[Federal Register Volume 72, Number 148 (Thursday, August 2, 2007)]
[Proposed Rules]
[Pages 42628-43129]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 07-3509]



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Part III

Book 2 of 2 Books

Pages 42627-43130





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Parts 410, 411, 414 et al.



Medicare and Medicaid Programs: CY 2008 Proposed Changes; Proposed Rule

Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / 
Proposed Rules

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410, 411, 414, 416, 419, 482, and 485

[CMS-1392-P]
RIN 0938-AO71


Medicare Program: Proposed Changes to the Hospital Outpatient 
Prospective Payment System and CY 2008 Payment Rates; Proposed Changes 
to the Ambulatory Surgical Center Payment System and CY 2008 Payment 
Rates; Medicare and Medicaid Programs: Proposed Changes to Hospital 
Conditions of Participation; Proposed Changes Affecting Necessary 
Provider Designations of Critical Access Hospitals

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Proposed rule.

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SUMMARY: This proposed rule would revise the Medicare hospital 
outpatient prospective payment system to implement applicable statutory 
requirements and changes arising from our continuing experience with 
this system. In this proposed rule, we describe the proposed changes to 
the amounts and factors used to determine the payment rates for 
Medicare hospital outpatient services paid under the prospective 
payment system. These changes would be applicable to services furnished 
on or after January 1, 2008.
    In addition, this proposed rule would update the revised Medicare 
ambulatory surgical center (ASC) payment system to implement certain 
related provisions of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA). In this proposed rule, we propose the 
applicable relative payment weights and amounts for services furnished 
in ASCs, specific HCPCS codes to which the final policies of the ASC 
payment system would apply, and other pertinent ratesetting information 
for the CY 2008 ASC payment system. These changes would be applicable 
to services furnished on or after January 1, 2008.
    In this proposed rule, we also are proposing changes to the 
policies relating to the necessary provider designations of critical 
access hospitals (CAHs) that are being recertified when a CAH enters 
into a new co-location arrangement with another hospital or CAH or when 
the CAH creates or acquires an off-campus location.
    Further, we are proposing changes to several of the current 
conditions of participation that hospitals must meet to participate in 
the Medicare and Medicaid programs to require the completion and 
documentation in the medical record of medical histories and physical 
examinations of patients conducted after admission and prior to surgery 
or a procedure requiring anesthesia services and for postanesthesia 
evaluations of patients before discharge or transfer from the 
postanesthesia recovery area.

DATES: To be assured consideration, comments on all sections of the 
preamble of this proposed rule must be received at one of the addresses 
provided in the ADDRESSES section no later than 5 p.m. on September 14, 
2007.

ADDRESSES: In commenting, please refer to file code CMS-1392-P. Because 
of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission.
    You may submit comments in one of four ways (no duplicates, 
please):
    1. Electronically. You may submit electronic comments on specific 
issues in this regulation to http://www.cms.hhs.gov/eRulemaking. Click 
on the link ``Submit electronic comments on CMS regulations with an 
open comment period.'' (Attachments should be in Microsoft Word, 
WordPerfect, or Excel; however, we prefer Microsoft Word.)
    2. By regular mail. You may mail written comments (one original and 
two copies) to the following address ONLY: Centers for Medicare & 
Medicaid Services, Department of Health and Human Services, Attention: 
CMS- 1392-P, P.O. Box 8011, Baltimore, MD 21244-1850.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments (one 
original and two copies) to the following address ONLY: Centers for 
Medicare & Medicaid Services, Department of Health and Human Services, 
Attention: CMS-1392-P, Mail Stop C4-26-05, 7500 Security Boulevard, 
Baltimore, MD 21244-1850.
    4. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments (one original and two copies) before the 
close of the comment period to one of the following addresses: Room 
445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD 21244-
1850.
    If you intend to deliver your comments to the Baltimore address, 
please call telephone number (410) 786-9994 in advance to schedule your 
arrival with one of our staff members.
    (Because access to the interior of the Hubert H. Humphrey Building 
is not readily available to persons without Federal Government 
identification, commenters are encouraged to leave their comments in 
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain proof of filing by 
stamping in and retaining an extra copy of the comments being filed.)
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and received after the comment 
period.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: 
Alberta Dwivedi, (410) 786-0378, Hospital outpatient prospective 
payment issues.
Dana Burley, (410) 786-0378, Ambulatory surgical center issues.
Suzanne Asplen, (410) 786-4558, Partial hospitalization and community 
mental health centers issues.
Sheila Blackstock, (410) 786-3502, Reporting of quality data issues.
Mary Collins, (410) 786-3189, and
Jeannie Miller, (410) 786-3164, Necessary provider designations for 
CAHs Issues.
Scott Cooper, (410) 786-9465, and
Jeannie Miller, (410) 786-3164, Hospital conditions of participation 
Issues.

SUPPLEMENTARY INFORMATION: 
    Submitting Comments: We welcome comments from the public on all 
issues set forth in this proposed rule to assist us in fully 
considering issues and developing policies. You can assist us by 
referencing file code CMS-1392-P and the specific ``issue identifier'' 
that precedes the section on which you choose to comment.
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. We post all comments 
received before the close of the comment period on the following Web 
site as soon as possible after they have been received: http://www.cms.hhs.gov/eRulemaking. Click on the link ``Electronic Comments on 
CMS Regulations'' on that Web site to view public comments.
    Comments received timely will also be available for public 
inspection as they are received, generally beginning approximately 3 
weeks after publication

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of a document, at the headquarters of the Centers for Medicare & 
Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244, on 
Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule 
an appointment to view public comments, phone 1-800-743-3951.

Electronic Access

    This Federal Register document is also available from the Federal 
Register online database through GPO Access, a service of the U.S. 
Government Printing Office. Free public access is available on a Wide 
Area Information Server (WAIS) through the Internet and via 
asynchronous dial-in. Internet users can access the database by using 
the World Wide Web; the Superintendent of Documents' home page address 
is http://www.gpoaccess.gov/index.html, by using local WAIS client 
software, or by telnet to swais.access.gpo.gov, then login as guest (no 
password required). Dial-in users should use communications software 
and modem to call (202) 512-1661; type swais, then login as guest (no 
password required).

Alphabetical List of Acronyms Appearing in the Proposed Rule

ACEP American College of Emergency Physicians
AHA American Hospital Association
AHIMA American Health Information Management Association
AMA American Medical Association
APC Ambulatory payment classification
AMP Average manufacturer price
ASC Ambulatory Surgical Center
ASP Average sales price
AWP Average wholesale price
BBA Balanced Budget Act of 1997, Pub. L. 105-33
BBRA Medicare, Medicaid, and SCHIP [State Children's Health Insurance 
Program] Balanced Budget Refinement Act of 1999, Pub. L. 106-113
BCA Blue Cross Association
BCBSA Blue Cross and Blue Shield Association
BIPA Medicare, Medicaid, and SCHIP Benefits Improvement and Protection 
Act of 2000, Pub. L. 106-554
CAH Critical access hospital
CAP Competitive Acquisition Program
CBSA Core-Based Statistical Area
CCR Cost-to-charge ratio
CERT Comprehensive Error Rate Testing
CMHC Community mental health center
CMS Centers for Medicare & Medicaid Services
CoP [Hospital] Condition of participation
CORF Comprehensive outpatient rehabilitation facility
CPT [Physicians'] Current Procedural Terminology, Fourth Edition, 2007, 
copyrighted by the American Medical Association
CRNA Certified registered nurse anesthetist
CY Calendar year
DMEPOS Durable medical equipment, prosthetics, orthotics, and supplies
DMERC Durable medical equipment regional carrier
DRA Deficit Reduction Act of 2005, Pub. L. 109-171
DSH Disproportionate share hospital
EACH Essential Access Community Hospital
E/M Evaluation and management
EPO Erythropoietin
ESRD End-stage renal disease
FACA Federal Advisory Committee Act, Pub. L. 92-463
FAR Federal Acquisition Regulations
FDA Food and Drug Administration
FFS Fee-for-service
FSS Federal Supply Schedule
FTE Full-time equivalent
FY Federal fiscal year
GAO Government Accountability Office
HCPCS Healthcare Common Procedure Coding System
HCRIS Hospital Cost Report Information System
HHA Home health agency
HIPAA Health Insurance Portability and Accountability Act of 1996, Pub. 
L. 104-191
HOPD Hospital outpatient department
HOP QDRP Hospital Outpatient Quality Data Reporting Program
ICD-9-CM International Classification of Diseases, Ninth Edition, 
Clinical Modification
IDE Investigational device exemption
IOL Intraocular lens
IPPS [Hospital] Inpatient prospective payment system
IVIG Intravenous immune globulin
MAC Medicare Administrative Contractors
MedPAC Medicare Payment Advisory Commission
MDH Medicare-dependent, small rural hospital
MIEA-TRHCA Medicare Improvements and Extension Act under Division B, 
Title I of the Tax Relief Health Care Act of 2006, Pub. L. 109-432
MMA Medicare Prescription Drug, Improvement, and Modernization Act of 
2003, Pub. L. 108-173
MPFS Medicare Physician Fee Schedule
MSA Metropolitan Statistical Area
NCCI National Correct Coding Initiative
NCD National Coverage Determination
NTIOL New technology intraocular lens
OCE Outpatient Code Editor
OMB Office of Management and Budget
OPD [Hospital] Outpatient department
OPPS [Hospital] Outpatient prospective payment system
PHP Partial hospitalization program
PM Program memorandum
PPI Producer Price Index
PPS Prospective payment system
PPV Pneumococcal pneumonia (virus)
PRA Paperwork Reduction Act
QIO Quality Improvement Organization
RFA Regulatory Flexibility Act
RHQDAPU Reporting Hospital Quality Data for Annual Payment Update 
[Program]
RHHI Regional home health intermediary
SBA Small Business Administration
SCH Sole community hospital
SDP Single Drug Pricer
SI Status indicator
TEFRA Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248
TOPS Transitional outpatient payments
USPDI United States Pharmacopoeia Drug Information
WAC Wholesale acquisition cost

    In this document, we address two payment systems under the Medicare 
program: the hospital outpatient prospective payment system (OPPS) and 
the revised ambulatory surgical center (ASC) revised payment system. 
The provisions relating to the OPPS are included in sections I. through 
XV., XVII., and XIX. through XXII. of this proposed rule and in Addenda 
A, B, C (Addendum C is available on the Internet only; see section XIX. 
of this proposed rule), D1, D2, E, L, and M to this proposed rule. The 
provisions related to the revised ASC payment system are included in 
sections XVI., XVII., and XIX. through XXII. of this proposed rule and 
in Addenda AA, BB, DD1, and DD2 to this proposed rule.

Table of Contents

I. Background for the OPPS
    A. Legislative and Regulatory Authority for the Hospital 
Outpatient Prospective Payment System
    B. Excluded OPPS Services and Hospitals
    C. Prior Rulemaking
    D. APC Advisory Panel
    1. Authority of the APC Panel
    2. Establishment of the APC Panel
    3. APC Panel Meetings and Organizational Structure
    E. Provisions of the Medicare Improvements and Extension Act 
under Division B of Title I of the Tax Relief and Health Care Act of 
2006

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    F. Summary of the Major Contents of This Proposed Rule
    1. Proposed Updates Affecting OPPS Payments
    2. Proposed OPPS Ambulatory Payment Classification (APC) Group 
Policies
    3. Proposed OPPS Payment for Devices
    4. Proposed OPPS Payment for Drugs, Biologicals, and 
Radiopharmaceuticals
    5. Proposed Estimate of OPPS Transitional Pass-Through Spending 
for Drugs, Biologicals, and Devices
    6. Proposed OPPS Payment for Brachytherapy Sources
    7. Proposed OPPS Coding and Payment for Drug Administration 
Services
    8. Proposed OPPS Hospital Coding and Payment for Visits
    9. Proposed OPPS Payment for Blood and Blood Products
    10. Proposed OPPS Payment for Observation Services
    11. Proposed Procedures That Will Be Paid Only as Inpatient 
Services
    12. Proposed Nonrecurring Technical and Policy Changes
    13. Proposed OPPS Payment Status and Comment Indicators
    14. OPPS Policy and Payment Recommendations
    15. Proposed Update of the Revised ASC Payment System
    16. Proposed Quality Data for Annual Payment Updates
    17. Proposed Changes Affecting Necessary Provider Critical 
Access Hospitals (CAHs) and Hospital Conditions of Participation 
(CoPs)
    18. Regulatory Impact Analysis
II. Proposed Updates Affecting OPPS Payments
    A. Proposed Recalibration of APC Relative Weights
    1. Database Construction
    a. Database Source and Methodology
    b. Proposed Use of Single and Multiple Procedure Claims
    (1) Proposed Use of Date of Service Stratification and a Bypass 
List To Increase the Amount of Data Used To Determine Medians
    (2) Exploration of Allocation of Packaged Costs to Separately 
Paid Procedure Codes
    c. Proposed Calculation of CCRs
    2. Proposed Calculation of Median Costs
    3. Proposed Calculation of OPPS Scaled Payment Weights
    4. Proposed Changes to Packaged Services
    a. Background
    b. Addressing Growth in OPPS Volume and Spending
    c. Proposed Packaging Approach
    (1) Guidance Services
    (2) Image Processing Services
    (3) Intraoperative Services
    (4) Imaging Supervision and Interpretation Services
    (5) Diagnostic Radiopharmaceuticals
    (6) Contrast Agents
    (7) Observation Services
    d. Proposed Development of Composite APCs
    (1) Background
    (2) Proposed Low Dose Rate (LDR) Prostate Brachytherapy 
Composite APC
    (a) Background
    (b) Proposed Payment for LDR Prostate Brachytherapy
    (3) Proposed Cardiac Electrophysiologic Evaluation and Ablation 
Composite APC
    (a) Background
    (b) Proposed Payment for Cardiac Electrophysiologic Evaluation 
and Ablation
    e. Service-Specific Packaging Issues
    B. Proposed Payment for Partial Hospitalization
    1. Background
    2. Proposed PHP APC Update
    3. Proposed Separate Threshold for Outlier Payments to CMHCs
    C. Proposed Conversion Factor Update
    D. Proposed Wage Index Changes
    E. Proposed Statewide Average Default CCRs
    F. Proposed OPPS Payments to Certain Rural Hospitals
    1. Hold Harmless Transitional Payment Changes Made by Pub. L. 
109-171 (DRA)
    2. Proposed Adjustment for Rural SCHs Implemented in CY 2006 
Related to Pub. L. 108-173 (MMA)
    G. Proposed Hospital Outpatient Outlier Payments
    H. Calculation of the Proposed National Unadjusted Medicare 
Payment
    I. Proposed Beneficiary Copayments
    1. Background
    2. Proposed Copayment
    3. Calculation of a Proposed Adjusted Copayment Amount for an 
APC Group
III. Proposed OPPS Ambulatory Payment Classification (APC) Group 
Policies
    A. Proposed Treatment of New HCPCS and CPT Codes
    1. Proposed Treatment of New HCPCS Codes Included in the April 
and July Quarterly OPPS Updates for CY 2007
    2. Proposed Treatment of New Category I and III CPT Codes and 
Level II HCPCS Codes
    B. Proposed Changes--Variations Within APCs
    1. Background
    2. Application of the 2 Times Rule
    3. Proposed Exceptions to the 2 Times Rule
    C. New Technology APCs
    1. Introduction
    2. Proposed Movement of Procedures From New Technology APCs to 
Clinical APCs
    a. Positron Emission Tomography (PET)/Computed Tomography (CT) 
Scans (New Technology APC 1511)
    b. IVIG Preadministration-Related Services (New Technology APC 
1502)
    c. Other Services in New Technology APCs
    D. Proposed APC-Specific Policies
    1. Hyperbaric Oxygen Therapy (APC 0659)
    2. Skin Repair Procedures (APCs 0024, 0025, 0027, and 0686)
    3. Cardiac Computed Tomography and Computed Tomographic 
Angiography (APCs 0282, 0376, 0377, and 0398)
    4. Ultrasound Ablation of Uterine Fibroids With Magnetic 
Resonance Guidance (MRgFUS) (APCs 0195 and 0202)
    5. Single Allergy Tests (APC 0381)
    6. Myocardial Positron Emission Tomography (PET) Scans (APC 
0307)
    7. Implantation of Cardioverter-Defibrillators (APCs 0107 and 
0108)
    8. Implantation of Spinal Neurostimulators (APC 0222)
    9. Stereotactic Radiosurgery (SRS) Treatment Delivery Services 
(APCs 0065, 0066, and 0067)
    10. Blood Transfusion (APC 0110)
    11. Screening Colonscopies and Screening Flexible 
Sigmoidoscopies (APCs 0158 and 0159)
IV. Proposed OPPS Payment for Devices
    A. Proposed Treatment of Device-Dependent APCs
    1. Background
    2. Proposed Payment
    3. Proposed Payment When Devices Are Replaced With Partial 
Credit to the Hospital
    B. Pass-Through Payments for Devices
    1. Expiration of Transitional Pass-Through Payments for Certain 
Devices
    a. Background
    b. Proposed Policy
    2. Proposed Provisions for Reducing Transitional Pass-Through 
Payments to Offset Costs Packaged Into APC Groups
    a. Background
    b. Proposed Policy
V. Proposed OPPS Payment Changes for Drugs, Biologicals, and 
Radiopharmaceuticals
    A. Proposed Transitional Pass-Through Payment for Additional 
Costs of Drugs and Biologicals
    1. Background
    2. Drugs and Biologicals with Expiring Pass-Through Status in CY 
2007
    3. Drugs and Biologicals With Proposed Pass-Through Status in CY 
2008
    B. Proposed Payment for Drugs, Biologicals, and 
Radiopharmaceuticals Without Pass-Through Status
    1. Background
    2. Proposed Criteria for Packaging Payment for Drugs and 
Biologicals
    3. Proposed Payment for Drugs and Biologicals Without Pass-
Through Status That Are Not Packaged
    a. Payment for Specified Covered Outpatient Drugs
    (1) Background
    (2) Proposed Payment Policy
    (3) Proposed Payment for Blood Clotting Factors
    (4) Proposed Payment for Radiopharmaceuticals
    (a) Background
    (b) Proposed Payment for Diagnostic Radiopharmaceuticals
    (c) Proposed Payment for Therapeutic Radiopharmaceuticals
    b. Proposed Payment for Nonpass-Through Drugs, Biologicals, and 
Radiopharmaceuticals With HCPCS Codes, But Without OPPS Hospital 
Claims Data
VI. Proposed Estimate of OPPS Transitional Pass-Through Spending for 
Drugs, Biologicals, Radiopharmaceuticals, and Devices
    A. Total Allowed Pass-Through Spending
    B. Proposed Estimate of Pass-Through Spending
VII. Proposed OPPS Payment for Brachytherapy Sources
    A. Background
    B. Proposed Payment for Brachytherapy Sources

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VIII. Proposed OPPS Drug Administration Coding and Payment
    A. Background
    B. Proposed Coding and Payment for Drug Administration Services
IX. Proposed Hospital Coding and Payments for Visits
    A. Background
    B. Proposed Policies for Hospital Outpatient Visits
    1. Clinic Visits: New and Established Patient Visits and 
Consultations
    2. Emergency Department Visits
    C. Proposed Visit Reporting Guidelines
    1. Background
    2. CY 2007 Work on Visit Guidelines
    3. Proposed Visit Guidelines
X. Proposed OPPS Payment for Blood and Blood Products
    A. Background
    B. Proposed Payment for Blood and Blood Products
XI. Proposed OPPS Payment for Observation Services
XII. Proposed Procedures That Will Be Paid Only as Inpatient 
Procedures
    A. Background
    B. Proposed Changes to the Inpatient List
XIII. Proposed Nonrecurring Technical and Policy Changes
    A. Outpatient Hospital Services and Supplies Incident to a 
Physician Service
    B. Interrupted Procedures
    C. Transitional Adjustments Hold Harmless Provisions
    D. Reporting of Wound Care Services
    E. Reporting of Cardiac Rehabilitation Services
    F. Reporting of Bone Marrow and Stem Cell Processing Services
XIV. Proposed OPPS Payment Status and Comment Indicators
    A. Proposed Payment Status Indicator Definitions
    1. Proposed Payment Status Indicators to Designate Services That 
Are Paid under the OPPS
    2. Proposed Payment Status Indicators to Designate Services That 
Are Paid Under a Payment System Other Than the OPPS
    3. Proposed Payment Status Indicators to Designate Services That 
Are Not Recognized under the OPPS But That May Be Recognized by 
Other Institutional Providers
    4. Proposed Payment Status Indicators to Designate Services That 
Are Not Payable by Medicare
    B. Proposed Comment Indicator Definitions
XV. OPPS Policy and Payment Recommendations
    A. MedPAC Recommendations
    B. APC Panel Recommendations
XVI. Proposed Update of the Revised Ambulatory Surgical Center 
Payment System
    A. Legislative and Regulatory Authority for the ASC Payment 
System
    B. Rulemaking for the Revised ASC Payment System
    C. Revisions to the ASC Payment System Effective January 1, 2008
    1. Covered Surgical Procedures under the Revised ASC Payment 
System
    a. Definition of Surgical Procedure
    b. Identification of Surgical Procedures Eligible for Payment 
under the Revised ASC Payment System
    c. Payment for Covered Surgical Procedures under the Revised ASC 
Payment System
    (1) General Policies
    (2) Office-Based Procedures
    (3) Device-Intensive Procedures
    (4) Multiple and Interrupted Procedure Discounting
    (5) Transition to Revised ASC Payment Rates
    2. Covered Ancillary Services under the Revised ASC Payment 
System
    a. General Policies
    b. Payment Policies for Specific Items and Services
    (1) Radiology Services
    (2) Brachytherapy Sources
    (3) Drugs and Biologicals
    (4) Implantable Devices with Pass-Through Status under the OPPS
    (5) Corneal Tissue Acquisition
    3. General Payment Policies
    a. Geographic Adjustment
    b. Beneficiary Coinsurance
    D. Proposed Treatment of New HCPCS Codes
    1. Treatment of New CY 2008 Category I and III CPT Codes and 
Level II HCPCS Codes
    2. Proposed Treatment of New Mid-Year Category III CPT Codes
    3. Proposed Treatment of Level II HCPCS Codes Released on a 
Quarterly Basis
    E. Proposed Updates to Covered Surgical Procedures and Covered 
Ancillary Services
    1. Identification of Covered Surgical Procedures
    a. General Policies
    b. Proposed Changes in Designation of Covered Surgical 
Procedures as Office-Based
    c. Proposed Changes in Designation of Covered Surgical 
Procedures as Device-Intensive
    2. Proposed Changes in Identification of Covered Ancillary 
Services
    F. Proposed Payment for Covered Surgical Procedures and Covered 
Ancillary Services
    1. Proposed Payment for Covered Surgical Procedures
    a. Proposed Update to Payment Rates
    b. Payment Policies When Devices Are Replaced at No Cost or With 
Credit
    (1) Policy When Devices Are Replaced at No Cost or With Full 
Credit
    (2) Proposed Policy When Implantable Devices Are Replaced With 
Partial Credit
    2. Proposed Payment for Covered Ancillary Services
    G. Physician Payment for Procedures and Services Provided in ASC
    H. Proposed Changes to Definitions of ``Radiology and Certain 
Other Imaging Services'' and ``Outpatient Prescription Drugs''
    I. New Technology Intraocular Lenses
    1. Background
    2. Changes to the NTIOL Determination Process Finalized for CY 
2008
    3. NTIOL Application Process for CY 2008 Payment Adjustment
    4. Classes of NTIOLS Approved for Payment Adjustment
    5. Payment Adjustment
    6. Proposed CY 2008 ASC Payment for Insertion of IOLs
    J. Proposed ASC Payment and Comment Indicators
    K. ASC Policy and Payment Recommendations
    L. Proposed Calculation of the ASC Conversion Factor and ASC 
Payment Rates
    1. Overview
    2. Budget Neutrality Requirement
    3. Calculation of the ASC Payment Rates for CY 2008
    4. Calculation of the ASC Payment Rates for CY 2009 and 
FutureYears
XVII. Reporting Quality Data for Annual Payment Rate Updates
    A. Background
    1. Reporting Hospital Outpatient Quality Data for Annual Payment 
Update
    2. Reporting ASC Quality Data for Annual Payment Increase
    B. Proposed Hospital Outpatient Measures
    C. Other Proposed Hospital Outpatient Measures
    D. Proposed Implementation of the HOP QDRP
    E. Proposed Requirements for HOP Quality Data Reporting for CY 
2009 and Subsequent Calendar Years
    1. Administrative Requirements
    2. Data Collection and Submission Requirements
    3. HOP QDRP Validation Requirements
    F. Publication of HOP QDRP Data Collected
    G. Proposed Attestation Requirement for Future Payment Years
    H. HOP QDRP Reconsiderations
    I. Reporting of ASC Quality Data
XVIII. Proposed Changes Affecting Critical Access Hospitals (CAHs) 
and Hospital Conditions of Participation (CoPs)
    A. Proposed Changes Affecting CAHs
    1. Background
    2. Co-Location of Necessary Provider CAHs
    3. Provider-Based Facilities of CAHs
    4. Termination of Provider Agreement
    5. Proposed Regulation Changes
    B. Proposed Revisions to Hospital CoPs
    1. Background
    2. Provisions of the Proposed Regulations
    a. Proposed Timeframes for Completion of the Medical History and 
Physical Examination
    b. Proposed Requirements for Preanesthesia and Postanesthesia 
Evaluations
    c. Proposed Technical Amendment to Nursing Services CoP
XIX. Files Available to the Public Via the Internet
    A. Information in Addenda Related to the CY 2008 Hospital OPPS
    B. Information in Addenda Related to the CY 2008 ASC Payment 
System
XX. Collection of Information Requirements
XXI. Response to Comments
XXII. Regulatory Impact Analysis
    A. Overall Impact
    1. Executive Order 12866
    2. Regulatory Flexibility Act (RFA)
    3. Small Rural Hospitals

[[Page 42632]]

    4. Unfunded Mandates
    5. Federalism
    B. Effects of OPPS Changes in This Proposed Rule
    1. Alternatives Considered
    2. Limitation of Our Analysis
    3. Estimated Impact of This Proposed Rule on Hospitals and CMHCs
    4. Estimated Effect of This Proposed Rule on Beneficiaries
    5. Conclusion
    6. Accounting Statement
    C. Effects of ASC Payment System Changes in This Proposed Rule
    1. Alternatives Considered
    2. Limitations on Our Analysis
    3. Estimated Effects of This Proposed Rule on ASCs
    4. Estimated Effects of This Proposed Rule on Beneficiaries
    5. Conclusion
    6. Accounting Statement
    D. Effects of the Proposed Requirements for Reporting of Quality 
Data for Hospital Outpatient Settings
    E. Effects of the Proposed Policy on CAH Off-Campus and Co-
Location Requirements
    F. Effects of Proposed Policy Revisions to the Hospital CoPs
    G. Executive Order 12866

Regulation Text

Addenda

Addendum A--Proposed OPPS APCs for CY 2008
Addendum AA--Proposed ASC Covered Surgical Procedures for CY 2008 
(Including Surgical Procedures for Which Payment is Packaged)
Addendum B--Proposed OPPS Payment By HCPCS Code for CY 2008
Addendum BB--Proposed ASC Covered Ancillary Services Integral to 
Covered Surgical Procedures for CY 2008 (Including Ancillary 
Services for Which Payment Is Packaged)
Addendum D1--Proposed OPPS Payment Status Indicators
Addendum D2--Proposed OPPS Comment Indicators
Addendum DD1--Proposed ASC Payment Indicators
Addendum DD2--Proposed ASC Comment Indicators
Addendum E--Proposed HCPCS Codes That Would Be Paid Only as 
Inpatient Procedures for CY 2008
Addendum L--Proposed Out-Migration Adjustment
Addendum M--Proposed HCPCS Codes for Assignment to Composite APCs 
for CY 2008

I. Background for the OPPS

A. Legislative and Regulatory Authority for the Hospital Outpatient 
Prospective Payment System

    When the Medicare statute was originally enacted, Medicare payment 
for hospital outpatient services was based on hospital-specific costs. 
In an effort to ensure that Medicare and its beneficiaries pay 
appropriately for services and to encourage more efficient delivery of 
care, the Congress mandated replacement of the reasonable cost-based 
payment methodology with a prospective payment system (PPS). The 
Balanced Budget Act (BBA) of 1997 (Pub. L. 105-33) added section 
1833(t) to the Social Security Act (the Act) authorizing implementation 
of a PPS for hospital outpatient services (OPPS).
    The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act 
(BBRA) of 1999 (Pub. L. 106-113) made major changes in the hospital 
OPPS. The Medicare, Medicaid, and SCHIP Benefits Improvement and 
Protection Act (BIPA) of 2000 (Pub. L. 106-554) made further changes in 
the OPPS. Section 1833(t) of the Act was also amended by the Medicare 
Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 
(Pub. L. 108-173). The Deficit Reduction Act (DRA) of 2005 (Pub. L. 
109-171), enacted on February 8, 2006, made additional changes in the 
OPPS. In addition, the Medicare Improvements and Extension Act under 
Division B of Title I of the Tax Relief and Health Care Act (MIEA-
TRHCA) of 2006 (Pub. L. 109-432), enacted on December 20, 2006, made 
further changes in the OPPS. A discussion of these provisions is 
included in sections I.E., VII., and XVII. of this proposed rule.
    The OPPS was first implemented for services furnished on or after 
August 1, 2000. Implementing regulations for the OPPS are located at 42 
CFR Part 419.
    Under the OPPS, we pay for hospital outpatient services on a rate-
per-service basis that varies according to the ambulatory payment 
classification (APC) group to which the service is assigned. We use the 
Healthcare Common Procedure Coding System (HCPCS) codes (which include 
certain Current Procedural Terminology (CPT) codes) and descriptors to 
identify and group the services within each APC group. The OPPS 
includes payment for most hospital outpatient services, except those 
identified in section I.B. of this proposed rule. Section 
1833(t)(1)(B)(ii) of the Act provides for Medicare payment under the 
OPPS for hospital outpatient services designated by the Secretary 
(which includes partial hospitalization services furnished by community 
mental health centers (CMHCs)) and hospital outpatient services that 
are furnished to inpatients who have exhausted their Part A benefits, 
or who are otherwise not in a covered Part A stay. Section 611 of Pub. 
L. 108-173 added provisions for Medicare coverage of an initial 
preventive physical examination, subject to the applicable deductible 
and coinsurance, as an outpatient department service, payable under the 
OPPS.
    The OPPS rate is an unadjusted national payment amount that 
includes the Medicare payment and the beneficiary copayment. This rate 
is divided into a labor-related amount and a nonlabor-related amount. 
The labor-related amount is adjusted for area wage differences using 
the hospital inpatient wage index value for the locality in which the 
hospital or CMHC is located.
    All services and items within an APC group are comparable 
clinically and with respect to resource use (section 1833(t)(2)(B) of 
the Act). In accordance with section 1833(t)(2) of the Act, subject to 
certain exceptions, services and items within an APC group cannot be 
considered comparable with respect to the use of resources if the 
highest median (or mean cost, if elected by the Secretary) for an item 
or service in the APC group is more than 2 times greater than the 
lowest median cost for an item or service within the same APC group 
(referred to as the ``2 times rule''). In implementing this provision, 
we use the median cost of the item or service assigned to an APC group.
    Special payments under the OPPS may be made for New Technology 
items and services in one of two ways. Section 1833(t)(6) of the Act 
provides for temporary additional payments, which we refer to as 
``transitional pass-through payments,'' for at least 2 but not more 
than 3 years for certain drugs, biological agents, brachytherapy 
devices used for the treatment of cancer, and categories of other 
medical devices. For New Technology services that are not eligible for 
transitional pass-through payments, and for which we lack sufficient 
data to appropriately assign them to a clinical APC group, we have 
established special APC groups based on costs, which we refer to as New 
Technology APCs. These New Technology APCs are designated by cost bands 
which allow us to provide appropriate and consistent payment for 
designated new procedures that are not yet reflected in our claims 
data. Similar to pass-through payments, an assignment to a New 
Technology APC is temporary; that is, we retain a service within a New 
Technology APC until we acquire sufficient data to assign it to a 
clinically appropriate APC group.

B. Excluded OPPS Services and Hospitals

    Section 1833(t)(1)(B)(i) of the Act authorizes the Secretary to 
designate the hospital outpatient services that are paid under the 
OPPS. While most hospital outpatient services are payable under the 
OPPS, section

[[Page 42633]]

1833(t)(1)(B)(iv) of the Act excludes payment for ambulance, physical 
and occupational therapy, and speech-language pathology services, for 
which payment is made under a fee schedule. Section 614 of Pub. L. 108-
173 amended section 1833(t)(1)(B)(iv) of the Act to exclude OPPS 
payment for screening and diagnostic mammography services. The 
Secretary exercised the authority granted under the statute to exclude 
from the OPPS those services that are paid under fee schedules or other 
payment systems. Such excluded services include, for example, the 
professional services of physicians and nonphysician practitioners paid 
under the Medicare Physician Fee Schedule (MPFS); laboratory services 
paid under the clinical diagnostic laboratory fee schedule (CLFS); 
services for beneficiaries with end-stage renal disease (ESRD) that are 
paid under the ESRD composite rate; and services and procedures that 
require an inpatient stay that are paid under the hospital inpatient 
prospective payment system (IPPS). We set forth the services that are 
excluded from payment under the OPPS in Sec.  419.22 of the 
regulations.
    Under Sec.  419.20(b) of the regulations, we specify the types of 
hospitals and entities that are excluded from payment under the OPPS. 
These excluded entities include Maryland hospitals, but only for 
services that are paid under a cost containment waiver in accordance 
with section 1814(b)(3) of the Act; critical access hospitals (CAHs); 
hospitals located outside of the 50 States, the District of Columbia, 
and Puerto Rico; and Indian Health Service hospitals.

C. Prior Rulemaking

    On April 7, 2000, we published in the Federal Register a final rule 
with comment period (65 FR 18434) to implement a prospective payment 
system for hospital outpatient services. The hospital OPPS was first 
implemented for services furnished on or after August 1, 2000. Section 
1833(t)(9) of the Act requires the Secretary to review certain 
components of the OPPS, no less often than annually, and to revise the 
groups, relative payment weights, and other adjustments that take into 
account changes in medical practices, changes in technologies, and the 
addition of new services, new cost data, and other relevant information 
and factors.
    Since initially implementing the OPPS, we have published final 
rules in the Federal Register annually to implement statutory 
requirements and changes arising from our continuing experience with 
this system. We published in the Federal Register on November 24, 2006 
the CY 2007 OPPS/ASC final rule with comment period (71 FR 67960). In 
that final rule with comment period, we revised the OPPS to update the 
payment weights and conversion factor for services payable under the CY 
2007 OPPS on the basis of claims data from January 1, 2005, through 
December 31, 2005, and to implement certain provisions of Pub. L. 108-
173 and Pub. L. 109-171. In addition, we responded to public comments 
received on the provisions of the November 10, 2005 final rule with 
comment period (70 FR 86516) pertaining to the APC assignment of HCPCS 
codes identified in Addendum B of that rule with the new interim (NI) 
comment indicator; and public comments received on the August 23, 2006 
OPPS/ASC proposed rule for CY 2007 (71 FR 49506).

D. APC Advisory Panel

1. Authority of the APC Panel
    Section 1833(t)(9)(A) of the Act, as amended by section 201(h) of 
the BBRA, and redesignated by section 202(a)(2) of the BBRA, requires 
that we consult with an outside panel of experts to review the clinical 
integrity of the payment groups and their weights under the OPPS. The 
Act further specifies that the panel will act in an advisory capacity. 
The Advisory Panel on Ambulatory Payment Classification (APC) Groups 
(the APC Panel), discussed under section I.D.2. of this proposed rule, 
fulfills these requirements. The APC Panel is not restricted to using 
data compiled by CMS, and may use data collected or developed by 
organizations outside the Department in conducting its review.
2. Establishment of the APC Panel
    On November 21, 2000, the Secretary signed the initial charter 
establishing the APC Panel. This expert panel, which may be composed of 
up to 15 representatives of providers subject to the OPPS (currently 
employed full-time, not as consultants, in their respective areas of 
expertise), reviews clinical data and advises CMS about the clinical 
integrity of the APC groups and their weights. For purposes of this 
Panel, consultants or independent contractors are not considered to be 
full-time employees. The APC Panel is technical in nature, and is 
governed by the provisions of the Federal Advisory Committee Act 
(FACA). Since its initial chartering, the Secretary has renewed the APC 
Panel's charter three times: on November 1, 2002; on November 1, 2004; 
and effective November 21, 2006. The current charter specifies, among 
other requirements, that the APC Panel continue to be technical in 
nature; be governed by the provisions of the FACA; may convene up to 
three meetings per year; has a Designated Federal Officer (DFO); and is 
chaired by a Federal official designated by the Secretary.
    The current APC Panel membership and other information pertaining 
to the APC Panel, including its charter, Federal Register notices, 
meeting dates, agenda topics, and meeting reports can be viewed on the 
CMS Web site at: http://www.cms.hhs.gov/FACA/05_AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp#TopOfPage.
3. APC Panel Meetings and Organizational Structure
    The APC Panel first met on February 27, February 28, and March 1, 
2001. Since the initial meeting, the APC Panel has held 11 subsequent 
meetings, with the last meeting taking place on March 7 and 8, 2007. 
Prior to each meeting, we publish a notice in the Federal Register to 
announce the meeting, and when necessary to solicit and announce 
nominations for the APC Panel's membership.
    The APC Panel has established an operational structure that, in 
part, includes the use of three subcommittees to facilitate its 
required APC review process. The three current subcommittees are the 
Data Subcommittee, the Observation and Visit Subcommittee, and the 
Packaging Subcommittee. The Data Subcommittee is responsible for 
studying the data issues confronting the APC Panel, and for 
recommending options for resolving them. The Observation and Visit 
Subcommittee reviews and makes recommendations to the APC Panel on all 
technical issues pertaining to observation services and hospital 
outpatient visits paid under the OPPS (for example, APC configurations 
and APC payment weights). The Packaging Subcommittee studies and makes 
recommendations on issues pertaining to services that are not 
separately payable under the OPPS, but whose payments are bundled or 
packaged into APC payments. Each of these subcommittees was established 
by a majority vote from the full APC Panel during a scheduled APC Panel 
meeting, and their continuation as subcommittees was approved at the 
March 2007 APC Panel meeting. All subcommittee recommendations are 
discussed and voted upon by the full APC Panel.
    Discussions of the recommendations resulting from the APC Panel's 
March

[[Page 42634]]

2007 meeting are included in the sections of this proposed rule that 
are specific to each recommendation. For discussions of earlier APC 
Panel meetings and recommendations, we reference previous hospital OPPS 
final rules or the Web site mentioned earlier in this section.

