognizes that, in general, the device costs are similar for ASCs and HOPDs. This specific transition approach for device-intensive procedures ensures that ASCs receive appropriate packaged payment for implantable devices during the transition years, even though payment for such devices is generally not included in their base CY 2007 ASC payment rates under the existing ASC payment system. A full discussion of the calculation of the payment rates for these device-intensive procedures can be found in section IV.C.2.e. of this final rule, in the context of establishing payment weights for device-intensive procedures under the revised ASC payment system. Tables 5 and 6 above are illustrative of the device-intensive procedures likely to be subject to this special transitional policy for device-intensive procedures under the revised ASC payment system, pending updating of their OPPS status in CY 2008 and future years. After considering the public comments received, we are finalizing a policy to phase in implementation of the payment rates calculated under the revised ASC payment system over 4 years. For CYs 2008, 2009, and 2010, payment will be made for each procedure on the CY 2007 ASC list of covered surgical procedures based on a 25/75, 50/50, and 75/25 blend, respectively, of the CY 2007 payment rate for the procedure and the payment rate for that procedure calculated under the standard revised payment system methodology set forth in § 416.171(a). Procedures that are newly approved for ASC payment in CY 2008 or later years are not subject to the transition policy. In CY 2011, we will fully implement the ASC payment rates calculated under the standard payment methodology of the revised ASC payment system. This final transition policy is set forth in § 416.171(c). The service payment portion of the total ASC payment for device-intensive procedures that are on the ASC list of covered surgical procedures in CY 2007 will be subject to the transition. The service payment portion calculated under the fully implemented revised ASC payment system methodology will be blended with the ASC payment for the procedure under the existing payment system. In contrast, the device payment portion of the total ASC payment for these procedures, where the device would generally have been paid separately according to the DMEPOS fee schedule under the existing ASC payment system, will not be subject to the transition. Rather, the contribution of the device payment portion to the total ASC payment during the transitional years will be calculated according to the methodology of the fully implemented revised ASC payment system. During the years of phase-in of the revised ASC payment system, the device payment portion will be summed with the blended service payment portion (that is, the 25/75, 50/50, or 75/25 blend, as appropriate) to establish the total ASC payment for these device-intensive procedures for each year of the transition. Device-intensive procedures new to the ASC list of covered surgical procedures for CY 2008 or later years will be paid the fully implemented revised payment system rates. V. Calculation of ASC Conversion Factor and ASC Payment Rates for CY 2008 A. Overview As discussed in section IV.B. of this final rule, in the August 2006 proposed rule, we proposed to base ASC relative payment weights and payment rates under the revised ASC payment system on APC groups and relative payment weights established under the OPPS. We also proposed 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 unadjusted nonfacility practice expense amount. We explained that the proposed ASC payment weights would be multiplied by an ASC conversion factor to calculate the ASC payment rates. In the August 2006 proposed rule, our estimate for the CY 2008 budget neutral ASC conversion factor was $39.688. In this final rule, we estimate that the ASC conversion factor for CY 2008 will be approximately $42.543. This new estimate of the ASC conversion factor differs from the estimate in the August 2006 proposed rule for a number of reasons, including: (1) Use of the final OPPS relative payment weights for CY 2007; (2) use of the final MPFS nonfacility practice expense payment amounts for CY 2007; (3) use of updated utilization data for the full year of CY 2005; (4) a 4-year instead of 2-year transition to the revised payment system rates, with a modified transition for device-intensive procedures; (5) more recent estimates of the hospital market basket update and the MPFS conversion factor update for CY 2008; and (6) adoption of the with-migration approach to calculation of the budget neutrality adjustment using different time periods for the assumed migration of procedures from physicians' offices and HOPDs to ASCs under the revised ASC payment system. Specific details regarding our final methodology for estimating the revised ASC payment system conversion factor are discussed later in this section. We are not able to provide the final CY 2008 ASC conversion factor in this final rule for the revised ASC payment system because the final conversion factor will be based on the final OPPS relative payment weights for CY 2008, the final MPFS nonfacility practice expense payment amounts for CY 2008, and updated and complete CY 2006 utilization data, all of which are unavailable at this time but will be available for the CY 2008 OPPS/ASC final rule. Therefore, in this final rule, we are finalizing the methodology for calculating the ASC conversion factor for the revised ASC payment system. When the necessary data are available, they will be used in the methodology described in this final rule, and we will provide the final CY 2008 ASC conversion factor and ASC relative 
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                        payment weights and rates in the CY 2008 OPPS/ASC final rule. B. Budget Neutrality Requirement Section 626(b) of Public Law 108-173 amended section 1833(i)(2) of the Act by adding subparagraph (D) to require that in the year the revised ASC 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. * * *” As discussed in the August 2006 proposed rule for the revised ASC payment system, the ASC conversion factor is calculated so that estimated total Medicare payments under the revised ASC payment system would be budget neutral to estimated total Medicare payments under the current ASC payment system as required by the statute. That is, application of the ASC conversion factor would be designed to result in aggregate expenditures under the revised ASC payment system in CY 2008 equal to aggregate expenditures that would have occurred in CY 2008 in the absence of the revised system, taking into consideration the cap on payments in CY 2007 as required under section 5103 of Public Law 109-171, which we discuss further in section IV.A. of this final rule. We note that, in the August 2006 proposed rule (71 FR 49656), we considered the term “expenditures” in the context of section 626(b) of the Public Law 108-173 budget neutrality requirement to mean expenditures from the Medicare Part B Trust Fund. We did not consider expenditures to include beneficiary coinsurance and copayments. C. Calculation of the ASC Payment Rates for CY 2008 1. Proposed Method for Calculation of the ASC Payment Rates for CY 2008 in the August 2006 Proposed Rule In the August 2006 proposed rule, we proposed to calculate the ASC payment rates for CY 2008 as follows: a. Estimated Medicare Program Payments (Excluding Beneficiary Coinsurance) Under the Current ASC Payment System in the August 2006 Proposed Rule *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 HCPCS code on the CY 2007 ASC list of covered surgical procedures by the estimated CY 2008 ASC payment rate for the HCPCS code under the existing ASC system, and then subtracted beneficiary coinsurance. In the August 2006 proposed rule, the estimated CY 2008 ASC payment rates were based on the proposed CY 2007 ASC payment rates, which were listed in Addendum AA to the rule, taking into account the OPPS cap on ASC services at the OPPS rate as required by section 5103 of Public Law 109-171 and reflecting the zero percent CY 2008 update for ASC services mandated by section 1833(i)(2)(C)(iv) of the Act. Although we did not specify in the August 2006 proposed rule that we did so, we also estimated the amount the Medicare program would pay in CY 2008 for implantable prosthetic devices and implantable DME for which ASCs currently receive separate payment under the DMEPOS fee schedule. We then summed the estimated DMEPOS fee schedule total amount and all of the estimated procedure payment amounts for services on the CY 2007 ASC list of covered surgical procedures to estimate the aggregate amount of expenditures that would be made in CY 2008 under the policies of the current ASC payment system. b. Estimated Medicare Program Payments (Excluding Beneficiary Coinsurance) Under the Proposed Revised ASC Payment System in the August 2006 Proposed Rule *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 HCPCS code on the CY 2007 ASC list of covered surgical procedures by the estimated CY 2008 OPPS payment rate for the HCPCS code, and then subtracted beneficiary coinsurance. We summed the results for all services on that ASC list of covered surgical procedures. c. Calculation of the Proposed CY 2008 Budget Neutrality Adjustment in the August 2006 Proposed Rule *Step 3:*
                         To calculate the proposed CY 2008 ASC budget neutrality adjustment, we divided the total expenditures calculated in Step 1 by the total expenditures calculated in Step 2. We calibrated this estimate of the budget neutrality adjustment to take into account that, in CY 2008, the payment rate for procedures on the CY 2007 ASC list of covered surgical procedures was proposed to be 50 percent of the CY 2007 ASC payment amount and 50 percent of the CY 2008 ASC payment rate calculated according to the proposed revised payment system methodology without the transition. The result of these calculations was a budget neutrality adjustment of 0.62. d. Application of the Budget Neutrality Adjustment To Determine the Proposed CY 2008 ASC Conversion Factor in the August 2006 Proposed Rule *Step 4:*
                         To determine the proposed CY 2008 ASC conversion factor, we multiplied the estimated CY 2008 OPPS conversion factor by the result of Step 3. The proposed estimated CY 2008 OPPS conversion factor was $64.013. Multiplying the estimated CY 2008 OPPS conversion factor by the 0.62 budget neutrality adjustment yielded our proposed CY 2008 ASC conversion factor of $39.688. e. Calculation of the Proposed CY 2008 ASC Payment Rates Under the Revised ASC Payment System in the August 2006 Proposed Rule *Step 5:*
                         To determine the proposed national ASC payment rates for covered surgical procedures under the revised payment system (including beneficiary coinsurance), we multiplied the ASC conversion factor from Step 4 by the ASC relative payment weight. The proposed ASC relative payment weights for covered surgical procedures were based on the relative payment weights for the APC groups established under the OPPS as described in section IV.B. of this final rule. However, as further discussed in section IV.E. of this final rule, the ASC relative payment weights for certain office-based surgical procedures were set so that the national ASC payment rate did not exceed the MPFS unadjusted nonfacility practice expense amount. f. Calculation of the Proposed CY 2008 ASC Payment Rates Under the Transition in the August 2006 Proposed Rule *Step 6:*
                         We proposed to fully implement the revised ASC payment rates through a 2-year transition to 100 percent implementation of the revised ASC payment rates for procedures included on the CY 2007 ASC list of covered surgical procedures. In the first year of the transition, the payment rate would be based on 50 percent of the final CY 2007 ASC payment rate under the existing ASC payment system and 50 percent of the final CY 2008 ASC payment rate calculated under the proposed revised payment methodology. The CY 2008 payment for procedures not on the CY 2007 ASC list of covered surgical procedures, but for which we proposed to make payment 
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                        under the revised payment system beginning in CY 2008, would be made at the fully implemented revised ASC payment rates. 2. Alternative Option for Calculating the Proposed Budget Neutrality Adjustment in the August 2006 Proposed Rule In the August 2006 proposed rule, we presented an alternative approach to calculating the budget neutrality adjustment under the revised ASC payment system, which would take into account the effects of migration of procedures across ASCs, physicians’ offices, and HOPDs that might be attributable to the revised ASC payment system (71 FR 49657 through 49658). In the following discussion, the phrase “new ASC procedure” refers to a surgical procedure not on the CY 2007 ASC list of covered surgical procedures but for which we proposed to make payment under the revised ASC payment system beginning in CY 2008. Under this alternative, we assumed that 25 percent of the HOPD utilization for new ASC procedures would migrate to ASCs, and we also assumed that 15 percent of the physician's office utilization for new ASC procedures would migrate to ASCs in the first year of the revised ASC payment system. In the August 2006 proposed rule, we also noted our belief that our assumptions of 25 percent and 15 percent migration from HOPDs and physicians’ offices to ASCs, respectively, were reasonable, given the general utilization relationships between those settings for services on the CY 2007 ASC list of covered surgical procedures. Services on the ASC list of covered surgical procedures that are predominantly performed in ASC and HOPD settings are, on average, performed 30 percent of the time in the ASC setting. Furthermore, services on the existing ASC list of covered surgical procedures that are mainly performed in ASC and physician's office settings are, on average, performed 17 percent of the time in the ASC setting. We assumed that new ASC procedures would migrate at slightly lower rates in the first year of the revised ASC payment system, yielding our migration assumptions to ASCs of 25 percent for the HOPD services and 15 percent for the physician's office services. We also assumed that the net impact of migration of services on the existing CY 2007 ASC list of covered surgical procedures would be negligible. We noted that payment rates for the current highest volume ASC procedures would generally decrease under the proposed revised ASC payment system, and the lower volume ASC procedures would experience significant payment increases. We believed it was reasonable to assume that some of the higher volume services would migrate from ASCs to other settings, and some of the current lower volume procedures would migrate to the ASC setting as a result of the payment changes. In order to calculate the budget neutrality adjustment under this alternative option in the August 2006 proposed rule, 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 rates were not revised and the ASC list of covered surgical procedures was not expanded, as described below. a. Estimated Medicare Program Payments (Excluding Beneficiary Coinsurance) Under the Existing ASC Payment System in the August 2006 Proposed Rule *Step 1:*
                         Migration from HOPDs to ASCs was valued using estimated CY 2008 OPPS payment rates. (a) We multiplied the estimated CY 2008 HOPD utilization for each new ASC procedure by 0.25, consistent with our assumption that 25 percent of the HOPD utilization for new ASC procedures would migrate to the ASC. (b) For each new ASC procedure, we multiplied the results of Step 1(a) by the estimated CY 2008 OPPS payment rate for the procedure, and then subtracted beneficiary coinsurance for the procedure. (c) We summed the results of Step 1(b) across all new ASC procedures. *Step 2:*
                         Migration of procedures from physicians’ offices to ASCs was valued using estimated CY 2008 MPFS physician in-office payment rates. “Physician in-office payment rate” was equal to the MPFS nonfacility practice expense RVUs multiplied by the estimated CY 2008 MPFS conversion factor. (a) To estimate the payment associated with our assumption that 15 percent of the physicians’ office utilization for new ASC procedures would migrate to the ASC, we multiplied the projected CY 2008 physicians'  office utilization for each new ASC procedure by 0.15. (b) For each new ASC procedure, we multiplied the results of Step 2(a) by the estimated CY 2008 physician in-office payment rate for the procedure, and then subtracted beneficiary coinsurance for the procedure. (c) We summed the results of Step 2(b) across all new ASC procedures. *Step 3:*
                         CY 2007 ASC services valued using the estimated CY 2008 ASC payment rates under the current ASC system. This is described under Step 1 in the Estimated Payments under the Current ASC Payment System section, specifically section V.C.1.a. above. *Step 4:*
                         The results of Steps 1-3 were summed. b. Estimated Medicare Program Payments (Excluding Beneficiary Coinsurance) Under the Proposed Revised ASC Payment System in the August 2006 Proposed Rule *Step 5:*
                         HOPD migration was valued using estimated CY 2008 OPPS payment rates. This step is the same as Step 1 in section V.C.2.a. above. *Step 6:*
                         We identified new ASC procedures that were office-based (as discussed in section III.C. of this final rule). *Step 7:*
                         Migration of new ASC office-based procedures from physicians' offices to ASCs was valued based on estimated CY 2008 OPPS payment rates capped at the estimated CY 2008 physician in-office payment rates, if appropriate. (a) For each new ASC procedure determined to be office-based, we multiplied the results of Step 2(a) from section V.C.2.a. above by the lesser of— (1) The estimated CY 2008 OPPS payment rate for the procedure; or (2) The estimated CY 2008 physician in-office payment rate for the procedure, and then subtracted beneficiary coinsurance for the procedure. (As noted in subsequent discussion in section V.C.3. of this final rule, we applied this adjustment for the capped office-based procedures after publication of the proposed rule and posted the results on our Web site.) (b) The results of Step 7(a) were summed across all new ASC procedures considered to be office-based. *Step 8:*
                         Migration of new ASC procedures that were not determined to be office-based from physicians'  offices to ASCs was valued using the estimated CY 2008 OPPS rates. (a) For each new ASC procedure not considered to be office-based, we multiplied the results of Step 2(a) from section V.C.2.a. above by the estimated CY 2008 OPPS rate for the procedure, and then subtracted beneficiary coinsurance for the procedure. (b) The results of Step 8(a) were summed across all new ASC procedures not considered to be office-based. *Step 9:*
                         Migration of new ASC procedures from physicians'  offices to ASCs was valued using the estimated CY 2008 MPFS physician out-of-office payment rates. “Physician out-of-office 
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                        payment rate” was equal to the facility practice expense RVUs multiplied by the estimated CY 2008 MPFS conversion factor. (a) For each new ASC procedure, we multiplied the results of Step 2(a) from section V.C.2.a. above by the estimated CY 2008 physician out-of-office payment rate for the procedure, and then subtracted beneficiary coinsurance for the procedure. (b) The results of Step 9(a) were summed across all new ASC procedures. Step 10: Current ASC services were valued using the estimated CY 2008 OPPS payment rates. This is described under Step 2 in section V.C.1.b. above. *Step 11:*
                         The results of Steps 5 and 7-10 were summed. c. Calculation of the Proposed CY 2008 Budget Neutrality Adjustment in the August 2006 Proposed Rule *Step 12:*
                         The result of Step 4 was divided by the result of Step 11. *Step 13:*
                         The calculation of the budget neutrality adjustment in Step 12 was calibrated in a number of ways. The application of the cap at the estimated CY 2008 MPFS nonfacility practice expense amount that occurred in Step 7 was dependent on the ASC conversion factor. The ASC budget neutrality adjustment resulting from Step 12 was calibrated to take into account the effects of the physician's office payment cap on the ASC conversion factor. The ASC budget neutrality calculation was also calibrated to take into account the fact that the additional physician out-of-office payments under the revised ASC payment system calculated in Step 9 must be fully offset by the budget neutrality adjustment to ASC services under the revised payment system. Furthermore, the budget neutrality calculation was calibrated to take into account the CY 2008 transitional payment rates for procedures on the CY 2007 ASC list of covered surgical procedures. As reported in the August 2006 proposed rule (71 FR 49658), the budget neutrality adjustment calculated using this alternative option that incorporated CMS'  migration assumptions was 0.62, indicating that under the migration assumptions described above there was no difference, rounded to the nearest hundredth, between our proposed budget neutrality adjustment without migration (0.62) and the alternative budget neutrality adjustment with migration (0.62). d. Discussion of the Alternative Calculation of the Budget Neutrality Adjustment We chose to propose calculation of the budget neutrality adjustment based on the CY 2007 final ASC list of covered surgical procedures and the most recent available ASC utilization data because we believed this was the most appropriate approach to estimating expenditures to result in a budget neutral payment system in CY 2008. We believed that the data available to us did not enable us to precisely estimate the net potential migration of services between the ASC, outpatient hospital, and physician's office settings that might result from implementation of the revised ASC payment system. Moreover, basing our estimate of expenditures on current ASC utilization without including migration from other sites of service was consistent with how we estimate expenditures for purposes of establishing budget neutrality in other Medicare payment systems. However, we recognized, that significant service migration would not generally be expected to occur under these other payment systems and acknowledged that the potential for migration could be significantly greater under the revised ASC payment system, with a possible effect on Medicare expenditures. Our recognition of the uniqueness of the revised ASC payment system was the reason we presented the alternative with-migration budget neutrality adjustment calculation in the August 2006 proposed rule, so commenters would have the opportunity to fully examine this model, in addition to the traditional without-migration methodology that we proposed to use. Given that the revised ASC payment system includes a significant expansion of procedures for which ASC payment would be allowed, in addition to the expected service mix changes that result from the changes in payment incentives that accompany the introduction of any revised payment system, we expected that some commenters might believe that it would be more appropriate to estimate the ASC budget neutrality adjustment taking into account the potential migration of services between the ASC, hospital outpatient, and physician's office settings, consistent with the alternative with-migration model discussed in the August 2006 proposed rule. In that proposed rule, we explained that we would welcome data supporting the use of specific migration assumptions in the calculation of the ASC budget neutrality adjustment. We described the budget neutrality calculation under the alternative approach based on our best estimate of the potential migration of services between the different settings, hoping to facilitate and stimulate comment on migration that could occur and specifically to encourage the submission of pertinent quantitative evidence of service migration resulting from changes in payment rates. We welcomed data on all of the migration assumptions presented in the proposed rule discussion of the alternative approach. We noted that there was no difference between our proposed budget neutrality calculation without migration (0.62) and the alternative budget neutrality adjustment with migration (0.62), when rounded to the nearest hundredth. *Comment:*
                         Many commenters recommended different interpretations of section 626(b) of Public Law 108-173. The commenters believed that CMS'  interpretation of the law's requirement that CMS ensure the budget neutrality of the revised system was overly restrictive and that consequently, the proposed budget neutrality factor was not adequate to make fair ASC payments. According to the commenters'  interpretations of the law, they believed that CMS has the clear legal authority to make assumptions regarding the migration of procedures between different sites of service, and that expenditures for all services covered by the ASC payment system, including beneficiary coinsurance, should be considered in the calculation of budget neutrality. Most of the commenters recommended that CMS include projected case migration across ASC, HOPD, and physician's office settings in its budget neutrality model and use total expenditures across all Medicare Part B sites of service, rather than limit the base solely to estimated CY 2008 aggregate expenditures under the ASC payment system. Several commenters supported the use of the alternative option for calculating budget neutrality that incorporated the case migration assumptions as they were presented in the August 2006 proposed rule, with the stipulation that several technical corrections to fully account for the Medicare expenditures for all procedures that were assumed to migrate to the ASC would be made and that the resulting conversion factor would be 64.6 percent. Most other commenters believed that case migration would certainly be one result of implementation of the revised ASC payment system, and that CMS' budget neutrality adjustment model should include recognition of those changes in sites of service and the related Medicare expenditures. They recommended that 
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                        CMS use a model like the alternative option for calculating budget neutrality presented in the August 2006 proposed rule and discussed above in this final rule, but that the specific assumptions CMS used should be revised as indicated in their comments. *Response:*
                         As discussed in the August 2006 proposed rule, we were interested in comments from the public about our interpretation of budget neutrality and our proposed methodology for developing the budget neutrality adjustment factor for the revised ASC payment system. We will fully address each of the specific technical corrections (for example, that we account for differences in beneficiary coinsurance amounts in HOPD and ASC settings) and migration assumption modifications that were recommended by commenters in section V.C.3. of this final rule. At the more general level, we noted the strong preference among commenters for CMS to use the alternative, with-migration methodology that would take into account the effects of assumed migration of cases across ambulatory sites of service that could result from the payment changes associated with the revised ASC payment system. The August 2006 proposal reflected our belief that adoption of the without-migration model was more appropriate than the alternative with-migration model that was also discussed. In the proposal, we explained that basing our estimate of expenditures on current utilization without including migration from other sites of services was consistent with how we estimate expenditures for purposes of maintaining budget neutrality in other Medicare payment systems. We realized that the influx of newly covered procedures was unique to our proposal for the revised ASC payment system, but because the budget neutrality adjustment that resulted from both models in the August 2006 proposed rule was the same and data to determine estimates of potential case migration were limited, we adopted the without-migration model in our proposal, consistent with our previous modeling to ensure that our payment systems are budget neutral. We agree with commenters that the flexibility to include migration assumptions in our calculation of budget neutrality for the revised ASC payment system is provided by the statute. Furthermore, our review of the extensive comments on the August 2006 proposed rule led to our conclusion in this final rule that the significant expansion of ASC covered surgical procedures proposed as part of the revised system is not only a unique aspect of the revised ASC payment system, but that its effects on ASC expenditures may be substantial. An influx of new covered services has not been a factor in developing the budget neutrality adjustment factors for our other prospective payment systems. The scope of services in other payment systems does not change significantly from one year to the next, as does the ASC scope of services between CYs 2007 and 2008 in the context of our final policies for the revised ASC payment system, as discussed in sections III. and IV. of this final rule. In view of our belief that the revised ASC payment system is unique because of the significant expansion of covered surgical procedures and covered ancillary services to be paid under the revised ASC payment system, we conclude that including estimates of case migration of the new procedures, as well as the existing ASC covered surgical procedures, is the most accurate method for developing the budget neutrality adjustment in this case. After reviewing all of the public comments and reexamining the available data, we believe that there is sufficient evidence to indicate that adoption of a with-migration methodology for calculating the budget neutrality adjustment for the revised ASC payment system is appropriate. Thus, we have determined that it would be prudent, and more accurate, to adopt a with-migration budget neutrality estimation methodology, in order to take into account the effects of the migration of procedures between ASCs, physicians'  offices, and HOPDs that might be attributable to the revised ASC payment system. While the budget neutrality estimation methodology that takes into account migration increases the complexity associated with establishing the budget neutrality adjustment, we believe that its application provides us with the most reasonable approach to establishing payment rates under the revised ASC payment system in order to assist in ensuring continued access to current ASC procedures and expanded access to new surgical procedures for Medicare beneficiaries in ASCs. Although we are convinced that the with-migration model is more appropriate for calculating the final budget neutrality adjustment factor for the revised ASC payment system, we calculated the budget neutrality adjustment for this final rule using both with-migration and without-migration models, as we had for the August 2006 proposed rule. However, in contrast to the results of our work for that proposed rule, where application of either model resulted in the same adjustment factor, the budget neutrality factors that resulted from application of the two methods for this final rule were different. The adjustment factor that resulted from application of our proposed model that did not consider migration was 0.64, while the with-migration model resulted in a 0.67 budget neutrality adjustment factor. For a full discussion of the calculation of the final budget neutrality adjustment factor, we refer readers to section V.C.3. of this final rule. *Comment:*
                         Several commenters agreed with the use of a blended rate for CY 2008 to calculate budget neutrality for the revised ASC payment system, based on the proposal for a 2-year transition to the fully implemented revised payment system. They believed this use of discretion was an appropriate interpretation of the legislation and produced the most reasonable result. They believed that, because the proposed CY 2008 rates were a 50/50 blend of the CY 2007 ASC rate and the estimated CY 2008 ASC rate calculated according to the methodology of the proposed revised ASC payment system, the ASC payment system would have increased expenditures in CY 2009 unless migration patterns differed from the assumptions discussed in the proposed rule regarding the alternative calculation of the budget neutrality adjustment. These commenters concluded that the increased expenditures that would result from our adoption of their recommendation to utilize a modification of the alternative calculation of the proposed budget neutrality adjustment were expected, appropriate, and consistent with the budget neutrality provision of section 626(b) of Public Law 108-173 for the revised ASC payment system. *Response:*
                         We agree with commenters that the migration assumptions influence the relationship between estimated expenditures under the current ASC system and the revised ASC payment system over time. As noted elsewhere in sections IV.J. and V.C.4 of this final rule, we have extended the transition period for payment of services on the CY 2007 ASC list of covered surgical procedures and have also modified our migration assumptions to reflect migration over a more extended time period than was reflected in our discussion of the alternative option for calculating the budget neutrality adjustment in the August 2006 proposed rule. As described in section X. of this final rule, we estimate that, over time, the expenditures under the revised ASC system using our final migration assumptions would be slightly less than 
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                        the expenditures that would occur if we did not revise the system. 3. Calculation of the Estimated CY 2008 Budget Neutrality Adjustment According to the Final Policy In the August 2006 proposed rule, and as discussed earlier in this section of the final rule, we described two methodologies for determining the budget neutrality adjustment under the revised ASC payment system that could then be used to establish the ASC conversion factor for CY 2008 (71 FR 49656 through 49658). We proposed that, under the standard methodology of the revised ASC payment system, the ASC conversion factor would be multiplied by the ASC payment weight for each covered surgical procedure to determine the procedure's CY 2008 ASC payment rate. As discussed in detail in section IV.C. of this final rule, our final policy will also provide separate payment for covered ancillary services under the revised ASC payment system. While the payment rates for separately payable drugs and biologicals, brachytherapy sources, corneal tissue acquisition, and implantable devices with OPPS pass-through status that are covered ancillary services, along with the device portion of ASC payment for device-intensive covered surgical procedures, will be determined without application of the ASC conversion factor, the final standard methodology of the revised ASC payment system will apply the ASC conversion factor to ASC payment weights to calculate the fully implemented payment rates for covered surgical procedures and covered ancillary radiology services. We received a number of general and specific comments on our proposal for calculating the CY 2008 ASC payment rates under the revised ASC payment system. *Comment:*
                         There was general agreement among the commenters that, in the absence of cost data for surgical procedures performed in ASCs, CMS’ proposal to base the revised ASC payment system on the OPPS APC groups and their relative payment weights was sound policy that could reasonably be expected to result in accurate ASC payments for most procedures. Further, the commenters generally agreed that ASC facility costs are lower than the HOPD costs for providing the same surgical services. The commenters gave specific examples of the reasons why higher costs are incurred by hospitals, including the requirement that HOPDs satisfy quality and safety standards that are not applied to ASCs; the fact that hospitals’ resources are available 24 hours a day, 7 days a week; Emergency Medical Treatment and Labor Act of 1986-related (EMTALA-related) requirements; treatment of a more acutely ill population with greater comorbidities; and higher uncompensated care rates. Moreover, those commenters cited MedPAC's findings reported in 2003 and 2004 that hospitals probably incur higher costs than ASCs for providing similar procedures, because HOPDs are subject to additional regulatory requirements which are likely to increase their overhead costs, and HOPDs also treat patients who are more medically complex. Beyond these points, the commenters diverged on their opinions about the accuracy and appropriateness of the proposed conversion factor, as discussed in detail below. *Response:*
                         We appreciate the commenters’ general support of our proposal to base payment under the revised ASC payment system on the OPPS relative payment weights and the APC groups. These comments were consistent with the recommendation of the GAO (GAO-07-86) that CMS should implement a payment system for procedures performed in ASCs based on the OPPS, taking into account the lower relative costs of procedures performed in ASCs compared to HOPDs. For further discussion of this subject, as well as a summary of additional public comments and our responses, we refer readers to section IV.B. of this final rule. *Comment:*
                         Several commenters specifically recommended that CMS adopt 75 percent as the multiplier to the OPPS conversion factor, so that payment rates under the revised ASC payment system would be 75 percent of the OPPS rates. They cited legislation that was introduced in the U.S. Senate in 2003 in which payments to ASCs were to have been provided at 75 percent of the OPPS rates. The proponents of that proposed legislation believed that, by using a 75 percent factor to reduce OPPS rates in order to provide payment for ASCs to perform procedures, Medicare would save 25 cents for every dollar spent for procedures performed in the ASC setting instead of the HOPD. Several commenters also believed that, because ASC rates have been frozen since 2003 while OPPS rates have been increased annually for inflation, an unfair differential in payments between the two payment systems has grown over the past several years. These commenters argued that by calculating budget neutrality for the revised ASC payment system using the static ASC rates in comparison with annually updated OPPS rates, CMS proposed an inappropriately low budget neutrality adjustment factor. They were convinced that, if CMS had implemented the revised ASC payment system immediately after Congress passed Public Law 108-173 in 2003, before the differential between the payment rates for the two systems increased due to the continued freeze on ASC rates, the budget neutrality adjustment for the revised payment system would have been close to 85 percent, rather than 62 percent as CMS proposed for the revised payment system to be implemented in CY 2008. Other commenters, noting that Congress gave CMS the authority to implement the revised payment system between CY 2006 and CY 2008, expressed their belief that, had CMS implemented the revised ASC payment system in an earlier year, the budget neutrality adjustment would have been at least 8 percent higher than the 62 percent that was proposed. *Response:*
                         We see no rationale for estimating the budget neutrality adjustment by comparing existing ASC payment system rates with OPPS rates from an earlier calendar year, prior to implementation of the revised ASC payment system. Congress provided CMS with the latitude to implement the revised ASC payment system beginning on or after January 1, 2006, and not later than January 1, 2008. We believe that the statute provides direction that the revised ASC payment system is to be budget neutral in its design in order to result in the same aggregate expenditures for services as would be made if the provisions of the revised ASC payment system did not apply, that the ASC conversion factor is not to be updated before CY 2010, and that implementation of the revised system by January 1, 2008 is timely. There is no evidence that Congress intended for CMS to attempt to maintain the relationship between OPPS payment rates and ASC payments that existed at the time of enactment of Public Law 108-173 (CY 2003) in the development of the revised ASC payment system. We also see no rationale for adopting an arbitrary multiplier, such as 75 percent of OPPS payment rates, that is not founded on explicit consideration of budget neutrality as required by the statute. We received many public comments in response to our proposed budget neutrality adjustment factor. A number of commenters included seven specific recommendations, three of which were related to the migration assumptions discussed as an alternative option for calculating the budget neutrality adjustment in the proposed rule. The 
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                        other four were technical in nature and related to our proposed budget neutrality model. A summary of the comments and our responses follow, beginning with the four recommended technical modifications to our proposed methodology, followed by the three migration assumption recommendations. *Comment:*
                         One of the recommended technical modifications was that, instead of basing ASC payments on CY 2007 rates for all procedures on the CY 2007 ASC list of covered surgical procedures, CMS should use the payment amounts that would be made in CY 2008 in the absence of the revised payment system for those ASC procedures whose payments are capped in CY 2007 due to section 5103 of Public Law 109-171. The commenters believed that using the lower CY 2007 rates for ASC procedures capped by section 5103 of Public Law 109-171 was an unfair representation of estimated ASC payments under the existing payment system in CY 2008. Their rationale was that, if the revised ASC system were not implemented in CY 2008, the payments for those services under the policy of the existing ASC payment system would increase in CY 2008, consistent with the overall projected increase in OPPS rates of 4 percent. The commenters expected that incorporation of this adjustment would result in a 0.11 percentage point increase to the budget neutrality adjustment. *Response:*
                         We do not agree that the ASC rates for these specific services would necessarily increase consistent with an overall increase in OPPS rates for CY 2008. Through the annual update of the OPPS, while the aggregate spending is generally projected to increase in the update, the specific payments for individual services may rise or fall from year to year based on a variety of factors, including APC recalibration. Because the ASC procedures that are capped at the OPPS rates in CY 2007 are a small subset of all OPPS services, we are unable to project that their rates would be subject to a 4 percent increase, or indeed any increase, as suggested by the commenters. In addition, we believe that Congress intended for the revised ASC payment system rates and budget neutrality to be related to the estimated aggregate expenditures for ASC services based on ASC payment rates from the year prior to implementation of the revised system. Congress mandated that the revised ASC system be budget neutral and be implemented by CY 2008. It also set ASC updates to zero percent for the calendar years through 2009. We believe all of those actions, in combination, provide clear indication that Congress did not intend for estimates of aggregate expenditures under the existing ASC payment system to take into account updated ASC payment rates for CY 2008. The limitations on ASC payments prior to implementation of the revised ASC payment system, specifically both section 626 of Public Law 108-173 that specifies that ASC rates would not be updated before CY 2010 and, further, the limit on ASC payment at the lesser of the OPPS or ASC rate, as required in section 5103 of Public Law 109-171 that extends until implementation of the revised ASC payment system, provide clear evidence that the CY 2007 ASC rates for covered procedures are to be used in developing the budget neutrality adjustment for the revised payment system. We continue to believe, for the purposes of this final rule, that the most appropriate course for calculation of the budget neutrality adjustment, consistent with our proposal, is to estimate that the CY 2008 rates for the ASC procedures subject to the cap set forth in section 5103 of Public Law 109-171 in CY 2007 will be the same as their CY 2007 rates. *Comment:*
                         Some commenters stated that, in CMS'  calculation of estimated ASC payments under the existing ASC payment system for comparison to payments under the proposed methodology for the revised ASC payment system, CMS did not include payments for the costs of implantable prosthetic devices that are currently separately paid to ASCs under the DMEPOS fee schedule. The commenters recommended that CMS include the amount paid to ASCs to cover the costs of separately payable implantable prosthetics and DME under the DMEPOS fee schedule to avoid understating Medicare's current full cost related to the surgical implantation procedures. The commenters believed that inclusion of those payments would increase the budget neutrality adjustment by 0.41 percentage points. *Response:*
                         We agree with the commenters that the payments to ASCs for the implantable prosthetic devices and DME should be included in estimating total ASC payments for CY 2008 under the policies of the existing ASC payment system. In fact, we did include those payments in our proposed budget neutrality adjustment calculation, but we failed to explicitly state that in our explanation in the August 2006 proposed rule. Therefore, the effect of including those payments was reflected in the budget neutrality adjustment that we proposed. We have also included these payments in our calculation of the budget neutrality adjustment for this final rule. *Comment:*
                         Several commenters believed that, although CMS accounted for the 20 percent beneficiary coinsurance in ASCs by discounting by 20 percent all of the payment rates used to estimate the CY 2008 payments under the existing ASC system and under the proposed methodology of the revised ASC payment system, CMS did not appropriately account for beneficiary coinsurance associated with the new ASC office-based procedures for which payment was proposed to be limited to the MPFS unadjusted nonfacility practice expense amount. They believed that CMS should apply the 20 percent discount to those procedures because that approach would more accurately and consistently reflect the Medicare program costs, and they concluded that this change would increase the budget neutrality adjustment by 0.43 percentage points. *Response:*
                         While we did not apply this discount to payment rates for the capped office-based procedures newly proposed for ASC payment in CY 2008 in our calculation of the proposed budget neutrality adjustment, we agree with this recommendation. Recognizing those lower costs to the Medicare program, consistent with our calculation of program costs under the existing ASC payment system and the standard methodology of the revised ASC payment system, would be more accurate. Soon after publication of the August 2006 proposed rule, we discovered this oversight, made the appropriate adjustments to the data, and posted the revised data on our Web site (
                        *http://www.cms.hhs.gov/​ASCPayment*). *Comment:*
                         Commenters noted that CMS did not account for the variable copayment amounts associated with procedures under the OPPS for purposes of establishing the budget neutrality adjustment under the revised ASC payment system. The beneficiary copayment under the OPPS varies from 20 to 40 percent of the payment rate, depending on the procedure, whereas the coinsurance under the ASC payment system is 20 percent for all procedures. The commenters believed that as a result of not considering the sometimes much higher copayments under the OPPS, CMS artificially inflated Medicare's estimated payments under the proposed methodology of the revised ASC payment system. They believed that accurately accounting for the OPPS copayments would increase the budget neutrality adjustment by 1.04 percentage points. *Response:*
                         We agree with the commenters regarding this 
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                        recommendation. We did not apply the variable OPPS copayment amounts in the model that was proposed. However, soon after publication of the August 2006 proposed rule, we discovered this oversight, made the appropriate adjustments to the data, and posted the revised data on our Web site (
                        *http://www.cms.hhs.gov/​ASCPayment*). After considering the first four technical recommendations of many commenters and making the two technical adjustments as described above, the resulting increase in the proposed budget neutrality adjustment was approximately 2.6 percentage points. We have applied these same two technical adjustments in our calculation of the budget neutrality adjustment for this final rule. In addition, we made another technical change in this final rule by taking the multiple procedure discount into account in our estimates of ASC, OPPS, and MPFS expenditures both before and after implementation of the revised ASC payment system. We factored the multiple procedure discount into our estimates of ASC, OPPS, and MPFS spending under the existing and revised ASC payment systems. We assumed that the pattern of multiple surgical procedures furnished in ASCs and physicians' offices would be similar to the pattern in HOPDs. Based on claims data indicating the prevalence of multiple procedures in HOPDs, we estimated the percentage of discounted units to total units for each procedure and then reduced the volume for those procedures prior to estimating expenditures in each year. We incorporated this reduction into our estimates of Medicare expenditures under the ASC, OPPS, and MPFS payment systems both before and after implementation of the revised ASC payment system. We had not factored the multiple procedure discount into the August 2006 proposed rule estimates. The final three recommendations by commenters that were related to the migration assumptions used in the alternative option for calculating the budget neutrality adjustment presented in the August 2006 proposed rule are discussed below. *Comment:*
                         Many commenters believed that the alternative method for calculating the budget neutrality adjustment that CMS discussed in the August 2006 proposed rule described a preferable and superior method for developing the budget neutrality adjustment for the revised ASC payment system. They believed that developing and applying some assumptions to account for the migration of services and their payment across Medicare Part B sites of care would be the most appropriate method for ensuring budget neutrality. However, they recommended that CMS revise some of the assumptions regarding migration that were described in that proposed rule. The first of their recommendations in this regard was that CMS use a much lower migration assumption of 2 percent for new ASC procedures migrating from physicians' offices to ASCs. They were convinced that CMS' assumption in the proposed rule that 15 percent of the current office utilization of new ASC procedures would migrate to ASCs was far greater than would be possible. They stated that ASCs do not have the capacity to absorb that level of services. Furthermore, they explained that ASCs have found that, once physicians acquire the equipment and resources to provide a procedure in their offices, they prefer to perform it there. The commenters believed that physicians only typically perform procedures in an ASC or HOPD setting when there is a particular patient need that requires the facility setting. They argued that by allowing the new ASC procedures to receive payment in ASCs, CMS would realize savings because cases could be moved from the office to an ASC instead of to the more costly HOPD setting when the physician determines that relocation of the service is preferable for a particular beneficiary. Furthermore, the commenters stated that ASCs would not only be overwhelmed by the volume of cases CMS assumed would migrate to that setting, but that ASCs would not welcome the influx of low paying, minor procedures that could generally be performed in physicians' offices over the more complex, higher paying procedures that ASCs are accustomed to providing in the more efficient and intensive facility setting. The commenters believed that adjusting the assumption for migration of new ASC procedures from physicians' offices to ASCs to 2 percent of the cases would be more appropriate and would result in a 3.11 percentage point increase in the budget neutrality adjustment. In addition, the commenters believed that CMS did not accurately adjust for the likely negative migration of cases involving procedures paid under the existing ASC payment system out of ASCs and into more costly HOPDs under the proposal for the revised payment system. They developed a model that they believed would more correctly predict the migration of procedures out of ASCs and into HOPDs based on the magnitude of the procedure's proposed payment rate decrease. In that model, the commenters assumed that for every 10 percent decrease in a procedure's ASC payment rate from the existing to the revised payment system, 1.5 percent of the ASC volume would migrate to HOPDs. They believed that CMS' application of this adjustment would result in a 0.51 percentage point decrease to the budget neutrality adjustment. They also recommended that CMS account for the positive migration of existing ASC covered procedures from HOPDs to ASCs by assuming that for every 10 percent increase in a procedure's ASC payment rate under the proposal for the revised ASC payment system, 1.5 percent of the HOPD volume would migrate to ASCs, up to a maximum of 25 percent of the procedure's current HOPD volume. Furthermore, commenters suggested that ASC capacity would limit movement of these procedures to no more than 25 percent of each procedure's existing ASC volume. The commenters believed that, although ASCs have significant excess capacity, as confirmed by a CY 2006 industry study that showed that only about one quarter of ASCs were operating above 60 percent operating room capacity, they could not absorb more than 25 percent of the HOPD volume for all ASC procedures for which payment was expected to increase under the proposed revised payment system. They explained that application of their assumption would result in a 5.57 percentage point increase in the budget neutrality adjustment. *Response:*
                         We appreciate the extensive comments we received regarding the appropriate migration assumptions to be applied in determining the budget neutrality adjustment for the revised ASC payment system. While commenters provided a number of suggestions regarding migration assumptions for both the procedures on the CY 2007 ASC list of covered surgical procedures and new ASC procedures, they did not provide data supporting all of the specific assumptions regarding the relationship between expected service migration and changes in payment rates that they recommended we adopt along with their other migration assumptions. However, as stated above, we are adopting a with-migration model for calculation of the final budget neutrality adjustment factor because we believe that it is more accurate than the without-migration model that we proposed that does not consider the migration of new procedures across sites of service, but we did not adopt the assumptions recommended by some commenters. 
                        ( print page 42529) The CMS Office of the Actuary (OACT) developed the assumptions utilized in the final budget neutrality model. With respect to current ASC covered surgical procedures paid under the existing ASC payment system, we did not accept the recommendation by commenters that we should assume that negative migration, that is, movement of existing ASC covered procedures out of ASCs and into the higher cost HOPD setting, would have an effect on our budget neutrality adjustment that is not equal to the effect of positive migration of cases from other settings into ASCs. Rather, in this final rule, after reviewing information provided by commenters and reevaluating current site-of-service utilization patterns for exiting and new ASC procedures, we are assuming that the effect on budget neutrality due to movement of cases involving existing ASC procedures out of ASCs will be balanced by movement of additional cases involving existing ASC procedures into ASCs. We believe that it is reasonable to assume that the payment increases for many currently low volume ASC procedures will result in higher ASC volumes for those procedures under the revised ASC payment system. Moreover, we believe that this anticipated positive migration of those procedures will balance the estimated negative migration of the high volume ASC procedures for which payment will decrease. Our actuaries project that the net budgetary effect of migration into and out of ASCs for procedures currently on the ASC list of covered surgical procedures will be negligible. Consistent with our assumption for the alternative budget neutrality adjustment model discussed in the August 2006 proposed rule, under the final methodology for the revised ASC payment system, we assume that 25 percent of the current HOPD volume of new ASC procedures would ultimately migrate from HOPDs to ASCs. However, taking into consideration the final, longer 4-year transition period to the fully implemented payment weights of the revised ASC payment system and the final modifications to several aspects of the proposed payment policy as discussed in this preamble, for this final rule, we assume that the 25 percent case migration would occur more gradually, over the first 2 years of the transition, instead of all in the first year. We believe the migration would occur over the first 2 years of the 4-year transition, as the ASC industry adapts to the revised ASC payment system and the significant expansion of covered surgical procedures described in this final rule. We agree with commenters that the level of migration in a single year, as discussed in our presentation of the with-migration budget neutrality adjustment model in the August 2006 proposed rule, would be difficult for ASCs to accommodate in a single year, but we believe, based on current ASC and HOPD utilization and ASC industry information, that the 25 percent case migration over 2 years is most likely. We believe that our assumption of 25 percent migration of current HOPD volume for new ASC procedures is reasonable, given the general utilization relationships between ASCs and HOPDs for services as discussed in section V.C.2. above. We also note that commenters generally did not disagree with our proposed HOPD migration assumption for the new ASC procedures. As discussed in the August 2006 proposed rule (71 FR 49657), services on the ASC list of covered surgical procedures that are predominantly performed in ASC and HOPD settings are, on average, performed 30 percent of the time in the ASC setting. Thus, for calculation of the budget neutrality adjustment according to the final policy of this final rule, we assume that new ASC procedures would migrate at the slightly slower rate of 25 percent over the first 2 years of the 4-year transition, reflecting their movement toward the general 30-percent site-of-service utilization pattern currently observed for ASC covered surgical procedures as ASCs transition to the revised ASC payment system. Our assumed 25 percent migration of new ASC procedures from HOPDs to ASCs differs considerably from the commenters' recommended positive migration assumptions, because the commenters' model included all current ASC procedures and applied a formula linking the magnitude of ASC payment changes under the revised ASC payment system to the expected volume of migration. Given that the commenters based their estimate for this assumption on existing ASC procedures, they used 25 percent of current HOPD volume as the upper limit for migration from HOPDs to ASCs, the same assumption we used for the migration of new ASC procedures in CY 2008. However, because they believed that ASC capacity would ultimately limit procedure movement, they also limited the movement to 25 percent of the existing ASC volume for those procedures. Our actuaries determined migration assumptions separately for existing ASC covered procedures and new ASC procedures. As mentioned earlier, the net effect of migration of existing procedures into and out of ASCs is assumed to be negligible. For the new ASC procedures, it is assumed that 25 percent of the current HOPD volume will migrate to ASCs during the first 2 years of the revised ASC payment system. The commenters assumed some negative migration of existing ASC covered procedures from ASCs to HOPDs in response to price changes under the revised ASC payment system, based on a relationship between a procedure's decrease in ASC payment and its volume of migration. However, as discussed above, we also believe that we have adequately accounted for the expected migration of procedures currently covered in ASCs from the ASC to the HOPD setting under the revised ASC payment system. Finally, the commenters' recommendation that we assume much less migration from physicians' offices to ASCs for new ASC procedures due to ASC capacity limitations led us to reconsider our earlier assumption articulated in the August 2006 proposed rule for the alternative model to calculate the budget neutrality adjustment. Thus, for this final rule, although the actuaries' assumption is that 15 percent of the physicians' office volume of new ASC procedures may eventually be expected to move into ASCs, they did take into consideration the commenters' argument that such a level of migration could not be fully accommodated by ASCs in CY 2008. Therefore, in our final policy we assume that the migration of these currently office-based cases would occur more gradually, with an additional one quarter of the total migration occurring in each year of the full 4-year transition period. Thus, we expect that only 3.75 percent of the office utilization of new ASC procedures would migrate to ASCs in CY 2008, followed by an additional quarter of new cases in each subsequent year, reaching the full 15 percent by the end of the transition period to the fully implemented revised ASC payment rates. Given the current 17 percent ASC utilization of procedures that are predominantly performed in physicians' offices and ASCs that are on the existing ASC list of covered surgical procedures, we see no reason to assume that only 2 percent of the current office volume for new ASC procedures would migrate to ASCs, as suggested by some commenters. Instead, we believe the eventual utilization data for those procedures would most likely resemble the site-of-service utilization for procedures predominantly performed in ASC and physician's office settings that are currently paid in ASCs. Our 
                        ( print page 42530)
                        assumption of 15 percent is slightly lower than the current pattern of 17 percent ASC utilization, consistent with our expectation that migration of the broad array of new ASC procedures would result in slightly lower ASC utilization in 4 years than the currently observed pattern for procedures on the CY 2007 ASC list of covered surgical procedures that are predominantly performed in physicians' offices and ASCs. In addition, in the context of developing the budget neutrality adjustment for the revised ASC payment system under the with-migration model, the actuaries took into consideration the final payment policies of the revised ASC payment system. These include the final changes to the payment rate calculations for device-intensive procedures, as well as the separate payment for covered ancillary services. While specific current and projected ASC utilization of covered ancillary services is difficult to estimate, in establishing the final budget neutrality adjustment, the actuaries took into account the findings of the GAO that payment for many of these ancillary services is currently provided to other Medicare Part B suppliers under the existing ASC payment system, and that most drugs and biologicals utilized with current ASC procedures do not receive separate payment under the OPPS. In summary, since our discussion of the alternative model for calculating the budget neutrality adjustment presented in the August 2006 proposed rule for the revised ASC payment system, the actuaries have continued to refine the assumptions and estimates related to the with-migration budget neutrality model to take into account policy decisions made in this final rule, additional research, information from industry experts, and public comments. Application of our final revised migration assumptions, along with changes to the OPPS rates, MPFS rates, and updated utilization data, as well as the final payment policies for the revised ASC payment system, taken together result in an estimated budget neutrality adjustment of 0.67. The estimated budget neutrality adjustment of 0.67 in this July 2007 final rule for the revised ASC payment system is based on the CY 2007 OPPS relative payment weights, with an estimated update factor for CY 2008, the CY 2007 MPFS PE RVUs trended forward to CY 2008, and CY 2005 utilization data projected forward to CY 2008. It is important to note that the budget neutrality estimate in this final rule is illustrative only. The CY 2008 ASC budget neutrality adjustment will be proposed in the CY 2008 OPPS/ASC proposed rule based on the methodology for calculating budget neutrality established in this final rule and incorporating the proposed CY 2008 OPPS relative payment weights, the proposed CY 2008 MPFS PE RVUs, and CY 2006 utilization information projected forward to CY 2008. The final CY 2008 ASC budget neutrality adjustment will be established in the CY 2008 OPPS/ASC final rule with comment period. The final CY 2008 ASC budget neutrality factor will be calculated in that rule in accord with the methodology for calculating budget neutrality established in this July 2007 final rule and based on the final CY 2008 OPPS relative payment weights, the final CY 2008 MPFS PE RVUs, and updated CY 2006 utilization data projected forward to CY 2008. 4. Final Calculation of the Estimated ASC Payment Rates for CY 2008 The following is a step-by-step illustration of the final budget neutrality adjustment calculation. a. Estimated CY 2008 Medicare Program Payments (Excluding Beneficiary Coinsurance) Under the Existing ASC Payment System *Step 1:*
                         Migration from HOPDs to ASCs is valued using estimated CY 2008 OPPS payment rates. (a) We multiply the estimated CY 2008 HOPD utilization for each new ASC procedure by 0.125, consistent with our assumption that 25 percent of the HOPD utilization for new ASC procedures will migrate to the ASC over the first 2 years of the revised ASC payment system, only half of which would be in CY 2008. In estimating HOPD utilization for CY 2008, we take into account the impact of the multiple procedure discount (as discussed in more detail in section V.C.3. of this final rule). (b) For each new ASC procedure, we multiply the results of Step 1(a) by the estimated CY 2008 OPPS payment rate for the procedure, and then subtract beneficiary coinsurance for the procedure. (c) We sum the results of Step 1(b) across all new ASC procedures. *Step 2:*
                         Migration of procedures from physicians' offices to ASCs is valued using estimated CY 2008 physician in-office payment rates. “Physician in-office payment rate” is equal to the MPFS nonfacility practice expense RVUs multiplied by the estimated CY 2008 MPFS conversion factor. (a) We multiply the estimated physician office utilization for CY 2008 for each new ASC procedure by 0.0375, consistent with our assumption that 15 percent of the physician's office utilization for new ASC procedures will migrate to the ASC over the full 4-year transition period. (b) For each new ASC procedure, we multiply the results of Step 2(a) by the estimated CY 2008 physician in-office payment rate for the procedure, and then subtract beneficiary coinsurance for the procedure. (c) We sum the results of Step 2(b) across all new ASC procedures. *Step 3:*
                         CY 2007 ASC services are valued using the estimated CY 2008 ASC payment rates under the current ASC system. To estimate the aggregate expenditures that would be made in CY 2008 under the existing ASC payment system: (a) We multiply the estimated CY 2008 ASC utilization for each HCPCS code on the CY 2007 ASC list by the estimated CY 2008 ASC payment rate for the HCPCS code under the existing ASC payment system, and then subtract beneficiary coinsurance for the procedure. The estimated CY 2008 ASC payment rates are based on the CY 2007 ASC payment rates, which were listed in Addendum AA to the CY 2007 OPPS/ASC final rule with comment period and take into account the OPPS cap on payment for ASC services as required by section 5103 of Public Law 109-171 and reflect the zero percent CY 2008 update for ASC services mandated by section 1833(i)(2)(C) of the Act. In estimating ASC utilization for CY 2008, we take into account the impact of the multiple procedure discount (as discussed in section V.C.3. of this final rule). (b) We estimate the amount the Medicare program would pay in CY 2008 for implantable prosthetic devices and implantable DME for which ASCs currently receive separate payment under the DMEPOS fee schedule. (c) We sum the results of Steps 3(a) and 3(b) to estimate the aggregate amount of expenditures that would be made in CY 2008 for current covered surgical procedures under the existing ASC payment system. *Step 4:*
                         Sum the results of Steps 1-3. b. Estimated Medicare Program Payments (Excluding Beneficiary Coinsurance) Under the Revised ASC Payment System *Step 5:*
                         HOPD migration is valued using estimated CY 2008 OPPS payment rates. This step is the same as Step 1, above. *Step 6:*
                         We identify new ASC procedures that are office-based (as discussed in section III.C. of this final rule). 
                        ( print page 42531) *Step 7:*
                         Migration of new ASC office-based procedures from physicians' offices to ASCs is valued based on estimated CY 2008 OPPS payment rates capped at the estimated CY 2008 physician in-office payment rates, if appropriate. (a) For each new ASC procedure determined to be office-based, we multiply the results of Step 2(a) above by the lesser of— (1) The estimated CY 2008 OPPS rate for the procedure; or (2) The estimated CY 2008 physician in-office payment rate for the procedure, and then subtract beneficiary coinsurance for the procedure. (b) The results of Step 7(a) are summed across all new ASC procedures considered to be office-based. *Step 8:*
                         Migration of new ASC procedures not determined to be office-based from physicians' offices to ASCs is valued using the estimated CY 2008 OPPS rates. (a) For each new ASC procedure not considered to be office-based, we multiply the results of Step 2(a) above by the estimated CY 2008 OPPS rate for the procedure, and then subtract beneficiary coinsurance for the procedure. (b) The results of Step 8(a) are summed across all new ASC procedures not considered to be office-based. *Step 9:*
                         Migration of new ASC procedures from physicians' offices to ASCs is valued using the estimated CY 2008 MPFS physician out-of-office payment rate. “Physician out-of-office payment rate” is equal to the facility practice expense RVUs multiplied by the estimated CY 2008 MFPS conversion factor. (a) For each new ASC procedure, we multiply the results of Step 2(a) from above by the estimated CY 2008 physician out-of-office payment rate for the procedure, and then subtract beneficiary coinsurance for the procedure. (b) The results of Step 9(a) are summed across all new ASC procedures. *Step 10:*
                         Current ASC services are valued using the estimated CY 2008 OPPS payment rates. To estimate the aggregate amount of expenditures that would be made in CY 2008, we use estimated CY 2008 OPPS payment amounts instead of estimated CY 2008 ASC payment amounts under the current system, and we multiply the estimated CY 2008 ASC volume for each HCPCS code on the CY 2007 ASC list by the estimated CY 2008 OPPS payment rate for the HCPCS code, and then subtract beneficiary coinsurance for the procedure. We sum the results over all services on that ASC list. *Step 11:*
                         The results of Steps 5 and 7-10 are summed. c. Calculation of the Final Estimated CY 2008 Budget Neutrality Adjustment *Step 12:*
                         The result of Step 4 is divided by the result of Step 11. *Step 13:*
                         The application of the cap at the estimated CY 2008 physician in-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's office payment cap. The ASC budget neutrality calculation is also calibrated to take into account the fact that the additional physician out-of-office payment rates under the revised ASC payment system calculated in Step 9 must be fully offset by the budget neutrality adjustment to ASC services under the revised payment system. Furthermore, the budget neutrality calculation is calibrated to take into account the CY 2008 transitional payment rates for procedures on the CY 2007 ASC list of covered surgical procedures. d. Calculation of the Final Estimated CY 2008 ASC Payment Rates As described earlier, the application of the methodology to the data available for this final rule results in an estimated budget neutrality adjustment of 0.67. The CY 2008 budget neutrality adjustment for the revised ASC payment system, based on the methodology outlined above, will be proposed in the CY 2008 OPPS/ASC proposed rule and finalized in the CY 2008 OPPS/ASC final rule with comment period, based on the methodology for calculating budget neutrality established in this July 2007 final rule. After developing the estimated CY 2008 budget neutrality adjustment of 0.67 according to the policies established in this final rule, in order to determine the estimated CY 2008 ASC conversion factor we multiply the estimated CY 2008 OPPS conversion factor by the budget neutrality adjustment. At this time, our estimate of the CY 2008 OPPS conversion factor is $63.497. Multiplying the estimated CY 2008 OPPS conversion factor by the 0.67 budget neutrality adjustment yields our estimated CY 2008 ASC conversion factor of $42.543 for this final rule. To determine the fully implemented ASC payment rates for this final rule, including beneficiary coinsurance, according to the final payment methodology that applies to covered surgical procedures and covered ancillary radiology services under the revised ASC payment system, we multiply the ASC conversion factor by the ASC relative payment weight for each procedure or service. As further discussed in sections IV.C. and IV.E. of this final rule, the ASC relative payment weights for certain office-based surgical procedures and covered ancillary radiology services are set so that the national unadjusted ASC payment rate does not exceed the MPFS unadjusted nonfacility practice expense amount. In addition, as discussed in section IV.C of this final rule, the ASC relative payment weights for device-intensive covered surgical procedures are set according to a modified payment methodology to ensure the same device payment under the revised ASC payment system as under the OPPS. We then calculate the estimated CY 2008 payment rate for procedures on the CY 2007 ASC list of covered surgical procedures using a blend of 75 percent of the final CY 2007 ASC payment rate and 25 percent of the estimated revised ASC payment rate developed according to methodology of the revised ASC payment system, applying the special transition treatment to device-intensive procedures as discussed in section IV.J. of this final rule. See Addenda AA and BB to this final rule for the illustrative estimated CY 2008 ASC payment weights and payment rates for covered surgical procedures and covered ancillary services that are expected to be paid separately under the CY 2008 revised ASC payment system. D. Calculation of the ASC Payment Rates for CY 2009 and Future Years 1. Updating the ASC Relative Payment Weights In the August 2006 proposed rule, we proposed to update the ASC relative payment weights each year using the national OPPS relative payment weights for that calendar year, as well as the practice expense payment amounts under the MPFS schedule for that calendar year because some covered office-based surgical procedures and covered ancillary services will be paid according to MPFS amounts if those are less than the rates calculated under the standard methodology of the revised ASC payment system. We further proposed to uniformly scale the ASC relative payment weights for each update year so that estimated aggregate expenditures using updated ASC relative payment weights would be the same as estimated aggregate expenditures using the current year ASC 
                        ( print page 42532)
                        relative payment weights. That is, we proposed to make the relative payment weights budget neutral to ensure that changes in the relative payment weights from year to year would not cause the estimated amount of expenditures to ASCs to increase or decrease as a function of those changes. For example, we proposed 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 would be the same as they would be using the CY 2008 ASC relative payment weights. Similarly, we proposed 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 would be the same as they would be using the CY 2009 ASC relative payment weights. We proposed to scale the relative payment weights annually because we believed that the purpose of using relative payment weights as part of the ratesetting methodology under the proposed revised ASC payment system was only to establish appropriate relativity among surgical procedures paid in ASCs. Changes in weights should not, in and of themselves, change aggregate payment levels under a prospective payment system. 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 outpatient hospital emergency or clinic visits relative to outpatient hospital surgical costs. Moreover, making the ASC relative weights budget neutral would shield the ASC payment system from the inadvertent impact of unrelated aggregate changes in OPPS expenditures. We proposed to continue this methodology to update the revised ASC payment system in future years. *Comment:*
                         Several commenters supported the proposal to annually update ASC relative payment weights using the national OPPS payment weights for the corresponding year; conversely, some commenters also expressed concern regarding our proposed policy of rescaling ASC relative weights. They were concerned that annual rescaling would cause divergence of the relative weights between the OPPS and the revised ASC payment system for individual procedures. *Response:*
                         We appreciate commenters’ support for annually updating ASC relative payment weights in coordination with the OPPS update, consistent with the proposed relationship between the two payment systems. We believe this process would provide more appropriate payments for surgical services under the revised ASC payment system that would reflect ongoing changes in the facility costs associated with different surgical procedures. We also acknowledge commenters’ concerns about our proposed policy of rescaling ASC relative weights. However, we note that rescaling the relative payment weights in the ASC payment system would not cause divergence in the relativity of the weights of various services under the two payment systems. Rescaling of the weights would equally increase or decrease the relative payment weights of services under the revised ASC payment system in comparison to the relative weights of the same services under the OPPS, but only to the extent necessary to ensure that changes in the relative weights do not, in and of themselves, change aggregate payments to ASCs. Rescaling of relative weights or the application of a budget neutrality adjustment is a common feature of Medicare payment systems, designed to ensure that the estimated aggregate payments under a payment system for an upcoming year would be neither greater than nor less than the aggregate payments that would be made in the prior year, taking into consideration any changes or recalibrations for the upcoming year. For example, in CY 2006, as required by section 1833(t)(9)(B) of the Act, we scaled relative weights under the OPPS by applying a budget neutrality adjustment to ensure that changes due to APC reclassification and recalibration changes, wage index changes, and other adjustments were made in a manner that ensured that estimated aggregate OPPS payments for CY 2006 would not exceed aggregate payments for CY 2005 (70 FR 68542). We continue to believe that this principle should apply as well in the revised ASC payment system. We note that while we do not currently have a provider-level dataset of ASC utilization that accurately identifies unique ASCs and their geographic information that would allow us to compare changes in geographic adjustment over time for budget neutrality purposes, we intend to take these changes into account in maintaining budget neutrality for the revised ASC payment system as soon as our provider-level ASC data permit. In addition to considerations that are common to many payment systems, there is another reason for adopting annual rescaling of the relative weights in the revised ASC payment system. Because we are finalizing our proposal to generally employ the relative payment weights developed under the OPPS in the revised ASC payment system as discussed earlier in section IV.B. of this final rule, aggregate payments to ASCs could, in the absence of rescaling, be affected by changes in the cost structure of HOPDs that ought to be relevant only under the OPPS. We provided an example of such a scenario in the August 2006 proposed rule. A sudden increase in the costs of hospital outpatient emergency or clinic visits due, for instance, to an increase in the volume of cases, would have the effect of increasing the weights for these services relative to the weights for surgical procedures in the hospital outpatient setting. In the absence of rescaling, this change in the relative weights under the OPPS would result in a decrease in the relative weights for surgical procedures under the ASC payment system and, therefore, a decrease in aggregate ASC payments for these same procedures. Because ASCs principally receive payment for surgical procedures, aggregate payments to ASCs could decline; ASCs would receive lower payments for surgical procedures without realizing the benefits of the higher payments provided to HOPDs for emergency or clinic visits. As we explained in the August 2006 proposed rule (71 FR 49657), we believe that changes in relative weights each year under the OPPS should not, in and of themselves, cause aggregate payments under the revised ASC payment system to increase or decrease. In fact, scaling the relative weights each year under the revised ASC payment system would serve as a buffer to protect ASCs from sudden changes that could occur under the OPPS. Rescaling of relative payment weights in a budget neutral manner under the revised ASC payment system would thus shield the ASC payment system from the inadvertent impact of unrelated aggregate changes in OPPS expenditures. It is important to note that the specific adjustment factor applied in the scaling process could be positive or negative in any particular year. Annual scaling would prevent both sudden decreases in aggregate payments to ASCs and sudden windfall payments due solely to changes in HOPD costs for nonsurgical services. In the example given above, the scaling adjustment would be positive, that is, scaling would increase the relative weights of all surgical procedures under the ASC payment system in order to maintain aggregate ASC payments for the 
                        ( print page 42533)
                        procedures at the same level, in the absence of other factors affecting the relative payment weights of hospital outpatient emergency or clinic visits and surgical procedures under the OPPS. After considering the public comments we received, we are finalizing our proposal, without modification, to update the ASC relative payment weights in the revised ASC payment system each year using the national OPPS relative payment weights for that same calendar year and to uniformly scale the ASC relative payment weights for each update year to make them budget neutral. For example, holding ASC utilization and the mix of services constant, for CY 2009, we will compare the total weight using the CY 2008 ASC relative payment weights under the 75/25 blend (of the CY 2007 payment rate and the revised payment rate) with the total weight using CY 2009 relative payment weights under the 50/50 blend (of the CY 2007 payment rate and the revised payment rate), taking into account the changes in the OPPS relative payment weights between CY 2008 and CY 2009. We will use the ratio of CY 2008 to CY 2009 total weight to scale the ASC relative payment weights for CY 2009. Scaling of ASC relative payment weights would apply to covered surgical procedures and covered ancillary radiology services whose payment rates are related to OPPS relative payment weights. Scaling would not apply in the case of ASC payment for other separately payable covered ancillary services that have a predetermined national payment amount (that is, their national payment amounts are not based on OPPS relative payment weights) such as drugs and biologicals that are separately paid under the OPPS. Any service with a predetermined national payment amount would be included in the budget neutrality comparison, but scaling of the relative payment weights would not apply to those services that have a predetermined payment amount. The ASC payment weights for those services without predetermined national payment amounts (that is, their national payment amounts would be based on OPPS relative payment weights if a payment limitation did not apply) would be scaled to eliminate any difference in the total payment weight between the current year and the update year. 2. Updating the ASC Conversion Factor Section 1833(i)(2)(C) of the Act requires that, if the Secretary has not updated the ASC payment 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. Therefore, in the August 2006 proposed rule for the revised ASC payment system we proposed to update the ASC conversion factor using the CPI-U in order to adjust ASC payment rates for inflation. We received a number of comments regarding our proposal to use the CPI-U to adjust payments to ASCs for inflation, and these comments and our responses are discussed in section IV.H. of this final rule, which addresses the adjustment for inflation under the revised ASC payment system. We did not receive any public comments regarding our proposal to adjust ASC payments for inflation by applying the inflation adjustment to the conversion factor under the revised ASC payment system. As explained in section IV.H. of this final rule, after consideration of the public comments we received, we are finalizing our proposal under §§ 416.171(a) and (b), without modification, to apply the CPI-U to adjust payments to ASCs for inflation. We will implement the annual update through an adjustment to the conversion factor under the revised ASC payment system, beginning in CY 2010 when the statutory requirement for a zero update no longer applies. E. Annual Updates Currently, under the existing ASC payment system, we update the ASC list of covered surgical procedures every 2 years through the notice and comment regulation process. We make additions to and deletions from the ASC list of covered surgical procedures based on clinical judgment and data that are available regarding utilization of care settings. We last published an updated list of the ASC covered surgical procedures in the CY 2007 OPPS/ASC final rule with comment period (71 FR 67960). Under the revised ASC payment system, which will be implemented effective January 1, 2008, we proposed in the August 2006 proposed rule 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 payment rate. To the extent possible under the rules and policies of the revised ASC payment system, we proposed to maintain consistency between the OPPS and the ASC payment system in the way we treat new and revised HCPCS and CPT codes for payment under the ASC payment system. We also proposed 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 proposed to update the ASC list of covered surgical procedures and payment system as part of the annual proposed and final rulemaking cycle updating the hospital OPPS. We believed 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 covered surgical procedures for which Medicare makes payment to ASCs 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 August 2006 proposed rule for the revised ASC payment system, we proposed to issue a final rule in the first part of CY 2007 in which we would respond to comments submitted timely regarding the proposals set forth in that proposed rule and make final the policy and regulations for the revised ASC payment system for implementation effective January 1, 2008. We also proposed to include the CY 2008 ASC payment rates for surgical procedures payable in an ASC as part of the proposed and final rules for the CY 2008 OPPS update. In addition, in the August 2006 proposed rule we proposed to evaluate each year all new 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 identify the facility resources required to perform them, we proposed to use other available information, including our clinical advisors' judgment, predecessor CPT and Level II 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 
                        ( print page 42534)
                        the new codes to be active January 1 of the update year. The ASC payment system treatment of those procedures would be open to comment on that final rule, and we would respond to comments about our interim 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 a new code was that it should reside on the ASC list of covered surgical procedures as an office-based procedure subject to the payment limitation, this determination would remain preliminary until we were able to consider more recent volume and utilization data for each individual procedure code and/or, if appropriate, the clinical characteristics, utilization, and volume of related codes. Using that information, if we confirmed our determination that the new code was appropriately assigned to an office-based payment indicator, it would then be permanently assigned to the list of office-based procedures subject to the payment limitation. Accordingly, we proposed to reflect this annual rulemaking and publication of revised payment methodologies and payment rates in new § 416.173 in proposed new Subpart F. *Comment:*
                         Several commenters recommended that CMS continue to consider the input of interested parties submitting comments regarding the assignment of HCPCS codes to appropriate APCs, additions to and deletions from the ASC list of covered surgical procedures, and creation of payment mechanisms to account for new technology. *Response:*
                         As stated in our August 2006 proposal for the annual update process, we intend to invite comments from interested parties as part of the consolidated annual update cycle for updating the hospital OPPS and revised ASC payment system. As always, the OPPS treatment, including APC assignments, of all HCPCS codes would be open to comment, and we proposed also to invite comment regarding whether 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. This approach is consistent with the recommendation of the PPAC that we utilize a process for the revised ASC payment system to obtain input from national medical specialty societies and the ASC community in order to provide payment to ASCs for all safe and appropriate procedures and to allow for changes in technology and evolution in medical practice. Annual updating will provide for the adaptable methodology that the PPAC recommends for the revised ASC payment system. *Comment:*
                         Some commenters supported our proposal for the annual updates, indicating that the proposed alignment of annual updates to the revised ASC payment system with the OPPS updates is appropriate and allows the industry to review and contemplate the changes in both payment systems simultaneously. *Response:*
                         We appreciate the commenters' support and continue to 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 ASCs 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. We believe this approach is especially appropriate, given the final policy of the revised ASC payment system as discussed further in section IV.B. of this final rule, to use the APC groups and 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 paid in ASCs beginning in CY 2008. The annually updated OPPS device offset percents will be used to establish ASC payment rates for device-intensive procedures. In addition, according to the final policies established in this final rule, the OPPS relative payment weights and rates will be used as the basis for the payment of most covered ancillary services under the revised ASC payment system, so coordinated annual updating of the OPPS and the revised ASC payment system is particularly important. *Comment:*
                         A number of commenters indicated that many ASCs were interested in submitting bills to Medicare using the same claim form that is used by HOPDs, the CMS UB-92 (soon to be the UB-04), so that CMS would have additional information available for the annual ASC update under the revised ASC payment system. The commenters stated that the CMS-1500 billing form currently used by most Medicare Part B providers and suppliers, including ASCs, limits the amount of information that ASCs can report on claims. The commenters expressed concern that, as a result of having to use the CMS-1500, the true costs incurred by ASCs to provide services are not available to CMS and that, consequently, CMS cannot include actual ASC costs in its analyses to develop and update the revised payment system. They recommended that ASCs be allowed to report to CMS the same level of detail about the services they provide as do HOPDs. Further, the commenters stated that it would be less burdensome than the current Medicare billing policy because ASCs already use the UB-92 to submit bills to commercial payors. Thus, they concluded that allowing ASCs to use the UB-92 for Medicare Part B billing would be advantageous for both CMS and ASCs, because ASCs could provide more detailed cost information to CMS and this change would reduce the administrative burden on ASCs that currently are maintaining billing capabilities for both the CMS-1500 and UB-92 formats. *Response:*
                         For future ASC update years, we will explore the feasibility of adopting the ASC billing change recommended by commenters, but this is not a change that we can make by January 2008. We understand the commenters' concerns in this regard and investigated the possibility of implementing this recommendation as part of the revised payment system, effective January 2008. A policy change that requires ASCs to use a different billing format would have to incorporate adequate time for CMS and ASCs to make the necessary systems changes and for CMS to provide training for contractors and ASCs prior to implementing the new format. Although we will continue to explore this recommendation, not only is there insufficient time to make systems changes and provide training before implementation of the revised ASC payment system, but CMS is in the midst of a comprehensive reorganization of its contracting functions, making adoption of any significant billing change at this time even more challenging. During the next few years, Medicare Part A and B claims will be processed by reconfigured contracting entities, and we believe that allowing ASCs to bill using the same format as HOPDs should be explored as part of that larger contractor reform. We plan to pursue the feasibility of this option and to coordinate any possible change to ASC billing requirements with CMS' overall contracting transition. We welcome additional information from the public regarding recommendations for ASC billing 
                        ( print page 42535)
                        modifications or improvements that we should consider once the revised payment system is implemented. We note that, under our final annual update methodology for the revised ASC payment system, we would not require ASC information beyond that currently available to us through the CMS-1500 in order to annually update the ASC payment system. After consideration of the public comments we received, we are finalizing our proposal as reflected in § 416.173, without modification, to annually update the ASC conversion factor, the relative payment weights and OPPS APC assignments of covered surgical procedures paid in ASCs, the ASC payment rates, and the list of surgical procedures for which Medicare would not make payment to ASCs as part of the annual proposed and final rulemaking cycle updating the hospital OPPS. In addition, we will annually update the list of covered ancillary services and their ASC payment rates. We also are finalizing our proposal, without modification, to evaluate each year all new HCPCS codes that describe surgical procedures to make preliminary determinations regarding whether they should be payable in the ASC setting and, if so, whether they are office-based procedures. The ASC treatment of these procedures would be open to comment in the final rule, and we would provide responses in the final rule for the following calendar year. Designations of new surgical procedure codes as office-based would remain preliminary until there are adequate physicians' claims data to assess their predominant sites of services, whereupon if we confirm their office-based nature, the codes would be permanently assigned to the list of office-based procedures subject to the ASC payment limitation. VI. Information in Addenda Related to the Revised CY 2008 ASC Payment System We include addenda to the preamble of proposed and final rules updating the ASC payment system to present national ASC unadjusted payment rates, by HCPCS code, and other factors that affect ratesetting. For example, in Addendum BB to the August 2006 proposed rule for the revised ASC payment system, we listed the HCPCS codes of surgical procedures for which we proposed to allow payment to ASCs in CY 2008, the short descriptors for those codes, and whether or not the code was proposed to be newly added to the list of covered surgical procedures. We also indicated for each HCPCS code: (1) Whether or not we proposed to designate it as office-based; (2) whether or not we proposed to cap it at the MPFS nonfacility practice expense rate; (3) the estimated proposed CY 2008 ASC relative payment weight; (4) the estimated proposed CY 2008 full payment and coinsurance amounts; and (5) the estimated proposed CY 2008 transitional payment and coinsurance amounts using a 50/50 blend of the current and proposed new rates. Addendum CC to the August 2006 proposed rule listed the specific subset of HCPCS codes and their short descriptors for procedures proposed for payment limitation at the MPFS nonfacility practice expense amount under the revised ASC payment system. We will continue to use addenda to summarize, as part of the annual proposed and final OPPS/ASC rules updating both payment systems, the annual update of the relative payment weights of ASC covered surgical procedures, the national unadjusted ASC payment amounts for those procedures, the procedures designated as office-based that are subject to payment limitation at the MPFS nonfacility practice expense amount, and other pertinent information that bears on the determination of the payment status and payment rates for services under the revised ASC payment system for the update year. We will also summarize in the addenda the covered ancillary services that will be separately paid under the revised ASC payment system if they are integral to the performance of a covered surgical procedure, including their updated relative payment weights as appropriate, the national unadjusted ASC payment amounts for those services, and other pertinent information. Although we are including addenda to this final rule, we emphasize that the information presented in these addenda is intended solely to demonstrate the payment rates that result from application of the revised ASC payment system methodology that we are finalizing in this final rule based on the most current data available. We caution readers that the illustrative relative payment weights, national payment amounts, and other information shown in the addenda to this final rule are neither the proposed nor final ASC rates for the CY 2008 revised ASC payment system. The information in the addenda to this final rule exemplifies the results of applying the revised ASC payment system methodology implemented in this final rule to the final or most recently updated CY 2007 OPPS information, with application of the estimated CY 2008 OPPS update, including the CY 2007 APC groupings and relative payment weights, the CY 2007 second quarter OPPS payment rates for drugs and biologicals, the CY 2007 OPPS payment methodology for brachytherapy sources, the specification of surgical procedures as subject to OPPS multiple procedure discounting, the designation of surgical procedures as inpatient only under the OPPS, the identification of surgical procedures for which payment is packaged under the OPPS rather than separately paid, and the CY 2007 OPPS device-dependent APCs and their respective device offset percents. The information is also based on the most recently available Part B utilization data derived from the full year of CY 2005 ASC and physicians' claims, and the CY 2008 estimated transitional nonfacility practice expense payment amounts for the CY 2008 MPFS, with application of the projected CY 2008 MPFS update. We reiterate that the information in the addenda to this final rule does not represent the rates that we will be proposing for implementation in CY 2008 under the revised ASC payment system, but merely serves to illustrate application of the final ratesetting methodology under the revised ASC payment system. All information included in Addendum AA and Addendum BB to this final rule is subject to change in the annual cycle of notice and comment rulemaking to update the OPPS/ASC payment rates for CY 2008, with the exception of the office-based designation of procedures whose designation is not marked as temporary. We note that we have also included in Addenda AA and BB to this final rule HCPCS codes for those surgical procedures, radiology services, implantable devices, and drugs and biologicals whose payment is packaged under the OPPS and which, therefore, would not be eligible for separate ASC payment as covered surgical procedures or covered ancillary services, in order to facilitate review of the ASC payment policies for these groups of services. Payment to ASCs under the revised ASC payment system for these services would also be packaged. We will propose the relative payment weights, payments rates, and other pertinent ratesetting information for the CY 2008 revised ASC payment system in the OPPS/ASC proposed rule to update both payment systems for CY 2008. This proposed rule will be issued in mid-summer of CY 2007. The relative payment weights and payment rates and other pertinent ratesetting information proposed for the revised ASC payment system in CY 2008 will be based on proposed CY 2008 OPPS payment weights and APC groups, proposed CY 
                        ( print page 42536)
                        2008 MPFS nonfacility practice expense payment amounts, CY 2007 second quarter OPPS payment rates for drugs and biologicals as established based on the ASP information for that quarter, and the most recent Part B utilization data available to us from CY 2006 claims. CMS will publish final relative payment weights and final payment rates and other pertinent ratesetting information for the CY 2008 revised ASC payment system in the final OPPS/ASC rule that updates both payment systems for CY 2008. Changes in CY 2008 payments for physicians' services under the MPFS, in first quarter CY 2008 prices for drugs and biologicals based on the most recent available ASP data, and in CY 2008 HCPCS codes and pricing of OPPS services that may occur and that would affect the CY 2008 revised ASC payment system between publication of the CY 2008 OPPS/ASC final rule and release of the January 2008 OPPS PRICER and the ASC payment files will be reflected in updated addenda that we will post on the CMS Web site. We have created Addendum DD1 to this final rule to define ASC payment indicators that we will use in Addenda AA and BB to provide payment information regarding covered surgical procedures and covered ancillary services, respectively, under the revised ASC payment system. Analogous to the OPPS payment status indicators that we publish in Addendum D1 as part of the annual OPPS rulemaking cycle, the ASC payment indicators in Addendum DD1 are intended to capture policy-relevant characteristics of HCPCS codes that may receive packaged or separate payment in ASCs, including their ASC payment status prior to CY 2008; their designation as device-intensive; their designation as office-based and the corresponding ASC payment methodology; and their classification as a separately payable radiology service, brachytherapy source, OPPS pass-through device, corneal tissue acquisition service, drug or biological, or NTIOL. VII. ASC Regulatory Changes In the August 23, 2006 proposed rule, we proposed to modify applicable ASC regulations under 42 CFR Parts 410, 414, and 416 to incorporate the requirements and conditions for payments for ASC facility services under the revised payment system that was proposed for implementation beginning January 1, 2008. A. Regulatory Changes That Were Finalized in the CY 2007 OPPS/ASC Final Rule With Comment Period In the August 23, 2006 proposed rule (71 FR 49631), we proposed the following regulatory changes which we finalized in the CY 2007 OPPS/ASC final rule with comment period (71 FR 68174). We proposed to revise the current regulations at Part 416, Subparts D and E, to ensure that the rules governing the current ASC payment system are clearly distinguishable from those that would apply to the revised system beginning January 1, 2008.
                    We proposed to revise Subparts D and E to Part 416 to reflect the rules governing the ASC payment system prior to January 1, 2008.
                    We proposed to redesignate existing Subpart F as Subpart G under Part 416 to codify the rules governing the ASC payment adjustment for NTIOLs (71 FR 49631).
                    We proposed several technical changes to Part 416 (71 FR 49659).
                    We proposed to revise existing § 416.1 (Basis and scope) to remove the obsolete reference to “a hospital outpatient department,” and to add provisions of section 5103 ofPublic Law 109-171 and applicable provisions of Public Law 108-173.
                    We proposed to revise existing § 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 proposed to remove the obsolete cross-reference in paragraph (a)(4) to § 405.310 and replace it with the correct cross-reference to § 411.15.
                    We proposed to revise § 416.125 (ASC facility services payment rate) to incorporate the limitation on payment imposed by section 5103 ofPublic Law 109-171.
                    We proposed to revise § 488.1 (Definitions) to add ambulatory surgical centers to the definition of a supplier in conformance with section 1861(d) of the Act.
                    We proposed to add new § 416.76 and new § 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. The bases for these proposed regulatory changes were discussed in detail throughout the preamble of the August 23, 2006 proposed rule. We did not receive any public comments on these proposed revisions. In the CY 2007 OPPS/ASC final rule with comment period, we made these provisions final as proposed, without modification (71 FR 68174). B. Regulatory Changes Included in This Final Rule In the August 23, 2006 proposed rule (71 FR 49699), we proposed to add a new Subpart F to Part 416 entitled “Subpart—Coverage, Scope of ASC Facility Services, and Prospective Payment System for Facility Services Furnished On or After January 1, 2008,” which would include the following new sections: § 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. We also proposed a technical change to 42 CFR Part 414 to conform with changes we were proposing under Part 416, new Subpart F (71 FR 49659), and we likewise proposed to revise § 410.152(i) to make it consistent with provisions of the revised ASC payment system. The numerous public comments that we received regarding the revised ASC payment system we proposed to implement January 1, 2008, are addressed in detail throughout the preamble of this final rule. As a result of our review of the public comments, in this final rule, we have made a number of modifications to our proposals for the revised ASC payment system. These modifications, which are also discussed in detail in other sections of this final rule, have necessitated corresponding changes in the regulations that we proposed for the revised ASC payment system. The following is a summary of changes to 42 CFR 410 and 416 that reflect those modifications, which we are finalizing in this final rule. We added a new paragraph (i)(2) under § 410.152 to specify the amount of payment the Medicare program makes for ASC services beginning January 1, 2008.
                    We decided not to finalize the proposed revision of § 414.22(b)(5)(i)(B) in this final rule.
                    In § 416.2, we revised the definitions of “ASC services,” “Covered surgical procedures,” and “Facility( print page 42537)
                        services,” and we added a definition of “Covered ancillary services.”
                    We added new Subpart F, as proposed, but modified the title to read “Coverage, Scope of ASC Services, and Prospective Payment System for ASC Services Furnished on or after January 1, 2008.” We also modified certain proposed sections under Subpart F and added other provisions as outlined below.
                    We revised the section headings of §§ 416.161 and 416.164 to read “Applicability of this subpart” and “Scope of ASC services,” respectively. We also revised the section heading of § 416.171 to read “Determination of payment rates for ASC services.” In addition, we added new § 416.179 with a new section heading. We added § 416.160(a)(4), which addresses payment rules for screening flexible sigmoidoscopy and screening colonoscopy services. Also, we reordered the paragraphs of § 416.160.
                    We revised § 416.160(b) to conform the text with the changes to the definitions in § 416.2.
                    We made a technical change to §§ 416.163(b) and (c) to specify that payment for anesthetists' services is made in accordance with42 CFR part 414, in addition to editorial changes to § 416.163(a) to reference ASC services rather than ASC facility services.
                    We revised § 416.164(a), “Included facility services,” and we renamed and revised § 416.164(b) as “Covered ancillary services,” to reflect the policy regarding the packaging of services which is made final in section IV.C. of this final rule. Proposed § 416.164(b) becomes final § 416.164(c), “Excluded services,” where we revised anesthetists' services, which are paid under42 CFR part 414 and where we changed x-ray procedures to radiology services and separated diagnostic procedures and radiology services into separate items. Also, “Excluded services” no longer includes costs incurred to procure corneal tissue.
                    In § 416.166(c), “General exclusions,” we deleted the phrase “other medical procedures” from the introductory sentence to conform with the definition of the type of procedures covered under the ASC benefit as discussed in section III. of this final rule. We moved the criterion proposed as paragraph (c)(5) (regarding the expected requirement for active medical monitoring and care at midnight following the procedure) to § 416.166(b) as an element of the “General standards.” We also added the following as new criteria for exclusion of a procedure from coverage when performed in an ASC: (1) Commonly require systemic thrombolytic therapy; (2) are designated as requiring inpatient care under § 419.22(n); and (3) can only be reported using a CPT unlisted surgical procedure code.
                    We made technical and editorial changes to § 416.167(a) and (b) to reference payment for ASC services and covered ancillary services.
                    We revised § 416.171 to reflect the modifications that we are making final in this final rule regarding separate payment for certain covered ancillary services and the extension of transitional payment rates from 1 to 3 years, as discussed in section IV. J. of this final rule.
                    We revised § 416.172 as follows: (1) Made minor changes to paragraphs (a), (b), (d), and (e) to reference ASC services and to clarify that the comparison for purposes of assessing the lesser of the actual charge or the prospective rate is to the geographically adjusted payment rate; and (2) revised paragraph (c) to exclude application of a geographic adjustment to payment rates for certain drugs, devices, and brachytherapy sources, as discussed in section IV. C. of this final rule. In addition, we added new paragraph (f) to reflect the payment adjustment when ASC services are interrupted due to circumstances that threaten the well-being of the beneficiary. We also added new paragraph (g) to reflect the payment adjustment for the insertion of NTIOLs.
                    We made editorial changes to § 416.173 and § 416.178.
                    We added new § 416.179, “Payment and coinsurance reduction for devices replaced without cost or when full credit is received,” as discussed in section IV.C. of this final rule. VIII. Files Available to the Public Via the Internet Addenda AA, BB, and DD1 to this final rule provide various data pertaining to the CY 2008 ASC list of covered procedures and the covered ancillary services that will be separately paid to ASCs beginning in CY 2008 when provided by an ASC as integral to a covered surgical procedure on the same day as the procedure. All relative payment weights and payment rates are illustrative only, demonstrating the payment rates that result from application of the revised ASC payment system methodology that we are finalizing in this final rule based on the most current data available. They exemplify the results of applying the revised ASC payment system methodology implemented in this final rule to the final or most recently updated CY 2007 OPPS information as updated by the currently estimated CY 2008 OPPS update factor and to the CY 2008 estimated transitional nonfacility practice expense amounts for the CY 2008 MPFS, with application of the projected CY 2008 MPFS update. As further discussed in section VI. of this final rule, Addendum DD1 defines the payment indicators that are used in Addenda AA and BB of this final rule, while Addenda AA and BB provide payment information regarding covered surgical procedures and covered ancillary services under the revised ASC payment system. These addenda, as well as the final rule preamble tables and other supporting data files, are included on the CMS Web site at: 
                        *http://www.cms.hhs.gov/​ASCPayment/​*
                         in a format that can easily be downloaded and manipulated. Proposed and final ASC relative weights and payment rates for CY 2008 will be published in the proposed and final CY 2008 OPPS/ASC rules, respectively, and related data files will be included on the CMS Web site as noted above. The OPPS data files are available to the public on the CMS Web site at: 
                        *http://www.cms.hhs.gov/​HospitalOutpatientPPS,*
                         and the MPFS data files are located at: 
                        *http://www.cms.hhs.gov/​PhysicianFeeSched.* We are not including as addenda to this final rule reprints of the final FY 2007 IPPS wage indexes that were included in a notice published in the 
                        **Federal Register**
                         on October 11, 2006 (71 FR 59886). Rather, we are providing a link on the CMS Web site at: 
                        *http://www.cms.hhs.gov/​AcuteInpatientPPS/​WIFN*
                         to all of the final FY 2007 IPPS wage index related tables. The final CY 2008 ASC payment system will utilize the FY 2008 IPPS wage index related tables that will be proposed and finalized in the FY 2008 IPPS rulemaking cycle, and we will provide a link on the CMS Web site to those proposed and final wage index related tables in the CY 2008 OPPS/ASC proposed and final rules, respectively. For additional assistance, contact Gift Tee, (410) 786-0378. IX. Collection of Information Requirements This document does not impose any information collection and recordkeeping requirements. Consequently, it need not be reviewed by the Office of Management and Budget under the authority of the Paperwork Reduction Act of 1995 (44 U.S.C. 35). 
                        ( print page 42538) X. Regulatory Impact Analysis A. Overall Impact We have examined the impacts of this final 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. 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 revised ASC payment system and the expanded ASC list of covered surgical procedures that we are implementing in CY 2008 will have no net effect on Medicare expenditures compared to the level of Medicare expenditures that would have occurred in CY 2008 in the absence of the revised payment system. A more detailed discussion of the effects of the changes to the ASC list of covered surgical procedures and the effects of the revisions to the ASC payment system in CY 2008 is provided in section X.B. below. While we estimate that there will be no net change in Medicare expenditures in CY 2008 as a result of the revised ASC payment system, we estimate that the revised system will result in savings of $240 million over 5 years due to migration of new ASC covered surgical procedures from HOPDs and physicians’ offices to ASCs over time. In addition, we note there will be a total increase in Medicare payments to ASCs for CY 2008 of approximately $270 million compared to Medicare expenditures that would have occurred in CY 2008 in the absence of the revised payment system. These additional payments to ASCs of approximately $270 million in CY 2008 will be fully offset by savings from reduced Medicare spending in HOPDs and physicians’ offices on services that migrate from these settings to ASCs in CY 2008 (as discussed in detail in section V.C. of this final rule). Therefore, this final 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 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 jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of $9 million to $31.5 million in any 1 year (65 FR 69432). For purposes of the RFA, we have determined that approximately 73 percent of ASCs would be considered small businesses according to the Small Business Administration (SBA) size standards. Individuals and States are not included in the definition of a small entity. We anticipate that this final rule will have a significant impact on a substantial number of small entities. 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 604 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital with fewer than 100 beds that is located outside of a Metropolitan Statistical Area (MSA). The Secretary certifies that this final rule will not have a significant impact on the operations of a substantial number of small rural hospitals. 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. This final 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, or otherwise has Federalism implications. We have examined this final 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. The changes related to payments to ASCs in CY 2008 will not affect payments to government hospitals. B. Effects of Revisions to the ASC Payment System for CY 2008 In CY 2008, we are implementing a 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 greatly expanding the list of procedures that will be eligible for payment under the revised ASC payment system. Second, we are moving from a limited fee schedule based on nine disparate payment groups to a payment system incorporating relative payment weights for groups of procedures with similar clinical and resource characteristics, based on the APCs that are key elements of the OPPS. Implementation by January 1, 2008 of a revised ASC payment system designed to result in budget neutrality is mandated by section 626 of Public Law 108-173. To set ASC payment rates for CY 2008 under the revised payment system, we are multiplying ASC relative payment weights for surgical procedures by an ASC conversion factor that we calculate to result in the same amount of aggregate Medicare expenditures for those services in CY 2008 as we estimate would have been made if the revised payment system were not implemented. The effects of the expanded numbers and types of procedures for which an ASC payment may be made and other policy changes that affect the revised payment system, combined with significant changes in payment rates for covered surgical procedures, will 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, the extent to which ASCs will offer different services, and the percentage of its patients that are Medicare beneficiaries. In this July 2007 final rule for the revised ASC payment system, we have estimated the CY 2008 ASC payment rates, budget neutrality factor, and impacts using the CY 2007 OPPS relative payment weights with an estimated update factor for CY 2008, the CY 2007 MPFS PE RVUs trended forward to CY 2008, and CY 2005 
                        ( print page 42539)
                        utilization data projected forward to CY 2008. We emphasize that the impact estimates in this final rule are illustrative only. The CY 2008 ASC payment rates and budget neutrality factor will be proposed in the CY 2008 OPPS/ASC proposed rule based on the methodology for calculating budget neutrality established in this final rule and incorporating the proposed CY 2008 OPPS relative payment weights, the proposed CY 2008 MPFS PE RVUs, and CY 2006 utilization information projected forward to CY 2008. The final CY 2008 ASC payment rates and budget neutrality factor will be established in the CY 2008 OPPS/ASC final rule with comment period, in accordance with the methodology for calculating budget neutrality established in this final rule and based on the final CY 2008 OPPS payment weights, the final CY 2008 MPFS RVUs, and updated CY 2006 utilization data projected forward to CY 2008. As discussed fully in section V.C. of this final rule, our final methodology for calculating the budget neutrality factor considers not only the effects of the new payment rates to be implemented under the revised payment system, but also the estimated net effect of migration of new ASC procedures across ambulatory care settings. The methodology for calculating the budget neutrality adjustment factor finalized in this rule assumes that over the first 2 years of the revised payment system, approximately 25 percent of the HOPD volume of new ASC procedures would migrate from the HOPD service setting to ASCs, and that over the 4-year transition period, approximately 15 percent of the physicians' office volume of new ASC procedures would migrate to ASCs. We estimate that the revised ASC payment system established in this final rule will result in neither savings nor costs to the Medicare program in CY 2008. That is, because it is designed to be budget neutral, in CY 2008, the revised ASC payment system will neither increase nor decrease expenditures under Part B of Medicare. We further estimate that beneficiaries will save approximately $20 million under the revised ASC payment system in CY 2008, because ASC payment rates will, in most cases, be lower than OPPS payment rates for the same services and, because, except for screening flexible sigmoidoscopy and screening colonoscopy procedures, beneficiary coinsurance for ASC services is 20 percent rather than 20 to 40 percent as is the case under the OPPS. (The only possible instance in which an ASC coinsurance amount could exceed the OPPS copayment amount would be when the coinsurance 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, but there is no such requirement related to the ASC coinsurance amount.) Beneficiary coinsurance for services migrating from physicians' offices to ASCs may decrease or increase under the revised ASC payment system, depending on the particular service and whether the Medicare payment to the physician for providing that service in his or her office is higher or lower than the sum of the Medicare payment to the ASC for providing the facility portion of that service and the Medicare payment to the physician for providing that service in a facility (nonoffice) setting. As noted previously, the net effect of the revised ASC payment system on beneficiary coinsurance, taking into account the migration of services from HOPDs and physicians' offices, is estimated to be $20 million in beneficiary savings in CY 2008. 1. Alternatives Considered We are issuing this final rule to meet a statutory requirement to implement, no later than January 1, 2008, a revised payment system for ASCs. We are implementing the revised ASC payment system through rulemaking in the 
                        **Federal Register**
                        . Through the August 2006 proposed rule, we have afforded interested parties an opportunity to comment on revisions we proposed to make to the policies and rules for identifying surgical procedures that would be excluded from payment in ASCs, to the ASC ratesetting methodology and payment policies, and to the regulations for the revised ASC payment system. Throughout the preamble of this final rule, we discuss the various options we considered as we developed policies to redesign the ASC payment system in broad terms, and specific policies, such as those affecting payment for covered ancillary services integral to covered surgical procedures, the definition of a covered surgical procedure, criteria for identifying procedures that are not safely or appropriately performed in an ASC, and the payment methodology for device-intensive procedures, among others. Although we proposed to phase in the new ASC payment rates under the revised payment system over a 2-year period, we are finalizing a policy to phase in the ASC payment rates under the revised payment system over a 4-year period. As we discuss in section X.B.3. of this final rule, we believe that allowing a longer transition period 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 decrease significantly under the revised payment system. We believe the 4-year transition will give ASCs time to reconfigure their mix of services and make other needed adjustments so they can focus on achieving more efficient delivery of a broader range of surgical procedures. 2. Limitations of Our Analysis Presented here are the projected effects of the policy and statutory changes that will be effective for CY 2008 on aggregate ASC utilization and Medicare payments. One limitation of this analysis is that we could only infer the effects of the revised payment system on different types of ASCs, for example, single or multispecialty, high or low volume, and urban or nonurban ASCs, based on an overall comparison of procedure volumes and facility payments between the current and the revised payment system. At this time, we do not have a provider-level dataset of CY 2005 ASC utilization that accurately identifies unique ASCs and their geographic information that would allow us to compare estimated payments and geographic adjustment among classes of ASCs based on a provider-level analysis. A second limitation is our lack of information on ASC resource use. ASCs are not required to file Medicare cost reports and, therefore, we do not have cost information to evaluate whether or not the payments for ASC services coincide with the resources required by ASCs to provide those services. A third limitation is our inability to predict changes in service mix between CY 2005 and CY 2008. The aggregated impact tables below are based upon a methodology that assumes no changes in service-mix with respect to the CY 2005 ASC data used for this final rule. We believe that the net effect on Medicare expenditures of changes in service-mix for current ASC covered surgical procedures will be negligible, in the aggregate. Such changes may have differential effects across surgical specialty procedure groups as ASCs adjust to the revised payment system. However, we are unable to accurately project such changes at a disaggregated level. Clearly, individual ASCs will experience changes in payment that 
                        ( print page 42540)
                        differ from the aggregated estimated changes presented in the tables below. Because we do not have experience with ASC payment under the revised payment system, we have relied on comments and information from stakeholders in response to our August 2006 proposed rule for the revised ASC payment system to mitigate the limitations in the data available to us for analysis of the impact of the changes on specific procedures, on classes of specialty ASCs, and on beneficiaries. 3. Estimated Effect of This Final 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, gastrointestinal procedures, or orthopedic surgery. The combined effect on an individual ASC of the CY 2008 revised payment system and the expanded ASC list of covered surgical procedures will 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, the percentage of its patients who are Medicare beneficiaries, and the extent to which an ASC will choose to provide different services under the revised payment system. The following discussion presents two tables that provide estimates of the impact of the revised ASC payment system on Medicare payments to ASCs for current ASC services, assuming the same mix of services as offered by ASCs in our CY 2005 claims data. The first table depicts aggregate percent change in payment by surgical specialty group and the other compares payment for procedures estimated to receive the most payment in CY 2008 under the current payment system. In section IV.J. of this final rule, we finalize our policy of a transition of 4 years for the revised payment rates, rather than the proposed 2-year transition, where payments will generally be made using a blend of the rates based on the CY 2007 ASC payment rate and the revised ASC payment rate. In comparing estimated payment rates for CY 2008 under the existing system with the estimated payment rates for CY 2008 under the revised system, we noted the negative effect the estimated proposed payment rates would have on Medicare payments to ASCs for certain surgical procedures that currently are performed frequently in ASCs. We were 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 revised system and wanted to encourage ASCs to continue to provide access to the high volume procedures that are currently performed there because, in all likelihood, the ASC has become an extremely efficient setting for those procedures, such as cataract extractions and colonoscopies. Moreover, we believe that a positive outcome of the revised ASC payment system could be to expand beneficiary and physician choice in selection of an appropriate site for ambulatory surgical services, as a consequence of the expansion of surgical procedures for which Medicare will make an ASC payment and the revised rates that will pay more appropriately for those services. We believe a 4-year transition will give ASCs additional time to reconfigure their mix of surgical services and make other needed adjustments so that they can focus on achieving more efficient delivery of a broader range of surgical procedures. In CY 2008, we will pay ASCs using a 75/25 blend, in which payment will be calculated by adding 75 percent of the CY 2007 ASC rate for a surgical procedure on the CY 2007 ASC list of covered surgical procedures and 25 percent of the revised CY 2008 ASC rate for the same procedure. For CYs 2009 and 2010, the blend will be transitioned first to 50/50 and then to a 25/75 blend of the CY 2007 ASC rate and the revised ASC payment rate. Beginning in CY 2011, payments will be made to ASCs for covered surgical procedures on the CY 2007 ASC list at the fully implemented revised ASC payment rates. Procedures that were not included on the ASC list of covered surgical procedures in CY 2007 will not be paid at the transitional rates for CYs 2008 through 2010 because they have no CY 2007 ASC payment rate. Those procedures will be paid at the fully implemented ASC rate, beginning in CY 2008. Table 11 shows the impact of the revised payment system at the surgical specialty group level. We have aggregated the surgical HCPCS codes by specialty group and estimated the effect on aggregated payment for surgical specialty groups, considering separately the CY 2008 transitional rate and the fully implemented revised payment rate. The groups are sorted for display in descending order by estimated Medicare program payment to ASCs for CY 2008 in the absence of the revised ASC payment system. The following is an explanation of the information presented in Table 11: Column 1—*Surgical Specialty Group*
                         indicates the surgical specialties into which ASC procedures are grouped. We used the CPT code range definitions and added the related Level II HCPCS codes and Category III CPT codes, as appropriate, to account for all surgical procedures to which the Medicare program payments are attributed.
                    Column 2—*Estimated CY 2008 ASC Payments*
                         in the absence of the revised ASC payment system were calculated by multiplying the CY 2007 ASC payment rate by CY 2008 ASC utilization (which is based on CY 2005 ASC utilization multiplied by a factor of 1.305 to take into account expected volume growth with volume adjustment, as appropriate, for the multiple procedure discount). The resulting amount was then multiplied by 0.8 to estimate the Medicare program's share of the total payments to the ASC. The payment amounts are expressed in millions of dollars.
                    Column 3—*Estimated CY 2008 Percent Change with Transition (75/25 Blend)*
                         is the aggregate percentage increase or decrease in Medicare program payment to ASCs for each surgical specialty group that is attributable to changes in the ASC payment rates for CY 2008 under the 75/25 blend of the CY 2007 ASC payment rate and the revised ASC payment rate.
                    Column 4—*Estimated CY 2008 Percent Change without Transition (Fully Implemented)*
                         is the aggregate percentage increase or decrease in Medicare program payment to ASCs for each surgical specialty group that is attributable to changes in the ASC payment rates for CY 2008 if there were no transition period to the revised payment rates. The percentages appearing in column 4 are presented as a comparison for the transition policy in column 3 and do not depict the impact of the fully implemented proposal in CY 2011. Table 11 reflects the changes for ASCs at the surgical specialty level and shows that for all but gastrointestinal procedures, if an ASC offers the same mix of services in CY 2008 that is reflected in our national CY 2005 claims data, Medicare payments to the ASC for services in that surgical specialty area would be estimated to increase under the revised payment system. If the revised payment system were fully implemented in CY 2008, we would expect all but gastrointestinal procedures and nervous system procedures to receive greater Medicare payment. In addition to the impacts on 
                        ( print page 42541)
                        Medicare payments for current ASC procedures shown in Table 11, it is important to note that overall CY 2008 payments to ASCs are estimated to increase by about $270 million as a result of the revised payment system. This increased spending in ASCs is projected to be fully offset by savings from reduced spending in HOPDs and physicians’ offices due to service migration. Table 11.—Estimated CY 2008 Impact of the Revised ASC Payment System on Estimated Aggregate CY 2008 Medicare Program Payments Under the 75/25 Transition Blend and Without a Transition, by Surgical Specialty Group
Surgical specialty group
Estimated
                                 CY 2008 
                                 ASC payments 
                                 (in millions)
Estimated
                                 CY 2008 
                                 percent change with transition 
                                 (75/25 blend)
Estimated
                                 CY 2008 percent change 
                                 without  
                                 transition 
                                 (fully implemented)(1)
(2)
(3)
(4)Eye and ocular adnexa
$1,365
1
5Digestive system
721
−4
−15Nervous system
274
2
−5Musculoskeletal system
167
24
97Integumentary system
85
4
15Genitourinary system
76
10
38Respiratory system
23
16
65Cardiovascular system
8
25
95Auditory system
4
30
85Hemic and lymphatic systems
2
28
110Other systems
0.1
19
75
 Table 12 below shows the estimated impact of the revised payment system on aggregate ASC payments for selected procedures during the first year of implementation (CY 2008) with and without the transitional blended rate. The table displays 30 of the procedures receiving the highest estimated CY 2008 ASC payments under the existing Medicare payment system. The HCPCS codes are sorted in descending order by estimated CY 2008 ASC program payments in the absence of the revised ASC payment system. Column 1—*HCPCS code.*
                    Column 2—*Short Descriptor*
                         of the HCPCS code.
                    Column 3—*Estimated CY 2008 ASC Payments*
                         in the absence of the revised payment system were calculated by multiplying the CY 2007 ASC payment rate by CY 2008 ASC utilization (which is based on CY 2005 ASC utilization multiplied by a factor of 1.305 to take into account expected volume growth with volume adjustment, as appropriate, for the multiple procedure discount). The resulting amount was then multiplied by 0.8 to estimate the Medicare program's share of the total payments to the ASC. The payment amounts are expressed in millions of dollars.
                    Column 4—*CY 2008 Percent Change with Transition (75/25 Blend)*
                         reflects the percent differences between the estimated ASC payment rates for CY 2008 under the current system and the estimated payment rates for CY 2008 under the revised system, incorporating a 75/25 blend of the estimated ASC payment using the CY 2007 ASC payment rate and the revised ASC payment rate.
                    Column 5—*CY 2008 Percent Change without Transition (Fully Implemented)*
                         reflects the percent differences between the estimated ASC payment rates for CY 2008 under the current system and the estimated payment rates for CY 2008 under the revised payment system if there were no transition period to the revised payment rates. The percentages appearing in column 5 are presented as a comparison for the transition policy in column 4 and do not depict the impact of the fully implemented proposal in CY 2011. Table 12.—Estimated CY 2008 Impact of Revised ASC Payment System on Aggregate Payments for Procedures With the Highest Estimated CY 2008 Payments Under the Current System
HCPCS code
Short descriptor
Estimated
                                 CY 2008 
                                 ASC payments 
                                 (in millions)
Estimated
                                 CY 2008 
                                 percent change 
                                 (75/25 blend)
Estimated
                                 CY 2008 percent changes 
                                 without  
                                 transition 
                                 (fully implemented)(1)
(2)
(3)
(4)
(5)66984
Cataract surg w/iol, 1 stage
$1,112
1
345378
Diagnostic colonoscopy
153
−4
−1643239
Upper GI endoscopy, biopsy
148
−5
−2145380
Colonoscopy and biopsy
114
−4
−1666821
After cataract laser surgery
102
−8
−3145385
Lesion removal colonoscopy
96
−4
−1662311
Inject spine l/s (cd)
81
−5
−1945384
Lesion remove colonoscopy
44
−4
−16( print page 42542)64483
Inj foramen epidural l/s
44
−5
−19G0121
Colon ca scrn not hi rsk ind
37
−6
−2515823
Revision of upper eyelid
35
−4
−1766982
Cataract surgery, complex
33
1
364476
Inj paravertebral l/s add-on
29
−7
−27G0105
Colorectal scrn; hi risk ind
27
−6
−2543235
Uppr gi endoscopy, diagnosis
25
2
652000
Cystoscopy
24
−4
−1764475
Inj paravertebral l/s
24
−5
−1967904
Repair eyelid defect
22
4
1664721
Carpal tunnel surgery
17
18
7029881
Knee arthroscopy/surgery
16
23
9343248
Uppr gi endoscopy/guide wire
15
−5
−2162310
Inject spine c/t
14
−5
−1929880
Knee arthroscopy/surgery
11
23
9364484
Inj foramen epidural add-on
11
−5
−1928285
Repair of hammertoe
10
18
7067038
Strip retinal membrane
10
31
12229848
Wrist endoscopy/surgery
9
−2
−964623
Destr paravertebral n add-on
9
−5
−1945383
Lesion removal colonoscopy
9
−4
−1626055
Incise finger tendon sheath
9
14
54
 Over time, we believe that 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. We would expect that, under the existing payment system, the ASC payment rates for many of the most frequently performed procedures in ASCs are similar to the OPPS payment rates for the same procedures. Conversely, we would expect that procedures with existing ASC payment rates that are substantially lower than the OPPS rates would be performed less often in ASCs. We believe the revised ASC payment system represents a major stride towards encouraging greater efficiency in ASCs and promoting a significant increase in the breadth of surgical procedures performed in ASCs, because it more appropriately distributes payments across the entire spectrum of covered surgical procedures, based on a coherent system of relative payment weights that are related to the clinical and facility resource characteristics of those procedures. Table 12 identifies a number of ASC procedures receiving the highest estimated CY 2008 payments under the current system and shows that most of them will experience payment decreases in CY 2008 under the revised ASC payment system. This contrasts with the estimated aggregate payment increases at the surgical specialty group level displayed in Table 11. In fact, Table 11 shows only one surgical specialty group of procedures for which the payments are expected to see a small decrease in the first year under the revised ASC payment system, and only two groups for which a decrease would be expected if there were no transition period to the revised payment rates. The increased payments at the full group level are due to the moderating effect of the payment increases for the less frequently performed procedures within the surgical specialty group. The exception to this is the surgical specialty group of eye and ocular adnexa where the aggregate increase in CY 2008 is driven by a small increase in payment for the highest volume procedure (CPT code 66984, Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedures), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification)). As a result of the redistribution of payments across the expanded breadth of surgical procedures for which Medicare will provide an ASC payment, we believe that ASCs may change the mix of services they provide over the next several years. The revised ASC payment system should encourage ASCs to expand their service mix beyond the handful of the highest paying procedures which comprise the majority of ASC utilization under the existing ASC payment system. For example, although cystoscopy (CPT code 52000), the highest volume ASC genitourinary procedure, is expected to experience a 4 percent payment rate decrease in CY 2008, overall payment to ASCs for the group of genitourinary procedures currently performed in ASCs is expected to increase by 10 percent. Although a urology specialty ASC may currently perform far more cystoscopy procedures than any other genitourinary procedure, we believe that under the revised ASC payment system, the ASC has the opportunity to adapt to the payment decrease for its most frequently performed procedures by offering an increased breadth of procedures, still within the clinical specialty area, and receive payments that are adequate to support continued operations. Similarly, payments for all of the highest volume pain management injection procedures are expected to decrease in CY 2008, although payments for nervous system procedures overall 
                        ( print page 42543)
                        are expected to increase. However, if there were no transition for CY 2008, payments would also decrease slightly for the nervous system surgical specialty group. For those procedures that will be paid a significantly lower amount under the revised payment system than they are currently paid, we believe that their current payment rates, which are closer to the OPPS payment rates than other ASC procedures, are likely to be generous relative to ASC costs, so ASCs would in all likelihood continue performing those procedures under the revised payment system. We also note that the majority of the most frequently performed ASC procedures specifically studied by the GAO, as described in the section II.B. of this final rule for the revised ASC payment system, appear in Table 12 with estimated payment decreases under the revised ASC payment system. The GAO concluded that, for these procedures, the OPPS APC groups accurately reflect the relative costs of procedures performed at ASCs and that ASCs have substantially lower costs. Generally, the payment changes for individual surgical procedures are relatively small in the first year under the transition to the revised payment system. As displayed in Table 12, a 1 percent increase in payment for the most common cataract surgery, CPT code 66984, is expected and mirrors the effect of the revised payment system on payment for the eye and ocular adnexa surgical specialty group (Table 11), even though payment for another relatively high volume eye procedure, CPT code 66821 (Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (e.g., YAG laser) (one or more stages)), is expected to decrease by 8 percent. For some procedures the estimated payment amounts in CY 2008 under the revised ASC payment system are much higher than the CY 2007 rates currently paid to ASCs. For example, payment for CPT code 67038 (Vitrectomy, mechanical, pars plana approach; with epiretinal membrane stripping) increases by 31 percent compared to estimated CY 2008 payments under the current system. Similarly, the estimated CY 2008 ASC payment for CPT code 29880 (Arthroscopy, knee, surgical; with meniscetomy (medial and lateral, including any meniscal shaving)) increases by 23 percent. For these two procedures and the other procedures with estimated payment increases greater than 10 percent, the increases are due to the comparatively higher OPPS rates which, when adjusted by the ASC budget neutrality factor and blended with the CY 2007 ASC payment amounts, generate CY 2008 ASC payment rates that are substantially above the current CY 2007 ASC payment rates. We estimate that payments for most of the highest volume colonoscopy and upper gastrointestinal endoscopy procedures will decrease under the revised payment system. In fact, payment decreases also are expected for the gastrointestinal surgical specialty group overall. We believe that decreased payments for so many of the gastrointestinal procedures are because current ASC payment rates are close to the OPPS rates. Procedures with current payment rates that are nearly as high as their OPPS rates are affected more negatively under the revised payment system than procedures for which ASC rates have historically been much lower than the comparable OPPS rates. The payment decreases expected in the first year under the revised ASC payment system for some of the high volume gastrointestinal procedures are not large (all less than 7 percent). We believe that ASCs can generally continue to cover their costs for these procedures, and that ASCs specializing in providing those services will be able to adapt their business practices and case-mix to manage declines for individual procedures. In CY 2008, we also are adding hundreds of surgical procedures to the already extensive list of procedures for which Medicare allows payment to ASCs, creating new opportunities for ASCs to expand their range of covered surgical procedures. For the first time, ASCs will be paid separately for covered ancillary services that are integral to covered surgical procedures, including certain radiology procedures, costly drugs and biologicals, devices with pass-through status under the OPPS, and brachytherapy sources. While separately paid radiology services will be paid based on their ASC relative payment weight calculated according to the standard ratesetting methodology of the revised ASC payment system or to the MPFS nonfacility practice expense amount, whichever is lower, the other items newly eligible for separate payment in ASCs will be paid comparably to their OPPS rates because we would not expect ASCs to experience efficiencies in providing them. Lastly, this final rule establishes a specific payment methodology for device-intensive procedures that provides the same packaged payment for the device as under the OPPS, while providing a reduced service payment that is subject to the 4-year transition if the device-intensive procedure is on the CY 2007 ASC list of covered surgical procedures. This final methodology should allow ASCs to continue to expand their provision of device-intensive services and to begin performing new device-intensive ASC procedures. 4. Estimated Effects of This Final Rule on Beneficiaries We estimate that the changes for CY 2008 will be positive for beneficiaries in at least two respects. Except for screening colonoscopy and flexible sigmoidoscopy procedures, the ASC coinsurance rate for all procedures is 20 percent. This contrasts with procedures performed in HOPDs where the beneficiary is responsible for copayments that range from 20 percent to 40 percent. In addition, ASC payment rates under the revised payment system are lower than payment rates for the same procedures under the OPPS, so the beneficiary coinsurance amount under the ASC payment system almost always will be less than the OPPS copayment amount for the same services. (The only exceptions will be when the ASC coinsurance amount exceeds the inpatient deductible. The statute requires that copayment amounts under the OPPS not exceed the inpatient deductible.) Beneficiary coinsurance for services migrating from physicians' offices to ASCs may decrease or increase under the revised ASC payment system, depending on the particular service and the relative payment amounts for that service in the physician's office compared with the ASC. As noted previously, the net effect of the revised ASC payment system on beneficiary coinsurance, taking into account the migration of services from HOPDs and physicians' offices, is estimated to be $20 million in beneficiary savings in CY 2008. In addition to the lower out-of-pocket expenses, we believe that beneficiaries also will have access to more services in ASCs as a result of the addition of 793 surgical procedures to the ASC list of covered surgical services eligible for Medicare payment. We expect that ASCs will provide a broader range of surgical services under the revised payment system and that beneficiaries will benefit from having access to a greater variety of surgical procedures in ASCs. 5. Conclusion The changes to the ASC payment system for CY 2008 will affect each of the more than 4,600 ASCs currently approved for participation in the Medicare program. The effect on an 
                        ( print page 42544)
                        individual ASC will depend on the ASC's mix of patients, the proportion of the ASC's patients that are Medicare beneficiaries, the degree to which the payments for the procedures offered by the ASC are changed under the revised payment system, and the degree to which the ASC chooses to provide a different set of procedures. The revised ASC payment system is designed to result in the same aggregate amount of Medicare expenditures in CY 2008 that would be made in the absence of the revised ASC payment system. As mentioned previously, we estimate that the revised ASC payment system and the expanded ASC list of covered surgical procedures that we are implementing in CY 2008 will have no net effect on Medicare expenditures compared to the level of Medicare expenditures that would have occurred in CY 2008 in the absence of the revised payment system. However, there will be a total increase in Medicare payments to ASCs for CY 2008 of approximately $270 million as a result of the revised ASC payment system, which will be fully offset by savings from reduced Medicare spending in HOPDs and physicians' offices on services that migrate from these settings to ASCs (as discussed in detail in section V.C. of this final rule). Furthermore, we estimate that the revised ASC payment system will result in Medicare savings of $240 million over 5 years due to migration of new ASC services from HOPDs and physicians' offices to ASCs over time. We anticipate that this final rule will have a significant economic impact on a substantial number of small entities. 6. Accounting Statement As required by OMB Circular A-4 (available at 
                        *http://www.whitehousegov/​omb/​circulars/​a004/​a-4.pdf*), in Table 13 below, we have prepared an accounting statement showing the classification of the expenditures associated with the implementation of the CY 2008 revised ASC payment system, based on the provisions of this final rule. As explained above, we estimate that Medicare payments to ASCs in CY 2008 will be about $270 million higher than they would otherwise be in the absence of the revised ASC payment system. This $270 million in additional payments to ASCs in CY 2008 will be fully offset by savings from reduced spending in HOPDs and physicians' offices on services that migrate from these settings to ASCs. This table provides our best estimate of Medicare payments to providers and suppliers as a result of the CY 2008 revised ASC payment system, as presented in this final rule. All expenditures are classified as transfers. Table 13.—Accounting Statement: Classification of Estimated Expenditures From CY 2007 to CY 2008 as a Result of the CY 2008 Revised ASC Payment System
Category
TransfersAnnualized Monetized Transfers
$0 Million.From Whom to Whom
Federal Government to Medicare Providers and Suppliers.Annualized Monetized Transfer
$0 Million.From Whom to Whom
Premium Payments from Beneficiaries to Federal Government.Total
$0 Million.
 C. Executive Order 12866 In accordance with the provisions of Executive Order 12866, this final 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 416 Health facilities
Kidney diseases
Medicare
Reporting and recordkeeping requirements
 For reasons stated in the preamble of this final rule, the Centers for Medicare & Medicaid Services is amending 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 adding a new paragraph (i)(2) to read as follows: § 410.152
  