E. Provisions of the Medicare Improvements and Extension Act Under 
Division B of Title I of the Tax Relief and Health Care Act of 2006

    The Medicare Improvements and Extension Act under Division B of 
Title I of the Tax Relief and Health Care Act (MIEA-TRHCA) of 2006, 
Pub. L. 109-432, enacted on December 20, 2006, included the following 
provisions affecting the OPPS:
    1. Section 107(a) of the MIEA-TRHCA amended section 1833(t)(16)(C) 
of the Act to extend the period for payment of brachytherapy devices 
based on the hospital's charges adjusted to cost for 1 additional year, 
through December 31, 2007.
    2. Section 107(b)(1) of the MIEA-TRHCA amended section 
1833(t)(2)(H) of the Act by adding stranded and non-stranded devices 
furnished on or after July 1, 2007, as additional classifications of 
brachytherapy devices for which separate payment groups must be 
established for payment under the OPPS. Section 107(b)(2) of the MIEA-
TRCHA provides that the Secretary may implement the section 107(b)(1) 
amendment to section 1833(t)(2)(H) of the Act ``by program instruction 
or otherwise.''
    3. Section 109(a) of the MIEA-TRHCA added new paragraph (17) to 
section 1833(t) of the Act which authorizes the Secretary, beginning in 
2009 and each subsequent year, to reduce the OPPS full annual update by 
2.0 percentage points if a hospital paid under the OPPS fails to submit 
data as required by the Secretary in the form and manner specified on 
selected measures of quality of care, including medication errors. In 
accordance with this provision, the selected measures are those that 
are appropriate for the measurement of quality of care furnished by 
hospitals in the outpatient setting, that reflect consensus among 
affected parties and, to the extent feasible and practicable, that 
include measures set forth by one or more of the national consensus 
entities, and that may be the same as those required for reporting by 
hospitals paid under the IPPS. This provision specifies that a 
reduction for 1 year cannot be taken into account when computing the 
OPPS update for a subsequent year. In addition, this provision requires 
the Secretary to establish a process for making the submitted data 
available for public review.

F. Summary of the Major Contents of This Proposed Rule

    In this proposed rule, we are setting forth proposed changes to the 
Medicare hospital OPPS for CY 2008. These changes would be effective 
for services furnished on or after January 1, 2008. We are also setting 
forth proposed changes to the Medicare ASC payment system for CY 2008. 
These changes would be effective for services furnished on or after 
January 1, 2008. The following is a summary of the major changes that 
we are proposing to make:
1. Proposed Updates Affecting OPPS Payments
    In section II. of this proposed rule, we set forth--
    <bullet> The methodology used to recalibrate the proposed APC 
relative payment weights.
    <bullet> The proposed payment for partial hospitalization services, 
including the proposed separate threshold for outlier payments for 
CMHCs.
    <bullet> The proposed update to the conversion factor used to 
determine payment rates under the OPPS.
    <bullet> The proposed retention of our current policy to use the 
IPPS wage indices to adjust, for geographic wage differences, the 
portion of the OPPS payment rate and the copayment standardized amount 
attributable to labor-related cost.
    <bullet> The proposed update of statewide average default CCRs.
    <bullet> The proposed application of hold harmless transitional 
outpatient payments (TOPs) for certain small rural hospitals.
    <bullet> The proposed payment adjustment for rural SCHs.
    <bullet> The proposed calculation of the hospital outpatient 
outlier payment.
    <bullet> The calculation of the proposed national unadjusted 
Medicare OPPS payment.
    <bullet> The proposed beneficiary copayments for OPPS services.
2. Proposed OPPS Ambulatory Payment Classification (APC) Group Policies
    In section III. of this proposed rule, we discuss the proposed 
additions of new procedure codes to the APCs; our proposal to establish 
a number of new APCs; and our analyses of Medicare claims data and 
certain recommendations of the APC Panel. We also discuss the 
application of the 2 times rule and proposed exceptions to it; proposed 
changes to specific APCs; and the proposed movement of procedures from 
New Technology APCs to clinical APCs.
3. Proposed OPPS Payment for Devices
    In section IV. of this proposed rule, we discuss proposed payment 
for device-dependent APCs and the pass-through payment for specific 
categories of devices.
4. Proposed OPPS Payment for Drugs, Biologicals, and 
Radiopharmaceuticals
    In section V. of this proposed rule, we discuss the proposed CY 
2008 OPPS payment for drugs, biologicals, and radiopharmaceuticals, 
including the proposed payment for drugs, biologicals, and 
radiopharmaceuticals with and without pass-through status.
5. Proposed Estimate of OPPS Transitional Pass-Through Spending for 
Drugs, Biologicals, and Devices
    In section VI. of this proposed rule, we discuss the estimate of CY 
2008 OPPS transitional pass-through spending for drugs, biologicals, 
and devices.
6. Proposed OPPS Payment for Brachytherapy Sources
    In section VII. of this proposed rule, we discuss our proposal 
concerning coding and payment for brachytherapy sources.
7. Proposed OPPS Coding and Payment for Drug Administration Services
    In section VIII. of this proposed rule, we set forth our proposed 
policy concerning coding and payment for drug administration services.
8. Proposed OPPS Hospital Coding and Payments for Visits
    In section IX. of this proposed rule, we set forth our proposed 
changes to policies for the coding and reporting of clinic and 
emergency department visits and critical care services on claims paid 
under the OPPS.
9. Proposed OPPS Payment for Blood and Blood Products
    In section X. of this proposed rule, we discuss our proposed 
payment for blood and blood products.
10. Proposed OPPS Payment for Observation Services
    In section XI. of this proposed rule, we discuss the proposed 
payment policies for observation services furnished to patients on an 
outpatient basis.
11. Proposed Procedures That Will Be Paid Only as Inpatient Services
    In section XII. of this proposed rule, we discuss the procedures 
that we are

[[Page 42635]]

proposing to remove from the inpatient list and assign to APCs.
12. Proposed Nonrecurring Technical and Policy Changes
    In section XIII. of this proposed rule, we set forth our proposals 
for nonrecurring technical and policy changes and clarifications 
relating to outpatient hospital services and supplies incident to a 
physician service; payment for interrupted procedures prior to and 
after the administration of anesthesia; transitional adjustments to 
payments for covered outpatient services furnished by small rural 
hospitals and SCHs located in rural areas; and reporting requirements 
for wound care services, cardiac rehabilitation services, and bone 
marrow and stem cell processing services.
13. Proposed OPPS Payment Status and Comment Indicators
    In section XIV. of this proposed rule, we discuss proposed changes 
to the definitions of status indicators assigned to APCs and present 
our proposed comment indicators for the OPPS/ASC final rule with 
comment period.
14. OPPS Policy and Payment Recommendations
    In section XV. of this proposed rule, we address recommendations 
made by MedPAC and the APC Panel regarding the OPPS for CY 2008.
15. Proposed Update of the Revised ASC Payment System
    In section XVI. of this proposed rule, we discuss the proposed 
update of the revised ASC payment system payment rates for CY 2008. We 
also discuss our proposed changes to our regulations Sec.  414.22 
(b)(5)(i)(A) and (B) regarding physician payment for performing 
noncovered ASC surgical procedures in ASCs. In addition, we are 
proposing to revise the definitions of ``radiology and certain other 
imaging services'' and ``outpatient prescription drugs'' when provided 
integral to an ASC covered surgical procedure.
16. Reporting Quality Data for Annual Payment Rate Updates
    In section XVII. of this proposed rule, we discuss the proposed 
quality measures for reporting hospital outpatient quality data for CY 
2009 and subsequent years and set forth the requirements for data 
collection and submission for the annual payment update. We also 
briefly discuss the legislative provisions of the MIEA-TRHCA that give 
the Secretary authority to develop quality measures for reporting by 
ASCs.
17. Proposed Changes Affecting Necessary Provider Critical Access 
Hospitals (CAHs) and Hospital Conditions of Participation (CoPs)
    In section XVIII. of this proposed rule, we discuss our proposed 
changes affecting necessary provider designations for CAHs that are 
being recertified when the CAH enters into a new co-location 
arrangement with another hospital or CAH or when the CAH creates or 
acquires an off-campus location. We also discuss our proposed changes 
relating to several hospital CoPs to require the completion of physical 
examinations and medical histories, and documentation in the medical 
records, for patients after admission and prior to surgery or a 
procedure requiring anesthesia services and for postanesthesia 
evaluations of patients before discharge or transfer from the 
postanesthesia recovery area.
18. Regulatory Impact Analysis
    In section XXII. of this proposed rule, we set forth an analysis of 
the impact the proposed changes will have on affected entities and 
beneficiaries.

II. Proposed Updates Affecting OPPS Payments

A. Proposed Recalibration of APC Relative Weights

    (If you choose to comment on issues in this section, please include 
the caption ``APC Relative Weights'' at the beginning of your comment.)
1. Database Construction
a. Database Source and Methodology
    Section 1833(t)(9)(A) of the Act requires that the Secretary review 
and revise the relative payment weights for APCs at least annually. In 
the April 7, 2000 OPPS final rule with comment period (65 FR 18482), we 
explained in detail how we calculated the relative payment weights that 
were implemented on August 1, 2000, for each APC group. Except for some 
reweighting due to a small number of APC changes, these relative 
payment weights continued to be in effect for CY 2001. This policy is 
discussed in the November 13, 2000 interim final rule (65 FR 67824 
through 67827).
    We are proposing to use the same basic methodology that we 
described in the April 7, 2000 OPPS final rule with comment period to 
recalibrate the APC relative payment weights for services furnished on 
or after January 1, 2008, and before January 1, 2009. That is, we are 
proposing to recalibrate the relative payment weights for each APC 
based on claims and cost report data for outpatient services. We are 
proposing to use the most recent available data to construct the 
database for calculating APC group weights. For the purpose of 
recalibrating the proposed APC relative payment weights for CY 2008, we 
used approximately 131 million final action claims for hospital OPD 
services furnished on or after January 1, 2006, and before January 1, 
2007. (For exact counts of claims used, we refer readers to the claims 
accounting narrative under supporting documentation for this proposed 
rule on the CMS Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/). Of the 131 million final action claims 
for services provided in hospital outpatient settings, approximately 
101 million claims were of the type of bill potentially appropriate for 
use in setting rates for OPPS services (but did not necessarily contain 
services payable under the OPPS). Of the 101 million claims, 
approximately 46 million were not for services paid under the OPPS or 
were excluded as not appropriate for use (for example, erroneous cost-
to-charge ratios (CCRs) or no HCPCS codes reported on the claim). We 
were able to use approximately 50 million whole claims of the 
approximately 54 million claims that remained to set the OPPS APC 
relative weights we are proposing for the CY 2008 OPPS. From the 50 
million whole claims, we created approximately 88 million single 
records, of which approximately 58 million were ``pseudo'' single 
claims (created from multiple procedure claims using the process we 
discuss in this section). Approximately 822,000 claims trimmed out on 
cost or units in excess of <plus-minus>3 standard deviations from the 
geometric mean, yielding approximately 87 million single bills used for 
median setting. Ultimately, we were able to use for proposed CY 2008 
ratesetting some portion of 92 percent of the CY 2006 claims containing 
services payable under the OPPS.
    The proposed APC relative weights and payments for CY 2008 in 
Addenda A and B to this proposed rule were calculated using claims from 
this period that were processed before January 1, 2007, and continue to 
be based on the median hospital costs for services in the APC groups. 
We selected claims for services paid under the OPPS and matched these 
claims to the most recent cost report filed by the individual hospitals 
represented in our claims data. We continue to believe that it is 
appropriate to use the most current full calendar year claims data and 
the most

[[Page 42636]]

recently submitted cost reports to calculate the median costs which we 
are proposing to convert to relative payment weights for purposes of 
calculating the CY 2008 payment rates.
b. Proposed Use of Single and Multiple Procedure Claims
    For CY 2008, in general, we are proposing to continue to use single 
procedure claims to set the medians on which the APC relative payment 
weights would be based, with some exceptions as discussed below. We 
have received many requests asking that we ensure that the data from 
claims that contain charges for multiple procedures are included in the 
data from which we calculate the relative payment weights. Requesters 
believe that relying solely on single procedure claims to recalibrate 
APC relative payment weights fails to take into account data for many 
frequently performed procedures, particularly those commonly performed 
in combination with other procedures. They believe that if a service is 
frequently performed in combination with others, the individual 
services are more complex and more resource-intensive than if they were 
performed alone. Stakeholders have suggested that including data from 
multiple procedure claims could increase the median cost estimates for 
the individual services. They believe that depending upon single 
procedure claims alone results in basing relative payment weights on 
the least costly services that are not representative of the typical 
services, thereby introducing downward bias to the medians on which the 
weights are based.
    We generally use single procedure claims to set the median costs 
for APCs because we believe that it is important that the OPPS relative 
weights on which payment rates are based be appropriate when one and 
only one procedure is furnished and because we are, so far, unable to 
ensure that packaged costs can be appropriately allocated across 
multiple procedures performed on the same date of service. We agree 
that, optimally, it is desirable to use the data from as many claims as 
possible to recalibrate the APC relative payment weights, including 
those claims for multiple procedures. We engaged in several efforts 
this year to improve our use of multiple procedure claims for 
ratesetting. As we have for several years, we continue to use date of 
service stratification and a list of codes to be bypassed to convert 
multiple procedure claims to ``pseudo'' single procedure claims. We 
also continued our internal efforts to better understand the patterns 
of services and costs from multiple bills toward the goal of using more 
multiple bill information by assessing the amount of packaging in the 
multiple bills and, specifically, by exploring the amount of packaging 
for drug administration services in the single and multiple bill 
claims. Moreover, in many cases, the proposed expansion of packaging 
also enables the use of more claims data by enabling us to treat claims 
with multiple procedure codes as single claims. We refer readers to 
section II.A.4. of this proposed rule for a full discussion of this 
proposal for CY 2008.
(1) Proposed Use of Date of Service Stratification and a Bypass List To 
Increase the Amount of Data Used To Determine Medians
    By bypassing specified codes that we believe do not have 
significant packaged costs, we are able to use more data from multiple 
procedure claims. In many cases, this enables us to create multiple 
``pseudo'' single claims from claims that, as submitted, contained 
multiple separately paid procedures on the same claim. We refer to 
these newly created single procedure claims as ``pseudo'' single claims 
because they were submitted by providers as multiple procedure claims. 
The history of our use of a bypass list to generate ``pseudo'' single 
claims is well documented, most recently in the CY 2007 OPPS/ASC final 
rule with comment period (71 FR 67969 through 67970).
    The date of service stratification and bypass list process we used 
for the CY 2007 OPPS (combined with the packaging changes we are 
proposing in section II.A.4. of this proposed rule) resulted in our 
being able to use some part of approximately 92 percent of the total 
claims that are eligible for use in the OPPS ratesetting and modeling 
for this proposed rule. This process enabled us to create, for CY 2008 
approximately 58 million ``pseudo'' singles and approximately 30 
million ``natural'' single bills. For this proposed rule, ``pseudo'' 
single procedure bills represented 66 percent of all single bills used 
to calculate median costs. This compares favorably to the CY 2007 OPPS 
final rule data in which ``pseudo'' single bills represented 68 percent 
of all single bills used to calculate the median costs on which the CY 
2007 OPPS payment rates were based. We believe that the reduction in 
the percent of ``pseudo'' single bills and the corresponding increase 
in the proportion of ``natural'' single bills occurred largely because 
of our proposal to increase packaging as discussed in section II.A.4. 
of this proposed rule. In many cases, the packaging proposal for CY 
2008 enabled us to use claims that would otherwise have been considered 
to be multiple procedure claims and, absent the proposal for additional 
packaging, could have been used for ratesetting only if we had been 
able to create ``pseudo'' single claims from them.
    For CY 2008, we are proposing to bypass 425 HCPCS codes that are 
identified in Table 1 of this proposed rule. We are proposing to 
continue the use of the codes on the CY 2007 OPPS bypass list but to 
remove codes we are proposing to package for CY 2008. We also are 
proposing to remove codes that were on the CY 2007 bypass list that 
ceased to meet the empirical criteria under the proposed packaging 
changes when clinical review confirmed that their removal would be 
appropriate in the context of the full proposal for the CY 2008 OPPS. 
Since the inception of the bypass list, we have calculated the percent 
of natural single bills that contained packaging for each code and the 
amount of packaging in each ``natural'' single bill for each code. We 
retained the codes on the previous year's bypass list and used the 
update year's data to determine whether it would be appropriate to add 
additional codes to the previous year's bypass list. The entire list 
(including the codes that remained on the bypass list from prior years) 
was open to public comment. For this CY 2008 proposed rule, we 
explicitly reviewed all ``natural'' single bills against the empirical 
criteria for all codes on the CY 2007 bypass list because of the 
proposal for greater packaging discussed in section II.A.4. of this 
proposed rule, as this effort increased the packaging associated with 
some codes. We removed 106 HCPCS codes from the CY 2007 bypass list for 
the CY 2008 proposal. We note also that many of the codes we are 
proposing to newly package for CY 2008 were on the bypass list used for 
setting the OPPS payment rates for CY 2007 and are no longer proposed 
for bypass because we are proposing to package them, as discussed in 
more detail below. We also are proposing to add to the bypass list 
HCPCS codes that, using the proposed rule data, meet the same 
previously established empirical criteria for the bypass list that are 
reviewed below or which our clinicians believe would have little 
associated packaging if the services were correctly coded.
    The CY 2008 packaging proposal minimally reduced the percentage of 
total claims that we were able to use, in whole or in part, from 93 
percent for CY 2007 to 92 percent for this proposed rule. The proposed 
packaging approach increased the number of ``natural'' single bills, in 
spite of reducing the

[[Page 42637]]

universe of codes requiring single bills for ratesetting, but reduced 
the number of ``pseudo'' single bills. More ``natural'' single 
procedure bills can be created by the packaging of codes that always 
appear with another procedure because these dependent services are 
supportive of and ancillary to the primary independent procedures for 
which payment is being made. A claim containing two independent 
procedure codes on the same date of service and not on the bypass list 
previously could not be used for ratesetting, but packaging the cost of 
one of the codes on the claim frees the claim to be used to calculate 
the median cost of the procedure that is not packaged. On the other 
hand, our proposed packaging approach reduced the number of codes 
eligible for the bypass list because of the limitation on packaging set 
by our previously established empirical criteria. A smaller bypass list 
and the presence of greater packaging on claims reduced the final 
number of ``pseudo'' single claims. In prior years, roughly 68 percent 
of single bills were ``pseudo'' single bills, but based on the CY 2008 
proposed rule data, 66 percent of single bills were ``pseudo'' singles. 
Moreover, the number of ``natural'' single bills and ``pseudo'' single 
bills are reduced by the volume of services that we are proposing to 
package. Hence, our CY 2008 proposal to package payment for some HCPCS 
codes with relatively high frequencies would eliminate for ratesetting 
the number of available ``natural'' and ``pseudo'' single bills 
attributable to the codes that we are proposing to package.
    As in prior years, we are proposing to use the following empirical 
criteria to determine the additional codes to add to the CY 2007 bypass 
list to create the CY 2008 bypass list. We assume that the 
representation of packaging on the single claims for any given code is 
comparable to packaging for that code in the multiple claims:
    <bullet> There are 100 or more single claims for the code. This 
number of single claims ensures that observed outcomes are sufficiently 
representative of packaging that might occur in the multiple claims.
    <bullet> Five percent or fewer of the single claims for the code 
have packaged costs on that single claim for the code. This criterion 
results in limiting the amount of packaging being redistributed to the 
payable procedure remaining on the claim after the bypass code is 
removed and ensures that the costs associated with the bypass code 
represent the cost of the bypassed service.
    <bullet> The median cost of packaging observed in the single claims 
is equal to or less than $50. This limits the amount of error in 
redistributed costs.
    <bullet> The code is not a code for an unlisted service.
    In addition, we are proposing to add to the bypass list codes that 
our clinicians believe have minimal associated packaging based on their 
clinical assessment of the full CY 2008 OPPS proposal. We note that 
this list contains bypass codes that are appropriate to claims for 
services in CY 2006 and, therefore, includes codes that have been 
deleted for CY 2007. Moreover, there are codes on the bypass list that 
are new for CY 2007 and which are appropriate additions to the bypass 
list in preparation for use of the CY 2007 claims for creation of the 
CY 2009 OPPS.
    In order to keep the established empirical criteria for the bypass 
list constant, we are seeking public comment on whether we should 
adjust the $50 packaging cost criterion for inflation each year and, if 
so, recommendations for the source of the adjustment. Adding an 
inflation adjustment factor would ensure that the same amount of 
packaging associated with candidate codes for the bypass list is 
reviewed each year relative to nominal costs.

 Table 1.--Proposed CY 2008 Bypass Codes for Creating ``Pseudo'' Single
                   Claims for Calculating Median Costs
------------------------------------------------------------------------
            HCPCS code                        Short descriptor
------------------------------------------------------------------------
11056............................  Trim skin lesions, 2 to 4.
11057............................  Trim skin lesions, over 4.
11300............................  Shave skin lesion.
11301............................  Shave skin lesion.
11719............................  Trim nail(s).
11720............................  Debride nail, 1-5.
11721............................  Debride nail, 6 or more.
11954............................  Therapy for contour defects.
17003............................  Destruct premalg les, 2-14.
31231............................  Nasal endoscopy, dx.
31579............................  Diagnostic laryngoscopy.
51798............................  Us urine capacity measure.
54240............................  Penis study.
56820............................  Exam of vulva w/scope.
67820............................  Revise eyelashes.
69210............................  Remove impacted ear wax.
69220............................  Clean out mastoid cavity.
70030............................  X-ray eye for foreign body.
70100............................  X-ray exam of jaw.
70110............................  X-ray exam of jaw.
70120............................  X-ray exam of mastoids.
70130............................  X-ray exam of mastoids.
70140............................  X-ray exam of facial bones.
70150............................  X-ray exam of facial bones.
70160............................  X-ray exam of nasal bones.
70200............................  X-ray exam of eye sockets.
70210............................  X-ray exam of sinuses.
70220............................  X-ray exam of sinuses.
70250............................  X-ray exam of skull.
70260............................  X-ray exam of skull.
70328............................  X-ray exam of jaw joint.
70330............................  X-ray exam of jaw joints.
70336............................  Magnetic image, jaw joint.
70355............................  Panoramic x-ray of jaws.
70360............................  X-ray exam of neck.
70370............................  Throat x-ray & fluoroscopy.
70371............................  Speech evaluation, complex.
70450............................  Ct head/brain w/o dye.
70480............................  Ct orbit/ear/fossa w/o dye.
70486............................  Ct maxillofacial w/o dye.
70490............................  Ct soft tissue neck w/o dye.
70544............................  Mr angiography head w/o dye.
70551............................  Mri brain w/o dye.
71010............................  Chest x-ray.
71015............................  Chest x-ray.
71020............................  Chest x-ray.
71021............................  Chest x-ray.
71022............................  Chest x-ray.
71023............................  Chest x-ray and fluoroscopy.
71030............................  Chest x-ray.
71034............................  Chest x-ray and fluoroscopy.
71035............................  Chest x-ray.
71100............................  X-ray exam of ribs.
71101............................  X-ray exam of ribs/chest.
71110............................  X-ray exam of ribs.
71111............................  X-ray exam of ribs/chest.
71120............................  X-ray exam of breastbone.
71130............................  X-ray exam of breastbone.
71250............................  Ct thorax w/o dye.
72010............................  X-ray exam of spine.
72020............................  X-ray exam of spine.
72040............................  X-ray exam of neck spine.
72050............................  X-ray exam of neck spine.
72052............................  X-ray exam of neck spine.
72069............................  X-ray exam of trunk spine.
72070............................  X-ray exam of thoracic spine.
72072............................  X-ray exam of thoracic spine.
72074............................  X-ray exam of thoracic spine.
72080............................  X-ray exam of trunk spine.
72090............................  X-ray exam of trunk spine.
72100............................  X-ray exam of lower spine.
72110............................  X-ray exam of lower spine.
72114............................  X-ray exam of lower spine.
72120............................  X-ray exam of lower spine.
72125............................  Ct neck spine w/o dye.
72128............................  Ct chest spine w/o dye.
72131............................  Ct lumbar spine w/o dye.
72141............................  Mri neck spine w/o dye.
72146............................  Mri chest spine w/o dye.
72148............................  Mri lumbar spine w/o dye.
72170............................  X-ray exam of pelvis.
72190............................  X-ray exam of pelvis.
72192............................  Ct pelvis w/o dye.
72202............................  X-ray exam sacroiliac joints.
72220............................  X-ray exam of tailbone.
73000............................  X-ray exam of collar bone.
73010............................  X-ray exam of shoulder blade.
73020............................  X-ray exam of shoulder.
73030............................  X-ray exam of shoulder.
73050............................  X-ray exam of shoulders.
            73060................  X-ray exam of humerus.
            73070................  X-ray exam of elbow.
            73080................  X-ray exam of elbow.
            73090................  X-ray exam of forearm.
            73100................  X-ray exam of wrist.
            73110................  X-ray exam of wrist.
            73120................  X-ray exam of hand.

[[Page 42638]]

 
            73130................  X-ray exam of hand.
            73140................  X-ray exam of finger(s).
            73200................  Ct upper extremity w/o dye.
            73218................  Mri upper extremity w/o dye.
            73221................  Mri joint upr extrem w/o dye.
            73510................  X-ray exam of hip.
            73520................  X-ray exam of hips.
            73540................  X-ray exam of pelvis & hips.
            73550................  X-ray exam of thigh.
            73560................  X-ray exam of knee, 1 or 2.
            73562................  X-ray exam of knee, 3.
            73564................  X-ray exam, knee, 4 or more.
            73565................  X-ray exam of knees.
            73590................  X-ray exam of lower leg.
            73600................  X-ray exam of ankle.
            73610................  X-ray exam of ankle.
            73620................  X-ray exam of foot.
            73630................  X-ray exam of foot.
            73650................  X-ray exam of heel.
            73660................  X-ray exam of toe(s).
            73700................  Ct lower extremity w/o dye.
            73718................  Mri lower extremity w/o dye.
            73721................  Mri jnt of lwr extre w/o dye.
            74000................  X-ray exam of abdomen.
            74010................  X-ray exam of abdomen.
            74020................  X-ray exam of abdomen.
            74022................  X-ray exam series, abdomen.
            74150................  Ct abdomen w/o dye.
            74210................  Contrst x-ray exam of throat.
            74220................  Contrast x-ray, esophagus.
            74230................  Cine/vid x-ray, throat/esoph.
            74246................  Contrst x-ray uppr gi tract.
            74247................  Contrst x-ray uppr gi tract.
            74249................  Contrst x-ray uppr gi tract.
            76020................  X-rays for bone age.
            76040................  X-rays, bone evaluation.
            76061................  X-rays, bone survey.
            76062................  X-rays, bone survey.
            76065................  X-rays, bone evaluation.
            76066................  Joint survey, single view.
            76070................  Ct bone density, axial.
            76071................  Ct bone density, peripheral.
            76075................  Dxa bone density, axial.
            76076................  Dxa bone density/peripheral
            76077................  Dxa bone density/v-fracture.
            76078................  Radiographic absorptiometry.
            76100................  X-ray exam of body section.
            76400................  Magnetic image, bone marrow.
            76510................  Ophth us, b & quant a.
            76511................  Ophth us, quant a only.
            76512................  Ophth us, b w/non-quant a.
            76513................  Echo exam of eye, water bath.
            76514................  Echo exam of eye, thickness.
            76516................  Echo exam of eye.
            76519................  Echo exam of eye.
            76536................  Us exam of head and neck.
            76645................  Us exam, breast(s).
            76700................  Us exam, abdom, complete.
            76705................  Echo exam of abdomen.
            76770................  Us exam abdo back wall, comp.
            76775................  Us exam abdo back wall, lim.
            76778................  Us exam kidney transplant.
            76801................  Ob us < 14 wks, single fetus.
            76805................  Ob us >/= 14 wks, sngl fetus.
            76811................  Ob us, detailed, sngl fetus.
            76816................  Ob us, follow-up, per fetus.
            76817................  Transvaginal us, obstetric.
            76830................  Transvaginal us, non-ob.
            76856................  Us exam, pelvic, complete.
            76857................  Us exam, pelvic, limited.
            76870................  Us exam, scrotum.
            76880................  Us exam, extremity.
            76970................  Ultrasound exam follow-up.
            76977................  Us bone density measure.
            76999................  Echo examination procedure.
            77300................  Radiation therapy dose plan.
            77301................  Radiotherapy dose plan, imrt.
            77315................  Teletx isodose plan complex.
            77326................  Brachytx isodose calc simp.
            77327................  Brachytx isodose calc interm.
            77328................  Brachytx isodose plan compl.
            77331................  Special radiation dosimetry.
            77336................  Radiation physics consult.
            77370................  Radiation physics consult.
            77401................  Radiation treatment delivery.
            77402................  Radiation treatment delivery.
            77403................  Radiation treatment delivery.
            77404................  Radiation treatment delivery.
            77407................  Radiation treatment delivery.
            77408................  Radiation treatment delivery.
            77409................  Radiation treatment delivery.
            77411................  Radiation treatment delivery.
            77412................  Radiation treatment delivery.
            77413................  Radiation treatment delivery.
            77414................  Radiation treatment delivery.
            77416................  Radiation treatment delivery.
            77418................  Radiation tx delivery, imrt.
            77470................  Special radiation treatment.
            77520................  Proton trmt, simple w/o comp.
            77523................  Proton trmt, intermediate.
              80500..............  Lab pathology consultation.
              80502..............  Lab pathology consultation.
              85097..............  Bone marrow interpretation.
              86510..............  Histoplasmosis skin test.
              86850..............  RBC antibody screen.
              86870..............  RBC antibody identification.
              86880..............  Coombs test, direct.
              86885..............  Coombs test, indirect, qual.
              86886..............  Coombs test, indirect, titer.
              86890..............  Autologous blood process.
              86900..............  Blood typing, ABO.
              86901..............  Blood typing, Rh (D).
              86903..............  Blood typing, antigen screen.
              86904..............  Blood typing, patient serum.
              86905..............  Blood typing, RBC antigens.
              86906..............  Blood typing, Rh phenotype.
              86930..............  Frozen blood prep.
              86970..............  RBC pretreatment.
              88104..............  Cytopath fl nongyn, smears.
              88106..............  Cytopath fl nongyn, filter.
              88107..............  Cytopath fl nongyn, sm/fltr.
              88108..............  Cytopath, concentrate tech.
              88112..............  Cytopath, cell enhance tech.
              88160..............  Cytopath smear, other source.
              88161..............  Cytopath smear, other source.
              88162..............  Cytopath smear, other source.
              88172..............  Cytopathology eval of fna.
              88173..............  Cytopath eval, fna, report.
              88182..............  Cell marker study.
              88184..............  Flowcytometry/tc, 1 marker.
              88185..............  Flowcytometry/tc, add-on.
              88300..............  Surgical path, gross.
              88302..............  Tissue exam by pathologist.
              88304..............  Tissue exam by pathologist.
              88305..............  Tissue exam by pathologist.
              88307..............  Tissue exam by pathologist.
              88311..............  Decalcify tissue.
              88312..............  Special stains.
              88313..............  Special stains.
              88321..............  Microslide consultation.
              88323..............  Microslide consultation.
              88325..............  Comprehensive review of data.
              88331..............  Path consult intraop, 1 bloc.
              88342..............  Immunohistochemistry.
              88346..............  Immunofluorescent study.
              88347..............  Immunofluorescent study.
              88348..............  Electron microscopy.
              88358..............  Analysis, tumor.
              88360..............  Tumor immunohistochem/manual.
              88365..............  Insitu hybridization (fish).
              88368..............  Insitu hybridization, manual.
              88399..............  Surgical pathology procedure.
              89049..............  Chct for mal hyperthermia.
              89230..............  Collect sweat for test.
              89240..............  Pathology lab procedure.
                90761............  Hydrate iv infusion, add-on.
                90766............  Ther/proph/dg iv inf, add-on.
                90801............  Psy dx interview.
                90802............  Intac psy dx interview.
                90804............  Psytx, office, 20-30 min.
                90805............  Psytx, off, 20-30 min w/e&m.
                90806............  Psytx, off, 45-50 min.
                90807............  Psytx, off, 45-50 min w/e&m.
                90808............  Psytx, office, 75-80 min.
                90809............  Psytx, off, 75-80, w/e&m.
                90810............  Intac psytx, off, 20-30 min.
                90812............  Intac psytx, off, 45-50 min.
                90816............  Psytx, hosp, 20-30 min.
                90818............  Psytx, hosp, 45-50 min.
                90826............  Intac psytx, hosp, 45-50 min.
                90845............  Psychoanalysis.
                90846............  Family psytx w/o patient.
                90847............  Family psytx w/patient.
                90853............  Group psychotherapy.
                90857............  Intac group psytx.
                90862............  Medication management.
                92002............  Eye exam, new patient.
                92004............  Eye exam, new patient.
                92012............  Eye exam established pat.
                92014............  Eye exam & treatment.
                92020............  Special eye evaluation.
                92081............  Visual field examination(s).
                92082............  Visual field examination(s).
                92083............  Visual field examination(s).
                92135............  Opthalmic dx imaging.
                92136............  Ophthalmic biometry.
                92225............  Special eye exam, initial.
                92226............  Special eye exam, subsequent.
                92230............  Eye exam with photos.
                92240............  Icg angiography.
                92250............  Eye exam with photos.
                92275............  Electroretinography.
                92285............  Eye photography.
                92286............  Internal eye photography.
                92520............  Laryngeal function studies.
                92541............  Spontaneous nystagmus test.
                92546............  Sinusoidal rotational test.
                92548............  Posturography.
                92552............  Pure tone audiometry, air.
                92553............  Audiometry, air & bone.
                92555............  Speech threshold audiometry.

[[Page 42639]]

 
                92556............  Speech audiometry, complete.
                92557............  Comprehensive hearing test.
                92567............  Tympanometry.
                92582............  Conditioning play audiometry.
                92585............  Auditor evoke potent, compre.
                92603............  Cochlear implt f/up exam 7 >.
                92604............  Reprogram cochlear implt 7 >.
                92626............  Eval aud rehab status.
                93005............  Electrocardiogram, tracing.
                93225............  ECG monitor/record, 24 hrs.
                93226............  ECG monitor/report, 24 hrs.
93231............................  Ecg monitor/record, 24 hrs.
93232............................  ECG monitor/report, 24 hrs.
93236............................  ECG monitor/report, 24 hrs.
93270............................  ECG recording.
93271............................  Ecg/monitoring and analysis.
93278............................  ECG/signal-averaged.
93727............................  Analyze ilr system.
93731............................  Analyze pacemaker system.
93732............................  Analyze pacemaker system.
93733............................  Telephone analy, pacemaker.
93734............................  Analyze pacemaker system.
93735............................  Analyze pacemaker system.
93736............................  Telephonic analy, pacemaker.
93741............................  Analyze ht pace device sngl.
93742............................  Analyze ht pace device sngl.
93743............................  Analyze ht pace device dual.
93744............................  Analyze ht pace device dual.
93786............................  Ambulatory BP recording.
93788............................  Ambulatory BP analysis.
93797............................  Cardiac rehab.
93798............................  Cardiac rehab/monitor.
93875............................  Extracranial study.
93880............................  Extracranial study.
93882............................  Extracranial study.
93886............................  Intracranial study.
93888............................  Intracranial study.
93922............................  Extremity study.
93923............................  Extremity study.
93924............................  Extremity study.
93925............................  Lower extremity study.
93926............................  Lower extremity study.
93930............................  Upper extremity study.
93931............................  Upper extremity study.
93965............................  Extremity study.
93970............................  Extremity study.
93971............................  Extremity study.
93975............................  Vascular study.
93976............................  Vascular study.
93978............................  Vascular study.
93979............................  Vascular study.
93990............................  Doppler flow testing.
94015............................  Patient recorded spirometry.
94690............................  Exhaled air analysis.
95115............................  Immunotherapy, one injection.
95117............................  Immunotherapy injections.
95165............................  Antigen therapy services.
95805............................  Multiple sleep latency test.
95806............................  Sleep study, unattended.
95807............................  Sleep study, attended.
95808............................  Polysomnography, 1-3.
95812............................  Eeg, 41-60 minutes.
95813............................  Eeg, over 1 hour.
95816............................  Eeg, awake and drowsy.
95819............................  Eeg, awake and asleep.
95822............................  Eeg, coma or sleep only.
95869............................  Muscle test, thor paraspinal.
95900............................  Motor nerve conduction test.
95921............................  Autonomic nerv function test.
95925............................  Somatosensory testing.
95930............................  Visual evoked potential test.
95950............................  Ambulatory eeg monitoring.
95953............................  EEG monitoring/computer.
95970............................  Analyze neurostim, no prog.
95972............................  Analyze neurostim, complex.
95974............................  Cranial neurostim, complex.
95978............................  Analyze neurostim brain/1h.
96000............................  Motion analysis, video/3d.
96101............................  Psycho testing by psych/phys.
96111............................  Developmental test, extend.
96116............................  Neurobehavioral status exam.
96118............................  Neuropsych tst by psych/phys.
96119............................  Neuropsych testing by tec.
96150............................  Assess hlth/behave, init.
96151............................  Assess hlth/behave, subseq.
96152............................  Intervene hlth/behave, indiv.
96153............................  Intervene hlth/behave, group.
96415............................  Chemo, iv infusion, addl hr.
96423............................  Chemo ia infuse each addl hr.
96900............................  Ultraviolet light therapy.
96910............................  Photochemotherapy with UV-B.
96912............................  Photochemotherapy with UV-A.
96913............................  Photochemotherapy, UV-A or B.
96920............................  Laser tx, skin < 250 sq cm.
98925............................  Osteopathic manipulation.
98926............................  Osteopathic manipulation.
98927............................  Osteopathic manipulation.
98940............................  Chiropractic manipulation.
98941............................  Chiropractic manipulation.
98942............................  Chiropractic manipulation.
99204............................  Office/outpatient visit, new.
99212............................  Office/outpatient visit, est.
99213............................  Office/outpatient visit, est.
99214............................  Office/outpatient visit, est.
99241............................  Office consultation.
99242............................  Office consultation.
99243............................  Office consultation.
99244............................  Office consultation.
99245............................  Office consultation.
0144T............................  CT heart wo dye; qual calc.
C8951............................  IV inf, tx/dx, each addl hr.
C8955............................  Chemotx adm, IV inf, addl hr.
G0008............................  Admin influenza virus vac.
G0101............................  CA screen;pelvic/breast exam.
G0127............................  Trim nail(s).
G0130............................  Single energy x-ray study.
G0166............................  Extrnl counterpulse, per tx.
G0175............................  OPPS Service,sched team conf.
G0332............................  Preadmin IV immunoglobulin.
G0340............................  Robt lin-radsurg fractx 2-5.
G0344............................  Initial preventive exam.
G0365............................  Vessel mapping hemo access.
G0367............................  EKG tracing for initial prev.
G0376............................  Smoke/tobacco counseling >10.
M0064............................  Visit for drug monitoring.
Q0091............................  Obtaining screen pap smear.
------------------------------------------------------------------------

(2) Exploration of Allocation of Packaged Costs to Separately Paid 
Procedure Codes
    During its August 23-24, 2006 meeting, the APC Panel recommended 
that CMS provide claims analysis of the contributions of packaged costs 
(including packaged revenue code charges and charges for packaged HCPCS 
codes) to the median cost of each drug administration service. (We 
refer readers to Recommendation <greek-i>28 in the August 23-24, 2006 
meeting recommendation summary on the CMS Web site at: http://www.cms.hhs.gov/FACA/05_AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp#TopOfPage.) In 
our continued effort to better understand the multiple claims in order 
to extract single bill information from them, we examined the extent to 
which the packaging in multiple procedure claims differs from the 
packaging in the single procedure claims on which we base the median 
costs both in general and more specifically for drug administration 
services. We performed this analysis using the claims data on which we 
based the CY 2007 OPPS/ASC final rule with comment period. We examined 
the amount of packaging in multiple procedure versus single procedure 
claims in general and in claims for drug administration services in 
particular. We conducted this analysis without taking into account the 
proposed packaging approach presented in this proposed rule. However, 
we do not expect the services newly proposed for packaged payment to 
commonly appear with a drug administration service. Therefore, we 
believe that the analysis conducted on the CY 2007 final rule with 
comment period data is sufficient to inform our development of this 
proposed rule.
    In general, we do not believe that the proportionate amount of 
packaged costs in the multiple bills relative to the number of primary 
services is greater than that in the single bills. The costs in uncoded 
revenue codes and HCPCS codes with a packaged status indicator account 
for 22 percent of observed costs in the universe of all CY 2005 claims 
that we used to model the CY 2007 OPPS (including both the single and 
multiple procedure bills). Similarly, the costs in uncoded revenue 
codes and HCPCS codes with a packaged status indicator account for 18 
percent of the total cost in the subset of CY 2005 single bills that we 
used to calculate the median costs on which the relative weights are 
based.
    However, the bypass methodology creates a ``pseudo'' single bill 
for all claims for services or items on the bypass list, and these 
``pseudo'' single bills have no associated packaging, by definition of 
the application of the bypass list. Excluding the total cost associated 
with bypass codes, 28 percent of observed costs in the single

[[Page 42640]]

bills are attributable to packaged services, and 29 percent of observed 
costs across all claims are attributable to packaged services. 
Therefore, we conclude that, in general, the extent of packaging in all 
bills is similar to the amount of packaging in the single procedure 
bills we use to set median costs for most APCs.
    We recognize that aggregate numbers do not address the packaging 
associated with single and multiple procedure claims for specific 
services. We have received comments stating that the amount of 
packaging in the single bills for drug administration services is not 
representative of the typical packaged costs of these drug 
administration services, which are usually performed in combination 
with one another, because the single bills represent less complex and 
less resource-intensive services than the usual cases.
    We published a study in the CY 2007 OPPS/ASC final rule with 
comment period (71 FR 68120 through 68121) that discussed the amount of 
packaging on the single bills for drug administration procedure codes, 
and we promised to replicate that study for the APC Panel. We discussed 
the results of this study with the APC Panel at its March 2007 meeting, 
in accordance with the APC Panel's August 2006 recommendation. Table 2 
below shows the drug administration HCPCS codes and their descriptors, 
status indicators, deleted code status, and CY 2007 APC assignments in 
columns 1, 2, 3, and 4, respectively. HCPCS codes for additional hours 
of infusion services are not presented because these codes were 
included on the CY 2007 bypass list and, therefore, we explicitly 
associated no packaged costs with them, as discussed in the CY 2007 
OPPS/ASC final rule with comment period (71 FR 68117 through 68118). 
Column 6 of the table contains the number of single bills relative to 
total occurrences of the code in the CY 2005 claims, and column 8 shows 
the percentage of single bills used to set payment rates. Drug 
administration services demonstrate reasonable single bill 
representation in comparison with other OPPS services. Single bills for 
drug administration constitute, roughly, 30 percent of all observed 
occurrences of drug administration services, varying by code from 7 to 
55 percent. Columns 10 through 13 of the table show measures of central 
tendency for packaged costs as a percentage of total cost on each 
single claim. Columns 10 and 11 show the mean and median of all 
packaged costs as a percentage of total costs, and columns 12 and 13 
break out the costs of packaged drug HCPCS codes and uncoded pharmacy 
revenue code charges for revenue codes in the 0250 series (Pharmacy), 
0260 series (IV Therapy), and 0630 series (Pharmacy--Extension). These 
columns demonstrate that packaged costs substantially contribute to 
median cost estimates for the majority of drug administration HCPCS 
codes.
    For all single bills for CPT code 90780 (Intravenous infusion for 
therapy/diagnosis, administered by physician or under direct 
supervision of physician; up to one hour), on average, packaged costs 
were 31 percent of total cost (median 27 percent). For the same code, 
packaged drug and pharmacy costs comprised, on average, 23 percent of 
total costs (median 15 percent). Single bills make up 34 percent of all 
line-item occurrences of the service, suggesting that this single bill 
median cost was fairly robust and probably captured packaging 
adequately. On the other hand, CPT code 90784 (Therapeutic, 
prophylactic or diagnostic injection (specify material injected); 
subcutaneous or intramuscular) demonstrates limited packaging (median 0 
percent and mean 17 percent), and the median cost for the code is 
derived from only 7 percent of all occurrences of the code. Across all 
drug administration codes, over half show significant median packaged 
costs largely attributable to packaged drug and pharmacy costs.

                                 Table 2.--Packaged Cost Data for CY 2005 Single Claims for Drug Administration Services
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                               All packaged costs     Packaged drug and
                                                                                                                 as a percent of     pharmacy costs as a
                                            Deleted              Single       Total      Percent     Median        total cost         percent of total
 HCPCS code   Short descriptor      SI       code       APC      bills      frequency     single    cost ($) ----------------------         cost
                                                                                          bills                                    ---------------------
                                                                                                                Median      Mean      Median      Mean
(1)          (2)...............  (3)....  (4).......     (5)          (6)          (7)        (8)        (9)       (10)       (11)       (12)       (13)
--------------------------------------------------------------------------------------------------------------------------------------------------------
90780......  IV infusion         S......  X.........    0440    1,008,055    2,974,785       33.9     110.43       27.1       30.8       15.3       22.6
              therapy, 1 hour.
90782......  Injection, sc/im..  S......  X.........    0437    1,326,094    2,894,231       45.8      24.77        0.0       10.1        0.0        8.7
90783......  Injection, ia.....  S......  X.........    0438          427        3,012       14.2      51.35        0.0       10.9        0.0        6.8
90784......  Injection, iv.....  S......  X.........    0438      183,096    2,812,204        6.5      49.54        0.0       16.7        0.0        9.7
90788......  Injection of        S......  X.........    0437       19,400      141,293       13.7      45.96       24.6       32.3       20.7       30.4
              antibiotic.
96400......  Chemotherapy, sc/   S......  ..........    0438       57,472       81,546       70.5      51.98        0.0        6.3        0.0        4.5
              im.
96405......  Chemo               S......  ..........    0438          142          181       78.5     193.65        0.0       12.0        0.0       10.5
              intralesional, up
              to 7.
96406......  Chemo               S......  ..........    0438            2            7       28.6      46.42        0.0        0.0        0.0        0.0
              intralesional
              over 7.
96408......  Chemotherapy, push  S......  ..........    0439       21,113      134,447       15.7      96.85       10.6       21.3        2.4       13.6
              technique.
96410......  Chemotherapy,       S......  ..........    0441      161,872      555,170       29.2     151.55       21.4       27.0       12.4       19.6
              infusion method.
96414......  Chemo, infuse       S......  ..........    0441        2,370       14,561       16.3     182.89       15.4       23.0        8.6       15.6
              method add-on.
96420......  Chemo, ia, push     S......  ..........    0439          170          933       18.2      99.86        9.6       27.6        4.2       15.4
              tecnique.
96422......  Chemo ia infusion   S......  ..........    0441          556        1,814       30.7     162.94       45.9       46.5       31.0       35.1
              up to 1 hr.
96425......  Chemotherapy,       S......  ..........    0441          149          557       26.8     216.68       29.4       33.5       14.7       24.4
              infusion method.
96440......  Chemotherapy,       S......  ..........    0439           38          104       36.5      37.12        0.0        2.1        0.0        1.5
              intracavitary.
96445......  Chemotherapy,       S......  ..........    0439           43          137       31.4      61.98       23.8       25.0       23.7       21.1
              intracavitary.
96450......  Chemotherapy, into  S......  ..........    0441          394          869       45.3     160.03       25.8       28.7        2.0        8.3
              CNS.
96520......  Port pump refill &  S......  ..........    0440        9,771       23,928       40.8     140.66       29.0       31.5       16.8       23.6
              main.
96530......  Syst pump refill &  S......  ..........    0440        8,334       19,283       43.2     100.00        7.4       22.2        0.7       13.7
              main.
96542......  Chemotherapy        S......  ..........    0438          511          929       55.0      51.56        0.0       10.8        0.0        6.5
              injection.
--------------------------------------------------------------------------------------------------------------------------------------------------------

    By definition, we are unable to precisely assess the amount of 
packaging associated with drug administration codes in the multiple 
bills. As a proxy, we estimated packaging as a percent of total cost on

[[Page 42641]]

each claim for two subsets of claims. Both analyses suggest the 
presence of moderate packaged costs, especially drug and pharmacy 
costs, associated with drug administration services in the multiple 
bills. Table 3 below shows measures of central tendency for packaging 
percentages in the multiple bills or portions of multiple bills 
remaining after ``pseudo'' singles have been created. We refer to this 
group of the multiple bills as the ``hardcore'' multiple bills. For the 
first subset of ``hardcore'' multiple bills with only drug 
administration codes, that is, where multiple drug administration codes 
are the only separately paid procedure codes on the claim (defined as 
procedure codes with a status indicator of ``S,'' ``T,'' ``V,'' ``X,'' 
or ``P''), we estimate that packaged costs are 22 percent of total 
costs (27 percent, on average), where total costs consist of costs for 
all payable codes. Costs for packaged drug HCPCS codes and pharmacy 
revenue codes comprise 13 percent of total cost at the median (19 
percent, on average). For the second subset of ``hardcore'' multiple 
bills with any drug administration code, that is, where a drug 
administration code appears with other payable codes (largely radiology 
services and visits), we estimate packaged costs are 13 percent of 
total cost at the median (19 percent, on average). Costs for packaged 
drugs and pharmacy revenue codes comprise 6 percent of total cost at 
the median (10 percent, on average). The amount of packaging in both 
proxy measures, but especially the first subset, closely resembles the 
packaged costs as a percentage of drug administration costs observed in 
the single bills for drug administration services. While finding a way 
to accurately use data from the ``hardcore'' multiple bills to estimate 
drug administration median costs undoubtedly would impact medians, 
these comparisons suggest that the multiple bill data probably would 
support current median estimates.

                Table 3.--Packaged Costs on Multiple Bill Claims for Drug Administration Services
----------------------------------------------------------------------------------------------------------------
                                                      All packaged costs as a       Packaged drug and pharmacy
                                                       percent of total cost        costs as a percent of total
                 Total frequency                 --------------------------------              cost
                                                                                 -------------------------------
                                                      Median           Mean           Median           Mean
----------------------------------------------------------------------------------------------------------------
                   Subset 1: ``Hardcore'' Multiple Claims with Only Drug Administration Codes
----------------------------------------------------------------------------------------------------------------
693,925.........................................            21.6            26.8            12.7            19.3
----------------------------------------------------------------------------------------------------------------
                    Subset 2: ``Multiple'' Claims with At Least One Drug Administration Code
----------------------------------------------------------------------------------------------------------------
4,816,338.......................................            13.2            19.4             5.8            10.0
----------------------------------------------------------------------------------------------------------------

    We have received several comments over the past few years offering 
algorithms for packaging the costs associated with specific revenue 
codes or packaged drugs with certain drug administration codes. Because 
of the complexity of even routine OPPS claims, prior research suggests 
that such algorithms have limited power to generate additional single 
bill claims and do little to change median cost estimates. We continue 
to look for simple, but powerful, methodologies like the bypass list 
and packaging of HCPCS codes for additional ancillary and supportive 
services to assign packaged costs to all services within the 
``hardcore'' multiple bills. Ideally, these methodologies should be 
intuitive to the provider community, easily integrated into the 
complexity of OPPS median cost estimation, and simple to maintain from 
year to year. We solicit and will carefully consider methodologies for 
creation of single bills that meet these criteria.
c. Proposed Calculation of CCRs
    We calculate hospital-specific overall CCRs and hospital-specific 
departmental CCRs for each hospital for which we have claims data in 
the period of claims being used to calculate the median costs that we 
convert to scaled relative weights for purposes of setting the OPPS 
payment rates. We apply the hospital-specific CCR to the hospital's 
charges at the most detailed level possible, based on a revenue code-
to-cost center crosswalk that contains a hierarchy of CCRs used to 
estimate costs from charges for each revenue code. That crosswalk is 
available for review and continuous comment on the CMS Web site at: 
http://www.cms.hhs.gov/HospitalOutpatientPPS/03_crosswalk.asp#TopOfPage. Comments on the proposed configuration of the 
crosswalk for CY 2008 should be included with comments on this section 
of this proposed rule. We calculate CCRs for the standard and 
nonstandard cost centers accepted by the electronic cost report 
database. In general, the most detailed level at which we calculate 
CCRs is the hospital-specific departmental level.
    Following the expiration of most medical devices from pass-through 
status in CY 2003, prior to which devices were paid at charges reduced 
to cost using the hospital's overall CCR, we received comments that our 
OPPS cost estimates for device implantation procedures systematically 
underestimate the cost of the devices included in the packaged payment 
for the procedures. Commenters informed us that hospitals routinely 
mark up charges for low cost items to a much greater extent than they 
mark up high cost items, and that these items are often combined in a 
single cost center on their Medicare cost report. Commenters stated 
that when items with widely varying costs are combined in a single cost 
center using that cost center's CCR to estimate costs from charges for 
those items, this approach will overestimate the cost of low cost items 
and underestimate the cost of high cost items. This is commonly known 
as ``charge compression.'' They stated that, in the case of implantable 
devices, the charges for both high cost devices and low cost supplies 
typically are reported under the medical supply revenue code series and 
that the costs of both typically are reported in the medical supply 
cost center on the cost report. Commenters stated that the application 
of one medical supply CCR to charges for all items reported under the 
medical supply revenue code underestimates the cost of expensive 
medical supplies and overestimates the cost of inexpensive supplies. 
They indicated that when these costs are packaged into the costs of the 
procedures in which they are used, the result is inaccurate median 
costs for the HCPCS codes and APCs, and thus the standard OPPS 
ratesetting methodology systematically distorts

[[Page 42642]]

relative payment weights for procedures using devices.
    In CY 2006, the device industry commissioned a study to interpolate 
a device-specific CCR from the medical supply CCR, using publicly 
available hospital claim and Medicare cost report data rather than 
proprietary data on device costs. After reviewing the device industry's 
data analysis and study model, CMS contracted with RTI International 
(RTI) to study the impact of charge compression on the cost-based 
weight methodology adopted in the FY 2007 IPPS final rule, to evaluate 
this model and to propose solutions. For more information, interested 
individuals can view RTI's report on the CMS Web site at: http://www.cms.hhs.gov/reports/downloads/Dalton.pdf.
    Any study of cost estimation in general, and charge compression 
specifically, has obvious importance for both the OPPS and the IPPS. 
RTI's research explicitly focused on the IPPS for several reasons, 
which include greater Medicare expenditure under the IPPS, a desire to 
evaluate the model quickly given IPPS regulation deadlines, and a focus 
on other components of the new FY 2007 IPPS cost-based weight 
methodology (CMS Contract No. 500-00-0024-T012, ``A Study of Charge 
Compression in Calculating DRG Relative Weights,'' page 5). The study 
first addressed the possibility of cross-aggregation bias in the CCRs 
used to estimate costs under the IPPS created by the IPPS methodology 
of aggregating cost centers into larger departments before calculating 
CCRs. The report also addressed potential bias created by estimating 
costs using a CCR that reflects the combined costs and charges of 
services with wide variation in the amount of hospital markup. In its 
assessment of the latter, RTI targeted its attempt to identify the 
presence of charge compression to those cost centers presumably 
associated with revenue codes demonstrating significant IPPS 
expenditures and utilization. RTI assessed the correlation between cost 
report CCRs and the percent of charges in a cost center attributable to 
a set of similar services represented by a group of revenue codes. RTI 
did not examine the correlation between CCRs and revenue codes without 
significant IPPS expenditures or a demonstrated concentration in a 
specific Diagnosis Related Group (DRG). For example, RTI did not 
examine revenue code groups within the pharmacy cost center with low 
proportionate inpatient charges that might be important to the OPPS, 
such as ``Pharmacy Incident to Radiology.'' RTI states this limitation 
in its study and specifically recommends that disaggregated CCRs be 
reestimated for outpatient hospital charges.
    Cost report CCRs combine both inpatient and outpatient services. 
Ideally, RTI would be able to examine the correlation between CCRs for 
Medicare inpatient services and inpatient claim charges and the 
correlation between CCRs for Medicare outpatient services and 
outpatient claim charges. However, the comprehensive nature of the cost 
report CCR (which combines inpatient and outpatient services) argues 
for an analysis of the correlation between CCRs and combined inpatient 
and outpatient claim charges. As noted, the RTI study accepted some 
measurement error in its analysis by matching an ``all charges'' CCR to 
inpatient estimates of charges for groups of similar services 
represented by revenue codes because of short timelines and because 
inpatient costs dominate outpatient costs in many ancillary cost 
centers. We believe that CCR adjustments used to calculate payment 
should be based on the comparison of cost report CCRs to combined 
inpatient and outpatient charges. An ``all charges'' model would reduce 
measurement error and estimate adjustments to disaggregated CCRs that 
could be used in both hospital inpatient and outpatient payment 
systems.
    RTI made several short-term recommendations for improving the 
accuracy of DRG weight estimates from a cost-based methodology to 
address bias in combining cost centers and charge compression that 
could be considered in the context of OPPS policy. We discuss each 
recommendation within the context of the OPPS and provide our 
assessment of its application to the OPPS. We do not discuss RTI's 
recommendations to change cost report policy, which, by definition, 
would not have an effect on payment weight estimates until several 
years in the future.
    (1) RTI recommends expansion of the number of CCRs used under the 
IPPS (RTI study, pages 11 and 85). Our OPPS methodology is already more 
specific than the RTI recommendation. To the extent possible, the OPPS 
uses hospital-specific cost centers, both standard and nonstandard, to 
reduce charges to estimated costs and, therefore, the OPPS ratesetting 
methodology is already more specific than the RTI recommendation.
    (2) RTI recommends disaggregation of emergency department and blood 
products from the ``other services'' CCR used in the IPPS (RTI study, 
pages 11 and 85). Because we use standard and nonstandard cost center 
data, our OPPS methodology already comports with this RTI 
recommendation. Further, we estimate a CCR for blood that is often 
higher than that in the cost report based on a special methodology that 
is discussed further in section X of this proposed rule. Therefore, the 
OPPS is already meeting, and in several cases exceeding, the RTI 
recommendation for specificity with regard to estimating the costs 
associated with emergency department and blood product services.
    (3) RTI recommends reclassification of intermediate care charges 
from the intensive care unit to the routine cost center (RTI study, 
pages 10 and 85). This recommendation is not relevant to the OPPS 
because our methodology for calculating costs under the OPPS relies 
solely on ancillary cost centers and does not use either cost center 
included in the recommendation to estimate costs for hospital 
outpatient services.
    (4) RTI recommends establishment of regression-based estimates as a 
temporary or permanent method for disaggregating national average CCRs 
for medical supplies, drugs, and radiology services under the IPPS (RTI 
study, pages 11 and 86). With regard to radiology services, RTI 
estimated significantly lower CCRs for the cost centers for computed 
tomography (CT) scans and magnetic resonance imaging (MRI) services. 
RTI triangulated its findings with lower observed CCRs for the one-
third of providers reporting nonstandard cost centers, specifically MRI 
Scan and CT Scan. However, in using CCRs for nonstandard cost centers, 
including MRI Scan and CT Scan, the OPPS already has partially 
implemented RTI's recommendation to use lower CCRs to estimate costs 
for those OPPS services allocated to these two imaging cost centers.
    For reasons discussed in more detail below, we are proposing to 
develop an all-charges model that would compare variation in CCRs with 
variation in combined inpatient and outpatient charges for sets of 
similar services and establish disaggregated CCRs that could be applied 
to both inpatient and outpatient charges. We are proposing to evaluate 
the results of that methodology for purposes of determining whether the 
resulting disaggregated CCRs should be proposed for use in developing 
the CY 2009 OPPS payment rates. The revised all-charges model and 
resulting disaggregated CCRs will not be available in time for use in 
the CY 2008 OPPS/ASC final rule with comment period.
    There are several reasons that we are not proposing to use the 
intradepartmental CCRs that RTI estimated using IPPS charges for the CY 
2008 OPPS estimation of median costs. We agree with RTI that the

[[Page 42643]]

intradepartmental CCRs it calculated for the IPPS would not always be 
appropriate for application to the OPPS (RTI study, pages 34 and 35). 
While RTI recommends that the model be recalibrated for outpatient 
charges before it is applied to the OPPS, we believe that the combined 
nature of the CCRs available from the cost report prevents an accurate 
outpatient recalibration that would be appropriate for the OPPS alone. 
The addition of outpatient charges could change the variability of 
combined charges for some groups of services. For example, if hospitals 
use a high volume of less complex devices with lower charges in the 
outpatient department, the inclusion or omission of the outpatient 
charges for these high volume and lower cost devices could change the 
estimated disaggregated device CCR. Furthermore, RTI's analysis 
excluded some revenue codes with extensive outpatient charges because 
these revenue codes play a minor role in the IPPS. Therefore, we 
believe that an all-charges model examining an expanded subset of 
revenue codes is most appropriate, and that this model must be 
developed before we could apply the resulting disaggregated CCRs to the 
charges for supplies paid under the OPPS.
    Moreover, to implement the disaggregated IPPS-based CCRs in the 
OPPS that RTI estimated for CY 2008 could result in greater instability 
in relative payment weights for CY 2008 than would otherwise occur. 
Significant changes in CCRs, both increases and decreases, could prompt 
the reassignment of services to different APCs due to the new estimates 
of median costs and require modification of the overall APC structure. 
Not only might there be significant fluctuations in payment between the 
CY 2007 and CY 2008 OPPS, but a subsequent change to application of the 
disaggregated CCRs resulting from development of an all-charges model 
might also result in significant fluctuations in median costs and 
increased instability in payments from CY 2008 to CY 2009. Therefore, 
these sequential changes could result in significant increases in 
median costs in one year and significant declines in median costs in 
the next year.
    Therefore, we are not proposing to adopt the RTI disaggregated CCRs 
under the CY 2008 OPPS. We will consider whether it would be 
appropriate to adopt disaggregated CCRs for the OPPS after we analyze 
the results of the use of both inpatient and outpatient charges across 
all payers to recalculate disaggregated CCRs.
2. Proposed Calculation of Median Costs
    In this section of this proposed rule, we discuss the use of claims 
to calculate the proposed OPPS payment rates for CY 2008. The hospital 
OPPS page on the CMS Web site on which this proposed rule is posted 
provides an accounting of claims used in the development of the 
proposed rates on the CMS Web site at: http://www.cms.hhs.gov/HospitalOutpatientPPS. The accounting of claims used in the development 
of this proposed rule is included on the Web site under supplemental 
materials for the CY 2008 proposed rule. That accounting provides 
additional detail regarding the number of claims derived at each stage 
of the process. In addition, below we discuss the files of claims that 
comprise the data sets that are available for purchase under a CMS data 
user contract. Our CMS Web site, http://www.cms.hhs.gov/HospitalOutpatientPPS, includes information about purchasing the 
following two OPPS data files: ``OPPS Limited Data Set'' and ``OPPS 
Identifiable Data Set.''
    We used the following methodology to establish the relative weights 
we are proposing to use in calculating the OPPS payment rates for CY 
2008 shown in Addenda A and B to this proposed rule. This methodology 
is as follows:
    We used outpatient claims for the full CY 2006, processed before 
January 1, 2007, to set the proposed relative weights for CY 2008. To 
begin the calculation of the relative weights for CY 2008, we pulled 
all claims for outpatient services furnished in CY 2006 from the 
national claims history file. This is not the population of claims paid 
under the OPPS, but all outpatient claims (including, for example, CAH 
claims and hospital claims for clinical laboratory services for persons 
who are neither inpatients nor outpatients of the hospital).
    We then excluded claims with condition codes 04, 20, 21, and 77. 
These are claims that providers submitted to Medicare knowing that no 
payment will be made. For example, providers submit claims with a 
condition code 21 to elicit an official denial notice from Medicare and 
document that a service is not covered. We then excluded claims for 
services furnished in Maryland, Guam, the U.S. Virgin Islands, American 
Samoa, and the Northern Mariana Islands because hospitals in those 
geographic areas are not paid under the OPPS.
    We divided the remaining claims into the three groups shown below. 
Groups 2 and 3 comprise the 101 million claims that contain hospital 
bill types paid under the OPPS.
    1. Claims that were not bill types 12X, 13X, 14X (hospital bill 
types), or 76X (CMHC bill types). Other bill types are not paid under 
the OPPS and, therefore, these claims were not used to set OPPS 
payment.
    2. Claims that were bill types 12X, 13X, or 14X (hospital bill 
types). These claims are hospital outpatient claims.
    3. Claims that were bill type 76X (CMHC). (These claims are later 
combined with any claims in item 2 above with a condition code 41 to 
set the per diem partial hospitalization rate determined through a 
separate process.)
    For the CCR calculation process, we used the same general approach 
as we used in developing the final APC rates for CY 2007, using the 
revised CCR calculation which excluded the costs of paramedical 
education programs and weighted the outpatient charges by the volume of 
outpatient services furnished by the hospital. We refer readers to the 
CY 2007 OPPS/ASC final rule with comment period for more information 
(71 FR 67983 through 67985). We first limited the population of cost 
reports to only those for hospitals that filed outpatient claims in CY 
2006 before determining whether the CCRs for such hospitals were valid.
    We then calculated the CCRs for each cost center and the overall 
CCR for each hospital for which we had claims data. We did this using 
hospital-specific data from the Healthcare Cost Report Information 
System (HCRIS). We used the most recent available cost report data, in 
most cases, cost reports for CY 2005. We used the most recently 
submitted cost report to calculate the CCRs to be used to calculate 
median costs for the proposed CY 2008 OPPS rates. If the most recent 
available cost report was submitted but not settled, we looked at the 
last settled cost report to determine the ratio of submitted to settled 
cost using the overall CCR, and we then adjusted the most recent 
available submitted but not settled cost report using that ratio. We 
calculated both an overall CCR and cost center-specific CCRs for each 
hospital. We used the overall CCR calculation discussed in section 
II.A.1.c. of this proposed rule for all purposes that require use of an 
overall CCR.
    We then flagged CAH claims, which are not paid under the OPPS, and 
claims from hospitals with invalid CCRs. The latter included claims 
from hospitals without a CCR; those from hospitals paid an all-
inclusive rate; those from hospitals with obviously erroneous CCRs 
(greater than 90 or less than .0001); and those from hospitals with

[[Page 42644]]

overall CCRs that were identified as outliers (3 standard deviations 
from the geometric mean after removing error CCRs). In addition, we 
trimmed the CCRs at the cost center (that is, departmental) level by 
removing the CCRs for each cost center as outliers if they exceeded 
<plus-minus>3 standard deviations from the geometric mean. We used a 
four-tiered hierarchy of cost center CCRs to match a cost center to 
every possible revenue code appearing in the outpatient claims, with 
the top tier being the most common cost center and the last tier being 
the default CCR. If a hospital's cost center CCR was deleted by 
trimming, we set the CCR for that cost center to ``missing,'' so that 
another cost center CCR in the revenue center hierarchy could apply. If 
no other cost center CCR could apply to the revenue code on the claim, 
we used the hospital's overall CCR for the revenue code in question. 
For example, if a visit was reported under the clinic revenue code, but 
the hospital did not have a clinic cost center, we mapped the hospital-
specific overall CCR to the clinic revenue code. The hierarchy of CCRs 
is available for inspection and comment on the CMS Web site: http://www.cms.hhs.gov/HospitalOutpatientPPS.
    We then converted the charges to costs on each claim by applying 
the CCR that we believed was best suited to the revenue code indicated 
on the line with the charge. Table 4 of this proposed rule contains a 
list of the allowed revenue codes. Revenue codes not included in Table 
4 are those not allowed under the OPPS because their services cannot be 
paid under the OPPS (for example, inpatient room and board charges), 
and thus charges with those revenue codes were not packaged for 
creation of the OPPS median costs. One exception is the calculation of 
median blood costs, as discussed in section X. of this proposed rule.
    Thus, we applied CCRs as described above to claims with bill types 
12X, 13X, or 14X, excluding all claims from CAHs and hospitals in 
Maryland, Guam, the U.S. Virgin Islands, American Samoa, and the 
Northern Mariana Islands and claims from all hospitals for which CCRs 
were flagged as invalid.
    We identified claims with condition code 41 as partial 
hospitalization services of hospitals and moved them to another file. 
These claims were combined with the 76X claims identified previously to 
calculate the partial hospitalization per diem rate.
    We then excluded claims without a HCPCS code. We moved to another 
file claims that contained nothing but influenza and pneumococcal 
pneumonia (``PPV'') vaccines. Influenza and PPV vaccines are paid at 
reasonable cost and, therefore, these claims are not used to set OPPS 
rates. We note that the separate file containing partial 
hospitalization claims is included in the files that are available for 
purchase as discussed above. Unlike years past, we did not create a 
separate file of claims containing observation services because we are 
proposing to package all observation care for the CY 2008 OPPS.
    We next copied line-item costs for drugs, blood, and devices (the 
lines stay on the claim, but are copied onto another file) to a 
separate file. No claims were deleted when we copied these lines onto 
another file. These line-items are used to calculate a per unit mean 
and median and a per day mean and median for drugs, radiopharmaceutical 
agents, blood and blood products, and devices, including, but not 
limited to, brachytherapy sources, as well as other information used to 
set payment rates, such as a unit-to-day ratio for drugs.
    We then divided the remaining claims into the following five 
groups:
    1. Single Major Claims: Claims with a single separately payable 
procedure (that is, status indicator ``S,'' `` T,'' ``V,'' or ``X'').
    2. Multiple Major Claims: Claims with more than one separately 
payable procedure (that is, status indicator ``S,'' ``T,'' ``V,'' or 
``X''), or multiple units for one payable procedure. As discussed 
below, some of these can be used in median setting. We also included in 
this set claims that contain one unit of one code when the bilateral 
modifier is appended to the code and the code is one that is 
conditionally or independently bilateral. In these cases, these claims 
represent more than one unit of the service described by the code, 
notwithstanding that only one unit is billed.
    3. Single Minor Claims: Claims with a single HCPCS code that is 
assigned to status indicator ``F,'' ``G,'' ``H,'' ``K,'' ``L,'' or 
``N.''
    4. Multiple Minor Claims: Claims with multiple HCPCS codes that are 
assigned to status indicator ``F,'' ``G,'' ``H,'' ``K,'' ``L,'' or 
``N.''
    5. Non-OPPS Claims: Claims that contain no services payable under 
the OPPS (that is, all status indicators other than those listed for 
major or minor status). These claims are excluded from the files used 
for the OPPS. Non-OPPS claims have codes paid under other fee 
schedules, for example, durable medical equipment or clinical 
laboratory tests, and do not contain either a code for a separately 
paid service or a code for a packaged service.
    We use status indicator ``Q'' in Addendum B to this proposed rule 
to identify services that receive separate HCPCS code-specific payment 
when specific criteria are met, and payment for the individual service 
is packaged in all other circumstances. We are proposing several 
different sets of criteria to determine whether separate payment would 
be made for specific services. For example, HCPCS code G0379 (Direct 
admission of patient for hospital observation care) is assigned to 
status indicator ``Q'' in Addendum B to this proposed rule because we 
are proposing that it receive separate payment only if it is billed on 
the same date of service as HCPCS code G0378 (Hospital observation 
service, per hour), without any services with status indicator ``T'' or 
``V,'' or Critical Care (APC 0617). Proposed payment for observation 
services is discussed in section XI. of this proposed rule. The 
specific services in the proposed composite APCs discussed in section 
II.A.4. of this proposed rule also are assigned to status indicator 
``Q'' in Addendum B to this proposed rule because we are proposing that 
their payment would be bundled into a single composite payment for a 
combination of major procedures under certain circumstances. These 
services would only receive separate code-specific payment if certain 
criteria are met. The same is true for those less intensive outpatient 
mental health treatment services for which payment is limited to the 
partial hospitalization per diem rate and which also are assigned to 
status indicator ``Q'' in Addendum B to this proposed rule. According 
to longstanding OPPS payment policy (65 FR 18455), payment for these 
individual mental health services is bundled into a single payment, APC 
0034 (Mental Health Services Composite), when the sum of the individual 
mental health service payments for all of these mental health services 
provided on the same day would exceed payment for a day of partial 
hospitalization services. However, the largest number of specific HCPCS 
codes identified by status indicator ``Q'' in Addendum B to this 
proposed rule are those codes that we identify as ``special'' packaged 
codes, where we are proposing that a service receives separate payment 
when it appears on the same day on a claim without another service that 
is assigned to status indicator ``S,'' ``T,'' ``V,'' or ``X.'' We are 
proposing to package payment for these HCPCS codes when the code 
appears on the same date of service with any other service that is