 (i) * * * (2) For ASC services furnished on or after January 1, 2008, in connection with the covered surgical procedures specified in § 416.166 of this subchapter, except as provided in paragraphs (i)(2)(i) and (i)(2)(ii) of this section, Medicare Part B pays the lesser of 80 percent of the actual charge or 80 percent of the prospective payment amount, geographically adjusted, if applicable, as determined under Subpart F of Part 416 of this subchapter. Part B coinsurance is 20 percent of the actual charge or 20 percent of the prospective payment amount, geographically adjusted, if applicable. (i) If the limitation described in § 416.167(b)(3) of this subchapter applies, Medicare pays 80 percent of the amount determined under Subpart B of Part 414 of this subchapter and Part B coinsurance is 20 percent of the applicable payment amount. (ii) Medicare Part B pays 75 percent of the applicable payment amount for screening flexible sigmoidoscopies and screening colonoscopies, and Part B coinsurance is 25 percent of the applicable payment amount.
 PART 416—AMBULATORY SURGICAL SERVICES
 3.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). 4.Section 416.2 is amended by— a.Revising the definition of “ASC services.” b.Adding a definition of “Covered ancillary services” in alphabetical order. c.Revising the definition of “Covered surgical procedures.” d.Revising the definition of “Facility services.” The revisions and addition read as follows: § 416.2
  
 *ASC services*
                                 means, for the period before January 1, 2008, facility services that are furnished in an ASC, and beginning January 1, 2008, means the combined facility services and covered ancillary services that are furnished in an ASC in connection with covered surgical procedures. *Covered ancillary services*
                                 means items and services that are integral to a covered surgical procedure performed in an ASC as provided in § 416.164(b), for which payment may be made under § 416.171 in addition to the payment for the facility services. *Covered surgical procedures*
                                 means those surgical procedures furnished before January 1, 2008, that meet the criteria specified in § 416.65 and those surgical procedures furnished on or after January 1, 2008, that meet the criteria specified in § 416.166. 
                                ( print page 42545) *Facility services*
                                 means for the period before January 1, 2008, services that are furnished in connection with covered surgical procedures performed in an ASC, and beginning January 1, 2008, means services that are furnished in connection with covered surgical procedures performed in an ASC as provided in § 416.164(a) for which payment is included in the ASC payment established under § 416.171 for the covered surgical procedure.
 5.A new Subpart F is added to read as follows: Subpart F—Coverage, Scope of ASC Services, and Prospective Payment System for ASC Services Furnished on or After January 1, 2008416.160
                                Basis and scope
                                416.161
                                Applicability of this subpart
                                416.163
                                General rules
                                416.164
                                Scope of ASC services
                                416.166
                                Covered surgical procedures
                                416.167
                                Basis of payment
                                416.171
                                Determination of 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
                                416.179
                                Payment and coinsurance reduction for devices replaced without cost or when full credit is received
 Subpart F—Coverage, Scope of ASC Services, and Prospective Payment System for ASC Services Furnished on or After January 1, 2008 § 416.160
  (a) 
                                    *Statutory basis.*
                                     (1) 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 was 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. (2) 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. (3) 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. (4) Section 1834(d) of the Act specifies that, when screening colonoscopies or screening flexible sigmoidoscopies are performed in an ASC or hospital outpatient department, payment shall be based on the lesser of the amount under the fee schedule that would apply to such services if they were performed in a hospital outpatient department in an area or the amount under the fee schedule that would apply to such services if they were performed in an ambulatory surgical center in the same area. Section 1834(d) of the Act further specifies that the coinsurance for screening flexible sigmoidoscopy and screening colonoscopy procedures is 25 percent of the payment amount. Section 1834(d) of the Act also specifies that, in the case of screening flexible sigmoidoscopy and screening colonoscopy services, their payment amounts must not exceed the payment rates established for the related diagnostic services. Section 1833(b)(8) of the Act specifies that the Part B deductible shall not apply with respect to colorectal screening tests as described in section 1861(pp)(1) of the Act, which include screening colonoscopies and screening flexible sigmoidoscopies. (b) 
                                    *Scope.*
                                     This subpart sets forth— (1) The scope of ASC services and the criteria for determining the covered surgical procedures for which Medicare provides payment for the associated facility services and covered ancillary services; (2) The basis of payment for facility services and for covered ancillary services furnished in an ASC in connection with a covered surgical procedure; (3) The methodologies by which Medicare determines payment amounts for ASC services.
 § 416.161
  The provisions of this subpart apply to ASC services furnished on or after January 1, 2008.
 § 416.163
  (a) Payment is made under this subpart for ASC services specified in §§ 416.164(a) and (b) 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) Payment for physicians' services and payment for anesthetists’ services are made in accordance with Part 414 of this subchapter. (c) Payment for items and services other than physicians’ and anesthetists’ services, as specified in § 416.164(c), is made in accordance with § 410.152 of this subchapter.
 § 416.164
  (a) 
                                    *Included facility services.*
                                     ASC services for which payment is packaged into the ASC payment for a covered surgical procedure under § 416.166 include, but are not limited to— (1) Nursing, technician, and related services; (2) Use of the facility where the surgical procedures are performed; (3) Any laboratory testing performed under a Clinical Laboratory Improvement Amendments of 1988 (CLIA) certificate of waiver; (4) Drugs and biologicals for which separate payment is not allowed under the hospital outpatient prospective payment system (OPPS); (5) Medical and surgical supplies not on pass-through status under Subpart G of Part 419 of this subchapter; (6) Equipment; (7) Surgical dressings; (8) Implanted prosthetic devices, including intraocular lenses (IOLs), and related accessories and supplies not on pass-through status under Subpart G of Part 419 of this subchapter; (9) Implanted DME and related accessories and supplies not on pass-through status under Subpart G of Part 419 of this subchapter; (10) Splints and casts and related devices; (11) Radiology services for which separate payment is not allowed under the OPPS, and other diagnostic tests or interpretive services that are integral to a surgical procedure; (12) Administrative, recordkeeping and housekeeping items and services; (13) Materials, including supplies and equipment for the administration and monitoring of anesthesia; and (14) Supervision of the services of an anesthetist by the operating surgeon. (b) 
                                    *Covered ancillary services.*
                                     Ancillary items and services that are integral to a covered surgical procedure, as defined in § 416.166, and for which separate payment is allowed include: (1) Brachytherapy sources; (2) Certain implantable items that have pass-through status under the OPPS; (3) Certain items and services that CMS designates as contractor-priced, 
                                    ( print page 42546)
                                    including, but not limited to, the procurement of corneal tissue; (4) Certain drugs and biologicals for which separate payment is allowed under the OPPS; (5) Certain radiology services for which separate payment is allowed under the OPPS. (c) 
                                    *Excluded services.*
                                     ASC services do not include items and services outside the scope of ASC services for which payment may be made under Part 414 of this subchapter in accordance with § 410.152, including, but not limited to— (1) Physicians' services (including surgical procedures and all preoperative and postoperative services that are performed by a physician); (2) Anesthetists' services; (3) Radiology services (other than those integral to performance of a covered surgical procedure); (4) Diagnostic procedures (other than those directly related to performance of a covered surgical procedure); (5) Ambulance services; (6) Leg, arm, back, and neck braces other than those that serve the function of a cast or splint; (7) Artificial limbs; (8) Nonimplantable prosthetic devices and DME.
 § 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 and published in the 
                                    **Federal Register**
                                     that are separately paid under the OPPS, that would not be expected to pose a significant safety risk to a Medicare beneficiary when performed in an ASC, and for which standard medical practice dictates that the beneficiary would not typically be expected to require active medical monitoring and care at midnight following the procedure. (c) 
                                    *General exclusions.*
                                     Notwithstanding paragraph (b) of this section, covered surgical procedures do not include those surgical 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) Commonly require systemic thrombolytic therapy; (6) Are designated as requiring inpatient care under § 419.22(n) of this subchapter; (7) Can only be reported using a CPT unlisted surgical procedure code; or (8) Are otherwise excluded under § 411.15 of this subchapter.
 § 416.167
  (a) 
                                    *Unit of payment.*
                                     Under the ASC payment system, prospectively determined amounts are paid for ASC services furnished to Medicare beneficiaries in connection with covered surgical procedures. Covered surgical procedures and covered ancillary services are identified by codes established under the Healthcare Common Procedure Coding System (HCPCS). The unadjusted national payment rate is determined according to the methodology described in § 416.171. The manner in which the Medicare payment amount and the beneficiary coinsurance amount for each ASC service is 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 subchapter. (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 relative payment weight is determined based on the APC relative payment weight for each covered surgical procedure and covered ancillary service that has an applicable APC relative payment weight described in § 419.31 of this subchapter. (3) Notwithstanding paragraph (b)(2) of this section, the relative payment weights for services paid in accordance with § 416.171(d) are determined so that the national ASC payment rate does not exceed the unadjusted nonfacility practice expense amount paid under the Medicare physician fee schedule for such procedures under Subpart B of Part 414 of this subchapter.
 § 416.171
  (a) 
                                    *Standard methodology.*
                                     The standard methodology for determining the national unadjusted payment rate for ASC services is to calculate the product of the applicable conversion factor and the relative payment weight established under § 416.167(b), unless otherwise indicated in this section. (1) 
                                    *Conversion factor for CY 2008.*
                                     CMS calculates a conversion factor so that payment for ASC services furnished in CY 2008 would result in the same aggregate amount of expenditures as would be made if the provisions in this Subpart F did not apply, as estimated by CMS. (2) 
                                    *Conversion factor for CY 2009 and subsequent calendar years.*
                                     The conversion factor for a calendar year is equal to the conversion factor calculated for the previous year, updated as follows: (i) For CY 2009, the update is equal to zero percent. (ii) For CY 2010 and subsequent calendar years, the update is 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. (b) 
                                    *Exception.*
                                     The national ASC payment rates for the following items and services are not determined in accordance with paragraph (a) of this section but are paid an amount derived from the payment rate for the equivalent item or service set under the payment system established in Part 419 of this subchapter as updated annually in the 
                                    **Federal Register**
                                    . If a payment rate is not available, the following items and services are designated as contractor-priced: (1) Covered ancillary services specified in § 416.164(b), with the exception of radiology services as provided in § 416.164(b)(5); (2) Device-intensive procedures assigned to device-dependent APCs under the OPPS with device costs greater than 50 percent of the APC cost; (3) Procedures using certain separately paid implantable devices that are approved for transitional pass-through payment in accordance with § 419.66 of this subchapter. (c) 
                                    *Transitional payment rates.*
                                     (1) ASC payment rates for CY 2008 are a transitional blend of 75 percent of the CY 2007 ASC payment rate for a covered surgical procedure on the CY 2007 ASC list of surgical procedures and 25 percent of the payment rate for the procedure calculated under the methodology described in paragraph (a) of this section. (2) ASC payment rates for CY 2009 are a transitional blend of 50 percent of the CY 2007 ASC payment rate for a covered 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 (a) of this section. (3) ASC payment rates for CY 2010 are a transitional blend of 25 percent of the CY 2007 ASC payment rate for a 
                                    ( print page 42547)
                                    covered surgical procedure on the CY 2007 ASC list of surgical procedures and 75 percent of the payment rate for the procedure calculated under the methodology described in paragraph (a) of this section. (4) The national ASC payment rate for CY 2011 and subsequent calendar years for a covered surgical procedure designated in accordance with § 416.166 is the payment rates for the procedure calculated under the methodology described in paragraph (a) of this section. (5) Covered ancillary services described in § 416.164(b) and surgical procedures identified as covered when performed in an ASC under § 416.166 for the first time beginning on or after January 1, 2008, are not subject to the transitional payment rates applicable in CYs 2008 through 2010 for ASC facility services. (d) 
                                    *Limitation on payment rates for office-based surgical procedures and covered ancillary radiology services.*
                                     Notwithstanding the provisions of paragraph (a) of this section, for any covered surgical procedure under § 416.166 that CMS determines is commonly performed in physicians' offices or for any covered ancillary radiology service, the national unadjusted ASC payment rates for these procedures and services will be the lesser of the amount determined under paragraph (a) of this section or the amount calculated at the nonfacility practice expense relative value units under § 414.22(b)(5)(i)(B) of this subchapter multiplied by the conversion factor described in § 414.20(a)(3) of this subchapter. (e) 
                                    *Budget neutrality.*
                                     (1) For CY 2008, CMS establishes the conversion factor to result in budget neutrality as estimated by CMS in accordance with paragraph (a)(1) of this section. (2) For CY 2009 and subsequent calendar 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 subchapter are budget neutral as estimated by CMS.
 § 416.172
  (a) 
                                    *General rule.*
                                     Contractors adjust the payment rates established for ASC services to determine Medicare program payment and beneficiary coinsurance amounts in accordance with paragraphs (b) through (g) of this section. (b) 
                                    *Lesser of actual charge or geographically adjusted payment rate.*
                                     Payments to ASCs equal 80 percent of the lesser of— (1) The actual charge for the service; or (2) The geographically adjusted payment rate determined under this subpart. (c) 
                                    *Geographic adjustment.*
                                    —(1) 
                                    *General rule.*
                                     Except as provided in paragraph (c)(2) of this section, the 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 nonlabor percentages, and localities specified by the Secretary. (2) 
                                    *Exception.*
                                     The geographic adjustment is not applied to the payment rates set for drugs, biologicals, devices with OPPS transitional pass-through payment status, and brachytherapy sources. (d) 
                                    *Deductibles and coinsurance.*
                                     Part B deductible and coinsurance amounts apply as specified in §§ 410.152(a) and (i)(2) of this subchapter. (e) 
                                    *Payment reductions for multiple surgical procedures.*
                                    —(1) 
                                    *General rule.*
                                     Except as provided in paragraph (e)(2) of this section, when more than one covered surgical procedure for which payment is made under the ASC payment system is performed during an operative session, the Medicare program payment amount and the beneficiary coinsurance amount are based on— (i) 100 percent of the applicable ASC payment amount for the procedure with the highest national unadjusted ASC payment rate; and (ii) 50 percent of the applicable ASC payment amount for all other covered surgical procedures. (2) 
                                    *Exception: Procedures not subject to multiple procedure discounting.*
                                     CMS 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 subchapter as may be consistent with the equitable and efficient administration of this part. (f) 
                                    *Interrupted procedures.*
                                     When a covered surgical procedure or covered ancillary service is terminated prior to completion due to extenuating circumstances or circumstances that threaten the well-being of the patient, the Medicare program payment amount and the beneficiary coinsurance amount are based on one of the following— (1) The full program and beneficiary coinsurance amounts if the procedure for which anesthesia is planned is discontinued after the induction of anesthesia or after the procedure is started; (2) One-half of the full program and beneficiary coinsurance amounts if the procedure for which anesthesia is planned is discontinued after the patient is prepared for surgery and taken to the room where the procedure is to be performed but before the anesthesia is induced; or (3) One-half of the full program and beneficiary coinsurance amounts if a covered surgical procedure or covered ancillary service for which anesthesia is not planned is discontinued after the patient is prepared and taken to the room where the service is to be provided. (g) 
                                    *Payment adjustment for new technology intraocular lenses (NTIOLs).*
                                     A payment adjustment will be made for insertion of an IOL approved as belonging to a class of NTIOLs as defined in Subpart G.
 § 416.173
  CMS publishes annually, through notice and comment rulemaking in the 
                                    **Federal Register**
                                    , the payment methodologies and payment rates for ASC services and designates the covered surgical procedures and covered ancillary services for which CMS will make an ASC payment and other revisions as appropriate.
 § 416.178
  There is no administrative or judicial review under section 1869 of the Act, section 1878 of the Act, or otherwise of the following: (a) The classification system; (b) Relative weights; (c) Payment amounts; and (d) Geographic adjustment factors.
 § 416.179
  (a) 
                                    *General rule.*
                                     CMS reduces the amount of payment for a covered surgical procedure for which CMS determines that a significant portion of the payment is attributable to the cost of an implanted device not on pass-through status under Subpart G of Part 419 of this subchapter when one of the following situations occur: (1) The device is replaced without cost to the ASC or the beneficiary; or (2) The ASC receives full credit for the cost of a replaced device. (b) 
                                    *Amount of reduction to the ASC payment for the covered surgical procedure.*
                                     The amount of the reduction to the ASC payment made under paragraph (a) of this section is calculated in the same manner as the device payment reduction that would be applied to the ASC payment for the covered surgical procedure in order to remove predecessor device costs so that 
                                    ( print page 42548)
                                    the ASC payment amount for a device with pass-through status under § 419.66 of this subchapter represents the full cost of the device, and no packaged device payment is provided through the ASC payment for the covered surgical procedure. (c) 
                                    *Amount of beneficiary coinsurance.*
                                     The beneficiary coinsurance is calculated based on the ASC payment for the covered surgical procedure after application of the reduction under paragraph (b) of this section. (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program)
 Dated: April 24, 2007. Leslie Norwalk, Acting Administrator, Centers for Medicare & Medicaid Services. Dated: May 31, 2007. Michael O. Leavitt, Secretary.
 
 
       Note: 
 
 Addendum AA.—Illustrative ASC Covered Surgical Procedures for CY 2008
[Including surgical procedures for which payment is packaged]
HCPCS code
Short descriptor
Subject to multiple procedure discounting
Payment indicator
CY 2007 ASC payment rate
Estimated fully implemented payment weight
Estimated CY 2008 fully implemented 
                                 payment
Estimated CY 2008 first transition year payment0016T
Thermotx choroids vasc lesion
Y
R2

3.9333
$167.33
$167.330017T
Photocoagulat macular drusen
Y
R2

3.9333
$167.33
$167.330027T
Endoscopic epidural lysis
Y
G2

17.8499
$759.39
$759.390031T
Speculoscopy

N10032T
Speculoscopy w/direct sample

N10046T
Cath lavage, mammary duct(s)
Y
R2

15.1024
$642.50
$642.500047T
Cath lavage, mammary duct(s)
Y
R2

15.1024
$642.50
$642.500062T
Rep intradisc annulus;1 lev
Y
G2

25.1296
$1,069.09
$1,069.090063T
Rep intradisc annulus;>1lev
Y
G2

25.1296
$1,069.09
$1,069.090084T
Temp prostate urethral stent
Y
G2

2.1393
$91.01
$91.010099T *
Implant corneal ring
Y
R2

15.2259
$647.76
$647.760100T
Prosth retina receive&gen
Y
G2

37.4290
$1,592.34
$1,592.340101T
Extracorp shockwv tx,hi enrg
Y
G2

25.1296
$1,069.09
$1,069.090102T
Extracorp shockwv tx,anesth
Y
G2

25.1296
$1,069.09
$1,069.090123T
Scleral fistulization
Y
G2

22.9970
$978.36
$978.360124T *
Conjunctival drug placement
Y
R2

6.0673
$258.12
$258.120133T
Esophageal implant injexn
Y
G2

25.7552
$1,095.70
$1,095.700176T
Aqu canal dilat w/o retent
Y
A2
$1,339.00
37.8967
$1,612.24
$1,407.310177T
Aqu canal dilat w retent
Y
A2
$1,339.00
37.8967
$1,612.24
$1,407.3110021
Fna w/o image
Y
P2

1.0995
$46.78
$46.7810022
Fna w/image
Y
G2

2.0738
$88.23
$88.2310040
Acne surgery
Y
P2

0.4760
$20.25
$20.2510060
Drainage of skin abscess
Y
P3

1.0944
$46.56
$46.5610061
Drainage of skin abscess
Y
P2

1.4392
$61.23
$61.2310080
Drainage of pilonidal cyst
Y
P2

1.4392
$61.23
$61.2310081
Drainage of pilonidal cyst
Y
P3

3.0339
$129.07
$129.0710120
Remove foreign body
Y
P2

1.4392
$61.23
$61.2310121
Remove foreign body
Y
A2
$446.00
15.1024
$642.50
$495.1310140
Drainage of hematoma/fluid
Y
P3

1.6174
$68.81
$68.8110160
Puncture drainage of lesion
Y
P2

1.0259
$43.64
$43.6410180
Complex drainage, wound
Y
A2
$446.00
17.5086
$744.87
$520.7211000
Debride infected skin
Y
P3

0.5312
$22.60
$22.6011001
Debride infected skin add-on
Y
P3

0.1850
$7.87
$7.8711010
Debride skin, fx
Y
A2
$251.52
4.0919
$174.08
$232.1611011
Debride skin/muscle, fx
Y
A2
$251.52
4.0919
$174.08
$232.1611012
Debride skin/muscle/bone, fx
Y
A2
$251.52
4.0919
$174.08
$232.1611040
Debride skin, partial
Y
P3

0.4828
$20.54
$20.5411041
Debride skin, full
Y
P3

0.5632
$23.96
$23.9611042
Debride skin/tissue
Y
A2
$164.42
2.6749
$113.80
$151.7711043
Debride tissue/muscle
Y
A2
$164.42
2.6749
$113.80
$151.7711044
Debride tissue/muscle/bone
Y
A2
$423.10
6.8832
$292.83
$390.5311055
Trim skin lesion
Y
P3

0.5552
$23.62
$23.6211056
Trim skin lesions, 2 to 4
Y
P3

0.6116
$26.02
$26.0211057
Trim skin lesions, over 4
Y
P3

0.7000
$29.78
$29.7811100
Biopsy, skin lesion
Y
P2

1.0259
$43.64
$43.6411101
Biopsy, skin add-on
Y
P3

0.2978
$12.67
$12.6711200
Removal of skin tags
Y
P3

0.9174
$39.03
$39.0311201
Remove skin tags add-on
Y
P3

0.1288
$5.48
$5.4811300
Shave skin lesion
Y
P2

0.8432
$35.87
$35.8711301
Shave skin lesion
Y
P2

0.8432
$35.87
$35.8711302
Shave skin lesion
Y
P2

1.0918
$46.45
$46.4511303
Shave skin lesion
Y
P3

1.4484
$61.62
$61.6211305
Shave skin lesion
Y
P3

0.7726
$32.87
$32.8711306
Shave skin lesion
Y
P3

1.0140
$43.14
$43.1411307
Shave skin lesion
Y
P2

1.0918
$46.45
$46.4511308
Shave skin lesion
Y
P2

1.0918
$46.45
$46.4511310
Shave skin lesion
Y
P3

1.0058
$42.79
$42.7911311
Shave skin lesion
Y
P2

1.0918
$46.45
$46.4511312
Shave skin lesion
Y
P2

1.0918
$46.45
$46.4511313
Shave skin lesion
Y
P3

1.6094
$68.47
$68.4711400
Exc tr-ext b9+marg 0.5 <cm
Y
P3

1.5530
$66.07
$66.0711401
Exc tr-ext b9+marg 0.6-1 cm
Y
P3

1.6980
$72.24
$72.2411402
Exc tr-ext b9+marg 1.1-2 cm
Y
P3

1.8508
$78.74
$78.74( print page 42550)11403
Exc tr-ext b9+marg 2.1-3 cm
Y
P3

1.9876
$84.56
$84.5611404
Exc tr-ext b9+marg 3.1-4 cm
Y
A2
$333.00
15.1024
$642.50
$410.3811406
Exc tr-ext b9+marg > 4.0 cm
Y
A2
$446.00
15.1024
$642.50
$495.1311420
Exc h-f-nk-sp b9+marg 0.5<
Y
P3

1.4484
$61.62
$61.6211421
Exc h-f-nk-sp b9+marg 0.6-1
Y
P3

1.7220
$73.26
$73.2611422
Exc h-f-nk-sp b9+marg 1.1-2
Y
P3

1.8750
$79.77
$79.7711423
Exc h-f-nk-sp b9+marg 2.1-3
Y
P3

2.1085
$89.70
$89.7011424
Exc h-f-nk-sp b9+marg 3.1-4
Y
A2
$446.00
15.1024
$642.50
$495.1311426
Exc h-f-nk-sp b9+marg > 4 cm
Y
A2
$446.00
20.0656
$853.65
$547.9111440
Exc face-mm b9+marg 0.5 < cm
Y
P3

1.6898
$71.89
$71.8911441
Exc face-mm b9+marg 0.6-1 cm
Y
P3

1.8993
$80.80
$80.8011442
Exc face-mm b9+marg 1.1-2 cm
Y
P3

2.0763
$88.33
$88.3311443
Exc face-mm b9+marg 2.1-3 cm
Y
P3

2.3256
$98.94
$98.9411444
Exc face-mm b9+marg 3.1-4 cm
Y
A2
$333.00
6.8083
$289.65
$322.1611446
Exc face-mm b9+marg > 4 cm
Y
A2
$446.00
20.0656
$853.65
$547.9111450
Removal, sweat gland lesion
Y
A2
$446.00
20.0656
$853.65
$547.9111451
Removal, sweat gland lesion
Y
A2
$446.00
20.0656
$853.65
$547.9111462
Removal, sweat gland lesion
Y
A2
$446.00
20.0656
$853.65
$547.9111463
Removal, sweat gland lesion
Y
A2
$446.00
20.0656
$853.65
$547.9111470
Removal, sweat gland lesion
Y
A2
$446.00
20.0656
$853.65
$547.9111471
Removal, sweat gland lesion
Y
A2
$446.00
20.0656
$853.65
$547.9111600
Exc tr-ext mlg+marg 0.5 < cm
Y
P3

2.1646
$92.09
$92.0911601
Exc tr-ext mlg+marg 0.6-1 cm
Y
P3

2.4787
$105.45
$105.4511602
Exc tr-ext mlg+marg 1.1-2 cm
Y
P3

2.6879
$114.35
$114.3511603
Exc tr-ext mlg+marg 2.1-3 cm
Y
P3

2.8729
$122.22
$122.2211604
Exc tr-ext mlg+marg 3.1-4 cm
Y
A2
$418.49
6.8083
$289.65
$386.2811606
Exc tr-ext mlg+marg > 4 cm
Y
A2
$446.00
15.1024
$642.50
$495.1311620
Exc h-f-nk-sp mlg+marg 0.5
Y
P3

2.1888
$93.12
$93.1211621
Exc h-f-nk-sp mlg+marg 0.6-1
Y
P3

2.4947
$106.13
$106.1311622
Exc h-f-nk-sp mlg+marg 1.1-2
Y
P3

2.7683
$117.77
$117.7711623
Exc h-f-nk-sp mlg+marg 2.1-3
Y
P3

3.0017
$127.70
$127.7011624
Exc h-f-nk-sp mlg+marg 3.1-4
Y
A2
$446.00
15.1024
$642.50
$495.1311626
Exc h-f-nk-sp mlg+mar > 4 cm
Y
A2
$446.00
20.0656
$853.65
$547.9111640
Exc face-mm malig+marg 0.5<
Y
P3

2.2934
$97.57
$97.5711641
Exc face-mm malig+marg 0.6-1
Y
P3

2.6796
$114.00
$114.0011642
Exc face-mm malig+marg 1.1-2
Y
P3

2.9937
$127.36
$127.3611643
Exc face-mm malig+marg 2.1-3
Y
P3

3.2511
$138.31
$138.3111644
Exc face-mm malig+marg 3.1-4
Y
A2
$446.00
15.1024
$642.50
$495.1311646
Exc face-mm mlg+marg > 4 cm
Y
A2
$446.00
20.0656
$853.65
$547.9111719
Trim nail(s)
Y
P3

0.2494
$10.61
$10.6111720
Debride nail, 1-5
Y
P3

0.3218
$13.69
$13.6911721
Debride nail, 6 or more
Y
P3

0.4024
$17.12
$17.1211730
Removal of nail plate
Y
P3

0.9576
$40.74
$40.7411732
Remove nail plate, add-on
Y
P3

0.4024
$17.12
$17.1211740
Drain blood from under nail
Y
P3

0.5392
$22.94
$22.9411750
Removal of nail bed
Y
P3

2.0763
$88.33
$88.3311752
Remove nail bed/finger tip
Y
P3

2.8729
$122.22
$122.2211755
Biopsy, nail unit
Y
P3

1.4566
$61.97
$61.9711760
Repair of nail bed
Y
G2

1.4843
$63.15
$63.1511762
Reconstruction of nail bed
Y
P2

1.4843
$63.15
$63.1511765
Excision of nail fold, toe
Y
P2

1.6241
$69.09
$69.0911770
Removal of pilonidal lesion
Y
A2
$510.00
20.0656
$853.65
$595.9111771
Removal of pilonidal lesion
Y
A2
$510.00
20.0656
$853.65
$595.9111772
Removal of pilonidal lesion
Y
A2
$510.00
20.0656
$853.65
$595.9111900
Injection into skin lesions
Y
P3

0.6358
$27.05
$27.0511901
Added skin lesions injection
Y
P3

0.6760
$28.76
$28.7611920
Correct skin color defects
Y
P2

1.4843
$63.15
$63.1511921
Correct skin color defects
Y
P2

1.4843
$63.15
$63.1511922
Correct skin color defects
Y
P3

0.8368
$35.60
$35.6011950
Therapy for contour defects
Y
P3

0.8048
$34.24
$34.2411951
Therapy for contour defects
Y
P3

1.0784
$45.88
$45.8811952
Therapy for contour defects
Y
P3

1.4484
$61.62
$61.6211954
Therapy for contour defects
Y
P2

1.4843
$63.15
$63.15( print page 42551)11960
Insert tissue expander(s)
Y
A2
$446.00
21.4302
$911.71
$562.4311970
Replace tissue expander
Y
A2
$510.00
41.0893
$1,748.06
$819.5211971
Remove tissue expander(s)
Y
A2
$333.00
20.0656
$853.65
$463.1611976
Removal of contraceptive cap
Y
P3

1.3760
$58.54
$58.5411980
Implant hormone pellet(s)
N
P2

0.6102
$25.96
$25.9611981
Insert drug implant device
N
P2

0.6102
$25.96
$25.9611982
Remove drug implant device
N
P2

0.6102
$25.96
$25.9611983
Remove/insert drug implant
N
P2

0.6102
$25.96
$25.9612001
Repair superficial wound(s)
Y
P2

1.4843
$63.15
$63.1512002
Repair superficial wound(s)
Y
P2

1.4843
$63.15
$63.1512004
Repair superficial wound(s)
Y
P2

1.4843
$63.15
$63.1512005
Repair superficial wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212006
Repair superficial wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212007
Repair superficial wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212011
Repair superficial wound(s)
Y
P2

1.4843
$63.15
$63.1512013
Repair superficial wound(s)
Y
P2

1.4843
$63.15
$63.1512014
Repair superficial wound(s)
Y
P2

1.4843
$63.15
$63.1512015
Repair superficial wound(s)
Y
G2

1.4843
$63.15
$63.1512016
Repair superficial wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212017
Repair superficial wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212018
Repair superficial wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212020
Closure of split wound
Y
A2
$91.24
1.4843
$63.15
$84.2212021
Closure of split wound
Y
A2
$91.24
1.4843
$63.15
$84.2212031
Layer closure of wound(s)
Y
P2

1.4843
$63.15
$63.1512032
Layer closure of wound(s)
Y
P2

1.4843
$63.15
$63.1512034
Layer closure of wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212035
Layer closure of wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212036
Layer closure of wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212037
Layer closure of wound(s)
Y
A2
$323.28
5.2594
$223.75
$298.4012041
Layer closure of wound(s)
Y
P2

1.4843
$63.15
$63.1512042
Layer closure of wound(s)
Y
P2

1.4843
$63.15
$63.1512044
Layer closure of wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212045
Layer closure of wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212046
Layer closure of wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212047
Layer closure of wound(s)
Y
A2
$323.28
5.2594
$223.75
$298.4012051
Layer closure of wound(s)
Y
P2

1.4843
$63.15
$63.1512052
Layer closure of wound(s)
Y
P2

1.4843
$63.15
$63.1512053
Layer closure of wound(s)
Y
P2

1.4843
$63.15
$63.1512054
Layer closure of wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212055
Layer closure of wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212056
Layer closure of wound(s)
Y
A2
$91.24
1.4843
$63.15
$84.2212057
Layer closure of wound(s)
Y
A2
$323.28
5.2594
$223.75
$298.4013100
Repair of wound or lesion
Y
A2
$323.28
5.2594
$223.75
$298.4013101
Repair of wound or lesion
Y
A2
$323.28
5.2594
$223.75
$298.4013102
Repair wound/lesion add-on
Y
A2
$91.24
1.4843
$63.15
$84.2213120
Repair of wound or lesion
Y
A2
$91.24
1.4843
$63.15
$84.2213121
Repair of wound or lesion
Y
A2
$91.24
1.4843
$63.15
$84.2213122
Repair wound/lesion add-on
Y
A2
$91.24
1.4843
$63.15
$84.2213131
Repair of wound or lesion
Y
A2
$91.24
1.4843
$63.15
$84.2213132
Repair of wound or lesion
Y
A2
$91.24
1.4843
$63.15
$84.2213133
Repair wound/lesion add-on
Y
A2
$91.24
1.4843
$63.15
$84.2213150
Repair of wound or lesion
Y
A2
$323.28
5.2594
$223.75
$298.4013151
Repair of wound or lesion
Y
A2
$323.28
5.2594
$223.75
$298.4013152
Repair of wound or lesion
Y
A2
$323.28
5.2594
$223.75
$298.4013153
Repair wound/lesion add-on
Y
A2
$91.24
1.4843
$63.15
$84.2213160
Late closure of wound
Y
A2
$446.00
21.4302
$911.71
$562.4314000
Skin tissue rearrangement
Y
A2
$446.00
14.0346
$597.07
$483.7714001
Skin tissue rearrangement
Y
A2
$510.00
21.4302
$911.71
$610.4314020
Skin tissue rearrangement
Y
A2
$510.00
14.0346
$597.07
$531.7714021
Skin tissue rearrangement
Y
A2
$510.00
14.0346
$597.07
$531.7714040
Skin tissue rearrangement
Y
A2
$446.00
14.0346
$597.07
$483.7714041
Skin tissue rearrangement
Y
A2
$510.00
14.0346
$597.07
$531.7714060
Skin tissue rearrangement
Y
A2
$510.00
14.0346
$597.07
$531.77( print page 42552)14061
Skin tissue rearrangement
Y
A2
$510.00
14.0346
$597.07
$531.7714300
Skin tissue rearrangement
Y
A2
$630.00
21.4302
$911.71
$700.4314350
Skin tissue rearrangement
Y
A2
$510.00
21.4302
$911.71
$610.4315002
Wnd prep, ch/inf, trk/arm/lg
Y
A2
$323.28
5.2594
$223.75
$298.4015003
Wnd prep, ch/inf addl 100 cm
Y
A2
$323.28
5.2594
$223.75
$298.4015004
Wnd prep ch/inf, f/n/hf/g
Y
A2
$323.28
5.2594
$223.75
$298.4015005
Wnd prep, f/n/hf/g, addl cm
Y
A2
$323.28
5.2594
$223.75
$298.4015040
Harvest cultured skin graft
Y
A2
$91.24
1.4843
$63.15
$84.2215050
Skin pinch graft
Y
A2
$323.28
5.2594
$223.75
$298.4015100
Skin splt grft, trnk/arm/leg
Y
A2
$446.00
21.4302
$911.71
$562.4315101
Skin splt grft t/a/l, add-on
Y
A2
$510.00
21.4302
$911.71
$610.4315110
Epidrm autogrft trnk/arm/leg
Y
A2
$446.00
21.4302
$911.71
$562.4315111
Epidrm autogrft t/a/l add-on
Y
A2
$333.00
21.4302
$911.71
$477.6815115
Epidrm a-grft face/nck/hf/g
Y
A2
$446.00
21.4302
$911.71
$562.4315116
Epidrm a-grft f/n/hf/g addl
Y
A2
$333.00
21.4302
$911.71
$477.6815120
Skn splt a-grft fac/nck/hf/g
Y
A2
$446.00
21.4302
$911.71
$562.4315121
Skn splt a-grft f/n/hf/g add
Y
A2
$510.00
21.4302
$911.71
$610.4315130
Derm autograft, trnk/arm/leg
Y
A2
$446.00
21.4302
$911.71
$562.4315131
Derm autograft t/a/l add-on
Y
A2
$333.00
21.4302
$911.71
$477.6815135
Derm autograft face/nck/hf/g
Y
A2
$446.00
21.4302
$911.71
$562.4315136
Derm autograft, f/n/hf/g add
Y
A2
$333.00
21.4302
$911.71
$477.6815150
Cult epiderm grft t/arm/leg
Y
A2
$446.00
21.4302
$911.71
$562.4315151
Cult epiderm grft t/a/l addl
Y
A2
$333.00
21.4302
$911.71
$477.6815152
Cult epiderm graft t/a/l +%
Y
A2
$333.00
21.4302
$911.71
$477.6815155
Cult epiderm graft, f/n/hf/g
Y
A2
$446.00
21.4302
$911.71
$562.4315156
Cult epidrm grft f/n/hfg add
Y
A2
$333.00
21.4302
$911.71
$477.6815157
Cult epiderm grft f/n/hfg +%
Y
A2
$333.00
21.4302
$911.71
$477.6815200
Skin full graft, trunk
Y
A2
$510.00
14.0346
$597.07
$531.7715201
Skin full graft trunk add-on
Y
A2
$323.28
5.2594
$223.75
$298.4015220
Skin full graft sclp/arm/leg
Y
A2
$446.00
14.0346
$597.07
$483.7715221
Skin full graft add-on
Y
A2
$323.28
5.2594
$223.75
$298.4015240
Skin full grft face/genit/hf
Y
A2
$510.00
14.0346
$597.07
$531.7715241
Skin full graft add-on
Y
A2
$323.28
5.2594
$223.75
$298.4015260
Skin full graft een & lips
Y
A2
$446.00
14.0346
$597.07
$483.7715261
Skin full graft add-on
Y
A2
$323.28
5.2594
$223.75
$298.4015300
Apply skinallogrft, t/arm/lg
Y
A2
$323.28
5.2594
$223.75
$298.4015301
Apply sknallogrft t/a/l addl
Y
A2
$323.28
5.2594
$223.75
$298.4015320
Apply skin allogrft f/n/hf/g
Y
A2
$323.28
5.2594
$223.75
$298.4015321
Aply sknallogrft f/n/hfg add
Y
A2
$323.28
5.2594
$223.75
$298.4015330
Aply acell alogrft t/arm/leg
Y
A2
$323.28
5.2594
$223.75
$298.4015331
Aply acell grft t/a/l add-on
Y
A2
$323.28
5.2594
$223.75
$298.4015335
Apply acell graft, f/n/hf/g
Y
A2
$323.28
5.2594
$223.75
$298.4015336
Aply acell grft f/n/hf/g add
Y
A2
$323.28
5.2594
$223.75
$298.4015340
Apply cult skin substitute
Y
P3

3.1385
$133.52
$133.5215341
Apply cult skin sub add-on
Y
G2

5.2594
$223.75
$223.7515360
Apply cult derm sub, t/a/l
Y
G2

5.2594
$223.75
$223.7515361
Aply cult derm sub t/a/l add
Y
G2

5.2594
$223.75
$223.7515365
Apply cult derm sub f/n/hf/g
Y
G2

5.2594
$223.75
$223.7515366
Apply cult derm f/hf/g add
Y
G2

5.2594
$223.75
$223.7515400
Apply skin xenograft, t/a/l
Y
A2
$323.28
5.2594
$223.75
$298.4015401
Apply skn xenogrft t/a/l add
Y
A2
$323.28
5.2594
$223.75
$298.4015420
Apply skin xgraft, f/n/hf/g
Y
A2
$323.28
5.2594
$223.75
$298.4015421
Apply skn xgrft f/n/hf/g add
Y
A2
$323.28
5.2594
$223.75
$298.4015430
Apply acellular xenograft
Y
A2
$323.28
5.2594
$223.75
$298.4015431
Apply acellular xgraft add
Y
A2
$323.28
5.2594
$223.75
$298.4015570
Form skin pedicle flap
Y
A2
$510.00
21.4302
$911.71
$610.4315572
Form skin pedicle flap
Y
A2
$510.00
21.4302
$911.71
$610.4315574
Form skin pedicle flap
Y
A2
$510.00
21.4302
$911.71
$610.4315576
Form skin pedicle flap
Y
A2
$510.00
14.0346
$597.07
$531.7715600
Skin graft
Y
A2
$510.00
21.4302
$911.71
$610.4315610
Skin graft
Y
A2
$510.00
21.4302
$911.71
$610.4315620
Skin graft
Y
A2
$630.00
21.4302
$911.71
$700.4315630
Skin graft
Y
A2
$510.00
21.4302
$911.71
$610.43( print page 42553)15650
Transfer skin pedicle flap
Y
A2
$717.00
21.4302
$911.71
$765.6815731
Forehead flap w/vasc pedicle
Y
A2
$510.00
14.0346
$597.07
$531.7715732
Muscle-skin graft, head/neck
Y
A2
$510.00
21.4302
$911.71
$610.4315734
Muscle-skin graft, trunk
Y
A2
$510.00
21.4302
$911.71
$610.4315736
Muscle-skin graft, arm
Y
A2
$510.00
21.4302
$911.71
$610.4315738
Muscle-skin graft, leg
Y
A2
$510.00
21.4302
$911.71
$610.4315740
Island pedicle flap graft
Y
A2
$446.00
14.0346
$597.07
$483.7715750
Neurovascular pedicle graft
Y
A2
$446.00
21.4302
$911.71
$562.4315760
Composite skin graft
Y
A2
$446.00
21.4302
$911.71
$562.4315770
Derma-fat-fascia graft
Y
A2
$510.00
21.4302
$911.71
$610.4315775
Hair transplant punch grafts
Y
A2
$323.28
5.2594
$223.75
$298.4015776
Hair transplant punch grafts
Y
A2
$323.28
5.2594
$223.75
$298.4015780
Abrasion treatment of skin
Y
P3

9.3992
$399.87
$399.8715781
Abrasion treatment of skin
Y
P2

4.0919
$174.08
$174.0815782
Abrasion treatment of skin
Y
P2

4.0919
$174.08
$174.0815783
Abrasion treatment of skin
Y
P2

2.6749
$113.80
$113.8015786
Abrasion, lesion, single
Y
P2

1.0918
$46.45
$46.4515787
Abrasion, lesions, add-on
Y
P3

0.7726
$32.87
$32.8715788
Chemical peel, face, epiderm
Y
P2

0.8432
$35.87
$35.8715789
Chemical peel, face, dermal
Y
P2

1.6241
$69.09
$69.0915792
Chemical peel, nonfacial
Y
P2

1.0918
$46.45
$46.4515793
Chemical peel, nonfacial
Y
P2

0.8432
$35.87
$35.8715819
Plastic surgery, neck
Y
G2

5.2594
$223.75
$223.7515820
Revision of lower eyelid
Y
A2
$510.00
21.4302
$911.71
$610.4315821
Revision of lower eyelid
Y
A2
$510.00
21.4302
$911.71
$610.4315822
Revision of upper eyelid
Y
A2
$510.00
21.4302
$911.71
$610.4315823
Revision of upper eyelid
Y
A2
$717.00
14.0346
$597.07
$687.0215824
Removal of forehead wrinkles
Y
A2
$510.00
21.4302
$911.71
$610.4315825
Removal of neck wrinkles
Y
A2
$510.00
21.4302
$911.71
$610.4315826
Removal of brow wrinkles
Y
A2
$510.00
21.4302
$911.71
$610.4315828
Removal of face wrinkles
Y
A2
$510.00
21.4302
$911.71
$610.4315829
Removal of skin wrinkles
Y
A2
$717.00
21.4302
$911.71
$765.6815830
Exc skin abd
Y
A2
$510.00
20.0656
$853.65
$595.9115832
Excise excessive skin tissue
Y
A2
$510.00
20.0656
$853.65
$595.9115833
Excise excessive skin tissue
Y
A2
$510.00
20.0656
$853.65
$595.9115834
Excise excessive skin tissue
Y
A2
$510.00
20.0656
$853.65
$595.9115835
Excise excessive skin tissue
Y
A2
$323.28
5.2594
$223.75
$298.4015836
Excise excessive skin tissue
Y
A2
$510.00
15.1024
$642.50
$543.1315837
Excise excessive skin tissue
Y
G2

15.1024
$642.50
$642.5015838
Excise excessive skin tissue
Y
G2

15.1024
$642.50
$642.5015839
Excise excessive skin tissue
Y
A2
$510.00
15.1024
$642.50
$543.1315840
Graft for face nerve palsy
Y
A2
$630.00
21.4302
$911.71
$700.4315841
Graft for face nerve palsy
Y
A2
$630.00
21.4302
$911.71
$700.4315842
Flap for face nerve palsy
Y
G2

14.0346
$597.07
$597.0715845
Skin and muscle repair, face
Y
A2
$630.00
21.4302
$911.71
$700.4315847
Exc skin abd add-on
Y
A2
$510.00
20.0656
$853.65
$595.9115850
Removal of sutures
Y
G2

2.6749
$113.80
$113.8015851
Removal of sutures
Y
P3

1.2070
$51.35
$51.3515852
Dressing change not for burn
N
G2

0.6102
$25.96
$25.9615860
Test for blood flow in graft
N
G2

0.6102
$25.96
$25.9615876
Suction assisted lipectomy
Y
A2
$510.00
21.4302
$911.71
$610.4315877
Suction assisted lipectomy
Y
A2
$510.00
21.4302
$911.71
$610.4315878
Suction assisted lipectomy
Y
A2
$510.00
14.0346
$597.07
$531.7715879
Suction assisted lipectomy
Y
A2
$510.00
21.4302
$911.71
$610.4315920
Removal of tail bone ulcer
Y
A2
$251.52
4.0919
$174.08
$232.1615922
Removal of tail bone ulcer
Y
A2
$630.00
21.4302
$911.71
$700.4315931
Remove sacrum pressure sore
Y
A2
$510.00
20.0656
$853.65
$595.9115933
Remove sacrum pressure sore
Y
A2
$510.00
20.0656
$853.65
$595.9115934
Remove sacrum pressure sore
Y
A2
$510.00
21.4302
$911.71
$610.4315935
Remove sacrum pressure sore
Y
A2
$630.00
21.4302
$911.71
$700.4315936
Remove sacrum pressure sore
Y
A2
$630.00
21.4302
$911.71
$700.4315937
Remove sacrum pressure sore
Y
A2
$630.00
21.4302
$911.71
$700.4315940
Remove hip pressure sore
Y
A2
$510.00
20.0656
$853.65
$595.91( print page 42554)15941
Remove hip pressure sore
Y
A2
$510.00
20.0656
$853.65
$595.9115944
Remove hip pressure sore
Y
A2
$510.00
21.4302
$911.71
$610.4315945
Remove hip pressure sore
Y
A2
$630.00
21.4302
$911.71
$700.4315946
Remove hip pressure sore
Y
A2
$630.00
21.4302
$911.71
$700.4315950
Remove thigh pressure sore
Y
A2
$510.00
20.0656
$853.65
$595.9115951
Remove thigh pressure sore
Y
A2
$630.00
20.0656
$853.65
$685.9115952
Remove thigh pressure sore
Y
A2
$510.00
21.4302
$911.71
$610.4315953
Remove thigh pressure sore
Y
A2
$630.00
21.4302
$911.71
$700.4315956
Remove thigh pressure sore
Y
A2
$510.00
21.4302
$911.71
$610.4315958
Remove thigh pressure sore
Y
A2
$630.00
21.4302
$911.71
$700.4316000
Initial treatment of burn(s)
Y
P3

0.6438
$27.39
$27.3916020
Dress/debrid p-thick burn, s
Y
P3

0.9656
$41.08
$41.0816025
Dress/debrid p-thick burn, m
Y
A2
$67.11
1.0918
$46.45
$61.9516030
Dress/debrid p-thick burn, l
Y
A2
$99.83
1.6241
$69.09
$92.1516035
Incision of burn scab, initi
Y
G2

2.6749
$113.80
$113.8017000
Destruct premalg lesion
Y
P2

0.4760
$20.25
$20.2517003
Destruct premalg les, 2-14
Y
P3

0.0886
$3.77
$3.7717004
Destroy premlg lesions 15+
Y
P3

1.8993
$80.80
$80.8017106
Destruction of skin lesions
Y
P2

2.5665
$109.19
$109.1917107
Destruction of skin lesions
Y
P2

2.5665
$109.19
$109.1917108
Destruction of skin lesions
Y
P2

2.5665
$109.19
$109.1917110
Destruct b9 lesion, 1-14
Y
P2

0.8432
$35.87
$35.8717111
Destruct lesion, 15 or more
Y
P2

1.0918
$46.45
$46.4517250
Chemical cautery, tissue
Y
P3

1.0220
$43.48
$43.4817260
Destruction of skin lesions
Y
P3

1.0944
$46.56
$46.5617261
Destruction of skin lesions
Y
P2

1.6241
$69.09
$69.0917262
Destruction of skin lesions
Y
P2

1.6241
$69.09
$69.0917263
Destruction of skin lesions
Y
P2

1.6241
$69.09
$69.0917264
Destruction of skin lesions
Y
P2

1.6241
$69.09
$69.0917266
Destruction of skin lesions
Y
P3

2.4382
$103.73
$103.7317270
Destruction of skin lesions
Y
P2

1.6241
$69.09
$69.0917271
Destruction of skin lesions
Y
P2

1.0918
$46.45
$46.4517272
Destruction of skin lesions
Y
P2

1.6241
$69.09
$69.0917273
Destruction of skin lesions
Y
P2

1.6241
$69.09
$69.0917274
Destruction of skin lesions
Y
P3

2.5026
$106.47
$106.4717276
Destruction of skin lesions
Y
P2

2.6749
$113.80
$113.8017280
Destruction of skin lesions
Y
P3

1.6014
$68.13
$68.1317281
Destruction of skin lesions
Y
P2

1.6241
$69.09
$69.0917282
Destruction of skin lesions
Y
P2

1.6241
$69.09
$69.0917283
Destruction of skin lesions
Y
P2

1.6241
$69.09
$69.0917284
Destruction of skin lesions
Y
P2

2.6749
$113.80
$113.8017286
Destruction of skin lesions
Y
P2

1.6241
$69.09
$69.0917311
Mohs, 1 stage, h/n/hf/g
Y
P2

3.7292
$158.65
$158.6517312
Mohs addl stage
Y
P2

3.7292
$158.65
$158.6517313
Mohs, 1 stage, t/a/l
Y
P2

3.7292
$158.65
$158.6517314
Mohs, addl stage, t/a/l
Y
P2

3.7292
$158.65
$158.6517315
Mohs surg, addl block
Y
P3

0.9254
$39.37
$39.3717340
Cryotherapy of skin
Y
P3

0.2816
$11.98
$11.9817360
Skin peel therapy
Y
P2

1.0918
$46.45
$46.4517380
Hair removal by electrolysis
Y
R2

1.0918
$46.45
$46.4519000
Drainage of breast lesion
Y
P3

1.5290
$65.05
$65.0519001
Drain breast lesion add-on
Y
P3

0.1932
$8.22
$8.2219020
Incision of breast lesion
Y
A2
$446.00
17.5086
$744.87
$520.7219030
Injection for breast x-ray

N119100
Bx breast percut w/o image
Y
A2
$240.00
3.9045
$166.11
$221.5319101
Biopsy of breast, open
Y
A2
$446.00
19.2788
$820.18
$539.5519102
Bx breast percut w/image
Y
A2
$240.00
3.9045
$166.11
$221.5319103
Bx breast percut w/device
Y
A2
$395.77
6.4387
$273.92
$365.3119105
Cryosurg ablate fa, each
Y
G2

28.0166
$1,191.91
$1,191.9119110
Nipple exploration
Y
A2
$446.00
19.2788
$820.18
$539.5519112
Excise breast duct fistula
Y
A2
$510.00
19.2788
$820.18
$587.5519120
Removal of breast lesion
Y
A2
$510.00
19.2788
$820.18
$587.5519125
Excision, breast lesion
Y
A2
$510.00
19.2788
$820.18
$587.55( print page 42555)19126
Excision, addl breast lesion
Y
A2
$510.00
19.2788
$820.18
$587.5519290
Place needle wire, breast

N1
$333.0019291
Place needle wire, breast

N1
$333.0019295
Place breast clip, percut
N
A2
$106.76
1.7369
$73.89
$98.5419296
Place po breast cath for rad
Y
A2
$1,339.00
51.2269
$2,179.35
$1,549.0919297
Place breast cath for rad
Y
A2
$1,339.00
51.2269
$2,179.35
$1,549.0919298
Place breast rad tube/caths
N
A2
$1,339.00
52.8730
$2,249.38
$1,566.6019300
Removal of breast tissue
Y
A2
$630.00
19.2788
$820.18
$677.5519301
Partical mastectomy
Y
A2
$510.00
19.2788
$820.18
$587.5519302
P-mastectomy w/ln removal
Y
A2
$995.00
36.9988
$1,574.04
$1,139.7619303
Mast, simple, complete
Y
A2
$630.00
28.0166
$1,191.91
$770.4819304
Mast, subq
Y
A2
$630.00
28.0166
$1,191.91
$770.4819316
Suspension of breast
Y
A2
$630.00
28.0166
$1,191.91
$770.4819318
Reduction of large breast
Y
A2
$630.00
36.9988
$1,574.04
$866.0119324
Enlarge breast
Y
A2
$630.00
36.9988
$1,574.04
$866.0119325
Enlarge breast with implant
Y
A2
$1,339.00
51.2269
$2,179.35
$1,549.0919328
Removal of breast implant
Y
A2
$333.00
28.0166
$1,191.91
$547.7319330
Removal of implant material
Y
A2
$333.00
28.0166
$1,191.91
$547.7319340
Immediate breast prosthesis
Y
A2
$446.00
37.8692
$1,611.07
$737.2719342
Delayed breast prosthesis
Y
A2
$510.00
51.2269
$2,179.35
$927.3419350
Breast reconstruction
Y
A2
$630.00
19.2788
$820.18
$677.5519355
Correct inverted nipple(s)
Y
A2
$630.00
28.0166
$1,191.91
$770.4819357
Breast reconstruction
Y
A2
$717.00
51.2269
$2,179.35
$1,082.5919366
Breast reconstruction
Y
A2
$717.00
28.0166
$1,191.91
$835.7319370
Surgery of breast capsule
Y
A2
$630.00
28.0166
$1,191.91
$770.4819371
Removal of breast capsule
Y
A2
$630.00
28.0166
$1,191.91
$770.4819380
Revise breast reconstruction
Y
A2
$717.00
37.8692
$1,611.07
$940.5219396
Design custom breast implant
Y
G2

28.0166
$1,191.91
$1,191.9120000
Incision of abscess
Y
P2

1.4392
$61.23
$61.2320005
Incision of deep abscess
Y
A2
$446.00
20.8706
$887.90
$556.4820103
Explore wound, extremity
Y
G2

4.2212
$179.58
$179.5820150
Excise epiphyseal bar
Y
G2

41.0893
$1,748.06
$1,748.0620200
Muscle biopsy
Y
A2
$446.00
15.1024
$642.50
$495.1320205
Deep muscle biopsy
Y
A2
$510.00
15.1024
$642.50
$543.1320206
Needle biopsy, muscle
Y
A2
$240.00
3.9045
$166.11
$221.5320220
Bone biopsy, trocar/needle
Y
A2
$251.52
4.0919
$174.08
$232.1620225
Bone biopsy, trocar/needle
Y
A2
$418.49
6.8083
$289.65
$386.2820240
Bone biopsy, excisional
Y
A2
$446.00
20.0656
$853.65
$547.9120245
Bone biopsy, excisional
Y
A2
$510.00
20.0656
$853.65
$595.9120250
Open bone biopsy
Y
A2
$510.00
20.8706
$887.90
$604.4820251
Open bone biopsy
Y
A2
$510.00
20.8706
$887.90
$604.4820500
Injection of sinus tract
Y
P3

1.4162
$60.25
$60.2520501
Inject sinus tract for x-ray

N120520
Removal of foreign body
Y
P3

2.2131
$94.15
$94.1520525
Removal of foreign body
Y
A2
$510.00
20.0656
$853.65
$595.9120526
Ther injection, carp tunnel
Y
P3

0.7162
$30.47
$30.4720550
Inj tendon sheath/ligament
Y
P3

0.5392
$22.94
$22.9420551
Inj tendon origin/insertion
Y
P3

0.5312
$22.60
$22.6020552
Inj trigger point, 1/2 muscl
Y
P3

0.5230
$22.25
$22.2520553
Inject trigger points, =/> 3
Y
P3

0.5874
$24.99
$24.9920600
Drain/inject, joint/bursa
Y
P3

0.5312
$22.60
$22.6020605
Drain/inject, joint/bursa
Y
P3

0.6036
$25.68
$25.6820610
Drain/inject, joint/bursa
Y
P3

0.8128
$34.58
$34.5820612
Aspirate/inj ganglion cyst
Y
P3

0.5714
$24.31
$24.3120615
Treatment of bone cyst
Y
P2

2.0687
$88.01
$88.0120650
Insert and remove bone pin
Y
A2
$510.00
20.8706
$887.90
$604.4820662
Application of pelvis brace
Y
R2

20.8706
$887.90
$887.9020663
Application of thigh brace
Y
R2

20.8706
$887.90
$887.9020665
Removal of fixation device
N
G2

0.6102
$25.96
$25.9620670
Removal of support implant
Y
A2
$333.00
15.1024
$642.50
$410.3820680
Removal of support implant
Y
A2
$510.00
20.0656
$853.65
$595.9120690
Apply bone fixation device
Y
A2
$446.00
25.1296
$1,069.09
$601.7720692
Apply bone fixation device
Y
A2
$510.00
25.1296
$1,069.09
$649.77( print page 42556)20693
Adjust bone fixation device
Y
A2
$510.00
20.8706
$887.90
$604.4820694
Remove bone fixation device
Y
A2
$333.00
20.8706
$887.90
$471.7320822
Replantation digit, complete
Y
G2

25.8758
$1,100.83
$1,100.8320900
Removal of bone for graft
Y
A2
$510.00
25.1296
$1,069.09
$649.7720902
Removal of bone for graft
Y
A2
$630.00
25.1296
$1,069.09
$739.7720910
Remove cartilage for graft
Y
A2
$510.00
21.4302
$911.71
$610.4320912
Remove cartilage for graft
Y
A2
$510.00
21.4302
$911.71
$610.4320920
Removal of fascia for graft
Y
A2
$630.00
14.0346
$597.07
$621.7720922
Removal of fascia for graft
Y
A2
$510.00
21.4302
$911.71
$610.4320924
Removal of tendon for graft
Y
A2
$630.00
25.1296
$1,069.09
$739.7720926
Removal of tissue for graft
Y
A2
$630.00
14.0346
$597.07
$621.7720950
Fluid pressure, muscle
Y
G2

1.4392
$61.23
$61.2320972
Bone/skin graft, metatarsal
Y
G2

40.8559
$1,738.13
$1,738.1320973
Bone/skin graft, great toe
Y
R2

40.8559
$1,738.13
$1,738.1320975
Electrical bone stimulation
N
A2
$37.51
0.6102
$25.96
$34.6220979
Us bone stimulation
N
P3

0.5552
$23.62
$23.6220982
Ablate, bone tumor(s) perq
Y
G2

41.0893
$1,748.06
$1,748.0621010
Incision of jaw joint
Y
A2
$446.00
23.3299
$992.52
$582.6321015
Resection of facial tumor
Y
A2
$510.00
16.4266
$698.84
$557.2121025
Excision of bone, lower jaw
Y
A2
$446.00
38.1991
$1,625.10
$740.7821026
Excision of facial bone(s)
Y
A2
$446.00
38.1991
$1,625.10
$740.7821029
Contour of face bone lesion
Y
A2
$446.00
38.1991
$1,625.10
$740.7821030
Excise max/zygoma b9 tumor
Y
P3

5.4479
$231.77
$231.7721031
Remove exostosis, mandible
Y
P3

4.4823
$190.69
$190.6921032
Remove exostosis, maxilla
Y
P3

4.5869
$195.14
$195.1421034
Excise max/zygoma mlg tumor
Y
A2
$510.00
38.1991
$1,625.10
$788.7821040
Excise mandible lesion
Y
A2
$446.00
23.3299
$992.52
$582.6321044
Removal of jaw bone lesion
Y
A2
$446.00
38.1991
$1,625.10
$740.7821046
Remove mandible cyst complex
Y
A2
$446.00
38.1991
$1,625.10
$740.7821047
Excise lwr jaw cyst w/repair
Y
A2
$446.00
38.1991
$1,625.10
$740.7821048
Remove maxilla cyst complex
Y
R2

38.1991
$1,625.10
$1,625.1021050
Removal of jaw joint
Y
A2
$510.00
38.1991
$1,625.10
$788.7821060
Remove jaw joint cartilage
Y
A2
$446.00
38.1991
$1,625.10
$740.7821070
Remove coronoid process
Y
A2
$510.00
38.1991
$1,625.10
$788.7821076
Prepare face/oral prosthesis
Y
P3

8.1760
$347.83
$347.8321077
Prepare face/oral prosthesis
Y
P3

20.1504
$857.26
$857.2621079
Prepare face/oral prosthesis
Y
P3

14.2437
$605.97
$605.9721080
Prepare face/oral prosthesis
Y
P3

16.3280
$694.64
$694.6421081
Prepare face/oral prosthesis
Y
P3

14.9437
$635.75
$635.7521082
Prepare face/oral prosthesis
Y
P3

13.8253
$588.17
$588.1721083
Prepare face/oral prosthesis
Y
P3

13.5113
$574.81
$574.8121084
Prepare face/oral prosthesis
Y
P3

15.6117
$664.17
$664.1721085
Prepare face/oral prosthesis
Y
P3

6.1079
$259.85
$259.8521086
Prepare face/oral prosthesis
Y
P3

14.7587
$627.88
$627.8821087
Prepare face/oral prosthesis
Y
P3

14.6621
$623.77
$623.7721088
Prepare face/oral prosthesis
Y
R2

38.1991
$1,625.10
$1,625.1021100
Maxillofacial fixation
Y
A2
$446.00
38.1991
$1,625.10
$740.7821110
Interdental fixation
Y
P2

7.5511
$321.25
$321.2521116
Injection, jaw joint x-ray

N121120
Reconstruction of chin
Y
A2
$995.00
23.3299
$992.52
$994.3821121
Reconstruction of chin
Y
A2
$995.00
23.3299
$992.52
$994.3821122
Reconstruction of chin
Y
A2
$995.00
23.3299
$992.52
$994.3821123
Reconstruction of chin
Y
A2
$995.00
23.3299
$992.52
$994.3821125
Augmentation, lower jaw bone
Y
A2
$995.00
23.3299
$992.52
$994.3821127
Augmentation, lower jaw bone
Y
A2
$1,339.00
38.1991
$1,625.10
$1,410.5321137
Reduction of forehead
Y
G2

23.3299
$992.52
$992.5221138
Reduction of forehead
Y
G2

38.1991
$1,625.10
$1,625.1021139
Reduction of forehead
Y
G2

38.1991
$1,625.10
$1,625.1021150
Reconstruct midface, lefort
Y
G2

38.1991
$1,625.10
$1,625.1021181
Contour cranial bone lesion
Y
A2
$995.00
23.3299
$992.52
$994.3821198
Reconstr lwr jaw segment
Y
G2

38.1991
$1,625.10
$1,625.1021199
Reconstr lwr jaw w/advance
Y
G2

38.1991
$1,625.10
$1,625.1021206
Reconstruct upper jaw bone
Y
A2
$717.00
38.1991
$1,625.10
$944.03( print page 42557)21208
Augmentation of facial bones
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5321209
Reduction of facial bones
Y
A2
$717.00
38.1991
$1,625.10
$944.0321210
Face bone graft
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5321215
Lower jaw bone graft
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5321230
Rib cartilage graft
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5321235
Ear cartilage graft
Y
A2
$995.00
23.3299
$992.52
$994.3821240
Reconstruction of jaw joint
Y
A2
$630.00
38.1991
$1,625.10
$878.7821242
Reconstruction of jaw joint
Y
A2
$717.00
38.1991
$1,625.10
$944.0321243
Reconstruction of jaw joint
Y
A2
$717.00
38.1991
$1,625.10
$944.0321244
Reconstruction of lower jaw
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5321245
Reconstruction of jaw
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5321246
Reconstruction of jaw
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5321248
Reconstruction of jaw
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5321249
Reconstruction of jaw
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5321260
Revise eye sockets
Y
G2

38.1991
$1,625.10
$1,625.1021267
Revise eye sockets
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5321270
Augmentation, cheek bone
Y
A2
$717.00
38.1991
$1,625.10
$944.0321275
Revision, orbitofacial bones
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5321280
Revision of eyelid
Y
A2
$717.00
38.1991
$1,625.10
$944.0321282
Revision of eyelid
Y
A2
$717.00
16.4266
$698.84
$712.4621295
Revision of jaw muscle/bone
Y
A2
$333.00
7.5511
$321.25
$330.0621296
Revision of jaw muscle/bone
Y
A2
$333.00
23.3299
$992.52
$497.8821310
Treatment of nose fracture
Y
A2
$150.72
2.4520
$104.32
$139.1221315
Treatment of nose fracture
Y
A2
$150.72
2.4520
$104.32
$139.1221320
Treatment of nose fracture
Y
A2
$446.00
7.5511
$321.25
$414.8121325
Treatment of nose fracture
Y
A2
$630.00
23.3299
$992.52
$720.6321330
Treatment of nose fracture
Y
A2
$717.00
23.3299
$992.52
$785.8821335
Treatment of nose fracture
Y
A2
$995.00
23.3299
$992.52
$994.3821336
Treat nasal septal fracture
Y
A2
$630.00
37.5382
$1,596.99
$871.7521337
Treat nasal septal fracture
Y
A2
$446.00
16.4266
$698.84
$509.2121338
Treat nasoethmoid fracture
Y
A2
$630.00
23.3299
$992.52
$720.6321339
Treat nasoethmoid fracture
Y
A2
$717.00
23.3299
$992.52
$785.8821340
Treatment of nose fracture
Y
A2
$630.00
38.1991
$1,625.10
$878.7821345
Treat nose/jaw fracture
Y
A2
$995.00
23.3299
$992.52
$994.3821355
Treat cheek bone fracture
Y
A2
$510.00
38.1991
$1,625.10
$788.7821356
Treat cheek bone fracture
Y
A2
$510.00
23.3299
$992.52
$630.6321390
Treat eye socket fracture
Y
G2

38.1991
$1,625.10
$1,625.1021400
Treat eye socket fracture
Y
A2
$446.00
7.5511
$321.25
$414.8121401
Treat eye socket fracture
Y
A2
$510.00
16.4266
$698.84
$557.2121406
Treat eye socket fracture
Y
G2

38.1991
$1,625.10
$1,625.1021407
Treat eye socket fracture
Y
G2

38.1991
$1,625.10
$1,625.1021421
Treat mouth roof fracture
Y
A2
$630.00
23.3299
$992.52
$720.6321440
Treat dental ridge fracture
Y
P3

7.0012
$297.85
$297.8521445
Treat dental ridge fracture
Y
A2
$630.00
23.3299
$992.52
$720.6321450
Treat lower jaw fracture
Y
A2
$150.72
2.4520
$104.32
$139.1221451
Treat lower jaw fracture
Y
A2
$464.15
7.5511
$321.25
$428.4321452
Treat lower jaw fracture
Y
A2
$446.00
16.4266
$698.84
$509.2121453
Treat lower jaw fracture
Y
A2
$510.00
38.1991
$1,625.10
$788.7821454
Treat lower jaw fracture
Y
A2
$717.00
23.3299
$992.52
$785.8821461
Treat lower jaw fracture
Y
A2
$630.00
38.1991
$1,625.10
$878.7821462
Treat lower jaw fracture
Y
A2
$717.00
38.1991
$1,625.10
$944.0321465
Treat lower jaw fracture
Y
A2
$630.00
38.1991
$1,625.10
$878.7821480
Reset dislocated jaw
Y
A2
$150.72
2.4520
$104.32
$139.1221485
Reset dislocated jaw
Y
A2
$446.00
16.4266
$698.84
$509.2121490
Repair dislocated jaw
Y
A2
$510.00
38.1991
$1,625.10
$788.7821495
Treat hyoid bone fracture
Y
G2

16.4266
$698.84
$698.8421497
Interdental wiring
Y
A2
$446.00
16.4266
$698.84
$509.2121501
Drain neck/chest lesion
Y
A2
$446.00
17.5086
$744.87
$520.7221502
Drain chest lesion
Y
A2
$446.00
20.8706
$887.90
$556.4821550
Biopsy of neck/chest
Y
G2

6.8083
$289.65
$289.6521555
Remove lesion, neck/chest
Y
A2
$446.00
20.0656
$853.65
$547.9121556
Remove lesion, neck/chest
Y
A2
$446.00
20.0656
$853.65
$547.9121557
Remove tumor, neck/chest
Y
G2

20.0656
$853.65
$853.65( print page 42558)21600
Partial removal of rib
Y
A2
$446.00
25.1296
$1,069.09
$601.7721610
Partial removal of rib
Y
A2
$446.00
25.1296
$1,069.09
$601.7721685
Hyoid myotomy & suspension
Y
G2

7.5511
$321.25
$321.2521700
Revision of neck muscle
Y
A2
$446.00
20.8706
$887.90
$556.4821720
Revision of neck muscle
Y
A2
$510.00
20.8706
$887.90
$604.4821725
Revision of neck muscle
Y
A2
$88.46
1.4392
$61.23
$81.6521800
Treatment of rib fracture
Y
A2
$103.62
1.6857
$71.71
$95.6421805
Treatment of rib fracture
Y
A2
$446.00
25.5264
$1,085.97
$605.9921820
Treat sternum fracture
Y
A2
$103.62
1.6857
$71.71
$95.6421920
Biopsy soft tissue of back
Y
P3

3.0983
$131.81
$131.8121925
Biopsy soft tissue of back
Y
A2
$446.00
20.0656
$853.65
$547.9121930
Remove lesion, back or flank
Y
A2
$446.00
20.0656
$853.65
$547.9121935
Remove tumor, back
Y
A2
$510.00
20.0656
$853.65
$595.9122102
Remove part, lumbar vertebra
Y
G2

44.1489
$1,878.23
$1,878.2322103
Remove extra spine segment
Y
G2

44.1489
$1,878.23
$1,878.2322305
Treat spine process fracture
Y
A2
$103.62
1.6857
$71.71
$95.6422310
Treat spine fracture
Y
A2
$103.62
1.6857
$71.71
$95.6422315
Treat spine fracture
Y
A2
$103.62
1.6857
$71.71
$95.6422505
Manipulation of spine
Y
A2
$446.00
14.5947
$620.90
$489.7322520
Percut vertebroplasty thor
Y
A2
$1,339.00
25.1296
$1,069.09
$1,271.5222521
Percut vertebroplasty lumb
Y
A2
$1,339.00
25.1296
$1,069.09
$1,271.5222522
Percut vertebroplasty add-on
Y
A2
$1,339.00
25.1296
$1,069.09
$1,271.5222523
Percut kyphoplasty, thor
Y
G2

66.5800
$2,832.51
$2,832.5122524
Percut kyphoplasty, lumbar
Y
G2

66.5800
$2,832.51
$2,832.5122525
Percut kyphoplasty, add-on
Y
G2

66.5800
$2,832.51
$2,832.5122900
Remove abdominal wall lesion
Y
A2
$630.00
20.0656
$853.65
$685.9123000
Removal of calcium deposits
Y
A2
$446.00
15.1024
$642.50
$495.1323020
Release shoulder joint
Y
A2
$446.00
41.0893
$1,748.06
$771.5223030
Drain shoulder lesion
Y
A2
$333.00
17.5086
$744.87
$435.9723031
Drain shoulder bursa
Y
A2
$510.00
17.5086
$744.87
$568.7223035
Drain shoulder bone lesion
Y
A2
$510.00
20.8706
$887.90
$604.4823040
Exploratory shoulder surgery
Y
A2
$510.00
25.1296
$1,069.09
$649.7723044
Exploratory shoulder surgery
Y
A2
$630.00
25.1296
$1,069.09
$739.7723065
Biopsy shoulder tissues
Y
P3

2.1888
$93.12
$93.1223066
Biopsy shoulder tissues
Y
A2
$446.00
20.0656
$853.65
$547.9123075
Removal of shoulder lesion
Y
A2
$446.00
15.1024
$642.50
$495.1323076
Removal of shoulder lesion
Y
A2
$446.00
20.0656
$853.65
$547.9123077
Remove tumor of shoulder
Y
A2
$510.00
20.0656
$853.65
$595.9123100
Biopsy of shoulder joint
Y
A2
$446.00
20.8706
$887.90
$556.4823101
Shoulder joint surgery
Y
A2
$995.00
25.1296
$1,069.09
$1,013.5223105
Remove shoulder joint lining
Y
A2
$630.00
25.1296
$1,069.09
$739.7723106
Incision of collarbone joint
Y
A2
$630.00
25.1296
$1,069.09
$739.7723107
Explore treat shoulder joint
Y
A2
$630.00
25.1296
$1,069.09
$739.7723120
Partial removal, collar bone
Y
A2
$717.00
41.0893
$1,748.06
$974.7723125
Removal of collar bone
Y
A2
$717.00
41.0893
$1,748.06
$974.7723130
Remove shoulder bone, part
Y
A2
$717.00
41.0893
$1,748.06
$974.7723140
Removal of bone lesion
Y
A2
$630.00
20.8706
$887.90
$694.4823145
Removal of bone lesion
Y
A2
$717.00
25.1296
$1,069.09
$805.0223146
Removal of bone lesion
Y
A2
$717.00
25.1296
$1,069.09
$805.0223150
Removal of humerus lesion
Y
A2
$630.00
25.1296
$1,069.09
$739.7723155
Removal of humerus lesion
Y
A2
$717.00
25.1296
$1,069.09
$805.0223156
Removal of humerus lesion
Y
A2
$717.00
25.1296
$1,069.09
$805.0223170
Remove collar bone lesion
Y
A2
$446.00
25.1296
$1,069.09
$601.7723172
Remove shoulder blade lesion
Y
A2
$446.00
25.1296
$1,069.09
$601.7723174
Remove humerus lesion
Y
A2
$446.00
25.1296
$1,069.09
$601.7723180
Remove collar bone lesion
Y
A2
$630.00
25.1296
$1,069.09
$739.7723182
Remove shoulder blade lesion
Y
A2
$630.00
25.1296
$1,069.09
$739.7723184
Remove humerus lesion
Y
A2
$630.00
25.1296
$1,069.09
$739.7723190
Partial removal of scapula
Y
A2
$630.00
25.1296
$1,069.09
$739.7723195
Removal of head of humerus
Y
A2
$717.00
25.1296
$1,069.09
$805.0223330
Remove shoulder foreign body
Y
A2
$333.00
6.8083
$289.65
$322.1623331
Remove shoulder foreign body
Y
A2
$333.00
20.0656
$853.65
$463.1623350
Injection for shoulder x-ray

N1( print page 42559)23395
Muscle transfer,shoulder/arm
Y
A2
$717.00
41.0893
$1,748.06
$974.7723397
Muscle transfers
Y
A2
$995.00
66.5800
$2,832.51
$1,454.3823400
Fixation of shoulder blade
Y
A2
$995.00
25.1296
$1,069.09
$1,013.5223405
Incision of tendon & muscle
Y
A2
$446.00
25.1296
$1,069.09
$601.7723406
Incise tendon(s) & muscle(s)
Y
A2
$446.00
25.1296
$1,069.09
$601.7723410
Repair rotator cuff, acute
Y
A2
$717.00
41.0893
$1,748.06
$974.7723412
Repair rotator cuff, chronic
Y
A2
$995.00
41.0893
$1,748.06
$1,183.2723415
Release of shoulder ligament
Y
A2
$717.00
41.0893
$1,748.06
$974.7723420
Repair of shoulder
Y
A2
$995.00
41.0893
$1,748.06
$1,183.2723430
Repair biceps tendon
Y
A2
$630.00
41.0893
$1,748.06
$909.5223440
Remove/transplant tendon
Y
A2
$630.00
41.0893
$1,748.06
$909.5223450
Repair shoulder capsule
Y
A2
$717.00
66.5800
$2,832.51
$1,245.8823455
Repair shoulder capsule
Y
A2
$995.00
66.5800
$2,832.51
$1,454.3823460
Repair shoulder capsule
Y
A2
$717.00
66.5800
$2,832.51
$1,245.8823462
Repair shoulder capsule
Y
A2
$995.00
41.0893
$1,748.06
$1,183.2723465
Repair shoulder capsule
Y
A2
$717.00
66.5800
$2,832.51
$1,245.8823466
Repair shoulder capsule
Y
A2
$995.00
41.0893
$1,748.06
$1,183.2723480
Revision of collar bone
Y
A2
$630.00
41.0893
$1,748.06
$909.5223485
Revision of collar bone
Y
A2
$995.00
66.5800
$2,832.51
$1,454.3823490
Reinforce clavicle
Y
A2
$510.00
41.0893
$1,748.06
$819.5223491
Reinforce shoulder bones
Y
A2
$510.00
66.5800
$2,832.51
$1,090.6323500
Treat clavicle fracture
Y
A2
$103.62
1.6857
$71.71
$95.6423505
Treat clavicle fracture
Y
A2
$103.62
1.6857
$71.71
$95.6423515
Treat clavicle fracture
Y
A2
$510.00
57.2172
$2,434.19
$991.0523520
Treat clavicle dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6423525
Treat clavicle dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6423530
Treat clavicle dislocation
Y
A2
$510.00
37.5382
$1,596.99
$781.7523532
Treat clavicle dislocation
Y
A2
$630.00
25.5264
$1,085.97
$743.9923540
Treat clavicle dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6423545
Treat clavicle dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6423550
Treat clavicle dislocation
Y
A2
$510.00
37.5382
$1,596.99
$781.7523552
Treat clavicle dislocation
Y
A2
$630.00
37.5382
$1,596.99
$871.7523570
Treat shoulder blade fx
Y
A2
$103.62
1.6857
$71.71
$95.6423575
Treat shoulder blade fx
Y
A2
$103.62
1.6857
$71.71
$95.6423585
Treat scapula fracture
Y
A2
$510.00
57.2172
$2,434.19
$991.0523600
Treat humerus fracture
Y
P2

1.6857
$71.71
$71.7123605
Treat humerus fracture
Y
A2
$103.62
1.6857
$71.71
$95.6423615
Treat humerus fracture
Y
A2
$630.00
57.2172
$2,434.19
$1,081.0523616
Treat humerus fracture
Y
A2
$630.00
57.2172
$2,434.19
$1,081.0523620
Treat humerus fracture
Y
P2

1.6857
$71.71
$71.7123625
Treat humerus fracture
Y
A2
$103.62
1.6857
$71.71
$95.6423630
Treat humerus fracture
Y
A2
$717.00
57.2172
$2,434.19
$1,146.3023650
Treat shoulder dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6423655
Treat shoulder dislocation
Y
A2
$333.00
14.5947
$620.90
$404.9823660
Treat shoulder dislocation
Y
A2
$510.00
37.5382
$1,596.99
$781.7523665
Treat dislocation/fracture
Y
A2
$103.62
1.6857
$71.71
$95.6423670
Treat dislocation/fracture
Y
A2
$510.00
57.2172
$2,434.19
$991.0523675
Treat dislocation/fracture
Y
A2
$103.62
1.6857
$71.71
$95.6423680
Treat dislocation/fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7523700
Fixation of shoulder
Y
A2
$333.00
14.5947
$620.90
$404.9823800
Fusion of shoulder joint
Y
A2
$630.00
66.5800
$2,832.51
$1,180.6323802
Fusion of shoulder joint
Y
A2
$995.00
41.0893
$1,748.06
$1,183.2723921
Amputation follow-up surgery
Y
A2
$323.28
5.2594
$223.75
$298.4023930
Drainage of arm lesion
Y
A2
$333.00
17.5086
$744.87
$435.9723931
Drainage of arm bursa
Y
A2
$446.00
17.5086
$744.87
$520.7223935
Drain arm/elbow bone lesion
Y
A2
$446.00
20.8706
$887.90
$556.4824000
Exploratory elbow surgery
Y
A2
$630.00
25.1296
$1,069.09
$739.7724006
Release elbow joint
Y
A2
$630.00
25.1296
$1,069.09
$739.7724065
Biopsy arm/elbow soft tissue
Y
P3