[[Page 42645]]

assigned to status indicator ``S,'' ``T,'' ``V,'' or ``X.''
    This last and largest subset of conditionally packaged services 
have to be integrated into the identification of single and multiple 
bills to ensure that the costs for these services are appropriately 
packaged when they appear with any other separately paid service. We 
handle these conditionally packaged services in the data by assigning 
the HCPCS code an APC and a data status indicator of ``N.'' When the 
conditionally packaged HCPCS code appears with a HCPCS code with a 
status indicator of ``S,'' ``T,'' ``V,'' or ``X'' on the same date of 
service, it is treated as a packaged code. The costs that appear on the 
line with the code are packaged into the cost of the HCPCS code with a 
status indicator of ``S,'' ``T,'' ``V,'' or ``X.'' When the 
conditionally packaged HCPCS code appears by itself, we change the 
status indicator on the line to the status indicator of the APC to 
which the conditionally packaged code is assigned, converting the 
service from a minor to a major procedure. This creates single bills 
for these conditionally packaged services that are then used to set the 
median cost for the conditionally packaged code and for the APC to 
which it is assigned when it is separately paid.
    The claims listed in numbers 1, 2, 3, and 4 above are included in 
the data files that can be purchased as described above.
    In years prior to the CY 2007 OPPS, we made a determination of 
whether each HCPCS code was a major code or a minor code or a code 
other than a major or minor code. We used those code-specific 
determinations to sort claims into the five groups identified above. 
For the CY 2007 OPPS, we used status indicators to sort the claims into 
these groups. We defined major procedures as any procedure having a 
status indicator of ``S,'' ``T,'' ``V,'' or ``X;'' defined minor 
procedures as any code having a status indicator of ``N;'' and 
classified ``other'' procedures as any code having a status indicator 
other than ``S,'' ``T,'' ``V,'' ``X,'' or ``N.'' For the CY 2007 OPPS 
proposed rule limited data set and identifiable data set, these 
definitions excluded claims on which hospitals billed drugs and devices 
without also billing separately paid procedure codes and, therefore, 
these public use files did not contain all claims used to calculate the 
drug and device frequencies and medians. We corrected this for the CY 
2007 OPPS/ASC final rule with comment period limited data set and 
identifiable data set by extracting claims containing drugs and devices 
from the set of ``other'' claims and adding them to the public use 
files.
    At its March 2007 meeting, the APC Panel recommended that CMS edit 
and return for correction claims that contain a HCPCS code for a 
separately paid drug or device but that also do not contain a HCPCS 
code assigned to a procedural APC (that is, those not assigned status 
indicator ``S,'' ``T,'' ``V,'' or ``X''). The APC Panel stated that 
this edit should improve the claims data and may increase the number of 
single bills available for ratesetting. We note that such an edit would 
be broader than the device-to-procedure code edits we implemented for 
CY 2007 for selected devices. While we encourage hospitals to code 
correctly in accordance with CPT, CMS, and local contractor guidance, 
in general we have historically implemented claims processing edits 
under the OPPS when we believe that these edits help ensure complete 
claims data for ratesetting. In the case of such Outpatient Code Editor 
(OCE) edits for drugs and devices that are separately paid, it is 
unclear to us that these edits would improve our claims data for median 
cost calculation because the items receive separate payment and do not 
result in multiple procedure claims when they are reported. We also are 
uncertain about the clinical circumstances that could result in a 
hospital submitting an OPPS claim that only reported a separately paid 
drug or device. We are soliciting comments specifically on the impact 
of establishing such edits on hospital billing processes and on related 
potential improvements to claims data used for median setting.
    Therefore, in view of the prior public comments and our desire to 
ensure that the public data files contain all appropriate data, for the 
CY 2008 OPPS, we are proposing to define major procedures as HCPCS 
codes that have a status indicator of ``S,'' ``T,'' ``V,'' or ``X.'' We 
are proposing to define minor procedures as HCPCS codes that have a 
status indicator of ``F,'' ``G,'' ``H,'' ``K,'' ``L,'' or ``N'' but, as 
we discuss above, to make single bills out of any claims for single 
procedures with a minor code that also has an APC assignment. This 
ensures that the claims that contain only codes for drugs and 
biologicals or devices but that do not contain codes for procedures are 
included in the limited data set and the identifiable data set. It also 
ensures, as discussed above, that conditionally packaged services that 
receive separate payment only when they are billed without any other 
separately payable OPPS services are treated appropriately for purposes 
of median cost calculations. We are proposing to define ``other'' 
services as HCPCS codes that have a status indicator other than those 
defined as major or minor procedures.
    We continue to believe that using status indicators, with the 
proposed changes, is an appropriate way to sort the claims into these 
groups and also to make our process more transparent to the public. We 
further believe that this proposed method of sorting claims would 
enhance the public's ability to derive useful information for analysis 
and public comment on this proposed rule.
    We set aside the single minor, multiple minor, and non-OPPS claims 
(numbers 3, 4, and 5 above) because we did not use these claims in 
calculating median costs of procedural APCs. We then examined the 
multiple major claims for dates of service to determine if we could 
break them into single procedure claims using the dates of service on 
all lines on the claim. If we could create claims with single major 
procedures by using date of service, we created a single procedure 
claim record for each separately paid procedure on a different date of 
service (that is, a ``pseudo'' single).
    We then used the bypass codes listed in Table 1 of this proposed 
rule and discussed in section II.A.1.b. of this proposed rule to remove 
separately payable procedures that we determined contain limited costs 
or no packaged costs or were otherwise suitable for inclusion on the 
bypass list from a multiple procedure bill. When one of the two 
separately payable procedures on a multiple procedure claim was on the 
bypass list, we split the claim into two ``pseudo'' single procedure 
claims records. The single procedure claim record that contained the 
bypass code did not retain packaged services. The single procedure 
claim record that contained the other separately payable procedure (but 
no bypass code) retained the packaged revenue code charges and the 
packaged HCPCS code charges.
    We also removed lines that contained multiple units of codes on the 
bypass list and treated them as ``pseudo'' single claims by dividing 
the cost for the multiple units by the number of units on the line. 
Where one unit of a single, separately paid procedure code remained on 
the claim after removal of the multiple units of the bypass code, we 
created a ``pseudo'' single claim from that residual claim record, 
which retained the costs of packaged revenue codes and packaged HCPCS 
codes. This enabled us to use claims that would otherwise be multiple 
procedure claims and could not be used. We excluded those claims that 
we were not able to

[[Page 42646]]

convert to single claims even after applying all of the techniques for 
creation of ``pseudo'' singles. Among those excluded were claims that 
contain codes that are viewed as independently or conditionally 
bilateral and that contain the bilateral modifier (Modifier 50, 
Bilateral procedure) because the line-item cost for the code represents 
the cost of two units of the procedure, notwithstanding that the code 
appears with a unit of one. Therefore, the charge on the line 
represents the charge for two services rather than a single service and 
using the line as reported would overstate the cost of a single 
procedure. We then packaged the costs of packaged HCPCS codes (codes 
with status indicator ``N'' listed in Addendum B to this proposed rule) 
and packaged revenue codes into the cost of the single major procedure 
remaining on the claim.
    The list of packaged revenue codes is shown in Table 4 of this 
proposed rule. At its March 2007 meeting the APC Panel recommended that 
CMS review the final list of packaged revenue codes for consistency 
with OPPS policy and ensure that future versions of the OCE edit 
accordingly. We compared the packaged revenue codes in the OCE to the 
finalized list of packaged revenue codes for the CY 2007 OPPS (71 FR 
67989 through 67990) that we used for packaging costs in median 
calculation. As a result of that analysis, we are accepting the APC 
Panel's recommendation and we are proposing to change the list of 
packaged revenue codes for the CY 2008 OPPS in the following manner. 
First, we are proposing to remove revenue codes 0274 (Prosthetic/
Orthotic devices) and 0290 (Durable Medical Equipment) from the list of 
packaged revenue codes because we do not permit hospitals to report 
implantable devices in these revenue codes (Internet Only Manual 100-4, 
Chapter 4, section 20.5.1.1). We also are proposing to add revenue code 
0273 (Take Home Supplies) to the list of packaged revenue codes because 
we believe that the charges under this revenue code are for the 
incidental supplies that hospitals sometimes provide for patients who 
are discharged at a time when it is not possible to secure the supplies 
needed for a brief time at home. We are proposing to conform the list 
of packaged revenue codes in the OCE to the OPPS for CY 2008.
    We packaged the costs of the HCPCS codes that are shown with status 
indicator ``N'' into the cost of the independent service to which the 
packaged service is ancillary or supportive. We refer readers to 
section II.A.4. of this proposed rule for a more complete discussion of 
the packaging changes we are proposing for CY 2008.
    After removing claims for hospitals with error CCRs, claims without 
HCPCS codes, claims for immunizations not covered under the OPPS, and 
claims for services not paid under the OPPS, approximately 54 million 
claims were left. Of these 54 million claims, we were able to use some 
portion of approximately 50 million whole claims (92 percent of 
approximately 54 million potentially usable claims) to create 
approximately 88 million single and ``pseudo'' single claims, of which 
we used 87 million single bills (after trimming out just over 822,000 
claims as discussed below) in the CY 2008 median development and for 
ratesetting.
    We also excluded (1) claims that had zero costs after summing all 
costs on the claim and (2) claims containing packaging flag number 3. 
Effective for services furnished on or after July 1, 2004, the OCE 
assigns packaging flag number 3 to claims on which hospitals submit 
token charges for a service with status indicator ``S'' or ``T'' (a 
major separately paid service under the OPPS) for which the fiscal 
intermediary is required to allocate the sum of charges for services 
with a status indicator equaling ``S'' or ``T'' based on the weight for 
the APC to which each code is assigned. We do not believe that these 
charges, which were token charges as submitted by the hospital, are 
valid reflections of hospital resources. Therefore, we deleted these 
claims. We also deleted claims for which the charges equal the revenue 
center payment (that is, the Medicare payment) on the assumption that 
where the charge equals the payment, to apply a CCR to the charge would 
not yield a valid estimate of relative provider cost.
    For the remaining claims, we then standardized 60 percent of the 
costs of the claim (which we have previously determined to be the 
labor-related portion) for geographic differences in labor input costs. 
We made this adjustment by determining the wage index that applied to 
the hospital that furnished the service and dividing the cost for the 
separately paid HCPCS code furnished by the hospital by that wage 
index. As has been our policy since the inception of the OPPS, we are 
proposing to use the pre-reclassified wage indices for standardization 
because we believe that they better reflect the true costs of items and 
services in the area in which the hospital is located than the post-
reclassification wage indices and, therefore, would result in the most 
accurate unadjusted median costs.
    We also excluded claims that were outside 3 standard deviations 
from the geometric mean of units for each HCPCS code on the bypass list 
(because, as discussed above, we used claims that contain multiple 
units of the bypass codes).
    We used the remaining claims to calculate the CY 2008 proposed 
median costs for each separately payable HCPCS code and each APC. The 
comparison of HCPCS and APC medians determines the applicability of the 
``2 times'' rule. Section 1833(t)(2) of the Act provides that, subject 
to certain exceptions, the items and services within an APC group 
cannot be considered comparable with respect to the use of resources if 
the highest median (or mean cost, if elected by the Secretary) for an 
item or service in the group is more than 2 times greater than the 
lowest median cost for an item or service within the same group (``the 
2 times rule''). Finally, we reviewed the medians and reassigned HCPCS 
codes to different APCs where we believed that it was appropriate. 
Section III. of this proposed rule includes a discussion of certain 
proposed HCPCS code assignment changes that resulted from examination 
of the medians and for other reasons. The APC medians were recalculated 
after we reassigned the affected HCPCS codes. Both the HCPCS medians 
and the APC medians were weighted to account for the inclusion of 
multiple units of the bypass codes in the creation of ``pseudo'' single 
bills.
    In our review of median costs for HCPCS codes and their assigned 
APCs, we have frequently noticed that some services are consistently 
rarely performed in the hospital outpatient setting for the Medicare 
population. In particular, there are a number of services, such as 
several procedures related to the care of pregnant women, that have 
annual Medicare claims volume of 100 or fewer occurrences. By 
definition, these services also have a small number of single bills 
from which to estimate median costs. In addition, in some cases, these 
codes have been historically assigned to clinical APCs where all the 
services are low volume. Therefore, the median costs for these services 
and APCs often fluctuate from year to year, in part due to the 
variability created by such a small number of claims. One of the 
benefits of basing payment on the median cost of many HCPCS codes with 
sufficient single bill representation in an APC is that such 
fluctuation is moderated by the increased number of observations for 
similar services on which the APC median cost is also based. We 
considered proposing a distinct methodology for calculation of the

[[Page 42647]]

median cost of low total volume APCs in order to provide more stability 
in payment from year to year for these low total volume services. 
However, after examination of the low total volume OPPS services and 
their assigned APCs, we concluded that there were other clinical APCs 
with higher volumes of total claims to which these low total volume 
services could be reassigned, while ensuring the continued clinical and 
resource homogeneity of the clinical APCs to which they would be newly 
reassigned. Therefore, we believe that it is more appropriate to 
reconfigure clinical APCs to eliminate most of the low total volume 
APCs. These low volume services differ from other OPPS services only 
because they are not often furnished to the Medicare population. 
Therefore, we are proposing to reconfigure certain clinical APCs for CY 
2008 as a way to promote stability and appropriate payment for the 
services assigned to them, including low total volume services. We 
believe that these proposed reconfigurations maintain APC clinical and 
resource homogeneity. We are proposing these changes as an alternative 
to developing specific quantitative approaches to treating low total 
volume APCs differently for purposes of median calculation. As a result 
of this proposal, 3 APCs proposed for CY 2008 (all of which are New 
Technology APCs) have a total volume of services less than 100, and 
only 17 APCs have a total volume of less than 1,000, in comparison with 
CY 2007 where 9 APCs (including 3 New Technology APCs) had a total 
volume of less than 100 and 36 APCs had a total volume of less than 
1,000.
    A detailed discussion of the medians for blood and blood products 
is included in section X. of this proposed rule. A discussion of the 
medians for APCs that require one or more devices when the service is 
performed is included in section IV.A. of this proposed rule. A 
discussion of the median for partial hospitalization is included below 
in section II.B. of this proposed rule.

            Table 4.--Proposed CY 2008 Packaged Revenue Codes
------------------------------------------------------------------------
     Revenue code                          Description
------------------------------------------------------------------------
0250..................  PHARMACY.
0251..................  GENERIC.
0252..................  NONGENERIC.
0254..................  PHARMACY INCIDENT TO OTHER DIAGNOSTIC.
0255..................  PHARMACY INCIDENT TO RADIOLOGY.
0257..................  NONPRESCRIPTION DRUGS.
0258..................  IV SOLUTIONS.
0259..................  OTHER PHARMACY.
0260..................  IV THERAPY, GENERAL CLASS.
0262..................  IV THERAPY/PHARMACY SERVICES.
0263..................  SUPPLY/DELIVERY.
0264..................  IV THERAPY/SUPPLIES.
0269..................  OTHER IV THERAPY.
0270..................  M&S SUPPLIES.
0271..................  NONSTERILE SUPPLIES.
0272..................  STERILE SUPPLIES.
0273..................  TAKE HOME SUPPLIES.
0275..................  PACEMAKER DRUG.
0276..................  INTRAOCULAR LENS SOURCE DRUG.
0278..................  OTHER IMPLANTS.
0279..................  OTHER M&S SUPPLIES.
0280..................  ONCOLOGY.
0289..................  OTHER ONCOLOGY.
0343..................  DIAGNOSTIC RADIOPHARMS.
0344..................  THERAPEUTIC RADIOPHARMS.
0370..................  ANESTHESIA.
0371..................  ANESTHESIA INCIDENT TO RADIOLOGY.
0372..................  ANESTHESIA INCIDENT TO OTHER DIAGNOSTIC.
0379..................  OTHER ANESTHESIA.
0390..................  BLOOD STORAGE AND PROCESSING.
0399..................  OTHER BLOOD STORAGE AND PROCESSING.
0560..................  MEDICAL SOCIAL SERVICES.
0569..................  OTHER MEDICAL SOCIAL SERVICES.
0621..................  SUPPLIES INCIDENT TO RADIOLOGY.
0622..................  SUPPLIES INCIDENT TO OTHER DIAGNOSTIC.
0624..................  INVESTIGATIONAL DEVICE (IDE).
0630..................  DRUGS REQUIRING SPECIFIC IDENTIFICATION, GENERAL
                         CLASS.
0631..................  SINGLE SOURCE.
0632..................  MULTIPLE.
0633..................  RESTRICTIVE PRESCRIPTION.
0681..................  TRAUMA RESPONSE, LEVEL I.
0682..................  TRAUMA RESPONSE, LEVEL II.
0683..................  TRAUMA RESPONSE, LEVEL III.
0684..................  TRAUMA RESPONSE, LEVEL IV.
0689..................  TRAUMA RESPONSE, OTHER.
0700..................  CAST ROOM.
0709..................  OTHER CAST ROOM.
0710..................  RECOVERY ROOM.
0719..................  OTHER RECOVERY ROOM.
0720..................  LABOR ROOM.

[[Page 42648]]

 
0721..................  LABOR.
0762..................  OBSERVATION ROOM.
0810..................  ORGAN ACQUISITION.
0819..................  OTHER ORGAN ACQUISITION.
0942..................  EDUCATION/TRAINING.
------------------------------------------------------------------------

3. Proposed Calculation of OPPS Scaled Payment Weights
    Using the median APC costs discussed previously, we calculated the 
proposed relative payment weights for each APC for CY 2008 shown in 
Addenda A and B to this proposed rule. In years prior to CY 2007, we 
standardized all the relative payment weights to APC 0601 (Mid Level 
Clinic Visit) because it is one of the most frequently performed 
services in the hospital outpatient setting. We assigned APC 0601 a 
relative payment weight of 1.00 and divided the median cost for each 
APC by the median cost for APC 0601 to derive the relative payment 
weight for each APC.
    Beginning with the CY 2007 OPPS, we standardized all of the 
relative payment weights to APC 0606 (Level 3 Clinic Visits) because we 
deleted APC 0601 as part of the reconfiguration of the visit APCs. We 
chose APC 0606 as the base because under our proposal to reconfigure 
the APCs where clinic visits are assigned for CY 2007, APC 0606 is the 
middle level clinic visit APC (that is, Level 3 of five levels). We 
have historically used the median cost of the middle level clinic visit 
APC (that is APC 0601 through CY 2006) to calculate unscaled weights 
because mid-level clinic visits are among the most frequently performed 
services in the hospital outpatient setting. Therefore, to maintain 
consistency in using a median for calculating unscaled weights 
representing the median cost of some of the most frequently provided 
services, we proposed to continue to use the median cost of the mid-
level clinic APC, proposed APC 0606, to calculate unscaled weights. 
Following our standard methodology, but using the CY 2007 median for 
APC 0606, for CY 2007 we assigned APC 0606 a relative payment weight of 
1.00 and divided the median cost of each APC by the median cost for APC 
0606 to derive the unscaled relative payment weight for each APC. The 
choice of the APC on which to base the relative weights for all other 
APCs does not affect the payments made under the OPPS because we scale 
the weights for budget neutrality. We are again proposing to use APC 
0606 as the base for the CY 2008 OPPS relative weights.
    Section 1833(t)(9)(B) of the Act requires that APC reclassification 
and recalibration changes, wage index changes, and other adjustments be 
made in a manner that assures that aggregate payments under the OPPS 
for CY 2008 are neither greater than nor less than the aggregate 
payments that would have been made without the changes. To comply with 
this requirement concerning the APC changes, we compared aggregate 
payments using the CY 2007 relative weights to aggregate payments using 
the CY 2008 proposed relative weights. This year, we included payments 
to CMHCs in our comparison. Based on this comparison, we adjusted the 
relative weights for purposes of budget neutrality. The unscaled 
relative payment weights were adjusted by a weight scaler of 1.3665 for 
budget neutrality. In addition to adjusting for increases and decreases 
in weight due to the recalibration of APC medians, the scaler also 
accounts for any change in the base, other than changes in volume, 
which are not a factor in the weight scaler.
    The proposed relative payment weights listed in Addenda A and B to 
this proposed rule incorporate the recalibration adjustments discussed 
in sections II.A.1. and 2. of this proposed rule.
    Section 1833(t)(14)(H) of the Act, as added by section 621(a)(1) of 
Pub. L. 108-173, states that ``Additional expenditures resulting from 
this paragraph shall not be taken into account in establishing the 
conversion factor, weighting and other adjustment factors for 2004 and 
2005 under paragraph (9) but shall be taken into account for subsequent 
years.'' Section 1833(t)(14) of the Act provides the payment rates for 
certain ``specified covered outpatient drugs.'' Therefore, the cost of 
those specified covered outpatient drugs (as discussed in section V. of 
this proposed rule) is included in the budget neutrality calculations 
for the CY 2008 OPPS.
4. Proposed Changes to Packaged Services
    (If you choose to comment on the issues in this section, please 
include the caption ``OPPS: Packaged Services'' at the beginning of 
your comment.)
a. Background
    When the Medicare program was first implemented, it paid for 
hospital services (inpatient and outpatient) based on hospital-specific 
reasonable costs attributable to furnishing services to Medicare 
beneficiaries. Later the law was amended to limit payment to the lesser 
of the hospital's reasonable cost or customary charges for services 
furnished to Medicare beneficiaries. Specific service-based 
methodologies were then developed for certain types of services, such 
as clinical laboratory tests and durable medical equipment, while 
payments for outpatient surgical procedures and other diagnostic tests 
were based on a blend of the hospital's aggregate Medicare costs for 
these services and Medicare's payment for similar services in other 
ambulatory settings. While this mix of different payment methodologies 
was in use, hospital outpatient services were growing rapidly following 
the implementation of the IPPS in 1983. The brisk increase in hospital 
outpatient services led to an interest in creating payment incentives 
to promote more efficient delivery of hospital outpatient services 
through a Medicare prospective payment system for hospital outpatient 
services, and the final statutory requirements for the OPPS were 
established by the BBA and the BBRA. During the period of time when 
different approaches to prospective payment for hospital outpatient 
services were being considered, a variety of reports to Congress (June 
1988, September 1990, and March 1995) discussed three major issues 
related to defining the unit of payment for the payment system, 
specifically the extent to which clinically similar procedures should 
be grouped for payment purposes and the logic that should be used for 
the groupings; the extent to which payment for minor, ancillary 
services associated with a significant

[[Page 42649]]

procedure should be packaged into a single payment for the procedure 
(which we refer to as ``packaging''); and the extent to which payment 
for multiple significant procedures related to an outpatient encounter 
or to an episode of care should be bundled into a single unit of 
payment (which we refer to as ``bundling''). Both packaging and 
bundling were presented as approaches to creating incentives for 
efficiency, with their potential policy disadvantages including 
inconsistency with other ambulatory fee schedules, reduced transparency 
of service-specific payment, and the potential for hospitals shifting 
the delivery of packaged or bundled services to delivery settings other 
than the hospital outpatient department (HOPD).
    The OPPS, like other prospective payment systems, relies on the 
concept of averaging, where the payment may be more or less than the 
estimated costs of providing a service or package of services for a 
particular patient, but with the exception of outlier cases, it is 
adequate to ensure access to appropriate care. Decisions about 
packaging and bundling payment involve a balance between ensuring some 
separate payment for individual services and establishing incentives 
for efficiency through larger units of payment. In many situations, the 
final payment rate for a package of services may do a better job of 
balancing variability in the relative costs of component services 
compared to individual rates covering a smaller unit of service without 
packaging or bundling. Packaging payments into larger payment bundles 
promotes the stability of payment for services over time, a 
characteristic that reportedly is very important to hospitals. Unlike 
packaged services, the costs of individual services typically show 
greater variation because the higher variability for some component 
items and services cannot be balanced with lower variability for others 
and because relative weights are typically estimated using a smaller 
set of claims. When compared to service-specific payment, packaging or 
bundling payment for component services may change payment at the 
hospital level to the extent that there are systematic differences 
across hospitals in their performance of the services included in that 
unit of payment. Hospitals spending more per case than payment received 
would be encouraged to review their service patterns to ensure that 
they furnish services as efficiently as possible. Similarly, we believe 
that unpackaging services heightens the hospital's focus on pricing 
individual services, rather than the efficient delivery of those 
services. Over the past several years of the OPPS, greater unpackaging 
of payment has occurred simultaneously with continued tremendous growth 
in OPPS expenditures as a result of increasing volumes of individual 
services, as discussed in further detail below. Also discussed in 
further detail below, most recently in its comments to the CY 2007 
OPPS/ASC proposed rule and in the context of this rapid spending 
growth, the Medicare Payment Advisory Commission (MedPAC) encouraged 
CMS to broaden the payment bundles under the OPPS to encourage 
providers to use resources efficiently.
    As permitted under section 1833(t)(2)(B) of the Act, the OPPS 
establishes groups of covered HOPD services, namely APC groups, and 
uses them as the basic unit of payment. During the evolution of the 
OPPS over the past 7 years, significant attention has been concentrated 
on service-specific payment for services furnished to particular 
patients, rather than on creating incentives for the efficient delivery 
of services through encounter or episode-of-care-based payment. Overall 
packaging included in the clinical APCs has decreased, and the 
procedure groupings have become smaller as the focus has shifted to 
refining service-level payment. Specifically, in the CY 2003 OPPS, 
there were 569 APCs, but by CY 2007, the number of APCs had grown to 
862, a 51-percent increase in 4 years. Similarly, the percentage of CPT 
codes for procedural services that receive packaged payment declined by 
over 10 percent between CY 2003 and CY 2007.
    Currently, the APC groups reflect a modest degree of packaging, 
including packaged payment for minor ancillary services, inexpensive 
drugs, medical supplies, implantable devices, capital-related costs, 
operating and recovery room use, and anesthesia services. Bundling 
payment for multiple significant services provided in the same hospital 
outpatient encounter or during an episode of care is not currently a 
common OPPS payment practice, because the APC groups generally reflect 
only the modest packaging associated with individual procedures or 
services. Unconditionally packaged services with HCPCS codes are 
identified by the status indicator ``N.'' Conditionally packaged 
services, specifically those services whose payment is packaged unless 
specific criteria for separate payment are met, are assigned to status 
indicator ``Q.'' To the extent possible, hospitals may use HCPCS codes 
to report any packaged services that were performed, consistent with 
CPT or CMS coding guidelines, but packaged costs also may be uncoded 
and included in specific revenue code charges. Hospitals include 
charges for packaged services on their claims, and the costs associated 
with those packaged services are then added into the costs of 
separately payable procedures on the same claims in establishing 
payment rates for the separately payable services.
    Packaging and bundling payment for multiple interrelated services 
into a single payment creates incentives for providers to furnish 
services in the most efficient way by enabling hospitals to manage 
their resources with maximum flexibility, thereby encouraging long-term 
cost containment. For example, where there are a variety of supplies 
that could be used to furnish a service, some of which are more 
expensive than others, packaging encourages hospitals to use the least 
expensive item that meets the patient's needs, rather than to routinely 
use a more expensive item. Packaging also encourages hospitals to 
negotiate carefully with manufacturers and suppliers to reduce the 
costs of purchased items and services or to explore alternative group 
purchasing arrangements, thereby encouraging the most economical health 
care. Similarly, packaging encourages hospitals to establish protocols 
that ensure that services are furnished only when they are important 
and to carefully scrutinize the services ordered by practitioners to 
maximize the efficient use of hospital resources. Finally, packaging 
payments into larger payment bundles promotes the stability of payment 
for services over time. Packaging also may reduce the importance of 
refining service-specific payment because there is more opportunity for 
hospitals to average payment across higher cost cases requiring many 
ancillary services and lower cost cases requiring fewer ancillary 
services.
b. Addressing Growth in OPPS Volume and Spending
    Creating additional incentives for providing only necessary 
services in the most efficient manner is of vital importance to 
Medicare today, in view of the recent explosion of growth in program 
expenditures for hospital outpatient services paid under the OPPS. As 
illustrated in Table 5 below, total spending has been growing at a rate 
of roughly 10 percent per year under the OPPS, and the Medicare 
Trustees project that total spending under the OPPS will increase by 
more than $3 billion from CY 2007 through CY 2008 to nearly $35 
billion. Implementation of the OPPS has not

[[Page 42650]]

slowed outpatient spending growth over the past few years; in fact, 
double-digit spending growth has generally been occurring. We are 
greatly concerned with this rate of increase in program expenditures 
under the OPPS.

                        Table 5.--Growth in Expenditures Under OPPS From CY 2001-CY 2008
                            [Projected Expenditures for CY 2006-CY 2008, in Billions]
----------------------------------------------------------------------------------------------------------------
           OPPS growth             CY 2001   CY 2002   CY 2003   CY 2004   CY 2005   CY 2006   CY 2007   CY 2008
----------------------------------------------------------------------------------------------------------------
Incurred Cost...................    17.702    19.561    21.156    23.866    26.572    29.338    31.641    34.960
Percent Increase................  ........    10.5       8.2      12.8      11.3      10.4       7.8      10.5
----------------------------------------------------------------------------------------------------------------
Source: CY 2007 Medicare Trustees' Report.

    As with the other Medicare fee-for-service payment systems that are 
experiencing rapid spending growth, brisk growth in the intensity and 
utilization of services is the major reason for the current rates of 
growth in the OPPS, rather than general price or enrollment changes. 
Table 6 below illustrates the increases in the volume and intensity of 
hospital outpatient services over the past several years.

               Table 6.--Percent Increase in Volume and Intensity of Hospital Outpatient Services
----------------------------------------------------------------------------------------------------------------
                                                                                       CY 2006  CY 2007  CY 2008
                                                   CY 2002  CY 2003  CY 2004  CY 2005   (Est.)   (Est.)   (Est.)
----------------------------------------------------------------------------------------------------------------
Percent Increase.................................     3.5      2.5      7.6      7.4      8.6      6.4     5.8
----------------------------------------------------------------------------------------------------------------
Source: CY 2007 Medicare Trustees' Report.

    For hospital outpatient services, the volume and intensity of 
services are estimated to have continued to increase significantly in 
recent years, at a rate of 8.6 percent between CY 2005 and CY 2006, the 
last two completed calendar years. As we discussed in the CY 2007 OPPS/
ASC final rule with comment period (71 FR 68189 through 68190), the 
rapid growth in utilization of services under the OPPS shows that 
Medicare is paying mainly for more services each year, regardless of 
their quality or impact on beneficiary health. In its March 2007 Report 
to Congress (pages 55 and 56), MedPAC confirmed that much of the growth 
in service volume from 2003 to 2005 resulted from increases in the 
number of services per beneficiary who received care, rather than from 
increases in the number of beneficiaries served. The MedPAC found that 
while the rate of growth in service volume declined over that time 
period, the complexity of services, defined as the sum of the relative 
payment weights of all OPPS services divided by the volume of all 
services, increased, and that most of the growth was attributable to 
the insertion of devices and the provision of complex imaging services. 
The MedPAC further found that regression analysis suggested that 
relatively complex hospital outpatient services may be more profitable 
for hospitals than less complex services. In addition, its analysis 
indicated that favorable payments for complex services give hospitals 
an incentive to provide more of those complex services rather than 
fewer basic services, which increases overall service complexity. The 
MedPAC expressed concern about this relationship and concluded that the 
historically large increases in outpatient volume and service 
complexity suggest a need to recalibrate the OPPS. In the future, 
MedPAC plans to examine options for recalibrating the payment system to 
accurately match payments to the costs of individual services (Medicare 
Payment Advisory Commission Report to the Congress: Medicare Payment 
Policy, March 2007, pages 55 and 56).
    As proposed for the CY 2007 OPPS and finalized for the CY 2009 
OPPS, we developed a plan to promote higher quality services under the 
OPPS, so that Medicare spending would be directed toward those higher 
quality services (71 FR 68189 through 68197). We believe that Medicare 
payments should encourage physicians and other providers in their 
efforts to achieve better health outcomes for Medicare beneficiaries at 
a lower cost. In the CY 2007 OPPS/ASC final rule with comment period, 
we discussed the concept of ``value-based purchasing'' in the OPPS as 
well as in other Medicare payment systems. ``Value-based purchasing'' 
may use a range of incentives to achieve identified quality and 
efficiency goals, as a means of promoting better quality of care and 
more effective resource use in the Medicare payment systems. In 
developing the concept of value-based purchasing for Medicare, we have 
been working closely with stakeholder partners.
    We continue to believe that the collection and submission of 
performance data and the public reporting of comparative information 
are strong incentives for hospital accountability in general and 
quality improvement in particular, while encouraging the most efficient 
and effective care. Measurement and reporting can focus the attention 
of hospitals and consumers on specific goals and on hospitals' 
performance relative to those goals. Development and implementation of 
performance measurement and reporting by hospitals can thus produce 
quality improvement in health care delivery. Hospital performance 
measures may also provide a foundation for performance-based rather 
than volume-based payments.
    In the CY 2007 OPPS/ASC final rule with comment period, as a first 
step in the OPPS toward value-based purchasing, we finalized a policy 
that would employ our equitable adjustment authority under section 
1833(t)(2)(E) of the Act to establish an OPPS Reporting Hospital 
Quality Data for Annual Payment Update (RHQDAPU) program based on 
measures specifically developed to characterize the quality of 
outpatient care (71 FR 68197). We finalized implementation of the 
program for CY 2009, when we would implement a 2.0 point reduction to 
the OPPS conversion factor update for those hospitals that do not meet 
the specific requirements of the CY 2009 OPPS RHQDAPU program. We 
described the

[[Page 42651]]

CY 2009 program which would be based upon CY 2008 hospital reporting of 
appropriate measures of the quality of hospital outpatient care that 
have been carefully developed and evaluated, and endorsed as 
appropriate, with significant input from stakeholders. We reiterated 
our belief that ensuring that Medicare beneficiaries receive the care 
they need and that such services are of high quality are the necessary 
initial steps to incorporating value-based purchasing into the OPPS. We 
explained that we are specifically seeking to encourage care that is 
both efficient and of high quality in the HOPD.
    Subsequent to the publication of the CY 2007 OPPS/ASC final rule 
with comment period, section 109(b) of the MIEA-TRHCA specifies that in 
the case of a subsection (d) hospital (defined under section 
1886(d)(1)(B) of the Act as hospitals that are located in the 50 States 
or the District of Columbia other than those categories of hospitals or 
hospital units that are specifically excluded from the IPPS, including 
psychiatric, rehabilitation, long-term care, children's, and cancer 
hospitals or hospital units) that does not submit to the Secretary the 
quality reporting data required for CY 2009 and each subsequent year, 
the OPPS annual update factor shall be reduced by 2.0 percentage 
points. The quality reporting program proposed for CY 2008 according to 
this provision is referred to as the Hospital Outpatient Quality Data 
Reporting Program (HOP QDRP) and is discussed in detail in section 
XVII. of this proposed rule.
    As the next step in our movement toward value-based purchasing 
under the OPPS and to complement the HOP QDRP for CY 2009, with measure 
reporting beginning in CY 2008, we believe it is important to initiate 
specific payment approaches to explicitly encourage efficiency in the 
hospital outpatient setting that we believe will control future growth 
in the volume of OPPS services. While the HOP QDRP will encourage the 
provision of higher quality hospital outpatient services that lead to 
improved health outcomes for Medicare beneficiaries, we believe that 
more targeted approaches are also necessary to encourage increased 
hospital efficiency. Two alternatives we have considered that would be 
feasible under current law include establishing a methodology to 
measure the growth in volume and reduce OPPS payment rates to account 
for unnecessary increases in volume or developing payment incentives 
for hospitals to ensure that they provide necessary services as 
efficiently as possible.
    With respect to the first alternative, section 1833(t)(2)(F) of the 
Act requires us to establish a methodology for controlling unnecessary 
increases in the volume of covered OPPS services, and section 
1833(t)(9)(C) of the Act authorizes us to adjust the update to the 
conversion factor if, under section 1833(t)(2)(F) of the Act, we 
determine that there is growth in volume that exceeds established 
tolerances. As we indicated in the September 8, 1998 proposed rule 
proposing the establishment of the OPPS (63 FR 47585), we considered 
creating a system that mirrors the sustainable growth rate (SGR) 
methodology applied to the MPFS update to control unnecessary growth in 
service volume. However, implementing such a system could have the 
potentially undesirable effect of escalating service volume as payment 
rates stagnate and hospital costs rise, thus actually resulting in a 
growth in volume rather than providing an incentive to control volume. 
Therefore, this approach to addressing the volume growth under the OPPS 
could inadvertently result in the exact opposite of our desired 
outcome.
    The second alternative we considered is to expand the packaging of 
supportive ancillary services and ultimately bundle payment for 
multiple independent services into a single OPPS payment. We believe 
that this would create incentives for hospitals to monitor and adjust 
the volume and efficiency of services themselves, by enabling them to 
manage their resources with maximum flexibility. Instead of external 
controls on volume, we believe that it is preferable for the OPPS to 
create payment incentives for hospitals to carefully scrutinize their 
service patterns to ensure that they furnish only those services that 
are necessary for high quality care and to ensure that they provide 
care as efficiently as possible. Specifically, we believe that 
increased packaging and bundling are the most appropriate payment 
strategies to establish such incentives in a prospective payment 
system, and that this approach is clearly preferable to the 
establishment of an SGR or other methodology that seeks to control 
spending by addressing significant growth in volume and program 
spending with lower payments.
    In its October 6, 2006 letter of comment on the CY 2007 OPPS/ASC 
proposed rule, MedPAC urged us to establish broader payment bundles in 
both the revised ASC and hospital outpatient prospective payment 
systems to promote efficient resource use and better align the two 
payment systems. In particular, our proposal for the CY 2008 revised 
ASC payment system proposed to package payment for all items and 
services directly related to the provision of covered surgical 
procedures into the ASC facility payment for the associated surgical 
procedure (71 FR 49468). These other items and services included all 
drugs, biologicals, contrast agents, implantable devices, and 
diagnostic services such as imaging. Because a number of these items 
and services are separately paid under the OPPS and the proposal 
included the establishment of most ASC payment weights based on the 
procedures' corresponding OPPS payment weights, MedPAC encouraged us to 
align the payment bundles in the two payment systems by increasing the 
size of the payment bundles under the OPPS.
    Moreover, MedPAC staff indicated in testimony at the January 9, 
2007 MedPAC public meeting that the growth in OPPS spending and volume 
raises questions about whether the OPPS should be changed to encourage 
greater efficiency (page 390 of the January 9, 2007 MedPAC meeting 
transcript available at http://www.medpac.gov). MedPAC staff explained 
at that time that MedPAC intends to perform a long-term assessment of 
the design of the OPPS, including considering the bundling of payments 
for procedures and visits furnished over a period of time into a single 
payment, assessing whether there should be an expenditure target for 
hospital outpatient services, evaluating whether payments for multiple 
imaging services provided in the same session should be discounted, and 
reviewing the methodology used by CMS to determine relative payment 
weights for hospital outpatient services. We welcome MedPAC's study of 
these areas, particularly with regard to how we might develop 
appropriate payment rates for larger bundles of services.
    Because we believe it is important that the OPPS create enhanced 
incentives for hospitals to provide only necessary, high quality care 
and to provide that care as efficiently as possible, we have given 
considerable thought to how we could increase packaging under the OPPS 
in a manner that would not place hospitals at substantial financial 
risk but which would create incentives for efficiency and volume 
control, while providing hospitals with flexibility to provide care in 
the most appropriate way for each Medicare beneficiary. We are 
considering the possibility of greater bundling of payment for major 
hospital outpatient services, which could result in establishing OPPS 
payments for episodes of care, and for this reason we particularly 
welcome MedPAC's