2.9695
$126.33
$126.3324066
Biopsy arm/elbow soft tissue
Y
A2
$446.00
15.1024
$642.50
$495.1324075
Remove arm/elbow lesion
Y
A2
$446.00
15.1024
$642.50
$495.1324076
Remove arm/elbow lesion
Y
A2
$446.00
20.0656
$853.65
$547.9124077
Remove tumor of arm/elbow
Y
A2
$510.00
20.0656
$853.65
$595.91( print page 42560)24100
Biopsy elbow joint lining
Y
A2
$333.00
20.8706
$887.90
$471.7324101
Explore/treat elbow joint
Y
A2
$630.00
25.1296
$1,069.09
$739.7724102
Remove elbow joint lining
Y
A2
$630.00
25.1296
$1,069.09
$739.7724105
Removal of elbow bursa
Y
A2
$510.00
20.8706
$887.90
$604.4824110
Remove humerus lesion
Y
A2
$446.00
20.8706
$887.90
$556.4824115
Remove/graft bone lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7724116
Remove/graft bone lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7724120
Remove elbow lesion
Y
A2
$510.00
20.8706
$887.90
$604.4824125
Remove/graft bone lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7724126
Remove/graft bone lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7724130
Removal of head of radius
Y
A2
$510.00
25.1296
$1,069.09
$649.7724134
Removal of arm bone lesion
Y
A2
$446.00
25.1296
$1,069.09
$601.7724136
Remove radius bone lesion
Y
A2
$446.00
25.1296
$1,069.09
$601.7724138
Remove elbow bone lesion
Y
A2
$446.00
25.1296
$1,069.09
$601.7724140
Partial removal of arm bone
Y
A2
$510.00
25.1296
$1,069.09
$649.7724145
Partial removal of radius
Y
A2
$510.00
25.1296
$1,069.09
$649.7724147
Partial removal of elbow
Y
A2
$446.00
25.1296
$1,069.09
$601.7724149
Radical resection of elbow
Y
G2

25.1296
$1,069.09
$1,069.0924152
Extensive radius surgery
Y
G2

41.0893
$1,748.06
$1,748.0624153
Extensive radius surgery
Y
G2

66.5800
$2,832.51
$2,832.5124155
Removal of elbow joint
Y
A2
$510.00
41.0893
$1,748.06
$819.5224160
Remove elbow joint implant
Y
A2
$446.00
25.1296
$1,069.09
$601.7724164
Remove radius head implant
Y
A2
$510.00
25.1296
$1,069.09
$649.7724200
Removal of arm foreign body
Y
P3

2.4867
$105.79
$105.7924201
Removal of arm foreign body
Y
A2
$446.00
15.1024
$642.50
$495.1324220
Injection for elbow x-ray

N124300
Manipulate elbow w/anesth
Y
G2

14.5947
$620.90
$620.9024301
Muscle/tendon transfer
Y
A2
$630.00
25.1296
$1,069.09
$739.7724305
Arm tendon lengthening
Y
A2
$630.00
25.1296
$1,069.09
$739.7724310
Revision of arm tendon
Y
A2
$510.00
20.8706
$887.90
$604.4824320
Repair of arm tendon
Y
A2
$510.00
41.0893
$1,748.06
$819.5224330
Revision of arm muscles
Y
A2
$510.00
66.5800
$2,832.51
$1,090.6324331
Revision of arm muscles
Y
A2
$510.00
41.0893
$1,748.06
$819.5224332
Tenolysis, triceps
Y
G2

20.8706
$887.90
$887.9024340
Repair of biceps tendon
Y
A2
$510.00
41.0893
$1,748.06
$819.5224341
Repair arm tendon/muscle
Y
A2
$510.00
41.0893
$1,748.06
$819.5224342
Repair of ruptured tendon
Y
A2
$510.00
41.0893
$1,748.06
$819.5224343
Repr elbow lat ligmnt w/tiss
Y
G2

25.1296
$1,069.09
$1,069.0924344
Reconstruct elbow lat ligmnt
Y
G2

66.5800
$2,832.51
$2,832.5124345
Repr elbw med ligmnt w/tissu
Y
A2
$446.00
25.1296
$1,069.09
$601.7724346
Reconstruct elbow med ligmnt
Y
G2

41.0893
$1,748.06
$1,748.0624350
Repair of tennis elbow
Y
A2
$510.00
25.1296
$1,069.09
$649.7724351
Repair of tennis elbow
Y
A2
$510.00
25.1296
$1,069.09
$649.7724352
Repair of tennis elbow
Y
A2
$510.00
25.1296
$1,069.09
$649.7724354
Repair of tennis elbow
Y
A2
$510.00
25.1296
$1,069.09
$649.7724356
Revision of tennis elbow
Y
A2
$510.00
25.1296
$1,069.09
$649.7724360
Reconstruct elbow joint
Y
A2
$717.00
33.4505
$1,423.08
$893.5224361
Reconstruct elbow joint
Y
A2
$717.00
107.1942
$4,560.36
$1,677.8424362
Reconstruct elbow joint
Y
A2
$717.00
47.4378
$2,018.15
$1,042.2924363
Replace elbow joint
Y
A2
$995.00
107.1942
$4,560.36
$1,886.3424365
Reconstruct head of radius
Y
A2
$717.00
33.4505
$1,423.08
$893.5224366
Reconstruct head of radius
Y
A2
$717.00
107.1942
$4,560.36
$1,677.8424400
Revision of humerus
Y
A2
$630.00
25.1296
$1,069.09
$739.7724410
Revision of humerus
Y
A2
$630.00
25.1296
$1,069.09
$739.7724420
Revision of humerus
Y
A2
$510.00
41.0893
$1,748.06
$819.5224430
Repair of humerus
Y
A2
$510.00
66.5800
$2,832.51
$1,090.6324435
Repair humerus with graft
Y
A2
$630.00
66.5800
$2,832.51
$1,180.6324470
Revision of elbow joint
Y
A2
$510.00
41.0893
$1,748.06
$819.5224495
Decompression of forearm
Y
A2
$446.00
25.1296
$1,069.09
$601.7724498
Reinforce humerus
Y
A2
$510.00
66.5800
$2,832.51
$1,090.6324500
Treat humerus fracture
Y
A2
$103.62
1.6857
$71.71
$95.6424505
Treat humerus fracture
Y
A2
$103.62
1.6857
$71.71
$95.6424515
Treat humerus fracture
Y
A2
$630.00
57.2172
$2,434.19
$1,081.05( print page 42561)24516
Treat humerus fracture
Y
A2
$630.00
57.2172
$2,434.19
$1,081.0524530
Treat humerus fracture
Y
A2
$103.62
1.6857
$71.71
$95.6424535
Treat humerus fracture
Y
A2
$103.62
1.6857
$71.71
$95.6424538
Treat humerus fracture
Y
A2
$446.00
25.5264
$1,085.97
$605.9924545
Treat humerus fracture
Y
A2
$630.00
57.2172
$2,434.19
$1,081.0524546
Treat humerus fracture
Y
A2
$717.00
57.2172
$2,434.19
$1,146.3024560
Treat humerus fracture
Y
A2
$103.62
1.6857
$71.71
$95.6424565
Treat humerus fracture
Y
A2
$103.62
1.6857
$71.71
$95.6424566
Treat humerus fracture
Y
A2
$446.00
25.5264
$1,085.97
$605.9924575
Treat humerus fracture
Y
A2
$510.00
57.2172
$2,434.19
$991.0524576
Treat humerus fracture
Y
A2
$103.62
1.6857
$71.71
$95.6424577
Treat humerus fracture
Y
A2
$103.62
1.6857
$71.71
$95.6424579
Treat humerus fracture
Y
A2
$510.00
57.2172
$2,434.19
$991.0524582
Treat humerus fracture
Y
A2
$446.00
25.5264
$1,085.97
$605.9924586
Treat elbow fracture
Y
A2
$630.00
57.2172
$2,434.19
$1,081.0524587
Treat elbow fracture
Y
A2
$717.00
57.2172
$2,434.19
$1,146.3024600
Treat elbow dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6424605
Treat elbow dislocation
Y
A2
$446.00
14.5947
$620.90
$489.7324615
Treat elbow dislocation
Y
A2
$510.00
57.2172
$2,434.19
$991.0524620
Treat elbow fracture
Y
A2
$103.62
1.6857
$71.71
$95.6424635
Treat elbow fracture
Y
A2
$510.00
57.2172
$2,434.19
$991.0524640
Treat elbow dislocation
Y
G2

1.6857
$71.71
$71.7124650
Treat radius fracture
Y
P2

1.6857
$71.71
$71.7124655
Treat radius fracture
Y
A2
$103.62
1.6857
$71.71
$95.6424665
Treat radius fracture
Y
A2
$630.00
37.5382
$1,596.99
$871.7524666
Treat radius fracture
Y
A2
$630.00
57.2172
$2,434.19
$1,081.0524670
Treat ulnar fracture
Y
A2
$103.62
1.6857
$71.71
$95.6424675
Treat ulnar fracture
Y
A2
$103.62
1.6857
$71.71
$95.6424685
Treat ulnar fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7524800
Fusion of elbow joint
Y
A2
$630.00
41.0893
$1,748.06
$909.5224802
Fusion/graft of elbow joint
Y
A2
$717.00
41.0893
$1,748.06
$974.7724925
Amputation follow-up surgery
Y
A2
$510.00
20.8706
$887.90
$604.4825000
Incision of tendon sheath
Y
A2
$510.00
20.8706
$887.90
$604.4825001
Incise flexor carpi radialis
Y
G2

20.8706
$887.90
$887.9025020
Decompress forearm 1 space
Y
A2
$510.00
20.8706
$887.90
$604.4825023
Decompress forearm 1 space
Y
A2
$510.00
25.1296
$1,069.09
$649.7725024
Decompress forearm 2 spaces
Y
A2
$510.00
25.1296
$1,069.09
$649.7725025
Decompress forearm 2 spaces
Y
A2
$510.00
25.1296
$1,069.09
$649.7725028
Drainage of forearm lesion
Y
A2
$333.00
20.8706
$887.90
$471.7325031
Drainage of forearm bursa
Y
A2
$446.00
20.8706
$887.90
$556.4825035
Treat forearm bone lesion
Y
A2
$446.00
20.8706
$887.90
$556.4825040
Explore/treat wrist joint
Y
A2
$717.00
25.1296
$1,069.09
$805.0225065
Biopsy forearm soft tissues
Y
P3

3.0259
$128.73
$128.7325066
Biopsy forearm soft tissues
Y
A2
$446.00
20.0656
$853.65
$547.9125075
Removal forearm lesion subcu
Y
A2
$446.00
15.1024
$642.50
$495.1325076
Removal forearm lesion deep
Y
A2
$510.00
20.0656
$853.65
$595.9125077
Remove tumor, forearm/wrist
Y
A2
$510.00
20.0656
$853.65
$595.9125085
Incision of wrist capsule
Y
A2
$510.00
20.8706
$887.90
$604.4825100
Biopsy of wrist joint
Y
A2
$446.00
20.8706
$887.90
$556.4825101
Explore/treat wrist joint
Y
A2
$510.00
25.1296
$1,069.09
$649.7725105
Remove wrist joint lining
Y
A2
$630.00
25.1296
$1,069.09
$739.7725107
Remove wrist joint cartilage
Y
A2
$510.00
25.1296
$1,069.09
$649.7725109
Excise tendon forearm/wrist
Y
G2

20.8706
$887.90
$887.9025110
Remove wrist tendon lesion
Y
A2
$510.00
20.8706
$887.90
$604.4825111
Remove wrist tendon lesion
Y
A2
$510.00
16.1540
$687.24
$554.3125112
Reremove wrist tendon lesion
Y
A2
$630.00
16.1540
$687.24
$644.3125115
Remove wrist/forearm lesion
Y
A2
$630.00
20.8706
$887.90
$694.4825116
Remove wrist/forearm lesion
Y
A2
$630.00
20.8706
$887.90
$694.4825118
Excise wrist tendon sheath
Y
A2
$446.00
25.1296
$1,069.09
$601.7725119
Partial removal of ulna
Y
A2
$510.00
25.1296
$1,069.09
$649.7725120
Removal of forearm lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7725125
Remove/graft forearm lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7725126
Remove/graft forearm lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.77( print page 42562)25130
Removal of wrist lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7725135
Remove & graft wrist lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7725136
Remove & graft wrist lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7725145
Remove forearm bone lesion
Y
A2
$446.00
25.1296
$1,069.09
$601.7725150
Partial removal of ulna
Y
A2
$446.00
25.1296
$1,069.09
$601.7725151
Partial removal of radius
Y
A2
$446.00
25.1296
$1,069.09
$601.7725210
Removal of wrist bone
Y
A2
$510.00
25.8758
$1,100.83
$657.7125215
Removal of wrist bones
Y
A2
$630.00
25.8758
$1,100.83
$747.7125230
Partial removal of radius
Y
A2
$630.00
25.1296
$1,069.09
$739.7725240
Partial removal of ulna
Y
A2
$630.00
25.1296
$1,069.09
$739.7725246
Injection for wrist x-ray

N125248
Remove forearm foreign body
Y
A2
$446.00
20.8706
$887.90
$556.4825250
Removal of wrist prosthesis
Y
A2
$333.00
25.1296
$1,069.09
$517.0225251
Removal of wrist prosthesis
Y
A2
$333.00
25.1296
$1,069.09
$517.0225259
Manipulate wrist w/anesthes
Y
G2

1.6857
$71.71
$71.7125260
Repair forearm tendon/muscle
Y
A2
$630.00
25.1296
$1,069.09
$739.7725263
Repair forearm tendon/muscle
Y
A2
$446.00
25.1296
$1,069.09
$601.7725265
Repair forearm tendon/muscle
Y
A2
$510.00
25.1296
$1,069.09
$649.7725270
Repair forearm tendon/muscle
Y
A2
$630.00
25.1296
$1,069.09
$739.7725272
Repair forearm tendon/muscle
Y
A2
$510.00
25.1296
$1,069.09
$649.7725274
Repair forearm tendon/muscle
Y
A2
$630.00
25.1296
$1,069.09
$739.7725275
Repair forearm tendon sheath
Y
A2
$630.00
25.1296
$1,069.09
$739.7725280
Revise wrist/forearm tendon
Y
A2
$630.00
25.1296
$1,069.09
$739.7725290
Incise wrist/forearm tendon
Y
A2
$510.00
25.1296
$1,069.09
$649.7725295
Release wrist/forearm tendon
Y
A2
$510.00
20.8706
$887.90
$604.4825300
Fusion of tendons at wrist
Y
A2
$510.00
25.1296
$1,069.09
$649.7725301
Fusion of tendons at wrist
Y
A2
$510.00
25.1296
$1,069.09
$649.7725310
Transplant forearm tendon
Y
A2
$510.00
41.0893
$1,748.06
$819.5225312
Transplant forearm tendon
Y
A2
$630.00
41.0893
$1,748.06
$909.5225315
Revise palsy hand tendon(s)
Y
A2
$510.00
41.0893
$1,748.06
$819.5225316
Revise palsy hand tendon(s)
Y
A2
$510.00
66.5800
$2,832.51
$1,090.6325320
Repair/revise wrist joint
Y
A2
$510.00
41.0893
$1,748.06
$819.5225332
Revise wrist joint
Y
A2
$717.00
33.4505
$1,423.08
$893.5225335
Realignment of hand
Y
A2
$510.00
41.0893
$1,748.06
$819.5225337
Reconstruct ulna/radioulnar
Y
A2
$717.00
41.0893
$1,748.06
$974.7725350
Revision of radius
Y
A2
$510.00
66.5800
$2,832.51
$1,090.6325355
Revision of radius
Y
A2
$510.00
41.0893
$1,748.06
$819.5225360
Revision of ulna
Y
A2
$510.00
25.1296
$1,069.09
$649.7725365
Revise radius & ulna
Y
A2
$510.00
25.1296
$1,069.09
$649.7725370
Revise radius or ulna
Y
A2
$510.00
41.0893
$1,748.06
$819.5225375
Revise radius & ulna
Y
A2
$630.00
41.0893
$1,748.06
$909.5225390
Shorten radius or ulna
Y
A2
$510.00
25.1296
$1,069.09
$649.7725391
Lengthen radius or ulna
Y
A2
$630.00
41.0893
$1,748.06
$909.5225392
Shorten radius & ulna
Y
A2
$510.00
25.1296
$1,069.09
$649.7725393
Lengthen radius & ulna
Y
A2
$630.00
41.0893
$1,748.06
$909.5225394
Repair carpal bone, shorten
Y
G2

16.1540
$687.24
$687.2425400
Repair radius or ulna
Y
A2
$510.00
25.1296
$1,069.09
$649.7725405
Repair/graft radius or ulna
Y
A2
$630.00
25.1296
$1,069.09
$739.7725415
Repair radius & ulna
Y
A2
$510.00
25.1296
$1,069.09
$649.7725420
Repair/graft radius & ulna
Y
A2
$630.00
66.5800
$2,832.51
$1,180.6325425
Repair/graft radius or ulna
Y
A2
$510.00
41.0893
$1,748.06
$819.5225426
Repair/graft radius & ulna
Y
A2
$630.00
41.0893
$1,748.06
$909.5225430
Vasc graft into carpal bone
Y
G2

25.8758
$1,100.83
$1,100.8325431
Repair nonunion carpal bone
Y
G2

25.8758
$1,100.83
$1,100.8325440
Repair/graft wrist bone
Y
A2
$630.00
66.5800
$2,832.51
$1,180.6325441
Reconstruct wrist joint
Y
A2
$717.00
107.1942
$4,560.36
$1,677.8425442
Reconstruct wrist joint
Y
A2
$717.00
107.1942
$4,560.36
$1,677.8425443
Reconstruct wrist joint
Y
A2
$717.00
47.4378
$2,018.15
$1,042.2925444
Reconstruct wrist joint
Y
A2
$717.00
47.4378
$2,018.15
$1,042.2925445
Reconstruct wrist joint
Y
A2
$717.00
47.4378
$2,018.15
$1,042.2925446
Wrist replacement
Y
A2
$995.00
107.1942
$4,560.36
$1,886.3425447
Repair wrist joint(s)
Y
A2
$717.00
33.4505
$1,423.08
$893.5225449
Remove wrist joint implant
Y
A2
$717.00
33.4505
$1,423.08
$893.52( print page 42563)25450
Revision of wrist joint
Y
A2
$510.00
41.0893
$1,748.06
$819.5225455
Revision of wrist joint
Y
A2
$510.00
41.0893
$1,748.06
$819.5225490
Reinforce radius
Y
A2
$510.00
41.0893
$1,748.06
$819.5225491
Reinforce ulna
Y
A2
$510.00
41.0893
$1,748.06
$819.5225492
Reinforce radius and ulna
Y
A2
$510.00
41.0893
$1,748.06
$819.5225500
Treat fracture of radius
Y
P2

1.6857
$71.71
$71.7125505
Treat fracture of radius
Y
A2
$103.62
1.6857
$71.71
$95.6425515
Treat fracture of radius
Y
A2
$510.00
37.5382
$1,596.99
$781.7525520
Treat fracture of radius
Y
A2
$103.62
1.6857
$71.71
$95.6425525
Treat fracture of radius
Y
A2
$630.00
37.5382
$1,596.99
$871.7525526
Treat fracture of radius
Y
A2
$717.00
37.5382
$1,596.99
$937.0025530
Treat fracture of ulna
Y
P2

1.6857
$71.71
$71.7125535
Treat fracture of ulna
Y
A2
$103.62
1.6857
$71.71
$95.6425545
Treat fracture of ulna
Y
A2
$510.00
37.5382
$1,596.99
$781.7525560
Treat fracture radius & ulna
Y
P2

1.6857
$71.71
$71.7125565
Treat fracture radius & ulna
Y
A2
$103.62
1.6857
$71.71
$95.6425574
Treat fracture radius & ulna
Y
A2
$510.00
57.2172
$2,434.19
$991.0525575
Treat fracture radius/ulna
Y
A2
$510.00
57.2172
$2,434.19
$991.0525600
Treat fracture radius/ulna
Y
P2

1.6857
$71.71
$71.7125605
Treat fracture radius/ulna
Y
A2
$103.62
1.6857
$71.71
$95.6425606
Treat fx distal radial
Y
A2
$510.00
25.5264
$1,085.97
$653.9925607
Treat fx rad extra-articul
Y
A2
$717.00
57.2172
$2,434.19
$1,146.3025608
Treat fx rad intra-articul
Y
A2
$717.00
57.2172
$2,434.19
$1,146.3025609
Treat fx radial 3+ frag
Y
A2
$717.00
57.2172
$2,434.19
$1,146.3025622
Treat wrist bone fracture
Y
P2

1.6857
$71.71
$71.7125624
Treat wrist bone fracture
Y
A2
$103.62
1.6857
$71.71
$95.6425628
Treat wrist bone fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7525630
Treat wrist bone fracture
Y
P2

1.6857
$71.71
$71.7125635
Treat wrist bone fracture
Y
A2
$103.62
1.6857
$71.71
$95.6425645
Treat wrist bone fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7525650
Treat wrist bone fracture
Y
P2

1.6857
$71.71
$71.7125651
Pin ulnar styloid fracture
Y
G2

25.5264
$1,085.97
$1,085.9725652
Treat fracture ulnar styloid
Y
G2

37.5382
$1,596.99
$1,596.9925660
Treat wrist dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6425670
Treat wrist dislocation
Y
A2
$510.00
25.5264
$1,085.97
$653.9925671
Pin radioulnar dislocation
Y
A2
$333.00
25.5264
$1,085.97
$521.2425675
Treat wrist dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6425676
Treat wrist dislocation
Y
A2
$446.00
25.5264
$1,085.97
$605.9925680
Treat wrist fracture
Y
A2
$103.62
1.6857
$71.71
$95.6425685
Treat wrist fracture
Y
A2
$510.00
25.5264
$1,085.97
$653.9925690
Treat wrist dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6425695
Treat wrist dislocation
Y
A2
$446.00
25.5264
$1,085.97
$605.9925800
Fusion of wrist joint
Y
A2
$630.00
66.5800
$2,832.51
$1,180.6325805
Fusion/graft of wrist joint
Y
A2
$717.00
41.0893
$1,748.06
$974.7725810
Fusion/graft of wrist joint
Y
A2
$717.00
66.5800
$2,832.51
$1,245.8825820
Fusion of hand bones
Y
A2
$630.00
16.1540
$687.24
$644.3125825
Fuse hand bones with graft
Y
A2
$717.00
25.8758
$1,100.83
$812.9625830
Fusion, radioulnar jnt/ulna
Y
A2
$717.00
66.5800
$2,832.51
$1,245.8825907
Amputation follow-up surgery
Y
A2
$510.00
20.8706
$887.90
$604.4825922
Amputate hand at wrist
Y
A2
$510.00
20.8706
$887.90
$604.4825929
Amputation follow-up surgery
Y
A2
$510.00
14.0346
$597.07
$531.7726010
Drainage of finger abscess
Y
P2

1.4392
$61.23
$61.2326011
Drainage of finger abscess
Y
A2
$333.00
11.1535
$474.50
$368.3826020
Drain hand tendon sheath
Y
A2
$446.00
16.1540
$687.24
$506.3126025
Drainage of palm bursa
Y
A2
$333.00
16.1540
$687.24
$421.5626030
Drainage of palm bursa(s)
Y
A2
$446.00
16.1540
$687.24
$506.3126034
Treat hand bone lesion
Y
A2
$446.00
16.1540
$687.24
$506.3126035
Decompress fingers/hand
Y
G2

16.1540
$687.24
$687.2426040
Release palm contracture
Y
A2
$630.00
25.8758
$1,100.83
$747.7126045
Release palm contracture
Y
A2
$510.00
25.8758
$1,100.83
$657.7126055
Incise finger tendon sheath
Y
A2
$446.00
16.1540
$687.24
$506.3126060
Incision of finger tendon
Y
A2
$446.00
16.1540
$687.24
$506.3126070
Explore/treat hand joint
Y
A2
$446.00
16.1540
$687.24
$506.31( print page 42564)26075
Explore/treat finger joint
Y
A2
$630.00
16.1540
$687.24
$644.3126080
Explore/treat finger joint
Y
A2
$630.00
16.1540
$687.24
$644.3126100
Biopsy hand joint lining
Y
A2
$446.00
16.1540
$687.24
$506.3126105
Biopsy finger joint lining
Y
A2
$333.00
16.1540
$687.24
$421.5626110
Biopsy finger joint lining
Y
A2
$333.00
16.1540
$687.24
$421.5626115
Removal hand lesion subcut
Y
A2
$446.00
20.0656
$853.65
$547.9126116
Removal hand lesion, deep
Y
A2
$446.00
20.0656
$853.65
$547.9126117
Remove tumor, hand/finger
Y
A2
$510.00
20.0656
$853.65
$595.9126121
Release palm contracture
Y
A2
$630.00
25.8758
$1,100.83
$747.7126123
Release palm contracture
Y
A2
$630.00
25.8758
$1,100.83
$747.7126125
Release palm contracture
Y
A2
$630.00
16.1540
$687.24
$644.3126130
Remove wrist joint lining
Y
A2
$510.00
16.1540
$687.24
$554.3126135
Revise finger joint, each
Y
A2
$630.00
25.8758
$1,100.83
$747.7126140
Revise finger joint, each
Y
A2
$446.00
16.1540
$687.24
$506.3126145
Tendon excision, palm/finger
Y
A2
$510.00
16.1540
$687.24
$554.3126160
Remove tendon sheath lesion
Y
A2
$510.00
16.1540
$687.24
$554.3126170
Removal of palm tendon, each
Y
A2
$510.00
16.1540
$687.24
$554.3126180
Removal of finger tendon
Y
A2
$510.00
16.1540
$687.24
$554.3126185
Remove finger bone
Y
A2
$630.00
16.1540
$687.24
$644.3126200
Remove hand bone lesion
Y
A2
$446.00
16.1540
$687.24
$506.3126205
Remove/graft bone lesion
Y
A2
$510.00
25.8758
$1,100.83
$657.7126210
Removal of finger lesion
Y
A2
$446.00
16.1540
$687.24
$506.3126215
Remove/graft finger lesion
Y
A2
$510.00
16.1540
$687.24
$554.3126230
Partial removal of hand bone
Y
A2
$992.95
16.1540
$687.24
$916.5226235
Partial removal, finger bone
Y
A2
$510.00
16.1540
$687.24
$554.3126236
Partial removal, finger bone
Y
A2
$510.00
16.1540
$687.24
$554.3126250
Extensive hand surgery
Y
A2
$510.00
16.1540
$687.24
$554.3126255
Extensive hand surgery
Y
A2
$510.00
25.8758
$1,100.83
$657.7126260
Extensive finger surgery
Y
A2
$510.00
16.1540
$687.24
$554.3126261
Extensive finger surgery
Y
A2
$510.00
16.1540
$687.24
$554.3126262
Partial removal of finger
Y
A2
$446.00
16.1540
$687.24
$506.3126320
Removal of implant from hand
Y
A2
$446.00
15.1024
$642.50
$495.1326340
Manipulate finger w/anesth
Y
G2

1.6857
$71.71
$71.7126350
Repair finger/hand tendon
Y
A2
$333.00
25.8758
$1,100.83
$524.9626352
Repair/graft hand tendon
Y
A2
$630.00
25.8758
$1,100.83
$747.7126356
Repair finger/hand tendon
Y
A2
$630.00
25.8758
$1,100.83
$747.7126357
Repair finger/hand tendon
Y
A2
$630.00
25.8758
$1,100.83
$747.7126358
Repair/graft hand tendon
Y
A2
$630.00
25.8758
$1,100.83
$747.7126370
Repair finger/hand tendon
Y
A2
$630.00
25.8758
$1,100.83
$747.7126372
Repair/graft hand tendon
Y
A2
$630.00
25.8758
$1,100.83
$747.7126373
Repair finger/hand tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126390
Revise hand/finger tendon
Y
A2
$630.00
25.8758
$1,100.83
$747.7126392
Repair/graft hand tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126410
Repair hand tendon
Y
A2
$510.00
16.1540
$687.24
$554.3126412
Repair/graft hand tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126415
Excision, hand/finger tendon
Y
A2
$630.00
25.8758
$1,100.83
$747.7126416
Graft hand or finger tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126418
Repair finger tendon
Y
A2
$630.00
16.1540
$687.24
$644.3126420
Repair/graft finger tendon
Y
A2
$630.00
25.8758
$1,100.83
$747.7126426
Repair finger/hand tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126428
Repair/graft finger tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126432
Repair finger tendon
Y
A2
$510.00
16.1540
$687.24
$554.3126433
Repair finger tendon
Y
A2
$510.00
16.1540
$687.24
$554.3126434
Repair/graft finger tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126437
Realignment of tendons
Y
A2
$510.00
16.1540
$687.24
$554.3126440
Release palm/finger tendon
Y
A2
$510.00
16.1540
$687.24
$554.3126442
Release palm & finger tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126445
Release hand/finger tendon
Y
A2
$510.00
16.1540
$687.24
$554.3126449
Release forearm/hand tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126450
Incision of palm tendon
Y
A2
$510.00
16.1540
$687.24
$554.3126455
Incision of finger tendon
Y
A2
$510.00
16.1540
$687.24
$554.3126460
Incise hand/finger tendon
Y
A2
$510.00
16.1540
$687.24
$554.3126471
Fusion of finger tendons
Y
A2
$446.00
16.1540
$687.24
$506.31( print page 42565)26474
Fusion of finger tendons
Y
A2
$446.00
16.1540
$687.24
$506.3126476
Tendon lengthening
Y
A2
$333.00
16.1540
$687.24
$421.5626477
Tendon shortening
Y
A2
$333.00
16.1540
$687.24
$421.5626478
Lengthening of hand tendon
Y
A2
$333.00
16.1540
$687.24
$421.5626479
Shortening of hand tendon
Y
A2
$333.00
16.1540
$687.24
$421.5626480
Transplant hand tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126483
Transplant/graft hand tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126485
Transplant palm tendon
Y
A2
$446.00
25.8758
$1,100.83
$609.7126489
Transplant/graft palm tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126490
Revise thumb tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126492
Tendon transfer with graft
Y
A2
$510.00
25.8758
$1,100.83
$657.7126494
Hand tendon/muscle transfer
Y
A2
$510.00
25.8758
$1,100.83
$657.7126496
Revise thumb tendon
Y
A2
$510.00
25.8758
$1,100.83
$657.7126497
Finger tendon transfer
Y
A2
$510.00
25.8758
$1,100.83
$657.7126498
Finger tendon transfer
Y
A2
$630.00
25.8758
$1,100.83
$747.7126499
Revision of finger
Y
A2
$510.00
25.8758
$1,100.83
$657.7126500
Hand tendon reconstruction
Y
A2
$630.00
16.1540
$687.24
$644.3126502
Hand tendon reconstruction
Y
A2
$630.00
25.8758
$1,100.83
$747.7126508
Release thumb contracture
Y
A2
$510.00
16.1540
$687.24
$554.3126510
Thumb tendon transfer
Y
A2
$510.00
25.8758
$1,100.83
$657.7126516
Fusion of knuckle joint
Y
A2
$333.00
25.8758
$1,100.83
$524.9626517
Fusion of knuckle joints
Y
A2
$510.00
25.8758
$1,100.83
$657.7126518
Fusion of knuckle joints
Y
A2
$510.00
25.8758
$1,100.83
$657.7126520
Release knuckle contracture
Y
A2
$510.00
16.1540
$687.24
$554.3126525
Release finger contracture
Y
A2
$510.00
16.1540
$687.24
$554.3126530
Revise knuckle joint
Y
A2
$510.00
33.4505
$1,423.08
$738.2726531
Revise knuckle with implant
Y
A2
$995.00
47.4378
$2,018.15
$1,250.7926535
Revise finger joint
Y
A2
$717.00
33.4505
$1,423.08
$893.5226536
Revise/implant finger joint
Y
A2
$717.00
47.4378
$2,018.15
$1,042.2926540
Repair hand joint
Y
A2
$630.00
16.1540
$687.24
$644.3126541
Repair hand joint with graft
Y
A2
$995.00
25.8758
$1,100.83
$1,021.4626542
Repair hand joint with graft
Y
A2
$630.00
16.1540
$687.24
$644.3126545
Reconstruct finger joint
Y
A2
$630.00
25.8758
$1,100.83
$747.7126546
Repair nonunion hand
Y
A2
$630.00
25.8758
$1,100.83
$747.7126548
Reconstruct finger joint
Y
A2
$630.00
25.8758
$1,100.83
$747.7126550
Construct thumb replacement
Y
A2
$446.00
25.8758
$1,100.83
$609.7126555
Positional change of finger
Y
A2
$510.00
25.8758
$1,100.83
$657.7126560
Repair of web finger
Y
A2
$446.00
16.1540
$687.24
$506.3126561
Repair of web finger
Y
A2
$510.00
25.8758
$1,100.83
$657.7126562
Repair of web finger
Y
A2
$630.00
25.8758
$1,100.83
$747.7126565
Correct metacarpal flaw
Y
A2
$717.00
25.8758
$1,100.83
$812.9626567
Correct finger deformity
Y
A2
$717.00
25.8758
$1,100.83
$812.9626568
Lengthen metacarpal/finger
Y
A2
$510.00
25.8758
$1,100.83
$657.7126580
Repair hand deformity
Y
A2
$717.00
16.1540
$687.24
$709.5626587
Reconstruct extra finger
Y
A2
$717.00
16.1540
$687.24
$709.5626590
Repair finger deformity
Y
A2
$717.00
16.1540
$687.24
$709.5626591
Repair muscles of hand
Y
A2
$510.00
25.8758
$1,100.83
$657.7126593
Release muscles of hand
Y
A2
$510.00
16.1540
$687.24
$554.3126596
Excision constricting tissue
Y
A2
$446.00
16.1540
$687.24
$506.3126600
Treat metacarpal fracture
Y
P2

1.6857
$71.71
$71.7126605
Treat metacarpal fracture
Y
A2
$103.62
1.6857
$71.71
$95.6426607
Treat metacarpal fracture
Y
A2
$103.62
1.6857
$71.71
$95.6426608
Treat metacarpal fracture
Y
A2
$630.00
25.5264
$1,085.97
$743.9926615
Treat metacarpal fracture
Y
A2
$630.00
37.5382
$1,596.99
$871.7526641
Treat thumb dislocation
Y
G2

1.6857
$71.71
$71.7126645
Treat thumb fracture
Y
A2
$103.62
1.6857
$71.71
$95.6426650
Treat thumb fracture
Y
A2
$446.00
25.5264
$1,085.97
$605.9926665
Treat thumb fracture
Y
A2
$630.00
37.5382
$1,596.99
$871.7526670
Treat hand dislocation
Y
G2

1.6857
$71.71
$71.7126675
Treat hand dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6426676
Pin hand dislocation
Y
A2
$446.00
25.5264
$1,085.97
$605.9926685
Treat hand dislocation
Y
A2
$510.00
37.5382
$1,596.99
$781.7526686
Treat hand dislocation
Y
A2
$510.00
57.2172
$2,434.19
$991.05( print page 42566)26700
Treat knuckle dislocation
Y
G2

1.6857
$71.71
$71.7126705
Treat knuckle dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6426706
Pin knuckle dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6426715
Treat knuckle dislocation
Y
A2
$630.00
37.5382
$1,596.99
$871.7526720
Treat finger fracture, each
Y
P2

1.6857
$71.71
$71.7126725
Treat finger fracture, each
Y
P2

1.6857
$71.71
$71.7126727
Treat finger fracture, each
Y
A2
$995.00
25.5264
$1,085.97
$1,017.7426735
Treat finger fracture, each
Y
A2
$630.00
37.5382
$1,596.99
$871.7526740
Treat finger fracture, each
Y
P2

1.6857
$71.71
$71.7126742
Treat finger fracture, each
Y
A2
$103.62
1.6857
$71.71
$95.6426746
Treat finger fracture, each
Y
A2
$717.00
37.5382
$1,596.99
$937.0026750
Treat finger fracture, each
Y
P2

1.6857
$71.71
$71.7126755
Treat finger fracture, each
Y
G2

1.6857
$71.71
$71.7126756
Pin finger fracture, each
Y
A2
$446.00
25.5264
$1,085.97
$605.9926765
Treat finger fracture, each
Y
A2
$630.00
37.5382
$1,596.99
$871.7526770
Treat finger dislocation
Y
G2

1.6857
$71.71
$71.7126775
Treat finger dislocation
Y
G2

14.5947
$620.90
$620.9026776
Pin finger dislocation
Y
A2
$446.00
25.5264
$1,085.97
$605.9926785
Treat finger dislocation
Y
A2
$446.00
25.5264
$1,085.97
$605.9926820
Thumb fusion with graft
Y
A2
$717.00
25.8758
$1,100.83
$812.9626841
Fusion of thumb
Y
A2
$630.00
25.8758
$1,100.83
$747.7126842
Thumb fusion with graft
Y
A2
$630.00
25.8758
$1,100.83
$747.7126843
Fusion of hand joint
Y
A2
$510.00
25.8758
$1,100.83
$657.7126844
Fusion/graft of hand joint
Y
A2
$510.00
25.8758
$1,100.83
$657.7126850
Fusion of knuckle
Y
A2
$630.00
25.8758
$1,100.83
$747.7126852
Fusion of knuckle with graft
Y
A2
$630.00
25.8758
$1,100.83
$747.7126860
Fusion of finger joint
Y
A2
$510.00
25.8758
$1,100.83
$657.7126861
Fusion of finger jnt, add-on
Y
A2
$446.00
25.8758
$1,100.83
$609.7126862
Fusion/graft of finger joint
Y
A2
$630.00
25.8758
$1,100.83
$747.7126863
Fuse/graft added joint
Y
A2
$510.00
25.8758
$1,100.83
$657.7126910
Amputate metacarpal bone
Y
A2
$510.00
25.8758
$1,100.83
$657.7126951
Amputation of finger/thumb
Y
A2
$446.00
16.1540
$687.24
$506.3126952
Amputation of finger/thumb
Y
A2
$630.00
16.1540
$687.24
$644.3126990
Drainage of pelvis lesion
Y
A2
$333.00
20.8706
$887.90
$471.7326991
Drainage of pelvis bursa
Y
A2
$333.00
20.8706
$887.90
$471.7327000
Incision of hip tendon
Y
A2
$446.00
20.8706
$887.90
$556.4827001
Incision of hip tendon
Y
A2
$510.00
25.1296
$1,069.09
$649.7727003
Incision of hip tendon
Y
A2
$510.00
25.1296
$1,069.09
$649.7727033
Exploration of hip joint
Y
A2
$510.00
41.0893
$1,748.06
$819.5227035
Denervation of hip joint
Y
A2
$630.00
41.0893
$1,748.06
$909.5227040
Biopsy of soft tissues
Y
A2
$333.00
6.8083
$289.65
$322.1627041
Biopsy of soft tissues
Y
A2
$418.49
6.8083
$289.65
$386.2827047
Remove hip/pelvis lesion
Y
A2
$446.00
20.0656
$853.65
$547.9127048
Remove hip/pelvis lesion
Y
A2
$510.00
20.0656
$853.65
$595.9127049
Remove tumor, hip/pelvis
Y
A2
$510.00
20.0656
$853.65
$595.9127050
Biopsy of sacroiliac joint
Y
A2
$510.00
20.8706
$887.90
$604.4827052
Biopsy of hip joint
Y
A2
$510.00
20.8706
$887.90
$604.4827060
Removal of ischial bursa
Y
A2
$717.00
20.8706
$887.90
$759.7327062
Remove femur lesion/bursa
Y
A2
$717.00
20.8706
$887.90
$759.7327065
Removal of hip bone lesion
Y
A2
$717.00
20.8706
$887.90
$759.7327066
Removal of hip bone lesion
Y
A2
$717.00
25.1296
$1,069.09
$805.0227067
Remove/graft hip bone lesion
Y
A2
$717.00
25.1296
$1,069.09
$805.0227080
Removal of tail bone
Y
A2
$446.00
25.1296
$1,069.09
$601.7727086
Remove hip foreign body
Y
A2
$333.00
6.8083
$289.65
$322.1627087
Remove hip foreign body
Y
A2
$510.00
20.8706
$887.90
$604.4827093
Injection for hip x-ray

N127095
Injection for hip x-ray

N127097
Revision of hip tendon
Y
A2
$510.00
25.1296
$1,069.09
$649.7727098
Transfer tendon to pelvis
Y
A2
$510.00
25.1296
$1,069.09
$649.7727100
Transfer of abdominal muscle
Y
A2
$630.00
41.0893
$1,748.06
$909.5227105
Transfer of spinal muscle
Y
A2
$630.00
41.0893
$1,748.06
$909.5227110
Transfer of iliopsoas muscle
Y
A2
$630.00
41.0893
$1,748.06
$909.5227111
Transfer of iliopsoas muscle
Y
A2
$630.00
41.0893
$1,748.06
$909.52( print page 42567)27193
Treat pelvic ring fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427194
Treat pelvic ring fracture
Y
A2
$446.00
14.5947
$620.90
$489.7327200
Treat tail bone fracture
Y
P2

1.6857
$71.71
$71.7127202
Treat tail bone fracture
Y
A2
$446.00
37.5382
$1,596.99
$733.7527220
Treat hip socket fracture
Y
G2

1.6857
$71.71
$71.7127230
Treat thigh fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427238
Treat thigh fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427246
Treat thigh fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427250
Treat hip dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6427252
Treat hip dislocation
Y
A2
$446.00
14.5947
$620.90
$489.7327256
Treat hip dislocation
Y
G2

1.6857
$71.71
$71.7127257
Treat hip dislocation
Y
A2
$510.00
14.5947
$620.90
$537.7327265
Treat hip dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6427266
Treat hip dislocation
Y
A2
$446.00
14.5947
$620.90
$489.7327275
Manipulation of hip joint
Y
A2
$446.00
14.5947
$620.90
$489.7327301
Drain thigh/knee lesion
Y
A2
$510.00
17.5086
$744.87
$568.7227305
Incise thigh tendon & fascia
Y
A2
$446.00
20.8706
$887.90
$556.4827306
Incision of thigh tendon
Y
A2
$510.00
20.8706
$887.90
$604.4827307
Incision of thigh tendons
Y
A2
$510.00
20.8706
$887.90
$604.4827310
Exploration of knee joint
Y
A2
$630.00
25.1296
$1,069.09
$739.7727323
Biopsy, thigh soft tissues
Y
A2
$333.00
6.8083
$289.65
$322.1627324
Biopsy, thigh soft tissues
Y
A2
$333.00
20.0656
$853.65
$463.1627325
Neurectomy, hamstring
Y
A2
$446.00
17.8499
$759.39
$524.3527326
Neurectomy, popliteal
Y
A2
$446.00
17.8499
$759.39
$524.3527327
Removal of thigh lesion
Y
A2
$446.00
20.0656
$853.65
$547.9127328
Removal of thigh lesion
Y
A2
$510.00
20.0656
$853.65
$595.9127329
Remove tumor, thigh/knee
Y
A2
$630.00
20.0656
$853.65
$685.9127330
Biopsy, knee joint lining
Y
A2
$630.00
25.1296
$1,069.09
$739.7727331
Explore/treat knee joint
Y
A2
$630.00
25.1296
$1,069.09
$739.7727332
Removal of knee cartilage
Y
A2
$630.00
25.1296
$1,069.09
$739.7727333
Removal of knee cartilage
Y
A2
$630.00
25.1296
$1,069.09
$739.7727334
Remove knee joint lining
Y
A2
$630.00
25.1296
$1,069.09
$739.7727335
Remove knee joint lining
Y
A2
$630.00
25.1296
$1,069.09
$739.7727340
Removal of kneecap bursa
Y
A2
$510.00
20.8706
$887.90
$604.4827345
Removal of knee cyst
Y
A2
$630.00
20.8706
$887.90
$694.4827347
Remove knee cyst
Y
A2
$630.00
20.8706
$887.90
$694.4827350
Removal of kneecap
Y
A2
$630.00
25.1296
$1,069.09
$739.7727355
Remove femur lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7727356
Remove femur lesion/graft
Y
A2
$630.00
25.1296
$1,069.09
$739.7727357
Remove femur lesion/graft
Y
A2
$717.00
25.1296
$1,069.09
$805.0227358
Remove femur lesion/fixation
Y
A2
$717.00
25.1296
$1,069.09
$805.0227360
Partial removal, leg bone(s)
Y
A2
$717.00
25.1296
$1,069.09
$805.0227370
Injection for knee x-ray

N127372
Removal of foreign body
Y
A2
$995.00
20.0656
$853.65
$959.6627380
Repair of kneecap tendon
Y
A2
$333.00
20.8706
$887.90
$471.7327381
Repair/graft kneecap tendon
Y
A2
$510.00
20.8706
$887.90
$604.4827385
Repair of thigh muscle
Y
A2
$510.00
20.8706
$887.90
$604.4827386
Repair/graft of thigh muscle
Y
A2
$510.00
20.8706
$887.90
$604.4827390
Incision of thigh tendon
Y
A2
$333.00
20.8706
$887.90
$471.7327391
Incision of thigh tendons
Y
A2
$446.00
20.8706
$887.90
$556.4827392
Incision of thigh tendons
Y
A2
$510.00
20.8706
$887.90
$604.4827393
Lengthening of thigh tendon
Y
A2
$446.00
25.1296
$1,069.09
$601.7727394
Lengthening of thigh tendons
Y
A2
$510.00
25.1296
$1,069.09
$649.7727395
Lengthening of thigh tendons
Y
A2
$510.00
41.0893
$1,748.06
$819.5227396
Transplant of thigh tendon
Y
A2
$510.00
25.1296
$1,069.09
$649.7727397
Transplants of thigh tendons
Y
A2
$510.00
41.0893
$1,748.06
$819.5227400
Revise thigh muscles/tendons
Y
A2
$510.00
41.0893
$1,748.06
$819.5227403
Repair of knee cartilage
Y
A2
$630.00
25.1296
$1,069.09
$739.7727405
Repair of knee ligament
Y
A2
$630.00
41.0893
$1,748.06
$909.5227407
Repair of knee ligament
Y
A2
$630.00
66.5800
$2,832.51
$1,180.6327409
Repair of knee ligaments
Y
A2
$630.00
41.0893
$1,748.06
$909.5227418
Repair degenerated kneecap
Y
A2
$510.00
41.0893
$1,748.06
$819.5227420
Revision of unstable kneecap
Y
A2
$510.00
41.0893
$1,748.06
$819.52( print page 42568)27422
Revision of unstable kneecap
Y
A2
$995.00
41.0893
$1,748.06
$1,183.2727424
Revision/removal of kneecap
Y
A2
$510.00
41.0893
$1,748.06
$819.5227425
Lat retinacular release open
Y
A2
$995.00
25.1296
$1,069.09
$1,013.5227427
Reconstruction, knee
Y
A2
$510.00
41.0893
$1,748.06
$819.5227428
Reconstruction, knee
Y
A2
$630.00
66.5800
$2,832.51
$1,180.6327429
Reconstruction, knee
Y
A2
$630.00
66.5800
$2,832.51
$1,180.6327430
Revision of thigh muscles
Y
A2
$630.00
41.0893
$1,748.06
$909.5227435
Incision of knee joint
Y
A2
$630.00
41.0893
$1,748.06
$909.5227437
Revise kneecap
Y
A2
$630.00
33.4505
$1,423.08
$828.2727438
Revise kneecap with implant
Y
A2
$717.00
47.4378
$2,018.15
$1,042.2927440
Revision of knee joint
Y
G2

33.4505
$1,423.08
$1,423.0827441
Revision of knee joint
Y
A2
$717.00
33.4505
$1,423.08
$893.5227442
Revision of knee joint
Y
A2
$717.00
33.4505
$1,423.08
$893.5227443
Revision of knee joint
Y
A2
$717.00
33.4505
$1,423.08
$893.5227446
Revision of knee joint
Y
G2

205.6815
$8,750.31
$8,750.3127496
Decompression of thigh/knee
Y
A2
$717.00
20.8706
$887.90
$759.7327497
Decompression of thigh/knee
Y
A2
$510.00
20.8706
$887.90
$604.4827498
Decompression of thigh/knee
Y
A2
$510.00
20.8706
$887.90
$604.4827499
Decompression of thigh/knee
Y
A2
$510.00
20.8706
$887.90
$604.4827500
Treatment of thigh fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427501
Treatment of thigh fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427502
Treatment of thigh fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427503
Treatment of thigh fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427508
Treatment of thigh fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427509
Treatment of thigh fracture
Y
A2
$510.00
25.5264
$1,085.97
$653.9927510
Treatment of thigh fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427516
Treat thigh fx growth plate
Y
A2
$103.62
1.6857
$71.71
$95.6427517
Treat thigh fx growth plate
Y
A2
$103.62
1.6857
$71.71
$95.6427520
Treat kneecap fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427530
Treat knee fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427532
Treat knee fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427538
Treat knee fracture(s)
Y
A2
$103.62
1.6857
$71.71
$95.6427550
Treat knee dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6427552
Treat knee dislocation
Y
A2
$333.00
14.5947
$620.90
$404.9827560
Treat kneecap dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6427562
Treat kneecap dislocation
Y
A2
$333.00
14.5947
$620.90
$404.9827566
Treat kneecap dislocation
Y
A2
$446.00
37.5382
$1,596.99
$733.7527570
Fixation of knee joint
Y
A2
$333.00
14.5947
$620.90
$404.9827594
Amputation follow-up surgery
Y
A2
$510.00
20.8706
$887.90
$604.4827600
Decompression of lower leg
Y
A2
$510.00
20.8706
$887.90
$604.4827601
Decompression of lower leg
Y
A2
$510.00
20.8706
$887.90
$604.4827602
Decompression of lower leg
Y
A2
$510.00
20.8706
$887.90
$604.4827603
Drain lower leg lesion
Y
A2
$446.00
17.5086
$744.87
$520.7227604
Drain lower leg bursa
Y
A2
$446.00
20.8706
$887.90
$556.4827605
Incision of achilles tendon
Y
A2
$333.00
20.4263
$869.00
$467.0027606
Incision of achilles tendon
Y
A2
$333.00
20.8706
$887.90
$471.7327607
Treat lower leg bone lesion
Y
A2
$446.00
20.8706
$887.90
$556.4827610
Explore/treat ankle joint
Y
A2
$446.00
25.1296
$1,069.09
$601.7727612
Exploration of ankle joint
Y
A2
$510.00
25.1296
$1,069.09
$649.7727613
Biopsy lower leg soft tissue
Y
P3

2.8569
$121.54
$121.5427614
Biopsy lower leg soft tissue
Y
A2
$446.00
20.0656
$853.65
$547.9127615
Remove tumor, lower leg
Y
A2
$510.00
25.1296
$1,069.09
$649.7727618
Remove lower leg lesion
Y
A2
$446.00
15.1024
$642.50
$495.1327619
Remove lower leg lesion
Y
A2
$510.00
20.0656
$853.65
$595.9127620
Explore/treat ankle joint
Y
A2
$630.00
25.1296
$1,069.09
$739.7727625
Remove ankle joint lining
Y
A2
$630.00
25.1296
$1,069.09
$739.7727626
Remove ankle joint lining
Y
A2
$630.00
25.1296
$1,069.09
$739.7727630
Removal of tendon lesion
Y
A2
$510.00
20.8706
$887.90
$604.4827635
Remove lower leg bone lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7727637
Remove/graft leg bone lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7727638
Remove/graft leg bone lesion
Y
A2
$510.00
25.1296
$1,069.09
$649.7727640
Partial removal of tibia
Y
A2
$446.00
41.0893
$1,748.06
$771.5227641
Partial removal of fibula
Y
A2
$446.00
25.1296
$1,069.09
$601.77( print page 42569)27647
Extensive ankle/heel surgery
Y
A2
$510.00
41.0893
$1,748.06
$819.5227648
Injection for ankle x-ray

N127650
Repair achilles tendon
Y
A2
$510.00
41.0893
$1,748.06
$819.5227652
Repair/graft achilles tendon
Y
A2
$510.00
66.5800
$2,832.51
$1,090.6327654
Repair of achilles tendon
Y
A2
$510.00
41.0893
$1,748.06
$819.5227656
Repair leg fascia defect
Y
A2
$446.00
20.8706
$887.90
$556.4827658
Repair of leg tendon, each
Y
A2
$333.00
20.8706
$887.90
$471.7327659
Repair of leg tendon, each
Y
A2
$446.00
20.8706
$887.90
$556.4827664
Repair of leg tendon, each
Y
A2
$446.00
20.8706
$887.90
$556.4827665
Repair of leg tendon, each
Y
A2
$446.00
25.1296
$1,069.09
$601.7727675
Repair lower leg tendons
Y
A2
$446.00
20.8706
$887.90
$556.4827676
Repair lower leg tendons
Y
A2
$510.00
25.1296
$1,069.09
$649.7727680
Release of lower leg tendon
Y
A2
$510.00
25.1296
$1,069.09
$649.7727681
Release of lower leg tendons
Y
A2
$446.00
25.1296
$1,069.09
$601.7727685
Revision of lower leg tendon
Y
A2
$510.00
25.1296
$1,069.09
$649.7727686
Revise lower leg tendons
Y
A2
$510.00
25.1296
$1,069.09
$649.7727687
Revision of calf tendon
Y
A2
$510.00
25.1296
$1,069.09
$649.7727690
Revise lower leg tendon
Y
A2
$630.00
41.0893
$1,748.06
$909.5227691
Revise lower leg tendon
Y
A2
$630.00
41.0893
$1,748.06
$909.5227692
Revise additional leg tendon
Y
A2
$510.00
41.0893
$1,748.06
$819.5227695
Repair of ankle ligament
Y
A2
$446.00
25.1296
$1,069.09
$601.7727696
Repair of ankle ligaments
Y
A2
$446.00
25.1296
$1,069.09
$601.7727698
Repair of ankle ligament
Y
A2
$446.00
25.1296
$1,069.09
$601.7727700
Revision of ankle joint
Y
A2
$717.00
33.4505
$1,423.08
$893.5227704
Removal of ankle implant
Y
A2
$446.00
20.8706
$887.90
$556.4827705
Incision of tibia
Y
A2
$446.00
41.0893
$1,748.06
$771.5227707
Incision of fibula
Y
A2
$446.00
20.8706
$887.90
$556.4827709
Incision of tibia & fibula
Y
A2
$446.00
25.1296
$1,069.09
$601.7727730
Repair of tibia epiphysis
Y
A2
$446.00
25.1296
$1,069.09
$601.7727732
Repair of fibula epiphysis
Y
A2
$446.00
25.1296
$1,069.09
$601.7727734
Repair lower leg epiphyses
Y
A2
$446.00
25.1296
$1,069.09
$601.7727740
Repair of leg epiphyses
Y
A2
$446.00
25.1296
$1,069.09
$601.7727742
Repair of leg epiphyses
Y
A2
$446.00
41.0893
$1,748.06
$771.5227745
Reinforce tibia
Y
A2
$510.00
66.5800
$2,832.51
$1,090.6327750
Treatment of tibia fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427752
Treatment of tibia fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427756
Treatment of tibia fracture
Y
A2
$510.00
25.5264
$1,085.97
$653.9927758
Treatment of tibia fracture
Y
A2
$630.00
37.5382
$1,596.99
$871.7527759
Treatment of tibia fracture
Y
A2
$630.00
57.2172
$2,434.19
$1,081.0527760
Treatment of ankle fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427762
Treatment of ankle fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427766
Treatment of ankle fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7527780
Treatment of fibula fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427781
Treatment of fibula fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427784
Treatment of fibula fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7527786
Treatment of ankle fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427788
Treatment of ankle fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427792
Treatment of ankle fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7527808
Treatment of ankle fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427810
Treatment of ankle fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427814
Treatment of ankle fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7527816
Treatment of ankle fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427818
Treatment of ankle fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427822
Treatment of ankle fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7527823
Treatment of ankle fracture
Y
A2
$510.00
57.2172
$2,434.19
$991.0527824
Treat lower leg fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427825
Treat lower leg fracture
Y
A2
$103.62
1.6857
$71.71
$95.6427826
Treat lower leg fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7527827
Treat lower leg fracture
Y
A2
$510.00
57.2172
$2,434.19
$991.0527828
Treat lower leg fracture
Y
A2
$630.00
57.2172
$2,434.19
$1,081.0527829
Treat lower leg joint
Y
A2
$446.00
37.5382
$1,596.99
$733.7527830
Treat lower leg dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6427831
Treat lower leg dislocation
Y
A2
$103.62
1.6857
$71.71
$95.64( print page 42570)27832
Treat lower leg dislocation
Y
A2
$446.00
37.5382
$1,596.99
$733.7527840
Treat ankle dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6427842
Treat ankle dislocation
Y
A2
$333.00
14.5947
$620.90
$404.9827846
Treat ankle dislocation
Y
A2
$510.00
37.5382
$1,596.99
$781.7527848
Treat ankle dislocation
Y
A2
$510.00
37.5382
$1,596.99
$781.7527860
Fixation of ankle joint
Y
A2
$333.00
14.5947
$620.90
$404.9827870
Fusion of ankle joint, open
Y
A2
$630.00
66.5800
$2,832.51
$1,180.6327871
Fusion of tibiofibular joint
Y
A2
$630.00
66.5800
$2,832.51
$1,180.6327884
Amputation follow-up surgery
Y
A2
$510.00
20.8706
$887.90
$604.4827889
Amputation of foot at ankle
Y
A2
$510.00
25.1296
$1,069.09
$649.7727892
Decompression of leg
Y
A2
$510.00
20.8706
$887.90
$604.4827893
Decompression of leg
Y
A2
$510.00
20.8706
$887.90
$604.4827894
Decompression of leg
Y
A2
$510.00
20.8706
$887.90
$604.4828001
Drainage of bursa of foot
Y
P3

2.8327
$120.51
$120.5128002
Treatment of foot infection
Y
A2
$510.00
20.8706
$887.90
$604.4828003
Treatment of foot infection
Y
A2
$510.00
20.8706
$887.90
$604.4828005
Treat foot bone lesion
Y
A2
$510.00
20.4263
$869.00
$599.7528008
Incision of foot fascia
Y
A2
$510.00
20.4263
$869.00
$599.7528010
Incision of toe tendon
Y
P3

2.1164
$90.04
$90.0428011
Incision of toe tendons
Y
A2
$510.00
20.4263
$869.00
$599.7528020
Exploration of foot joint
Y
A2
$446.00
20.4263
$869.00
$551.7528022
Exploration of foot joint
Y
A2
$446.00
20.4263
$869.00
$551.7528024
Exploration of toe joint
Y
A2
$446.00
20.4263
$869.00
$551.7528035
Decompression of tibia nerve
Y
A2
$630.00
17.8499
$759.39
$662.3528043
Excision of foot lesion
Y
A2
$446.00
20.0656
$853.65
$547.9128045
Excision of foot lesion
Y
A2
$510.00
20.4263
$869.00
$599.7528046
Resection of tumor, foot
Y
A2
$510.00
20.4263
$869.00
$599.7528050
Biopsy of foot joint lining
Y
A2
$446.00
20.4263
$869.00
$551.7528052
Biopsy of foot joint lining
Y
A2
$446.00
20.4263
$869.00
$551.7528054
Biopsy of toe joint lining
Y
A2
$446.00
20.4263
$869.00
$551.7528055
Neurectomy, foot
Y
A2
$630.00
17.8499
$759.39
$662.3528060
Partial removal, foot fascia
Y
A2
$446.00
20.4263
$869.00
$551.7528062
Removal of foot fascia
Y
A2
$510.00
20.4263
$869.00
$599.7528070
Removal of foot joint lining
Y
A2
$510.00
20.4263
$869.00
$599.7528072
Removal of foot joint lining
Y
A2
$510.00
20.4263
$869.00
$599.7528080
Removal of foot lesion
Y
A2
$510.00
20.4263
$869.00
$599.7528086
Excise foot tendon sheath
Y
A2
$446.00
20.4263
$869.00
$551.7528088
Excise foot tendon sheath
Y
A2
$446.00
20.4263
$869.00
$551.7528090
Removal of foot lesion
Y
A2
$510.00
20.4263
$869.00
$599.7528092
Removal of toe lesions
Y
A2
$510.00
20.4263
$869.00
$599.7528100
Removal of ankle/heel lesion
Y
A2
$446.00
20.4263
$869.00
$551.7528102
Remove/graft foot lesion
Y
A2
$510.00
40.8559
$1,738.13
$817.0328103
Remove/graft foot lesion
Y
A2
$510.00
40.8559
$1,738.13
$817.0328104
Removal of foot lesion
Y
A2
$446.00
20.4263
$869.00
$551.7528106
Remove/graft foot lesion
Y
A2
$510.00
40.8559
$1,738.13
$817.0328107
Remove/graft foot lesion
Y
A2
$510.00
40.8559
$1,738.13
$817.0328108
Removal of toe lesions
Y
A2
$446.00
20.4263
$869.00
$551.7528110
Part removal of metatarsal
Y
A2
$510.00
20.4263
$869.00
$599.7528111
Part removal of metatarsal
Y
A2
$510.00
20.4263
$869.00
$599.7528112
Part removal of metatarsal
Y
A2
$510.00
20.4263
$869.00
$599.7528113
Part removal of metatarsal
Y
A2
$510.00
20.4263
$869.00
$599.7528114
Removal of metatarsal heads
Y
A2
$510.00
20.4263
$869.00
$599.7528116
Revision of foot
Y
A2
$510.00
20.4263
$869.00
$599.7528118
Removal of heel bone
Y
A2
$630.00
20.4263
$869.00
$689.7528119
Removal of heel spur
Y
A2
$630.00
20.4263
$869.00
$689.7528120
Part removal of ankle/heel
Y
A2
$995.00
20.4263
$869.00
$963.5028122
Partial removal of foot bone
Y
A2
$510.00
20.4263
$869.00
$599.7528124
Partial removal of toe
Y
P3

4.7639
$202.67
$202.6728126
Partial removal of toe
Y
A2
$510.00
20.4263
$869.00
$599.7528130
Removal of ankle bone
Y
A2
$510.00
20.4263
$869.00
$599.7528140
Removal of metatarsal
Y
A2
$510.00
20.4263
$869.00
$599.7528150
Removal of toe
Y
A2
$510.00
20.4263
$869.00
$599.7528153
Partial removal of toe
Y
A2
$510.00
20.4263
$869.00
$599.75( print page 42571)28160
Partial removal of toe
Y
A2
$510.00
20.4263
$869.00
$599.7528171
Extensive foot surgery
Y
A2
$510.00
20.4263
$869.00
$599.7528173
Extensive foot surgery
Y
A2
$510.00
20.4263
$869.00
$599.7528175
Extensive foot surgery
Y
A2
$510.00
20.4263
$869.00
$599.7528190
Removal of foot foreign body
Y
P3

2.9855
$127.01
$127.0128192
Removal of foot foreign body
Y
A2
$446.00
15.1024
$642.50
$495.1328193
Removal of foot foreign body
Y
A2
$418.49
6.8083
$289.65
$386.2828200
Repair of foot tendon
Y
A2
$510.00
20.4263
$869.00
$599.7528202
Repair/graft of foot tendon
Y
A2
$510.00
20.4263
$869.00
$599.7528208
Repair of foot tendon
Y
A2
$510.00
20.4263
$869.00
$599.7528210
Repair/graft of foot tendon
Y
A2
$510.00
40.8559
$1,738.13
$817.0328220
Release of foot tendon
Y
P3

4.4823
$190.69
$190.6928222
Release of foot tendons
Y
A2
$333.00
20.4263
$869.00
$467.0028225
Release of foot tendon
Y
A2
$333.00
20.4263
$869.00
$467.0028226
Release of foot tendons
Y
A2
$333.00
20.4263
$869.00
$467.0028230
Incision of foot tendon(s)
Y
P3

4.4341
$188.64
$188.6428232
Incision of toe tendon
Y
P3

4.2329
$180.08
$180.0828234
Incision of foot tendon
Y
A2
$446.00
20.4263
$869.00
$551.7528238
Revision of foot tendon
Y
A2
$510.00
40.8559
$1,738.13
$817.0328240
Release of big toe
Y
A2
$446.00
20.4263
$869.00
$551.7528250
Revision of foot fascia
Y
A2
$510.00
20.4263
$869.00
$599.7528260
Release of midfoot joint
Y
A2
$510.00
20.4263
$869.00
$599.7528261
Revision of foot tendon
Y
A2
$510.00
20.4263
$869.00
$599.7528262
Revision of foot and ankle
Y
A2
$630.00
20.4263
$869.00
$689.7528264
Release of midfoot joint
Y
A2
$333.00
40.8559
$1,738.13
$684.2828270
Release of foot contracture
Y
A2
$510.00
20.4263
$869.00
$599.7528272
Release of toe joint, each
Y
P3

4.0559
$172.55
$172.5528280
Fusion of toes
Y
A2
$446.00
20.4263
$869.00
$551.7528285
Repair of hammertoe
Y
A2
$510.00
20.4263
$869.00
$599.7528286
Repair of hammertoe
Y
A2
$630.00
20.4263
$869.00
$689.7528288
Partial removal of foot bone
Y
A2
$510.00
20.4263
$869.00
$599.7528289
Repair hallux rigidus
Y
A2
$510.00
20.4263
$869.00
$599.7528290
Correction of bunion
Y
A2
$446.00
28.2349
$1,201.20
$634.8028292
Correction of bunion
Y
A2
$446.00
28.2349
$1,201.20
$634.8028293
Correction of bunion
Y
A2
$510.00
28.2349
$1,201.20
$682.8028294
Correction of bunion
Y
A2
$510.00
28.2349
$1,201.20
$682.8028296
Correction of bunion
Y
A2
$510.00
28.2349
$1,201.20
$682.8028297
Correction of bunion
Y
A2
$510.00
28.2349
$1,201.20
$682.8028298
Correction of bunion
Y
A2
$510.00
28.2349
$1,201.20
$682.8028299
Correction of bunion
Y
A2
$717.00
28.2349
$1,201.20
$838.0528300
Incision of heel bone
Y
A2
$446.00
40.8559
$1,738.13
$769.0328302
Incision of ankle bone
Y
A2
$446.00
20.4263
$869.00
$551.7528304
Incision of midfoot bones
Y
A2
$446.00
40.8559
$1,738.13
$769.0328305
Incise/graft midfoot bones
Y
A2
$510.00
40.8559
$1,738.13
$817.0328306
Incision of metatarsal
Y
A2
$630.00
20.4263
$869.00
$689.7528307
Incision of metatarsal
Y
A2
$630.00
20.4263
$869.00
$689.7528308
Incision of metatarsal
Y
A2
$446.00
20.4263
$869.00
$551.7528309
Incision of metatarsals
Y
A2
$630.00
40.8559
$1,738.13
$907.0328310
Revision of big toe
Y
A2
$510.00
20.4263
$869.00
$599.7528312
Revision of toe
Y
A2
$510.00
20.4263
$869.00
$599.7528313
Repair deformity of toe
Y
A2
$446.00
20.4263
$869.00
$551.7528315
Removal of sesamoid bone
Y
A2
$630.00
20.4263
$869.00
$689.7528320
Repair of foot bones
Y
A2
$630.00
40.8559
$1,738.13
$907.0328322
Repair of metatarsals
Y
A2
$630.00
40.8559
$1,738.13
$907.0328340
Resect enlarged toe tissue
Y
A2
$630.00
20.4263
$869.00
$689.7528341
Resect enlarged toe
Y
A2
$630.00
20.4263
$869.00
$689.7528344
Repair extra toe(s)
Y
A2
$630.00
20.4263
$869.00
$689.7528345
Repair webbed toe(s)
Y
A2
$630.00
20.4263
$869.00
$689.7528400
Treatment of heel fracture
Y
A2
$103.62
1.6857
$71.71
$95.6428405
Treatment of heel fracture
Y
A2
$103.62
1.6857
$71.71
$95.6428406
Treatment of heel fracture
Y
A2
$446.00
25.5264
$1,085.97
$605.9928415
Treat heel fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7528420
Treat/graft heel fracture
Y
A2
$630.00
37.5382
$1,596.99
$871.75( print page 42572)28430
Treatment of ankle fracture
Y
P2