[[Page 42652]]

exploration of how such an approach might be incorporated into the OPPS 
payment methodology. We are particularly concerned about the potential 
for shifting higher cost bundled services to other ambulatory settings, 
and we welcome ideas on deterring such activity. We are currently 
considering the complex policy issues related to the possible 
development and implementation of a bundled payment policy for hospital 
outpatient services that involves significant services provided over a 
period of time which could be paid through an episode-based payment 
methodology, but we consider this possible approach to be a long-term 
policy objective. We encourage public comments regarding the specific 
hospital outpatient services, clinical and financial issues, 
ratesetting methodologies, and operational challenges we should 
consider in our exploratory work in this area.
    We also are examining how we might possibly establish payments for 
same-day care encounters, building upon the current use of APCs for 
payment through greater packaging of supportive ancillary services. 
This could include conditional packaging of supportive ancillary 
services into payment for the procedure that is the reason for the OPPS 
encounter (for example, diagnostic tests performed on the day of a 
scheduled procedure). Another approach could include creation of 
composite APCs for frequently performed combinations of surgical 
procedures (for example, one APC payment for multiple cardiac 
electrophysiologic procedures performed on the same date). Not only 
could these encounter-based payment groups create enhanced incentives 
for efficiency, but they may also enable us to utilize for ratesetting 
many of the multiple procedure claims that are not now used in our 
establishment of OPPS rates for single procedures. (We refer readers to 
section II.A.1.b. of this proposed rule for a more detailed discussion 
of the treatment of multiple procedure claims in the ratesetting 
process.) For CY 2008, we are proposing two new composite APCs for CY 
2008 payment of combinations of services in two clinical care areas, as 
discussed under section II.A.4.d. of this proposed rule. We look 
forward to receiving public comment on this proposal as we explore the 
possibility of moving toward basing OPPS payment on larger packages and 
bundles of services provided in a single hospital outpatient encounter.
    We intend to involve the APC Panel in our future exploration of how 
we can develop encounter-based and episode-based payment groups, and we 
look forward to the findings and recommendations of MedPAC in this 
area. This is a significant change in direction for the OPPS, and we 
specifically seek the recommendations of all stakeholders with regard 
to which ancillary services could be packaged and those combinations of 
services provided in a single encounter or over time that could be 
bundled together for payment. We are hopeful that expanded packaging 
and, ultimately, greater bundling under the OPPS may result in 
sufficient moderation of growth in volume and spending that further 
controls would not be needed. However, if spending were to continue to 
escalate at the current rates, even after we have exhausted our options 
for increased packaging and bundling, we are considering multiple 
options under our authority to address these issues, including the 
possibility of imposing external controls that could link growth in 
volume to reduced payments under the OPPS in the future.
c. Proposed Packaging Approach
    With the exception of the two composite APCs that we are proposing 
for CY 2008 and discuss in detail in section II.A.4.d. of this proposed 
rule, we are not currently prepared to propose an episode-based or 
fully developed encounter-based payment methodology for CY 2008 as our 
next step in value-based purchasing for the OPPS. However, in reviewing 
our approach to revising payment packages and bundles, we have examined 
services currently provided under the OPPS, looking for categories of 
ancillary items and services for which we believe payment could be 
appropriately packaged into larger payment packages for the encounter. 
For this first step in creating larger payment groups, we examined the 
HCPCS code definitions (including CPT code descriptors) to see whether 
there were categories of codes for which packaging would be a logical 
expansion of the longstanding packaging policy that has been a part of 
the OPPS since its inception. In general, we have often packaged the 
costs of selected HCPCS codes into payment for services reported with 
other HCPCS codes where we believed that one code reported an item or 
service that was integral to the provision of care that was reported by 
another HCPCS code.
    As an example of a previous change in the OPPS packaging status for 
a HCPCS code that is ancillary and supportive, under the CY 2007 OPPS, 
we note that CPT code 93641 (Electrophysiologic evaluation of single or 
dual chamber pacing cardioverter defibrillator leads including 
defibrillation threshold evaluation (induction of arrhythmia, evaluate 
of sensing an pacing for arrhythmia termination) at the time of initial 
implantation or replacement; with testing of single chamber or dual 
chamber cardioverter defibrillator) went from separate to packaged 
payment. This service is only performed during the course of a surgical 
procedure for implantation or replacement of implantable cardioverter-
defibrillator (ICD) leads, and these surgical implantation procedures 
are currently assigned to APC 0106 (Insertion/Replacement/Repair of 
Pacemaker and/or Electrodes) and APC 0108 (Insertion/Replacement/Repair 
of Cardioverter-Defibrillator Leads). We considered the 
electrophysiologic evaluation service (CPT code 93641) to be an 
ancillary supportive service that may be performed only in the same 
operative session as a procedure that could otherwise be performed 
independently of the electrophysiologic evaluation service. In this 
particular case, the APC Panel recommended for CY 2007 that we package 
payment for this diagnostic test and we adopted that recommendation for 
the CY 2007 OPPS. Making this payment change in this specific case 
resulted in the availability of significantly more claims data and, 
therefore, establishment of more valid and representative estimated 
median costs for the lead insertion and electrophysiologic evaluation 
services furnished in the single hospital encounter.
    In the case of much of the care furnished in the HOPD, we believe 
that it is appropriate to view a complete service as potentially being 
reported by a combination of two or more HCPCS codes, rather than a 
single code, and to establish payment policy that supports this view. 
Ideally, we would consider a complete HOPD service to be the totality 
of care furnished in a hospital outpatient encounter or in an episode 
of care. In general, we believe that it is particularly appropriate to 
package payment for those items and services that are typically 
ancillary and supportive into the payment for the primary diagnostic or 
therapeutic modalities in which they are used. As a significant first 
step towards creating payment units that represent larger units of 
service, we examined whether there are categories of HCPCS codes that 
are typically ancillary and supportive to diagnostic and therapeutic 
modalities.
    Specifically, as our initial substantial step toward creating 
larger payment groups for hospital outpatient care, we are proposing to 
package payment for

[[Page 42653]]

items and services in the seven categories listed below into the 
payment for the primary diagnostic or therapeutic modality to which we 
believe these items and services are typically ancillary and 
supportive. We specifically chose these categories of HCPCS codes for 
packaging because we believe that the items and services described by 
the codes in these categories are the HCPCS codes that are typically 
ancillary and supportive to a primary diagnostic or therapeutic 
modality and, in those cases, are an integral part of the primary 
service they support. We are proposing to assign status indicator ``N'' 
to those HCPCS codes that we believe are always integral to the 
performance of the primary modality and to package their costs into the 
costs of the separately paid primary services with which they are 
billed. We are proposing to assign status indicator ``Q'' to those 
HCPCS codes that we believe are typically integral to the performance 
of the primary modality and to package payment for their costs into the 
costs of the separately paid primary services with which they are 
usually billed but to pay them separately in those uncommon cases in 
which no other separately paid primary service is furnished in the 
hospital outpatient encounter.
    For ease of reference in our subsequent discussion in each of the 
seven areas, we refer to the HCPCS codes for which we are proposing to 
package (or conditionally package) payment as dependent services. We 
use the term ``independent service'' to refer to the HCPCS codes that 
represent the primary therapeutic or diagnostic modality into which we 
are proposing to package payment for the dependent service. We note 
that, in future years as we consider the development of larger payment 
groups that more broadly reflect services provided in an encounter or 
episode of care, it is possible that we might propose to bundle payment 
for a service that we now refer to as ``independent'' in this proposed 
rule.
    Specifically, we are proposing to package the payment for HCPCS 
codes describing the dependent items and services in the following 
seven categories into the payment for the independent services with 
which they are furnished:
    <bullet> Guidance services.
    <bullet> Image processing services.
    <bullet> Intraoperative services.
    <bullet> Imaging supervision and interpretation services.
    <bullet> Diagnostic radiopharmaceuticals.
    <bullet> Contrast media and.
    <bullet> Observation services.
    We identify the HCPCS codes we are proposing to package for CY 
2008, explain our rationale for proposing to package the codes in these 
categories, provide examples of how HCPCS and APC median costs and 
payments would change under these proposals, and discuss the impact of 
these changes in the discussion below under each category.
    The median costs of services at the HCPCS level for many separately 
paid procedures change as a result of this proposal because we are 
proposing to change the composition of the payment packages associated 
with the HCPCS codes. Moreover, as a result of changes to the HCPCS 
median costs, we are proposing to reassign some HCPCS codes to 
different clinical APCs for CY 2008 to avoid 2 times violations and to 
ensure continuing clinical and resource homogeneity of the APCs. 
Therefore, the APC median costs change not only as a result of the 
increased packaging itself but also as a result of the migration of 
HCPCS codes into and out of APCs through APC reconfiguration. The file 
of HCPCS code and APC median costs resulting from our proposal is found 
under supporting documentation for this proposed rule on the CMS Web 
site at http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp#TopOfPage.
    Review of the HCPCS median costs indicates that, while the proposed 
median costs rise for some HCPCS codes as a result of increased 
packaging that expands the costs included in the payment packages, 
there are also cases in which the proposed median costs decline as a 
result of these proposed changes. While it seems intuitive to believe 
that the proposed median costs of the remaining separately paid 
services should rise when the costs of services previously paid 
separately are packaged into larger payment groups, it is more 
challenging to understand why the proposed median costs of separately 
paid services would not change or would decline when the costs of 
previously paid services are packaged.
    Medians are generally more stable than means because they are less 
sensitive to extreme observations, but medians typically do not reflect 
subtle changes in cost distributions. The OPPS' use of medians rather 
than means usually results in relative weight estimates being less 
sensitive to packaging decisions. Specifically, the median cost for a 
particular independent procedure generally will be higher as a result 
of added packaging, but also could change little or be lower because 
median costs typically do not reflect small distributional changes and 
also because changes to the packaged HCPCS codes affect both the number 
and composition of single bills and the mix of hospitals contributing 
those single bills. Such a decline, no change, or an increase in the 
median cost at the HCPCS code level could result from a change in the 
number of single bills used to set the median cost. With greater 
packaging, more ``natural'' single bills are created for some codes but 
fewer ``pseudo'' single bills are created. Thus, some APCs gain single 
bills and some lose single bills due to packaging changes, as well as 
to the reassignment of some codes to different APCs. When more claims 
from a different mix of providers are used to set the median cost for 
the HCPCS code, the median cost could move higher or lower within the 
array of per claim costs.
    Similarly, proposed revisions to APC assignments that are necessary 
to resolve 2 times violations that could arise as a result of changes 
in the HCPCS median cost for one or more codes due to additional 
packaging may also result in increases or decreases to APC median costs 
and, therefore, to increases or decreases in the payments for HCPCS 
codes that would not be otherwise affected except for the CY 2008 
proposed packaging approach for the seven categories of items and 
services.
    We have examined the proposed aggregate impact of making these 
changes on payment for CY 2008. Because the OPPS is a budget neutral 
payment system in which the amount of payment weight in the system is 
annually adjusted for changes in expenditures created by changes in APC 
weights and codes (but is not currently adjusted based on estimated 
growth in service volume), the effects of the packaging changes we are 
proposing result in changes to scaled weights and, therefore, to the 
payment rates for all separately paid procedures. These changes result 
from both shifts in median costs as a result of increased packaging, 
changes in multiple procedure discounting patterns, and a higher weight 
scaler that is applied to all unscaled APC weights. (We refer readers 
to section II.A.3. of this proposed rule for an explanation of the 
weight scaler.) In a budget neutral system, the monies previously paid 
for services that are now proposed to be packaged are not lost, but are 
redistributed to all other services. A higher weight scaler would 
increase payment rates relative to observed median costs for 
independent services by redistributing the lost weight of packaged 
items that historically have

[[Page 42654]]

been paid separately and the lost weight when the median costs of 
independent services do not completely reflect the full incremental 
cost of the packaged services. The impact of this proposed change on 
proposed CY 2008 OPPS payments is discussed in section XXII B. of this 
proposed rule, and the impact on various classifications of hospitals 
is shown in Column 2B in Table 67 in that section.
    We estimate that our CY 2008 proposal would redistribute 
approximately 1.2 percent of the estimated CY 2007 base year 
expenditures under the OPPS. The monies associated with this 
redistribution would be in addition to any increase that would 
otherwise occur due to a proposed higher median cost for the APC as a 
result of the expanded payment package. If the relative weight for a 
particular APC decreases as a result of the proposed packaging 
approach, the increased weight scaler may or may not result in a 
relative weight that is equal to or greater than the relative weight 
that would occur without the proposed packaging approach. In general, 
the packaging that we are proposing would have more effect on payment 
for some services than on payment for others because the dependent 
items and services that we are proposing for packaging are furnished 
more often with some independent services than with others. However, 
because of the amount of payment weight that would be redistributed by 
this proposal, there would be some impact on payments for all OPPS 
services whose rates are set based on payment weights, and the impact 
on any given hospital would vary based on the mix of services furnished 
by the hospital.
    The following discussion separately addresses each of the seven 
categories of items and services for which we are proposing to package 
payment under the CY 2008 OPPS as part of our packaging proposal. Many 
codes that we are proposing to package for CY 2008 could fit into more 
than one of those seven categories. For example, CPT code 93325 
(Doppler echocardiography color flow velocity mapping (List separately 
in addition to codes for echocardiography)) could be included in both 
the intraoperative and image processing categories. Therefore, for 
organizational purposes, both to ensure that each code appears in only 
one category and to facilitate discussion of our CY 2008 proposal, we 
have created a hierarchy of categories that determines which category 
each code appropriately falls into. This hierarchy is organized from 
the most clinically specific to the most general type of category. The 
hierarchy of categories is as follows: guidance services, image 
processing services, intraoperative services, and imaging supervision 
and interpretation services. Therefore, while CPT code 93325 may 
logically be grouped with either imaging processing services or 
intraoperative services, it is treated as an image processing service 
because that group is more clinically specific and precedes 
intraoperative services in the hierarchy. We did not believe it was 
necessary to include diagnostic radiopharmaceuticals, contrast media, 
or observation categories in this list because those services generally 
map to only one of those categories. We note that there is no cost 
estimation or payment implications related to the assignment of a HCPCS 
code for purposes of discussion to any specific category.
(1) Guidance Services
    We are proposing to package payment for HCPCS guidance codes for CY 
2008, specifically those codes that are reported for supportive 
guidance services, such as ultrasound, fluoroscopic, and stereotactic 
navigation services, that aid the performance of an independent 
procedure. We performed a broad search for such services, relying upon 
the American Medical Association's (AMA's) CY 2007 book of CPT codes 
and the CY 2007 book of Level II HCPCS codes, which identified specific 
HCPCS codes as guidance codes. Moreover, we performed a clinical review 
of all HCPCS codes to capture additional codes that are not necessarily 
identified as ``guidance'' services but describe services that provide 
directional information during the course of performing an independent 
procedure. For example, we are proposing to package CPT code 61795 
(Stereotactic computer-assisted volumetric (navigational) procedure, 
intracranial, extracranial, or spinal (List separately in addition to 
code for primary procedure)) because we consider it to be a guidance 
service that provides three-dimensional information to direct the 
performance of intracranial or other diagnostic or therapeutic 
procedures. We also included HCPCS codes that existed in CY 2006 but 
were deleted and were replaced in CY 2007. We included the CY 2006 
HCPCS codes because we are proposing to use the CY 2006 claims data to 
calculate the CY 2008 OPPS median costs on which the CY 2008 payment 
rates would be based. Many, although not all, of the CPT guidance codes 
we identified are designated by CPT as add-on codes that are to be 
reported in addition to the CPT code for the primary procedure. We also 
note that there are a number of CPT codes describing independent 
surgical procedures but which the code descriptors indicate that 
guidance is included in the code reported for the surgical procedure if 
it is used and, therefore, packaged payment is already made for the 
associated guidance service under the OPPS. For example, the 
independent procedure described by CPT code 55873 (Cryosurgical 
ablation of the prostate (includes ultrasonic guidance for interstitial 
cryosurgical probe placement)) already includes the ultrasound guidance 
that may be used. We believe packaging payment for every guidance 
service under the OPPS would provide consistently packaged payment for 
all these services that are used to direct independent procedures, even 
if they are currently separately reported.
    Because these dependent guidance procedures support the performance 
of an independent procedure and they are generally provided in the same 
operative session as the independent procedure, we believe that it 
would be appropriate to package their payment into the OPPS payment for 
the independent procedure performed. However, guidance services differ 
from some of the other categories of services that we are proposing to 
package for CY 2008. Hospitals sometimes may have the option of 
choosing whether to perform a guidance service immediately preceding or 
during the main independent procedure, or not at all, unlike many of 
the imaging supervision and interpretation services, for example, which 
are generally always reported when the independent procedure is 
performed. Once a hospital decides that guidance is appropriate, the 
hospital may have several options regarding the type of guidance 
service that can be performed. For example, when inserting a central 
venous access device, hospitals have the option of using no guidance, 
ultrasound guidance, or fluoroscopic guidance, and the selection in any 
specific case will depend upon the specific clinical circumstances of 
the device insertion procedure. In fact, the historical hospital claims 
data demonstrate that various guidance services for the insertion of 
these devices, which have historically received packaged payment under 
the OPPS, are used frequently for the insertion of vascular access 
devices.
    Thus, we recognize hospitals have several options regarding the 
performance and types of guidance services they use. However, we 
believe that hospitals utilize the most appropriate form of guidance 
for the specific procedure that is performed.

[[Page 42655]]

We do not want to create payment incentives to use guidance for all 
independent procedures or to provide one form of guidance instead of 
another. Therefore, by proposing to package payment for all forms of 
guidance, we are specifically encouraging hospitals to utilize the most 
cost effective and clinically advantageous method of guidance that is 
appropriate in each situation by providing them with the maximum 
flexibility associated with a single payment for the independent 
procedure. Similarly, hospitals may appropriately not utilize guidance 
services in certain situations based on clinical indications.
    Because guidance services can be appropriately reported in 
association with many independent procedures, under our proposed 
packaging of guidance services for CY 2008, the costs associated with 
guidance services would be mapped to a larger number of independent 
procedures than some other categories of codes that we are proposing to 
package. For example, CPT code 76001 (Fluoroscopy, physician time more 
than one hour, assisting a non-radiologic physician (e.g., 
nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)) can be 
reported with a wide range of services. According to the CPT code 
descriptor, these procedures include nephrostolithotomy, which may be 
reported with CPT code 50080 (Percutaneous nephrostolithotomy or 
pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, 
stenting, or basket extraction; up to 2 cm), and endoscopic retrograde 
cholangiopancreatography, which may be reported with CPT code 43260 
(Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, 
with or without collection of specimen(s) by brushing or washing 
(separate procedure)). Therefore, the cost of the fluoroscopic guidance 
would be reflected in the payment for each of these independent 
services, in addition to numerous other procedures, rather than in the 
payment for only one or two independent services, as is the case for 
some of the other categories of codes that we are proposing to package 
for CY 2008.
    In addition, because independent procedures such as CPT code 20610 
(Arthrocentesis, aspiration and/or injection; major joint or bursa 
(e.g., shoulder, hip, knee joint, subacromial bursa)) may be reported 
with or without guidance, the cost for the guidance will be reflected 
in the median cost for the independent procedure as a function of the 
frequency that guidance is reported with that procedure. As we stated 
previously, the median cost for a particular independent procedure 
generally will be higher as a result of added packaging, but also could 
change little or be lower because median costs typically do not reflect 
small distributional changes and because changes to the packaged HCPCS 
codes affect both the number and composition of single bills and the 
mix of hospitals contributing those single bills. In fact, the CY 2007 
CPT book indicates that if guidance is performed with CPT code 20610, 
it may be appropriate to bill CPT code 76942 (Ultrasonic guidance for 
needle placement (e.g. biopsy, aspiration, injection, localization 
device), imaging supervision and interpretation); 77002 (Fluoroscopic 
guidance for needle placement (e.g. biopsy, aspiration, injection, 
localization device)); 77012 (Computed tomography guidance for needle 
placement (e.g. biopsy, aspiration, injection, localization device), 
radiological supervision and interpretation); or 77021 (Magnetic 
resonance guidance for needle placement (e.g., for biopsy, needle 
aspiration, injection, or placement of localization device) 
radiological supervision and interpretation). The CY 2007 CPT book also 
implies that it is not always clinically necessary to use guidance in 
performing an arthrocentesis described by CPT code 20610.
    The guidance procedures that we are proposing to package for CY 
2008 vary in their resource costs. Resource cost was not a factor we 
considered when proposing to package guidance procedures. Notably, most 
of the guidance procedures are relatively low cost in comparison to the 
independent services they frequently accompany.
    The codes we are proposing to identify as guidance codes for CY 
2008 that would receive packaged payment are listed in Table 8 below.
    Several of these codes, including CPT code 76937 (Ultrasound 
guidance for vascular access requiring ultrasound evaluation of 
potential access sites, documentation of selected vessel patency, 
concurrent realtime ultrasound visualization of vascular needle entry, 
with permanent recording and reporting (List separately in addition to 
code for primary procedure)), are already unconditionally (that is, 
always) packaged under the CY 2007 OPPS, where they have been assigned 
to status indicator ``N.'' Payment for these services is currently made 
as part of the payment for the separately payable, independent services 
with which they are billed. No separate payment is made for services 
that we have assigned to status indicator ``N.'' We are not proposing 
status indicator changes for the five guidance procedures that were 
unconditionally packaged for CY 2007.
    We are proposing to change the status indicators for 31 guidance 
procedures from separately paid to unconditionally packaged (status 
indicator ``N'') for the CY 2008 OPPS. We believe that these services 
are always integral to and dependent upon the independent services that 
they support and, therefore, their payment would be appropriately 
packaged because they would generally be performed on the same date and 
in the same hospital as the independent services.
    We are proposing to change the status indicator for 1 guidance 
procedure from separately paid to conditionally packaged (status 
indicator ``Q''), and we will treat it as a ``special'' packaged code 
for the CY 2008 OPPS, specifically, CPT code 76000 (Fluoroscopy 
(separate procedure), up to 1 hour physician time, other than 71023 or 
71034 (e.g. cardiac fluoroscopy)). This code was discussed in the past 
with the Packaging Subcommittee of the APC Panel which determined that, 
consistent with its code descriptor as a separate procedure, this 
procedure could sometimes be provided alone, without any other services 
on the claim. We believe that this procedure would usually be provided 
by a hospital as guidance in conjunction with another significant 
independent procedure on the same date of service but may occasionally 
be provided without another independent service. As a ``special'' 
packaged code, if the fluoroscopy service were billed without any other 
service assigned to status indicator ``S,'' ``T,'' ``V,'' or ``X'' 
reported on the same date of service, under our proposal we would not 
treat the fluoroscopy procedure as a dependent service for purposes of 
payment. If we were to unconditionally package payment for this 
procedure, treating it as a dependent service, hospitals would receive 
no payment at all when providing this service alone, although the 
procedure would not be functioning as a guidance service in that case. 
However, according to our proposal, its conditionally packaged status 
with its designation as a ``special'' packaged code would allow payment 
to be provided for this ``Q'' status fluoroscopy procedure, in which 
case it would be treated as an independent service under these limited 
circumstances. On the other hand, when the fluoroscopy service is 
furnished as a guidance procedure on the same day and in the same 
hospital as independent, separately paid services that are assigned to 
status indicator ``S,''

[[Page 42656]]

``T,'' ``V,'' or ``X,'' we are proposing to package payment for it as a 
dependent service. In all cases, we are proposing that hospitals that 
furnish independent services on the same date as dependent guidance 
services must bill them all on the same claim. We believe that when 
dependent guidance services and independent services are furnished on 
the same date and in the same facility, they are part of a single 
complete hospital outpatient service that is reported with more than 
one HCPCS code, and no separate payment should be made for the guidance 
service which supports the independent service.
    We have calculated the median costs on which the proposed CY 2008 
payment rates are based using the packaging status of each code as 
provided in Table 8 below. As we discussed earlier in more detail, this 
has the effect of both changing the median cost for the independent 
service into which the cost of the dependent service is packaged and 
also of redistributing payment that would otherwise have been made 
separately for the service we are proposing to newly package for CY 
2008.
    For example, CPT code 76940 (Ultrasound guidance for, and 
monitoring of, parenchymal tissue ablation) is assigned to APC 0268 
(Level I Ultrasound Guidance Procedures) for CY 2007. We are proposing 
to discontinue APC 0268 for CY 2008 and to provide packaged payment for 
the HCPCS codes that were previously assigned to APC 0268. CPT code 
76940 was billed with CPT code 47382 (Ablation, one or more liver 
tumor(s), percutaneous, radiofrequency) 148 times in the CY 2008 OPPS 
proposed rule claims data, and 42 percent of the claims for CPT code 
76940 reported CPT code 47382 on the same date of service. Similarly, 
we note that almost 19 percent of the claims for CPT code 47382 also 
reported the ultrasound guidance service described by CPT code 76940. 
Under our proposed policy for the CY 2008 OPPS, we are proposing to 
expand the packaging associated with CPT code 47382 so that payment for 
the ultrasound guidance, if performed, would be packaged into the 
payment for the liver tumor ablation. Specifically, we would package 
payment for CPT code 76940 so that under the CY 2008 OPPS, the 
dependent procedure, in this case ultrasound guidance, would receive 
packaged payment through the separate OPPS payment for the independent 
procedure, in this case, the liver tumor ablation. The payment rates 
for this example associated with our CY 2008 proposal are outlined in 
Table 7 below.
    In this case, the proposed CY 2008 median cost for APC 0423 (Level 
II Percutaneous Abdominal and Biliary Procedures) to which CPT code 
47382 is assigned is $2,775.33, while the CY 2007 median cost of APC 
0423 is $2,283.08 and of APC 0268 is $72.61. However, as discussed in 
section II.A.4.c. of this proposed rule concerning our general proposed 
packaging approach, the added effect of the budget neutrality 
adjustment that would result from the aggregate effects of the CY 2008 
packaging proposal (were there no further budget neutrality adjustment 
for other reasons) significantly changes the final payment rates 
relative to median cost estimates. Table 7 presents a comparison of the 
CY 2007 payment for CPT codes 47382 and 76940, where CPT code 76940 is 
paid separately, to the CY 2008 payment we are proposing for CPT codes 
47382 and 76940, where payment for CPT code 76940 would be packaged. 
This example cannot demonstrate the overall impact of packaging 
guidance services on payment to any given hospital because each 
individual hospital's case-mix and billing patterns would be different. 
The overall impact of packaging payment for CPT code 76940, as well as 
all the other proposed packaging changes we are proposing for CY 2008, 
can only be assessed in the aggregate for classes of hospitals. Section 
XXII.B. of this proposed rule displays the overall impact of APC weight 
recalibration and packaging changes we are proposing by classes of 
hospitals, and the OPPS Hospital-Specific Impacts--Provider-Specific 
Data file presents our estimates of CY 2008 hospital payment for those 
hospitals we include in our ratesetting and payment simulation 
database. The hospital-specific impacts file can be found on the CMS 
Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/ under 
supporting documentation for this proposed rule.

   Table 7.--Example of the Effects of the CY 2008 Packaging Proposal on Payment for CPT Codes 76940 and 47382
----------------------------------------------------------------------------------------------------------------
                                                                                  Sum of CY 2007  Sum of CY 2008
                                                                                  payment (76940     proposed
                HCPCS code                            Short descriptor                 paid       payment (76940
                                                                                    separately)      packaged)
----------------------------------------------------------------------------------------------------------------
76940.....................................  Us guide, tissue ablation spine               $73.04           $0.00
                                             (dependent service).
47382.....................................  Percut ablate liver rf (independent         2,296.47        2,810.08
                                             service).
                                                                                 -------------------------------
    Total Payment.........................  ....................................        2,369.51        2,810.08
----------------------------------------------------------------------------------------------------------------

    The estimated overall impact of these changes presented in section 
XXII.B. of this proposed rule is based on the assumption that hospital 
behavior would not change with regard to when these dependent services 
are performed on the same date and by the same hospital that performs 
the independent services. To the extent that hospitals could change 
their behavior and perform the guidance services more or less 
frequently, on subsequent dates, or at settings outside of the 
hospital, the data would show such a change in practice in future years 
and that change would be reflected in future budget neutrality 
adjustments. However, with respect to guidance services in particular, 
we believe that hospitals are limited in the extent to which they could 
change their behavior with regard to how they furnish these services. 
By their definition, these guidance services generally must be 
furnished on the same date and at the same operative location as the 
independent procedure in order for the guidance service to meaningfully 
contribute to the treatment of the patient in directing the performance 
of the independent procedure. We do not believe the clinical 
characteristics of the guidance services reported with the guidance 
HCPCS codes listed in Table 8 below will change in the immediate 
future.
    As we indicated earlier, in all cases we are proposing that 
hospitals that furnish the guidance service on the same date as the 
independent service

[[Page 42657]]

must bill both services on the same claim. We expect to carefully 
monitor any changes in billing practices on a service-specific and 
hospital-specific basis to determine whether there is reason to request 
that Quality Improvement Organizations (QIOs) review the quality of 
care furnished or to request that Program Safeguard Contractors review 
the claims against the medical record.

                     Table 8.--Guidance HCPCS Codes Proposed for Packaged Payment in CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                                 Inactive HCPCS
                                                                                 Code effective
                                                                                   1/1/2008 or
                                                            Proposed   Proposed      earlier          Short
    HCPCS code     Short descriptor   CY 2007    CY 2007    CY 2008    CY 2008   (listed on the   descriptor of
                                         SI        APC         SI        APC      same line as     the inactive
                                                                                       its          HCPCS code
                                                                                   replacement
                                                                                      code)
----------------------------------------------------------------------------------------------------------------
19295............  Place breast              S       0657          N        n/a
                    clip, precut.
61795............  Brain surgery             S       0302          N        n/a
                    using computer.
62160............  Neuroendoscopy            T       0122          N        n/a
                    add-on.
76000............  Fluoroscope               X       0272          Q       0272
                    examination.
76001............  Fluoroscope               N        n/a          N        n/a
                    exam, extensive.
76930............  Echo guide,               S       0268          N        n/a
                    cardiocentesis.
76932............  Echo guide for            S       0309          N        n/a
                    heart biopsy.
76936............  Echo guide for            S       0309          N        n/a
                    artery repair.
76937............  Us guide,                 N        n/a          N        n/a
                    vascular access.
76940............  Us guide, tissue          S       0268          N        n/a
                    ablation.
76941............  Echo guide for            S       0268          N        n/a
                    transfusion.
76942............  Echo guide for            S       0268          N        n/a
                    biopsy.
76945............  Echo guide,               S       0268          N        n/a
                    villus sampling.
76946............  Echo guide for            S       0268          N        n/a
                    amniocentesis.
76948............  Echo guide, ova           S       0309          N        n/a
                    aspiration.
76950............  Echo guidance             S       0268          N        n/a
                    radiotherapy.
76965............  Echo guidance             S       0308          N        n/a
                    radiotherapy.
76975............  GI endoscopic             S       0266          N        n/a
                    ultrasound.
76998............  Us guide,                 S       0266          N        n/a           76986  Ultrasound
                    intraop.                                                                      guide
                                                                                                  intraoper.
77001............  Fluoro guide for          N        n/a          N        n/a           75998  Fluoro guide
                    vein device.                                                                  for vein
                                                                                                  device.
77002............  Needle                    N        n/a          N        n/a           76003  Needle
                    localization by                                                               localization
                    xray.                                                                         by xray.
77003............  Fluoroguide for           N        n/a          N        n/a           76005  Fluoroguide for
                    spine inject.                                                                 spine inject.
77011............  Ct scan for               S       0283          N        n/a           76355  Ct scan for
                    localization.                                                                 localization.
77012............  Ct scan for               S       0283          N        n/a           76360  Ct scan for
                    needle biopsy.                                                                needle biopsy.
77013............  Ct guide for              S       0333          N        n/a           76362  Ct guide for
                    tissue ablation.                                                              tissue
                                                                                                  ablation.
77014............  Ct scan for               S       0282          N        n/a           76370  Ct scan for
                    therapy guide.                                                                therapy guide.
77021............  Mr guidance for           S       0335          N        n/a           76393  Mr guidance for
                    needle place.                                                                 needle place.
77022............  Mri for tissue            S       0335          N        n/a           76394  Mri for tissue
                    ablation.                                                                     ablation.
77031............  Stereotact guide          X       0264          N        n/a           76095  Stereotactic
                    for brst bx.                                                                  breast biopsy.
77032............  Guidance for              X       0263          N        n/a
                    needle, breast.
77417............  Radiology port            X       0260          N        n/a
                    film(s).
77421............  Stereoscopic x-           S       0257          N        n/a
                    ray guidance.
95873............  Guide nerv                S       0215          N        n/a
                    destr, elec
                    stim.
95874............  Guide nerv                S       0215          N        n/a
                    destr, needle
                    emg.
0054T............  Bone surgery              S       0302          N        n/a
                    using computer.
0055T............  Bone surgery              S       0302          N        n/a
                    using computer.
0056T............  Bone surgery              S       0302          N        n/a
                    using computer.
----------------------------------------------------------------------------------------------------------------

(2) Image Processing Services
    We are proposing to package payment for ``image processing'' HCPCS 
codes for CY 2008, specifically those codes that are reported as 
supportive dependent services to process and integrate diagnostic test 
data in the development of images, performed concurrently or after the 
independent service is complete. We performed a broad search for such 
services, relying upon the AMA's CY 2007 book of CPT codes and the CY 
2007 book of Level II HCPCS codes, which identified specific codes as 
``processing'' codes. In addition, we performed a clinical review of 
all HCPCS codes to capture additional codes that we consider to be 
image processing. For example, we are proposing to package payment for 
CPT code 93325 (Doppler echocardiography color flow velocity mapping 
(List separately in addition to codes for echocardiography)) because it 
is an image processing procedure, even though the code descriptor does 
not specifically indicate it as such.
    An image processing service processes and integrates diagnostic 
test data that were captured during another independent procedure, 
usually one that is separately payable under the OPPS. The image 
processing service is not necessarily provided on the same date of 
service as the independent procedure. In fact, several of the image 
processing services that we are proposing to package for CY 2008 do not 
need to be provided face-to-face with the patient in the same encounter 
as the independent service. While this approach to service delivery may 
be administratively advantageous from a hospital's perspective, 
providing separate payment for each image processing service whenever 
it is performed is not consistent with encouraging value-based 
purchasing under the OPPS. We believe it is important to package 
payment for supportive dependent services that accompany independent 
services but that may not need to be provided face-to-face with the 
patient in the same

[[Page 42658]]

encounter because the supportive services utilize data that were 
collected during the preceding independent services and packaging their 
payment encourages the most efficient use of hospital resources. We are 
particularly concerned with any continuance of current OPPS payment 
policies that could encourage certain inefficient and more costly 
service patterns. As stated above, packaging encourages hospitals to 
establish protocols that ensure that services are furnished only when 
they are medically necessary and to carefully scrutinize the services 
ordered by practitioners to minimize unnecessary use of hospital 
resources. Our standard methodology to calculate median costs packages 
the costs of dependent services with the costs of independent services 
on ``natural'' single claims across different dates of service, so we 
are confident that we would capture the costs of the supportive image 
processing services for ratesetting when they are packaged according to 
our CY 2008 proposal, even if they were provided on a different date 
than the independent procedure.
    We list the image processing services that would be packaged for CY 
2008 in Table 10 below. As these services support the performance of an 
independent service, we believe it would be appropriate to package 
their payment into the OPPS payment for the independent service 
provided.
    As many independent services may be reported with or without image 
processing services, the cost of the image processing services will be 
reflected in the median cost for the independent HCPCS code as a 
function of the frequency that image processing services are reported 
with that particular HCPCS code. Again, while the median cost for a 
particular independent procedure generally will be higher as a result 
of added packaging, it could also change little or be lower because 
median costs typically do not reflect small distributional changes and 
because changes to the packaged HCPCS codes affect both the number and 
composition of single bills and the mix of hospitals contributing those 
single bills. For example, CPT code 70450 (Computed tomography, head or 
brain; without contrast material) may be provided alone or in 
conjunction with CPT code 76376 (3D rendering with interpretation and 
reporting of computed tomography, magnetic resource imaging, 
ultrasound, or other tomographic modality; not requiring image 
postprocessing on an independent workstation). In fact, CPT code 70450 
was provided approximately 1.5 million times based on CY 2008 proposed 
rule claims data. CPT code 76376 was provided with CPT code 70450 less 
than 2 percent of the total instances that CPT code 70450 was billed. 
Therefore, as the frequency of CPT code 76376 provided in conjunction 
with CPT code 70450 increases, the median cost for CPT code 70450 would 
be more likely to reflect that additional cost.
    The image processing services that we are proposing to package vary 
in their hospital resource costs. Resource cost was not a factor we 
considered when proposing to package supportive image processing 
services. Notably, the majority of image processing services that we 
are proposing to package have modest median costs in relationship to 
the cost of the independent service that they typically accompany.
    Several of these codes, including CPT code 76350 (Subtraction in 
conjunction with contrast studies), are already unconditionally (that 
is, always) packaged under the CY 2007 OPPS, where they have been 
assigned to status indicator ``N.'' Payment for these services is made 
as part of the payment for the separately payable, independent services 
with which they are billed. No separate payment is made for services 
that we have assigned to status indicator ``N.'' We are not proposing 
status indicator changes for the four image processing services that 
were unconditionally packaged for CY 2007.
    We are proposing to change the status indicator for seven image 
processing services from separately paid to unconditionally packaged 
(status indicator ``N'') for the CY 2008 OPPS. We believe that these 
services are always integral to and dependent upon the independent 
service that they support and, therefore, their payment would be 
appropriately packaged. We have calculated the median costs on which 
the proposed CY 2008 payment rates are based using the packaging status 
of each code as provided in Table 10 below. As we discuss above in more 
detail, this has the effect of both changing the median cost for the 
independent service into which the cost of the dependent service is 
packaged and also of redistributing payment that would otherwise have 
been made separately for the service we are proposing to newly package 
for CY 2008.
    For example, CPT code 93325 (Doppler echocardiography color flow 
velocity mapping (List separately in addition to codes for 
echocardiography)) is assigned to APC 0697 (Level I Echocardiogram 
Except Transesophageal) for CY 2007. The proposed CY 2008 median cost 
of APC 0697 is $302.40. CPT code 93325 was billed with CPT code 93350 
(Echocardiography, transthoracic, real-time with image documentation 
(2D), with or without M-mode recording, during rest and cardiovascular 
stress test using treadmill, bicycle exercise and/or pharmacologically 
induced stress, with interpretation and report) approximately 43,000 
times in the CY 2008 OPPS proposed rule data, and 5 percent of the 
claims for CPT code 93325 reported CPT code 93350 on the same date of 
service. Similarly, we note that almost 35 percent of the claims for 
CPT code 93350 also reported the image processing service described by 
CPT code 93325. Because CPT code 93350 is designated by CPT as an add-
on code to a stress test service, as would be expected, we also 
observed that a CPT code for a stress test, most commonly CPT code 
93017 (Cardiovascular stress test using maximal or submaximal treadmill 
or bicycle exercise, continuous electrocardiographic monitoring, and/or 
pharmacological stress; with physician supervision, with interpretation 
and report) was also frequently reported on the same claim on the same 
day as both of the other two CPT codes. CPT code 93017 is assigned to 
APC 0100 (Cardiac Stress Tests) with a proposed CY 2008 median cost of 
$180.10. Under our proposed policy for the CY 2008, we are proposing to 
expand the packaging associated with the independent stress test and 
echocardiography services so that payment for the echocardiography 
color flow velocity mapping, if performed, would be packaged. 
Specifically, we would package payment for CPT code 93325, the 
echocardiography color flow velocity mapping, so that this dependent 
procedure would receive packaged payment through the separate OPPS 
payments for the independent procedures, here the stress test and 
echocardiography services. The payment rates for this example 
associated with our CY 2008 proposal are outlined in Table 9 below.
    In this case, the proposed CY 2008 median cost for APC 0100 to 
which CPT code 93017 is assigned is $180.10. The proposed CY 2008 
median cost for APC 0697, to which CPT code 93350 is assigned, is 
$302.40. The CY 2007 median cost for APC 0100 is $154.83 and the median 
cost for APC 0697 is $97.61. However, as discussed in section II.A.4.c. 
of this proposed rule concerning our general proposed packaging 
approach, the added effect of the budget neutrality adjustment that 
would result from the aggregate effects of the CY 2008 packaging 
proposal

[[Page 42659]]

(were there no further budget neutrality adjustment for other reasons) 
significantly changes the final payment rates relative to the median 
cost estimates. Table 9 presents a comparison of payments for CPT codes 
93017, 93350, and 93325 in CY 2007, where payment for CPT code 93325 is 
made separately, to our CY 2008 proposed payments for CPT codes 93017, 
93350, and 93325, where payment for CPT code 93325 would be packaged. 
This example cannot demonstrate the overall impact of packaging image 
processing services on payment to any given hospital because each 
individual hospital's case-mix and billing patterns would be different. 
The overall impact of packaging payment for CPT code 93325, as well as 
the proposed packaging changes that we are proposing for CY 2008, can 
only be assessed in the aggregate for classes of hospitals. Section 
XXII.B. of this proposed rule displays the overall impact of APC weight 
recalibration and packaging changes that we are proposing by classes of 
hospitals, and the OPPS Hospital-Specific Impacts--Provider-Specific 
Data file presents our estimates of CY 2008 hospital payment for those 
hospitals we include in our ratesetting and payment simulation 
database. The hospital-specific impacts file can be found on the CMS 
Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/ under 
supporting documentation for this proposed rule.