1.6857
$71.71
$71.7128435
Treatment of ankle fracture
Y
A2
$103.62
1.6857
$71.71
$95.6428436
Treatment of ankle fracture
Y
A2
$446.00
25.5264
$1,085.97
$605.9928445
Treat ankle fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7528450
Treat midfoot fracture, each
Y
P2

1.6857
$71.71
$71.7128455
Treat midfoot fracture, each
Y
P2

1.6857
$71.71
$71.7128456
Treat midfoot fracture
Y
A2
$446.00
25.5264
$1,085.97
$605.9928465
Treat midfoot fracture, each
Y
A2
$510.00
37.5382
$1,596.99
$781.7528470
Treat metatarsal fracture
Y
P2

1.6857
$71.71
$71.7128475
Treat metatarsal fracture
Y
P2

1.6857
$71.71
$71.7128476
Treat metatarsal fracture
Y
A2
$446.00
25.5264
$1,085.97
$605.9928485
Treat metatarsal fracture
Y
A2
$630.00
37.5382
$1,596.99
$871.7528490
Treat big toe fracture
Y
P3

1.6579
$70.53
$70.5328495
Treat big toe fracture
Y
P2

1.6857
$71.71
$71.7128496
Treat big toe fracture
Y
A2
$446.00
25.5264
$1,085.97
$605.9928505
Treat big toe fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7528510
Treatment of toe fracture
Y
P3

1.2956
$55.12
$55.1228515
Treatment of toe fracture
Y
P3

1.6658
$70.87
$70.8728525
Treat toe fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7528530
Treat sesamoid bone fracture
Y
P3

1.2392
$52.72
$52.7228531
Treat sesamoid bone fracture
Y
A2
$510.00
37.5382
$1,596.99
$781.7528540
Treat foot dislocation
Y
P2

1.6857
$71.71
$71.7128545
Treat foot dislocation
Y
A2
$333.00
25.5264
$1,085.97
$521.2428546
Treat foot dislocation
Y
A2
$446.00
25.5264
$1,085.97
$605.9928555
Repair foot dislocation
Y
A2
$446.00
37.5382
$1,596.99
$733.7528570
Treat foot dislocation
Y
P2

1.6857
$71.71
$71.7128575
Treat foot dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6428576
Treat foot dislocation
Y
A2
$510.00
25.5264
$1,085.97
$653.9928585
Repair foot dislocation
Y
A2
$510.00
37.5382
$1,596.99
$781.7528600
Treat foot dislocation
Y
P2

1.6857
$71.71
$71.7128605
Treat foot dislocation
Y
A2
$103.62
1.6857
$71.71
$95.6428606
Treat foot dislocation
Y
A2
$446.00
25.5264
$1,085.97
$605.9928615
Repair foot dislocation
Y
A2
$510.00
37.5382
$1,596.99
$781.7528630
Treat toe dislocation
Y
G2

1.6857
$71.71
$71.7128635
Treat toe dislocation
Y
A2
$333.00
14.5947
$620.90
$404.9828636
Treat toe dislocation
Y
A2
$510.00
25.5264
$1,085.97
$653.9928645
Repair toe dislocation
Y
A2
$510.00
37.5382
$1,596.99
$781.7528660
Treat toe dislocation
Y
G2

1.6857
$71.71
$71.7128665
Treat toe dislocation
Y
A2
$333.00
14.5947
$620.90
$404.9828666
Treat toe dislocation
Y
A2
$510.00
25.5264
$1,085.97
$653.9928675
Repair of toe dislocation
Y
A2
$510.00
37.5382
$1,596.99
$781.7528705
Fusion of foot bones
Y
A2
$630.00
40.8559
$1,738.13
$907.0328715
Fusion of foot bones
Y
A2
$630.00
40.8559
$1,738.13
$907.0328725
Fusion of foot bones
Y
A2
$630.00
40.8559
$1,738.13
$907.0328730
Fusion of foot bones
Y
A2
$630.00
40.8559
$1,738.13
$907.0328735
Fusion of foot bones
Y
A2
$630.00
40.8559
$1,738.13
$907.0328737
Revision of foot bones
Y
A2
$717.00
40.8559
$1,738.13
$972.2828740
Fusion of foot bones
Y
A2
$630.00
40.8559
$1,738.13
$907.0328750
Fusion of big toe joint
Y
A2
$630.00
40.8559
$1,738.13
$907.0328755
Fusion of big toe joint
Y
A2
$630.00
20.4263
$869.00
$689.7528760
Fusion of big toe joint
Y
A2
$630.00
40.8559
$1,738.13
$907.0328810
Amputation toe & metatarsal
Y
A2
$446.00
20.4263
$869.00
$551.7528820
Amputation of toe
Y
A2
$446.00
20.4263
$869.00
$551.7528825
Partial amputation of toe
Y
A2
$446.00
20.4263
$869.00
$551.7528890
High energy eswt, plantar f
Y
G2

25.1296
$1,069.09
$1,069.0929000
Application of body cast
N
G2

1.0607
$45.13
$45.1329010
Application of body cast
N
P2

2.2777
$96.90
$96.9029015
Application of body cast
N
P2

2.2777
$96.90
$96.9029020
Application of body cast
N
G2

1.0607
$45.13
$45.1329025
Application of body cast
N
P2

1.0607
$45.13
$45.1329035
Application of body cast
N
G2

2.2777
$96.90
$96.9029040
Application of body cast
N
G2

1.0607
$45.13
$45.1329044
Application of body cast
N
P2

2.2777
$96.90
$96.90( print page 42573)29046
Application of body cast
N
G2

2.2777
$96.90
$96.9029049
Application of figure eight
N
P3

0.9736
$41.42
$41.4229055
Application of shoulder cast
N
P2

2.2777
$96.90
$96.9029058
Application of shoulder cast
N
P2

1.0607
$45.13
$45.1329065
Application of long arm cast
N
P3

1.0462
$44.51
$44.5129075
Application of forearm cast
N
P3

0.9978
$42.45
$42.4529085
Apply hand/wrist cast
N
P3

1.0220
$43.48
$43.4829086
Apply finger cast
N
P3

0.8048
$34.24
$34.2429105
Apply long arm splint
N
P3

0.9334
$39.71
$39.7129125
Apply forearm splint
N
P3

0.7966
$33.89
$33.8929126
Apply forearm splint
N
P3

0.8932
$38.00
$38.0029130
Application of finger splint
N
P3

0.3622
$15.41
$15.4129131
Application of finger splint
N
P3

0.5472
$23.28
$23.2829200
Strapping of chest
N
P3

0.5312
$22.60
$22.6029220
Strapping of low back
N
P3

0.5312
$22.60
$22.6029240
Strapping of shoulder
N
P3

0.6116
$26.02
$26.0229260
Strapping of elbow or wrist
N
P3

0.5632
$23.96
$23.9629280
Strapping of hand or finger
N
P3

0.5874
$24.99
$24.9929305
Application of hip cast
N
G2

2.2777
$96.90
$96.9029325
Application of hip casts
N
G2

2.2777
$96.90
$96.9029345
Application of long leg cast
N
P3

1.3760
$58.54
$58.5429355
Application of long leg cast
N
P3

1.3438
$57.17
$57.1729358
Apply long leg cast brace
N
P3

1.6496
$70.18
$70.1829365
Application of long leg cast
N
P3

1.3036
$55.46
$55.4629405
Apply short leg cast
N
P3

0.9736
$41.42
$41.4229425
Apply short leg cast
N
P3

0.9898
$42.11
$42.1129435
Apply short leg cast
N
P3

1.2392
$52.72
$52.7229440
Addition of walker to cast
N
P3

0.5230
$22.25
$22.2529445
Apply rigid leg cast
N
P3

1.3760
$58.54
$58.5429450
Application of leg cast
N
P2

1.0607
$45.13
$45.1329505
Application, long leg splint
N
G2

1.0607
$45.13
$45.1329515
Application lower leg splint
N
G2

1.0607
$45.13
$45.1329520
Strapping of hip
N
P3

0.6116
$26.02
$26.0229530
Strapping of knee
N
P3

0.5714
$24.31
$24.3129540
Strapping of ankle and/or ft
N
P3

0.3862
$16.43
$16.4329550
Strapping of toes
N
P3

0.4024
$17.12
$17.1229580
Application of paste boot
N
P3

0.5552
$23.62
$23.6229590
Application of foot splint
N
P3

0.4506
$19.17
$19.1729700
Removal/revision of cast
N
P3

0.7484
$31.84
$31.8429705
Removal/revision of cast
N
P3

0.6438
$27.39
$27.3929710
Removal/revision of cast
N
P3

1.1990
$51.01
$51.0129715
Removal/revision of cast
N
P3

0.9254
$39.37
$39.3729720
Repair of body cast
N
P3

0.9254
$39.37
$39.3729730
Windowing of cast
N
P3

0.6276
$26.70
$26.7029740
Wedging of cast
N
P3

0.8852
$37.66
$37.6629750
Wedging of clubfoot cast
N
P3

0.7966
$33.89
$33.8929800
Jaw arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429804
Jaw arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429805
Shoulder arthroscopy, dx
Y
A2
$510.00
28.6245
$1,217.77
$686.9429806
Shoulder arthroscopy/surgery
Y
A2
$510.00
45.5027
$1,935.82
$866.4629807
Shoulder arthroscopy/surgery
Y
A2
$510.00
45.5027
$1,935.82
$866.4629819
Shoulder arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429820
Shoulder arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429821
Shoulder arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429822
Shoulder arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429823
Shoulder arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429824
Shoulder arthroscopy/surgery
Y
A2
$717.00
28.6245
$1,217.77
$842.1929825
Shoulder arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429826
Shoulder arthroscopy/surgery
Y
A2
$510.00
45.5027
$1,935.82
$866.4629827
Arthroscop rotator cuff repr
Y
A2
$717.00
45.5027
$1,935.82
$1,021.7129830
Elbow arthroscopy
Y
A2
$510.00
28.6245
$1,217.77
$686.9429834
Elbow arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429835
Elbow arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.94( print page 42574)29836
Elbow arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429837
Elbow arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429838
Elbow arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429840
Wrist arthroscopy
Y
A2
$510.00
28.6245
$1,217.77
$686.9429843
Wrist arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429844
Wrist arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429845
Wrist arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429846
Wrist arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429847
Wrist arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429848
Wrist endoscopy/surgery
Y
A2
$1,339.00
28.6245
$1,217.77
$1,308.6929850
Knee arthroscopy/surgery
Y
A2
$630.00
28.6245
$1,217.77
$776.9429851
Knee arthroscopy/surgery
Y
A2
$630.00
45.5027
$1,935.82
$956.4629855
Tibial arthroscopy/surgery
Y
A2
$630.00
45.5027
$1,935.82
$956.4629856
Tibial arthroscopy/surgery
Y
A2
$630.00
28.6245
$1,217.77
$776.9429860
Hip arthroscopy, dx
Y
A2
$630.00
28.6245
$1,217.77
$776.9429861
Hip arthroscopy/surgery
Y
A2
$630.00
28.6245
$1,217.77
$776.9429862
Hip arthroscopy/surgery
Y
A2
$1,339.00
45.5027
$1,935.82
$1,488.2129863
Hip arthroscopy/surgery
Y
A2
$630.00
45.5027
$1,935.82
$956.4629870
Knee arthroscopy, dx
Y
A2
$510.00
28.6245
$1,217.77
$686.9429871
Knee arthroscopy/drainage
Y
A2
$510.00
28.6245
$1,217.77
$686.9429873
Knee arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429874
Knee arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429875
Knee arthroscopy/surgery
Y
A2
$630.00
28.6245
$1,217.77
$776.9429876
Knee arthroscopy/surgery
Y
A2
$630.00
28.6245
$1,217.77
$776.9429877
Knee arthroscopy/surgery
Y
A2
$630.00
28.6245
$1,217.77
$776.9429879
Knee arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429880
Knee arthroscopy/surgery
Y
A2
$630.00
28.6245
$1,217.77
$776.9429881
Knee arthroscopy/surgery
Y
A2
$630.00
28.6245
$1,217.77
$776.9429882
Knee arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429883
Knee arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429884
Knee arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429885
Knee arthroscopy/surgery
Y
A2
$510.00
45.5027
$1,935.82
$866.4629886
Knee arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429887
Knee arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429888
Knee arthroscopy/surgery
Y
A2
$510.00
45.5027
$1,935.82
$866.4629889
Knee arthroscopy/surgery
Y
A2
$510.00
45.5027
$1,935.82
$866.4629891
Ankle arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429892
Ankle arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429893
Scope, plantar fasciotomy
Y
A2
$1,255.56
20.4263
$869.00
$1,158.9229894
Ankle arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429895
Ankle arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429897
Ankle arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429898
Ankle arthroscopy/surgery
Y
A2
$510.00
28.6245
$1,217.77
$686.9429899
Ankle arthroscopy/surgery
Y
A2
$510.00
45.5027
$1,935.82
$866.4629900
Mcp joint arthroscopy, dx
Y
A2
$510.00
16.1540
$687.24
$554.3129901
Mcp joint arthroscopy, surg
Y
A2
$510.00
16.1540
$687.24
$554.3129902
Mcp joint arthroscopy, surg
Y
A2
$510.00
16.1540
$687.24
$554.3130000
Drainage of nose lesion
Y
P2

2.4520
$104.32
$104.3230020
Drainage of nose lesion
Y
P2

2.4520
$104.32
$104.3230100
Intranasal biopsy
Y
P3

1.7625
$74.98
$74.9830110
Removal of nose polyp(s)
Y
P3

2.7683
$117.77
$117.7730115
Removal of nose polyp(s)
Y
A2
$446.00
16.4266
$698.84
$509.2130117
Removal of intranasal lesion
Y
A2
$510.00
16.4266
$698.84
$557.2130118
Removal of intranasal lesion
Y
A2
$510.00
23.3299
$992.52
$630.6330120
Revision of nose
Y
A2
$333.00
16.4266
$698.84
$424.4630124
Removal of nose lesion
Y
R2

7.5511
$321.25
$321.2530125
Removal of nose lesion
Y
A2
$446.00
38.1991
$1,625.10
$740.7830130
Excise inferior turbinate
Y
A2
$510.00
16.4266
$698.84
$557.2130140
Resect inferior turbinate
Y
A2
$446.00
23.3299
$992.52
$582.6330150
Partial removal of nose
Y
A2
$510.00
38.1991
$1,625.10
$788.7830160
Removal of nose
Y
A2
$630.00
38.1991
$1,625.10
$878.7830200
Injection treatment of nose
Y
P3

1.4082
$59.91
$59.9130210
Nasal sinus therapy
Y
P3

1.7784
$75.66
$75.66( print page 42575)30220
Insert nasal septal button
Y
A2
$464.15
7.5511
$321.25
$428.4330300
Remove nasal foreign body
N
P2

0.6102
$25.96
$25.9630310
Remove nasal foreign body
Y
A2
$333.00
16.4266
$698.84
$424.4630320
Remove nasal foreign body
Y
A2
$446.00
16.4266
$698.84
$509.2130400
Reconstruction of nose
Y
A2
$630.00
38.1991
$1,625.10
$878.7830410
Reconstruction of nose
Y
A2
$717.00
38.1991
$1,625.10
$944.0330420
Reconstruction of nose
Y
A2
$717.00
38.1991
$1,625.10
$944.0330430
Revision of nose
Y
A2
$510.00
23.3299
$992.52
$630.6330435
Revision of nose
Y
A2
$717.00
38.1991
$1,625.10
$944.0330450
Revision of nose
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5330460
Revision of nose
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5330462
Revision of nose
Y
A2
$1,339.00
38.1991
$1,625.10
$1,410.5330465
Repair nasal stenosis
Y
A2
$1,339.00
38.1991
$1,625.10
$1,410.5330520
Repair of nasal septum
Y
A2
$630.00
23.3299
$992.52
$720.6330540
Repair nasal defect
Y
A2
$717.00
38.1991
$1,625.10
$944.0330545
Repair nasal defect
Y
A2
$717.00
38.1991
$1,625.10
$944.0330560
Release of nasal adhesions
Y
A2
$150.72
2.4520
$104.32
$139.1230580
Repair upper jaw fistula
Y
A2
$630.00
38.1991
$1,625.10
$878.7830600
Repair mouth/nose fistula
Y
A2
$630.00
38.1991
$1,625.10
$878.7830620
Intranasal reconstruction
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5330630
Repair nasal septum defect
Y
A2
$995.00
23.3299
$992.52
$994.3830801
Ablate inf turbinate, superf
Y
A2
$333.00
7.5511
$321.25
$330.0630802
Cauterization, inner nose
Y
A2
$333.00
7.5511
$321.25
$330.0630901
Control of nosebleed
Y
P3

1.0300
$43.82
$43.8230903
Control of nosebleed
Y
A2
$72.48
1.1791
$50.16
$66.9030905
Control of nosebleed
Y
A2
$72.48
1.1791
$50.16
$66.9030906
Repeat control of nosebleed
Y
A2
$72.48
1.1791
$50.16
$66.9030915
Ligation, nasal sinus artery
Y
A2
$446.00
24.8809
$1,058.51
$599.1330920
Ligation, upper jaw artery
Y
A2
$510.00
24.8809
$1,058.51
$647.1330930
Ther fx, nasal inf turbinate
Y
A2
$630.00
16.4266
$698.84
$647.2131000
Irrigation, maxillary sinus
Y
P3

2.3499
$99.97
$99.9731002
Irrigation, sphenoid sinus
Y
R2

7.5511
$321.25
$321.2531020
Exploration, maxillary sinus
Y
A2
$446.00
23.3299
$992.52
$582.6331030
Exploration, maxillary sinus
Y
A2
$510.00
38.1991
$1,625.10
$788.7831032
Explore sinus, remove polyps
Y
A2
$630.00
38.1991
$1,625.10
$878.7831040
Exploration behind upper jaw
Y
R2

23.3299
$992.52
$992.5231050
Exploration, sphenoid sinus
Y
A2
$446.00
38.1991
$1,625.10
$740.7831051
Sphenoid sinus surgery
Y
A2
$630.00
38.1991
$1,625.10
$878.7831070
Exploration of frontal sinus
Y
A2
$446.00
23.3299
$992.52
$582.6331075
Exploration of frontal sinus
Y
A2
$630.00
38.1991
$1,625.10
$878.7831080
Removal of frontal sinus
Y
A2
$630.00
38.1991
$1,625.10
$878.7831081
Removal of frontal sinus
Y
A2
$630.00
38.1991
$1,625.10
$878.7831084
Removal of frontal sinus
Y
A2
$630.00
38.1991
$1,625.10
$878.7831085
Removal of frontal sinus
Y
A2
$630.00
38.1991
$1,625.10
$878.7831086
Removal of frontal sinus
Y
A2
$630.00
38.1991
$1,625.10
$878.7831087
Removal of frontal sinus
Y
A2
$630.00
38.1991
$1,625.10
$878.7831090
Exploration of sinuses
Y
A2
$717.00
38.1991
$1,625.10
$944.0331200
Removal of ethmoid sinus
Y
A2
$446.00
38.1991
$1,625.10
$740.7831201
Removal of ethmoid sinus
Y
A2
$717.00
38.1991
$1,625.10
$944.0331205
Removal of ethmoid sinus
Y
A2
$510.00
38.1991
$1,625.10
$788.7831231
Nasal endoscopy, dx
Y
P2

1.4054
$59.79
$59.7931233
Nasal/sinus endoscopy, dx
Y
A2
$86.39
1.4054
$59.79
$79.7431235
Nasal/sinus endoscopy, dx
Y
A2
$333.00
14.7928
$629.33
$407.0831237
Nasal/sinus endoscopy, surg
Y
A2
$446.00
14.7928
$629.33
$491.8331238
Nasal/sinus endoscopy, surg
Y
A2
$333.00
14.7928
$629.33
$407.0831239
Nasal/sinus endoscopy, surg
Y
A2
$630.00
21.9512
$933.87
$705.9731240
Nasal/sinus endoscopy, surg
Y
A2
$446.00
14.7928
$629.33
$491.8331254
Revision of ethmoid sinus
Y
A2
$510.00
21.9512
$933.87
$615.9731255
Removal of ethmoid sinus
Y
A2
$717.00
21.9512
$933.87
$771.2231256
Exploration maxillary sinus
Y
A2
$510.00
21.9512
$933.87
$615.9731267
Endoscopy, maxillary sinus
Y
A2
$510.00
21.9512
$933.87
$615.9731276
Sinus endoscopy, surgical
Y
A2
$510.00
21.9512
$933.87
$615.9731287
Nasal/sinus endoscopy, surg
Y
A2
$510.00
21.9512
$933.87
$615.97( print page 42576)31288
Nasal/sinus endoscopy, surg
Y
A2
$510.00
21.9512
$933.87
$615.9731300
Removal of larynx lesion
Y
A2
$717.00
23.3299
$992.52
$785.8831320
Diagnostic incision, larynx
Y
A2
$446.00
38.1991
$1,625.10
$740.7831400
Revision of larynx
Y
A2
$446.00
38.1991
$1,625.10
$740.7831420
Removal of epiglottis
Y
A2
$446.00
38.1991
$1,625.10
$740.7831500
Insert emergency airway
N
G2

2.4233
$103.09
$103.0931502
Change of windpipe airway
Y
G2

2.3587
$100.35
$100.3531505
Diagnostic laryngoscopy
Y
P2

0.7698
$32.75
$32.7531510
Laryngoscopy with biopsy
Y
A2
$446.00
14.7928
$629.33
$491.8331511
Remove foreign body, larynx
Y
A2
$86.39
1.4054
$59.79
$79.7431512
Removal of larynx lesion
Y
A2
$446.00
14.7928
$629.33
$491.8331513
Injection into vocal cord
Y
A2
$86.39
1.4054
$59.79
$79.7431515
Laryngoscopy for aspiration
Y
A2
$333.00
14.7928
$629.33
$407.0831520
Dx laryngoscopy, newborn
Y
G2

1.4054
$59.79
$59.7931525
Dx laryngoscopy excl nb
Y
A2
$333.00
14.7928
$629.33
$407.0831526
Dx laryngoscopy w/oper scope
Y
A2
$446.00
21.9512
$933.87
$567.9731527
Laryngoscopy for treatment
Y
A2
$333.00
21.9512
$933.87
$483.2231528
Laryngoscopy and dilation
Y
A2
$446.00
14.7928
$629.33
$491.8331529
Laryngoscopy and dilation
Y
A2
$446.00
14.7928
$629.33
$491.8331530
Laryngoscopy w/fb removal
Y
A2
$446.00
21.9512
$933.87
$567.9731531
Laryngoscopy w/fb & op scope
Y
A2
$510.00
21.9512
$933.87
$615.9731535
Laryngoscopy w/biopsy
Y
A2
$446.00
21.9512
$933.87
$567.9731536
Laryngoscopy w/bx & op scope
Y
A2
$510.00
21.9512
$933.87
$615.9731540
Laryngoscopy w/exc of tumor
Y
A2
$510.00
21.9512
$933.87
$615.9731541
Larynscop w/tumr exc + scope
Y
A2
$630.00
21.9512
$933.87
$705.9731545
Remove vc lesion w/scope
Y
A2
$630.00
21.9512
$933.87
$705.9731546
Remove vc lesion scope/graft
Y
A2
$630.00
21.9512
$933.87
$705.9731560
Laryngoscop w/arytenoidectom
Y
A2
$717.00
21.9512
$933.87
$771.2231561
Larynscop, remve cart + scop
Y
A2
$717.00
21.9512
$933.87
$771.2231570
Laryngoscope w/vc inj
Y
A2
$446.00
14.7928
$629.33
$491.8331571
Laryngoscop w/vc inj + scope
Y
A2
$446.00
21.9512
$933.87
$567.9731575
Diagnostic laryngoscopy
Y
P3

1.4002
$59.57
$59.5731576
Laryngoscopy with biopsy
Y
A2
$446.00
21.9512
$933.87
$567.9731577
Remove foreign body, larynx
Y
A2
$236.42
3.8463
$163.63
$218.2231578
Removal of larynx lesion
Y
A2
$446.00
21.9512
$933.87
$567.9731579
Diagnostic laryngoscopy
Y
P3

2.5833
$109.90
$109.9031580
Revision of larynx
Y
A2
$717.00
38.1991
$1,625.10
$944.0331582
Revision of larynx
Y
A2
$717.00
38.1991
$1,625.10
$944.0331588
Revision of larynx
Y
A2
$717.00
38.1991
$1,625.10
$944.0331590
Reinnervate larynx
Y
A2
$717.00
38.1991
$1,625.10
$944.0331595
Larynx nerve surgery
Y
A2
$446.00
38.1991
$1,625.10
$740.7831603
Incision of windpipe
Y
A2
$333.00
7.5511
$321.25
$330.0631605
Incision of windpipe
Y
G2

7.5511
$321.25
$321.2531611
Surgery/speech prosthesis
Y
A2
$510.00
23.3299
$992.52
$630.6331612
Puncture/clear windpipe
Y
A2
$333.00
23.3299
$992.52
$497.8831613
Repair windpipe opening
Y
A2
$446.00
23.3299
$992.52
$582.6331614
Repair windpipe opening
Y
A2
$446.00
38.1991
$1,625.10
$740.7831615
Visualization of windpipe
Y
A2
$333.00
9.5228
$405.13
$351.0331620
Endobronchial us add-on
N
A2
$333.00
32.2854
$1,373.52
$593.1331622
Dx bronchoscope/wash
Y
A2
$333.00
9.5228
$405.13
$351.0331623
Dx bronchoscope/brush
Y
A2
$446.00
9.5228
$405.13
$435.7831624
Dx bronchoscope/lavage
Y
A2
$446.00
9.5228
$405.13
$435.7831625
Bronchoscopy w/biopsy(s)
Y
A2
$446.00
9.5228
$405.13
$435.7831628
Bronchoscopy/lung bx, each
Y
A2
$446.00
9.5228
$405.13
$435.7831629
Bronchoscopy/needle bx, each
Y
A2
$446.00
9.5228
$405.13
$435.7831630
Bronchoscopy dilate/fx repr
Y
A2
$446.00
22.0099
$936.37
$568.5931631
Bronchoscopy, dilate w/stent
Y
A2
$446.00
22.0099
$936.37
$568.5931632
Bronchoscopy/lung bx, add'l
Y
G2

9.5228
$405.13
$405.1331633
Bronchoscopy/needle bx add'l
Y
G2

9.5228
$405.13
$405.1331635
Bronchoscopy w/fb removal
Y
A2
$446.00
9.5228
$405.13
$435.7831636
Bronchoscopy, bronch stents
Y
A2
$446.00
22.0099
$936.37
$568.5931637
Bronchoscopy, stent add-on
Y
A2
$333.00
9.5228
$405.13
$351.0331638
Bronchoscopy, revise stent
Y
A2
$446.00
22.0099
$936.37
$568.59( print page 42577)31640
Bronchoscopy w/tumor excise
Y
A2
$446.00
22.0099
$936.37
$568.5931641
Bronchoscopy, treat blockage
Y
A2
$446.00
22.0099
$936.37
$568.5931643
Diag bronchoscope/catheter
Y
A2
$446.00
9.5228
$405.13
$435.7831645
Bronchoscopy, clear airways
Y
A2
$333.00
9.5228
$405.13
$351.0331646
Bronchoscopy, reclear airway
Y
A2
$333.00
9.5228
$405.13
$351.0331656
Bronchoscopy, inj for x-ray
Y
A2
$333.00
9.5228
$405.13
$351.0331715
Injection for bronchus x-ray

N131717
Bronchial brush biopsy
Y
A2
$236.42
3.8463
$163.63
$218.2231720
Clearance of airways
Y
A2
$47.32
0.7698
$32.75
$43.6831730
Intro, windpipe wire/tube
Y
A2
$236.42
3.8463
$163.63
$218.2231750
Repair of windpipe
Y
A2
$717.00
38.1991
$1,625.10
$944.0331755
Repair of windpipe
Y
A2
$446.00
38.1991
$1,625.10
$740.7831820
Closure of windpipe lesion
Y
A2
$333.00
16.4266
$698.84
$424.4631825
Repair of windpipe defect
Y
A2
$446.00
23.3299
$992.52
$582.6331830
Revise windpipe scar
Y
A2
$446.00
23.3299
$992.52
$582.6332000
Drainage of chest
Y
A2
$222.78
3.6244
$154.19
$205.6332002
Treatment of collapsed lung
Y
G2

3.6244
$154.19
$154.1932019
Insert pleural catheter
Y
G2

29.5416
$1,256.79
$1,256.7932400
Needle biopsy chest lining
Y
A2
$333.00
6.1384
$261.15
$315.0432405
Biopsy, lung or mediastinum
Y
A2
$333.00
6.1384
$261.15
$315.0432420
Puncture/clear lung
Y
A2
$222.78
3.6244
$154.19
$205.6332960
Therapeutic pneumothorax
Y
G2

3.6244
$154.19
$154.1933010
Drainage of heart sac
Y
A2
$222.78
3.6244
$154.19
$205.6333011
Repeat drainage of heart sac
Y
A2
$222.78
3.6244
$154.19
$205.6333206
Insertion of heart pacemaker
Y
J8

170.6370
$7,259.41
$7,259.4133207
Insertion of heart pacemaker
Y
J8

170.6370
$7,259.41
$7,259.4133208
Insertion of heart pacemaker
Y
J8

210.2184
$8,943.32
$8,943.3233210
Insertion of heart electrode
Y
G2

58.8594
$2,504.06
$2,504.0633211
Insertion of heart electrode
Y
G2

58.8594
$2,504.06
$2,504.0633212
Insertion of pulse generator
Y
H8
$510.00
134.4886
$5,721.55
$5,311.7633213
Insertion of pulse generator
Y
H8
$510.00
155.7342
$6,625.40
$6,192.9033214
Upgrade of pacemaker system
Y
J8

210.2184
$8,943.32
$8,943.3233215
Reposition pacing-defib lead
Y
G2

25.6142
$1,089.70
$1,089.7033216
Insert lead pace-defib, one
Y
G2

58.8594
$2,504.06
$2,504.0633217
Insert lead pace-defib, dual
Y
G2

58.8594
$2,504.06
$2,504.0633218
Repair lead pace-defib, one
Y
G2

25.6142
$1,089.70
$1,089.7033220
Repair lead pace-defib, dual
Y
G2

25.6142
$1,089.70
$1,089.7033222
Revise pocket, pacemaker
Y
A2
$446.00
21.4302
$911.71
$562.4333223
Revise pocket, pacing-defib
Y
A2
$446.00
21.4302
$911.71
$562.4333224
Insert pacing lead & connect
Y
J8

439.4366
$18,694.95
$18,694.9533225
Lventric pacing lead add-on
Y
J8

439.4366
$18,694.95
$18,694.9533226
Reposition 1 ventric lead
Y
G2

25.6142
$1,089.70
$1,089.7033233
Removal of pacemaker system
Y
A2
$446.00
25.6142
$1,089.70
$606.9333234
Removal of pacemaker system
Y
G2

25.6142
$1,089.70
$1,089.7033235
Removal pacemaker electrode
Y
G2

25.6142
$1,089.70
$1,089.7033241
Remove pulse generator
Y
G2

25.6142
$1,089.70
$1,089.7033282
Implant pat-active ht record
N
J8

99.9215
$4,250.96
$4,250.9633284
Remove pat-active ht record
Y
G2

10.9918
$467.62
$467.6233508
Endoscopic vein harvest

N135188
Repair blood vessel lesion
Y
A2
$630.00
37.7391
$1,605.53
$873.8835207
Repair blood vessel lesion
Y
A2
$630.00
37.7391
$1,605.53
$873.8835473
Repair arterial blockage
Y
G2

42.9360
$1,826.63
$1,826.6335474
Repair arterial blockage
Y
G2

42.9360
$1,826.63
$1,826.6335476
Repair venous blockage
Y
G2

42.9360
$1,826.63
$1,826.6335492
Atherectomy, percutaneous
Y
G2

42.9360
$1,826.63
$1,826.6335572
Harvest femoropopliteal vein

N135761
Exploration of artery/vein
Y
G2

29.2133
$1,242.82
$1,242.8235875
Removal of clot in graft
Y
A2
$1,339.00
37.7391
$1,605.53
$1,405.6335876
Removal of clot in graft
Y
A2
$1,339.00
37.7391
$1,605.53
$1,405.6336000
Place needle in vein

N136002
Pseudoaneurysm injection trt
N
G2

2.4606
$104.68
$104.6836005
Injection ext venography

N136010
Place catheter in vein

N1( print page 42578)36011
Place catheter in vein

N136012
Place catheter in vein

N136013
Place catheter in artery

N136014
Place catheter in artery

N136015
Place catheter in artery

N136100
Establish access to artery

N136120
Establish access to artery

N136140
Establish access to artery

N136145
Artery to vein shunt

N136160
Establish access to aorta

N136200
Place catheter in aorta

N136215
Place catheter in artery

N136216
Place catheter in artery

N136217
Place catheter in artery

N136218
Place catheter in artery

N136245
Place catheter in artery

N136246
Place catheter in artery

N136247
Place catheter in artery

N136248
Place catheter in artery

N136260
Insertion of infusion pump
Y
A2
$510.00
28.5032
$1,212.61
$685.6536261
Revision of infusion pump
Y
A2
$446.00
28.5032
$1,212.61
$637.6536262
Removal of infusion pump
Y
A2
$333.00
22.6665
$964.30
$490.8336400
Bl draw <3 yrs fem/jugular

N136405
Bl draw <3 yrs scalp vein

N136406
Bl draw <3 yrs other vein

N136410
Non-routine bl draw >3 yrs

N136416
Capillary blood draw

N136420
Vein access cutdown <1 yr
Y
G2

0.1999
$8.50
$8.5036425
Vein access cutdown >1 yr
Y
R2

0.1999
$8.50
$8.5036430
Blood transfusion service
N
P3

0.7806
$33.21
$33.2136440
Bl push transfuse, 2 yr or <
N
R2

3.4584
$147.13
$147.1336450
Bl exchange/transfuse, nb
N
R2

3.4584
$147.13
$147.1336468
Injection(s), spider veins
Y
R2

1.0798
$45.94
$45.9436469
Injection(s), spider veins
Y
G2

1.0798
$45.94
$45.9436470
Injection therapy of vein
Y
P2

1.0798
$45.94
$45.9436471
Injection therapy of veins
Y
P2

1.0798
$45.94
$45.9436475
Endovenous rf, 1st vein
Y
A2
$1,339.00
34.7288
$1,477.47
$1,373.6236476
Endovenous rf, vein add-on
Y
A2
$1,339.00
34.7288
$1,477.47
$1,373.6236478
Endovenous laser, 1st vein
Y
A2
$1,339.00
24.8809
$1,058.51
$1,268.8836479
Endovenous laser vein addon
Y
A2
$1,339.00
24.8809
$1,058.51
$1,268.8836481
Insertion of catheter, vein

N136500
Insertion of catheter, vein

N136510
Insertion of catheter, vein

N136511
Apheresis wbc
N
G2

11.7134
$498.32
$498.3236512
Apheresis rbc
N
G2

11.7134
$498.32
$498.3236513
Apheresis platelets
N
G2

11.7134
$498.32
$498.3236514
Apheresis plasma
N
G2

11.7134
$498.32
$498.3236515
Apheresis, adsorp/reinfuse
N
G2

30.2231
$1,285.78
$1,285.7836516
Apheresis, selective
N
G2

30.2231
$1,285.78
$1,285.7836522
Photopheresis
N
G2

30.2231
$1,285.78
$1,285.7836540
Collect blood venous device

N136550
Declot vascular device
Y
P3

0.2816
$11.98
$11.9836555
Insert non-tunnel cv cath
Y
A2
$333.00
8.7846
$373.72
$343.1836556
Insert non-tunnel cv cath
Y
A2
$333.00
8.7846
$373.72
$343.1836557
Insert tunneled cv cath
Y
A2
$446.00
22.6665
$964.30
$575.5836558
Insert tunneled cv cath
Y
A2
$446.00
22.6665
$964.30
$575.5836560
Insert tunneled cv cath
Y
A2
$510.00
28.5032
$1,212.61
$685.6536561
Insert tunneled cv cath
Y
A2
$510.00
28.5032
$1,212.61
$685.6536563
Insert tunneled cv cath
Y
A2
$510.00
28.5032
$1,212.61
$685.6536565
Insert tunneled cv cath
Y
A2
$510.00
28.5032
$1,212.61
$685.6536566
Insert tunneled cv cath
Y
H8
$510.00
107.1217
$4,557.28
$3,809.6036568
Insert picc cath
Y
A2
$333.00
8.7846
$373.72
$343.1836569
Insert picc cath
Y
A2
$333.00
8.7846
$373.72
$343.18( print page 42579)36570
Insert picvad cath
Y
A2
$510.00
22.6665
$964.30
$623.5836571
Insert picvad cath
Y
A2
$510.00
22.6665
$964.30
$623.5836575
Repair tunneled cv cath
Y
A2
$446.00
8.7846
$373.72
$427.9336576
Repair tunneled cv cath
Y
A2
$446.00
8.7846
$373.72
$427.9336578
Replace tunneled cv cath
Y
A2
$446.00
22.6665
$964.30
$575.5836580
Replace cvad cath
Y
A2
$333.00
8.7846
$373.72
$343.1836581
Replace tunneled cv cath
Y
A2
$446.00
22.6665
$964.30
$575.5836582
Replace tunneled cv cath
Y
A2
$510.00
28.5032
$1,212.61
$685.6536583
Replace tunneled cv cath
Y
A2
$510.00
28.5032
$1,212.61
$685.6536584
Replace picc cath
Y
A2
$333.00
8.7846
$373.72
$343.1836585
Replace picvad cath
Y
A2
$510.00
22.6665
$964.30
$623.5836589
Removal tunneled cv cath
Y
A2
$333.00
8.7846
$373.72
$343.1836590
Removal tunneled cv cath
Y
A2
$333.00
8.7846
$373.72
$343.1836595
Mech remov tunneled cv cath
Y
G2

22.6665
$964.30
$964.3036596
Mech remov tunneled cv cath
Y
G2

8.7846
$373.72
$373.7236597
Reposition venous catheter
Y
G2

8.7846
$373.72
$373.7236598 *
Inj w/fluor, eval cv device
N
P2

0.6102
$25.96
$25.9636600
Withdrawal of arterial blood

N136620
Insertion catheter, artery

N136625
Insertion catheter, artery

N136640
Insertion catheter, artery
Y
A2
$333.00
28.5032
$1,212.61
$552.9036680
Insert needle, bone cavity
Y
G2

1.0995
$46.78
$46.7836800
Insertion of cannula
Y
A2
$510.00
29.2133
$1,242.82
$693.2136810
Insertion of cannula
Y
A2
$510.00
29.2133
$1,242.82
$693.2136815
Insertion of cannula
Y
A2
$510.00
29.2133
$1,242.82
$693.2136818
Av fuse, uppr arm, cephalic
Y
A2
$510.00
37.7391
$1,605.53
$783.8836819
Av fuse, uppr arm, basilic
Y
A2
$510.00
37.7391
$1,605.53
$783.8836820
Av fusion/forearm vein
Y
A2
$510.00
37.7391
$1,605.53
$783.8836821
Av fusion direct any site
Y
A2
$510.00
37.7391
$1,605.53
$783.8836825
Artery-vein autograft
Y
A2
$630.00
37.7391
$1,605.53
$873.8836830
Artery-vein nonautograft
Y
A2
$630.00
37.7391
$1,605.53
$873.8836831
Open thrombect av fistula
Y
A2
$1,339.00
37.7391
$1,605.53
$1,405.6336832
Av fistula revision, open
Y
A2
$630.00
37.7391
$1,605.53
$873.8836833
Av fistula revision
Y
A2
$630.00
37.7391
$1,605.53
$873.8836834
Repair A-V aneurysm
Y
A2
$510.00
37.7391
$1,605.53
$783.8836835
Artery to vein shunt
Y
A2
$630.00
29.2133
$1,242.82
$783.2136860
External cannula declotting
Y
A2
$127.40
2.0726
$88.17
$117.5936861
Cannula declotting
Y
A2
$510.00
29.2133
$1,242.82
$693.2136870
Percut thrombect av fistula
Y
A2
$1,339.00
32.3818
$1,377.62
$1,348.6637184
Prim art mech thrombectomy
Y
G2

37.7391
$1,605.53
$1,605.5337185
Prim art m-thrombect add-on
Y
G2

37.7391
$1,605.53
$1,605.5337186
Sec art m-thrombect add-on
Y
G2

37.7391
$1,605.53
$1,605.5337187
Venous mech thrombectomy
Y
G2

37.7391
$1,605.53
$1,605.5337188
Venous m-thrombectomy add-on
Y
G2

37.7391
$1,605.53
$1,605.5337200
Transcatheter biopsy
Y
G2

6.1384
$261.15
$261.1537203
Transcatheter retrieval
Y
G2

16.2375
$690.79
$690.7937250
Iv us first vessel add-on
N
G2

32.5472
$1,384.66
$1,384.6637251
Iv us each add vessel add-on
N
G2

32.5472
$1,384.66
$1,384.6637500
Endoscopy ligate perf veins
Y
A2
$510.00
34.7288
$1,477.47
$751.8737607
Ligation of a-v fistula
Y
A2
$510.00
24.8809
$1,058.51
$647.1337609
Temporal artery procedure
Y
A2
$446.00
15.1024
$642.50
$495.1337650
Revision of major vein
Y
A2
$446.00
24.8809
$1,058.51
$599.1337700
Revise leg vein
Y
A2
$446.00
34.7288
$1,477.47
$703.8737718
Ligate/strip short leg vein
Y
A2
$510.00
34.7288
$1,477.47
$751.8737722
Ligate/strip long leg vein
Y
A2
$510.00
34.7288
$1,477.47
$751.8737735
Removal of leg veins/lesion
Y
A2
$510.00
34.7288
$1,477.47
$751.8737760
Ligation, leg veins, open
Y
A2
$510.00
24.8809
$1,058.51
$647.1337765
Phleb veins - extrem - to 20
Y
R2

24.8809
$1,058.51
$1,058.5137766
Phleb veins - extrem 20+
Y
R2

24.8809
$1,058.51
$1,058.5137780
Revision of leg vein
Y
A2
$510.00
24.8809
$1,058.51
$647.1337785
Ligate/divide/excise vein
Y
A2
$510.00
24.8809
$1,058.51
$647.1337790
Penile venous occlusion
Y
A2
$510.00
32.9873
$1,403.38
$733.3538200
Injection for spleen x-ray

N1( print page 42580)38204
Bl donor search management

N138205
Harvest allogenic stem cells
N
G2

11.7134
$498.32
$498.3238206
Harvest auto stem cells
N
G2

11.7134
$498.32
$498.3238220
Bone marrow aspiration
Y
P2

2.4011
$102.15
$102.1538221
Bone marrow biopsy
Y
P2

2.4011
$102.15
$102.1538230
Bone marrow collection
N
G2

20.3582
$866.10
$866.1038241
Bone marrow/stem transplant
N
G2

20.3582
$866.10
$866.1038242
Lymphocyte infuse transplant
N
R2

11.7134
$498.32
$498.3238300
Drainage, lymph node lesion
Y
A2
$333.00
11.1535
$474.50
$368.3838305
Drainage, lymph node lesion
Y
A2
$446.00
17.5086
$744.87
$520.7238308
Incision of lymph channels
Y
A2
$446.00
21.2621
$904.55
$560.6438500
Biopsy/removal, lymph nodes
Y
A2
$446.00
21.2621
$904.55
$560.6438505
Needle biopsy, lymph nodes
Y
A2
$240.00
3.9045
$166.11
$221.5338510
Biopsy/removal, lymph nodes
Y
A2
$446.00
21.2621
$904.55
$560.6438520
Biopsy/removal, lymph nodes
Y
A2
$446.00
21.2621
$904.55
$560.6438525
Biopsy/removal, lymph nodes
Y
A2
$446.00
21.2621
$904.55
$560.6438530
Biopsy/removal, lymph nodes
Y
A2
$446.00
21.2621
$904.55
$560.6438542
Explore deep node(s), neck
Y
A2
$446.00
37.7224
$1,604.82
$735.7138550
Removal, neck/armpit lesion
Y
A2
$510.00
21.2621
$904.55
$608.6438555
Removal, neck/armpit lesion
Y
A2
$630.00
21.2621
$904.55
$698.6438570
Laparoscopy, lymph node biop
Y
A2
$1,339.00
43.5488
$1,852.70
$1,467.4338571
Laparoscopy, lymphadenectomy
Y
A2
$1,339.00
70.5066
$2,999.56
$1,754.1438572
Laparoscopy, lymphadenectomy
Y
A2
$1,339.00
43.5488
$1,852.70
$1,467.4338700
Removal of lymph nodes, neck
Y
G2

21.2621
$904.55
$904.5538740
Remove armpit lymph nodes
Y
A2
$446.00
37.7224
$1,604.82
$735.7138745
Remove armpit lymph nodes
Y
A2
$630.00
37.7224
$1,604.82
$873.7138760
Remove groin lymph nodes
Y
A2
$446.00
21.2621
$904.55
$560.6438790
Inject for lymphatic x-ray

N138792
Identify sentinel node

N138794
Access thoracic lymph duct

N140490
Biopsy of lip
Y
P3

1.4968
$63.68
$63.6840500
Partial excision of lip
Y
A2
$446.00
16.4266
$698.84
$509.2140510
Partial excision of lip
Y
A2
$446.00
23.3299
$992.52
$582.6340520
Partial excision of lip
Y
A2
$446.00
16.4266
$698.84
$509.2140525
Reconstruct lip with flap
Y
A2
$446.00
23.3299
$992.52
$582.6340527
Reconstruct lip with flap
Y
A2
$446.00
23.3299
$992.52
$582.6340530
Partial removal of lip
Y
A2
$446.00
23.3299
$992.52
$582.6340650
Repair lip
Y
A2
$464.15
7.5511
$321.25
$428.4340652
Repair lip
Y
A2
$464.15
7.5511
$321.25
$428.4340654
Repair lip
Y
A2
$464.15
7.5511
$321.25
$428.4340700
Repair cleft lip/nasal
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5340701
Repair cleft lip/nasal
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5340702
Repair cleft lip/nasal
Y
R2

38.1991
$1,625.10
$1,625.1040720
Repair cleft lip/nasal
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5340761
Repair cleft lip/nasal
Y
A2
$510.00
38.1991
$1,625.10
$788.7840800
Drainage of mouth lesion
Y
P2

1.4392
$61.23
$61.2340801
Drainage of mouth lesion
Y
A2
$446.00
7.5511
$321.25
$414.8140804
Removal, foreign body, mouth
N
P2

0.6102
$25.96
$25.9640805
Removal, foreign body, mouth
Y
P3

3.8385
$163.30
$163.3040806
Incision of lip fold
Y
P3

1.6898
$71.89
$71.8940808
Biopsy of mouth lesion
Y
P2

2.4520
$104.32
$104.3240810
Excision of mouth lesion
Y
P3

2.5913
$110.24
$110.2440812
Excise/repair mouth lesion
Y
P3

3.3155
$141.05
$141.0540814
Excise/repair mouth lesion
Y
A2
$446.00
16.4266
$698.84
$509.2140816
Excision of mouth lesion
Y
A2
$446.00
23.3299
$992.52
$582.6340818
Excise oral mucosa for graft
Y
A2
$150.72
2.4520
$104.32
$139.1240819
Excise lip or cheek fold
Y
A2
$333.00
7.5511
$321.25
$330.0640820
Treatment of mouth lesion
Y
P3

3.6455
$155.09
$155.0940830
Repair mouth laceration
Y
G2

2.4520
$104.32
$104.3240831
Repair mouth laceration
Y
A2
$333.00
7.5511
$321.25
$330.0640840
Reconstruction of mouth
Y
A2
$446.00
23.3299
$992.52
$582.6340842
Reconstruction of mouth
Y
A2
$510.00
23.3299
$992.52
$630.6340843
Reconstruction of mouth
Y
A2
$510.00
23.3299
$992.52
$630.63( print page 42581)40844
Reconstruction of mouth
Y
A2
$717.00
38.1991
$1,625.10
$944.0340845
Reconstruction of mouth
Y
A2
$717.00
38.1991
$1,625.10
$944.0341000
Drainage of mouth lesion
Y
P3

1.9394
$82.51
$82.5141005
Drainage of mouth lesion
Y
A2
$150.72
2.4520
$104.32
$139.1241006
Drainage of mouth lesion
Y
A2
$333.00
23.3299
$992.52
$497.8841007
Drainage of mouth lesion
Y
A2
$333.00
16.4266
$698.84
$424.4641008
Drainage of mouth lesion
Y
A2
$333.00
16.4266
$698.84
$424.4641009
Drainage of mouth lesion
Y
A2
$150.72
2.4520
$104.32
$139.1241010
Incision of tongue fold
Y
A2
$333.00
7.5511
$321.25
$330.0641015
Drainage of mouth lesion
Y
A2
$150.72
2.4520
$104.32
$139.1241016
Drainage of mouth lesion
Y
A2
$333.00
7.5511
$321.25
$330.0641017
Drainage of mouth lesion
Y
A2
$333.00
7.5511
$321.25
$330.0641018
Drainage of mouth lesion
Y
A2
$333.00
7.5511
$321.25
$330.0641100
Biopsy of tongue
Y
P3

2.0118
$85.59
$85.5941105
Biopsy of tongue
Y
P3

1.9634
$83.53
$83.5341108
Biopsy of floor of mouth
Y
P3

1.7947
$76.35
$76.3541110
Excision of tongue lesion
Y
P3

2.5913
$110.24
$110.2441112
Excision of tongue lesion
Y
A2
$446.00
16.4266
$698.84
$509.2141113
Excision of tongue lesion
Y
A2
$446.00
16.4266
$698.84
$509.2141114
Excision of tongue lesion
Y
A2
$446.00
23.3299
$992.52
$582.6341115
Excision of tongue fold
Y
P3

3.0339
$129.07
$129.0741116
Excision of mouth lesion
Y
A2
$333.00
16.4266
$698.84
$424.4641120
Partial removal of tongue
Y
A2
$717.00
23.3299
$992.52
$785.8841250
Repair tongue laceration
Y
A2
$150.72
2.4520
$104.32
$139.1241251
Repair tongue laceration
Y
A2
$150.72
2.4520
$104.32
$139.1241252
Repair tongue laceration
Y
A2
$446.00
7.5511
$321.25
$414.8141500
Fixation of tongue
Y
A2
$333.00
23.3299
$992.52
$497.8841510
Tongue to lip surgery
Y
A2
$333.00
16.4266
$698.84
$424.4641520
Reconstruction, tongue fold
Y
A2
$446.00
7.5511
$321.25
$414.8141800
Drainage of gum lesion
Y
A2
$88.46
1.4392
$61.23
$81.6541805
Removal of foreign body, gum
Y
P3

2.9695
$126.33
$126.3341806
Removal of foreign body, jawbone
Y
P3

3.8145
$162.28
$162.2841820
Excision, gum, each quadrant
Y
R2

7.5511
$321.25
$321.2541821
Excision of gum flap
Y
G2

7.5511
$321.25
$321.2541822
Excision of gum lesion
Y
P3

3.4363
$146.19
$146.1941823
Excision of gum lesion
Y
P3

4.8525
$206.44
$206.4441825
Excision of gum lesion
Y
P3

2.6879
$114.35
$114.3541826
Excision of gum lesion
Y
P3

3.0339
$129.07
$129.0741827
Excision of gum lesion
Y
A2
$446.00
23.3299
$992.52
$582.6341828
Excision of gum lesion
Y
P3

3.1867
$135.57
$135.5741830
Removal of gum tissue
Y
P3

4.4261
$188.30
$188.3041850
Treatment of gum lesion
Y
R2

16.4266
$698.84
$698.8441870
Gum graft
Y
G2

23.3299
$992.52
$992.5241872
Repair gum
Y
P3

4.3939
$186.93
$186.9341874
Repair tooth socket
Y
P3

4.2651
$181.45
$181.4542000
Drainage mouth roof lesion
Y
A2
$150.72
2.4520
$104.32
$139.1242100
Biopsy roof of mouth
Y
P3

1.7220
$73.26
$73.2642104
Excision lesion, mouth roof
Y
P3

2.3980
$102.02
$102.0242106
Excision lesion, mouth roof
Y
P3

3.0741
$130.78
$130.7842107
Excision lesion, mouth roof
Y
A2
$446.00
23.3299
$992.52
$582.6342120
Remove palate/lesion
Y
A2
$630.00
38.1991
$1,625.10
$878.7842140
Excision of uvula
Y
A2
$446.00
7.5511
$321.25
$414.8142145
Repair palate, pharynx/uvula
Y
A2
$717.00
23.3299
$992.52
$785.8842160
Treatment mouth roof lesion
Y
P3

3.1707
$134.89
$134.8942180
Repair palate
Y
A2
$150.72
2.4520
$104.32
$139.1242182
Repair palate
Y
A2
$446.00
38.1991
$1,625.10
$740.7842200
Reconstruct cleft palate
Y
A2
$717.00
38.1991
$1,625.10
$944.0342205
Reconstruct cleft palate
Y
A2
$717.00
38.1991
$1,625.10
$944.0342210
Reconstruct cleft palate
Y
A2
$717.00
38.1991
$1,625.10
$944.0342215
Reconstruct cleft palate
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5342220
Reconstruct cleft palate
Y
A2
$717.00
38.1991
$1,625.10
$944.0342226
Lengthening of palate
Y
A2
$717.00
38.1991
$1,625.10
$944.0342235
Repair palate
Y
A2
$717.00
16.4266
$698.84
$712.46( print page 42582)42260
Repair nose to lip fistula
Y
A2
$630.00
23.3299
$992.52
$720.6342280
Preparation, palate mold
Y
P3

1.6898
$71.89
$71.8942281
Insertion, palate prosthesis
Y
G2

16.4266
$698.84
$698.8442300
Drainage of salivary gland
Y
A2
$333.00
16.4266
$698.84
$424.4642305
Drainage of salivary gland
Y
A2
$446.00
16.4266
$698.84
$509.2142310
Drainage of salivary gland
Y
A2
$150.72
2.4520
$104.32
$139.1242320
Drainage of salivary gland
Y
A2
$150.72
2.4520
$104.32
$139.1242330
Removal of salivary stone
Y
P3

2.5511
$108.53
$108.5342335
Removal of salivary stone
Y
P3

4.1685
$177.34
$177.3442340
Removal of salivary stone
Y
A2
$446.00
16.4266
$698.84
$509.2142400
Biopsy of salivary gland
Y
P3

1.4244
$60.60
$60.6042405
Biopsy of salivary gland
Y
A2
$446.00
16.4266
$698.84
$509.2142408
Excision of salivary cyst
Y
A2
$510.00
16.4266
$698.84
$557.2142409
Drainage of salivary cyst
Y
A2
$510.00
16.4266
$698.84
$557.2142410
Excise parotid gland/lesion
Y
A2
$510.00
38.1991
$1,625.10
$788.7842415
Excise parotid gland/lesion
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5342420
Excise parotid gland/lesion
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5342425
Excise parotid gland/lesion
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5342440
Excise submaxillary gland
Y
A2
$510.00
38.1991
$1,625.10
$788.7842450
Excise sublingual gland
Y
A2
$446.00
23.3299
$992.52
$582.6342500
Repair salivary duct
Y
A2
$510.00
23.3299
$992.52
$630.6342505
Repair salivary duct
Y
A2
$630.00
38.1991
$1,625.10
$878.7842507
Parotid duct diversion
Y
A2
$510.00
38.1991
$1,625.10
$788.7842508
Parotid duct diversion
Y
A2
$630.00
38.1991
$1,625.10
$878.7842509
Parotid duct diversion
Y
A2
$630.00
38.1991
$1,625.10
$878.7842510
Parotid duct diversion
Y
A2
$630.00
38.1991
$1,625.10
$878.7842550
Injection for salivary x-ray

N142600
Closure of salivary fistula
Y
A2
$333.00
16.4266
$698.84
$424.4642650
Dilation of salivary duct
Y
P3

0.9254
$39.37
$39.3742660
Dilation of salivary duct
Y
P3

1.1186
$47.59
$47.5942665
Ligation of salivary duct
Y
A2
$995.00
23.3299
$992.52
$994.3842700
Drainage of tonsil abscess
Y
A2
$150.72
2.4520
$104.32
$139.1242720
Drainage of throat abscess
Y
A2
$333.00
16.4266
$698.84
$424.4642725
Drainage of throat abscess
Y
A2
$446.00
38.1991
$1,625.10
$740.7842800
Biopsy of throat
Y
P3

1.7947
$76.35
$76.3542802
Biopsy of throat
Y
A2
$333.00
16.4266
$698.84
$424.4642804
Biopsy of upper nose/throat
Y
A2
$333.00
16.4266
$698.84
$424.4642806
Biopsy of upper nose/throat
Y
A2
$446.00
23.3299
$992.52
$582.6342808
Excise pharynx lesion
Y
A2
$446.00
16.4266
$698.84
$509.2142809
Remove pharynx foreign body
N
G2

0.6102
$25.96
$25.9642810
Excision of neck cyst
Y
A2
$510.00
23.3299
$992.52
$630.6342815
Excision of neck cyst
Y
A2
$717.00
38.1991
$1,625.10
$944.0342820
Remove tonsils and adenoids
Y
A2
$510.00
22.1165
$940.90
$617.7342821
Remove tonsils and adenoids
Y
A2
$717.00
22.1165
$940.90
$772.9842825
Removal of tonsils
Y
A2
$630.00
22.1165
$940.90
$707.7342826
Removal of tonsils
Y
A2
$630.00
22.1165
$940.90
$707.7342830
Removal of adenoids
Y
A2
$630.00
22.1165
$940.90
$707.7342831
Removal of adenoids
Y
A2
$630.00
22.1165
$940.90
$707.7342835
Removal of adenoids
Y
A2
$630.00
22.1165
$940.90
$707.7342836
Removal of adenoids
Y
A2
$630.00
22.1165
$940.90
$707.7342860
Excision of tonsil tags
Y
A2
$510.00
22.1165
$940.90
$617.7342870
Excision of lingual tonsil
Y
A2
$510.00
22.1165
$940.90
$617.7342890
Partial removal of pharynx
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5342892
Revision of pharyngeal walls
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5342900
Repair throat wound
Y
A2
$333.00
7.5511
$321.25
$330.0642950
Reconstruction of throat
Y
A2
$446.00
23.3299
$992.52
$582.6342955
Surgical opening of throat
Y
A2
$446.00
23.3299
$992.52
$582.6342960
Control throat bleeding
Y
A2
$72.48
1.1791
$50.16
$66.9042962
Control throat bleeding
Y
A2
$446.00
38.1991
$1,625.10
$740.7842970
Control nose/throat bleeding
Y
R2

1.1791
$50.16
$50.1642972
Control nose/throat bleeding
Y
A2
$510.00
16.4266
$698.84
$557.2143030
Throat muscle surgery
Y
G2

16.4266
$698.84
$698.8443200
Esophagus endoscopy
Y
A2
$333.00
8.3175
$353.85
$338.21( print page 42583)43201
Esoph scope w/submucous inj
Y
A2
$333.00
8.3175
$353.85
$338.2143202
Esophagus endoscopy, biopsy
Y
A2
$333.00
8.3175
$353.85
$338.2143204
Esoph scope w/sclerosis inj
Y
A2
$333.00
8.3175
$353.85
$338.2143205
Esophagus endoscopy/ligation
Y
A2
$333.00
8.3175
$353.85
$338.2143215
Esophagus endoscopy
Y
A2
$333.00
8.3175
$353.85
$338.2143216
Esophagus endoscopy/lesion
Y
A2
$333.00
8.3175
$353.85
$338.2143217
Esophagus endoscopy
Y
A2
$333.00
8.3175
$353.85
$338.2143219
Esophagus endoscopy
Y
A2
$333.00
22.9475
$976.26
$493.8243220
Esoph endoscopy, dilation
Y
A2
$333.00
8.3175
$353.85
$338.2143226
Esoph endoscopy, dilation
Y
A2
$333.00
8.3175
$353.85
$338.2143227
Esoph endoscopy, repair
Y
A2
$446.00
8.3175
$353.85
$422.9643228
Esoph endoscopy, ablation
Y
A2
$446.00
25.7552
$1,095.70
$608.4343231
Esoph endoscopy w/us exam
Y
A2
$446.00
8.3175
$353.85
$422.9643232
Esoph endoscopy w/us fn bx
Y
A2
$446.00
8.3175
$353.85
$422.9643234
Upper GI endoscopy, exam
Y
A2
$333.00
8.3175
$353.85
$338.2143235
Uppr gi endoscopy, diagnosis
Y
A2
$333.00
8.3175
$353.85
$338.2143236
Uppr gi scope w/submuc inj
Y
A2
$446.00
8.3175
$353.85
$422.9643237
Endoscopic us exam, esoph
Y
A2
$446.00
8.3175
$353.85
$422.9643238
Uppr gi endoscopy w/us fn bx
Y
A2
$446.00
8.3175
$353.85
$422.9643239
Upper GI endoscopy, biopsy
Y
A2
$446.00
8.3175
$353.85
$422.9643240
Esoph endoscope w/drain cyst
Y
A2
$446.00
8.3175
$353.85
$422.9643241
Upper GI endoscopy with tube
Y
A2
$446.00
8.3175
$353.85
$422.9643242
Uppr gi endoscopy w/us fn bx
Y
A2
$446.00
8.3175
$353.85
$422.9643243
Upper gi endoscopy & inject
Y
A2
$446.00
8.3175
$353.85
$422.9643244
Upper GI endoscopy/ligation
Y
A2
$446.00
8.3175
$353.85
$422.9643245
Uppr gi scope dilate strictr
Y
A2
$446.00
8.3175
$353.85
$422.9643246
Place gastrostomy tube
Y
A2
$446.00
8.3175
$353.85
$422.9643247
Operative upper GI endoscopy
Y
A2
$446.00
8.3175
$353.85
$422.9643248
Uppr gi endoscopy/guide wire
Y
A2
$446.00
8.3175
$353.85
$422.9643249
Esoph endoscopy, dilation
Y
A2
$446.00
8.3175
$353.85
$422.9643250
Upper GI endoscopy/tumor
Y
A2
$446.00
8.3175
$353.85
$422.9643251
Operative upper GI endoscopy
Y
A2
$446.00
8.3175
$353.85
$422.9643255
Operative upper GI endoscopy
Y
A2
$446.00
8.3175
$353.85
$422.9643256
Uppr gi endoscopy w/stent
Y
A2
$510.00
22.9475
$976.26
$626.5743257
Uppr gi scope w/thrml txmnt
Y
A2
$510.00
25.7552
$1,095.70
$656.4343258
Operative upper GI endoscopy
Y
A2
$510.00
8.3175
$353.85
$470.9643259
Endoscopic ultrasound exam
Y
A2
$510.00
8.3175
$353.85
$470.9643260
Endo cholangiopancreatograph
Y
A2
$446.00
19.8381
$843.97
$545.4943261
Endo cholangiopancreatograph
Y
A2
$446.00
19.8381
$843.97
$545.4943262
Endo cholangiopancreatograph
Y
A2
$446.00
19.8381
$843.97
$545.4943263
Endo cholangiopancreatograph
Y
A2
$446.00
19.8381
$843.97
$545.4943264
Endo cholangiopancreatograph
Y
A2
$446.00
19.8381
$843.97
$545.4943265
Endo cholangiopancreatograph
Y
A2
$446.00
19.8381
$843.97
$545.4943267
Endo cholangiopancreatograph
Y
A2
$446.00
19.8381
$843.97
$545.4943268
Endo cholangiopancreatograph
Y
A2
$446.00
22.9475
$976.26
$578.5743269
Endo cholangiopancreatograph
Y
A2
$446.00
22.9475
$976.26
$578.5743271
Endo cholangiopancreatograph
Y
A2
$446.00
19.8381
$843.97
$545.4943272
Endo cholangiopancreatograph
Y
A2
$446.00
19.8381
$843.97
$545.4943450
Dilate esophagus
Y
A2
$333.00
5.4566
$232.14
$307.7943453
Dilate esophagus
Y
A2
$333.00
5.4566
$232.14
$307.7943456
Dilate esophagus
Y
A2
$335.41
5.4566
$232.14
$309.5943458
Dilate esophagus
Y
A2
$335.41
5.4566
$232.14
$309.5943600
Biopsy of stomach
Y
A2
$333.00
8.3175
$353.85
$338.2143653
Laparoscopy, gastrostomy
Y
A2
$1,339.00
43.5488
$1,852.70
$1,467.4343750
Place gastrostomy tube
Y
A2
$446.00
8.3175
$353.85
$422.9643760
Change gastrostomy tube
Y
A2
$144.98
2.3587
$100.35
$133.8243761
Reposition gastrostomy tube
Y
A2
$333.00
7.4800
$318.22
$329.3143870
Repair stomach opening
Y
A2
$333.00
8.3175
$353.85
$338.2143886
Revise gastric port, open
Y
G2