  Table 9.--Example of the Effects of the CY 2008 Packaging Proposal on Payment for CPT Codes 93325, 93350, and
                                                      93017
----------------------------------------------------------------------------------------------------------------
                                                                                  Sum of CY 2007  Sum of CY 2008
                                                                                  payment (93325     proposed
                HCPCS code                            Short descriptor                 paid       payment (93325
                                                                                    separately)      Packaged)
----------------------------------------------------------------------------------------------------------------
93325.....................................  Doppler color flow add-on (dependent          $98.18           $0.00
                                             service).
93350.....................................  Echo transthoracic (independent               197.64          306.18
                                             service).
93017.....................................  Cardiovascular stress test                    155.74          182.36
                                             (independent service).
                                                                                 -------------------------------
    Total Payment.........................  ....................................          451.56          488.54
----------------------------------------------------------------------------------------------------------------

    The estimated overall impact of these proposed changes presented in 
section XXII.B. of this proposed rule is based on the assumption that 
hospital behavior would not change with regard to how often these 
dependent image processing services are performed in conjunction with 
the independent services. To the extent that hospitals could change 
their behavior and perform the image processing services more or less 
frequently, the data would show such a change in practice in future 
years and that change would be reflected in future budget neutrality 
adjustments.
    As we indicated earlier, in all cases we are proposing that 
hospitals that furnish the image processing procedure in association 
with the independent service must bill both services on the same claim. 
We expect to carefully monitor any changes in billing practices on a 
service-specific and hospital-specific basis to determine whether there 
is reason to request that QIOs review the quality of care furnished or 
to request that Program Safeguard Contractors review the claims against 
the medical record.

                                    Table 10.--Image Processing HCPCS Codes Proposed for Packaged Payment in CY 2008
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                    Inactive CPT
                                                                                                                  code effective 1/
                                                                                                                   1/08 or earlier   Short descriptor of
      HCPCS code         Short descriptor          CY 2007 SI            CY 2007 APC        Proposed CY 2008 SI    (listed on the     the inactive CPT
                                                                                                                  same line as its          code
                                                                                                                  replacement code
--------------------------------------------------------------------------------------------------------------------------------------------------------
76125................  Cine/video x-rays     X....................  0260.................  N                                        ....................
                        add-on.
76350................  Special x-ray         N....................  n/a..................  N                                        ....................
                        contrast study.
76376................  3d render w/o         X....................  0340.................  N                                        ....................
                        postprocess.
76377................  3d rendering w/       S....................  0282.................  N                                        ....................
                        postprocess.
93325................  Doppler color flow    S....................  0697.................  N                                        ....................
                        add-on.
93613................  Electrophys map 3d,   T....................  0087.................  N                                        ....................
                        add-on.
95957................  EEG digital analysis  S....................  0214.................  N                                        ....................
0159T................  Cad breast MRI......  N....................  n/a..................  N                                        ....................
0174T................  Cad cxr remote......  N....................  n/a..................  N....................             0152T  Computer chest add-
                                                                                                                                     on.
0175T................  Cad cxr with interp.  N....................  n/a..................  N....................             0152T  Computer chest add-
                                                                                                                                     on.
G0288................  Recon, CTA for surg   S....................  0417.................  N                                        ....................
                        plan.
--------------------------------------------------------------------------------------------------------------------------------------------------------

(3) Intraoperative Services
    We are proposing to package payment for ``intraoperative'' HCPCS 
codes for CY 2008, specifically those codes that are reported for 
supportive dependent diagnostic testing or other minor procedures 
performed during independent procedures. We performed a broad search 
for possible intraoperative HCPCS codes, relying upon the AMA's CY 2007 
book of CPT codes and the CY 2007 book of Level II HCPCS codes, to 
identify specific codes as ``intraoperative'' codes. Furthermore, we 
performed a clinical review of all HCPCS codes to capture additional 
supportive diagnostic testing or other minor intraoperative or 
intraprocedural codes that are not necessarily identified as 
``intraoperative'' codes. For example, we are proposing to package 
payment for CPT code 95955 (Electroencephalogram (EEG) during

[[Page 42660]]

nonintracranial surgery (e.g., carotid surgery)) because it is a minor 
intraoperative diagnostic testing procedure even though the code 
descriptor does not indicate it as such. Although we use the term 
``intraoperative'' to categorize these procedures, we also have 
included supportive dependent services in this group that are provided 
during an independent procedure, although that procedure may not 
necessarily be a surgical procedure. These dependent services clearly 
fit into this category because they are provided during, and are 
integral to, an independent procedure, like all the other 
intraoperative codes, but the independent procedure they accompany may 
not necessarily be a surgical procedure. For example, we are proposing 
to package HCPCS code G0268 (Removal of impacted cerumen (one or both 
ears) by physician on same date of service as audiologic function 
testing). While specific audiologic function testing procedures are not 
surgical procedures performed in an operating room, they are 
independent procedures that are separately payable under the OPPS, and 
HCPCS code G0268 is a supportive dependent service always provided in 
association with one of these independent services. All references to 
``intraoperative'' below refer to services that are usually or always 
provided during a surgical procedure or other independent procedure.
    By definition, a service that is performed intraoperatively is 
provided during and, therefore, on the same date of service as another 
procedure that is separately payable under the OPPS. Because these 
intraoperative services support the performance of an independent 
procedure and they are provided in the same operative session as the 
independent procedure, we believe it would be appropriate to package 
their payment into the OPPS payment for the independent procedure 
performed. Therefore, we are not proposing to package payment for CY 
2008 for those diagnostic services, such as CPT code 93005 
(Electrocardiogram, routine ECG with at least 12 leads; tracing only, 
without interpretation and report) that are sometimes or only rarely 
performed and reported as supportive services in association with other 
independent procedures. Instead, we are proposing to include those 
HCPCS codes that are usually or always performed intraoperatively, 
based upon our review of the codes described above. The intraoperative 
services that we are proposing to package vary in hospital resource 
costs. Resource cost was not a factor we considered when determining 
which supportive intraoperative procedures to package.
    The codes we are proposing to identify as intraoperative services 
for CY 2008 that would receive packaged payment under the OPPS are 
listed in Table 12 below.
    Several of these codes, including CPT code 93640 
(Electrophysiologic evaluation of single or dual chamber pacing 
cardioverter-defibrillator leads including defibrillation threshold 
evaluation (induction of arrhythmia, evaluation of sensing and pacing 
for arrhythmia termination) at the time of initial implantation or 
replacement), are already unconditionally (that is, always) packaged 
under the CY 2007 OPPS, where they have been assigned to status 
indicator ``N.'' Payment for these services is made through the payment 
for the separately payable, independent services with which they are 
billed. No separate payment is made for services that we have assigned 
to status indicator ``N.'' We are not proposing status indicator 
changes for the five diagnostic intraoperative services that were 
unconditionally packaged for CY 2007.
    We are proposing to change the status indicator for 34 
intraoperative services from separately paid to unconditionally 
packaged (status indicator ``N'') for the CY 2008 OPPS. We believe that 
these services are always integral to and dependent upon the 
independent services that they support and, therefore, their payment 
would be appropriately packaged because they would generally be 
performed on the same date and in the same hospital as the independent 
services.
    We are also proposing to change the status indicator for one 
intraoperative procedure from unconditionally packaged to conditionally 
packaged (status indicator ``Q'') as a ``special'' packaged code for 
the CY 2008 OPPS, specifically, CPT code 0126T (Common carotid intima-
media thickness (IMT) study for evaluation of atherosclerotic burden or 
coronary heart disease risk factor assessment). This code was discussed 
in the past with the Packaging Subcommittee of the APC Panel which 
determined that, consistent with its code descriptor as a separate 
procedure, this procedure could sometimes be provided alone, without 
any other OPPS services on the claim. We believe that this procedure 
would usually be provided by a hospital in conjunction with another 
independent procedure on the same date of service but may occasionally 
be provided without another independent service. As a ``special'' 
packaged code, if the study were billed without any other service 
assigned to status indicator ``S,'' ``T,'' ``V,'' or ``X'' reported on 
the same date of service, under our proposal we would not treat the IMT 
study as a dependent service for purposes of payment. If we were to 
continue to unconditionally package payment for this procedure, 
treating it as a dependent service, hospitals would receive no payment 
at all when providing this service alone, although the procedure would 
not be functioning as an intraoperative service in that case. However, 
according to our proposal, its conditionally packaged status as a 
``special'' packaged code would allow payment to be provided for this 
``Q'' status IMT study when provided alone, in which case it would be 
treated as an independent service under these limited circumstances. On 
the other hand, when this service is furnished as an intraoperative 
procedure on the same day and in the same hospital as independent, 
separately paid services that are assigned to status indicator ``S,'' 
``T,'' ``V,'' or ``X,'' we are proposing to package payment for it as a 
dependent service. In all cases, we are proposing that hospitals that 
furnish independent services on the same date as this IMT procedure 
must bill them all on the same claim. We believe that when dependent 
and independent services are furnished on the same date and in the same 
facility, they are part of a single complete hospital outpatient 
service that is reported with more than one HCPCS code, and no separate 
payment should be made for the intraoperative procedure that supports 
the independent service.
    We have calculated the median costs on which the proposed CY 2008 
payment rates are based using the packaging status of each code as 
provided in Table 12 below. As we discuss above in more detail, this 
has the effect of both changing the median cost for the independent 
service into which the cost of the dependent service is packaged and 
also of redistributing payment that would otherwise have been made 
separately for the service we are proposing to newly package for CY 
2008.
    For example, CPT code 92547 (Use of vertical electrodes (List 
separately in addition to code for primary procedure)) is assigned to 
APC 0363 (Level I Otorhinolaryngologic Function Tests) for CY 2007. The 
proposed CY 2008 median cost of APC 0363 is $53.73. CPT code 92547 was 
billed with CPT code 92541 (Spontaneous nystagmus test, including gaze 
and fixation nystagmus, with recording) 6,056 times in the CY 2008 OPPS 
proposed rule data, and 97

[[Page 42661]]

percent of the claims for CPT code 92547 reported CPT code 92541 on the 
same date of service. Similarly, we note that over half of the claims 
for CPT code 92541 also reported the service described by CPT code 
92547. Under our proposed policy for the CY 2008 OPPS, we are proposing 
to expand the packaging associated with the independent nystagmus test 
so that payment for the use of vertical electrodes, if used, would be 
packaged. Specifically, we would package payment for CPT code 92547 so 
that under the CY 2008 OPPS the commonly billed dependent procedure, 
the use of vertical electrodes, would receive packaged payment through 
the separate OPPS payment for the independent procedure, in this case 
the nystagmus test. The payment rates for this example associated with 
our CY 2008 proposal are outlined in Table 11 below.
    In this case, the proposed CY 2008 median cost for APC 0363, to 
which CPT code 92541 is assigned, is $53.73, while the CY 2007 median 
cost of this APC with status indicator ``S'' and to which both CPT 
codes 92547 and 02541 are assigned is $52.09. However, as discussed in 
the section II.A.4. of this proposed rule concerning our general 
proposed packaging approach, the added effect of the budget neutrality 
adjustment that would result from the aggregate effects of the complete 
CY 2008 packaging proposal (were there no further budget neutrality 
adjustment for other reasons) significantly changes the final payment 
rates relative to median cost estimates. Table 11 presents a comparison 
of payment for CPT codes 92541 and 92547 in CY 2007, where CPT code 
92547 is paid separately, to our CY 2008 proposed payment for CPT codes 
92541 and 92547, where payment for CPT code 92547 would be packaged. 
This example cannot demonstrate the overall impact of packaging 
intraoperative services on payment to any given hospital because each 
individual hospital's case-mix and billing patterns would be different. 
The overall impact of packaging payment for CPT code 92547, as well as 
all other packaging changes we are proposing for CY 2008, can only be 
assessed in the aggregate for classes of hospitals. Section XXII.B. of 
this proposed rule displays the overall impact of APC weight 
recalibration and packaging changes we are proposing by classes of 
hospitals, and the OPPS Hospital-Specific Impacts--Provider-Specific 
Data file presents our estimates of CY 2008 hospital payment for those 
hospitals we include in our ratesetting and payment simulation 
database. The hospital-specific impacts file can be found on the CMS 
Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/ under 
supporting documentation for this proposed rule.

  Table 11.-- Example of the Effects of the CY 2008 Packaging Proposal on Payment for CPT Codes 92541 and 92547
----------------------------------------------------------------------------------------------------------------
                                                                                  Sum of CY 2007  Sum of CY 2008
                                                                                  payment (92547     proposed
                HCPCS Code                            Short descriptor                 paid       payment (92547
                                                                                    separately)      packaged)
----------------------------------------------------------------------------------------------------------------
92541.....................................  Spontaneous nystagmus study                   $52.40          $54.41
                                             (independent service).
92547.....................................  Supplemental electrical test                   52.40            0.00
                                             (dependent service).
                                           ---------------------------------------------------------------------
    Total Payment...............................................................          104.80           54.41
----------------------------------------------------------------------------------------------------------------

    The estimated overall impact of these proposed changes is based on 
the assumption that hospital behavior would not change with regard to 
when these dependent intraoperative services are performed on the same 
date and by the same hospital that performs the independent services. 
To the extent that hospitals could change their behavior and perform 
the intraoperative services more or less frequently, on subsequent 
dates, or at settings outside of the hospital, the data would show such 
a change in practice in future years and that change would be reflected 
in future budget neutrality adjustments. However, with respect to 
intraoperative services in particular, we believe that hospitals are 
limited in the extent to which they could change their behavior with 
regard to how they furnish these services. By their definition, these 
intraoperative services generally must be furnished on the same date 
and at the same operative location as the independent procedure in 
order to be considered intraoperative. For these codes, we assume that 
both the dependent and independent services would be furnished on the 
same date in the same hospital, and hospitals should bill them on the 
same claim with the same date of service.
    As we indicated earlier, in all cases we are proposing that 
hospitals that furnish the intraoperative procedure on the same date as 
the independent service must bill both services on the same claim. We 
expect to carefully monitor any changes in billing practices on a 
service-specific and hospital-specific basis to determine whether there 
is reason to request that QIOs review the quality of care furnished or 
to request that Program Safeguard Contractors review the claims against 
the medical record.

                 Table 12.--Intraoperative HCPCS Codes Proposed for Packaged Payment in CY 2008
----------------------------------------------------------------------------------------------------------------
       HCPCS Code           Short descriptor            CY 2007 SI          CY 2007 APC     Proposed CY 2008 SI
----------------------------------------------------------------------------------------------------------------
20975..................  Electrical bone         X......................            0340  N
                          stimulation.
31620..................  Endobronchial us add-   S......................            0670  N
                          on.
37250..................  Iv us first vessel add- S......................            0416  N
                          on.
37251..................  Iv us each add vessel   S......................            0416  N
                          add-on.
58110..................  Bx done w/colposcopy    T......................            0188  N
                          add-on.
67299..................  Eye surgery procedure.  T......................            0235  N
73530..................  X-ray exam of hip.....  X......................            0261  N
74300..................  X-ray bile ducts/       X......................            0263  N
                          pancreas.

[[Page 42662]]

 
74301..................  X-rays at surgery add-  X......................            0263  N
                          on.
75898..................  Follow-up angiography.  X......................            0263  N
78020..................  Thyroid met uptake....  S......................            0399  N
78478..................  Heart wall motion add-  S......................            0399  N
                          on.
78480..................  Heart function add-on.  S......................            0399  N
78496..................  Heart first pass add-   S......................            0399  N
                          on.
92547..................  Supplemental            X......................            0363  N
                          electrical test.
92978..................  Intravasc us, heart     S......................            0670  N
                          add-on.
92979..................  Intravasc us, heart     S......................            0416  N
                          add-on.
93320..................  Doppler echo exam,      S......................            0697  N
                          heart.
93321..................  Doppler echo exam,      S......................            0697  N
                          heart.
93571..................  Heart flow reserve      S......................            0670  N
                          measure.
93572..................  Heart flow reserve      S......................            0416  N
                          measure.
93609..................  Map tachycardia, add-   T......................            0087  N
                          on.
93613..................  Electrophys map 3d,     T......................            0087  N
                          add-on.
93621..................  Electrophysiology       T......................            0085  N
                          evaluation.
93622..................  Electrophysiology       T......................            0085  N
                          evaluation.
93623..................  Stimulation, pacing     T......................            0087  N
                          heart.
93631..................  Heart pacing, mapping.  T......................            0087  N
93640..................  Evaluation heart        N......................             n/a  N
                          device.
93641..................  Electrophysiology       N......................             n/a  N
                          evaluation.
93662..................  Intracardiac ecg (ice)  S......................            0670  N
95829..................  Surgery                 S......................            0214  N
                          electrocorticogram.
95920..................  Intraop nerve test add- S......................            0216  N
                          on.
95955..................  EEG during surgery....  S......................            0213  N
95999..................  Neurological procedure  S......................            0215  N
96020..................  Functional brain        X......................            0373  N
                          mapping.
0126T..................  Chd risk imt study....  N......................             n/a  Q
0173T..................  Iop monit io pressure.  N......................             n/a  N
G0268..................  Removal of impacted     X......................            0340  N
                          wax md.
G0275..................  Renal angio, cardiac    N......................             n/a  N
                          cath.
G0278..................  Iliac art angio,        N......................             n/a  N
                          cardiac cath.
----------------------------------------------------------------------------------------------------------------

(4) Imaging Supervision and Interpretation Services
    We are proposing to change the packaging status of many imaging 
supervision and interpretation codes for CY 2008. We define ``imaging 
supervision and interpretation codes'' as HCPCS codes for services that 
are defined as ``radiological supervision and interpretation'' in the 
radiology series, 70000 through 79999, of the AMA's CY 2007 book of CPT 
codes, with the addition of some services in other code ranges of CPT, 
Category III CPT tracking codes, or Level II HCPCS codes that are 
clinically similar or directly crosswalk to codes defined as 
radiological supervision and interpretation services in the CPT 
radiology range. We also included HCPCS codes that existed in CY 2006 
but were deleted and were replaced in CY 2007. We included the CY 2006 
HCPCS codes because we are proposing to use the CY 2006 claims data to 
calculate the CY 2008 OPPS median costs on which the CY 2008 payment 
rates would be based.
    In its discussion of ``radiological supervision and 
interpretation,'' CPT indicates that ``when a procedure is performed by 
two physicians, the radiologic portion of the procedure is designated 
as `radiological supervision and interpretation'.'' In addition, CPT 
guidance notes that, ``When a physician performs both the procedure and 
provides imaging supervision and interpretation, a combination of 
procedure codes outside the 70000 series and imaging supervision and 
interpretation codes are to be used.'' In the hospital outpatient 
setting, the concept of one or more than one physician performing 
related procedures does not apply to the reporting of these codes, but 
the radiological supervision and interpretation codes clearly are 
established for reporting in association with other procedural services 
outside the CPT 70000 series. Because these imaging supervision and 
interpretation codes are always reported for imaging services that 
support the performance of an independent procedure and they are, by 
definition, always provided in the same operative session as the 
independent procedure, we believe that it would be appropriate to 
package their payment into the OPPS payment for the independent 
procedure performed.
    In addition to radiological supervision and interpretation codes in 
the radiology range of CPT codes, there are CPT codes in other series 
that describe similar procedures that we are proposing to include in 
the group of imaging supervision and interpretation codes proposed for 
packaging under the CY 2008 OPPS. For example, CPT code 93555 (Imaging 
supervision, interpretation and report for injection procedure(s) 
during cardiac catheterization; ventricular and/or atrial angiography) 
whose payment under the OPPS is currently packaged, is commonly 
reported with an injection procedure code, such as CPT code 93543 
(Injection procedure during cardiac catheterization; for selective left 
ventricular or left atrial angiography), whose payment is also 
currently packaged under the OPPS, and a cardiac catheterization 
procedure code, such as CPT code 93526 (Combined right heart 
catheterization and retrograde left heart catheterization), that is 
separately paid. In the case of cardiac catheterization, CPT code 93555 
describes an imaging supervision and interpretation service in support 
of the cardiac catheterization procedure, and this dependent service is 
clinically quite similar to radiological supervision and interpretation 
codes in the radiology range of CPT. Payment for the cardiac 
catheterization imaging

[[Page 42663]]

supervision and interpretation services has been packaged since the 
beginning of the OPPS. Therefore, in developing this proposal for the 
CY 2008 proposed rule, we conducted a comprehensive clinical review of 
all Category I and Category III CPT codes and Level II HCPCS codes to 
identify all codes that describe imaging supervision and interpretation 
services. The codes we are proposing to identify as imaging supervision 
and interpretation codes for CY 2008 that would receive packaged 
payment are listed in Table 14 below.
    Several of these codes, including CPT code 93555 discussed above, 
are already unconditionally (that is, always) packaged under the CY 
2007 OPPS, where they have been assigned to status indicator ``N.'' 
Payment for these services is made as part of the payment for the 
separately payable, independent services with which they are billed. No 
separate payment is made for services that we have assigned to status 
indicator ``N.'' We are not proposing status indicator changes for the 
six imaging supervision and interpretation services that were 
unconditionally packaged for CY 2007.
    We are proposing to change the status indicator for 33 imaging 
supervision and interpretation services from separately paid to 
unconditionally packaged (status indicator ``N'') for the CY 2008 OPPS. 
We believe that these services are always integral to and dependent 
upon the independent services that they support and, therefore, their 
payment would be appropriately packaged because they would generally be 
performed on the same date and in the same hospital as the independent 
services.
    We are proposing to change the status indicator for 93 imaging 
supervision and interpretation services from separately paid to 
conditionally packaged (status indicator ``Q'') as ``special'' packaged 
codes for the CY 2008 OPPS. These services may occasionally be provided 
at the same time and at the same hospital with one or more other 
procedures for which payment is currently packaged under the OPPS, most 
commonly injection procedures, and in these cases we would not treat 
the imaging supervision and interpretation services as dependent 
services for purposes of payment. If we were to unconditionally package 
payment for these imaging supervision and interpretation services as 
dependent services, hospitals would receive no payment at all for 
providing the imaging supervision and interpretation service and the 
other minor procedure(s). However, according to our proposal, their 
conditional packaging status as ``special'' packaged codes would allow 
payment to be provided for these ``Q'' status imaging supervision and 
interpretation services as independent services in these limited 
circumstances, and for which payment for the accompanying minor 
procedure would be packaged. However, when these imaging supervision 
and interpretation dependent services are furnished on the same day and 
in the same hospital as independent separately paid services, 
specifically, any service assigned to status indicator ``S,'' ``T,'' 
``V,'' or ``X,'' we are proposing to package payment for them as 
dependent services. In all cases, we are proposing that hospitals that 
furnish the independent services on the same date as the dependent 
services must bill them all on the same claim. We believe that when the 
dependent and independent services are furnished on the same date and 
in the same hospital, they are part of a single complete hospital 
outpatient service that is reported with more than one HCPCS code, and 
no separate payment should be made for the imaging supervision and 
interpretation service that supports the independent service.
    In the case of services for which we are proposing conditional 
packaging, we would expect that, although these services would always 
be performed in the same session as another procedure, in some cases 
that other procedure's payment would also be packaged. For example, CPT 
code 73525 (Radiological examination, hip, arthrography, radiological 
supervision and interpretation) and CPT code 27093 (Injection procedure 
for hip arthrography; without anesthesia) could be provided in a single 
hospital outpatient encounter and reported as the only two services on 
a claim. In the case where only these two services were performed, the 
conditionally packaged status of CPT code 73525 would appropriately 
allow for its separate payment as an independent imaging supervision 
and interpretation arthrography service, into which payment for the 
dependent injection procedure would be packaged.
    We have calculated the median costs on which the proposed CY 2008 
payment rates are based using the packaging status of each code as 
provided in Table 14 below. As we discuss above in more detail, this 
has the effect of both changing the median cost for the independent 
service into which the cost of the dependent service is packaged and 
also of redistributing payment that would otherwise have been made 
separately for the service we are proposing to newly package for CY 
2008.
    For example, CPT code 72265 (Myelography, lumbosacral, radiological 
supervision and interpretation) is assigned to APC 0274 (Myelography) 
for CY 2007. The proposed CY 2008 median cost of APC 0274 is $245.38. 
CPT code 72265 was billed with CPT code 72132 (Computed tomography, 
lumbar spine; with contrast material) 20,233 times in the CY 2008 OPPS 
proposed rule data, and 62 percent of the claims for CPT code 72265 
reported CPT code 72132 on the same date of service. Similarly, we note 
that over half of the claims for CPT code 72132 also reported the 
myelography service described by CPT code 72265. As would be expected, 
we also observed that a CPT code for the clinically necessary 
intrathecal injection, specifically CPT code 62284 (Injection procedure 
for myelography and/or computed tomography, spinal (other than C1-C2 
and posterior fossa)) was also frequently reported on the same claim on 
the same day as both of the other two CPT codes. Payment for CPT code 
62284 is already packaged under the OPPS for CY 2007, as is payment for 
most HCPCS codes that describe dependent injection procedures that 
accompany independent procedures. Under our proposed policy for the CY 
2008 OPPS, we are proposing to expand the packaging associated with the 
independent spinal computed tomography (CT) scan so that payment for 
both the associated injection procedure and the related myelography 
service, if performed, would be packaged. Specifically, we would 
package payment for CPT code 72265 when it appears on the same claim 
with a separately paid service such as CPT code 72132, so that, under 
the CY 2008 OPPS, both commonly billed dependent procedures, the 
injection procedure and the myelography service, would receive packaged 
payment through the separate OPPS payment for the independent 
procedure, the CT scan. The payment rates for this example associated 
with our CY 2008 proposal are outlined in Table 13 below. The proposed 
conditionally packaged status for CPT code 72265 would ensure that if 
lumbosacral myelography was performed alone, separate payment for the 
myelography service would be made under the OPPS as the myelography 
service would not be a dependent service in that situation.
    The proposed policy would result in no separate payment for CPT 
code 72265 when it is billed on the same day and by the same hospital 
as any separately paid service, such as CPT code 72132. Moreover, as 
discussed

[[Page 42664]]

later in this section, the proposed policy would provide packaged 
payment for the contrast agent that is required to perform the 
independent computed tomography service. For purposes of the example in 
Table 13 below, we include the payment for HCPCS code Q9947 (Low 
osmolar contrast material 200-249 mg/ml iodine concentration, per ml) 
which was reported on about one-third of the CY 2008 proposed rule 
claims for CPT code 72132. To calculate the CY 2007 payment for the 
contrast agent, we multiplied the mean number of units per day from our 
CY 2008 proposed rule data (48.3) by the April 2007 per unit payment 
rate for HCPCS code Q9947 ($1.33).
    In this case, the proposed CY 2008 median cost for APC 0316 (Level 
II Computed Tomography with Contrast) to which CPT code 72132 is 
assigned is $741.80. The CY 2007 median cost for APC 0283 to which CPT 
code 72132 is assigned is $249.48 and the median cost of APC 0274 to 
which CPT code 72265 is assigned is $156.10. However, as discussed in 
section II.A.4.c. of this proposed rule concerning our general proposed 
packaging approach, the added effect of the budget neutrality 
adjustment that would result from the aggregate effects of the CY 2008 
packaging proposal (were there no further budget neutrality adjustment 
for other reasons) significantly changes the final payment rates 
relative to median cost estimates. Table 13 presents a comparison of 
payment for CPT codes 72132 and 72265 and HCPCS code Q9947 in CY 2007, 
where CPT code 72265 and HCPCS code Q9947 are paid separately, to our 
CY 2008 proposed payment for CPT codes 72132 and 77265 and HCPCS code 
Q9947, where payment for CPT code 72265 and HCPCS code Q9947 would be 
packaged. This example cannot demonstrate the overall impact of 
packaging imaging supervision and interpretation services on payment to 
any given hospital because each individual hospital's case-mix and 
billing patterns would be different. The overall impact of packaging 
payment CPT code 77265 when it appears with any other separately paid 
service, as well as all other packaging changes that we are proposing 
for CY 2008, can only be assessed in aggregate for classes of 
hospitals. Section XXII.B. of this proposed rule displays the overall 
impact of APC weight recalibration and packaging changes we are 
proposing by classes of hospitals, and the OPPS Hospital-Specific 
Impacts--Provider-Specific Data file presents our estimates of CY 2008 
hospital payment for those hospitals we include in our ratesetting and 
payment simulation database. The hospital-specific impacts file can be 
found on the CMS Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/ under supporting documentation for this proposed 
rule.

Table 13.--Example of the Effects of the CY 2008 Packaging Proposal on Payment for CPT Codes 72265 and 72132 and
                                                HCPCS Code Q9947
----------------------------------------------------------------------------------------------------------------
                                                                                  Sum of CY 2007  Sum of CY 2008
                                                                                  payment (72265     proposed
                 HCPCS code                            Short descriptor                paid       payment (72265
                                                                                    separately)      packaged)
----------------------------------------------------------------------------------------------------------------
62284......................................  Injection for myelogram (dependent            $0.00           $0.00
                                              service).
Q9947*.....................................  LOCM 200-249mg/ml iodine, 1ml                 64.24            0.00
                                              (dependent service).
72265......................................  Contrast x-ray lower spine                   157.01            0.00
                                              (dependent service).
72132......................................  CT lumbar spine w/dye (independent           250.94          751.09
                                              service).
                                                                                 -------------------------------
    Total Payment..........................  ...................................          472.14         751.09
----------------------------------------------------------------------------------------------------------------
* Based on the mean number of units per day from our CY 2008 proposed rule data (48.3) and the April 2007 per
  unit payment rate for Q9947 ($1.33).

    The estimated overall impact of these changes presented in XXII.B. 
of this proposed rule is based on the assumption that hospital behavior 
would not change with regard to when these dependent services are 
performed on the same date and by the same hospital that performs the 
independent services. To the extent that hospitals could change their 
behavior and perform the imaging supervision and interpretation 
services more or less frequently, on subsequent dates, or at settings 
outside of the hospital, the data would show such a change in practice 
in future years and that change would be reflected in future budget 
neutrality adjustments. However, with respect to the imaging 
supervision and interpretation services in particular, we believe that 
hospitals are limited in the extent to which they could change their 
behavior with regard to how they furnish these services. By their 
definition, these imaging and supervision services generally must be 
furnished on the same date and at the same operative location as the 
independent procedure in order for the imaging service to meaningfully 
contribute to the diagnosis or treatment of the patient. For those 
radiological supervision and interpretation codes in the radiology 
range of CPT in particular, if the same physician is able to perform 
both the procedure and the supervision and interpretation as stated by 
CPT, we assume that both the dependent and independent services would 
be furnished on the same date in the same hospital, and hospitals 
should bill them on the same claim with the same date of service.
    As we indicated earlier in this section, in all cases we are 
proposing that hospitals that furnish the imaging supervision and 
interpretation service on the same date as the independent service must 
bill both services on the same claim. We expect to carefully monitor 
any changes in billing practices on a service-specific and hospital-
specific basis to determine whether there is reason to request that 
QIOs review the quality of care furnished or to request that Program 
Safeguard Contractors review the claims against the medical record.

[[Page 42665]]



                         Table 14.--Imaging Supervision and Interpretation HCPCS Codes Proposed for Packaged Payment in CY 2008
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                               Inactive
                                                                                                               CPT code
                                                                                                             effective 1/
                                                                                                              1/2008 or
                                                                              Proposed CY 2008  Proposed CY    earlier        Short descriptor of the
    HCPCS code         Short descriptor          CY 2007 SI     CY 2007 APC          SI           2008 APC    (listed on         inactive CPT code
                                                                                                               the same
                                                                                                             line as its
                                                                                                             replacement
                                                                                                                code)
--------------------------------------------------------------------------------------------------------------------------------------------------------
70010............  Contrast x-ray of brain.  S................         0274  Q................         0274
70015............  Contrast x-ray of brain.  S................         0274  Q................         0274
70170............  X-ray exam of tear duct.  X................         0264  Q................         0264
70332............  X-ray exam of jaw joint.  S................         0275  Q................         0275
70373............  Contrast x-ray of larynx  X................         0263  Q................         0263
70390............  X-ray exam of salivary    X................         0263  Q................         0263
                    duct.
71040............  Contrast x-ray of         X................         0263  Q................         0263
                    bronchi.
71060............  Contrast x-ray of         X................         0263  Q................         0263
                    bronchi.
71090............  X-ray & pacemaker         X................         0272  N................          n/a
                    insertion.
72240............  Contrast x-ray of neck    S................         0274  Q................         0274
                    spine.
72255............  Contrast x-ray, thorax    S................         0274  Q................         0274
                    spine.
72265............  Contrast x-ray, lower     S................         0274  Q................         0274
                    spine.
72270............  Contrast x-ray, spine...  S................         0274  Q................         0274
72275............  Epidurography...........  S................         0274  N................          n/a
72285............  X-ray c/t spine disk....  S................         0388  Q................         0388
72291............  Perq vertebroplasty,      S................         0274  N................          n/a        76012  Perq vertebroplasty, fluor.
                    fluor.
72292............  Perq vertebroplasty, ct.  S................         0274  N................          n/a        76013  Perq vertebroplasty, ct.
72295............  X-ray of lower spine      S................         0388  Q................         0388
                    disk.
73040............  Contrast x-ray of         S................         0275  Q................         0275
                    shoulder.
73085............  Contrast x-ray of elbow.  S................         0275  Q................         0275
73115............  Contrast x-ray of wrist.  S................         0275  Q................         0275
73525............  Contrast x-ray of hip...  S................         0275  Q................         0275
73542............  X-ray exam, sacroiliac    S................         0275  Q................         0275
                    joint.
73580............  Contrast x-ray of knee    S................         0275  Q................         0275
                    joint.
73615............  Contrast x-ray of ankle.  S................         0275  Q................         0275
74190............  X-ray exam of peritoneum  S................         0264  Q................         0264
74235............  Remove esophagus          S................         0257  N................          n/a
                    obstruction.
74305............  X-ray bile ducts/         X................         0263  N................          n/a
                    pancreas.
74320............  Contrast x-ray of bile    X................         0264  Q................         0264
                    ducts.
74327............  X-ray bile stone removal  S................         0296  N................          n/a
74328............  X-ray bile duct           N................          n/a  N................          n/a
                    endoscopy.
74329............  X-ray for pancreas        N................          n/a  N................           ma
                    endoscopy.
74330............  X-ray bile/panc           N................          n/a  N................          n/a
                    endoscopy.
74340............  X-ray guide for GI tube.  X................         0272  N................          n/a
74350............  X-ray guide, stomach      X................         0263  N................          n/a
                    tube.
74355............  X-ray guide, intestinal   X................         0263  N................          n/a
                    tube.
74360............  X-ray guide, GI dilation  S................         0257  N................          n/a
74363............  X-ray, bile duct          S................         0297  N................          n/a
                    dilation.
74425............  Contrast x-ray, urinary   S................         0278  Q................         0278
                    tract.
74430............  Contrast x-ray, bladder.  S................         0278  Q................         0278
74440............  X-ray, male genital       S................         0278  Q................         0278
                    tract.
74445............  X-ray exam of penis.....  S................         0278  Q................         0278
74450............  X-ray, urethra/bladder..  S................         0278  Q................         0278
74455............  X-ray, urethra/bladder..  S................         0278  Q................         0278
74470............  X-ray exam of kidney      X................         0263  Q................         0263
                    lesion.
74475............  X-ray control, cath       S................         0297  Q................         0297
                    insert.
74480............  X-ray control, cath       S................         0296  Q................         0296
                    insert.
74485............  X-ray guide, GU dilation  S................         0296  Q................         0296
74740............  X-ray, female genital     X................         0264  Q................         0264
                    tract.
74742............  X-ray, fallopian tube...  X................         0264  N................
75600............  Contrast x-ray exam of    S................         0280  Q................         0280
                    aorta.
75605............  Contrast x-ray exam of    S................         0280  Q................         0280
                    aorta.
75625............  Contrast x-ray exam of    S................         0280  Q................         0280
                    aorta.
75630............  X-ray aorta, leg          S................         0280  Q................         0280
                    arteries.
75635............  Ct angio abdominal        S................         0662  Q................         0662
                    arteries.
75650............  Artery x-rays, head &     S................         0280  Q................         0280
                    neck.
75658............  Artery x-rays, arm......  S................         0279  Q................         0279
75660............  Artery x-rays, head &     S................         0668  Q................         0668
                    neck.
75662............  Artery x-rays, head &     S................         0280  Q................         0280
                    neck.
75665............  Artery x-rays, head &     S................         0280  Q................         0280
                    neck.
75671............  Artery x-rays, head &     S................         0280  Q................         0280
                    neck.