5.2594
$223.75
$223.7543887
Remove gastric port, open
Y
G2

5.2594
$223.75
$223.7543888
Change gastric port, open
Y
G2

14.0346
$597.07
$597.0744100
Biopsy of bowel
Y
A2
$333.00
8.3175
$353.85
$338.2144312
Revision of ileostomy
Y
A2
$333.00
21.4302
$911.71
$477.68( print page 42584)44340
Revision of colostomy
Y
A2
$510.00
21.4302
$911.71
$610.4344360
Small bowel endoscopy
Y
A2
$446.00
9.4946
$403.93
$435.4844361
Small bowel endoscopy/biopsy
Y
A2
$446.00
9.4946
$403.93
$435.4844363
Small bowel endoscopy
Y
A2
$446.00
9.4946
$403.93
$435.4844364
Small bowel endoscopy
Y
A2
$446.00
9.4946
$403.93
$435.4844365
Small bowel endoscopy
Y
A2
$446.00
9.4946
$403.93
$435.4844366
Small bowel endoscopy
Y
A2
$446.00
9.4946
$403.93
$435.4844369
Small bowel endoscopy
Y
A2
$446.00
9.4946
$403.93
$435.4844370
Small bowel endoscopy/stent
Y
A2
$1,339.00
22.9475
$976.26
$1,248.3244372
Small bowel endoscopy
Y
A2
$446.00
9.4946
$403.93
$435.4844373
Small bowel endoscopy
Y
A2
$446.00
9.4946
$403.93
$435.4844376
Small bowel endoscopy
Y
A2
$446.00
9.4946
$403.93
$435.4844377
Small bowel endoscopy/biopsy
Y
A2
$446.00
9.4946
$403.93
$435.4844378
Small bowel endoscopy
Y
A2
$446.00
9.4946
$403.93
$435.4844379
Sbowel endoscope w/stent
Y
A2
$1,339.00
22.9475
$976.26
$1,248.3244380
Small bowel endoscopy
Y
A2
$333.00
9.4946
$403.93
$350.7344382
Small bowel endoscopy
Y
A2
$333.00
9.4946
$403.93
$350.7344383
Ileoscopy w/stent
Y
A2
$1,339.00
22.9475
$976.26
$1,248.3244385
Endoscopy of bowel pouch
Y
A2
$333.00
8.7686
$373.04
$343.0144386
Endoscopy, bowel pouch/biop
Y
A2
$333.00
8.7686
$373.04
$343.0144388
Colonoscopy
Y
A2
$333.00
8.7686
$373.04
$343.0144389
Colonoscopy with biopsy
Y
A2
$333.00
8.7686
$373.04
$343.0144390
Colonoscopy for foreign body
Y
A2
$333.00
8.7686
$373.04
$343.0144391
Colonoscopy for bleeding
Y
A2
$333.00
8.7686
$373.04
$343.0144392
Colonoscopy & polypectomy
Y
A2
$333.00
8.7686
$373.04
$343.0144393
Colonoscopy, lesion removal
Y
A2
$333.00
8.7686
$373.04
$343.0144394
Colonoscopy w/snare
Y
A2
$333.00
8.7686
$373.04
$343.0144397
Colonoscopy w/stent
Y
A2
$333.00
22.9475
$976.26
$493.8244701
Intraop colon lavage add-on

N145000
Drainage of pelvic abscess
Y
A2
$312.07
5.0770
$215.99
$288.0545005
Drainage of rectal abscess
Y
A2
$446.00
12.7389
$541.95
$469.9945020
Drainage of rectal abscess
Y
A2
$446.00
12.7389
$541.95
$469.9945100
Biopsy of rectum
Y
A2
$333.00
22.2682
$947.36
$486.5945108
Removal of anorectal lesion
Y
A2
$446.00
22.2682
$947.36
$571.3445150
Excision of rectal stricture
Y
A2
$446.00
22.2682
$947.36
$571.3445160
Excision of rectal lesion
Y
A2
$446.00
22.2682
$947.36
$571.3445170
Excision of rectal lesion
Y
A2
$446.00
22.2682
$947.36
$571.3445190
Destruction, rectal tumor
Y
A2
$1,339.00
22.2682
$947.36
$1,241.0945300
Proctosigmoidoscopy dx
Y
P3

1.3922
$59.23
$59.2345303
Proctosigmoidoscopy dilate
Y
P2

8.5477
$363.64
$363.6445305
Proctosigmoidoscopy w/bx
Y
A2
$333.00
8.5477
$363.64
$340.6645307
Proctosigmoidoscopy fb
Y
A2
$333.00
20.6375
$877.98
$469.2545308
Proctosigmoidoscopy removal
Y
A2
$333.00
8.5477
$363.64
$340.6645309
Proctosigmoidoscopy removal
Y
A2
$333.00
8.5477
$363.64
$340.6645315
Proctosigmoidoscopy removal
Y
A2
$333.00
8.5477
$363.64
$340.6645317
Proctosigmoidoscopy bleed
Y
A2
$333.00
8.5477
$363.64
$340.6645320
Proctosigmoidoscopy ablate
Y
A2
$333.00
20.6375
$877.98
$469.2545321
Proctosigmoidoscopy volvul
Y
A2
$333.00
20.6375
$877.98
$469.2545327
Proctosigmoidoscopy w/stent
Y
A2
$333.00
22.9475
$976.26
$493.8245330
Diagnostic sigmoidoscopy
Y
P3

1.9152
$81.48
$81.4845331
Sigmoidoscopy and biopsy
Y
A2
$299.24
4.8683
$207.11
$276.2145332
Sigmoidoscopy w/fb removal
Y
A2
$299.24
4.8683
$207.11
$276.2145333
Sigmoidoscopy & polypectomy
Y
A2
$333.00
8.5477
$363.64
$340.6645334
Sigmoidoscopy for bleeding
Y
A2
$333.00
8.5477
$363.64
$340.6645335
Sigmoidoscopy w/submuc inj
Y
A2
$299.24
4.8683
$207.11
$276.2145337
Sigmoidoscopy & decompress
Y
A2
$299.24
4.8683
$207.11
$276.2145338
Sigmoidoscopy w/tumr remove
Y
A2
$333.00
8.5477
$363.64
$340.6645339
Sigmoidoscopy w/ablate tumr
Y
A2
$333.00
8.5477
$363.64
$340.6645340
Sig w/balloon dilation
Y
A2
$333.00
8.5477
$363.64
$340.6645341
Sigmoidoscopy w/ultrasound
Y
A2
$333.00
8.5477
$363.64
$340.6645342
Sigmoidoscopy w/us guide bx
Y
A2
$333.00
8.5477
$363.64
$340.6645345
Sigmoidoscopy w/stent
Y
A2
$333.00
22.9475
$976.26
$493.8245355
Surgical colonoscopy
Y
A2
$333.00
8.7686
$373.04
$343.01( print page 42585)45378
Diagnostic colonoscopy
Y
A2
$446.00
8.7686
$373.04
$427.7645379
Colonoscopy w/fb removal
Y
A2
$446.00
8.7686
$373.04
$427.7645380
Colonoscopy and biopsy
Y
A2
$446.00
8.7686
$373.04
$427.7645381
Colonoscopy, submucous inj
Y
A2
$446.00
8.7686
$373.04
$427.7645382
Colonoscopy/control bleeding
Y
A2
$446.00
8.7686
$373.04
$427.7645383
Lesion removal colonoscopy
Y
A2
$446.00
8.7686
$373.04
$427.7645384
Lesion remove colonoscopy
Y
A2
$446.00
8.7686
$373.04
$427.7645385
Lesion removal colonoscopy
Y
A2
$446.00
8.7686
$373.04
$427.7645386
Colonoscopy dilate stricture
Y
A2
$446.00
8.7686
$373.04
$427.7645387
Colonoscopy w/stent
Y
A2
$333.00
22.9475
$976.26
$493.8245391
Colonoscopy w/endoscope us
Y
A2
$446.00
8.7686
$373.04
$427.7645392
Colonoscopy w/endoscopic fnb
Y
A2
$446.00
8.7686
$373.04
$427.7645500
Repair of rectum
Y
A2
$446.00
22.2682
$947.36
$571.3445505
Repair of rectum
Y
A2
$446.00
29.6189
$1,260.08
$649.5245520
Treatment of rectal prolapse
Y
P2

1.0798
$45.94
$45.9445560
Repair of rectocele
Y
A2
$446.00
29.6189
$1,260.08
$649.5245900
Reduction of rectal prolapse
Y
A2
$312.07
5.0770
$215.99
$288.0545905
Dilation of anal sphincter
Y
A2
$333.00
22.2682
$947.36
$486.5945910
Dilation of rectal narrowing
Y
A2
$333.00
22.2682
$947.36
$486.5945915
Remove rectal obstruction
Y
A2
$312.07
5.0770
$215.99
$288.0545990
Surg dx exam, anorectal
Y
A2
$312.07
5.0770
$215.99
$288.0546020
Placement of seton
Y
A2
$510.00
22.2682
$947.36
$619.3446030
Removal of rectal marker
Y
A2
$312.07
5.0770
$215.99
$288.0546040
Incision of rectal abscess
Y
A2
$510.00
22.2682
$947.36
$619.3446045
Incision of rectal abscess
Y
A2
$446.00
22.2682
$947.36
$571.3446050
Incision of anal abscess
Y
A2
$312.07
5.0770
$215.99
$288.0546060
Incision of rectal abscess
Y
A2
$446.00
22.2682
$947.36
$571.3446070
Incision of anal septum
Y
G2

12.7389
$541.95
$541.9546080
Incision of anal sphincter
Y
A2
$510.00
22.2682
$947.36
$619.3446083
Incise external hemorrhoid
Y
P3

1.9554
$83.19
$83.1946200
Removal of anal fissure
Y
A2
$446.00
22.2682
$947.36
$571.3446210
Removal of anal crypt
Y
A2
$446.00
22.2682
$947.36
$571.3446211
Removal of anal crypts
Y
A2
$446.00
22.2682
$947.36
$571.3446220
Removal of anal tag
Y
A2
$333.00
22.2682
$947.36
$486.5946221
Ligation of hemorrhoid(s)
Y
P3

2.5591
$108.87
$108.8746230
Removal of anal tags
Y
A2
$333.00
22.2682
$947.36
$486.5946250
Hemorrhoidectomy
Y
A2
$510.00
22.2682
$947.36
$619.3446255
Hemorrhoidectomy
Y
A2
$510.00
22.2682
$947.36
$619.3446257
Remove hemorrhoids & fissure
Y
A2
$510.00
22.2682
$947.36
$619.3446258
Remove hemorrhoids & fistula
Y
A2
$510.00
22.2682
$947.36
$619.3446260
Hemorrhoidectomy
Y
A2
$510.00
22.2682
$947.36
$619.3446261
Remove hemorrhoids & fissure
Y
A2
$630.00
22.2682
$947.36
$709.3446262
Remove hemorrhoids & fistula
Y
A2
$630.00
22.2682
$947.36
$709.3446270
Removal of anal fistula
Y
A2
$510.00
22.2682
$947.36
$619.3446275
Removal of anal fistula
Y
A2
$510.00
22.2682
$947.36
$619.3446280
Removal of anal fistula
Y
A2
$630.00
22.2682
$947.36
$709.3446285
Removal of anal fistula
Y
A2
$333.00
22.2682
$947.36
$486.5946288
Repair anal fistula
Y
A2
$630.00
22.2682
$947.36
$709.3446320
Removal of hemorrhoid clot
Y
P3

1.8186
$77.37
$77.3746500
Injection into hemorrhoid(s)
Y
P3

2.2934
$97.57
$97.5746505
Chemodenervation anal musc
Y
G2

5.0770
$215.99
$215.9946600
Diagnostic anoscopy
N
P2

0.6102
$25.96
$25.9646604
Anoscopy and dilation
Y
P2

8.5477
$363.64
$363.6446606
Anoscopy and biopsy
Y
P3

3.0821
$131.12
$131.1246608
Anoscopy, remove for body
Y
A2
$333.00
8.5477
$363.64
$340.6646610
Anoscopy, remove lesion
Y
A2
$333.00
20.6375
$877.98
$469.2546611
Anoscopy
Y
A2
$333.00
8.5477
$363.64
$340.6646612
Anoscopy, remove lesions
Y
A2
$333.00
20.6375
$877.98
$469.2546614
Anoscopy, control bleeding
Y
P3

1.9634
$83.53
$83.5346615
Anoscopy
Y
A2
$446.00
20.6375
$877.98
$554.0046700
Repair of anal stricture
Y
A2
$510.00
22.2682
$947.36
$619.3446706
Repr of anal fistula w/glue
Y
A2
$333.00
29.6189
$1,260.08
$564.7746750
Repair of anal sphincter
Y
A2
$510.00
37.8991
$1,612.34
$785.59( print page 42586)46753
Reconstruction of anus
Y
A2
$510.00
22.2682
$947.36
$619.3446754
Removal of suture from anus
Y
A2
$446.00
22.2682
$947.36
$571.3446760
Repair of anal sphincter
Y
A2
$446.00
37.8991
$1,612.34
$737.5946761
Repair of anal sphincter
Y
A2
$510.00
37.8991
$1,612.34
$785.5946762
Implant artificial sphincter
Y
A2
$995.00
37.8991
$1,612.34
$1,149.3446900
Destruction, anal lesion(s)
Y
P3

2.4947
$106.13
$106.1346910
Destruction, anal lesion(s)
Y
P3

2.7281
$116.06
$116.0646916
Cryosurgery, anal lesion(s)
Y
P2

1.0918
$46.45
$46.4546917
Laser surgery, anal lesions
Y
A2
$333.00
20.4276
$869.05
$467.0146922
Excision of anal lesion(s)
Y
A2
$333.00
20.4276
$869.05
$467.0146924
Destruction, anal lesion(s)
Y
A2
$333.00
20.4276
$869.05
$467.0146934
Destruction of hemorrhoids
Y
P3

4.2087
$179.05
$179.0546935
Destruction of hemorrhoids
Y
P3

2.8729
$122.22
$122.2246936
Destruction of hemorrhoids
Y
P3

4.4341
$188.64
$188.6446937
Cryotherapy of rectal lesion
Y
A2
$446.00
22.2682
$947.36
$571.3446938
Cryotherapy of rectal lesion
Y
A2
$446.00
29.6189
$1,260.08
$649.5246940
Treatment of anal fissure
Y
P3

1.9394
$82.51
$82.5146942
Treatment of anal fissure
Y
P3

1.8588
$79.08
$79.0846945
Ligation of hemorrhoids
Y
P3

3.2511
$138.31
$138.3146946
Ligation of hemorrhoids
Y
A2
$333.00
12.7389
$541.95
$385.2446947
Hemorrhoidopexy by stapling
Y
A2
$995.00
29.6189
$1,260.08
$1,061.2747000
Needle biopsy of liver
Y
A2
$333.00
6.1384
$261.15
$315.0447001
Needle biopsy, liver add-on

N147382
Percut ablate liver rf
Y
G2

37.3604
$1,589.42
$1,589.4247500
Injection for liver x-rays

N147505
Injection for liver x-rays

N147510
Insert catheter, bile duct
Y
A2
$446.00
20.2682
$862.27
$550.0747511
Insert bile duct drain
Y
A2
$1,245.85
20.2682
$862.27
$1,149.9647525
Change bile duct catheter
Y
A2
$333.00
11.6575
$495.95
$373.7447530
Revise/reinsert bile tube
Y
A2
$333.00
11.6575
$495.95
$373.7447552
Biliary endoscopy thru skin
Y
A2
$446.00
20.2682
$862.27
$550.0747553
Biliary endoscopy thru skin
Y
A2
$510.00
20.2682
$862.27
$598.0747554
Biliary endoscopy thru skin
Y
A2
$510.00
20.2682
$862.27
$598.0747555
Biliary endoscopy thru skin
Y
A2
$510.00
20.2682
$862.27
$598.0747556
Biliary endoscopy thru skin
Y
A2
$1,245.85
20.2682
$862.27
$1,149.9647560
Laparoscopy w/cholangio
Y
A2
$510.00
32.1241
$1,366.66
$724.1747561
Laparo w/cholangio/biopsy
Y
A2
$510.00
32.1241
$1,366.66
$724.1747562
Laparoscopic cholecystectomy
Y
G2

43.5488
$1,852.70
$1,852.7047563
Laparo cholecystectomy/graph
Y
G2

43.5488
$1,852.70
$1,852.7047564
Laparo cholecystectomy/explr
Y
G2

43.5488
$1,852.70
$1,852.7047630
Remove bile duct stone
Y
A2
$510.00
20.2682
$862.27
$598.0748102
Needle biopsy, pancreas
Y
A2
$333.00
6.1384
$261.15
$315.0449080
Puncture, peritoneal cavity
Y
A2
$222.78
3.6244
$154.19
$205.6349081
Removal of abdominal fluid
Y
A2
$222.78
3.6244
$154.19
$205.6349180
Biopsy, abdominal mass
Y
A2
$333.00
6.1384
$261.15
$315.0449250
Excision of umbilicus
Y
A2
$630.00
22.0832
$939.49
$707.3749320
Diag laparo separate proc
Y
A2
$510.00
32.1241
$1,366.66
$724.1749321
Laparoscopy, biopsy
Y
A2
$630.00
32.1241
$1,366.66
$814.1749322
Laparoscopy, aspiration
Y
A2
$630.00
32.1241
$1,366.66
$814.1749400
Air injection into abdomen

N149402
Remove foreign body, adbomen
Y
A2
$446.00
22.0832
$939.49
$569.3749419
Insrt abdom cath for chemotx
Y
A2
$333.00
29.2133
$1,242.82
$560.4649420
Insert abdom drain, temp
Y
A2
$333.00
29.5416
$1,256.79
$563.9549421
Insert abdom drain, perm
Y
A2
$333.00
29.5416
$1,256.79
$563.9549422
Remove perm cannula/catheter
Y
A2
$333.00
25.6142
$1,089.70
$522.1849423
Exchange drainage catheter
Y
G2

11.6575
$495.95
$495.9549424
Assess cyst, contrast inject

N149426
Revise abdomen-venous shunt
Y
A2
$446.00
22.0832
$939.49
$569.3749427
Injection, abdominal shunt

N149429
Removal of shunt
Y
G2

25.6142
$1,089.70
$1,089.7049495
Rpr ing hernia baby, reduc
Y
A2
$630.00
29.2182
$1,243.03
$783.2649496
Rpr ing hernia baby, blocked
Y
A2
$630.00
29.2182
$1,243.03
$783.2649500
Rpr ing hernia, init, reduce
Y
A2
$630.00
29.2182
$1,243.03
$783.26( print page 42587)49501
Rpr ing hernia, init blocked
Y
A2
$1,339.00
29.2182
$1,243.03
$1,315.0149505
Prp i/hern init reduc > 5 yr
Y
A2
$630.00
29.2182
$1,243.03
$783.2649507
Prp i/hern init block > 5 yr
Y
A2
$1,339.00
29.2182
$1,243.03
$1,315.0149520
Rerepair ing hernia, reduce
Y
A2
$995.00
29.2182
$1,243.03
$1,057.0149521
Rerepair ing hernia, blocked
Y
A2
$1,339.00
29.2182
$1,243.03
$1,315.0149525
Repair ing hernia, sliding
Y
A2
$630.00
29.2182
$1,243.03
$783.2649540
Repair lumbar hernia
Y
A2
$446.00
29.2182
$1,243.03
$645.2649550
Rpr rem hernia, init, reduce
Y
A2
$717.00
29.2182
$1,243.03
$848.5149553
Rpr fem hernia, init blocked
Y
A2
$1,339.00
29.2182
$1,243.03
$1,315.0149555
Rerepair fem hernia, reduce
Y
A2
$717.00
29.2182
$1,243.03
$848.5149557
Rerepair fem hernia, blocked
Y
A2
$1,339.00
29.2182
$1,243.03
$1,315.0149560
Rpr ventral hern init, reduc
Y
A2
$630.00
29.2182
$1,243.03
$783.2649561
Rpr ventral hern init, block
Y
A2
$1,339.00
29.2182
$1,243.03
$1,315.0149565
Rerepair ventrl hern, reduce
Y
A2
$630.00
29.2182
$1,243.03
$783.2649566
Rerepair ventrl hern, block
Y
A2
$1,339.00
29.2182
$1,243.03
$1,315.0149568
Hernia repair w/mesh
Y
A2
$995.00
29.2182
$1,243.03
$1,057.0149570
Rpr epigastric hern, reduce
Y
A2
$630.00
29.2182
$1,243.03
$783.2649572
Rpr epigastric hern, blocked
Y
A2
$1,339.00
29.2182
$1,243.03
$1,315.0149580
Rpr umbil hern, reduc < 5 yr
Y
A2
$630.00
29.2182
$1,243.03
$783.2649582
Rpr umbil hern, block < 5 yr
Y
A2
$1,339.00
29.2182
$1,243.03
$1,315.0149585
Rpr umbil hern, reduc > 5 yr
Y
A2
$630.00
29.2182
$1,243.03
$783.2649587
Rpr umbil hern, block > 5 yr
Y
A2
$1,339.00
29.2182
$1,243.03
$1,315.0149590
Repair spigelian hernia
Y
A2
$510.00
29.2182
$1,243.03
$693.2649600
Repair umbilical lesion
Y
A2
$630.00
29.2182
$1,243.03
$783.2649650
Laparo hernia repair initial
Y
A2
$630.00
43.5488
$1,852.70
$935.6849651
Laparo hernia repair recur
Y
A2
$995.00
43.5488
$1,852.70
$1,209.4350200
Biopsy of kidney
Y
A2
$333.00
6.1384
$261.15
$315.0450382
Change ureter stent, percut
Y
G2

19.2251
$817.89
$817.8950384
Remove ureter stent, percut
Y
G2

19.2251
$817.89
$817.8950387
Change ext/int ureter stent
Y
G2

7.4800
$318.22
$318.2250389
Remove renal tube w/fluoro
Y
G2

3.4079
$144.98
$144.9850390
Drainage of kidney lesion
Y
A2
$333.00
6.1384
$261.15
$315.0450391
Instll rx agnt into rnal tub
Y
P2

1.0887
$46.32
$46.3250392
Insert kidney drain
Y
A2
$333.00
19.2251
$817.89
$454.2250393
Insert ureteral tube
Y
A2
$333.00
19.2251
$817.89
$454.2250394
Injection for kidney x-ray

N150395
Create passage to kidney
Y
A2
$333.00
19.2251
$817.89
$454.2250396
Measure kidney pressure
Y
A2
$131.50
2.1393
$91.01
$121.3850398
Change kidney tube
Y
A2
$333.00
7.4800
$318.22
$329.3150551
Kidney endoscopy
Y
A2
$333.00
6.4951
$276.32
$318.8350553
Kidney endoscopy
Y
A2
$333.00
19.2251
$817.89
$454.2250555
Kidney endoscopy & biopsy
Y
A2
$333.00
6.4951
$276.32
$318.8350557
Kidney endoscopy & treatment
Y
A2
$333.00
23.8700
$1,015.50
$503.6350561
Kidney endoscopy & treatment
Y
A2
$333.00
19.2251
$817.89
$454.2250562
Renal scope w/tumor resect
Y
G2

6.4951
$276.32
$276.3250570
Kidney endoscopy
Y
G2

6.4951
$276.32
$276.3250572
Kidney endoscopy
Y
G2

6.4951
$276.32
$276.3250574
Kidney endoscopy & biopsy
Y
G2

6.4951
$276.32
$276.3250575
Kidney endoscopy
Y
G2

34.9261
$1,485.86
$1,485.8650576
Kidney endoscopy & treatment
Y
G2

19.2251
$817.89
$817.8950590
Fragmenting of kidney stone
Y
G2

43.5398
$1,852.31
$1,852.3150592
Perc rf ablate renal tumor
Y
G2

37.3604
$1,589.42
$1,589.4250684
Injection for ureter x-ray

N150686
Measure ureter pressure
Y
P2

1.0887
$46.32
$46.3250688
Change of ureter tube/stent
Y
A2
$333.00
7.4800
$318.22
$329.3150690
Injection for ureter x-ray

N150947
Laparo new ureter/bladder
Y
A2
$1,339.00
43.5488
$1,852.70
$1,467.4350948
Laparo new ureter/bladder
Y
A2
$1,339.00
43.5488
$1,852.70
$1,467.4350951
Endoscopy of ureter
Y
A2
$333.00
6.4951
$276.32
$318.8350953
Endoscopy of ureter
Y
A2
$333.00
6.4951
$276.32
$318.8350955
Ureter endoscopy & biopsy
Y
A2
$333.00
19.2251
$817.89
$454.2250957
Ureter endoscopy & treatment
Y
A2
$333.00
19.2251
$817.89
$454.2250961
Ureter endoscopy & treatment
Y
A2
$333.00
19.2251
$817.89
$454.22( print page 42588)50970
Ureter endoscopy
Y
A2
$333.00
6.4951
$276.32
$318.8350972
Ureter endoscopy & catheter
Y
A2
$333.00
6.4951
$276.32
$318.8350974
Ureter endoscopy & biopsy
Y
A2
$333.00
19.2251
$817.89
$454.2250976
Ureter endoscopy & treatment
Y
A2
$333.00
19.2251
$817.89
$454.2250980
Ureter endoscopy & treatment
Y
A2
$333.00
19.2251
$817.89
$454.2251000
Drainage of bladder
Y
P3

1.1588
$49.30
$49.3051005
Drainage of bladder
Y
P2

1.0887
$46.32
$46.3251010
Drainage of bladder
Y
A2
$333.00
18.1679
$772.92
$442.9851020
Incise & treat bladder
Y
A2
$630.00
23.8700
$1,015.50
$726.3851030
Incise & treat bladder
Y
A2
$630.00
23.8700
$1,015.50
$726.3851040
Incise & drain bladder
Y
A2
$630.00
23.8700
$1,015.50
$726.3851045
Incise bladder/drain ureter
Y
A2
$399.24
6.4951
$276.32
$368.5151050
Removal of bladder stone
Y
A2
$630.00
23.8700
$1,015.50
$726.3851065
Remove ureter calculus
Y
A2
$630.00
23.8700
$1,015.50
$726.3851080
Drainage of bladder abscess
Y
A2
$333.00
17.5086
$744.87
$435.9751500
Removal of bladder cyst
Y
A2
$630.00
29.2182
$1,243.03
$783.2651520
Removal of bladder lesion
Y
A2
$630.00
23.8700
$1,015.50
$726.3851600
Injection for bladder x-ray

N151605
Preparation for bladder xray

N151610
Injection for bladder x-ray

N151700
Irrigation of bladder
Y
P3

1.2554
$53.41
$53.4151701
Insert bladder catheter
N
P2

0.6102
$25.96
$25.9651702
Insert temp bladder cath
N
P2

0.6102
$25.96
$25.9651703
Insert bladder cath, complex
Y
P2

1.0887
$46.32
$46.3251705
Change of bladder tube
Y
P3

1.7302
$73.61
$73.6151710
Change of bladder tube
Y
A2
$333.00
7.4800
$318.22
$329.3151715
Endoscopic injection/implant
Y
A2
$510.00
29.0253
$1,234.82
$691.2151720
Treatment of bladder lesion
Y
P3

1.3600
$57.86
$57.8651725
Simple cystometrogram
Y
P2

2.1393
$91.01
$91.0151726
Complex cystometrogram
Y
A2
$209.48
3.4079
$144.98
$193.3651736
Urine flow measurement
Y
P3

0.4264
$18.14
$18.1451741
Electro-uroflowmetry, first
Y
P3

0.4990
$21.23
$21.2351772
Urethra pressure profile
Y
A2
$131.50
2.1393
$91.01
$121.3851784
Anal/urinary muscle study
Y
P2

1.0887
$46.32
$46.3251785
Anal/urinary muscle study
Y
A2
$66.92
1.0887
$46.32
$61.7751792
Urinary reflex study
Y
P2

1.0887
$46.32
$46.3251795
Urine voiding pressure study
Y
P2

2.1393
$91.01
$91.0151797
Intraabdominal pressure test
Y
P2

2.1393
$91.01
$91.0151798
Us urine capacity measure
N
P3

0.3702
$15.75
$15.7551880
Repair of bladder opening
Y
A2
$333.00
23.8700
$1,015.50
$503.6351992
Laparo sling operation
Y
A2
$717.00
43.5488
$1,852.70
$1,000.9352000
Cystoscopy
Y
A2
$333.00
6.4951
$276.32
$318.8352001
Cystoscopy, removal of clots
Y
A2
$399.24
6.4951
$276.32
$368.5152005
Cystoscopy & ureter catheter
Y
A2
$446.00
19.2251
$817.89
$538.9752007
Cystoscopy and biopsy
Y
A2
$446.00
19.2251
$817.89
$538.9752010
Cystoscopy & duct catheter
Y
A2
$399.24
6.4951
$276.32
$368.5152204
Cystoscopy w/biopsy(s)
Y
A2
$446.00
19.2251
$817.89
$538.9752214
Cystoscopy and treatment
Y
A2
$446.00
23.8700
$1,015.50
$588.3852224
Cystoscopy and treatment
Y
A2
$446.00
23.8700
$1,015.50
$588.3852234
Cystoscopy and treatment
Y
A2
$446.00
23.8700
$1,015.50
$588.3852235
Cystoscopy and treatment
Y
A2
$510.00
23.8700
$1,015.50
$636.3852240
Cystoscopy and treatment
Y
A2
$510.00
23.8700
$1,015.50
$636.3852250
Cystoscopy and radiotracer
Y
A2
$630.00
23.8700
$1,015.50
$726.3852260
Cystoscopy and treatment
Y
A2
$446.00
19.2251
$817.89
$538.9752265
Cystoscopy and treatment
Y
P2

6.4951
$276.32
$276.3252270
Cystoscopy & revise urethra
Y
A2
$446.00
19.2251
$817.89
$538.9752275
Cystoscopy & revise urethra
Y
A2
$446.00
19.2251
$817.89
$538.9752276
Cystoscopy and treatment
Y
A2
$510.00
19.2251
$817.89
$586.9752277
Cystoscopy and treatment
Y
A2
$446.00
23.8700
$1,015.50
$588.3852281
Cystoscopy and treatment
Y
A2
$446.00
19.2251
$817.89
$538.9752282
Cystoscopy, implant stent
Y
A2
$1,339.00
34.9261
$1,485.86
$1,375.7252283
Cystoscopy and treatment
Y
A2
$446.00
19.2251
$817.89
$538.9752285
Cystoscopy and treatment
Y
A2
$446.00
19.2251
$817.89
$538.97( print page 42589)52290
Cystoscopy and treatment
Y
A2
$446.00
19.2251
$817.89
$538.9752300
Cystoscopy and treatment
Y
A2
$446.00
19.2251
$817.89
$538.9752301
Cystoscopy and treatment
Y
A2
$510.00
19.2251
$817.89
$586.9752305
Cystoscopy and treatment
Y
A2
$446.00
19.2251
$817.89
$538.9752310
Cystoscopy and treatment
Y
A2
$399.24
6.4951
$276.32
$368.5152315
Cystoscopy and treatment
Y
A2
$446.00
19.2251
$817.89
$538.9752317
Remove bladder stone
Y
A2
$333.00
23.8700
$1,015.50
$503.6352318
Remove bladder stone
Y
A2
$446.00
23.8700
$1,015.50
$588.3852320
Cystoscopy and treatment
Y
A2
$717.00
23.8700
$1,015.50
$791.6352325
Cystoscopy, stone removal
Y
A2
$630.00
23.8700
$1,015.50
$726.3852327
Cystoscopy, inject material
Y
A2
$446.00
23.8700
$1,015.50
$588.3852330
Cystoscopy and treatment
Y
A2
$446.00
23.8700
$1,015.50
$588.3852332
Cystoscopy and treatment
Y
A2
$446.00
23.8700
$1,015.50
$588.3852334
Create passage to kidney
Y
A2
$510.00
23.8700
$1,015.50
$636.3852341
Cysto w/ureter stricture tx
Y
A2
$510.00
23.8700
$1,015.50
$636.3852342
Cysto w/up stricture tx
Y
A2
$510.00
23.8700
$1,015.50
$636.3852343
Cysto w/renal stricture tx
Y
A2
$510.00
23.8700
$1,015.50
$636.3852344
Cysto/uretero, stricture tx
Y
A2
$510.00
23.8700
$1,015.50
$636.3852345
Cysto/uretero w/up stricture
Y
A2
$510.00
23.8700
$1,015.50
$636.3852346
Cystouretero w/renal strict
Y
A2
$510.00
23.8700
$1,015.50
$636.3852351
Cystouretero & or pyeloscope
Y
A2
$510.00
19.2251
$817.89
$586.9752352
Cystouretero w/stone remove
Y
A2
$630.00
23.8700
$1,015.50
$726.3852353
Cystouretero w/lithotripsy
Y
A2
$630.00
34.9261
$1,485.86
$843.9752354
Cystouretero w/biopsy
Y
A2
$630.00
23.8700
$1,015.50
$726.3852355
Cystouretero w/excise tumor
Y
A2
$630.00
23.8700
$1,015.50
$726.3852400
Cystouretero w/congen repr
Y
A2
$510.00
23.8700
$1,015.50
$636.3852402
Cystourethro cut ejacul duct
Y
A2
$510.00
23.8700
$1,015.50
$636.3852450
Incision of prostate
Y
A2
$510.00
23.8700
$1,015.50
$636.3852500
Revision of bladder neck
Y
A2
$510.00
23.8700
$1,015.50
$636.3852510
Dilation prostatic urethra
Y
A2
$510.00
19.2251
$817.89
$586.9752601
Prostatectomy (TURP)
Y
A2
$630.00
34.9261
$1,485.86
$843.9752606
Control postop bleeding
Y
A2
$333.00
23.8700
$1,015.50
$503.6352612
Prostatectomy, first stage
Y
A2
$446.00
34.9261
$1,485.86
$705.9752614
Prostatectomy, second stage
Y
A2
$333.00
34.9261
$1,485.86
$621.2252620
Remove residual prostate
Y
A2
$333.00
34.9261
$1,485.86
$621.2252630
Remove prostate regrowth
Y
A2
$446.00
34.9261
$1,485.86
$705.9752640
Relieve bladder contracture
Y
A2
$446.00
23.8700
$1,015.50
$588.3852647
Laser surgery of prostate
Y
A2
$1,339.00
43.1004
$1,833.62
$1,462.6652648
Laser surgery of prostate
Y
A2
$1,339.00
43.1004
$1,833.62
$1,462.6652700
Drainage of prostate abscess
Y
A2
$446.00
23.8700
$1,015.50
$588.3853000
Incision of urethra
Y
A2
$333.00
18.3960
$782.62
$445.4153010
Incision of urethra
Y
A2
$333.00
18.3960
$782.62
$445.4153020
Incision of urethra
Y
A2
$333.00
18.3960
$782.62
$445.4153025
Incision of urethra
Y
R2

18.3960
$782.62
$782.6253040
Drainage of urethra abscess
Y
A2
$446.00
18.3960
$782.62
$530.1653060
Drainage of urethra abscess
Y
P3

1.6416
$69.84
$69.8453080
Drainage of urinary leakage
Y
A2
$510.00
18.3960
$782.62
$578.1653085
Drainage of urinary leakage
Y
G2

18.3960
$782.62
$782.6253200
Biopsy of urethra
Y
A2
$333.00
18.3960
$782.62
$445.4153210
Removal of urethra
Y
A2
$717.00
29.0253
$1,234.82
$846.4653215
Removal of urethra
Y
A2
$717.00
18.3960
$782.62
$733.4153220
Treatment of urethra lesion
Y
A2
$446.00
29.0253
$1,234.82
$643.2153230
Removal of urethra lesion
Y
A2
$446.00
29.0253
$1,234.82
$643.2153235
Removal of urethra lesion
Y
A2
$510.00
18.3960
$782.62
$578.1653240
Surgery for urethra pouch
Y
A2
$446.00
29.0253
$1,234.82
$643.2153250
Removal of urethra gland
Y
A2
$446.00
18.3960
$782.62
$530.1653260
Treatment of urethra lesion
Y
A2
$446.00
18.3960
$782.62
$530.1653265
Treatment of urethra lesion
Y
A2
$446.00
18.3960
$782.62
$530.1653270
Removal of urethra gland
Y
A2
$446.00
18.3960
$782.62
$530.1653275
Repair of urethra defect
Y
A2
$446.00
18.3960
$782.62
$530.1653400
Revise urethra, stage 1
Y
A2
$510.00
29.0253
$1,234.82
$691.2153405
Revise urethra, stage 2
Y
A2
$446.00
29.0253
$1,234.82
$643.2153410
Reconstruction of urethra
Y
A2
$446.00
29.0253
$1,234.82
$643.21( print page 42590)53420
Reconstruct urethra, stage 1
Y
A2
$510.00
29.0253
$1,234.82
$691.2153425
Reconstruct urethra, stage 2
Y
A2
$446.00
29.0253
$1,234.82
$643.2153430
Reconstruction of urethra
Y
A2
$446.00
29.0253
$1,234.82
$643.2153431
Reconstruct urethra/bladder
Y
A2
$446.00
29.0253
$1,234.82
$643.2153440
Male sling procedure
N
A2
$446.00
79.2092
$3,369.80
$1,176.9553442
Remove/revise male sling
Y
A2
$333.00
29.0253
$1,234.82
$558.4653444
Insert tandem cuff
N
A2
$446.00
79.2092
$3,369.80
$1,176.9553445
Insert uro/ves nck sphincter
N
H8
$333.00
178.7754
$7,605.64
$6,152.7553446
Remove uro sphincter
Y
A2
$333.00
29.0253
$1,234.82
$558.4653447
Remove/replace ur sphincter
N
H8
$333.00
178.7754
$7,605.64
$6,152.7553449
Repair uro sphincter
Y
A2
$333.00
29.0253
$1,234.82
$558.4653450
Revision of urethra
Y
A2
$333.00
29.0253
$1,234.82
$558.4653460
Revision of urethra
Y
A2
$333.00
18.3960
$782.62
$445.4153502
Repair of urethra injury
Y
A2
$446.00
18.3960
$782.62
$530.1653505
Repair of urethra injury
Y
A2
$446.00
29.0253
$1,234.82
$643.2153510
Repair of urethra injury
Y
A2
$446.00
18.3960
$782.62
$530.1653515
Repair of urethra injury
Y
A2
$446.00
29.0253
$1,234.82
$643.2153520
Repair of urethra defect
Y
A2
$446.00
29.0253
$1,234.82
$643.2153600
Dilate urethra stricture
Y
P3

0.9254
$39.37
$39.3753601
Dilate urethra stricture
Y
P3

1.0702
$45.53
$45.5353605
Dilate urethra stricture
Y
A2
$446.00
19.2251
$817.89
$538.9753620
Dilate urethra stricture
Y
P3

1.4888
$63.34
$63.3453621
Dilate urethra stricture
Y
P3

1.5692
$66.76
$66.7653660
Dilation of urethra
Y
P3

1.0542
$44.85
$44.8553661
Dilation of urethra
Y
P3

1.0462
$44.51
$44.5153665
Dilation of urethra
Y
A2
$333.00
18.3960
$782.62
$445.4153850
Prostatic microwave thermotx
Y
P2

41.1375
$1,750.11
$1,750.1153852
Prostatic rf thermotx
Y
P2

41.1375
$1,750.11
$1,750.1153853
Prostatic water thermother
Y
P2

23.8700
$1,015.50
$1,015.5054000
Slitting of prepuce
Y
A2
$446.00
18.3960
$782.62
$530.1654001
Slitting of prepuce
Y
A2
$446.00
18.3960
$782.62
$530.1654015
Drain penis lesion
Y
A2
$630.00
17.5086
$744.87
$658.7254050
Destruction, penis lesion(s)
Y
P2

1.0918
$46.45
$46.4554055
Destruction, penis lesion(s)
Y
P3

1.4404
$61.28
$61.2854056
Cryosurgery, penis lesion(s)
Y
P2

0.8432
$35.87
$35.8754057
Laser surg, penis lesion(s)
Y
A2
$333.00
17.4423
$742.05
$435.2654060
Excision of penis lesion(s)
Y
A2
$333.00
17.4423
$742.05
$435.2654065
Destruction, penis lesion(s)
Y
A2
$333.00
20.4276
$869.05
$467.0154100
Biopsy of penis
Y
A2
$333.00
15.1024
$642.50
$410.3854105
Biopsy of penis
Y
A2
$333.00
20.0656
$853.65
$463.1654110
Treatment of penis lesion
Y
A2
$446.00
32.9873
$1,403.38
$685.3554111
Treat penis lesion, graft
Y
A2
$446.00
32.9873
$1,403.38
$685.3554112
Treat penis lesion, graft
Y
A2
$446.00
32.9873
$1,403.38
$685.3554115
Treatment of penis lesion
Y
A2
$333.00
17.5086
$744.87
$435.9754120
Partial removal of penis
Y
A2
$446.00
32.9873
$1,403.38
$685.3554150
Circumcision w/regionl block
Y
A2
$333.00
20.5513
$874.31
$468.3354160
Circumcision, neonate
Y
A2
$446.00
20.5513
$874.31
$553.0854161
Circum 28 days or older
Y
A2
$446.00
20.5513
$874.31
$553.0854162
Lysis penil circumic lesion
Y
A2
$446.00
20.5513
$874.31
$553.0854163
Repair of circumcision
Y
A2
$446.00
20.5513
$874.31
$553.0854164
Frenulotomy of penis
Y
A2
$446.00
20.5513
$874.31
$553.0854200
Treatment of penis lesion
Y
P3

1.5370
$65.39
$65.3954205
Treatment of penis lesion
Y
A2
$630.00
32.9873
$1,403.38
$823.3554220
Treatment of penis lesion
Y
A2
$131.50
2.1393
$91.01
$121.3854230
Prepare penis study

N154231
Dynamic cavernosometry
Y
P3

1.3036
$55.46
$55.4654235
Penile injection
Y
P3

0.9496
$40.40
$40.4054240
Penis study
Y
P3

0.6518
$27.73
$27.7354250
Penis study
Y
P3

0.2254
$9.59
$9.5954300
Revision of penis
Y
A2
$510.00
32.9873
$1,403.38
$733.3554304
Revision of penis
Y
A2
$510.00
32.9873
$1,403.38
$733.3554308
Reconstruction of urethra
Y
A2
$510.00
32.9873
$1,403.38
$733.3554312
Reconstruction of urethra
Y
A2
$510.00
32.9873
$1,403.38
$733.35( print page 42591)54316
Reconstruction of urethra
Y
A2
$510.00
32.9873
$1,403.38
$733.3554318
Reconstruction of urethra
Y
A2
$510.00
32.9873
$1,403.38
$733.3554322
Reconstruction of urethra
Y
A2
$510.00
32.9873
$1,403.38
$733.3554324
Reconstruction of urethra
Y
A2
$510.00
32.9873
$1,403.38
$733.3554326
Reconstruction of urethra
Y
A2
$510.00
32.9873
$1,403.38
$733.3554328
Revise penis/urethra
Y
A2
$510.00
32.9873
$1,403.38
$733.3554340
Secondary urethral surgery
Y
A2
$510.00
32.9873
$1,403.38
$733.3554344
Secondary urethral surgery
Y
A2
$510.00
32.9873
$1,403.38
$733.3554348
Secondary urethral surgery
Y
A2
$510.00
32.9873
$1,403.38
$733.3554352
Reconstruct urethra/penis
Y
A2
$510.00
32.9873
$1,403.38
$733.3554360
Penis plastic surgery
Y
A2
$510.00
32.9873
$1,403.38
$733.3554380
Repair penis
Y
A2
$510.00
32.9873
$1,403.38
$733.3554385
Repair penis
Y
A2
$510.00
32.9873
$1,403.38
$733.3554400
Insert semi-rigid prosthesis
N
A2
$510.00
79.2092
$3,369.80
$1,224.9554401
Insert self-contd prosthesis
N
H8
$510.00
178.7754
$7,605.64
$6,285.5054405
Insert multi-comp penis pros
N
H8
$510.00
178.7754
$7,605.64
$6,285.5054406
Remove muti-comp penis pros
Y
A2
$510.00
32.9873
$1,403.38
$733.3554408
Repair multi-comp penis pros
Y
A2
$510.00
32.9873
$1,403.38
$733.3554410
Remove/replace penis prosth
N
H8
$510.00
178.7754
$7,605.64
$6,285.5054415
Remove self-contd penis pros
Y
A2
$510.00
32.9873
$1,403.38
$733.3554416
Remv/repl penis contain pros
N
H8
$510.00
178.7754
$7,605.64
$6,285.5054420
Revision of penis
Y
A2
$630.00
32.9873
$1,403.38
$823.3554435
Revision of penis
Y
A2
$630.00
32.9873
$1,403.38
$823.3554440
Repair of penis
Y
A2
$630.00
32.9873
$1,403.38
$823.3554450
Preputial stretching
Y
A2
$209.48
3.4079
$144.98
$193.3654500
Biopsy of testis
Y
A2
$333.00
10.2655
$436.73
$358.9354505
Biopsy of testis
Y
A2
$333.00
23.5310
$1,001.08
$500.0254512
Excise lesion testis
Y
A2
$446.00
23.5310
$1,001.08
$584.7754520
Removal of testis
Y
A2
$510.00
23.5310
$1,001.08
$632.7754522
Orchiectomy, partial
Y
A2
$510.00
23.5310
$1,001.08
$632.7754530
Removal of testis
Y
A2
$630.00
29.2182
$1,243.03
$783.2654550
Exploration for testis
Y
A2
$630.00
29.2182
$1,243.03
$783.2654560
Exploration for testis
Y
G2

23.5310
$1,001.08
$1,001.0854600
Reduce testis torsion
Y
A2
$630.00
23.5310
$1,001.08
$722.7754620
Suspension of testis
Y
A2
$510.00
23.5310
$1,001.08
$632.7754640
Suspension of testis
Y
A2
$630.00
29.2182
$1,243.03
$783.2654660
Revision of testis
Y
A2
$446.00
23.5310
$1,001.08
$584.7754670
Repair testis injury
Y
A2
$510.00
23.5310
$1,001.08
$632.7754680
Relocation of testis(es)
Y
A2
$510.00
23.5310
$1,001.08
$632.7754690
Laparoscopy, orchiectomy
Y
A2
$1,339.00
43.5488
$1,852.70
$1,467.4354692
Laparoscopy, orchiopexy
Y
G2

70.5066
$2,999.56
$2,999.5654700
Drainage of scrotum
Y
A2
$446.00
23.5310
$1,001.08
$584.7754800
Biopsy of epididymis
Y
A2
$127.16
2.0687
$88.01
$117.3754830
Remove epididymis lesion
Y
A2
$510.00
23.5310
$1,001.08
$632.7754840
Remove epididymis lesion
Y
A2
$630.00
23.5310
$1,001.08
$722.7754860
Removal of epididymis
Y
A2
$510.00
23.5310
$1,001.08
$632.7754861
Removal of epididymis
Y
A2
$630.00
23.5310
$1,001.08
$722.7754865
Explore epididymis
Y
A2
$333.00
23.5310
$1,001.08
$500.0254900
Fusion of spermatic ducts
Y
A2
$630.00
23.5310
$1,001.08
$722.7754901
Fusion of spermatic ducts
Y
A2
$630.00
23.5310
$1,001.08
$722.7755000
Drainage of hydrocele
Y
P3

1.5772
$67.10
$67.1055040
Removal of hydrocele
Y
A2
$510.00
29.2182
$1,243.03
$693.2655041
Removal of hydroceles
Y
A2
$717.00
29.2182
$1,243.03
$848.5155060
Repair of hydrocele
Y
A2
$630.00
23.5310
$1,001.08
$722.7755100
Drainage of scrotum abscess
Y
A2
$333.00
11.1535
$474.50
$368.3855110
Explore scrotum
Y
A2
$446.00
23.5310
$1,001.08
$584.7755120
Removal of scrotum lesion
Y
A2
$446.00
23.5310
$1,001.08
$584.7755150
Removal of scrotum
Y
A2
$333.00
23.5310
$1,001.08
$500.0255175
Revision of scrotum
Y
A2
$333.00
23.5310
$1,001.08
$500.0255180
Revision of scrotum
Y
A2
$446.00
23.5310
$1,001.08
$584.7755200
Incision of sperm duct
Y
A2
$446.00
23.5310
$1,001.08
$584.7755250
Removal of sperm duct(s)
Y
A2
$446.00
23.5310
$1,001.08
$584.7755300
Prepare, sperm duct x-ray

N1( print page 42592)55400
Repair of sperm duct
Y
A2
$333.00
23.5310
$1,001.08
$500.0255450
Ligation of sperm duct
Y
P3

5.2227
$222.19
$222.1955500
Removal of hydrocele
Y
A2
$510.00
23.5310
$1,001.08
$632.7755520
Removal of sperm cord lesion
Y
A2
$630.00
23.5310
$1,001.08
$722.7755530
Revise spermatic cord veins
Y
A2
$630.00
23.5310
$1,001.08
$722.7755535
Revise spermatic cord veins
Y
A2
$630.00
29.2182
$1,243.03
$783.2655540
Revise hernia & sperm veins
Y
A2
$717.00
29.2182
$1,243.03
$848.5155550
Laparo ligate spermatic vein
Y
A2
$1,339.00
43.5488
$1,852.70
$1,467.4355600
Incise sperm duct pouch
Y
R2

23.5310
$1,001.08
$1,001.0855680
Remove sperm pouch lesion
Y
A2
$333.00
23.5310
$1,001.08
$500.0255700
Biopsy of prostate
Y
A2
$345.83
5.6262
$239.36
$319.2155705
Biopsy of prostate
Y
A2
$345.83
5.6262
$239.36
$319.2155720
Drainage of prostate abscess
Y
A2
$333.00
23.8700
$1,015.50
$503.6355725
Drainage of prostate abscess
Y
A2
$446.00
23.8700
$1,015.50
$588.3855860
Surgical exposure, prostate
Y
G2

18.1679
$772.92
$772.9255870
Electroejaculation
Y
P3

1.6094
$68.47
$68.4755873
Cryoablate prostate
Y
H8
$1,339.00
137.5639
$5,852.38
$5,252.7455875
Transperi needle place, pros
Y
A2
$1,339.00
34.9261
$1,485.86
$1,375.7255876 *
Place rt device/marker, pros
Y
P3

1.6416
$69.84
$69.8456405
I & D of vulva/perineum
Y
P3

1.0058
$42.79
$42.7956420
Drainage of gland abscess
Y
P2

1.2900
$54.88
$54.8856440
Surgery for vulva lesion
Y
A2
$446.00
20.5081
$872.48
$552.6256441
Lysis of labial lesion(s)
Y
A2
$333.00
14.8489
$631.72
$407.6856442
Hymenotomy
Y
A2
$333.00
14.8489
$631.72
$407.6856501
Destroy, vulva lesions, sim
Y
P3

1.3680
$58.20
$58.2056515
Destroy vulva lesion/s compl
Y
A2
$510.00
20.4276
$869.05
$599.7656605
Biopsy of vulva/perineum
Y
P3

0.7966
$33.89
$33.8956606
Biopsy of vulva/perineum
Y
P3

0.3460
$14.72
$14.7256620
Partial removal of vulva
Y
A2
$717.00
28.5095
$1,212.88
$840.9756625
Complete removal of vulva
Y
A2
$995.00
28.5095
$1,212.88
$1,049.4756700
Partial removal of hymen
Y
A2
$333.00
20.5081
$872.48
$467.8756740
Remove vagina gland lesion
Y
A2
$510.00
20.5081
$872.48
$600.6256800
Repair of vagina
Y
A2
$510.00
20.5081
$872.48
$600.6256805
Repair clitoris
Y
G2

14.8489
$631.72
$631.7256810
Repair of perineum
Y
A2
$717.00
20.5081
$872.48
$755.8756820
Exam of vulva w/scope
Y
P3

1.0058
$42.79
$42.7956821
Exam/biopsy of vulva w/scope
Y
P3

1.3116
$55.80
$55.8057000
Exploration of vagina
Y
A2
$333.00
14.8489
$631.72
$407.6857010
Drainage of pelvic abscess
Y
A2
$446.00
14.8489
$631.72
$492.4357020
Drainage of pelvic fluid
Y
A2
$409.33
6.6592
$283.30
$377.8257022
I & d vaginal hematoma, pp
Y
G2

11.1535
$474.50
$474.5057023
I & d vag hematoma, non-ob
Y
A2
$333.00
17.5086
$744.87
$435.9757061
Destroy vag lesions, simple
Y
P3

1.2634
$53.75
$53.7557065
Destroy vag lesions, complex
Y
A2
$333.00
20.5081
$872.48
$467.8757100
Biopsy of vagina
Y
P3

0.8048
$34.24
$34.2457105
Biopsy of vagina
Y
A2
$446.00
20.5081
$872.48
$552.6257130
Remove vagina lesion
Y
A2
$446.00
20.5081
$872.48
$552.6257135
Remove vagina lesion
Y
A2
$446.00
20.5081
$872.48
$552.6257150
Treat vagina infection
Y
P2

0.1468
$6.25
$6.2557155
Insert uteri tandems/ovoids
Y
A2
$409.33
6.6592
$283.30
$377.8257160
Insert pessary/other device
Y
P3

0.8208
$34.92
$34.9257170
Fitting of diaphragm/cap
Y
P2

0.1468
$6.25
$6.2557180
Treat vaginal bleeding
Y
A2
$178.05
2.8966
$123.23
$164.3557200
Repair of vagina
Y
A2
$333.00
20.5081
$872.48
$467.8757210
Repair vagina/perineum
Y
A2
$446.00
20.5081
$872.48
$552.6257220
Revision of urethra
Y
A2
$510.00
42.9896
$1,828.91
$839.7357230
Repair of urethral lesion
Y
A2
$510.00
28.5095
$1,212.88
$685.7257240
Repair bladder & vagina
Y
A2
$717.00
28.5095
$1,212.88
$840.9757250
Repair rectum & vagina
Y
A2
$717.00
28.5095
$1,212.88
$840.9757260
Repair of vagina
Y
A2
$717.00
28.5095
$1,212.88
$840.9757265
Extensive repair of vagina
Y
A2
$995.00
42.9896
$1,828.91
$1,203.4857267
Insert mesh/pelvic flr addon
Y
A2
$995.00
28.5095
$1,212.88
$1,049.4757268
Repair of bowel bulge
Y
A2
$510.00
28.5095
$1,212.88
$685.72( print page 42593)57287
Revise/remove sling repair
Y
G2

28.5095
$1,212.88
$1,212.8857288
Repair bladder defect
Y
A2
$717.00
42.9896
$1,828.91
$994.9857289
Repair bladder & vagina
Y
A2
$717.00
28.5095
$1,212.88
$840.9757291
Construction of vagina
Y
A2
$717.00
28.5095
$1,212.88
$840.9757300
Repair rectum-vagina fistula
Y
A2
$510.00
28.5095
$1,212.88
$685.7257320
Repair bladder-vagina lesion
Y
G2

28.5095
$1,212.88
$1,212.8857400
Dilation of vagina
Y
A2
$446.00
20.5081
$872.48
$552.6257410
Pelvic examination
Y
A2
$446.00
14.8489
$631.72
$492.4357415
Remove vaginal foreign body
Y
A2
$446.00
20.5081
$872.48
$552.6257420
Exam of vagina w/scope
Y
P3

1.0380
$44.16
$44.1657421
Exam/biopsy of vag w/scope
Y
P3

1.3842
$58.89
$58.8957452
Exam of cervix w/scope
Y
P3

0.9818
$41.77
$41.7757454
Bx/curett of cervix w/scope
Y
P3

1.2232
$52.04
$52.0457455
Biopsy of cervix w/scope
Y
P3

1.2876
$54.78
$54.7857456
Endocerv curettage w/scope
Y
P3

1.2474
$53.07
$53.0757460
Bx of cervix w/scope, leep
Y
P3

4.0639
$172.89
$172.8957461
Conz of cervix w/scope, leep
Y
P3

4.2811
$182.13
$182.1357500
Biopsy of cervix
Y
P3

1.8186
$77.37
$77.3757505
Endocervical curettage
Y
P3

1.1104
$47.24
$47.2457510
Cauterization of cervix
Y
P3

1.1508
$48.96
$48.9657511
Cryocautery of cervix
Y
P2

1.2900
$54.88
$54.8857513
Laser surgery of cervix
Y
A2
$446.00
14.8489
$631.72
$492.4357520
Conization of cervix
Y
A2
$446.00
20.5081
$872.48
$552.6257522
Conization of cervix
Y
A2
$446.00
28.5095
$1,212.88
$637.7257530
Removal of cervix
Y
A2
$510.00
28.5095
$1,212.88
$685.7257550
Removal of residual cervix
Y
A2
$510.00
28.5095
$1,212.88
$685.7257556
Remove cervix, repair bowel
Y
A2
$717.00
42.9896
$1,828.91
$994.9857558
D&c of cervical stump
Y
A2
$510.00
17.7499
$755.13
$571.2857700
Revision of cervix
Y
A2
$333.00
20.5081
$872.48
$467.8757720
Revision of cervix
Y
A2
$510.00
20.5081
$872.48
$600.6257800
Dilation of cervical canal
Y
P3

0.5874
$24.99
$24.9958100
Biopsy of uterus lining
Y
P3

0.9818
$41.77
$41.7758110 *
Bx done w/colposcopy add-on
Y
P3

0.3782
$16.09
$16.0958120
Dilation and curettage
Y
A2
$446.00
17.7499
$755.13
$523.2858145
Myomectomy vag method
Y
A2
$717.00
28.5095
$1,212.88
$840.9758301
Remove intrauterine device
Y
P3

0.9496
$40.40
$40.4058321
Artificial insemination
Y
P3

0.8450
$35.95
$35.9558322
Artificial insemination
Y
P3

0.9012
$38.34
$38.3458323
Sperm washing
Y
P3

0.2736
$11.64
$11.6458340
Catheter for hysterography

N158345
Reopen fallopian tube
Y
R2

14.8489
$631.72
$631.7258346
Insert heyman uteri capsule
Y
A2
$446.00
14.8489
$631.72
$492.4358350
Reopen fallopian tube
Y
A2
$510.00
28.5095
$1,212.88
$685.7258353
Endometr ablate, thermal
Y
A2
$995.00
28.5095
$1,212.88
$1,049.4758356
Endometrial cryoablation
Y
P3

41.9827
$1,786.07
$1,786.0758545
Laparoscopic myomectomy
Y
A2
$1,339.00
32.1241
$1,366.66
$1,345.9258546
Laparo-myomectomy, complex
Y
A2
$1,339.00
43.5488
$1,852.70
$1,467.4358550
Laparo-asst vag hysterectomy
Y
A2
$1,339.00
70.5066
$2,999.56
$1,754.1458552
Laparo-vag hyst incl t/o
Y
G2

43.5488
$1,852.70
$1,852.7058555
Hysteroscopy, dx, sep proc
Y
A2
$333.00
21.3586
$908.66
$476.9258558
Hysteroscopy, biopsy
Y
A2
$510.00
21.3586
$908.66
$609.6758559
Hysteroscopy, lysis
Y
A2
$446.00
21.3586
$908.66
$561.6758560
Hysteroscopy, resect septum
Y
A2
$510.00
34.0155
$1,447.12
$744.2858561
Hysteroscopy, remove myoma
Y
A2
$510.00
34.0155
$1,447.12
$744.2858562
Hysteroscopy, remove fb
Y
A2
$510.00
21.3586
$908.66
$609.6758563
Hysteroscopy, ablation
Y
A2
$1,339.00
34.0155
$1,447.12
$1,366.0358565
Hysteroscopy, sterilization
Y
A2
$1,339.00
42.9896
$1,828.91
$1,461.4858600
Division of fallopian tube
Y
G2

28.5095
$1,212.88
$1,212.8858615
Occlude fallopian tube(s)
Y
G2

20.5081
$872.48
$872.4858660
Laparoscopy, lysis
Y
A2
$717.00
43.5488
$1,852.70
$1,000.9358661
Laparoscopy, remove adnexa
Y
A2
$717.00
43.5488
$1,852.70
$1,000.9358662
Laparoscopy, excise lesions
Y
A2
$717.00
43.5488
$1,852.70
$1,000.9358670
Laparoscopy, tubal cautery
Y
A2
$510.00
43.5488
$1,852.70
$845.68( print page 42594)58671
Laparoscopy, tubal block
Y
A2
$510.00
43.5488
$1,852.70
$845.6858672
Laparoscopy, fimbrioplasty
Y
A2
$717.00
43.5488
$1,852.70
$1,000.9358673
Laparoscopy, salpingostomy
Y
A2
$717.00
43.5488
$1,852.70
$1,000.9358800
Drainage of ovarian cyst(s)
Y
A2
$510.00
14.8489
$631.72
$540.4358820
Drain ovary abscess, open
Y
A2
$510.00
28.5095
$1,212.88
$685.7258900
Biopsy of ovary(s)
Y
A2
$510.00
14.8489
$631.72
$540.4358970
Retrieval of oocyte
Y
A2
$245.92
4.0007
$170.20
$226.9958974
Transfer of embryo
Y
A2
$245.92
4.0007
$170.20
$226.9958976
Transfer of embryo
Y
A2
$245.92
4.0007
$170.20
$226.9959000
Amniocentesis, diagnostic
Y
P2

1.4222
$60.50
$60.5059001
Amniocentesis, therapeutic
Y
R2

6.6592
$283.30
$283.3059012
Fetal cord puncture, prenatal
Y
G2

1.4222
$60.50
$60.5059015
Chorion biopsy
Y
P3

1.1910
$50.67
$50.6759020
Fetal contract stress test
Y
P3

0.5632
$23.96
$23.9659025
Fetal non-stress test
Y
P3

0.2816
$11.98
$11.9859070
Transabdom amnioinfus w/us
Y
G2

1.4222
$60.50
$60.5059072
Umbilical cord occlud w/us
Y
G2

1.4222
$60.50
$60.5059076
Fetal shunt placement, w/us
Y
G2

1.4222
$60.50
$60.5059100
Remove uterus lesion
Y
R2

28.5095
$1,212.88
$1,212.8859150
Treat ectopic pregnancy
Y
G2

43.5488
$1,852.70
$1,852.7059151
Treat ectopic pregnancy
Y
G2

43.5488
$1,852.70
$1,852.7059160
D& c after delivery
Y
A2
$510.00
17.7499
$755.13
$571.2859200
Insert cervical dilator
Y
P3

0.8530
$36.29
$36.2959300
Episiotomy or vaginal repair
Y
P3

1.7542
$74.63
$74.6359320
Revision of cervix
Y
A2
$333.00
20.5081
$872.48
$467.8759412
Antepartum manipulation
Y
G2

2.3864
$101.52
$101.5259414
Deliver placenta
Y
G2

14.8489
$631.72
$631.7259812
Treatment of miscarriage
Y
A2
$717.00
18.5201
$787.90
$734.7359820
Care of miscarriage
Y
A2
$717.00
18.5201
$787.90
$734.7359821
Treatment of miscarriage
Y
A2
$717.00
18.5201
$787.90
$734.7359840
Abortion
Y
A2
$717.00
16.9328
$720.37
$717.8459841
Abortion
Y
A2
$717.00
16.9328
$720.37
$717.8459866
Abortion (mpr)
Y
G2

1.4222
$60.50
$60.5059870
Evacuate mole of uterus
Y
A2
$717.00
18.5201
$787.90
$734.7359871
Remove cerclage suture
Y
A2
$717.00
20.5081
$872.48
$755.8760000
Drain thyroid/tongue cyst
Y
A2
$333.00
7.5511
$321.25
$330.0660001
Aspirate/inject thyriod cyst
Y
P3

1.3116
$55.80
$55.8060100
Biopsy of thyroid
Y
P3

1.0462
$44.51
$44.5160200
Remove thyroid lesion
Y
A2
$446.00
37.7224
$1,604.82
$735.7160280
Remove thyroid duct lesion
Y
A2
$630.00
37.7224
$1,604.82
$873.7160281
Remove thyroid duct lesion
Y
A2
$630.00
37.7224
$1,604.82
$873.7161000
Remove cranial cavity fluid
Y
R2

2.9907
$127.23
$127.2361001
Remove cranial cavity fluid
Y
R2

2.9907
$127.23
$127.2361020
Remove brain cavity fluid
Y
A2
$183.83
2.9907
$127.23
$169.6861026
Injection into brain canal
Y
A2
$183.83
2.9907
$127.23
$169.6861050
Remove brain canal fluid
Y
A2
$183.83
2.9907
$127.23
$169.6861055
Injection into brain canal
Y
A2
$183.83
2.9907
$127.23
$169.6861070
Brain canal shunt procedure
Y
A2
$183.83
2.9907
$127.23
$169.6861215
Insert brain-fluid device
Y
A2
$510.00
47.0342
$2,000.98
$882.7561330
Decompress eye socket
Y
G2

38.1991
$1,625.10
$1,625.1061334
Explore orbit/remove object
Y
G2

38.1991
$1,625.10
$1,625.1061790
Treat trigeminal nerve
Y
A2
$510.00
17.8499
$759.39
$572.3561791
Treat trigeminal tract
Y
A2
$351.92
5.7253
$243.57
$324.8361795
Brain surgery using computer
N
A2
$302.04
4.9138
$209.05
$278.7961880
Revise/remove neuroelectrode
Y
G2

17.8334
$758.69
$758.6961885
Insrt/redo neurostim 1 array
N
H8
$446.00
260.1530
$11,067.69
$10,137.6661886
Implant neurostim arrays
Y
H8
$510.00
342.4747
$14,569.90
$13,649.3961888
Revise/remove neuroreceiver
Y
A2
$333.00
35.5702
$1,513.26
$628.0762194
Replace/irrigate catheter
Y
A2
$333.00
11.6575
$495.95
$373.7462225
Replace/irrigate catheter
Y
A2
$333.00
11.6575
$495.95
$373.7462230
Replace/revise brain shunt
Y
A2
$446.00
47.0342
$2,000.98
$834.7562252
Csf shunt reprogram
N
P3

1.0462
$44.51
$44.5162263
Epidural lysis mult sessions
Y
A2
$333.00
12.1702
$517.76
$379.19( print page 42595)62264
Epidural lysis on single day
Y
A2
$333.00
12.1702
$517.76
$379.1962268
Drain spinal cord cyst
Y
A2
$183.83
2.9907
$127.23
$169.6862269
Needle biopsy, spinal cord
Y
A2
$333.00
6.1384
$261.15
$315.0462270
Spinal fluid tap, diagnostic
Y
A2
$139.00
2.2614
$96.21
$128.3062272
Drain cerebro spinal fluid
Y
A2
$139.00
2.2614
$96.21
$128.3062273
Inject epidural patch
Y
A2
$333.00
5.7253
$243.57
$310.6462280
Treat spinal cord lesion
Y
A2
$333.00
6.3603
$270.59
$317.4062281
Treat spinal cord lesion
Y
A2
$333.00
6.3603
$270.59
$317.4062282
Treat spinal canal lesion
Y
A2
$333.00
6.3603
$270.59
$317.4062284
Injection for myelogram

N162287
Percutaneous diskectomy
Y
A2
$1,339.00
33.1520
$1,410.39
$1,356.8562290
Inject for spine disk x-ray

N162291
Inject for spine disk x-ray

N162292
Injection into disk lesion
Y
G2

2.9907
$127.23
$127.2362294
Injection into spinal artery
Y
A2
$183.83
2.9907
$127.23
$169.6862310
Inject spine c/t
Y
A2
$333.00
6.3603
$270.59
$317.4062311
Inject spine l/s (cd)
Y
A2
$333.00
6.3603
$270.59
$317.4062318
Inject spine w/cath, c/t
Y
A2
$333.00
6.3603
$270.59
$317.4062319
Inject spine w/cath l/s (cd)
Y
A2
$333.00
6.3603
$270.59
$317.4062350
Implant spinal canal cath
Y
A2
$446.00
30.8394
$1,312.00
$662.5062355
Remove spinal canal catheter
Y
A2
$446.00
12.1702
$517.76
$463.9462360
Insert spine infusion device
Y
A2
$446.00
112.6322
$4,791.71
$1,532.4362361
Implant spine infusion pump
Y
H8
$446.00
243.3568
$10,353.13
$9,589.6962362
Implant spine infusion pump
Y
H8
$446.00
243.3568
$10,353.13
$9,589.6962365
Remove spine infusion device
Y
A2
$446.00
33.1520
$1,410.39
$687.1062367
Analyze spine infusion pump
N
P3

0.4104
$17.46
$17.4662368
Analyze spine infusion pump
N
P3

0.5150
$21.91
$21.9163600
Remove spinal cord lesion
Y
A2
$446.00
17.8499
$759.39
$524.3563610
Stimulation of spinal cord
Y
A2
$333.00
17.8499
$759.39
$439.6063615
Remove lesion of spinal cord
Y
R2

17.8499
$759.39
$759.3963650
Implant neuroelectrodes
N
H8
$446.00
71.6329
$3,047.48
$2,552.7663655
Implant neuroelectrodes
N
J8

109.1028
$4,641.56
$4,641.5663660
Revise/remove neuroelectrode
Y
A2
$333.00
17.8334
$758.69
$439.4263685
Insrt/redo spine n generator
Y
H8
$446.00
251.0862
$10,681.96
$9,721.2563688
Revise/remove neuroreceiver
Y
A2
$333.00
35.5702
$1,513.26
$628.0763744
Revision of spinal shunt
Y
A2
$510.00
39.2633
$1,670.38
$800.1063746
Removal of spinal shunt
Y
A2
$446.00
10.9918
$467.62
$451.4164400
Nblock inj, trigeminal
Y
P3

1.3198
$56.15
$56.1564402
Nblock inj, facial
Y
P3

1.2312
$52.38
$52.3864405
Nblock inj, occipital
Y
P3

1.0542
$44.85
$44.8564408
Nblock inj, vagus
Y
P3

1.2232
$52.04
$52.0464410
Nblock inj, phrenic
Y
A2
$333.00
5.7253
$243.57
$310.6464412
Nblock inj, spinal accessor
Y
P3

1.8830
$80.11
$80.1164413
Nblock inj, cervical plexus
Y
P3

1.2554
$53.41
$53.4164415
Nblock inj, brachial plexus
Y
A2
$139.00
2.2614
$96.21
$128.3064416
Nblock cont infuse, b plex
Y
G2

2.2614
$96.21
$96.2164417
Nblock inj, axillary
Y
A2
$139.00
2.2614
$96.21
$128.3064418
Nblock inj, suprascapular
Y
P3

1.8026
$76.69
$76.6964420
Nblock inj, intercost, sng
Y
A2
$139.00
2.2614
$96.21
$128.3064421
Nblock inj, intercost, mlt
Y
A2
$333.00
5.7253
$243.57
$310.6464425
Nblock inj, ilio-ing/hypogi
Y
P3

1.1990
$51.01
$51.0164430
Nblock inj, pudendal
Y
A2
$139.00
2.2614
$96.21
$128.3064435
Nblock inj, paracervical
Y
P3

1.8026
$76.69
$76.6964445
Nblock inj, sciatic, sng
Y
P3

1.7382
$73.95
$73.9564446
Nblk inj, sciatic, cont inf
Y
G2

5.7253
$243.57
$243.5764447
Nblock inj fem, single
Y
G2

2.2614
$96.21
$96.2164450
Nblock, other peripheral
Y
P3

1.0140
$43.14
$43.1464470
Inj paravertebral c/t
Y
A2
$333.00
6.3603
$270.59
$317.4064472
Inj paravertebral c/t add-on
Y
A2
$333.00
5.7253
$243.57
$310.6464475
Inj paravertebral l/s
Y
A2
$333.00
6.3603
$270.59
$317.4064476
Inj paravertebral l/s add-on
Y
A2
$333.00
5.7253
$243.57
$310.6464479
Inj foramen epidural c/t
Y
A2
$333.00
6.3603
$270.59
$317.4064480
Inj foramen epidural add-on
Y
A2
$333.00
6.3603
$270.59
$317.40( print page 42596)64483
Inj foramen epidural l/s
Y
A2
$333.00
6.3603
$270.59
$317.4064484
Inj foramen epidural add-on
Y
A2
$333.00
6.3603
$270.59
$317.4064505
Nblock, spenopalatine gangl
Y
P3

0.9416
$40.06
$40.0664508
Nblock, carotid sinus s/p
Y
P3

2.0922
$89.01
$89.0164510
Nblock, stellate ganglion
Y
A2
$333.00
6.3603
$270.59
$317.4064517
Nblock inj, hypogas plxs
Y
A2
$139.00
2.2614
$96.21
$128.3064520
Nblock, lumbar/thoracic
Y
A2
$333.00
6.3603
$270.59
$317.4064530
Nblock inj, celiac pelus
Y
A2
$333.00
6.3603
$270.59
$317.4064553
Implant neuroelectrodes
N
H8
$333.00
307.2433
$13,071.05
$11,841.7964555
Implant neuroelectrodes
N
J8

71.6329
$3,047.48
$3,047.4864560
Implant neuroelectrodes
N
J8

71.6329
$3,047.48
$3,047.4864561
Implant neuroelectrodes
N
H8
$510.00
71.6329
$3,047.48
$2,600.7664565
Implant neuroelectrodes
N
J8

71.6329
$3,047.48
$3,047.4864573
Implant neuroelectrodes
N
H8
$333.00
307.2433
$13,071.05
$11,841.7964575
Implant neuroelectrodes
N
H8
$333.00
109.1028
$4,641.56
$3,818.3364577
Implant neuroelectrodes
N
H8
$333.00
109.1028
$4,641.56
$3,818.3364580
Implant neuroelectrodes
N
H8
$333.00
109.1028
$4,641.56
$3,818.3364581
Implant neuroelectrodes
N
H8
$510.00
109.1028
$4,641.56
$3,951.0864585
Revise/remove neuroelectrode
Y
A2
$333.00
17.8334
$758.69
$439.4264590
Insrt/redo pn/gastr stimul
Y
H8
$446.00
251.0862
$10,681.96
$9,721.2564595
Revise/rmv pn/gastr stimul
Y
A2
$333.00
35.5702
$1,513.26
$628.0764600
Injection treatment of nerve
Y
A2
$333.00
12.1702
$517.76
$379.1964605
Injection treatment of nerve
Y
A2
$333.00
12.1702
$517.76
$379.1964610
Injection treatment of nerve
Y
A2
$333.00
12.1702
$517.76
$379.1964612
Destroy nerve, face muscle
Y
P3

1.6579
$70.53
$70.5364613
Destroy nerve, neck muscle
Y
P3

1.7302
$73.61
$73.6164614
Destroy nerve, extrem musc
Y
P3

1.9474
$82.85
$82.8564620
Injection treatment of nerve
Y
A2
$333.00
12.1702
$517.76
$379.1964622
Destr paravertebrl nerve l/s
Y
A2
$333.00
12.1702
$517.76
$379.1964623
Destr paravertebral n add-on
Y
A2
$333.00
6.3603
$270.59
$317.4064626
Destr paravertebrl nerve c/t
Y
A2
$333.00
12.1702
$517.76
$379.1964627
Destr paravertebral n add-on
Y
A2
$333.00
6.3603
$270.59
$317.4064630
Injection treatment of nerve
Y
A2
$351.92
5.7253
$243.57
$324.8364640
Injection treatment of nerve
Y
P3

2.6716
$113.66
$113.6664650
Chemodenerv eccrine glands
Y
G2

2.2614
$96.21
$96.2164653
Chemodenerv eccrine glands
Y
G2

2.2614
$96.21
$96.2164680
Injection treatment of nerve
Y
A2
$390.95
6.3603
$270.59
$360.8664681
Injection treatment of nerve
Y
A2
$446.00
12.1702
$517.76
$463.9464702
Revise finger/toe nerve
Y
A2
$333.00
17.8499
$759.39
$439.6064704
Revise hand/foot nerve
Y
A2
$333.00
17.8499
$759.39
$439.6064708
Revise arm/leg nerve
Y
A2
$446.00
17.8499
$759.39
$524.3564712
Revision of sciatic nerve
Y
A2
$446.00
17.8499
$759.39
$524.3564713
Revision of arm nerve(s)
Y
A2
$446.00
17.8499
$759.39
$524.3564714
Revise low back nerve(s)
Y
A2
$446.00
17.8499
$759.39
$524.3564716
Revision of cranial nerve
Y
A2
$510.00
17.8499
$759.39
$572.3564718
Revise ulnar nerve at elbow
Y
A2
$446.00
17.8499
$759.39
$524.3564719
Revise ulnar nerve at wrist
Y
A2
$446.00
17.8499
$759.39
$524.3564721
Carpal tunnel surgery
Y
A2
$446.00
17.8499
$759.39
$524.3564722
Relieve pressure on nerve(s)
Y
A2
$333.00
17.8499
$759.39
$439.6064726
Release foot/toe nerve
Y
A2
$333.00
17.8499
$759.39
$439.6064727
Internal nerve revision
Y
A2
$333.00
17.8499
$759.39
$439.6064732
Incision of brow nerve
Y
A2
$446.00
17.8499
$759.39
$524.3564734
Incision of cheek nerve
Y
A2
$446.00
17.8499
$759.39
$524.3564736
Incision of chin nerve
Y
A2
$446.00
17.8499
$759.39
$524.3564738
Incision of jaw nerve
Y
A2
$446.00
17.8499
$759.39
$524.3564740
Incision of tongue nerve
Y
A2
$446.00
17.8499
$759.39
$524.3564742
Incision of facial nerve
Y
A2
$446.00
17.8499
$759.39
$524.3564744
Incise nerve, back of head
Y
A2
$446.00
17.8499
$759.39
$524.3564746
Incise diaphragm nerve
Y
A2
$446.00
17.8499
$759.39
$524.3564761
Incision of pelvis nerve
Y
G2

17.8499
$759.39
$759.3964763
Incise hip/thigh nerve
Y
G2

17.8499
$759.39
$759.3964766
Incise hip/thigh nerve
Y
G2

33.1520
$1,410.39
$1,410.3964771
Sever cranial nerve
Y
A2
$446.00
17.8499
$759.39
$524.35( print page 42597)64772
Incision of spinal nerve
Y
A2
$446.00
17.8499
$759.39
$524.3564774
Remove skin nerve lesion
Y
A2
$446.00
17.8499
$759.39
$524.3564776
Remove digit nerve lesion
Y
A2
$510.00
17.8499
$759.39
$572.3564778
Digit nerve surgery add-on
Y
A2
$446.00
17.8499
$759.39
$524.3564782
Remove limb nerve lesion
Y
A2
$510.00
17.8499
$759.39
$572.3564783
Limb nerve surgery add-on
Y
A2
$446.00
17.8499
$759.39
$524.3564784
Remove nerve lesion
Y
A2
$510.00
17.8499
$759.39
$572.3564786
Remove sciatic nerve lesion
Y
A2
$510.00
33.1520
$1,410.39
$735.1064787
Implant nerve end
Y
A2
$446.00
17.8499
$759.39
$524.3564788
Remove skin nerve lesion
Y
A2
$510.00
17.8499
$759.39
$572.3564790
Removal of nerve lesion
Y
A2
$510.00
17.8499
$759.39
$572.3564792
Removal of nerve lesion
Y
A2
$510.00
33.1520
$1,410.39
$735.1064795
Biopsy of nerve
Y
A2
$446.00
17.8499
$759.39
$524.3564802
Remove sympathetic nerves
Y
A2
$446.00
17.8499
$759.39
$524.3564820
Remove sympathetic nerves
Y
G2

17.8499
$759.39
$759.3964821
Remove sympathetic nerves
Y
A2
$630.00
25.8758
$1,100.83
$747.7164822
Remove sympathetic nerves
Y
G2

25.8758
$1,100.83
$1,100.8364823
Remove sympathetic nerves
Y
G2

25.8758
$1,100.83
$1,100.8364831
Repair of digit nerve
Y
A2
$630.00
33.1520
$1,410.39
$825.1064832
Repair nerve add-on
Y
A2
$333.00
33.1520
$1,410.39
$602.3564834
Repair of hand or foot nerve
Y
A2
$446.00
33.1520
$1,410.39
$687.1064835
Repair of hand or foot nerve
Y
A2
$510.00
33.1520
$1,410.39
$735.1064836
Repair of hand or foot nerve
Y
A2
$510.00
33.1520
$1,410.39
$735.1064837
Repair nerve add-on
Y
A2
$333.00
33.1520
$1,410.39
$602.3564840
Repair of leg nerve
Y
A2
$446.00
33.1520
$1,410.39
$687.1064856
Repair/transpose nerve
Y
A2
$446.00
33.1520
$1,410.39
$687.1064857
Repair arm/leg nerve
Y
A2
$446.00
33.1520
$1,410.39
$687.1064858
Repair sciatic nerve
Y
A2
$446.00
33.1520
$1,410.39
$687.1064859
Nerve surgery
Y
A2
$333.00
33.1520
$1,410.39
$602.3564861
Repair of arm nerves
Y
A2
$510.00
33.1520
$1,410.39
$735.1064862
Repair of low back nerves
Y
A2
$510.00
33.1520
$1,410.39
$735.1064864
Repair of facial nerve
Y
A2
$510.00
33.1520
$1,410.39
$735.1064865
Repair of facial nerve
Y
A2
$630.00
33.1520
$1,410.39
$825.1064870
Fusion of facial/other nerve
Y
A2
$630.00
33.1520
$1,410.39
$825.1064872
Subsequent repair of nerve
Y
A2
$446.00
33.1520
$1,410.39
$687.1064874
Repair & revise nerve add-on
Y
A2
$510.00
33.1520
$1,410.39
$735.1064876
Repair nerve/shorten bone
Y
A2
$510.00
33.1520
$1,410.39
$735.1064885
Nerve graft, head or neck
Y
A2
$446.00
33.1520
$1,410.39
$687.1064886
Nerve graft, head or neck
Y
A2
$446.00
33.1520
$1,410.39
$687.1064890
Nerve graft, hand or foot
Y
A2
$446.00
33.1520
$1,410.39
$687.1064891
Nerve graft, hand or foot
Y
A2
$446.00
33.1520
$1,410.39
$687.1064892
Nerve graft, arm or leg
Y
A2
$446.00
33.1520
$1,410.39
$687.1064893
Nerve graft, arm or leg
Y
A2
$446.00
33.1520
$1,410.39
$687.1064895
Nerve graft, hand or foot
Y
A2
$510.00
33.1520
$1,410.39
$735.1064896
Nerve graft, hand or foot
Y
A2
$510.00
33.1520
$1,410.39
$735.1064897
Nerve graft, arm or leg
Y
A2
$510.00
33.1520
$1,410.39
$735.1064898
Nerve graft, arm or leg
Y
A2
$510.00
33.1520
$1,410.39
$735.1064901
Nerve graft add-on
Y
A2
$446.00
33.1520
$1,410.39
$687.1064902
Nerve graft add-on
Y
A2
$446.00
33.1520
$1,410.39
$687.1064905
Nerve pedicle transfer
Y
A2
$446.00
33.1520
$1,410.39
$687.1064907
Nerve pedicle transfer
Y
A2
$333.00
33.1520
$1,410.39
$602.3565091
Revise eye
Y
A2
$510.00
35.2292
$1,498.76
$757.1965093
Revise eye with implant
Y
A2
$510.00
35.2292
$1,498.76
$757.1965101
Removal of eye
Y
A2
$510.00
35.2292
$1,498.76
$757.1965103
Remove eye/insert implant
Y
A2
$510.00
35.2292
$1,498.76
$757.1965105
Remove eye/attach implant
Y
A2
$630.00
35.2292
$1,498.76
$847.1965110
Removal of eye
Y
A2
$717.00
35.2292
$1,498.76
$912.4465112
Remove eye/revise socket
Y
A2
$995.00
35.2292
$1,498.76
$1,120.9465114
Remove eye/revise socket
Y
A2
$995.00
35.2292
$1,498.76
$1,120.9465125
Revise ocular implant
Y
G2

17.1243
$728.52
$728.5265130
Insert ocular implant
Y
A2
$510.00
25.2550
$1,074.42
$651.1165135
Insert ocular implant
Y
A2
$446.00
25.2550
$1,074.42
$603.1165140
Attach ocular implant
Y
A2
$510.00
35.2292
$1,498.76
$757.19( print page 42598)65150
Revise ocular implant
Y
A2
$446.00
25.2550
$1,074.42
$603.1165155
Reinsert ocular implant
Y
A2
$510.00
35.2292
$1,498.76
$757.1965175
Removal of ocular implant
Y
A2
$333.00
17.1243
$728.52
$431.8865205
Remove foreign body from eye
N
P3

0.4990
$21.23
$21.2365210
Remove foreign body from eye
N
P3

0.6196
$26.36
$26.3665220
Remove foreign body from eye
N
G2

1.1607
$49.38
$49.3865222
Remove foreign body from eye
N
P3

0.6840
$29.10
$29.1065235
Remove foreign body from eye
Y
A2
$446.00
15.2259
$647.76
$496.4465260
Remove foreign body from eye
Y
A2
$510.00
16.5239
$702.98
$558.2565265
Remove foreign body from eye
Y
A2
$630.00
27.6020
$1,174.27
$766.0765270
Repair of eye wound
Y
A2
$446.00
17.1243
$728.52
$516.6365272
Repair of eye wound
Y
A2
$446.00
22.9970
$978.36
$579.0965275
Repair of eye wound
Y
A2
$630.00
22.9970
$978.36
$717.0965280
Repair of eye wound
Y
A2
$630.00
16.5239
$702.98
$648.2565285
Repair of eye wound
Y
A2
$630.00
37.4290
$1,592.34
$870.5965286
Repair of eye wound
Y
P2

6.0673
$258.12
$258.1265290
Repair of eye socket wound
Y
A2
$510.00
21.2801
$905.32
$608.8365400
Removal of eye lesion
Y
A2
$333.00
15.2259
$647.76
$411.6965410
Biopsy of cornea
Y
A2
$446.00
15.2259
$647.76
$496.4465420
Removal of eye lesion
Y
A2
$446.00
15.2259
$647.76
$496.4465426
Removal of eye lesion
Y
A2
$717.00
22.9970
$978.36
$782.3465430
Corneal smear
N
P3

0.9736
$41.42
$41.4265435
Curette/treat cornea
Y
P3

0.7564
$32.18
$32.1865436
Curette/treat cornea
Y
G2

15.2259
$647.76
$647.7665450
Treatment of corneal lesion
N
G2

2.1451
$91.26
$91.2665600
Revision of cornea
Y
P3

3.8707
$164.67
$164.6765710
Corneal transplant
Y
A2
$995.00
38.2707
$1,628.15
$1,153.2965730
Corneal transplant
Y
A2
$995.00
38.2707
$1,628.15
$1,153.2965750
Corneal transplant
Y
A2
$995.00
38.2707
$1,628.15
$1,153.2965755
Corneal transplant
Y
A2
$995.00
38.2707
$1,628.15
$1,153.2965770
Revise cornea with implant
Y
A2
$995.00
51.9894
$2,211.78
$1,299.2065772
Correction of astigmatism
Y
A2
$630.00
15.2259
$647.76
$634.4465775
Correction of astigmatism
Y
A2
$630.00
15.2259
$647.76
$634.4465780
Ocular reconst, transplant
Y
A2
$717.00
38.2707
$1,628.15
$944.7965781
Ocular reconst, transplant
Y
A2
$717.00
38.2707
$1,628.15
$944.7965782
Ocular reconst, transplant
Y
A2
$717.00
38.2707
$1,628.15
$944.7965800
Drainage of eye
Y
A2
$333.00
15.2259
$647.76
$411.6965805
Drainage of eye
Y
A2
$333.00
15.2259
$647.76
$411.6965810
Drainage of eye
Y
A2
$510.00
22.9970
$978.36
$627.0965815
Drainage of eye
Y
A2
$446.00
22.9970
$978.36
$579.0965820
Relieve inner eye pressure
Y
A2
$333.00
6.0673
$258.12
$314.2865850
Incision of eye
Y
A2
$630.00
22.9970
$978.36
$717.0965855
Laser surgery of eye
Y
P3

3.1947
$135.91
$135.9165860
Incise inner eye adhesions
Y
P3

2.9855
$127.01
$127.0165865
Incise inner eye adhesions
Y
A2
$333.00
15.2259
$647.76
$411.6965870
Incise inner eye adhesions
Y
A2
$630.00
22.9970
$978.36
$717.0965875
Incise inner eye adhesions
Y
A2
$630.00
22.9970
$978.36
$717.0965880
Incise inner eye adhesions
Y
A2
$630.00
15.2259
$647.76
$634.4465900
Remove eye lesion
Y
A2
$717.00
15.2259
$647.76
$699.6965920
Remove implant of eye
Y
A2
$995.00
22.9970
$978.36
$990.8465930
Remove blood clot from eye
Y
A2
$717.00
22.9970
$978.36
$782.3466020
Injection treatment of eye
Y
A2
$333.00
15.2259
$647.76
$411.6966030
Injection treatment of eye
Y
A2
$333.00
6.0673
$258.12
$314.2866130
Remove eye lesion
Y
A2
$995.00
22.9970
$978.36
$990.8466150
Glaucoma surgery
Y
A2
$630.00
22.9970
$978.36
$717.0966155
Glaucoma surgery
Y
A2
$630.00
22.9970
$978.36
$717.0966160
Glaucoma surgery
Y
A2
$446.00
22.9970
$978.36
$579.0966165
Glaucoma surgery
Y
A2
$630.00
22.9970
$978.36
$717.0966170
Glaucoma surgery
Y
A2
$630.00
22.9970
$978.36
$717.0966172
Incision of eye
Y
A2
$630.00
22.9970
$978.36
$717.0966180
Implant eye shunt
Y
A2
$717.00
37.8967
$1,612.24
$940.8166185
Revise eye shunt
Y
A2
$446.00
37.8967
$1,612.24
$737.5666220
Repair eye lesion
Y
A2
$510.00
37.4290
$1,592.34
$780.59( print page 42599)66225
Repair/graft eye lesion
Y
A2
$630.00
37.8967
$1,612.24
$875.5666250
Follow-up surgery of eye
Y
A2
$446.00
15.2259
$647.76
$496.4466500
Incision of iris
Y
A2
$333.00
6.0673
$258.12
$314.2866505
Incision of iris
Y
A2
$333.00
6.0673
$258.12
$314.2866600
Remove iris and lesion
Y
A2
$510.00
22.9970
$978.36
$627.0966605
Removal of iris
Y
A2
$510.00
22.9970
$978.36
$627.0966625
Removal of iris
Y
A2
$372.94
6.0673
$258.12
$344.2466630
Removal of iris
Y
A2
$510.00
22.9970
$978.36
$627.0966635
Removal of iris
Y
A2
$510.00
22.9970
$978.36
$627.0966680
Repair iris & ciliary body
Y
A2
$510.00
22.9970
$978.36
$627.0966682
Repair iris & ciliary body
Y
A2
$446.00
22.9970
$978.36
$579.0966700
Destruction, ciliary body
Y
A2
$446.00
15.2259
$647.76
$496.4466710
Ciliary transsleral therapy
Y
A2
$446.00
15.2259
$647.76
$496.4466711
Ciliary endoscopic ablation
Y
A2
$446.00
15.2259
$647.76
$496.4466720
Destruction, ciliary body
Y
A2
$446.00
15.2259
$647.76
$496.4466740
Destruction, ciliary body
Y
A2
$446.00
22.9970
$978.36
$579.0966761
Revision of iris
Y
P3

4.3375
$184.53
$184.5366762
Revision of iris
Y
P3

4.4019
$187.27
$187.2766770
Removal of inner eye lesion
Y
P3

4.7639
$202.67
$202.6766820
Incision, secondary cataract
Y
G2

6.0673
$258.12
$258.1266821
After cataract laser surgery
Y
A2
$312.50
5.0839
$216.28
$288.4566825
Reposition intraocular lens
Y
A2
$630.00
22.9970
$978.36
$717.0966830
Removal of lens lesion
Y
A2
$372.94
6.0673
$258.12
$344.2466840
Removal of lens material
Y
A2
$630.00
14.8702
$632.62
$630.6666850
Removal of lens material
Y
A2
$995.00
29.2281
$1,243.45
$1,057.1166852
Removal of lens material
Y
A2
$630.00
29.2281
$1,243.45
$783.3666920
Extraction of lens
Y
A2
$630.00
29.2281
$1,243.45
$783.3666930
Extraction of lens
Y
A2
$717.00
29.2281
$1,243.45
$848.6166940
Extraction of lens
Y
A2
$717.00
14.8702
$632.62
$695.9166982
Cataract surgery, complex
Y
A2
$973.00
23.6313
$1,005.35
$981.0966983
Cataract surg w/iol, 1 stage
Y
A2
$973.00
23.6313
$1,005.35
$981.0966984
Cataract surg w/iol, 1 stage
Y
A2
$973.00
23.6313
$1,005.35
$981.0966985
Insert lens prosthesis
Y
A2
$826.00
23.6313
$1,005.35
$870.8466986
Exchange lens prosthesis
Y
A2
$826.00
23.6313
$1,005.35
$870.8466990
Ophthalmic endoscope add-on

N167005
Partial removal of eye fluid
Y
A2
$630.00
27.6020
$1,174.27
$766.0767010
Partial removal of eye fluid
Y
A2
$630.00
27.6020
$1,174.27
$766.0767015
Release of eye fluid
Y
A2
$333.00
27.6020
$1,174.27
$543.3267025
Replace eye fluid
Y
A2
$333.00
27.6020
$1,174.27
$543.3267027
Implant eye drug system
Y
A2
$630.00
37.4290
$1,592.34
$870.5967028
Injection eye drug
Y
P3

1.9876
$84.56
$84.5667030
Incise inner eye strands
Y
A2
$333.00
16.5239
$702.98
$425.5067031
Laser surgery, eye strands
Y
A2
$312.50
5.0839
$216.28
$288.4567036
Removal of inner eye fluid
Y
A2
$630.00
37.4290
$1,592.34
$870.5967038
Strip retinal membrane
Y
A2
$717.00
37.4290
$1,592.34
$935.8467039
Laser treatment of retina
Y
A2
$995.00
37.4290
$1,592.34
$1,144.3467040
Laser treatment of retina
Y
A2
$995.00
37.4290
$1,592.34
$1,144.3467101
Repair detached retina
Y
P3

7.2104
$306.75
$306.7567105
Repair detached retina
Y
P2

5.0841
$216.29
$216.2967107
Repair detached retina
Y
A2
$717.00
37.4290
$1,592.34
$935.8467108
Repair detached retina
Y
A2
$995.00
37.4290
$1,592.34
$1,144.3467110
Repair detached retina
Y
P3

7.8462
$333.80
$333.8067112
Rerepair detached retina
Y
A2
$995.00
37.4290
$1,592.34
$1,144.3467115
Release encircling material
Y
A2
$446.00
16.5239
$702.98
$510.2567120
Remove eye implant material
Y
A2
$446.00
16.5239
$702.98
$510.2567121
Remove eye implant material
Y
A2
$446.00
27.6020
$1,174.27
$628.0767141
Treatment of retina
Y
A2
$241.77
3.9333
$167.33
$223.1667145
Treatment of retina
Y
P3

4.5387
$193.09
$193.0967208
Treatment of retinal lesion
Y
P3

4.8283
$205.41
$205.4167210
Treatment of retinal lesion
Y
P2

5.0841
$216.29
$216.2967218
Treatment of retinal lesion
Y
A2
$717.00
16.5239
$702.98
$713.5067220
Treatment of choroid lesion
Y
P2

3.9333
$167.33
$167.3367221
Ocular photodynamic ther
Y
P3

2.9695
$126.33
$126.33( print page 42600)67225
Eye photodynamic ther add-on
Y
P3

0.2012
$8.56
$8.5667227
Treatment of retinal lesion
Y
A2
$333.00
27.6020
$1,174.27
$543.3267228
Treatment of retinal lesion
Y
P2

5.0841
$216.29
$216.2967250
Reinforce eye wall
Y
A2
$510.00
17.1243
$728.52
$564.6367255
Reinforce/graft eye wall
Y
A2
$510.00
27.6020
$1,174.27
$676.0767311
Revise eye muscle
Y
A2
$510.00
21.2801
$905.32
$608.8367312
Revise two eye muscles
Y
A2
$630.00
21.2801
$905.32
$698.8367314
Revise eye muscle
Y
A2
$630.00
21.2801
$905.32
$698.8367316
Revise two eye muscles
Y
A2
$630.00
21.2801
$905.32
$698.8367318
Revise eye muscle(s)
Y
A2
$630.00
21.2801
$905.32
$698.8367320
Revise eye muscle(s) add-on
Y
A2
$630.00
21.2801
$905.32
$698.8367331
Eye surgery follow-up add-on
Y
A2
$630.00
21.2801
$905.32
$698.8367332
Rerevise eye muscles add-on
Y
A2
$630.00
21.2801
$905.32
$698.8367334
Revise eye muscle w/suture
Y
A2
$630.00
21.2801
$905.32
$698.8367335
Eye suture during surgery
Y
A2
$630.00
21.2801
$905.32
$698.8367340
Revise eye muscle add-on
Y
A2
$630.00
21.2801
$905.32
$698.8367343
Release eye tissue
Y
A2
$995.00
21.2801
$905.32
$972.5867345
Destroy nerve of eye muscle
Y
P3

1.9634
$83.53
$83.5367346
Biopsy, eye muscle
Y
A2
$333.00
14.3845
$611.96
$402.7467400
Explore/biopsy eye socket
Y
A2
$510.00
25.2550
$1,074.42
$651.1167405
Explore/drain eye socket
Y
A2
$630.00
25.2550
$1,074.42
$741.1167412
Explore/treat eye socket
Y
A2
$717.00
25.2550
$1,074.42
$806.3667413
Explore/treat eye socket
Y
A2
$717.00
25.2550
$1,074.42
$806.3667414
Explr/decompress eye socket
Y
G2

35.2292
$1,498.76
$1,498.7667415
Aspiration, orbital contents
Y
A2
$333.00
17.1243
$728.52
$431.8867420
Explore/treat eye socket
Y
A2
$717.00
35.2292
$1,498.76
$912.4467430
Explore/treat eye socket
Y
A2
$717.00
35.2292
$1,498.76
$912.4467440
Explore/drain eye socket
Y
A2
$717.00
35.2292
$1,498.76
$912.4467445
Explr/decompress eye socket
Y
A2
$717.00
35.2292
$1,498.76
$912.4467450
Explore/biopsy eye socket
Y
A2
$717.00
35.2292
$1,498.76
$912.4467500
Inject/treat eye socket
N
G2

2.1451
$91.26
$91.2667505
Inject/treat eye socket
Y
G2

2.8954
$123.18
$123.1867515
Inject/treat eye socket
Y
P3

0.5714
$24.31
$24.3167550
Insert eye socket implant
Y
A2
$630.00
35.2292
$1,498.76
$847.1967560
Revise eye socket implant
Y
A2
$446.00
25.2550
$1,074.42
$603.1167570
Decompress optic nerve
Y
A2
$630.00
35.2292
$1,498.76
$847.1967700
Drainage of eyelid abscess
Y
P2

2.8954
$123.18
$123.1867710
Incision of eyelid
Y
P3

3.6777
$156.46
$156.4667715
Incision of eyelid fold
Y
A2
$333.00
17.1243
$728.52
$431.8867800
Remove eyelid lesion
Y
P3

1.2312
$52.38
$52.3867801
Remove eyelid lesions
Y
P3

1.4888
$63.34
$63.3467805
Remove eyelid lesions
Y
P3

1.9232
$81.82
$81.8267808
Remove eyelid lesion(s)
Y
A2
$446.00
17.1243
$728.52
$516.6367810
Biopsy of eyelid
Y
P2

2.8954
$123.18
$123.1867820
Revise eyelashes
N
P3

0.4264
$18.14
$18.1467825
Revise eyelashes
Y
P3

1.2794
$54.43
$54.4367830
Revise eyelashes
Y
A2
$446.00
7.2819
$309.79
$411.9567835
Revise eyelashes
Y
A2
$446.00
17.1243
$728.52
$516.6367840
Remove eyelid lesion
Y
P3

3.8063
$161.93
$161.9367850
Treat eyelid lesion
Y
P3

2.6879
$114.35
$114.3567875
Closure of eyelid by suture
Y
G2

7.2819
$309.79
$309.7967880
Revision of eyelid
Y
A2
$510.00
15.2259
$647.76
$544.4467882
Revision of eyelid
Y
A2
$510.00
17.1243
$728.52
$564.6367900
Repair brow defect
Y
A2
$630.00
17.1243
$728.52
$654.6367901
Repair eyelid defect
Y
A2
$717.00
17.1243
$728.52
$719.8867902
Repair eyelid defect
Y
A2
$717.00
17.1243
$728.52
$719.8867903
Repair eyelid defect
Y
A2
$630.00
17.1243
$728.52
$654.6367904
Repair eyelid defect
Y
A2
$630.00
17.1243
$728.52
$654.6367906
Repair eyelid defect
Y
A2
$717.00
17.1243
$728.52
$719.8867908
Repair eyelid defect
Y
A2
$630.00
17.1243
$728.52
$654.6367909
Revise eyelid defect
Y
A2
$630.00
17.1243
$728.52
$654.6367911
Revise eyelid defect
Y
A2
$510.00
17.1243
$728.52
$564.6367912
Correction eyelid w/implant
Y
A2
$510.00
17.1243
$728.52
$564.63( print page 42601)67914
Repair eyelid defect
Y
A2
$510.00
17.1243
$728.52
$564.6367915
Repair eyelid defect
Y
P3

4.2329
$180.08
$180.0867916
Repair eyelid defect
Y
A2
$630.00
17.1243
$728.52
$654.6367917
Repair eyelid defect
Y
A2
$630.00
17.1243
$728.52
$654.6367921
Repair eyelid defect
Y
A2
$510.00
17.1243
$728.52
$564.6367922
Repair eyelid defect
Y
P3

4.1685
$177.34
$177.3467923
Repair eyelid defect
Y
A2
$630.00
17.1243
$728.52
$654.6367924
Repair eyelid defect
Y
A2
$630.00
17.1243
$728.52
$654.6367930
Repair eyelid wound
Y
P3

4.1121
$174.94
$174.9467935
Repair eyelid wound
Y
A2
$446.00
17.1243
$728.52
$516.6367938
Remove eyelid foreign body
N
P2

1.1607
$49.38
$49.3867950
Revision of eyelid
Y
A2
$446.00
17.1243
$728.52
$516.6367961
Revision of eyelid
Y
A2
$510.00
17.1243
$728.52
$564.6367966
Revision of eyelid
Y
A2
$510.00
17.1243
$728.52
$564.6367971
Reconstruction of eyelid
Y
A2
$510.00
25.2550
$1,074.42
$651.1167973
Reconstruction of eyelid
Y
A2
$510.00
25.2550
$1,074.42
$651.1167974
Reconstruction of eyelid
Y
A2
$510.00
25.2550
$1,074.42
$651.1167975
Reconstruction of eyelid
Y
A2
$510.00
17.1243
$728.52
$564.6368020
Incise/drain eyelid lining
Y
P3

1.0864
$46.22
$46.2268040
Treatment of eyelid lesions
N
P3

0.5392
$22.94
$22.9468100
Biopsy of eyelid lining
Y
P3

2.2775
$96.89
$96.8968110
Remove eyelid lining lesion
Y
P3

2.9131
$123.93
$123.9368115
Remove eyelid lining lesion
Y
A2
$446.00
17.1243
$728.52
$516.6368130
Remove eyelid lining lesion
Y
A2
$446.00
15.2259
$647.76
$496.4468135
Remove eyelid lining lesion
Y
P3

1.3922
$59.23
$59.2368200
Treat eyelid by injection
N
P3

0.4024
$17.12
$17.1268320
Revise/graft eyelid lining
Y
A2
$630.00
17.1243
$728.52
$654.6368325
Revise/graft eyelid lining
Y
A2
$630.00
25.2550
$1,074.42
$741.1168326
Revise/graft eyelid lining
Y
A2
$630.00
25.2550
$1,074.42
$741.1168328
Revise/graft eyelid lining
Y
A2
$630.00
25.2550
$1,074.42
$741.1168330
Revise eyelid lining
Y
A2
$630.00
22.9970
$978.36
$717.0968335
Revise/graft eyelid lining
Y
A2
$630.00
25.2550
$1,074.42
$741.1168340
Separate eyelid adhesions
Y
A2
$630.00
17.1243
$728.52
$654.6368360
Revise eyelid lining
Y
A2
$446.00
22.9970
$978.36
$579.0968362
Revise eyelid lining
Y
A2
$446.00
22.9970
$978.36
$579.0968371
Harvest eye tissue, alograft
Y
A2
$446.00
15.2259
$647.76
$496.4468400
Incise/drain tear gland
Y
P2

2.8954
$123.18
$123.1868420
Incise/drain tear sac
Y
P3

4.3777
$186.24
$186.2468440
Incise tear duct opening
Y
P3

1.3520
$57.52
$57.5268500
Removal of tear gland
Y
A2
$510.00
25.2550
$1,074.42
$651.1168505
Partial removal, tear gland
Y
A2
$510.00
25.2550
$1,074.42
$651.1168510
Biopsy of tear gland
Y
A2
$333.00
17.1243
$728.52
$431.8868520
Removal of tear sac
Y
A2
$510.00
25.2550
$1,074.42
$651.1168525
Biopsy of tear sac
Y
A2
$333.00
17.1243
$728.52
$431.8868530
Clearance of tear duct
Y
P3

5.5929
$237.94
$237.9468540
Remove tear gland lesion
Y
A2
$510.00
25.2550
$1,074.42
$651.1168550
Remove tear gland lesion
Y
A2
$510.00
25.2550
$1,074.42
$651.1168700
Repair tear ducts
Y
A2
$446.00
25.2550
$1,074.42
$603.1168705
Revise tear duct opening
Y
P2

2.8954
$123.18
$123.1868720
Create tear sac drain
Y
A2
$630.00
25.2550
$1,074.42
$741.1168745
Create tear duct drain
Y
A2
$630.00
25.2550
$1,074.42
$741.1168750
Create tear duct drain
Y
A2
$630.00
25.2550
$1,074.42
$741.1168760
Close tear duct opening
N
P2

2.1451
$91.26
$91.2668761
Close tear duct opening
N
P3

1.6658
$70.87
$70.8768770
Close tear system fistula
Y
A2
$630.00
17.1243
$728.52
$654.6368801
Dilate tear duct opening
N
P2

1.1607
$49.38
$49.3868810
Probe nasolacrimal duct
N
A2
$131.86
2.1451
$91.26
$121.7168811
Probe nasolacrimal duct
Y
A2
$446.00
17.1243
$728.52
$516.6368815
Probe nasolacrimal duct
Y
A2
$446.00
17.1243
$728.52
$516.6368840
Explore/irrigate tear ducts
N
P2

1.1607
$49.38
$49.3868850
Injection for tear sac x-ray

N169000
Drain external ear lesion
Y
P2

1.4392
$61.23
$61.2369005
Drain external ear lesion
Y
P3

2.2934
$97.57
$97.57( print page 42602)69020
Drain outer ear canal lesion
Y
P2

1.4392
$61.23
$61.2369100
Biopsy of external ear
Y
P3

1.4404
$61.28
$61.2869105
Biopsy of external ear canal
Y
P3

1.9474
$82.85
$82.8569110
Remove external ear, partial
Y
A2
$333.00
15.1024
$642.50
$410.3869120
Removal of external ear
Y
A2
$446.00
23.3299
$992.52
$582.6369140
Remove ear canal lesion(s)
Y
A2
$446.00
23.3299
$992.52
$582.6369145
Remove ear canal lesion(s)
Y
A2
$446.00
15.1024
$642.50
$495.1369150
Extensive ear canal surgery
Y
A2
$464.15
7.5511
$321.25
$428.4369200
Clear outer ear canal
N
P2

0.6102
$25.96
$25.9669205
Clear outer ear canal
Y
A2
$333.00
20.0656
$853.65
$463.1669210
Remove impacted ear wax
N
P3

0.4748
$20.20
$20.2069220
Clean out mastoid cavity
Y
P2

0.8432
$35.87
$35.8769222
Clean out mastoid cavity
Y
P3

3.0339
$129.07
$129.0769300
Revise external ear
Y
A2
$510.00
23.3299
$992.52
$630.6369310
Rebuild outer ear canal
Y
A2
$510.00
38.1991
$1,625.10
$788.7869320
Rebuild outer ear canal
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369400
Inflate middle ear canal
Y
P3

1.9152
$81.48
$81.4869401
Inflate middle ear canal
Y
P3

1.0944
$46.56
$46.5669405
Catheterize middle ear canal
Y
P3

2.7842
$118.45
$118.4569420
Incision of eardrum
Y
P2

2.4520
$104.32
$104.3269421
Incision of eardrum
Y
A2
$510.00
16.4266
$698.84
$557.2169424
Remove ventilating tube
Y
P3

1.7542
$74.63
$74.6369433
Create eardrum opening
Y
P3

2.4787
$105.45
$105.4569436
Create eardrum opening
Y
A2
$510.00
16.4266
$698.84
$557.2169440
Exploration of middle ear
Y
A2
$510.00
23.3299
$992.52
$630.6369450
Eardrum revision
Y
A2
$333.00
38.1991
$1,625.10
$656.0369501
Mastoidectomy
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369502
Mastoidectomy
Y
A2
$995.00
23.3299
$992.52
$994.3869505
Remove mastoid structures
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369511
Extensive mastoid surgery
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369530
Extensive mastoid surgery
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369540
Remove ear lesion
Y
P3

2.9615
$125.99
$125.9969550
Remove ear lesion
Y
A2
$717.00
38.1991
$1,625.10
$944.0369552
Remove ear lesion
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369601
Mastoid surgery revision
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369602
Mastoid surgery revision
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369603
Mastoid surgery revision
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369604
Mastoid surgery revision
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369605
Mastoid surgery revision
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369610
Repair of eardrum
Y
P3

4.0477
$172.20
$172.2069620
Repair of eardrum
Y
A2
$446.00
23.3299
$992.52
$582.6369631
Repair eardrum structures
Y
A2
$717.00
38.1991
$1,625.10
$944.0369632
Rebuild eardrum structures
Y
A2
$717.00
38.1991
$1,625.10
$944.0369633
Rebuild eardrum structures
Y
A2
$717.00
38.1991
$1,625.10
$944.0369635
Repair eardrum structures
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369636
Rebuild eardrum structures
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369637
Rebuild eardrum structures
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369641
Revise middle ear & mastoid
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369642
Revise middle ear & mastoid
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369643
Revise middle ear & mastoid
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369644
Revise middle ear & mastoid
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369645
Revise middle ear & mastoid
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369646
Revise middle ear & mastoid
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369650
Release middle ear bone
Y
A2
$995.00
23.3299
$992.52
$994.3869660
Revise middle ear bone
Y
A2
$717.00
38.1991
$1,625.10
$944.0369661
Revise middle ear bone
Y
A2
$717.00
38.1991
$1,625.10
$944.0369662
Revise middle ear bone
Y
A2
$717.00
38.1991
$1,625.10
$944.0369666
Repair middle ear structures
Y
A2
$630.00
38.1991
$1,625.10
$878.7869667
Repair middle ear structures
Y
A2
$630.00
38.1991
$1,625.10
$878.7869670
Remove mastoid air cells
Y
A2
$510.00
38.1991
$1,625.10
$788.7869676
Remove middle ear nerve
Y
A2
$510.00
38.1991
$1,625.10
$788.7869700
Close mastoid fistula
Y
A2
$510.00
38.1991
$1,625.10
$788.7869711
Remove/repair hearing aid
Y
A2
$333.00
38.1991
$1,625.10
$656.03( print page 42603)69714
Implant temple bone w/stimul
Y
A2
$1,339.00
38.1991
$1,625.10
$1,410.5369715
Temple bne implnt w/stimulat
Y
A2
$1,339.00
38.1991
$1,625.10
$1,410.5369717
Temple bone implant revision
Y
A2
$1,339.00
38.1991
$1,625.10
$1,410.5369718
Revise temple bone implant
Y
A2
$1,339.00
38.1991
$1,625.10
$1,410.5369720
Release facial nerve
Y
A2
$717.00
38.1991
$1,625.10
$944.0369740
Repair facial nerve
Y
A2
$717.00
38.1991
$1,625.10
$944.0369745
Repair facial nerve
Y
A2
$717.00
38.1991
$1,625.10
$944.0369801
Incise inner ear
Y
A2
$717.00
38.1991
$1,625.10
$944.0369802
Incise inner ear
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369805
Explore inner ear
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369806
Explore inner ear
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369820
Establish inner ear window
Y
A2
$717.00
38.1991
$1,625.10
$944.0369840
Revise inner ear window
Y
A2
$717.00
38.1991
$1,625.10
$944.0369905
Remove inner ear
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369910
Remove inner ear &  mastoid
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369915
Incise inner ear nerve
Y
A2
$995.00
38.1991
$1,625.10
$1,152.5369930
Implant cochlear device
Y
H8
$995.00
587.7216
$25,003.44
$23,712.5869990
Microsurgery add-on

N1C9716
Radiofrequency energy to anu
Y
G2

29.6189
$1,260.08
$1,260.08C9724
EPS gast cardia plic
Y
G2

25.7552
$1,095.70
$1,095.70C9725
Place endorectal app
N
G2

8.9477
$380.66
$380.66C9726
Rxt breast appl place/remov
N
G2

10.5746
$449.88
$449.88C9727
Insert palate implants
N
G2

13.8283
$588.30
$588.30G0104
CA screen;flexi sigmoidscope
N
P3

1.9152
$81.48
$81.48G0105
Colorectal scrn; hi risk ind
Y
A2
$446.00
7.8492
$333.93
$417.98G0121
Colon ca scrn not hi rsk ind
Y
A2
$446.00
7.8492
$333.93
$417.98G0127
Trim nail(s)
Y
P3

0.2494
$10.61
$10.61G0186
Dstry eye lesn,fdr vssl tech
Y
R2

3.9333
$167.33
$167.33G0247
Routine footcare pt w lops
Y
P3

0.4828
$20.54
$20.54G0259
Inject for sacroiliac joint

N1G0260
Inj for sacroiliac jt anesth
Y
A2
$333.00
5.7253
$243.57
$310.64G0268
Removal of impacted wax md
N
P3

0.4990
$21.23
$21.23G0269
Occlusive device in vein art

N1G0289
Arthro, loose body + chondro

N1G0297
Insert single chamber/cd
Y
J8

440.1206
$18,724.05
$18,724.05G0298
Insert dual chamber/cd
Y
J8

440.1206
$18,724.05
$18,724.05G0299
Inser/repos single icd+leads
Y
J8

546.9370
$23,268.34
$23,268.34G0300
Insert reposit lead dual+gen
Y
J8

546.9370
$23,268.34
$23,268.34G0364
Bone marrow aspirate & biopsy
Y
P3

0.1208
$5.14
$5.14G0392
AV fistula or graft arterial
Y
A2
$1,339.00
42.9360
$1,826.63
$1,460.91G0393
AV fistula or graft venous
Y
A2
$1,339.00
42.9360
$1,826.63
$1,460.91**Note:**
                             The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent.* Refers to codes designated as “office-based,” whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available.
 
 
  
 
       Note: 
 