[[Page 42666]]

 
75676............  Artery x-rays, neck.....  S................         0280  Q................         0280
75680............  Artery x-rays, neck.....  S................         0280  Q................         0280
75685............  Artery x-rays, spine....  S................         0280  Q................         0280
75705............  Artery x-rays, spine....  S................         0668  Q................         0668
75710............  Artery x-rays, arm/leg..  S................         0280  Q................         0280
75716............  Artery x-rays, arms/legs  S................         0280  Q................         0280
75722............  Artery x-rays, kidney...  S................         0280  Q................         0280
75724............  Artery x-rays, kidneys..  S................         0280  Q................         0280
75726............  Artery x-rays, abdomen..  S................         0280  Q................         0280
75731............  Artery x-rays, adrenal    S................         0280  Q................         0280
                    gland.
75733............  Artery x-rays, adrenals.  S................         0668  Q................         0668
75736............  Artery x-rays, pelvis...  S................         0280  Q................         0280
75741............  Artery x-rays, lung.....  S................         0279  Q................         0279
75743............  Artery x-rays, lungs....  S................         0280  Q................         0280
75746............  Artery x-rays, lung.....  S................         0279  Q................         0279
75756............  Artery x-rays, chest....  S................         0279  Q................         0279
75774............  Artery x-ray, each        S................         0279  N................          n/a
                    vessel.
75790............  Visualize A-V shunt.....  S................         0279  Q................         0279
75801............  Lymph vessel x-ray, arm/  X................         0264  Q................         0264
                    leg.
75803............  Lymph vessel x-ray,arms/  X................         0264  Q................         0264
                    legs.
75805............  Lymph vessel x-ray,       X................         0264  Q................         0264
                    trunk.
75807............  Lymph vessel x-ray,       X................         0264  Q................         0264
                    trunk.
75809............  Nonvascular shunt, x-ray  X................         0263  Q................         0263
75810............  Vein x-ray, spleen/liver  S................         0279  Q................         0279
75820............  Vein x-ray, arm/leg.....  S................         0668  Q................         0668
75822............  Vein x-ray, arms/legs...  S................         0668  Q................         0668
75825............  Vein x-ray, trunk.......  S................         0279  Q................         0279
75827............  Vein x-ray, chest.......  S................         0279  Q................         0279
75831............  Vein x-ray, kidney......  S................         0279  Q................         0279
75833............  Vein x-ray, kidneys.....  S................         0279  Q................         0279
75840............  Vein x-ray, adrenal       S................         0280  Q................         0280
                    gland.
75842............  Vein x-ray, adrenal       S................         0280  Q................         0280
                    glands.
75860............  Vein x-ray, neck........  S................         0668  Q................         0668
75870............  Vein x-ray, skull.......  S................         0668  Q................         0668
75872............  Vein x-ray, skull.......  S................         0279  Q................         0279
75880............  Vein x-ray, eye socket..  S................         0668  Q................         0668
75885............  Vein x-ray, liver.......  S................         0280  Q................         0280
75887............  Vein x-ray, liver.......  S................         0279  Q................         0279
75889............  Vein x-ray, liver.......  S................         0280  Q................         0280
75891............  Vein x-ray, liver.......  S................         0279  Q................         0279
75893............  Venous sampling by        Q................         0668  Q................         0668
                    catheter.
75894............  X-rays, transcath         S................         0298  N................          n/a
                    therapy.
75896............  X-rays, transcath         S................         0263  N................          n/a
                    therapy.
75901............  Remove cva device         X................         0263  N................          n/a
                    obstruct.
75902............  Remove cva lumen          X................         0263  N................          n/a
                    obstruct.
75940............  X-ray placement, vein     S................         0298  N................          n/a
                    filter.
75945............  Intravascular us........  S................         0267  Q................         0267
75946............  Intravascular us add-on.  S................         0266  N................          n/a
75960............  Transcath iv stent rs&i.  S................         0668  N................          n/a
75961............  Retrieval, broken         S................         0668  N................          n/a
                    catheter.
75962............  Repair arterial blockage  S................         0668  Q................         0668
75964............  Repair Artery blockage,   S................         0668  N................          n/a
                    each.
75966............  Repair arterial blockage  S................         0668  Q................         0668
75968............  Repair Artery blockage,   S................         0668  N................          n/a
                    each.
75970............  Vascular biopsy.........  S................         0668  N................          n/a
75978............  Repair venous blockage..  S................         0668  Q................         0668
75980............  Contrast xray exam bile   S................         0297  N................          n/a
                    duct.
75982............  Contrast xray exam bile   S................         0297  N................          n/a
                    duct.
75984............  Xray control catheter     X................         0263  N................          n/a
                    change.
75989............  Abscess drainage under x- N................  ...........  N................          n/a
                    ray.
75992............  Atherectomy, x-ray exam.  S................         0668  N................          n/a
75993............  Atherectomy, x-ray exam.  S................         0668  N................          n/a
75994............  Atherectomy, x-ray exam.  S................         0668  N................          n/a

[[Page 42667]]

 
75995............  Atherectomy, x-ray exam.  S................         0668  N................          n/a
75996............  Atherectomy, x-ray exam.  S................         0668  N................          n/a
76080............  X-ray exam of fistula...  X................         0263  Q................         0263
76975............  GI endoscopic ultrasound  S................         0266  Q................         0266
77053............  X-ray of mammary duct...  X................         0263  Q................         0263        76086  X-ray of mammary duct.
77054............  X-ray of mammary ducts..  X................         0263  Q................         0263        76088  X-ray of mammary ducts.
93555............  Imaging, cardiac cath...  N................          n/a  N................          n/a
93556............  Imaging, cardiac cath...  N................          n/a  N................          n/a
--------------------------------------------------------------------------------------------------------------------------------------------------------

(5) Diagnostic Radiopharmaceuticals
    For CY 2008, we are proposing to change the packaging status of 
diagnostic radiopharmaceuticals as part of our overall enhanced 
packaging approach for the CY 2008 OPPS. Packaging costs into a single 
aggregate payment for a service, encounter, or episode of care is a 
fundamental principle that distinguishes a prospective payment system 
from a fee schedule. In general, packaging the costs of supportive 
items and services into the payment for the independent procedure or 
service with which they are associated encourages hospital efficiencies 
and also enables hospitals to manage their resources with maximum 
flexibility. As we stated in the CY 2007 OPPS/ASC final rule with 
comment period, we believe that a policy to package payment for 
additional radiopharmaceuticals (other than those already packaged when 
their per day costs are below the packaging threshold for OPPS drugs, 
biologicals, and radiopharmaceuticals based on data for the update 
year) is consistent with OPPS packaging principles and would provide 
greater administrative simplicity for hospitals (71 FR 68094).
    All nuclear medicine procedures require the use of at least one 
radiopharmaceutical, and there are only a small number of 
radiopharmaceuticals that may be appropriately billed with each 
diagnostic nuclear medicine procedure. While examining the CY 2005 
hospital claims data in preparation for the CY 2007 OPPS/ASC proposed 
rule, we identified a significant number of diagnostic nuclear medicine 
procedure claims that were missing HCPCS codes for the associated 
radiopharmaceutical. At that time, we believed that there could be two 
reasons for the presence of these claims in the data. One reason could 
be that the radiopharmaceutical used for the procedure was packaged 
under the OPPS and, therefore, some hospitals may have decided not to 
include the specific radiopharmaceutical HCPCS code and an associated 
charge on the claim. A second reason could be that the hospitals may 
have incorporated the cost of the radiopharmaceutical into the charges 
for the associated nuclear medicine procedures. A third possibility not 
offered in the CY 2007 OPPS/ASC proposed rule is that hospitals may 
have included the charges for radiopharmaceuticals on an uncoded 
revenue code line.
    In the CY 2007 OPPS/ASC proposed rule, we did not propose packaging 
payment for radiopharmaceuticals with per day costs above the $55 CY 
2007 packaging threshold because we indicated that we were concerned 
that payments for certain nuclear medicine procedures could potentially 
be less than the costs of some of the packaged radiopharmaceuticals, 
especially those that are relatively expensive. At the same time, we 
also noted the GAO's comment in reference to the CY 2006 OPPS proposed 
rule that stated a methodology that includes packaging all 
radiopharmaceutical costs into the payments for the nuclear medicine 
procedures may result in payments that exceed hospitals' acquisition 
costs for certain radiopharmaceuticals because there may be more than 
one radiopharmaceutical that may be used for a particular procedure. We 
also expressed concern that packaging payment for additional 
radiopharmaceuticals could provoke treatment decisions that may not 
reflect use of the most clinically appropriate radiopharmaceutical for 
a particular nuclear medicine procedure in any specific case (71 FR 
68094).
    After considering this issue further and examining our CY 2006 
claims data for the CY 2008 OPPS update, we believe that it is most 
appropriate to package payment for some radiopharmaceuticals, 
specifically diagnostic radiopharmaceuticals, into the payment for 
diagnostic nuclear medicine procedures for CY 2008. We expect that 
packaging would encourage hospitals to use the most cost efficient 
diagnostic radiopharmaceutical products that are clinically 
appropriate. We anticipate that hospitals would continue to provide 
care that is aligned with the best interests of the patient. 
Furthermore, we believe that it would be the intent of most hospitals 
to provide both the diagnostic radiopharmaceutical and the associated 
diagnostic nuclear medicine procedure at the time the diagnostic 
radiopharmaceutical is administered and not to send patients to a 
different provider for administration of the radiopharmaceutical. We do 
not believe that our packaging proposal would limit beneficiaries' 
ability to receive clinically appropriate diagnostic procedures. Again, 
the OPPS is a system of averages, and payment in the aggregate is 
intended to be adequate, although payment for any one service may be 
higher or lower than a hospital's actual costs in that case.
    For CY 2008, we have separated radiopharmaceuticals into two 
groupings. The first group includes diagnostic radiopharmaceuticals, 
while

[[Page 42668]]

the second group includes therapeutic radiopharmaceuticals. We 
identified all diagnostic radiopharmaceuticals as those Level II HCPCS 
codes that include the term ``diagnostic'' along with a 
radiopharmaceutical in their long code descriptors. Therefore, we were 
able to distinguish therapeutic radiopharmaceuticals from diagnostic 
radiopharmaceuticals as those Level II HCPCS codes that have the term 
``therapeutic'' along with a radiopharmaceutical in their long code 
descriptors. There currently are no HCPCS C-codes used to report 
radiopharmaceuticals under the OPPS. For CY 2008, we are proposing to 
package payment for all diagnostic radiopharmaceuticals that are not 
otherwise packaged according to the proposed CY 2008 packaging 
threshold for drugs, biologicals, and radiopharmaceuticals. We are 
proposing this packaging approach for diagnostic radiopharmaceuticals, 
while we are proposing to continue to pay separately for therapeutic 
radiopharmaceuticals with an average per day cost of more than $60 as 
discussed in section V.B.3. of this proposed rule. In that section, we 
review our reasons for treating diagnostic radiopharmaceuticals (as 
well as contrast media) differently from other types of specified 
covered outpatient drugs identified in section 1833(t)(B) of the Act.
    Diagnostic radiopharmaceuticals are always intended to be used with 
a diagnostic nuclear medicine procedure. In examining our CY 2006 
claims data, we were able to match most diagnostic radiopharmaceuticals 
to their associated diagnostic procedures and most diagnostic nuclear 
medicine procedures to their associated diagnostic radiopharmaceuticals 
in the vast majority of single bills used for ratesetting. We estimate 
that less than 5 percent of all claims with a diagnostic 
radiopharmaceutical had no corresponding diagnostic nuclear medicine 
procedure. In addition, we found that only about 13 percent of all 
single bills with a diagnostic nuclear medicine procedure code had no 
corresponding diagnostic radiopharmaceutical billed. These statistics 
indicate that, in a majority of our single bills for diagnostic nuclear 
medicine procedures, a diagnostic radiopharmaceutical HCPCS code is 
included on the single bill. Table 15 presents the top 20 diagnostic 
nuclear medicine procedures in terms of the overall frequency with 
which they are reported in the OPPS claims data. Among these high 
volume diagnostic nuclear medicine procedures, their single bills 
include a HCPCS code for a diagnostic radiopharmaceutical at least 84 
percent of the time for 19 out of the top 20 procedures. More 
specifically, 84 to 86 percent of the single bills for 4 diagnostic 
nuclear medicine procedures include a diagnostic radiopharmaceutical, 
87 to 89 percent of the single bills for 8 diagnostic nuclear medicine 
procedures include a diagnostic radiopharmaceutical, and 90 percent or 
more of the single bills for 7 diagnostic nuclear medicine procedures 
include a diagnostic radiopharmaceutical.

                              Table 15.--Top 20 Diagnostic Nuclear Medicine Procedures Sorted by CY 2006 OPPS Total Volume
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                     Single bills with a   Single bills
                                                                                                       Total line-   radiopharmaceutical   as a percent
       HCPCS code                 Short descriptor                    SI                   APC       item frequency  as a percent of all  of total line-
                                                                                                                         single bills     item frequency
--------------------------------------------------------------------------------------------------------------------------------------------------------
78465...................  Heart image (3d), multiple.....  S.......................            0377         566,252                 88                 9
78306...................  Bone imaging, whole body.......  S.......................            0396         368,452                 90                76
78815...................  Tumorimage pet/ct skul-thigh...  S.......................            0308         122,126                100                84
78223...................  Hepatobiliary imaging..........  S.......................            0394          69,066                 85                90
78315...................  Bone imaging, 3 phase..........  S.......................            0396          56,524                 89                88
78464...................  Heart image (3d), single.......  S.......................            0398          35,866                 93                29
78472...................  Gated heart, planar, single....  S.......................            0398          32,154                 89                80
78264...................  Gastric emptying study.........  S.......................            0395          31,190                 88                94
78812...................  Tumor image (pet)/skul-thigh...  S.......................            0308          27,345                100                86
78007...................  Thyroid image, mult uptakes....  S.......................            0391          23,703                 84                96
78195...................  Lymph system imaging...........  S.......................            0400          20,187                 89                18
78585...................  Lung V/Q imaging...............  S.......................            0378          20,036                 91                48
78070...................  Parathyroid nuclear imaging....  S.......................            0391          18,752                 94                84
78006...................  Thyroid imaging with uptake....  S.......................            0390          18,613                 86                95
78300...................  Bone imaging, limited area.....  S.......................            0396          18,333                 89                90
78320...................  Bone imaging (3D)..............  S.......................            0396          16,710                 84                35
78588...................  Perfusion lung image...........  S.......................            0378          14,323                 88                48
78707...................  K flow/funct image w/o drug....  S.......................            0404          13,820                 89                90
78580...................  Lung perfusion imaging.........  S.......................            0401          13,011                 66                19
78816...................  Tumor image pet/ct full body...  S.......................            0308          12,349                100                86
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Among the lower volume diagnostic nuclear medicine procedures 
(which are outside the top 20 in terms of volume), there is still good 
representation of diagnostic radiopharmaceutical HCPCS codes on the 
single bills for most procedures. About 40 percent of the low volume 
diagnostic nuclear medicine procedures have at least 80 percent of the 
single bills for that diagnostic procedure that include a diagnostic 
radiopharmaceutical HCPCS code; about 37 percent of the low volume 
diagnostic procedures have between 50 to 79 percent of the single bills 
that include a diagnostic radiopharmaceutical HCPCS code; and about 23 
percent of the low volume diagnostic procedures have less than 50 
percent of the single bills that include a diagnostic 
radiopharmaceutical HCPCS code. For the few diagnostic nuclear medicine 
procedures where less than 50 percent of the single bills include a 
diagnostic radiopharmaceutical HCPCS code, we believe there could be 
several reasons why the percentage of single bills for the diagnostic 
nuclear medicine procedure with a diagnostic radiopharmaceutical HCPCS 
code is low.
    As noted earlier, it is possible that hospitals may be including 
the charge for the radiopharmaceutical in the

[[Page 42669]]

charge for the diagnostic nuclear medicine procedure itself or on an 
uncoded revenue code line instead of reporting charges for a specific 
diagnostic radiopharmaceutical HCPCS code. We found that 24 percent of 
all single bills for a diagnostic nuclear medicine procedure but 
without a coded diagnostic radiopharmaceutical had uncoded costs in a 
revenue code that might contain diagnostic radiopharmaceutical costs, 
specifically, revenue codes 0254 (Drugs Incident to Other Diagnostic 
Services), 0255 (Drugs Incident to Radiology), 0343 (Diagnostic 
Radiopharmaceuticals), 0621 (Supplies Incident to Radiology), and 0622 
(Supplies Incident to Other Diagnostic Services). In comparison, we 
found that only 2 percent of diagnostic nuclear medicine single bills 
with a nuclear medicine procedure and a coded diagnostic 
radiopharmaceutical had uncoded costs in these revenue codes. It is 
also possible that some of these procedures typically use a diagnostic 
radiopharmaceutical subject to packaged payment under the CY 2006 OPPS, 
and hospitals may have chosen not to report a separate charge for the 
diagnostic radiopharmaceutical. Payment for diagnostic 
radiopharmaceuticals commonly used with some diagnostic nuclear 
medicine procedures would already be packaged because these diagnostic 
radiopharmaceuticals' average per day cost were less than $50 in CY 
2006. The CY 2008 proposal to package additional diagnostic 
radiopharmaceuticals would have little impact on the payment for those 
diagnostic procedures that typically use inexpensive diagnostic 
radiopharmaceuticals that would be packaged under our proposed CY 2008 
packaging threshold of $60, except to the extent that the budget 
neutrality adjustment due to the broader packaging proposal leads to an 
increase in the scaler and an increase in the payment for procedures in 
general.
    At its March 2007 meeting, the APC Panel recommended that CMS work 
with stakeholders on issues related to payment for 
radiopharmaceuticals, including evaluating claims data for different 
classes of radiopharmaceuticals and ensuring that a nuclear medicine 
procedure claim always includes at least one reported 
radiopharmaceutical agent. We are accepting the APC Panel's 
recommendation, and we specifically welcome public comment on the 
hospitals' burden involved should we require such precise reporting. We 
also are seeking comment on the importance of such a requirement in 
light of our above discussion on the representation of diagnostic 
radiopharmaceuticals in the single bills for diagnostic nuclear 
medicine procedures, the presence of uncoded revenue code charges 
specific to diagnostic radiopharmaceuticals on claims without a coded 
diagnostic radiopharmaceutical, and our proposal to package payment for 
all diagnostic radiopharmaceuticals.
    It has come to our attention that several diagnostic 
radiopharmaceuticals may be used for multiple day studies; that is, a 
particular diagnostic radiopharmaceutical may be administered on one 
day and a related diagnostic nuclear medicine procedure may be 
performed on a subsequent day. While we understand that multiple day 
episodes for diagnostic radiopharmaceuticals and the related diagnostic 
nuclear medicine procedures occur, we expect that this would be a small 
proportion of all diagnostic nuclear medicine imaging procedures. We 
estimate that, roughly, 15 diagnostic radiopharmaceuticals have a half-
life longer than one day such that they could support diagnostic 
nuclear medicine scans on different days. We believe these diagnostic 
radiopharmaceuticals would be concentrated in a specific set of 
diagnostic procedures. Excluding the 5 percent of diagnostic 
radiopharmaceutical claims with no matching diagnostic nuclear medicine 
scan for the same beneficiary, we found that a diagnostic nuclear 
medicine scan was reported on the same day as a coded diagnostic 
radiopharmaceutical 90 percent or more of the time for 10 of these 15 
diagnostic radiopharmaceuticals. Further, between 80 and 90 percent 
single bills for each of the remaining 5 diagnostic 
radiopharmaceuticals had a diagnostic nuclear medicine scan on the same 
day. In the ``natural'' single bills we use for ratesetting, we package 
payment across dates of service. In light of such high percentages of 
extended half-life diagnostic radiopharmaceuticals with same day 
diagnostic nuclear medicine scans and the ability of ``natural'' 
singles to package costs across days, we believe that our standard OPPS 
ratesetting methodology of using median costs calculated from claims 
data adequately captures the costs of diagnostic radiopharmaceuticals 
associated with diagnostic nuclear medicine procedures that are not 
provided on the same date of service.
    This packaging proposal reduces the overall frequency of single 
bills for diagnostic nuclear medicine procedures, but the percent of 
single bills out of total claims remains robust for the majority of 
diagnostic nuclear medicine procedures. Typically, packaging more 
procedures should improve the number of single bill claims from which 
to derive median cost estimates because packaging reduces the number of 
separately paid procedures on a claim, thereby creating more single 
procedure bills. In the case of diagnostic nuclear medicine procedures, 
packaging diagnostic radiopharmaceuticals reduces the overall number of 
single bills available to calculate median costs by increasing packaged 
costs that previously were ignored in the bypass process. In prior 
years, we did not consider the costs of radiopharmaceuticals when we 
used our bypass methodology to extract ``pseudo'' single claims because 
we assumed that the cost of radiopharmaceutical overhead and handling 
would be included in the line-item charge for the radiopharmaceutical, 
and the diagnostic radiopharmaceuticals were subject to potential 
separate payment if their mean per day cost fell above the packaging 
threshold. The bypass process sets empirical and clinical criteria for 
minimal packaging for a specific list of procedures and services in 
order to assign packaged costs to other procedures on a claim and is 
discussed at length in section II.A.1. of this proposed rule. 
Generally, changing the status of diagnostic radiopharmaceuticals to 
packaged increases packaging on each claim. This could make it both 
harder for nuclear medicine procedures to qualify for the bypass list 
and more difficult to assign packaging to individual diagnostic nuclear 
medicine procedures, resulting in a possible reduction of the number of 
``pseudo'' singles that are produced by the bypass process. 
Notwithstanding this potentiality, diagnostic nuclear medicine 
procedures continue to have good representation in the single bills. On 
average, single bills as a percent of total occurrences remains 
substantial at 55 percent for individual procedures. We discuss our 
process for ratesetting, including the construction and use of single 
and multiple bills, in greater detail in section II.A.1. of this 
proposed rule.
    We believe our CY 2006 claims data support our CY 2008 proposal to 
package payment for all diagnostic radiopharmaceuticals and lead to 
proposed payment rates for diagnostic nuclear medicine procedures that 
appropriately reflect payment for the costs of the diagnostic 
radiopharmaceuticals that are administered to carry out those 
diagnostic nuclear medicine procedures. Among the top 20 high volume

[[Page 42670]]

diagnostic nuclear medicine procedures, at least 84 percent of the 
single bills for almost every diagnostic nuclear medicine procedure 
included a diagnostic radiopharmaceutical HCPCS code. While a 
diagnostic radiopharmaceutical, by definition, would be anticipated to 
accompany 100 percent of the diagnostic nuclear medicine procedures, it 
is not unexpected that while percentages in our claims data are high, 
they are less than 100 percent. As noted previously, we have heard 
anecdotal reports that some hospitals may include the charges for 
diagnostic radiopharmaceuticals in their charge for the diagnostic 
nuclear medicine procedure or on an uncoded revenue code line, rather 
than reporting a HCPCS code for the diagnostic radiopharmaceutical. 
Thus, it is likely that the frequency of diagnostic radiopharmaceutical 
costs reflected in our claims data are even higher than the percentages 
indicate. Furthermore, we note that the OPPS ratesetting methodology is 
based on medians, which are less sensitive to extremes than means and 
typically do not reflect subtle changes in cost distributions. 
Therefore, to the extent that the vast majority of single bills for a 
particular diagnostic nuclear medicine procedure include a diagnostic 
radiopharmaceutical HCPCS code, the fact that the percentage is 
somewhat less than 100 percent is likely to have minimal impact on the 
median cost of the procedure in most cases. Even in those few instances 
where we have a low total number of single bills, largely because of 
low overall volume, we have ample representation of diagnostic 
radiopharmaceutical HCPCS codes on the single bills for the majority of 
lower volume nuclear medicine procedures. We also continue to have 
reasonable representation of single bills out of total claims in 
general. Finally, as noted previously, to the extent that the 
diagnostic radiopharmaceuticals commonly used with a particular 
diagnostic nuclear medicine procedure are already packaged, the 
proposal to package additional diagnostic radiopharmaceuticals would 
have little impact on the payment for these procedures.
    We have calculated the median costs on which we are proposing to 
base the CY 2008 payment rates using the packaging status of each 
diagnostic radiopharmaceutical HCPCS code as provided in Table 17 
below. As we discussed earlier in more detail, this has the effect of 
both changing the median cost for the independent service (the 
diagnostic nuclear medicine procedure) into which the cost of the 
dependent service (the diagnostic radiopharmaceutical) is packaged and 
also of redistributing payment that would otherwise have been made 
separately for the service we are proposing to newly package for CY 
2008.
    For example, HCPCS code A9552 (Fluorodeoxyglucose F-18 FDG, 
Diagnostic, per study dose, up to 45 millicuries) that describes the 
diagnostic radiopharmaceutical commonly called FDG is frequently billed 
with CPT code 78815 (Tumor imaging, positron emission tomography (PET) 
with concurrently acquired computed tomography (CT) for attenuation 
correction and anatomical localization; skull base to mid-thigh). HCPCS 
code A9552 is assigned to APC 1651 (F18 fdg) for CY 2007. HCPCS code 
A9552 was billed with CPT code 78815 101,242 times in the single bills 
available for this CY 2008 proposed rule, and 97 percent of the single 
bills for CPT code 78815 also reported HCPCS code A9552. Under our 
proposed policy for CY 2008, we are proposing to package payment for 
HCPCS code A9552 into the payment for separately payable procedures 
that are provided in conjunction with HCPCS code A9552. In this 
example, HCPCS code A9552 would receive packaged payment through the 
separate OPPS payment for CPT code 78815. CPT code 78815 is assigned to 
APC 1511 (New Technology--Level XI ($900-$1000)) for CY 2007 with a CY 
2007 median cost for PET/CT procedures of $850.36 and to APC 0308 (Non-
Myocardial Positron Emission Tomography (PET) Imaging) for CY 2008 with 
a proposed CY 2008 APC median cost of $1,093.52.
    The proposed CY 2008 payment rates associated with this example are 
outlined in Table 16 below. The table indicates that the proposed CY 
2008 payment rate for the skull base to mid-thigh PET/CT scan would be 
substantially higher than the CY 2007 payment amount for that code. The 
proposed increase for the PET/CT scan is slightly more than the 
estimated average CY 2007 payment for the separately payable FDG (paid 
in CY 2007 at charges reduced to cost).
    This example cannot demonstrate the overall impact of packaging 
diagnostic radiopharmaceuticals on payment to any given hospital 
because each individual hospital's case mix and billing patterns would 
be different. The overall impact of packaging diagnostic 
radiopharmaceuticals, as well as all other packaging changes proposed 
for CY 2008, can only be assessed in the aggregate for each hospital. 
Section XXII.B. of this proposed rule displays the overall impact of 
APC weight recalibration and packaging changes that we are proposing by 
classes of hospitals, and the OPPS Hospital-Specific Impacts--Provider-
Specific Data file presents our estimates of CY 2008 hospital payment 
for those hospitals we include in our ratesetting and payment 
simulation database. The hospital-specific impacts file can be found on 
the CMS Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/ under 
supporting documentation for this proposed rule.

Table 16.--Example of the Effects of the CY 2008 Packaging Proposal on Payment for HCPCS Code A9552 and CPT Code
                                                      78815
----------------------------------------------------------------------------------------------------------------
                                                                                  Sum of CY 2007
                                                                                  payment (A9552  Sum of CY 2008
                HCPCS code                            Short descriptor                 paid          proposed
                                                                                   separately at  payment (A9552
                                                                                       cost)         packaged)
----------------------------------------------------------------------------------------------------------------
A9552.....................................  F18 fdg (dependent service).........        *$279.29            0.00
78815.....................................  Tumor image pet/ct skul-thigh                 950.00        1,107.22
                                             (independent service).
                                                                                 -------------------------------
    Total Payment...............................................................        1,229.29       1,107.22
----------------------------------------------------------------------------------------------------------------
*Estimated average CY 2007 payment at charges reduced to cost.


[[Page 42671]]

    The estimated overall impact of these changes that we are proposing 
for CY 2008 is based on the assumption that hospital behavior would not 
change with regard to when the dependent diagnostic 
radiopharmaceuticals are provided by the same hospital that performs 
the independent services. In order to provide diagnostic nuclear 
medicine procedures under this proposal, hospitals would either need to 
administer the necessary diagnostic radiopharmaceuticals themselves or 
refer patients elsewhere for the administration of the diagnostic 
radiopharmaceuticals. In the latter case, claims data would show such a 
change in practice in future years and that change would be reflected 
in future ratesetting. However, with respect to diagnostic 
radiopharmaceuticals, we believe that hospitals are limited in the 
extent to which they could change their behavior with regard to how 
they furnish these items because diagnostic radiopharmaceuticals are 
typically provided on the same day as a diagnostic nuclear medicine 
procedure. It would be difficult for Hospital A to send patients to 
receive diagnostic radiopharmaceuticals from Hospital B and then have 
the patients return to Hospital A for the diagnostic nuclear medicine 
procedure in the appropriate timeframe (given the radiopharmaceutical's 
half life) to perform a high quality study. We would expect that 
hospitals would always bill the diagnostic radiopharmaceutical on the 
same claim as the other independent services for which the 
radiopharmaceutical was administered.
    As we indicate above, in all cases, we are proposing that hospitals 
that furnish diagnostic radiopharmaceuticals in association with 
diagnostic nuclear medicine procedures bill both the item and the 
procedure on the same claim so that the costs of the diagnostic 
radiopharmaceuticals can be appropriately packaged into payment for the 
diagnostic nuclear medicine procedure. We expect to carefully monitor 
any changes in billing practices on a service-specific and hospital-
specific basis to determine whether there is reason to request that 
QIOs review the quality of care furnished or to request that Program 
Safeguard Contractors review the claims against the medical record.

         Table 17.--Diagnostic Radiopharmaceutical HCPCS Codes Proposed for Packaged Payment in CY 2008
----------------------------------------------------------------------------------------------------------------
       HCPCS code           Short descriptor            CY 2007 SI          CY 2007 APC    CY 2008  proposed SI
----------------------------------------------------------------------------------------------------------------
A4641..................  Radiopharm dx agent     N......................             n/a  N
                          noc.
A4642..................  In111 satumomab.......  H......................            0704  N
A9500..................  Tc99m sestamibi.......  H......................            1600  N
A9502..................  Tc99m tetrofosmin.....  H......................            0705  N
A9503..................  Tc99m medronate.......  N......................             n/a  N*
A9504..................  Tc99m apcitide........  N......................             n/a  N*
A9505..................  TL201 thallium........  H......................            1603  N
A9507..................  In111 capromab........  H......................            1604  N
A9508..................  I131 iodobenguate, dx.  H......................            1045  N
A9510..................  Tc99m disofenin.......  N......................             n/a  N*
A9512..................  Tc99m pertechnetate...  N......................             n/a  N*
A9516..................  I123 iodide cap, dx...  H......................            9148  N
A9521..................  Tc99m exametazime.....  H......................            1096  N
A9524..................  I131 serum albumin, dx  H......................            9100  N
A9526..................  Nitrogen N-13 ammonia.  H......................            0737  N
A9528..................  Iodine I-131 iodide     H......................            1088  N
                          cap, dx.
A9529..................  I131 iodide sol, dx...  N......................             n/a  N
A9531..................  I131 max 100uCi.......  N......................             n/a  N*
A9532..................  I125 serum albumin, dx  N......................             n/a  N
A9536..................  Tc99m depreotide......  H......................            0739  N
A9537..................  Tc99m mebrofenin......  N......................             n/a  N*
A9538..................  Tc99m pyrophosphate...  N......................             n/a  N*
A9539..................  Tc99m pentetate.......  H......................            0722  N*
A9540..................  Tc99m MAA.............  N......................             n/a  N*
A9541..................  Tc99m sulfur colloid..  N......................             n/a  N*
A9542..................  In111 ibritumomab, dx.  H......................            1642  N
A9544..................  I131 tositumomab, dx..  H......................            1644  N
A9546..................  Co57/58...............  H......................            0723  N
A9547..................  In111 oxyquinoline....  H......................            1646  N
A9548..................  In111 pentetate.......  H......................            1647  N
A9550..................  Tc99m gluceptate......  H......................            0740  N
A9551..................  Tc99m succimer........  H......................            1650  N
A9552..................  F18 fdg...............  H......................            1651  N
A9553..................  Cr51 chromate.........  H......................            0741  N
A9554..................  I125 iothalamate, dx..  N......................             n/a  N
A9555..................  Rb82 rubidium.........  H......................            1654  N
A9556..................  Ga67 gallium..........  H......................            1671  N
A9557..................  Tc99m bicisate........  H......................            1672  N
A9558..................  Xe133 xenon 10mci.....  N......................             n/a  N*
A9559..................  Co57 cyano............  H......................            0724  N
A9560..................  Tc99m labeled rbc.....  H......................            0742  N
A9561..................  Tc99m oxidronate......  N......................             n/a  N*
A9562..................  Tc99m mertiatide......  H......................            0743  N
A9565..................  In111 pentetreotide...  H......................            1677  N
A9566..................  Tc99m fanolesomab.....  H......................            1678  N
A9567..................  Technetium TC-99m       H......................            0829  N*
                          aerosol.

[[Page 42672]]

 
A9568..................  Tc99m arcitumomab.....  H......................            1648  N
----------------------------------------------------------------------------------------------------------------
* Indicates that the radiopharmaceutical would have been packaged under the $60 packaging threshold methodology
  in CY 2008, even in the absence of the broader packaging proposal for radiopharmaceuticals.