 Addendum BB.—Illustrative ASC Covered Ancillary Services Integral to Covered Surgical Procedures for CY 2008 (Including Ancillary Services for Which Payment is Packaged)
HCPCS code
Short descriptor
Payment indicator
Estimated CY 2008 payment weights
Estimated CY 2008 payment0028T
Dexa body composition study
N10042T
Ct perfusion w/contrast, cbf
N10054T
Bone surgery using computer
Z2
4.9138
$209.050055T
Bone surgery using computer
Z2
4.9138
$209.050056T
Bone surgery using computer
Z2
4.9138
$209.050067T
Ct colonography;dx
Z2
4.8405
$205.930071T
U/s leiomyomata ablate <200
Z2
28.5095
$1,212.880072T
U/s leiomyomata ablate >200
Z2
42.9896
$1,828.910073T
Delivery, comp imrt
Z2
5.4731
$232.840126T
Chd risk imt study
N10144T
CT heart wo dye; qual calc
Z2
4.1265
$175.550145T
CT heart w/wo dye funct
Z2
4.9832
$212.000146T
CCTA w/wo dye
Z2
4.9832
$212.000147T
CCTA w/wo, quan calcium
Z2
4.9832
$212.000148T
CCTA w/wo, strxr
Z2
6.5012
$276.580149T
CCTA w/wo, strxr quan calc
Z2
6.5012
$276.580150T
CCTA w/wo, disease strxr
Z2
4.1265
$175.550151T
CT heart funct add-on
Z2
1.5379
$65.430159T
Cad breast mri
N10174T
Cad cxr with interp
N10175T
Cad cxr remote
N170010
Contrast x-ray of brain
Z2
2.5544
$108.6770015
Contrast x-ray of brain
Z3
1.4806
$62.9970030
X-ray eye for foreign body
Z3
0.3782
$16.0970100
X-ray exam of jaw
Z3
0.4346
$18.4970110
X-ray exam of jaw
Z3
0.5230
$22.2570120
X-ray exam of mastoids
Z3
0.4990
$21.2370130
X-ray exam of mastoids
Z2
0.7093
$30.1870134
X-ray exam of middle ear
Z3
0.6036
$25.6870140
X-ray exam of facial bones
Z3
0.4346
$18.4970150
X-ray exam of facial bones
Z3
0.6116
$26.0270160
X-ray exam of nasal bones
Z3
0.4506
$19.1770170
X-ray exam of tear duct
Z2
2.9586
$125.8770190
X-ray exam of eye sockets
Z3
0.4990
$21.2370200
X-ray exam of eye sockets
Z3
0.6116
$26.0270210
X-ray exam of sinuses
Z3
0.4506
$19.1770220
X-ray exam of sinuses
Z3
0.5632
$23.9670240
X-ray exam, pituitary saddle
Z3
0.3862
$16.4370250
X-ray exam of skull
Z3
0.4908
$20.8870260
X-ray exam of skull
Z3
0.6518
$27.7370300
X-ray exam of teeth
Z3
0.1932
$8.2270310
X-ray exam of teeth
Z3
0.4828
$20.5470320
Full mouth x-ray of teeth
Z2
0.6550
$27.8770328
X-ray exam of jaw joint
Z3
0.4104
$17.4670330
X-ray exam of jaw joints
Z3
0.6920
$29.4470332
X-ray exam of jaw joint
Z3
1.3520
$57.5270336
Magnetic image, jaw joint
Z2
4.5523
$193.6770350
X-ray head for orthodontia
Z3
0.2576
$10.9670355
Panoramic x-ray of jaws
Z3
0.3218
$13.6970360
X-ray exam of neck
Z3
0.3622
$15.4170370
Throat x-ray & fluoroscopy
Z3
1.1346
$48.2770371
Speech evaluation, complex
Z2
1.2908
$54.9170373
Contrast x-ray of larynx
Z3
1.3036
$55.4670380
X-ray exam of salivary gland
Z3
0.5714
$24.3170390
X-ray exam of salivary duct
Z3
1.5612
$66.4270450
Ct head/brain w/o dye
Z2
3.0908
$131.4970460
Ct head/brain w/dye
Z2
4.0825
$173.6870470
Ct head/brain w/o & w/dye
Z2
4.8405
$205.9370480
Ct orbit/ear/fossa w/o dye
Z2
3.0908
$131.4970481
Ct orbit/ear/fossa w/dye
Z2
4.0825
$173.6870482
Ct orbit/ear/fossa w/o & w/dye
Z2
4.8405
$205.9370486
Ct maxillofacial w/o dye
Z2
3.0908
$131.4970487
Ct maxillofacial w/dye
Z2
4.0825
$173.6870488
Ct maxillofacial w/o & w/dye
Z2
4.8405
$205.93( print page 42605)70490
Ct soft tissue neck w/o dye
Z2
3.0908
$131.4970491
Ct soft tissue neck w/dye
Z2
4.0825
$173.6870492
Ct sft tsue nck w/o & w/dye
Z2
4.8405
$205.9370496
Ct angiography, head
Z2
4.8552
$206.5570498
Ct angiography, neck
Z2
4.8552
$206.5570540
Mri orbit/face/neck w/o dye
Z2
5.6745
$241.4170542
Mri orbit/face/neck w/dye
Z2
6.1231
$260.5070543
Mri orbt/fac/nck w/o & w/dye
Z2
8.1155
$345.2670544
Mr angiography head w/o dye
Z2
5.6745
$241.4170545
Mr angiography head w/dye
Z2
6.1231
$260.5070546
Mr angiograph head w/o & w/dye
Z2
8.1155
$345.2670547
Mr angiography neck w/o dye
Z2
5.6745
$241.4170548
Mr angiography neck w/dye
Z2
6.1231
$260.5070549
Mr angiograph neck w/o & w/dye
Z2
8.1155
$345.2670551
Mri brain w/o dye
Z2
5.6745
$241.4170552
Mri brain w/dye
Z2
6.1231
$260.5070553
Mri brain w/o & w/dye
Z2
8.1155
$345.2670554
Fmri brain by tech
Z2
5.6745
$241.4170555
Fmri brain by phys/psych
Z2
5.6745
$241.4170557
Mri brain w/o dye
Z2
5.6745
$241.4170558
Mri brain w/dye
Z2
6.1231
$260.5070559
Mri brain w/o & w/dye
Z2
8.1155
$345.2671010
Chest x-ray
Z3
0.3300
$14.0471015
Chest x-ray
Z3
0.4024
$17.1271020
Chest x-ray
Z3
0.4426
$18.8371021
Chest x-ray
Z3
0.5392
$22.9471022
Chest x-ray
Z3
0.6036
$25.6871023
Chest x-ray and fluoroscopy
Z3
0.8690
$36.9771030
Chest x-ray
Z3
0.6276
$26.7071034
Chest x-ray and fluoroscopy
Z2
1.2908
$54.9171035
Chest x-ray
Z3
0.4828
$20.5471040
Contrast x-ray of bronchi
Z3
1.3278
$56.4971060
Contrast x-ray of bronchi
Z2
1.6956
$72.1471090
X-ray & pacemaker insertion
Z2
1.2908
$54.9171100
X-ray exam of ribs
Z3
0.4426
$18.8371101
X-ray exam of ribs/chest
Z3
0.5230
$22.2571110
X-ray exam of ribs
Z3
0.5794
$24.6571111
X-ray exam of ribs/chest
Z3
0.7322
$31.1571120
X-ray exam of breastbone
Z3
0.4748
$20.2071130
X-ray exam of breastbone
Z3
0.5472
$23.2871250
Ct thorax w/o dye
Z2
3.0908
$131.4971260
Ct thorax w/dye
Z2
4.0825
$173.6871270
Ct thorax w/o & w/dye
Z2
4.8405
$205.9371275
Ct angiography, chest
Z2
4.8552
$206.5571550
Mri chest w/o dye
Z2
5.6745
$241.4171551
Mri chest w/dye
Z2
6.1231
$260.5071552
Mri chest w/o & w/dye
Z2
8.1155
$345.2672010
X-ray exam of spine
Z2
0.7093
$30.1872020
X-ray exam of spine
Z3
0.3218
$13.6972040
X-ray exam of neck spine
Z3
0.5150
$21.9172050
X-ray exam of neck spine
Z3
0.7322
$31.1572052
X-ray exam of neck spine
Z3
0.9416
$40.0672069
X-ray exam of trunk spine
Z3
0.4586
$19.5172070
X-ray exam of thoracic spine
Z3
0.4748
$20.2072072
X-ray exam of thoracic spine
Z3
0.5552
$23.6272074
X-ray exam of thoracic spine
Z3
0.7000
$29.7872080
X-ray exam of trunk spine
Z3
0.5070
$21.5772090
X-ray exam of trunk spine
Z3
0.6196
$26.3672100
X-ray exam of lower spine
Z3
0.5552
$23.6272110
X-ray exam of lower spine
Z3
0.7644
$32.5272114
X-ray exam of lower spine
Z3
1.0380
$44.1672120
X-ray exam of lower spine
Z3
0.7484
$31.8472125
Ct neck spine w/o dye
Z2
3.0908
$131.4972126
Ct neck spine w/dye
Z2
4.0825
$173.68( print page 42606)72127
Ct neck spine w/o & w/dye
Z2
4.8405
$205.9372128
Ct chest spine w/o dye
Z2
3.0908
$131.4972129
Ct chest spine w/dye
Z2
4.0825
$173.6872130
Ct chest spine w/o & w/dye
Z2
4.8405
$205.9372131
Ct lumbar spine w/o dye
Z2
3.0908
$131.4972132
Ct lumbar spine w/dye
Z2
4.0825
$173.6872133
Ct lumbar spine w/o & w/dye
Z2
4.8405
$205.9372141
Mri neck spine w/o dye
Z2
5.6745
$241.4172142
Mri neck spine w/dye
Z2
6.1231
$260.5072146
Mri chest spine w/o dye
Z2
5.6745
$241.4172147
Mri chest spine w/dye
Z2
6.1231
$260.5072148
Mri lumbar spine w/o dye
Z2
5.6745
$241.4172149
Mri lumbar spine w/dye
Z2
6.1231
$260.5072156
Mri neck spine w/o & w/dye
Z2
8.1155
$345.2672157
Mri chest spine w/o & w/dye
Z2
8.1155
$345.2672158
Mri lumbar spine w/o & w/dye
Z2
8.1155
$345.2672170
X-ray exam of pelvis
Z3
0.3782
$16.0972190
X-ray exam of pelvis
Z3
0.5714
$24.3172191
Ct angiograph pelv w/o & w/dye
Z2
4.8552
$206.5572192
Ct pelvis w/o dye
Z2
3.0908
$131.4972193
Ct pelvis w/dye
Z2
4.0825
$173.6872194
Ct pelvis w/o & w/dye
Z2
4.8405
$205.9372195
Mri pelvis w/o dye
Z2
5.6745
$241.4172196
Mri pelvis w/dye
Z2
6.1231
$260.5072197
Mri pelvis w/o & w/dye
Z2
8.1155
$345.2672200
X-ray exam sacroiliac joints
Z3
0.4184
$17.8072202
X-ray exam sacroiliac joints
Z3
0.5070
$21.5772220
X-ray exam of tailbone
Z3
0.4264
$18.1472240
Contrast x-ray of neck spine
Z2
2.5544
$108.6772255
Contrast x-ray, thorax spine
Z3
2.5026
$106.4772265
Contrast x-ray, lower spine
Z3
2.4867
$105.7972270
Contrast x-ray, spine
Z2
2.5544
$108.6772275
Epidurography
Z3
1.4404
$61.2872285
X-ray c/t spine disk
Z3
3.8145
$162.2872291
Perq vertebroplasty, fluor
Z2
2.5544
$108.6772292
Perq vertebroplasty, ct
Z2
2.5544
$108.6772295
X-ray of lower spine disk
Z3
3.6213
$154.0673000
X-ray exam of collar bone
Z3
0.4024
$17.1273010
X-ray exam of shoulder blade
Z3
0.4184
$17.8073020
X-ray exam of shoulder
Z3
0.3460
$14.7273030
X-ray exam of shoulder
Z3
0.4264
$18.1473040
Contrast x-ray of shoulder
Z3
1.6256
$69.1673050
X-ray exam of shoulders
Z3
0.5230
$22.2573060
X-ray exam of humerus
Z3
0.4264
$18.1473070
X-ray exam of elbow
Z3
0.4024
$17.1273080
X-ray exam of elbow
Z3
0.4990
$21.2373085
Contrast x-ray of elbow
Z3
1.4806
$62.9973090
X-ray exam of forearm
Z3
0.4024
$17.1273092
X-ray exam of arm, infant
Z3
0.4024
$17.1273100
X-ray exam of wrist
Z3
0.4104
$17.4673110
X-ray exam of wrist
Z3
0.4908
$20.8873115
Contrast x-ray of wrist
Z3
1.4806
$62.9973120
X-ray exam of hand
Z3
0.3944
$16.7873130
X-ray exam of hand
Z3
0.4426
$18.8373140
X-ray exam of finger(s)
Z3
0.4184
$17.8073200
Ct upper extremity w/o dye
Z2
3.0908
$131.4973201
Ct upper extremity w/dye
Z2
4.0825
$173.6873202
Ct uppr extremity w/o & w/dye
Z2
4.8405
$205.9373206
Ct angio upr extrm w/o & w/dye
Z2
4.8552
$206.5573218
Mri upper extremity w/o dye
Z2
5.6745
$241.4173219
Mri upper extremity w/dye
Z2
6.1231
$260.5073220
Mri uppr extremity w/o & w/dye
Z2
8.1155
$345.2673221
Mri joint upr extrem w/o dye
Z2
5.6745
$241.4173222
Mri joint upr extrem w/dye
Z2
6.1231
$260.50( print page 42607)73223
Mri joint upr extr w/o & w/dye
Z2
8.1155
$345.2673500
X-ray exam of hip
Z3
0.3540
$15.0673510
X-ray exam of hip
Z3
0.5070
$21.5773520
X-ray exam of hips
Z3
0.5392
$22.9473525
Contrast x-ray of hip
Z3
1.4726
$62.6573530
X-ray exam of hip
Z2
1.2224
$52.0073540
X-ray exam of pelvis & hips
Z3
0.5150
$21.9173542
X-ray exam, sacroiliac joint
Z3
1.2312
$52.3873550
X-ray exam of thigh
Z3
0.4184
$17.8073560
X-ray exam of knee, 1 or 2
Z3
0.4184
$17.8073562
X-ray exam of knee, 3
Z3
0.4908
$20.8873564
X-ray exam, knee, 4 or more
Z3
0.5552
$23.6273565
X-ray exam of knees
Z3
0.4264
$18.1473580
Contrast x-ray of knee joint
Z3
1.9152
$81.4873590
X-ray exam of lower leg
Z3
0.3944
$16.7873592
X-ray exam of leg, infant
Z3
0.4104
$17.4673600
X-ray exam of ankle
Z3
0.3944
$16.7873610
X-ray exam of ankle
Z3
0.4506
$19.1773615
Contrast x-ray of ankle
Z3
1.5128
$64.3673620
X-ray exam of foot
Z3
0.3944
$16.7873630
X-ray exam of foot
Z3
0.4426
$18.8373650
X-ray exam of heel
Z3
0.3862
$16.4373660
X-ray exam of toe(s)
Z3
0.4024
$17.1273700
Ct lower extremity w/o dye
Z2
3.0908
$131.4973701
Ct lower extremity w/dye
Z2
4.0825
$173.6873702
Ct lwr extremity w/o & w/dye
Z2
4.8405
$205.9373706
Ct angio lwr extr w/o & w/dye
Z2
4.8552
$206.5573718
Mri lower extremity w/o dye
Z2
5.6745
$241.4173719
Mri lower extremity w/dye
Z2
6.1231
$260.5073720
Mri lwr extremity w/o & w/dye
Z2
8.1155
$345.2673721
Mri jnt of lwr extre w/o dye
Z2
5.6745
$241.4173722
Mri joint of lwr extr w/dye
Z2
6.1231
$260.5073723
Mri joint lwr extr w/o & w/dye
Z2
8.1155
$345.2674000
X-ray exam of abdomen
Z3
0.3622
$15.4174010
X-ray exam of abdomen
Z3
0.5070
$21.5774020
X-ray exam of abdomen
Z3
0.5150
$21.9174022
X-ray exam series, abdomen
Z3
0.6196
$26.3674150
Ct abdomen w/o dye
Z2
3.0908
$131.4974160
Ct abdomen w/dye
Z2
4.0825
$173.6874170
Ct abdomen w/o & w/dye
Z2
4.8405
$205.9374175
Ct angio abdom w/o & w/dye
Z2
4.8552
$206.5574181
Mri abdomen w/o dye
Z2
5.6745
$241.4174182
Mri abdomen w/dye
Z2
6.1231
$260.5074183
Mri abdomen w/o & w/dye
Z2
8.1155
$345.2674190
X-ray exam of peritoneum
Z2
2.9586
$125.8774210
Contrst x-ray exam of throat
Z3
1.1024
$46.9074220
Contrast x-ray, esophagus
Z3
1.1830
$50.3374230
Cine/vid x-ray, throat/esoph
Z3
1.1990
$51.0174235
Remove esophagus obstruction
Z2
1.0974
$46.6974240
X-ray exam, upper gi tract
Z3
1.3680
$58.2074241
X-ray exam, upper gi tract
Z2
1.4294
$60.8174245
X-ray exam, upper gi tract
Z2
2.2176
$94.3474246
Contrst x-ray uppr gi tract
Z2
1.4294
$60.8174247
Contrst x-ray uppr gi tract
Z2
1.4294
$60.8174249
Contrst x-ray uppr gi tract
Z2
2.2176
$94.3474250
X-ray exam of small bowel
Z3
1.4082
$59.9174251
X-ray exam of small bowel
Z2
2.2176
$94.3474260
X-ray exam of small bowel
Z2
1.4294
$60.8174270
Contrast x-ray exam of colon
Z2
1.4294
$60.8174280
Contrast x-ray exam of colon
Z2
2.2176
$94.3474283
Contrast x-ray exam of colon
Z2
1.4294
$60.8174290
Contrast x-ray, gallbladder
Z3
0.8450
$35.9574291
Contrast x-rays, gallbladder
Z3
0.7726
$32.8774300
X-ray bile ducts/pancreas
Z2
1.6956
$72.14( print page 42608)74301
X-rays at surgery add-on
Z2
1.6956
$72.1474305
X-ray bile ducts/pancreas
Z2
1.6956
$72.1474320
Contrast x-ray of bile ducts
Z3
2.0039
$85.2574327
X-ray bile stone removal
Z3
1.7462
$74.2974328
X-ray bile duct endoscopy
N174329
X-ray for pancreas endoscopy
N174330
X-ray bile/panc endoscopy
N174340
X-ray guide for GI tube
Z2
1.2908
$54.9174350
X-ray guide, stomach tube
Z2
1.6956
$72.1474355
X-ray guide, intestinal tube
Z2
1.6956
$ 72.1474360
X-ray guide, GI dilation
Z2
1.0974
$46.6974363
X-ray, bile duct dilation
Z2
3.6392
$154.8274400
Contrst x-ray, urinary tract
Z3
1.6094
$68.4774410
Contrst x-ray, urinary tract
Z3
1.7625
$74.9874415
Contrst x-ray, urinary tract
Z3
2.0440
$86.9674420
Contrst x-ray, urinary tract
Z2
2.4159
$102.7874425
Contrst x-ray, urinary tract
Z2
2.4159
$102.7874430
Contrast x-ray, bladder
Z3
1.1346
$48.2774440
X-ray, male genital tract
Z3
1.2634
$53.7574445
X-ray exam of penis
Z2
2.4159
$102.7874450
X-ray, urethra/bladder
Z2
2.4159
$102.7874455
X-ray, urethra/bladder
Z3
1.4324
$60.9474470
X-ray exam of kidney lesion
Z2
1.6956
$72.1474475
X-ray control, cath insert
Z3
2.3738
$100.9974480
X-ray control, cath insert
Z3
2.3738
$100.9974485
X-ray guide, GU dilation
Z3
2.0683
$87.9974710
X-ray measurement of pelvis
Z3
0.6276
$26.7074740
X-ray, female genital tract
Z3
1.1508
$48.9674742
X-ray, fallopian tube
Z2
2.9586
$125.8774775
X-ray exam of perineum
Z2
2.4159
$102.7875552
Heart mri for morph w/o dye
Z2
5.6745
$241.4175553
Heart mri for morph w/dye
Z2
6.1231
$260.5075554
Cardiac MRI/function
Z2
5.6745
$241.4175555
Cardiac MRI/limited study
Z2
5.6745
$241.4175600
Contrast x-ray exam of aorta
Z3
7.5404
$320.7975605
Contrast x-ray exam of aorta
Z3
6.2929
$267.7275625
Contrast x-ray exam of aorta
Z3
6.2125
$264.3075630
X-ray aorta, leg arteries
Z3
6.4941
$276.2875635
Ct angio abdominal arteries
Z2
4.8552
$206.5575650
Artery x-rays, head & neck
Z3
6.2125
$264.3075658
Artery x-rays, arm
Z3
6.3815
$271.4975660
Artery x-rays, head & neck
Z2
6.2463
$265.7475662
Artery x-rays, head & neck
Z3
6.7840
$288.6175665
Artery x-rays, head & neck
Z3
6.4699
$275.2575671
Artery x-rays, head & neck
Z3
6.7920
$288.9575676
Artery x-rays, neck
Z3
6.3815
$271.4975680
Artery x-rays, neck
Z3
6.5987
$280.7375685
Artery x-rays, spine
Z3
6.3736
$271.1575705
Artery x-rays, spine
Z2
6.2463
$265.7475710
Artery x-rays, arm/leg
Z3
6.4619
$274.9175716
Artery x-rays, arms/legs
Z3
6.7920
$288.9575722
Artery x-rays, kidney
Z3
6.4055
$272.5175724
Artery x-rays, kidneys
Z3
6.8242
$290.3275726
Artery x-rays, abdomen
Z3
6.3413
$269.7875731
Artery x-rays, adrenal gland
Z3
6.4055
$272.5175733
Artery x-rays, adrenals
Z2
6.2463
$265.7475736
Artery x-rays, pelvis
Z3
6.3975
$272.1775741
Artery x-rays, lung
Z3
6.0999
$259.5175743
Artery x-rays, lungs
Z3
6.1963
$263.6175746
Artery x-rays, lung
Z3
6.2607
$266.3575756
Artery x-rays, chest
Z3
6.5828
$280.0575774
Artery x-ray, each vessel
Z3
6.0033
$255.4075790
Visualize A-V shunt
Z3
1.5210
$64.7175801
Lymph vessel x-ray, arm/leg
Z2
2.9586
$125.87( print page 42609)75803
Lymph vessel x-ray, arms/legs
Z2
2.9586
$125.8775805
Lymph vessel x-ray, trunk
Z2
2.9586
$125.8775807
Lymph vessel x-ray, trunk
Z2
2.9586
$125.8775809
Nonvascular shunt, x-ray
Z3
1.0864
$46.2275810
Vein x-ray, spleen/liver
Z2
9.5061
$404.4275820
Vein x-ray, arm/leg
Z3
1.4484
$61.6275822
Vein x-ray, arms/legs
Z3
1.6738
$71.2175825
Vein x-ray, trunk
Z3
6.0515
$257.4575827
Vein x-ray, chest
Z3
6.0677
$258.1475831
Vein x-ray, kidney
Z3
6.0999
$259.5175833
Vein x-ray, kidneys
Z3
6.3009
$268.0675840
Vein x-ray, adrenal gland
Z3
6.1723
$262.5975842
Vein x-ray, adrenal glands
Z3
6.2769
$267.0475860
Vein x-ray, neck
Z3
6.2285
$264.9875870
Vein x-ray, skull
Z3
6.1641
$262.2475872
Vein x-ray, skull
Z3
6.4459
$274.2375880
Vein x-ray, eye socket
Z3
1.4484
$61.6275885
Vein x-ray, liver
Z3
6.0837
$258.8275887
Vein x-ray, liver
Z3
6.1561
$261.9075889
Vein x-ray, liver
Z3
6.0837
$258.8275891
Vein x-ray, liver
Z3
6.0837
$258.8275893
Venous sampling by catheter
N175894
X-rays, transcath therapy
Z2
8.3906
$356.9675896
X-rays, transcath therapy
Z2
8.3906
$356.9675898
Follow-up angiography
Z2
1.6956
$72.1475901
Remove cva device obstruct
Z2
1.6956
$72.1475902
Remove cva lumen obstruct
Z3
1.1024
$46.9075940
X-ray placement, vein filter
Z2
8.3906
$356.9675945
Intravascular us
Z2
2.4606
$104.6875946
Intravascular us add-on
Z2
1.5607
$66.4075960
Transcath iv stent rs&i
Z2
6.2463
$265.7475961
Retrieval, broken catheter
Z3
5.4399
$231.4375962
Repair arterial blockage
Z2
6.2463
$265.7475964
Repair artery blockage, each
Z3
4.2571
$181.1175966
Repair arterial blockage
Z2
6.2463
$265.7475968
Repair artery blockage, each
Z3
4.2731
$181.7975970
Vascular biopsy
Z2
6.2463
$265.7475978
Repair venous blockage
Z2
6.2463
$265.7475980
Contrast xray exam bile duct
Z2
3.6392
$154.8275982
Contrast xray exam bile duct
Z2
3.6392
$154.8275984
Xray control catheter change
Z3
1.5692
$66.7675989
Abscess drainage under x-ray
N175992
Atherectomy, x-ray exam
Z2
6.2463
$265.7475993
Atherectomy, x-ray exam
Z2
6.2463
$265.7475994
Atherectomy, x-ray exam
Z2
6.2463
$265.7475995
Atherectomy, x-ray exam
Z2
6.2463
$265.7475996
Atherectomy, x-ray exam
Z2
6.2463
$265.7476000
Fluoroscope examination
Z2
1.2908
$54.9176001
Fluoroscope exam, extensive
N176010
X-ray, nose to rectum
Z3
0.3944
$16.7876080
X-ray exam of fistula
Z3
0.7644
$32.5276098
X-ray exam, breast specimen
Z3
0.2736
$11.6476100
X-ray exam of body section
Z2
1.2224
$52.0076101
Complex body section x-ray
Z2
1.6956
$72.1476102
Complex body section x-rays
Z2
2.9586
$125.8776120
Cine/video x-rays
Z3
1.1024
$46.9076125
Cine/video x-rays add-on
Z2
0.7093
$30.1876150
X-ray exam, dry process
Z3
0.4346
$18.4976350
Special x-ray contrast study
N176376
3d render w/o postprocess
Z2
0.6102
$25.9676377
3d rendering w/postprocess
Z2
1.5379
$65.4376380
CAT scan follow-up study
Z2
1.5379
$65.4376496
Fluoroscopic procedure
Z2
1.2908
$54.9176497
Ct procedure
Z2
1.5379
$65.43( print page 42610)76498
Mri procedure
Z2
4.5523
$193.6776499
Radiographic procedure
Z2
0.7093
$30.1876506
Echo exam of head
Z2
0.9923
$42.2276510
Ophth us, b & quant a
Z2
1.5607
$66.4076511
Ophth us, quant a only
Z3
1.2312
$52.3876512
Ophth us, b w/non-quant a
Z3
1.0702
$45.5376513
Echo exam of eye, water bath
Z3
1.1426
$48.6176514
Echo exam of eye, thickness
Z3
0.0644
$2.7476516
Echo exam of eye
Z3
0.8852
$37.6676519
Echo exam of eye
Z3
0.9736
$41.4276529
Echo exam of eye
Z3
0.8450
$35.9576536
Us exam of head and neck
Z3
1.5290
$65.0576604
Us exam, chest
Z2
0.9923
$42.2276645
Us exam, breast(s)
Z2
0.9923
$42.2276700
Us exam, abdom, complete
Z2
1.5607
$66.4076705
Echo exam of abdomen
Z3
1.3922
$59.2376770
Us exam abdo back wall, comp
Z2
1.5607
$66.4076775
Us exam abdo back wall, lim
Z3
1.4002
$59.5776776
Us exam k transpl w/doppler
Z2
1.5607
$66.4076800
Us exam, spinal canal
Z3
1.3680
$58.2076801
Ob us < 14 wks, single fetus
Z2
1.5607
$66.4076802
Ob us < 14 wks, add'l fetus
Z3
0.7000
$29.7876805
Ob us >/= 14 wks, sngl fetus
Z2
1.5607
$66.4076810
Ob us >/= 14 wks, addl fetus
Z3
0.9576
$40.7476811
Ob us, detailed, sngl fetus
Z3
2.4060
$102.3676812
Ob us, detailed, addl fetus
Z2
0.9923
$42.2276813
Ob us nuchal meas, 1 gest
Z3
1.3922
$59.2376814
Ob us nuchal meas, add-on
Z3
0.6760
$28.7676815
Ob us, limited, fetus(s)
Z2
0.9923
$42.2276816
Ob us, follow-up, per fetus
Z2
0.9923
$42.2276817
Transvaginal us, obstetric
Z2
0.9923
$42.2276818
Fetal biophys profile w/nst
Z3
1.3922
$59.2376819
Fetal biophys profil w/o nst
Z3
1.1990
$51.0176820
Umbilical artery echo
Z3
0.8128
$34.5876821
Middle cerebral artery echo
Z3
1.3036
$55.4676825
Echo exam of fetal heart
Z2
1.5973
$67.9576826
Echo exam of fetal heart
Z3
1.2794
$54.4376827
Echo exam of fetal heart
Z3
1.0462
$44.5176828
Echo exam of fetal heart
Z3
0.6358
$27.0576830
Transvaginal us, non-ob
Z2
1.5607
$66.4076831
Echo exam, uterus
Z3
1.6094
$68.4776856
Us exam, pelvic, complete
Z2
1.5607
$66.4076857
Us exam, pelvic, limited
Z2
0.9923
$42.2276870
Us exam, scrotum
Z2
1.5607
$66.4076872
Us, transrectal
Z2
1.5607
$66.4076873
Echograp trans r, pros study
Z2
1.5607
$66.4076880
Us exam, extremity
Z2
1.5607
$66.4076885
Us exam infant hips, dynamic
Z2
0.9923
$42.2276886
Us exam infant hips, static
Z2
0.9923
$42.2276930
Echo guide, cardiocentesis
Z2
1.1882
$50.5576932
Echo guide for heart biopsy
Z2
2.1012
$89.3976936
Echo guide for artery repair
Z2
2.1012
$89.3976937
Us guide, vascular access
N176940
Us guide, tissue ablation
Z2
1.1882
$50.5576941
Echo guide for transfusion
Z2
1.1882
$50.5576942
Echo guide for biopsy
Z2
1.1882
$50.5576945
Echo guide, villus sampling
Z2
1.1882
$50.5576946
Echo guide for amniocentesis
Z3
0.7404
$31.5076948
Echo guide, ova aspiration
Z3
0.7404
$31.5076950
Echo guidance radiotherapy
Z3
0.9416
$40.0676965
Echo guidance radiotherapy
Z2
2.1012
$89.3976970
Ultrasound exam follow-up
Z2
0.9923
$42.2276975
GI endoscopic ultrasound
Z2
1.5607
$66.4076977
Us bone density measure
Z3
0.3702
$15.75( print page 42611)76998
Us guide, intraop
Z2
1.5607
$66.4076999
Echo examination procedure
Z2
0.9923
$42.2277001
Fluoroguide for vein device
N177002
Needle localization by xray
N177003
Fluoroguide for spine inject
N177011
Ct scan for localization
Z2
4.0825
$173.6877012
Ct scan for needle biopsy
Z3
4.0559
$172.5577013
Ct guide for tissue ablation
Z2
4.8405
$205.9377014
Ct scan for therapy guide
Z2
1.5379
$65.4377021
Mr guidance for needle place
Z2
4.5523
$193.6777022
Mri for tissue ablation
Z2
4.5523
$193.6777031
Stereotact guide for brst bx
Z2
2.9586
$125.8777032
Guidance for needle, breast
Z3
0.6840
$29.1077053
X-ray of mammary duct
Z3
1.2554
$53.4177054
X-ray of mammary ducts
Z2
1.6956
$72.1477071
X-ray stress view
Z3
0.3782
$16.0977072
X-rays for bone age
Z3
0.2736
$11.6477073
X-rays, bone length studies
Z3
0.5312
$22.6077074
X-rays, bone survey, limited
Z3
0.8852
$37.6677075
X-rays, bone survey complete
Z2
1.2224
$52.0077076
X-rays, bone survey, infant
Z2
0.7093
$30.1877077
Joint survey, single view
Z3
0.6598
$28.0777078
Ct bone density, axial
Z2
1.1755
$50.0177079
Ct bone density, peripheral
Z3
1.4566
$61.9777080
Dxa bone density, axial
Z2
1.1755
$50.0177081
Dxa bone density/peripheral
Z2
0.5497
$23.3977082
Dxa bone density, vert fx
Z3
0.4426
$18.8377083
Radiographic absorptiometry
Z3
0.4264
$18.1477084
Magnetic image, bone marrow
Z2
4.5523
$193.6777280
Sbrt management
Z2
1.5735
$66.9477285
Set radiation therapy field
Z2
3.9723
$168.9977290
Set radiation therapy field
Z2
3.9723
$168.9977295
Set radiation therapy field
Z3
13.6401
$580.2977299
Radiation therapy planning
Z2
1.5735
$66.9477300
Radiation therapy dose plan
Z3
0.9334
$39.7177301
Radiotherapy dose plan, imrt
Z2
13.8081
$587.4477305
Teletx isodose plan simple
Z3
1.0140
$43.1477310
Teletx isodose plan intermed
Z3
1.3036
$55.4677315
Teletx isodose plan complex
Z3
1.7060
$72.5877321
Special teletx port plan
Z3
2.1085
$89.7077326
Brachytx isodose calc simp
Z2
1.5735
$66.9477327
Brachytx isodose calc interm
Z3
2.8649
$121.8877328
Brachytx isodose plan compl
Z3
3.8305
$162.9677331
Special radiation dosimetry
Z3
0.4104
$17.4677332
Radiation treatment aid(s)
Z3
1.0944
$46.5677333
Radiation treatment aid(s)
Z3
0.8610
$36.6377334
Radiation treatment aid(s)
Z3
2.2453
$95.5277336
Radiation physics consult
Z2
1.5735
$66.9477370
Radiation physics consult
Z2
1.5735
$66.9477371
Srs, multisource
Z3
24.3429
$1,035.6277399
External radiation dosimetry
Z2
1.5735
$66.9477401
Radiation treatment delivery
Z3
0.9094
$38.6977402
Radiation treatment delivery
Z2
1.4826
$63.0777403
Radiation treatment delivery
Z2
1.4826
$63.0777404
Radiation treatment delivery
Z2
1.4826
$63.0777406
Radiation treatment delivery
Z2
1.4826
$63.0777407
Radiation treatment delivery
Z2
1.4826
$63.0777408
Radiation treatment delivery
Z2
1.4826
$63.0777409
Radiation treatment delivery
Z2
1.4826
$63.0777411
Radiation treatment delivery
Z2
2.2295
$94.8577412
Radiation treatment delivery
Z2
2.2295
$94.8577413
Radiation treatment delivery
Z2
2.2295
$94.8577414
Radiation treatment delivery
Z2
2.2295
$94.8577416
Radiation treatment delivery
Z2
2.2295
$94.85( print page 42612)77417
Radiology port film(s)
Z3
0.3782
$16.0977418
Radiation tx delivery, imrt
Z2
5.4731
$232.8477421
Stereoscopic x-ray guidance
Z2
1.0974
$46.6977422
Neutron beam tx, simple
Z2
2.2295
$94.8577423
Neutron beam tx, complex
Z2
2.2295
$94.8577435
Sbrt management
N177470
Special radiation treatment
Z3
4.9813
$211.9277520
Proton trmt, simple w/o comp
Z2
18.8926
$803.7577522
Proton trmt, simple w/comp
Z2
18.8926
$803.7577523
Proton trmt, intermediate
Z2
22.6031
$961.6077525
Proton treatment, complex
Z2
22.6031
$961.6077600
Hyperthermia treatment
Z2
3.3461
$142.3577605
Hyperthermia treatment
Z2
3.3461
$142.3577610
Hyperthermia treatment
Z2
3.3461
$142.3577615
Hyperthermia treatment
Z2
3.3461
$142.3577620
Hyperthermia treatment
Z2
3.3461
$142.3577750
Infuse radioactive materials
Z3
1.7140
$72.9277761
Apply intrcav radiat simple
Z3
3.0419
$129.4177762
Apply intrcav radiat interm
Z3
3.7741
$160.5677763
Apply intrcav radiat compl
Z3
4.8283
$205.4177776
Apply interstit radiat simpl
Z3
3.2109
$136.6077777
Apply interstit radiat inter
Z3
3.8707
$164.6777778
Apply interstit radiat compl
Z3
5.1261
$218.0877781
High intensity brachytherapy
Z3
9.7854
$416.3077782
High intensity brachytherapy
Z2
12.8473
$546.5677783
High intensity brachytherapy
Z2
12.8473
$546.5677784
High intensity brachytherapy
Z2
12.8473
$546.5677789
Apply surface radiation
Z3
0.8530
$36.2977790
Radiation handling
N177799
Radium/radioisotope therapy
Z2
4.8569
$206.6378000
Thyroid, single uptake
Z3
1.0622
$45.1978001
Thyroid, multiple uptakes
Z3
1.3520
$57.5278003
Thyroid suppress/stimul
Z3
1.0622
$45.1978006
Thyroid imaging with uptake
Z2
2.3432
$99.6978007
Thyroid image, mult uptakes
Z3
2.1085
$89.7078010
Thyroid imaging
Z3
2.2692
$96.5478011
Thyroid imaging with flow
Z2
2.3432
$99.6978015
Thyroid met imaging
Z3
3.0097
$128.0478016
Thyroid met imaging/studies
Z2
3.9934
$169.8978018
Thyroid met imaging, body
Z2
3.9934
$169.8978020
Thyroid met uptake
Z3
1.1346
$48.2778070
Parathyroid nuclear imaging
Z2
2.7146
$115.4978075
Adrenal nuclear imaging
Z2
2.7146
$115.4978099
Endocrine nuclear procedure
Z2
2.3432
$99.6978102
Bone marrow imaging, ltd
Z3
2.3336
$99.2878103
Bone marrow imaging, mult
Z3
3.2431
$137.9778104
Bone marrow imaging, body
Z2
3.9073
$166.2378110
Plasma volume, single
Z3
1.1830
$50.3378111
Plasma volume, multiple
Z3
1.8266
$77.7178120
Red cell mass, single
Z3
1.4566
$61.9778121
Red cell mass, multiple
Z3
1.9634
$83.5378122
Blood volume
Z3
2.6394
$112.2978130
Red cell survival study
Z3
2.4060
$102.3678135
Red cell survival kinetics
Z2
3.7562
$159.8078140
Red cell sequestration
Z3
2.5913
$110.2478185
Spleen imaging
Z3
2.8808
$122.5678190
Platelet survival, kinetics
Z2
2.0057
$85.3378191
Platelet survival
Z2
2.0057
$85.3378195
Lymph system imaging
Z2
3.9073
$166.2378199
Blood/lymph nuclear exam
Z2
3.9073
$166.2378201
Liver imaging
Z3
2.7039
$115.0378202
Liver imaging with flow
Z3
3.1385
$133.5278205
Liver imaging (3D)
Z3
4.2811
$182.1378206
Liver image (3d) with flow
Z2
4.3774
$186.23( print page 42613)78215
Liver and spleen imaging
Z3
2.9453
$125.3078216
Liver & spleen image/flow
Z3
2.3980
$102.0278220
Liver function study
Z3
2.5833
$109.9078223
Hepatobiliary imaging
Z2
4.3774
$186.2378230
Salivary gland imaging
Z3
2.3980
$102.0278231
Serial salivary imaging
Z3
2.2775
$96.8978232
Salivary gland function exam
Z3
2.4143
$102.7178258
Esophageal motility study
Z3
3.2995
$140.3778261
Gastric mucosa imaging
Z2
3.6526
$155.3978262
Gastroesophageal reflux exam
Z2
3.6526
$155.3978264
Gastric emptying study
Z2
3.6526
$155.3978270
Vit B-12 absorption exam
Z3
1.3278
$56.4978271
Vit B-12 absrp exam, int fac
Z3
1.3760
$58.5478272
Vit B-12 absorp, combined
Z3
1.6898
$71.8978278
Acute GI blood loss imaging
Z2
3.6526
$155.3978282
GI protein loss exam
Z2
3.6526
$155.3978290
Meckel's divert exam
Z2
3.6526
$155.3978291
Leveen/shunt patency exam
Z3
3.4765
$147.9078299
GI nuclear procedure
Z2
3.6526
$155.3978300
Bone imaging, limited area
Z3
2.5106
$106.8178305
Bone imaging, multiple areas
Z3
3.4443
$146.5378306
Bone imaging, whole body
Z3
3.9029
$166.0478315
Bone imaging, 3 phase
Z2
3.9174
$166.6678320
Bone imaging (3D)
Z2
3.9174
$166.6678399
Musculoskeletal nuclear exam
Z2
3.9174
$166.6678414
Non-imaging heart function
Z2
4.1265
$175.5578428
Cardiac shunt imaging
Z3
2.8729
$122.2278445
Vascular flow imaging
Z2
2.4204
$102.9778456
Acute venous thrombus image
Z2
2.4204
$102.9778457
Venous thrombosis imaging
Z2
2.4204
$102.9778458
Ven thrombosis images, bilat
Z2
2.4204
$102.9778459
Heart muscle imaging (PET)
Z2
11.8963
$506.1078460
Heart muscle blood, single
Z3
2.6235
$111.6178461
Heart muscle blood, multiple
Z3
3.2673
$139.0078464
Heart image (3d), single
Z2
4.1265
$175.5578465
Heart image (3d), multiple
Z2
6.5012
$276.5878466
Heart infarct image
Z3
2.7039
$115.0378468
Heart infarct image (ef)
Z3
3.7099
$157.8378469
Heart infarct image (3D)
Z2
4.1265
$175.5578472
Gated heart, planar, single
Z2
4.1265
$175.5578473
Gated heart, multiple
Z2
4.9832
$212.0078478
Heart wall motion add-on
Z3
0.8530
$36.2978480
Heart function add-on
Z3
0.8530
$36.2978481
Heart first pass, single
Z3
3.9431
$167.7578483
Heart first pass, multiple
Z2
4.9832
$212.0078491
Heart image (pet), single
Z2
11.8963
$506.1078492
Heart image (pet), multiple
Z2
11.8963
$506.1078494
Heart image, spect
Z2
4.1265
$175.5578496
Heart first pass add-on
Z2
1.5054
$64.0478499
Cardiovascular nuclear exam
Z2
4.1265
$175.5578580
Lung perfusion imaging
Z2
3.1802
$135.3078584
Lung V/Q image single breath
Z3
2.2775
$96.8978585
Lung V/Q imaging
Z2
5.0975
$216.8678586
Aerosol lung image, single
Z3
2.5670
$109.2178587
Aerosol lung image, multiple
Z3
3.1305
$133.1878588
Perfusion lung image
Z3
4.4261
$188.3078591
Vent image, 1 breath, 1 proj
Z3
2.6637
$113.3278593
Vent image, 1 proj, gas
Z3
3.1465
$133.8678594
Vent image, mult proj, gas
Z2
3.1802
$135.3078596
Lung differential function
Z2
5.0975
$216.8678599
Respiratory nuclear exam
Z2
3.1802
$135.3078600
Brain imaging, ltd static
Z3
3.8627
$164.3378601
Brain imaging, ltd w/flow
Z3
3.3315
$141.7378605
Brain imaging, complete
Z3
3.1063
$132.15( print page 42614)78606
Brain imaging, compl w/flow
Z2
4.6418
$197.4878607
Brain imaging (3D)
Z2
4.6418
$197.4878608
Brain imaging (PET)
Z2
13.9166
$592.0578610
Brain flow imaging only
Z3
2.2855
$97.2378615
Cerebral vascular flow image
Z3
3.5327
$150.2978630
Cerebrospinal fluid scan
Z2
3.4923
$148.5778635
CSF ventriculography
Z2
3.4923
$148.5778645
CSF shunt evaluation
Z2
3.4923
$148.5778647
Cerebrospinal fluid scan
Z2
3.4923
$148.5778650
CSF leakage imaging
Z2
3.4923
$148.5778660
Nuclear exam of tear flow
Z3
2.4143
$102.7178699
Nervous system nuclear exam
Z2
4.6418
$197.4878700
Kidney imaging, morphol
Z3
2.8891
$122.9178701
Kidney imaging with flow
Z3
3.4041
$144.8278707
Kflow/funct image w/o drug
Z2
3.4209
$145.5478708
Kflow/funct image w/drug
Z3
2.9373
$124.9678709
Kflow/funct image, multiple
Z2
4.0378
$171.7878710
Kidney imaging (3D)
Z2
3.4209
$145.5478725
Kidney function study
Z2
1.3754
$58.5178730
Urinary bladder retention
Z2
0.6102
$25.9678740
Ureteral reflux study
Z3
2.8649
$121.8878761
Testicular imaging w/flow
Z3
3.0499
$129.7578799
Genitourinary nuclear exam
Z2
3.4209
$145.5478800
Tumor imaging, limited area
Z3
2.9293
$124.6278801
Tumor imaging, mult areas
Z3
3.9271
$167.0778802
Tumor imaging, whole body
Z2
3.9934
$169.8978803
Tumor imaging (3D)
Z2
3.9934
$169.8978804
Tumor imaging, whole body
Z2
5.9245
$252.0578805
Abscess imaging, ltd area
Z3
2.8729
$122.2278806
Abscess imaging, whole body
Z2
3.9934
$169.8978807
Nuclear localization/abscess
Z2
3.9934
$169.8978811
Tumor imaging (pet), limited
Z2
13.9166
$592.0578812
Tumor image (pet)/skul-thigh
Z2
13.9166
$592.0578813
Tumor image (pet) full body
Z2
13.9166
$592.0578814
Tumor image pet/ct, limited
Z2
15.4552
$657.5178815
Tumorimage pet/ct skul-thigh
Z2
15.4552
$657.5178816
Tumor image pet/ct full body
Z2
15.4552
$657.5178890
Nuclear medicine data proc
N178891
Nuclear med data proc
N178999
Nuclear diagnostic exam
Z2
1.3754
$58.5179005
Nuclear rx, oral admin
Z3
1.5370
$65.3979101
Nuclear rx, iv admin
Z3
1.6094
$68.4779200
Nuclear rx, intracav admin
Z3
1.6738
$71.2179300
Nuclr rx, interstit colloid
Z2
3.1779
$135.2079403
Hematopoietic nuclear tx
Z3
2.5591
$108.8779440
Nuclear rx, intra-articular
Z3
1.4968
$63.6879445
Nuclear rx, intra-arterial
Z2
3.1779
$135.2079999
Nuclear medicine therapy
Z2
3.1779
$135.2090371
Hep b ig, im
K2

$133.6990375
Rabies ig, im/sc
K2

$65.4490376
Rabies ig, heat treated
K2

$70.0690396
Varicella-zoster ig, im
K2

$122.7490585
Bcg vaccine, precut
K2

$113.6390675
Rabies vaccine, im
K2

$146.9190676
Rabies vaccine, id
K2

$119.8690708
Measles-rubella vaccine, sc
K2

$45.5390720
Dtp/hib vaccine, im
K2

$58.7090727
Plague vaccine, im
K2

$7.1390733
Meningococcal vaccine, sc
K2

$89.4390734
Meningococcal vaccine, im
K2

$82.0090735
Encephalitis vaccine, sc
K2

$99.11A4218
Sterile saline or water
N1A4220
Infusion pump refill kit
N1A4248
Chlorhexidine antisept
N1( print page 42615)A4262
Temporary tear duct plug
N1A4263
Permanent tear duct plug
N1A4270
Disposable endoscope sheath
N1A4300
Cath impl vasc access portal
N1A4301
Implantable access syst perc
N1A4305
Drug delivery system ≧50 ML
N1A4306
Drug delivery system ≦50 ml
N1A9527
Iodine I-125 sodium iodide
H7A9698
Non-rad contrast materialNOC
N1C1713
Anchor/screw bn/bn,tis/bn
N1C1714
Cath, trans atherectomy, dir
N1C1715
Brachytherapy needle
N1C1716
Brachytx source, Gold 198
H7C1717
Brachytx source, HDR Ir-192
H7C1718
Brachytx source, Iodine 125
H7C1719
Brachytx sour, Non-HDR Ir-192
H7C1720
Brachytx sour, Palladium 103
H7C1721
AICD, dual chamber
N1C1722
AICD, single chamber
N1C1724
Cath, trans atherec, rotation
N1C1725
Cath, translumin non-laser
N1C1726
Cath, bal dil, non-vascular
N1C1727
Cath, bal tis dis, non-vas
N1C1728
Cath, brachytx seed adm
N1C1729
Cath, drainage
N1C1730
Cath, EP, 19 or few elect
N1C1731
Cath, EP, 20 or more elec
N1C1732
Cath, EP, diag/abl, 3D/vect
N1C1733
Cath, EP, othr than cool-tip
N1C1750
Cath, hemodialysis, long-term
N1C1751
Cath, inf, per/cent/midline
N1C1752
Cath, hemodialysis, short-term
N1C1753
Cath, intravas ultrasound
N1C1754
Catheter, intradiscal
N1C1755
Catheter, intraspinal
N1C1756
Cath, pacing, transesoph
N1C1757
Cath, thrombectomy/embolect
N1C1758
Catheter, ureteral
N1C1759
Cath, intra echocardiography
N1C1760
Closure dev, vasc
N1C1762
Conn tiss, human (inc fascia)
N1C1763
Conn tiss, non-human
N1C1764
Event recorder, cardiac
N1C1765
Adhesion barrier
N1C1766
Intro/sheath, strble, non-peel
N1C1767
Generator, neuro non-recharg
N1C1768
Graft, vascular
N1C1769
Guide wire
N1C1770
Imaging coil, MR, insertable
N1C1771
Rep dev, urinary, w/sling
N1C1772
Infusion pump, programmable
N1C1773
Ret dev, insertable
N1C1776
Joint device (implantable)
N1C1777
Lead, AICD, endo single coil
N1C1778
Lead, neurostimulator
N1C1779
Lead, pmkr, transvenous VDD
N1C1780
Lens, intraocular (new tech)
N1C1781
Mesh (implantable)
N1C1782
Morcellator
N1C1783
Ocular imp, aqueous drain de
N1C1784
Ocular dev, intraop, det ret
N1C1785
Pmkr, dual, rate-resp
N1C1786
Pmkr, single, rate-resp
N1C1787
Patient progr, neurostim
N1( print page 42616)C1788
Port, indwelling, imp
N1C1789
Prosthesis, breast, imp
N1C1813
Prosthesis, penile, inflatab
N1C1814
Retinal tamp, silicone oil
N1C1815
Pros, urinary sph, imp
N1C1816
Receiver/transmitter, neuro
N1C1817
Septal defect imp sys
N1C1818
Integrated keratoprosthesis
N1C1819
Tissue localization-excision
N1C1820
Generator neuro rechg bat sy
J7C1821
Interspinous implant
J7C1874
Stent, coated/cov w/del sys
N1C1875
Stent, coated/cov w/o del sy
N1C1876
Stent, non-coa/non-cov w/del
N1C1877
Stent, non-coat/cov w/o del
N1C1878
Matrl for vocal cord
N1C1879
Tissue marker, implantable
N1C1880
Vena cava filter
N1C1881
Dialysis access system
N1C1882
AICD, other than sing/dual
N1C1883
Adapt/ext, pacing/neuro lead
N1C1884
Embolization Protect syst
N1C1885
Cath, translumin angio laser
N1C1887
Catheter, guiding
N1C1888
Endovas non-cardiac abl cath
N1C1891
Infusion pump, non-prog, perm
N1C1892
Intro/sheath, fixed, peel-away
N1C1893
Intro/sheath, fixed, non-peel
N1C1894
Intro/sheath, non-laser
N1C1895
Lead, AICD, endo dual coil
N1C1896
Lead, AICD, non sing/dual
N1C1897
Lead, neurostim test kit
N1C1898
Lead, pmkr, other than trans
N1C1899
Lead, pmkr/AICD combination
N1C1900
Lead, coronary venous
N1C2614
Probe, perc lumb disc
N1C2615
Sealant, pulmonary, liquid
N1C2616
Brachytx source, Yttrium-90
H7C2617
Stent, non-cor, tem w/o del
N1C2618
Probe, cryoablation
N1C2619
Pmkr, dual, non rate-resp
N1C2620
Pmkr, single, non rate-resp
N1C2621
Pmkr, other than sing/dual
N1C2622
Prosthesis, penile, non-inf
N1C2625
Stent, non-cor, tem w/del sy
N1C2626
Infusion pump, non-prog, temp
N1C2627
Cath, suprapubic/cystoscopic
N1C2628
Catheter, occlusion
N1C2629
Intro/sheath, laser
N1C2630
Cath, EP, cool-tip
N1C2631
Rep dev, urinary, w/o sling
N1C2633
Brachytx source, Cesium-131
H7C2634
Brachytx source, HA, I-125
H7C2635
Brachytx source, HA, P-103
H7C2636
Brachytx linear source, P-103
H7C2637
Brachytx, Ytterbium-169
H7C8900
MRA w/cont, abd
Z2
6.1231
$260.50C8901
MRA w/o cont, abd
Z2
5.6745
$241.41C8902
MRA w/o fol w/cont, abd
Z2
8.1155
$345.26C8903
MRI w/cont, breast,  uni
Z2
6.1231
$260.50C8904
MRI w/o cont, breast, uni
Z2
5.6745
$241.41C8905
MRI w/o fol w/cont, brst, un
Z2
8.1155
$345.26C8906
MRI w/cont, breast,  bi
Z2
6.1231
$260.50C8907
MRI w/o cont, breast, bi
Z2
5.6745
$241.41( print page 42617)C8908
MRI w/o fol w/cont, breast,
Z2
8.1155
$345.26C8909
MRA w/cont, chest
Z2
6.1231
$260.50C8910
MRA w/o cont, chest
Z2
5.6745
$241.41C8911
MRA w/o fol w/cont, chest
Z2
8.1155
$345.26C8912
MRA w/cont, lwr ext
Z2
6.1231
$260.50C8913
MRA w/o cont, lwr ext
Z2
5.6745
$241.41C8914
MRA w/o fol w/cont, lwr ext
Z2
8.1155
$345.26C8918
MRA w/cont, pelvis
Z2
6.1231
$260.50C8919
MRA w/o cont, pelvis
Z2
5.6745
$241.41C8920
MRA w/o fol w/cont, pelvis
Z2
8.1155
$345.26C9003
Palivizumab, per 50 mg
K2

$684.43C9113
Inj pantoprazole sodium, via
N1C9121
Injection, argatroban
K2

$18.04C9232
Injection, idursulfase
K2

$455.03C9233
Injection, ranibizumab
K2

$2,030.92C9234
Inj, alglucosidase alfa
K2

$127.20C9235
Injection, panitumumab
K2

$84.80C9350
Porous collagen tube per cm
K2

$485.91C9351
Acellular derm tissue percm2
K2

$41.59C9399
Unclassified drugs or biolog
K7E0616
Cardiac event recorder
N1E0749
Elec osteogen stim implanted
N1E0782
Non-programble infusion pump
N1E0783
Programmable infusion pump
N1E0785
Replacement impl pump cathet
N1E0786
Implantable pump replacement
N1G0130
Single energy x-ray study
Z3
0.5150
$21.91G0173
Linear acc stereo radsur com
Z2
63.3759
$2,696.20G0251
Linear acc based stero radio
Z2
20.3224
$864.58G0288
Recon, CTA for surg plan
Z2
3.2393
$137.81G0339
Robot lin-radsurg com, first
Z2
63.3759
$2,696.20G0340
Robt lin-radsurg fractx 2-5
Z2
43.0297
$1,830.61J0120
Tetracyclin injection
N1J0128
Abarelix injection
K2

$68.62J0129
Abatacept injection
K2

$18.69J0130
Abciximab injection
K2

$413.16J0132
Acetylcysteine injection
K2

$1.95J0133
Acyclovir injection
N1J0135
Adalimumab injection
K2

$319.03J0150
Injection adenosine 6 MG
K2

$22.86J0152
Adenosine injection
K2

$69.16J0170
Adrenalin epinephrin inject
N1J0180
Agalsidase beta injection
K2

$127.20J0190
Inj biperiden lactate/5 mg
K2

$88.15J0200
Alatrofloxacin mesylate
N1J0205
Alglucerase injection
K2

$39.22J0207
Amifostine
K2

$480.64J0210
Methyldopate hcl injection
K2

$10.11J0215
Alefacept
K2

$26.07J0256
Alpha 1 proteinase inhibitor
K2

$3.28J0278
Amikacin sulfate injection
N1J0280
Aminophyllin 250 MG inj
N1J0282
Amiodarone HCl
N1J0285
Amphotericin B
N1J0287
Amphotericin b lipid complex
K2

$10.38J0288
Ampho b cholesteryl sulfate
K2

$12.00J0289
Amphotericin b liposome inj
K2

$17.24J0290
Ampicillin 500 MG inj
N1J0295
Ampicillin sodium per 1.5 gm
N1J0300
Amobarbital 125 MG inj
N1J0330
Succinycholine chloride inj
N1J0348
Anadulafungin injection
K2

$1.91J0350
Injection anistreplase 30 u
K2

$2,693.80J0360
Hydralazine hcl injection
N1( print page 42618)J0364
Apomorphine hydrochloride
K2

$2.99J0365
Aprotonin, 10,000 kiu
K2

$2.52J0380
Inj metaraminol bitartrate
K2

$15.67J0390
Chloroquine injection
N1J0395
Arbutamine HCl injection
K2

$182.40J0456
Azithromycin
N1J0460
Atropine sulfate injection
N1J0470
Dimecaprol injection
N1J0475
Baclofen 10 MG injection
K2

$197.04J0476
Baclofen intrathecal trial
K2

$71.59J0480
Basiliximab
K2

$1,359.97J0500
Dicyclomine injection
N1J0515
Inj benztropine mesylate
N1J0520
Bethanechol chloride inject
N1J0530
Penicillin g benzathine inj
N1J0540
Penicillin g benzathine inj
N1J0550
Penicillin g benzathine inj
N1J0560
Penicillin g benzathine inj
N1J0570
Penicillin g benzathine inj
N1J0580
Penicillin g benzathine inj
N1J0583
Bivalirudin
K2

$1.74J0585
Botulinum toxin a per unit
K2

$5.10J0587
Botulinum toxin type B
K2

$8.37J0592
Buprenorphine hydrochloride
N1J0594
Busulfan injection
K2

$8.89J0595
Butorphanol tartrate 1 mg
N1J0600
Edetate calcium disodium inj
K2

$40.19J0610
Calcium gluconate injection
N1J0620
Calcium glycer & lact/10 ML
N1J0630
Calcitonin salmon injection
N1J0636
Inj calcitriol per 0.1 mcg
N1J0637
Caspofungin acetate
K2

$30.35J0640
Leucovorin calcium injection
N1J0670
Inj mepivacaine HCL/10 ml
N1J0690
Cefazolin sodium injection
N1J0692
Cefepime HCl for injection
N1J0694
Cefoxitin sodium injection
N1J0696
Ceftriaxone sodium injection
N1J0697
Sterile cefuroxime injection
N1J0698
Cefotaxime sodium injection
N1J0702
Betamethasone acet&sod phosp
N1J0704
Betamethasone sod phosp/4 MG
N1J0706
Caffeine citrate injection
K2

$3.36J0710
Cephapirin sodium injection
N1J0713
Inj ceftazidime per 500 mg
N1J0715
Ceftizoxime sodium/500 MG
N1J0720
Chloramphenicol sodium injec
N1J0725
Chorionic gonadotropin/1000u
N1J0735
Clonidine hydrochloride
K2

$63.46J0740
Cidofovir injection
K2

$761.81J0743
Cilastatin sodium injection
N1J0744
Ciprofloxacin iv
N1J0745
Inj codeine phosphate /30 MG
N1J0760
Colchicine injection
N1J0770
Colistimethate sodium inj
N1J0780
Prochlorperazine injection
N1J0795
Corticorelin ovine triflutal
K2

$4.31J0800
Corticotropin injection
K2

$127.73J0835
Inj cosyntropin per 0.25 MG
K2

$63.85J0850
Cytomegalovirus imm IV /vial
K2

$868.05J0878
Daptomycin injection
K2

$0.33J0881
Darbepoetin alfa, non-esrd
K2

$3.14J0885
Epoetin alfa, non-esrd
K2

$9.45J0894
Decitabine injection
K2

$26.48( print page 42619)J0895
Deferoxamine mesylate inj
K2

$14.52J0900
Testosterone enanthate inj
N1J0945
Brompheniramine maleate inj
N1J0970
Estradiol valerate injection
N1J1000
Depo-estradiol cypionate inj
N1J1020
Methylprednisolone 20 MG inj
N1J1030
Methylprednisolone 40 MG inj
N1J1040
Methylprednisolone 80 MG inj
N1J1051
Medroxyprogesterone inj
N1J1060
Testosterone cypionate 1 ML
N1J1070
Testosterone cypionat 100 MG
N1J1080
Testosterone cypionat 200 MG
N1J1094
Inj dexamethasone acetate
N1J1100
Dexamethasone sodium phos
N1J1110
Inj dihydroergotamine mesylt
N1J1120
Acetazolamid sodium injectio
N1J1160
Digoxin injection
N1J1162
Digoxin immune fab (ovine)
K2

$516.35J1165
Phenytoin sodium injection
N1J1170
Hydromorphone injection
N1J1180
Dyphylline injection
N1J1190
Dexrazoxane HCl injection
K2

$174.07J1200
Diphenhydramine hcl injectio
N1J1205
Chlorothiazide sodium inj
K2

$123.84J1212
Dimethyl sulfoxide 50% 50 ML
N1J1230
Methadone injection
N1J1240
Dimenhydrinate injection
N1J1245
Dipyridamole injection
N1J1250
Inj dobutamine HCL/250 mg
N1J1260
Dolasetron mesylate
K2

$6.11J1265
Dopamine injection
N1J1270
Injection, doxercalciferol
N1J1320
Amitriptyline injection
N1J1324
Enfuvirtide injection
K2

$22.91J1325
Epoprostenol injection
N1J1327
Eptifibatide injection
K2

$16.05J1330
Ergonovine maleate injection
K2

$4.00J1335
Ertapenem injection
N1J1364
Erythro lactobionate /500 MG
N1J1380
Estradiol valerate 10 MG inj
N1J1390
Estradiol valerate 20 MG inj
N1J1410
Inj estrogen conjugate 25 MG
K2

$60.90J1430
Ethanolamine oleate 100 mg
K2

$79.01J1435
Injection estrone per 1 MG
N1J1436
Etidronate disodium inj
K2

$71.41J1438
Etanercept injection
K2

$161.55J1440
Filgrastim 300 mcg injection
K2

$189.47J1441
Filgrastim 480 mcg injection
K2

$300.58J1450
Fluconazole
N1J1451
Fomepizole, 15 mg
K2

$12.39J1452
Intraocular Fomivirsen na
K2

$237.50J1455
Foscarnet sodium injection
K2

$10.20J1457
Gallium nitrate injection
N1J1458
Galsulfase injection
K2

$299.92J1460
Gamma globulin 1 CC inj
K2

$11.42J1562
Immune globulin subcutaneous
K2

$12.72J1565
RSV-ivig
K2

$16.18J1566
Immune globulin, powder
K2

$25.72J1567
Immune globulin, liquid
K2

$30.57J1570
Ganciclovir sodium injection
N1J1580
Garamycin gentamicin inj
N1J1590
Gatifloxacin injection
N1J1595
Injection glatiramer acetate
N1J1600
Gold sodium thiomaleate inj
N1( print page 42620)J1610
Glucagon hydrochloride/1 MG
K2

$66.27J1620
Gonadorelin hydroch/ 100 mcg
K2

$180.30J1626
Granisetron HCl injection
K2

$7.50J1630
Haloperidol injection
N1J1631
Haloperidol decanoate inj
N1J1640
Hemin, 1 mg
K2

$6.80J1642
Inj heparin sodium per 10 u
N1J1644
Inj heparin sodium per 1000u
N1J1645
Dalteparin sodium
N1J1650
Inj enoxaparin sodium
N1J1652
Fondaparinux sodium
N1J1655
Tinzaparin sodium injection
K2

$2.45J1670
Tetanus immune globulin inj
K2

$97.26J1700
Hydrocortisone acetate inj
N1J1710
Hydrocortisone sodium ph inj
N1J1720
Hydrocortisone sodium succ i
N1J1730
Diazoxide injection
K2

$114.32J1740
Ibandronate sodium injection
K2

$138.71J1742
Ibutilide fumarate injection
K2

$266.92J1745
Infliximab injection
K2

$53.76J1751
Iron dextran 165 injection
K2

$11.72J1752
Iron dextran 267 injection
K2

$10.42J1756
Iron sucrose injection
K2

$0.37J1785
Injection imiglucerase /unit
K2

$3.92J1790
Droperidol injection
N1J1800
Propranolol injection
N1J1815
Insulin injection
N1J1817
Insulin for insulin pump use
N1J1830
Interferon beta-1b /.25 MG
K2

$84.92J1835
Itraconazole injection
K2

$38.41J1840
Kanamycin sulfate 500 MG inj
N1J1850
Kanamycin sulfate 75 MG inj
N1J1885
Ketorolac tromethamine inj
N1J1890
Cephalothin sodium injection
N1J1931
Laronidase injection
K2

$23.87J1940
Furosemide injection
N1J1945
Lepirudin
K2

$154.89J1950
Leuprolide acetate /3.75 MG
K2

$433.92J1956
Levofloxacin injection
N1J1960
Levorphanol tartrate inj
N1J1980
Hyoscyamine sulfate inj
N1J1990
Chlordiazepoxide injection
N1J2001
Lidocaine injection
N1J2010
Lincomycin injection
N1J2020
Linezolid injection
K2

$25.17J2060
Lorazepam injection
N1J2150
Mannitol injection
N1J2170
Mecasermin injection
K2

$11.93J2175
Meperidine hydrochl /100 MG
N1J2180
Meperidine/promethazine inj
N1J2185
Meropenem
K2

$3.71J2210
Methylergonovin maleate inj
N1J2248
Micafungin sodium injection
K2

$1.71J2250
Inj midazolam hydrochloride
N1J2260
Inj milrinone lactate/5 MG
N1J2270
Morphine sulfate injection
N1J2271
Morphine so4 injection 100 mg
N1J2275
Morphine sulfate injection
N1J2278
Ziconotide injection
K2

$6.52J2280
Inj, moxifloxacin 100 mg
N1J2300
Inj nalbuphine hydrochloride
N1J2310
Inj naloxone hydrochloride
N1J2315
Naltrexone, depot form
K2

$1.90J2320
Nandrolone decanoate 50 MG
N1( print page 42621)J2321
Nandrolone decanoate 100 MG
N1J2322
Nandrolone decanoate 200 MG
N1J2325
Nesiritide injection
K2

$31.66J2353
Octreotide injection, depot
K2

$96.77J2354
Octreotide inj, non-depot
N1J2355
Oprelvekin injection
K2

$247.31J2357
Omalizumab injection
K2

$16.95J2360
Orphenadrine injection
N1J2370
Phenylephrine hcl injection
N1J2400
Chloroprocaine hcl injection
N1J2405
Ondansetron hcl injection
K2

$3.40J2410
Oxymorphone hcl injection
N1J2425
Palifermin injection
K2

$11.43J2430
Pamidronate disodium/30 MG
K2

$30.78J2440
Papaverin hcl injection
N1J2460
Oxytetracycline injection
N1J2469
Palonosetron HCl
K2

$16.00J2501
Paricalcitol
N1J2503
Pegaptanib sodium injection
K2

$1,054.70J2504
Pegademase bovine, 25 iu
K2

$177.83J2505
Injection, pegfilgrastim 6mg
K2

$2,163.33J2510
Penicillin g procaine inj
N1J2513
Pentastarch 10% solution
N1J2515
Pentobarbital sodium inj
N1J2540
Penicillin g potassium inj
N1J2543
Piperacillin/tazobactam
N1J2550
Promethazine hcl injection
N1J2560
Phenobarbital sodium inj
N1J2590
Oxytocin injection
N1J2597
Inj desmopressin acetate
N1J2650
Prednisolone acetate inj
N1J2670
Totazoline hcl injection
N1J2675
Inj progesterone per 50 MG
N1J2680
Fluphenazine decanoate 25 MG
N1J2690
Procainamide hcl injection
N1J2700
Oxacillin sodium injection
N1J2710
Neostigmine methylslfte inj
N1J2720
Inj protamine sulfate/10 MG
N1J2725
Inj protirelin per 250 mcg
N1J2730
Pralidoxime chloride inj
N1J2760
Phentolaine mesylate inj
N1J2765
Metoclopramide hcl injection
N1J2770
Quinupristin/dalfopristin
K2

$117.81J2780
Ranitidine hydrochloride inj
N1J2783
Rasburicase
K2

$132.53J2788
Rho d immune globulin 50 mcg
K2

$26.66J2790
Rho d immune globulin inj
K2

$81.48J2792
Rho(D) immune globulin h, sd
K2

$15.91J2794
Risperidone, long acting
K2

$4.85J2795
Ropivacaine HCl injection
N1J2800
Methocarbamol injection
N1J2805
Sincalide injection
N1J2810
Inj theophylline per 40 MG
N1J2820
Sargramostim injection
K2

$25.31J2850
Inj secretin synthetic human
K2

$20.31J2910
Aurothioglucose injection
N1J2916
Na ferric gluconate complex
N1J2920
Methylprednisolone injection
N1J2930
Methylprednisolone injection
N1J2940
Somatrem injection
K2

$168.90J2941
Somatropin injection
K2

$47.19J2950
Promazine hcl injection
N1J2993
Reteplase injection
K2

$899.51J2995
Inj streptokinase /250000 IU
K2

$129.75( print page 42622)J2997
Alteplase recombinant
K2

$32.79J3000
Streptomycin injection
N1J3010
Fentanyl citrate injeciton
N1J3030
Sumatriptan succinate / 6 MG
K2

$59.38J3070
Pentazocine injection
N1J3100
Tenecteplase injection
K2

$2,043.40J3105
Terbutaline sulfate inj
N1J3120
Testosterone enanthate inj
N1J3130
Testosterone enanthate inj
N1J3140
Testosterone suspension inj
N1J3150
Testosterone propionate inj
N1J3230
Chlorpromazine hcl injection
N1J3240
Thyrotropin injection
K2

$765.38J3243
Tigecycline injection
K2

$0.91J3246
Tirofiban HCl
K2

$7.73J3250
Trimethobenzamide hcl inj
N1J3260
Tobramycin sulfate injection
N1J3265
Injection torsemide 10 mg/ml
N1J3280
Thiethylperazine maleate inj
N1J3285
Treprostinil injection
K2

$55.89J3301
Triamcinolone acetonide inj
N1J3302
Triamcinolone diacetate inj
N1J3303
Triamcinolone hexacetonl inj
N1J3305
Inj trimetrexate glucoronate
K2

$145.26J3310
Perphenazine injection
N1J3315
Triptorelin pamoate
K2

$155.44J3320
Spectinomycn di-hcl inj
K2

$30.08J3350
Urea injection
K2

$74.16J3355
Urofollitropin, 75 iu
K2

$50.70J3360
Diazepam injection
N1J3364
Urokinase 5000 IU injection
N1J3365
Urokinase 250,000 IU inj
K2

$457.73J3370
Vancomycin hcl injection
N1J3396
Verteporfin injection
K2

$8.92J3400
Triflupromazine hcl inj
N1J3410
Hydroxyzine hcl injection
N1J3411
Thiamine hcl 100 mg
N1J3415
Pyridoxine hcl 100 mg
N1J3420
Vitamin b12 injection
N1J3430
Vitamin k phytonadione inj
N1J3465
Injection, voriconazole
K2

$4.99J3470
Hyaluronidase injection
N1J3471
Ovine, up to 999 USP units
N1J3472
Ovine, 1000 USP units
K2

$135.04J3473
Hyaluronidase recombinant
K2

$0.40J3475
Inj magnesium sulfate
N1J3480
Inj potassium chloride
N1J3485
Zidovudine
N1J3486
Ziprasidone mesylate
N1J3487
Zoledronic acid
K2

$206.04J3490
Drugs unclassified injection
N1J3530
Nasal vaccine inhalation
N1J3590
Unclassified biologics
N1J7030
Normal saline solution infus
N1J7040
Normal saline solution infus
N1J7042
5% dextrose/normal saline
N1J7050
Normal saline solution infus
N1J7060
5% dextrose/water
N1J7070
D5w infusion
N1J7100
Dextran 40 infusion
N1J7110
Dextran 75 infusion
N1J7120
Ringers lactate infusion
N1J7130
Hypertonic saline solution
N1J7187
Inj Vonwillebrand factor IU
K2

$0.88( print page 42623)J7189
Factor viia
K2

$1.12J7190
Factor viii
K2

$0.70J7191
Factor VIII (porcine)
K2

$0.75J7192
Factor viii recombinant
K2

$1.07J7193
Factor IX non-recombinant
K2

$0.89J7194
Factor ix complex
K2

$0.75J7195
Factor IX recombinant
K2

$0.99J7197
Antithrombin iii injection
K2

$1.64J7198
Anti-inhibitor
K2

$1.36J7308
Aminolevulinic acid hcl top
K2

$105.43J7310
Ganciclovir long act implant
K2

$4,752.26J7311
Fluocinolone acetonide implt
K2

$19,345.00J7340
Metabolic active D/E tissue
K2

$28.78J7341
Non-human, metabolic tissue
K2

$1.82J7342
Metabolically active tissue
K2

$31.66J7343
Nonmetabolic act d/e tissue
K2

$18.30J7344
Nonmetabolic active tissue
K2

$89.21J7345
Non-human, non-metab tissue
K2

$36.10J7346
Injectable human tissue
K2

$735.38J7500
Azathioprine oral 50 mg
N1J7501
Azathioprine parenteral
K2

$48.44J7502
Cyclosporine oral 100 mg
K2

$3.60J7504
Lymphocyte immune globulin
K2

$317.18J7505
Monoclonal antibodies
K2

$895.15J7506
Prednisone oral
N1J7507
Tacrolimus oral per 1 MG
K2

$3.66J7509
Methylprednisolone oral
N1J7510
Prednisolone oral per 5 mg
N1J7511
Antithymocyte globuln rabbit
K2

$327.75J7513
Daclizumab, parenteral
K2

$299.86J7515
Cyclosporine oral 25 mg
N1J7516
Cyclosporin parenteral 250 mg
N1J7517
Mycophenolate mofetil oral
K2

$2.62J7518
Mycophenolic acid
K2

$2.27J7520
Sirolimus, oral
K2

$7.22J7525
Tacrolimus injection
K2

$140.44J7599
Immunosuppressive drug noc
N1J7674
Methacholine chloride, neb
N1J7799
Non-inhalation drug for DME
N1J8501
Oral aprepitant
K2

$5.07J8510
Oral busulfan
K2

$2.14J8520
Capecitabine, oral, 150 mg
K2

$3.97J8530
Cyclophosphamide oral 25 MG
N1J8540
Oral dexamethasone
N1J8560
Etoposide oral 50 MG
K2

$29.60J8597
Antiemetic drug oral NOS
N1J8600
Melphalan oral 2 MG
N1J8610
Methotrexate oral 2.5 MG
N1J8650
Nabilone oral
K2

$16.96J8700
Temozolomide
K2

$7.41J9000
Doxorubic hcl 10 MG vl chemo
K2

$6.31J9001
Doxorubicin hcl liposome inj
K2

$389.48J9010
Alemtuzumab injection
K2

$541.20J9015
Aldesleukin/single use vial
K2

$762.98J9017
Arsenic trioxide
K2

$34.17J9020
Asparaginase injection
K2

$54.72J9025
Azacitidine injection
K2

$4.30J9027
Clofarabine injection
K2

$116.75J9031
Bcg live intravesical vac
K2

$110.67J9035
Bevacizumab injection
K2

$57.53J9040
Bleomycin sulfate injection
K2

$35.85J9041
Bortezomib injection
K2

$32.68J9045
Carboplatin injection
K2

$8.46J9050
Carmus bischl nitro inj
K2

$139.84( print page 42624)J9055
Cetuximab injection
K2

$49.81J9060
Cisplatin 10 MG injection
N1J9065
Inj cladribine per 1 MG
K2

$36.12J9070
Cyclophosphamide 100 MG inj
N1J9093
Cyclophosphamide lyophilized
K2

$1.99J9098
Cytarabine liposome
K2

$395.04J9100
Cytarabine hcl 100 MG inj
N1J9120
Dactinomycin actinomycin d
K2

$493.43J9130
Dacarbazine 100 mg inj
K2

$5.25J9150
Daunorubicin
K2

$20.47J9151
Daunorubicin citrate liposom
K2

$55.92J9160
Denileukin diftitox, 300 mcg
K2

$1,406.59J9165
Diethylstilbestrol injection
N1J9170
Docetaxel
K2

$306.81J9175
Elliotts b solution per ml
N1J9178
Inj, epirubicin hcl, 2 mg
K2

$21.21J9181
Etoposide 10 MG inj
N1J9185
Fludarabine phosphate inj
K2

$236.44J9190
Fluorouracil injection
N1J9200
Floxuridine injection
K2

$51.31J9201
Gemcitabine HCl
K2

$125.16J9202
Goserelin acetate implant
K2

$198.68J9206
Irinotecan injection
K2

$126.00J9208
Ifosfomide injection
K2

$46.59J9209
Mesna injection
K2

$8.97J9211
Idarubicin hcl injection
K2

$304.61J9212
Interferon alfacon-1
K2

$4.65J9213
Interferon alfa-2a inj
K2

$37.89J9214
Interferon alfa-2b inj
K2

$13.88J9215
Interferon alfa-n3 inj
K2

$9.12J9216
Interferon gamma 1-b inj
K2

$289.87J9217
Leuprolide acetate suspnsion
K2

$229.50J9218
Leuprolide acetate injeciton
K2

$8.88J9219
Leuprolide acetate implant
K2

$1,713.12J9225
Histrelin implant
K2

$1,460.77J9230
Mechlorethamine hcl inj
K2

$141.61J9245
Inj melphalan hydrochl 50 MG
K2

$1,284.12J9250
Methotrexate sodium inj
N1J9261
Nelarabine injection
K2

$83.33J9263
Oxaliplatin
K2

$8.97J9264
Paclitaxel protein bound
K2

$8.73J9265
Paclitaxel injection
K2

$12.59J9266
Pegaspargase/singl dose vial
K2

$1,683.49J9268
Pentostatin injection
K2

$1,934.91J9270
Plicamycin (mithramycin) inj
K2

$172.41J9280
Mitomycin 5 MG inj
K2

$16.13J9293
Mitoxantrone hydrochl / 5 MG
K2

$168.23J9300
Gemtuzumab ozogamicin
K2

$2,356.98J9305
Pemetrexed injection
K2

$43.79J9310
Rituximab cancer treatment
K2

$496.22J9320
Streptozocin injection
K2

$153.73J9340
Thiotepa injection
K2

$40.70J9350
Topotecan
K2

$830.74J9355
Trastuzumab
K2

$57.87J9357
Valrubicin, 200 mg
K2

$77.96J9360
Vinblastine sulfate inj
N1J9370
Vincristine sulfate 1 MG inj
N1J9390
Vinorelbine tartrate/10 mg
K2

$20.07J9395
Injection, Fulvestrant
K2

$80.56J9600
Porfimer sodium
K2

$2,563.31J9999
Chemotherapy drug
N1L8600
Implant breast silicone/eq
N1L8603
Collagen imp urinary 2.5 ml
N1L8606
Synthetic implnt urinary 1ml
N1( print page 42625)L8609
Artificial cornea
N1L8610
Ocular implant
N1L8612
Aqueous shunt prosthesis
N1L8613
Ossicular implant
N1L8614
Cochlear device
N1L8630
Metacarpophalangeal implant
N1L8631
MCP joint repl 2 pc or more
N1L8641
Metatarsal joint implant
N1L8642
Hallux implant
N1L8658
Interphalangeal joint spacer
N1L8659
Interphalangeal joint repl
N1L8670
Vascular graft, synthetic
N1L8682
Implt neurostim radiofq rec
N1L8690
Aud osseo dev, int/ext comp
J7L8699
Prosthetic implant NOS
N1Q0163
Diphenhydramine HCl 50mg
N1Q0164
Prochlorperazine maleate 5mg
N1Q0166
Granisetron HCl 1 mg oral
K2

$44.87Q0167
Dronabinol 2.5 mg oral
N1Q0169
Promethazine HCl 12.5 mg oral
N1Q0171
Chlorpromazine HCl 10 mg oral
N1Q0173
Trimethobenzamide HCl 250 mg
N1Q0174
Thiethylperazine maleate 10 mg
N1Q0175
Perphenazine 4 mg oral
N1Q0177
Hydroxyzine pamoate 25 mg
N1Q0179
Ondansetron HCl 8 mg oral
K2

$36.55Q0180
Dolasetron mesylate oral
K2

$47.52Q0515
Sermorelin acetate injection
K2

$1.75Q1003
Ntiol category 3
L6

$50.00Q2004
Bladder calculi irrig sol
N1Q2009
Fosphenytoin, 50 mg
K2

$5.66Q2017
Teniposide, 50 mg
K2

$264.09Q3025
IM inj interferon beta 1-a
K2

$114.57Q4079
Natalizumab injection
K2

$7.52Q4083
Hyalgan/supartz inj per dose
K2

$104.85Q4084
Synvisc inj per dose
K2

$186.66Q4085
Euflexxa inj per dose
K2

$115.16Q4086
Orthovisc inj per dose
K2

$198.34Q9945
LOCM ≦149 mg/ml iodine, 1 ml
K2

$0.42Q9946
LOCM 150-199 mg/ml iodine,1 ml
K2

$1.95Q9947
LOCM 200-249 mg/ml iodine,1 ml
K2

$1.33Q9948
LOCM 250-299 mg/ml iodine,1 ml
K2

$0.36Q9949
LOCM 300-349 mg/ml iodine,1 ml
K2

$0.37Q9950
LOCM 350-399 mg/ml iodine,1 ml
K2

$0.22Q9951
LOCM ≧ 400 mg/ml iodine,1 ml
K2

$0.22Q9952
Inj Gad-base MR contrast,1 ml
K2

$2.82Q9953
Inj Fe-based MR contrast,1 ml
K2

$30.41Q9954
Oral MR contrast, 100 ml
K2

$8.82Q9955
Inj perflexane lip micros, ml
K2

$12.96Q9956
Inj octafluoropropane mic, ml
K2

$49.61Q9957
Inj perflutren lip micros, ml
K2

$61.55Q9958
HOCM ≦149 mg/ml iodine, 1ml
N1Q9959
HOCM 150-199 mg/ml iodine, 1ml
N1Q9960
HOCM 200-249 mg/ml iodine, 1 ml
N1Q9961
HOCM 250-299 mg/ml iodine, 1ml
N1Q9962
HOCM 300-349 mg/ml iodine, 1 ml
N1Q9963
HOCM 350-399 mg/ml iodine, 1ml
N1Q9964
HOCM≧ 400 mg/ml iodine, 1 ml
N1V2630
Anter chamber intraocul lens
N1V2631
Iris support intraoclr lens
N1V2632
Post chmbr intraocular lens
N1V2785
Corneal tissue processing
F4( print page 42626)V2790
Amniotic membrane
N1**Note:**
                             The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent.
 
 
  Addendum DD1.—Illustrative ASC Payment Indicators
Indicator
Payment indicator definitionA2
Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.F4
Corneal tissue acquisition; paid at reasonable cost.G2
Non office-based surgical procedure added to ASC list in CY 2008 or later; payment based on OPPS relative payment weight.H7
Brachytherapy source paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced.H8
Device-intensive procedure on ASC list in CY 2007; paid at adjusted rate.J7
OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced.J8
Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.K2
Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.K7
Unclassified drugs and biologicals; payment contractor-priced.L6
New Technology Intraocular Lens (NTIOL); special payment.N1
Packaged procedure/item; no separate payment made.P2
Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight.P3
Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs.R2
Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight.Z2
Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight.Z3
Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on MPFS nonfacility PE RVUs.


[FR Doc. 07-3490 Filed 7-16-07; 4:00 pm] BILLING CODE 4120-01-P