(6) Contrast Agents
    For CY 2008, we are proposing to package payment for all contrast 
media into their associated independent diagnostic and therapeutic 
procedures as part of our proposed packaging approach for the CY 2008 
OPPS. As noted in section II.A.4.c. of this proposed rule, packaging 
the costs of supportive items and services into the payment for the 
independent procedure or service with which they are associated 
encourages hospital efficiencies and also enables hospitals to manage 
their resources with maximum flexibility. We believe that contrast 
agents are particularly well suited for packaging because they are 
always provided in support of an independent diagnostic or therapeutic 
procedure that involves imaging, and thus payment for contrast agents 
can be packaged into the payment for the associated separately payable 
procedures.
    Contrast agents are generally considered to be those substances 
introduced into or around a structure that, because of the differential 
absorption of x-rays, alteration of magnetic fields, or other effects 
of the contrast medium in comparison with surrounding tissues, permit 
visualization of the structure through an imaging modality. The use of 
certain contrast agents is generally associated with specific imaging 
modalities, including x-ray, computed tomography (CT), ultrasound, and 
magnetic resonance imaging (MRI), for purposes of diagnostic testing or 
treatment. They are most commonly administered through an oral or 
intravascular route in association with the performance of the 
independent procedures involving imaging that are the basis for their 
administration. Even in the absence of this proposal to package payment 
for all contrast agents, we would propose to package the majority of 
HCPCS codes for contrast agents recognized under the OPPS in CY 2008. 
We consider contrast agents to be drugs under the OPPS, and as a result 
they are packaged if their estimated mean per day cost is equal to or 
less than $60 for CY 2008. (For more discussion of our drug packaging 
criteria, we refer readers to section V.B.2 of this proposed rule.) 
Seventy-five percent of contrast agents HCPCS codes have an estimated 
mean per day cost equal to or less than $60 based on our CY 2006 claims 
data.
    Contrast agents are described by those Level II HCPCS codes in the 
range from Q9945 through Q9964. There currently are no HCPCS C-codes or 
other Level II HCPCS codes outside the range specified above used to 
report contrast agents under the OPPS. As shown in Table 19, in CY 
2007, we packaged 7 out of 20 of these contrast agent HCPCS codes based 
on the $55 packaging threshold. For CY 2008, we are proposing to 
package all drugs with a per day mean cost of $60 or less. For CY 2008, 
the vast majority of contrast agents would be packaged under the 
traditional OPPS packaging methodology using the $60 packaging 
threshold, based on the CY 2006 claims data available for this proposed 
rule. In fact, of the 20 contrast agent HCPCS codes we are including in 
our proposed packaging approach, 15 would have been proposed to be 
packaged for CY 2008 under our drug packaging methodology. These 15 
codes represent 94 percent of all occurrences of contrast agents billed 
under the OPPS. We believe that this shift in the packaging status for 
several of these agents between CYs 2007 and 2008 may be because, in CY 
2007, a number of the contrast agents exceeded the $55 threshold by 
only a small amount and, based on our latest claims data for CY 2008, a 
number of these products have now fallen below the proposed $60 
threshold. Given that the vast majority of contrast agents billed would 
already be packaged under the OPPS in CY 2008, we believe it would be 
desirable to package payment for the remaining contrast agents as it 
promotes efficiency and results in a consistent payment policy across 
products that may be used in many of the same independent procedures. 
We also note that the significant costs associated with these 15 
contrast agents would already be reflected in the proposed median costs 
for those independent procedures and, if we were to pay for the 5 
remaining agents separately, we would be treating these 5 agents 
differently than the others. If the 5 agents remained separately 
payable, there would effectively be two payments for contrast agents 
when these 5 agents were billed--a separate payment and a payment for 
packaged contrast agents that was part of the procedure payment. This 
could potentially provide a payment incentive to administer certain 
contrast agents that might not be the most clinically appropriate or 
cost effective. Moreover, as noted previously, contrast agents are 
always provided with independent procedures and, under a consistent 
approach to packaging in keeping with our enhanced efforts to encourage 
hospital efficiency and promote value-based purchasing under the OPPS, 
their payment would be appropriately packaged for CY 2008.
    We have calculated the median costs on which the proposed CY 2008 
payment rates are based using the packaging status of each contrast 
agent HCPCS code as provided in Table 19 below. As we discussed earlier 
in more detail, this has the effect of both changing the median cost 
for the independent service (the diagnostic or therapeutic procedure 
requiring imaging) into which the cost of the dependent service (the 
contrast agent) is packaged and also of redistributing payment that 
would otherwise have been made separately for the service we are 
proposing to newly package for CY 2008.
    For example, HCPCS code Q9947 (Low osmolar contrast material, 200-
249 mg/ml iodine concentration, per ml) is one of the contrast agents 
that we are proposing to package that would not otherwise be packaged 
in CY 2008 under the proposed $60 packaging threshold. HCPCS code Q9947 
is sometimes billed with CPT code 71260 (Computed tomography, thorax; 
with contrast material(s)). HCPCS code Q9947 is assigned to APC 9159 
(LOCM 200-249 mg/ml iodine, 1ml) for CY 2007. HCPCS code Q9947 was 
billed with CPT code 71260 8,172 times in the single bills available 
for this CY 2008 proposed rule, and 2 percent of the single bills for 
CPT code 71260 also reported HCPCS code Q9947. Under our proposed 
policy for CY 2008, we are proposing to package payment for

[[Page 42673]]

HCPCS code Q9947 into the payment for separately payable procedures 
that are provided in conjunction with the contrast agent. Specifically, 
we would package payment for HCPCS code Q9947 so that, in this example, 
HCPCS code Q9947 would receive packaged payment through the separate 
OPPS payment for CPT code 71260. CPT code 71260 is assigned to APC 0283 
(Computed Tomography with Contrast) for CY 2007 with a CY 2007 median 
cost of $249.48. The procedure is assigned to APC 0283, with a proposed 
APC name change to ``Level I Computed Tomography with Contrast'' for CY 
2008 and a proposed CY 2008 median cost of $286.13.
    The proposed CY 2008 payment rates associated with this example are 
outlined in Table 18 below. The table indicates that the CY 2008 
payment that we are proposing for CPT code 71260 is higher than the CY 
2007 payment amount for that code. The proposed increase in the payment 
rate for CPT code 71260 in CY 2008 is slightly greater than the 
estimated CY 2007 payment for the separately payable HCPCS code Q9947. 
Notably, a number of low osmolar contrast agents other than HCPCS code 
Q9947 that were separately paid in CY 2007 also are proposed for 
packaged payment in CY 2008 because their mean per day cost falls below 
the $60 packaging threshold for drugs, biologicals, and 
radiopharmaceuticals for CY 2008. Packaging the costs of these contrast 
media also affects the proposed payment rate for CPT code 71260. For 
another example of packaging contrast agents, we refer readers to the 
example included in Table 13 of section II.A.4.c.(4) of this proposed 
rule on packaging imaging supervision and interpretation services. That 
example illustrates the effect of packaging both a supervision and 
interpretation service (CPT code 72265 (Myelography, lumbosacral, 
radiological supervision and interpretation)) and a contrast agent 
(HCPCS code Q9947 (low osmolar contrast material, 200-249 mg/ml iodine, 
per ml)) into the payment for an imaging procedure (CPT code 72132 
(Computed tomography, lumbar spine; with contrast material)).
    This example cannot demonstrate the overall impact of packaging 
contrast agents on any given hospital because each individual 
hospital's case mix and billing pattern differs. The overall impact of 
packaging contrast agents, as well as all the other proposed packaging 
changes, can only be assessed in the aggregate for classes of 
hospitals. Section XXII.B. of this proposed rule displays the overall 
impact of APC weight recalibration and packaging changes we are 
proposing by classes of hospitals, and the OPPS Hospital-Specific 
Impacts--Provider-Specific Data file presents our estimates of CY 2008 
hospital payment for those hospitals we include in our ratesetting and 
payment simulation database. The hospital-specific impact file can be 
found on the CMS Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/ under supporting documentation for this proposed 
rule.

Table 18.--Example of the Effects of the CY 2008 Packaging Proposal on Payment for CPT Code 72160 and HCPCS Code
                                                      Q9947
----------------------------------------------------------------------------------------------------------------
                                                                                  Sum of CY 2007  Sum of CY 2008
                                                                                  payment (Q9947     proposed
                HCPCS code                            Short descriptor                 paid       payment (Q9947
                                                                                    separately)      packaged)
----------------------------------------------------------------------------------------------------------------
Q9947.....................................  LOCM 200-249 mg/ml iodine, 1 ml              *$64.24           $0.00
                                             (dependent service).
71260.....................................  Ct thorax w/dye (independent                  250.94          289.71
                                             service).
                                                                                 -------------------------------
    Total Payment...............................................................          315.18         289.71
----------------------------------------------------------------------------------------------------------------
*Based on the mean number of units per day from our CY 2008 proposed rule data (48.3) and the April 2007 per
  unit payment rate for Q9947 ($1.33).

    The estimated overall impact of these changes that we are proposing 
for CY 2008 is based on the assumption that hospital behavior would not 
change with regard to when the contrast agents are provided by the same 
hospital that performs the imaging procedure. Under this proposal, in 
order to provide imaging procedures requiring contrast agents, 
hospitals would either need to administer the necessary contrast agent 
themselves or refer patients elsewhere for the administration of the 
contrast agent. In the latter case, claims data would show such a 
change in practice in future years and that change would be reflected 
in future ratesetting. However, with respect to contrast agents, we 
believe that hospitals are limited in the extent to which they could 
change their behavior with regard to how they furnish these services 
because contrast agents are typically provided on the same day 
immediately prior to an imaging procedure being performed. We would 
expect that hospitals would always bill the contrast agent on the same 
claim as the other independent services for which the contrast agent 
was administered.
    As we indicated earlier, in all cases we are proposing that 
hospitals that furnish the supportive contrast agent in association 
with independent procedures involving imaging must bill both services 
on the same claim so that the cost of the contrast agent can be 
appropriately packaged into payment for the significant independent 
procedure. We expect to carefully monitor any changes in billing 
practices on a service-specific and hospital specific basis to 
determine whether there is reason to request that QIOs review the 
quality of care furnished or to request that Program Safeguard 
Contractors review the claims against the medical record.

                 Table 19.--Contrast Media HCPCS Codes Proposed for Packaged Payment in CY 2008
----------------------------------------------------------------------------------------------------------------
       HCPCS code           Short descriptor            CY 2007 SI          CY 2007 APC     Proposed CY 2008 SI
----------------------------------------------------------------------------------------------------------------
Q9945..................  LOCM <=149 mg/ml        K......................            9157  N*
                          iodine, 1 ml.
Q9946..................  LOCM 150-199 mg/ml      K......................            9158  N*
                          iodine, 1 ml.
Q9947..................  LOCM 200-249 mg/ml      K......................            9159  N
                          iodine, 1 ml.

[[Page 42674]]

 
Q9948..................  LOCM 250-299 mg/ml      K......................            9160  N*
                          iodine, 1 ml.
Q9949..................  LOCM 300-349 mg/ml      K......................            9161  N*
                          iodine, 1 ml.
Q9950..................  LOCM 350-399 mg/ml      K......................            9162  N*
                          iodine, 1 ml.
Q9951..................  LOCM >= 400 mg/ml       K......................            9163  N*
                          iodine, 1 ml.
Q9952..................  Inj Gad-base MR         K......................            9164  N*
                          contrast, 1 ml.
Q9953..................  Inj Fe-based MR         K......................            1713  N
                          contrast, 1 ml.
Q9954..................  Oral MR contrast, 100   K......................            9165  N*
                          ml.
Q9955..................  Inj perflexane lip      K......................            9203  N*
                          micros, ml.
Q9956..................  Inj octafluoropropane   K......................            9202  N
                          mic, ml.
Q9957..................  Inj perflutren lip      K......................            9112  N
                          micros, ml.
Q9958..................  HOCM <=149 mg/ml        N......................             n/a  N*
                          iodine, 1 ml.
Q9959..................  HOCM 150-199 mg/ml      N......................             n/a  N
                          iodine, 1 ml.
Q9960..................  HOCM 200-249 mg/ml      N......................             n/a  N*
                          iodine, 1 ml.
Q9961..................  HOCM 250-299 mg/ml      N......................             n/a  N*
                          iodine, 1 ml.
Q9962..................  HOCM 300-349 mg/ml      N......................             n/a  N*
                          iodine, 1 ml.
Q9963..................  HOCM 350-399 mg/ml      N......................             n/a  N*
                          iodine, 1 ml.
Q9964..................  HOCM>= 400 mg/ml        N......................             n/a  N*
                          iodine, 1 ml.
----------------------------------------------------------------------------------------------------------------
*Indicates that the contrast agent would have been packaged under the $60 packaging threshold methodology in CY
  2008, even in the absence the broader packaging proposal for contrast agents.

(7) Observation Services
    We are proposing to package payment for all observation care, 
reported under HCPCS code G0378 (Hospital observation services, per 
hour) for CY 2008. Payment for observation would be packaged as part of 
the payment for the separately payable services with which it is 
billed. We have defined observation care as a well-defined set of 
specific, clinically appropriate services that include ongoing short-
term treatment, assessment, and reassessment before a decision can be 
made regarding whether patients will require further treatment as 
hospital inpatients or if they are able to be discharged from the 
hospital. Observation status is commonly assigned to patients who 
present to the emergency department and who then require a significant 
period of treatment or monitoring before a decision is made concerning 
their next placement or to patients with unexpectedly prolonged 
recovery after surgery. Throughout this proposed rule, as well as in 
our manuals and guidance documents, we use both of the terms 
``observation services'' and ``observation care'' in reference to the 
services defined above.
    Payment for all observation care under the OPPS was packaged prior 
to CY 2002. Since CY 2002, separate payment of a single unit of an 
observation APC for an episode of observation care has been provided in 
limited circumstances. Effective for services furnished on or after 
April 1, 2002, separate payment for observation was made if the 
beneficiary had chest pain, asthma, or congestive heart failure and met 
additional criteria for diagnostic testing, minimum and maximum limits 
to observation care time, physician care, and documentation in the 
medical record (66 FR 59856, 59879). Payment for observation care that 
did not meet these specified criteria was packaged. Between CY 2003 and 
CY 2006, several more changes were made to the OPPS policy regarding 
separate payment for observation services, such as: Clarification that 
observation is not separately payable when billed with ``T'' status 
procedures on the day of or day before observation care; development of 
specific Level II HCPCS codes for hospital observation services and 
direct admission to observation care; and removal of the initially 
established diagnostic testing requirements for separately payable 
observation (67 FR 66794, 69 FR 65828, and 70 FR 68688). Throughout 
this time period, we maintained separate payment for observation care 
only for the three specified medical conditions, and OPPS payment for 
observation for all other clinical conditions remained packaged.
    Since January 1, 2006, hospitals have reported observation services 
based on an hourly unit of care using HCPCS code G0378. This code has a 
status indicator of ``Q'' under the CY 2007 OPPS, meaning that the OPPS 
claims processing logic determines whether the observation is packaged 
or separately payable. The OCE's current logic determines whether 
observation services billed under HCPCS code G0378 are separately 
payable through APC 0339 (Observation) or whether payment for 
observation services will be packaged into the payment for other 
separately payable services provided by the hospital in the same 
encounter based on criteria discussed subsequently. (We note that if an 
HOPD directly admits a patient to observation, Medicare currently pays 
separately for that direct admission reported under HCPCS code G0379 
(Direct admission of patient for hospital observation care) in 
situations where payment for the actual observation care reported under 
HCPCS code G0378 is packaged.) For CY 2008, as discussed in more detail 
later in this proposed rule (section XI.), we are proposing to continue 
the coding and payment methodology for direct admission to observation 
status, with the exception of the requirement that HCPCS code G0379 is 
only eligible for separate payment if observation care reported under 
HCPCS code G0378 does not qualify for separate payment. This 
requirement would no longer be applicable under our proposal to package 
all observation services reported under HCPCS code G0378.
    Currently, separate OPPS payment may be made for observation 
services reported under HCPCS code G0378 provided to a patient when all 
of the following requirements are met. The hospital would receive a 
single separate payment for an episode of observation care (APC 0339) 
when:
1. Diagnosis Requirements
    a. The beneficiary must have one of three medical conditions: 
congestive heart failure, chest pain, or asthma.
    b. Qualifying ICD-9-CM diagnosis codes must be reported in Form 
Locator (FL) 76, Patient Reason for Visit, or FL 67, principal 
diagnosis, or both in order for the hospital to receive separate 
payment for APC 0339. If a qualifying ICD-9-CM diagnosis code(s) is 
reported in the secondary diagnosis field, but is

[[Page 42675]]

not reported in either the Patient Reason for Visit field (FL 76) or in 
the principal diagnosis field (FL 67), separate payment for APC 0339 is 
not allowed.
2. Observation Time
    a. Observation time must be documented in the medical record.
    b. A beneficiary's time in observation (and hospital billing) 
begins with the beneficiary's admission to an observation bed.
    c. A beneficiary's time in observation (and hospital billing) ends 
when all clinical or medical interventions have been completed, 
including followup care furnished by hospital staff and physicians that 
may take place after a physician has ordered the patient be released or 
admitted as an inpatient.
    d. The number of units reported with HCPCS code G0378 must equal or 
exceed 8 hours.
3. Additional Hospital Services
    a. The claim for observation services must include one of the 
following services in addition to the reported observation services. 
The additional services listed below must have a line-item date of 
service on the same day or the day before the date reported for 
observation:
    <bullet> An emergency department visit (APC 0609, 0613, 0614, 0615, 
or 0616); or
    <bullet> A clinic visit (APC 0604, 0605, 0606, 0607, or 0608); or
    <bullet> Critical care (APC 0617); or
    <bullet> Direct admission to observation reported with HCPCS code 
G0379 (APC 0604).
    b. No procedure with a ``T'' status indicator can be reported on 
the same day or day before observation care is provided.
4. Physician Evaluation
    a. The beneficiary must be in the care of a physician during the 
period of observation, as documented in the medical record by 
admission, discharge, and other appropriate progress notes that are 
timed, written, and signed by the physician.
    b. The medical record must include documentation that the physician 
explicitly assessed patient risk to determine that the beneficiary 
would benefit from observation care.
    In the context of our proposed CY 2008 packaging approach, for 
several reasons we believe that it is appropriate to package payment 
for all observation services reported with HCPCS code G0378 under the 
CY 2008 OPPS. Primarily, observation services are ideal for packaging 
because they are always provided as a supportive service in conjunction 
with other independent separately payable hospital outpatient services 
such as an emergency department visit, surgical procedure, or another 
separately payable service, and thus observation costs can logically be 
packaged into OPPS payment for independent services. As discussed 
extensively earlier in this section, packaging payment into larger 
payment bundles creates incentives for providers to furnish services in 
the most efficient way that meets the needs of the patient, encouraging 
long-term cost containment.
    As we discussed in the general overview of the CY 2008 packaging 
approach earlier in this section (section II.A.4.b. of this proposed 
rule), there has been substantial growth in program expenditures for 
hospital outpatient services under the OPPS in recent years. The 
primary reason for this upsurge is growth in the intensity and 
utilization of services rather than the general price of services or 
enrollment changes. This observed trend is notably reflected in the 
frequency and costs of separately payable observation care for the last 
few years. While median costs for an episode of observation care that 
would meet the criteria for separate payment have remained relatively 
stable between CY 2003 and CY 2006, the frequency of claims for 
separately payable observation services has rapidly increased. 
Comparing claims data for separately payable observation care available 
for proposed rules spanning from CY 2005 to CY 2008 (that is, claims 
data reflecting services furnished from CY 2003 to CY 2006), we see 
substantial growth in separately payable observation care billed under 
the OPPS over that time. In CY 2003, the full first year when 
observation care was separately payable, there were approximately 
56,000 claims for separately payable observation care. In CY 2004, 
there were approximately 77,000 claims for separately payable 
observation care. In CY 2005, that number increased to approximately 
124,300 claims, representing about a 61 percent increase in one year. 
In addition, in the CY 2006 data available for this proposed rule, the 
frequency of claims for separately payable observation services 
increased again, to more than 271,200 claims, about a 118-percent 
increase over CY 2005 and more than triple the number of claims from 2 
years earlier. While it is not possible to discern the specific factors 
responsible for the growth in claims for separately payable observation 
services, as there have been minor changes in both the process and 
criteria for separate payment for these services over this time period, 
the substantial growth by itself is noteworthy.
    We are also concerned that the current criteria for separate 
payment for observation services may provide disincentives for 
efficiency. In order for observation services to be separately payable, 
they must last at least 8 hours. While this criterion was put in place 
to ensure that separate payment is made only for observation services 
of a substantial duration, it may create a financial disincentive for 
an HOPD to make a timely determination regarding a patient's safe 
disposition after observation care ends. By packaging payment for all 
observation services, regardless of their duration, we would provide 
incentives for more efficient delivery of services and timely decision-
making. The current criterion also prohibits separate payment for 
observation services when a ``T'' status procedure (generally a 
surgical procedure) is provided on the same day or the previous day by 
the HOPD to the same Medicare beneficiary. Again, this may create a 
financial disincentive for hospitals to provide minor surgical 
procedures during a patient's observation stay, unless those procedures 
are essential to the patient's care during that time period, even if 
the most efficient and effective performance of those procedures could 
be during the single HOPD encounter.
    Currently, the OPPS pays separately for observation care for only 
the three original medical conditions designated in CY 2002, 
specifically chest pain, asthma, and congestive heart failure. As 
discussed in more detail in the observation section (section XI.) of 
this proposed rule, the APC Panel recommended at its March 2007 meeting 
that we consider expanding separate payment for observation services to 
include two additional diagnoses, syncope and dehydration. As mentioned 
previously, we have defined observation care as a well-defined set of 
specific, clinically appropriate services, which include ongoing, 
short-term treatment, assessment, and reassessment, that are furnished 
while a decision is being made regarding whether a patient will require 
further treatment as a hospital inpatient or if the individual is able 
to be discharged from the hospital. Given the definition of observation 
services, it is clear that, in certain circumstances, observation care 
could be appropriate for patients with a range of diagnoses. Both the 
APC Panel and numerous commenters to prior OPPS proposed rules have 
confirmed their agreement with this perspective. In addition, the June 
2006

[[Page 42676]]

Institute of Medicine (IOM) Report entitled, ``Hospital-Based Emergency 
Care: At the Breaking Point,'' encourages hospitals to apply tools to 
improve the flow of patients through emergency departments, including 
developing clinical decisions units where observation care is provided. 
The IOM's Committee on the Future of Emergency Care in the United 
States Health System recommended that CMS remove the current 
limitations on the medical conditions that are eligible for separate 
observation care payment in order to encourage the development of such 
observation units.
    As packaging payment provides desirable incentives for greater 
efficiency in the delivery of health care and provides hospitals with 
significant flexibility to manage their resources, we believe it is 
most appropriate to treat observation care for all diagnoses similarly 
by packaging its costs into payment for the separately payable 
independent services with which the observation is associated. This 
consistent payment methodology would provide hospitals with the 
flexibility to assess their approaches to patient care and patient flow 
and provide observation care for patients with a variety of clinical 
conditions when hospitals conclude that observation services would 
improve their treatment of those patients. Approximately 70 percent of 
the occurrences of observation care billed under the OPPS are currently 
packaged, and this proposal would extend the incentives for efficiency 
already present for the vast majority of observation services that are 
already packaged under the OPPS to the remaining 30 percent of 
observation services for which we currently make separate payment.
    We have calculated the median costs on which the proposed CY 2008 
payment rates are based according to our proposed packaging approach 
under which payment for HCPCS code G0378 would always be packaged 
(status indicator ``N''). As we discussed previously in more detail, in 
this section, this has the effect of both changing the median costs for 
the independent services into which the costs of the dependent and 
supportive observation services are packaged and also of redistributing 
payment that would otherwise have been made separately for the 
observation services we are proposing to newly package for CY 2008.
    For example, separately payable observation care is frequently 
billed with CPT code 99285 (Emergency department visit for the 
evaluation and management of a patient (Level 5)). In the CY 2008 OPPS 
proposed rule claims data, CPT code 99285 was billed 157,668 times on 
claims with HCPCS code G0378 that meet our current criteria for 
separate payment for observation care. In addition, about 57 percent of 
the claims for HCPCS code G0378 that meet our current criteria for 
separate payment also reported CPT code 99285. Under our proposed 
policy for CY 2008, we are proposing to package payment for HCPCS code 
G0378 into the payment for separately payable procedures that are 
provided in conjunction with HCPCS code G0378. Specifically, we would 
package payment for HCPCS code G0378 when it is provided with a 
separately paid service such as CPT code 99285, so that in this example 
observation would receive packaged payment through the separate OPPS 
payment for the Level 5 emergency department visit. CPT code 99285 is 
assigned to APC 0616 (Level 5 Emergency Visits), with a CY 2007 APC 
median cost of $323.36 and a proposed CY 2008 median cost of $344.50. 
The CY 2007 median cost of APC 0339 for separately payable observation 
is $440.22.
    The proposed CY 2008 payment rates associated with this example are 
outlined in Table 20 below. The table indicates that the proposed CY 
2008 payment for a Level 5 emergency department visit is higher than 
the CY 2007 payment amount for that code. However, the proposed 
increase in the Level 5 emergency department visit payment rate for CY 
2008 is significantly less than the CY 2007 payment for separately 
payable observation. This is due to the fact that, although observation 
services are commonly billed with a Level 5 emergency department visit, 
the proportion of all Level 5 emergency department visits that include 
observation (12 percent) is relatively small. Thus, when observation 
care that would have met the CY 2007 criteria for separate payment is 
packaged into payment for separately payable services such as a Level 5 
emergency department visit, it raises the payment rate for that 
separately payable service for all occurrences of the service, even 
those occurrences where observation care is not provided. As a result, 
the payment rate for the separately payable service, the Level 5 
emergency department visit, does not increase by the full amount of the 
former payment rate for separately payable observation care as that 
amount is spread over many more occurrences of Level 5 emergency 
department visits. In addition, OPPS' use of medians leads relative 
weight estimates to be less sensitive to packaging decisions.

 Table 20.--Example of the Effects of the CY 2008 Packaging Proposal on Payment for Observation Care (HCPCS Code
                                            G0378) and CPT Code 99295
----------------------------------------------------------------------------------------------------------------
                                                                                  Sum of CY 2007  Sum of CY 2008
                                                                                   payment (some     proposed
                  HCPCS code                            Short descriptor            G0378 paid    payment (G0378
                                                                                    separately)      packaged)
----------------------------------------------------------------------------------------------------------------
G0378 (under criteria for separately paid       Hospital observation per hr              $442.81           $0.00
 observation care).                              (dependent service).
99285.........................................  Emergency dept visit                      325.26          348.81
                                                 (independent service).
                                                                                 -------------------------------
    Total Payment.............................  ................................          768.07          348.81
----------------------------------------------------------------------------------------------------------------

    This example cannot demonstrate the overall impact of packaging 
observation services on any given hospital because each individual 
hospital's case-mix and billing pattern would be different. The overall 
impact of packaging HCPCS code G0378, as well as all other packaging 
changes that we are proposing for CY 2008, can only be assessed in the 
aggregate for classes of hospitals. Section XXII.B. of this proposed 
rule displays the overall impact of APC weight recalibration and 
packaging changes that we are proposing by classes of hospitals, and 
the OPPS Hospital-Specific Impacts--Provider-Specific Data file 
presents our estimates of CY 2008 hospital payment

[[Page 42677]]

for those hospitals we include in our ratesetting and payment 
simulation database. The hospital-specific impact file can be found at 
http://www.cms.hhs.gov/HospitalOutpatientPPS/ under supporting 
documentation for this proposed rule.
    The estimated overall impact of these changes that we are proposing 
for CY 2008 presented in section XXII.B. of this proposed rule is based 
on the assumption that hospital behavior would not change with regard 
to when the dependent observation care is provided in the same 
encounter and by the same hospital that performs the independent 
services. To the extent that hospitals could change their behavior and 
cease providing observation services, refer patients elsewhere for that 
care, or increase the frequency of observation services, the data would 
show such a change in practice in future years and that change would be 
reflected in future budget neutrality adjustments. However, with 
respect to observation care, we believe that hospitals are limited in 
the extent to which they could change their behavior with regard to how 
they furnish these services because observation care, by definition, is 
short-term treatment, assessment, and reassessment before a decision 
can be made regarding whether patients will require further treatment 
as hospital inpatients or if they are able to be discharged from the 
hospital after receiving the independent services. We believe it is 
unlikely that hospitals would cease providing medically necessary 
observation care or refer patients elsewhere for that care if they were 
unable to reach a decision that the patient could be safely discharged 
from the outpatient department. We would expect that hospitals would 
always bill the supportive observation care on the same claim as the 
other independent services provided in the single hospital encounter.
    As we indicated earlier, in all cases we are proposing that 
hospitals that furnish the observation care in association with 
independent services must bill those services on the same claim so that 
the costs of the observation care can be appropriately packaged into 
payment for the independent services. We expect to carefully monitor 
any changes in billing practices on a service-specific and hospital-
specific basis to determine whether there is reason to request that 
QIOs review the quality of care furnished or to request that Program 
Safeguard Contractors review the claims against the medical record.
    In summary, we are proposing to package payment for all observation 
services reported with HCPCS code G0378 for CY 2008. Payment for 
observation services would be made as part of the payment for the 
separately payable independent services with which they are billed. As 
part of this proposal, we would change the status indicator for HCPCS 
code G0378 from ``Q'' to ``N.'' In addition, we would no longer require 
the current criteria for separate payment related to hospital visits 
and ``T'' status procedures, minimum number of hours, and qualifying 
diagnoses. However, we would retain as general reporting requirements 
those criteria related to physician evaluation, documentation, and 
observation beginning and ending time as listed in sections II.A.2.a., 
b., and c., and 4.a. and b. of this proposed rule. Those are more 
general requirements that encourage hospitals to provide medically 
reasonable and necessary care and help to ensure the proper reporting 
of observation services on correctly coded hospital claims that reflect 
the full charges associated with all hospital resources utilized to 
provide the reported services.
d. Proposed Development of Composite APCs
(1) Background
    As we discuss above in regard to our reasons for our proposed 
packaging approach for the CY 2008 OPPS, we believe that it is crucial 
that the payment approach of the OPPS create incentives for hospitals 
to seek ways to provide services more efficiently than exist under the 
current OPPS structure and allow hospitals maximum flexibility to 
manage their resources. The current OPPS structure usually provides 
payment for individual services which are generally defined by 
individual HCPCS codes. We currently package the costs of some items 
and services (such as drugs and biologicals with an average per day 
cost of less than $55) into the payment for separately payable 
individual services. However, because the extent of packaging in the 
OPPS is currently modest, furnishing many individual separately payable 
services increases total payment to the hospital. We believe that this 
aspect of the current OPPS structure is a significant factor in the 
growth in volume and spending that we discuss in our general overview 
and provides a primary rationale for our proposed packaging approach 
for services in the CY 2008 OPPS. While packaging payment for 
supportive dependent services into the payment for the independent 
services which they accompany promotes greater efficiency and gives 
hospitals some flexibility to manage their resources, we believe that 
payment for larger bundles of major separately paid services that are 
commonly performed in the same hospital outpatient encounter or as part 
of a multi-day episode of care would create even more incentives for 
efficiency, as discussed earlier. Moreover, defining the ``service'' 
paid under the OPPS by combinations of HCPCS codes for component 
services that are commonly performed in the same encounter and that 
result in the provision of a complete service would enable us to use 
more claims data and to establish payment rates that we believe more 
appropriately capture the costs of services paid under the OPPS.
    Section 1833(t)(1)(B) of the Act permits us to define what 
constitutes a ``service'' for purposes of payment under the OPPS and is 
not restricted to defining a ``service'' as a single HCPCS code. For 
example, the OPPS currently packages payment for certain items and 
services reported with HCPCS codes into the payment for other 
separately payable services on the claim. Consistent with our statutory 
flexibility to define what constitutes a service under the OPPS, we are 
proposing to view a service, in some cases, as not just the diagnostic 
or treatment modality identified by one individual HCPCS code but as 
the totality of care provided in a hospital outpatient encounter that 
would be reported with two or more HCPCS codes for component services.
    In view of this statutory flexibility to define what constitutes a 
``service'' for purposes of OPPS payment, our desire to encourage 
efficiency in HOPD care, our focus on value-based purchasing, and our 
desire to use as much claims data as possible to set payment rates 
under the OPPS, we examined our claims data to determine how we could 
best use the multiple procedure claims (``hardcore'' multiples) that 
are otherwise not available for ratesetting because they include 
multiple separately payable procedures furnished on the same date of 
service. As discussed in more detail in our discussion of single and 
multiple procedure claims in section II.A.1.b. of this proposed rule, 
we have focused in recent years on ways to convert multiple procedure 
claims to single procedure claims to maximize our use of the claims 
data in setting median costs for separately payable procedures. We have 
been successful in using the bypass list to generate ``pseudo'' single 
procedure claims for use in median setting, but this approach generally 
does not enable us to use the hardcore multiple claims that contain 
multiple separately payable

[[Page 42678]]

procedures, all with associated packaging that cannot be split among 
them. We believe that we could use the data from many more multiple 
procedure claims by creating APCs for payment of those services defined 
as frequently occurring common combinations of HCPCS codes for 
component services that we see in correctly coded multiple procedure 
claims.
    Our examination of data for multiple procedure claims identified 
two specific sets of services that we believe are good candidates for 
payment based on the naturally occurring common combinations of 
component codes that we see on the multiple procedure claims. These are 
low dose rate (LDR) prostate brachytherapy and cardiac 
electrophysiologic evaluation and ablation services.
    Specifically, we have been told (and our data support) that claims 
for LDR prostate brachytherapy, when correctly coded, report at least 
two major separately payable procedure codes the majority of the time. 
For reasons discussed below, we are proposing to use these correctly 
coded claims that would otherwise be unusable hardcore multiples as the 
basis for an encounter-based composite APC that would make a single 
payment when both codes are reported with the same date of service. We 
also are proposing to pay separately for these procedure codes in cases 
where only one of the two procedures is provided in a hospital 
encounter, through the APC associated with that component procedure 
code that is furnished.
    Similarly, we have been told (and our data support) that multiple 
cardiac electrophysiologic evaluation, mapping, and ablation services 
are typically furnished on the same date of service and that the 
correctly coded claims are typically the multiple procedure claims that 
include several component services and that we are unable to use in our 
current claims process. The CY 2007 CPT book introductory discussion in 
the section entitled ``Intracardiac Electrophysiological Procedures/
Studies'' notes that, in many circumstances, patients with arrhythmias 
are evaluated and treated at the same encounter. Therefore, as 
discussed in detail below, we are also proposing to establish an 
encounter based composite APC for these services that would provide a 
single payment for certain common combinations of component cardiac 
electrophysiologic services that are reported on the same date of 
service.
    These composite APCs reflect an evolution in our approach to 
payment under the OPPS. Where the claims data show that combinations of 
services are commonly furnished together, in the future we will 
actively examine whether it would be more appropriate to establish a 
composite APC under which we would pay a single rate for the service 
reported with a combination of HCPCS codes on the same date of service 
(or different dates of service) than to continue to pay for these 
individual services under service-specific APCs. We are proposing these 
specific encounter-based composite APCs for CY 2008 because we believe 
that this approach could move the OPPS toward possible payment based on 
an encounter or episode-of-care basis, enable us to use more valid and 
complete claims data, create hospital incentives for efficiency, and 
provide hospitals with significant flexibility to manage their 
resources that do not exist when we pay for services on a per service 
basis. As such, these proposed composite APCs may serve as a prototype 
for future creation of more composite APCs, through which we could 
provide OPPS payment for other types of services in the future. We note 
that while these proposed composite APCs for CY 2008 are based on 
observed combinations of component HCPCS codes reported on the same 
date of service for a single encounter, we also will be exploring in 
the future how we could set payments based on episodes of care 
involving services that extend beyond the same date but which are all 
supportive of a single, related course of treatment. While we are not 
proposing to implement multi-day episode-of-care APCs in CY 2008, we 
welcome comments on the concept of developing these APCs to provide 
payment for such episodes in order to inform our future analyses in 
this area.
    While we have never previously used the term ``composite'' APC 
under the OPPS, we do have one historical payment policy that resembles 
the CY 2008 proposed composite APC policy. Since the inception of the 
OPPS, CMS has limited the aggregate payment for specified less 
intensive mental health services furnished on the same date to the 
payment for a day of partial hospitalization, which we considered to be 
the most resource intensive of all outpatient mental health treatment 
(65 FR 18455). The costs associated with administering a partial 
hospitalization program represent the most resource intensive of all 
outpatient mental health treatment, and we do not believe that we 
should pay more for a day of individual mental health services under 
the OPPS. Through the OCE, when the payment for specified mental health 
services provided by one hospital to a single beneficiary on one date 
of service based on the payment rates associated with the APCs for the 
individual services would exceed the per diem partial hospitalization 
payment (listed as APC 0033 (Partial Hospitalization)), those specified 
mental health services are assigned to APC 0034, which has the same 
payment rate as APC 0033, and the hospital is paid one unit of APC 
0034. This longstanding policy regarding payment of APC 0034 for 
combinations of independent services provided in a single hospital 
encounter resembles the payment policy for composite APCs that we are 
proposing for LDR prostate brachytherapy and cardiac electrophysiologic 
evaluation and ablation services for CY 2008. Similar to the logic for 
the proposed composite APCs, the OCE determines whether to pay these 
specified mental health services individually or to make a single 
payment at the same rate as the per diem rate for partial 
hospitalization for all of the specified mental health services 
furnished on that date of service. However, we note this established 
policy for payment of APC 0034 differs from the proposed policies for 
the new CY 2008 composite APCs because APC 0034 is only paid if the sum 
of the individual payment rates for the specified mental health 
services provided on one date of service exceeds the APC 0034 payment 
rate, which equals the per diem rate of APC 0033 for partial 
hospitalization.
    We are not proposing to change this mental health services payment 
policy for CY 2008. However, we are proposing to change the status 
indicator from ``S'' to ``Q'' for the HCPCS codes for the specified 
mental health services to which APC 0034 applies because those codes 
are conditionally packaged when the sum of the payment rates for the 
single code APCs to which they are assigned exceeds the per diem 
payment rate for partial hospitalization. While we have not published 
APC 0034 in Addendum A in the past, we are including it in Addendum A 
to this proposed rule entitled ``Mental Health Composite,'' consistent 
with our naming taxonomy and publication of the two other proposed 
composite APCs. We are also including the mental health composite APC 
0034 and its member HCPCS codes in Addendum M to this proposed rule in 
the same way that we show the HCPCS codes to which the LDR Prostate 
Brachytherapy Composite APC and Cardiac Electrophysiologic Evaluation 
and Ablation Composite APC apply.

[[Page 42679]]

    In summary, we are not proposing a change to the longstanding 
payment policy under which the OPPS pays one unit of APC 0034 in cases 
in which the total payments for specified mental health services 
provided on the same date of service would otherwise exceed the payment 
rate for APC 0033. However, we are proposing to change the status 
indicator to ``Q'' for the HCPCS codes for mental health services to 
which this policy applies and which comprise this existing composite 
APC, because payment for these services would be packaged unless the 
sum of the individual payments assigned to the codes would be less than 
the payment for APC 0034.
    We look forward to public comments on the concept of composite APCs 
in general and, specifically, the two new proposed encounter-based 
composite APCs for CY 2008, and we hope to involve the public and the 
APC Panel in the creation of additional composite APCs. Our goal would 
be to use the many naturally occurring multiple procedure claims that 
cannot currently be incorporated under the existing APC structure, 
regardless of whether the naturally occurring pattern of multiple 
procedure claims prevents the development of single bills.
(2) Proposed Low Dose Rate (LDR) Prostate Brachytherapy Composite APC 
(a) Background
    LDR prostate brachytherapy is a treatment for prostate cancer in 
which needles or catheters are inserted into the prostate, and then 
radioactive sources are permanently implanted into the prostate through 
the hollow needles or catheters. The needles or catheters are then 
removed from the body, leaving the radioactive sources in the prostate 
forever, where they slowly give off radiation to destroy the cancer 
cells until the sources are no longer radioactive. At least two CPT 
codes are used to report the composite treatment service because there 
are separate codes that describe placement of the needles or catheters 
and application of the brachytherapy sources. LDR prostate 
brachytherapy cannot be furnished without the services described by 
both of these codes. Generally, the component services represented by 
both codes occur in the same operative session in the same hospital on 
the same date of service. However, we have been told of uncommon cases 
in which they are furnished in different locations, with the patient 
being transported from one location to another for application of the 
sources. In addition, other services, commonly CPT code 76965 
(Ultrasonic guidance for interstitial radioelement application) and CPT 
code 77290 (Therapeutic radiology simulation-aided field setting; 
complex) are often provided in the same hospital encounter.
    CPT code 55875 (Transperineal placement of needles or catheters 
into prostate for interstitial radioelement application, with or 
without cystoscopy) reports the placement of the needles or catheters 
for services furnished on or after January 1, 2007. Before this date, 
including in the claims for services furnished in CY 2006 that were 
used to develop this proposed rule, CPT code 55859 (Transperineal 
placement of needles or catheters into prostate for interstitial 
radioelement application, with or without cystoscopy) reported this 
service. All of the claims for CPT code 55859 (as reported in the CY 
2006 claims data) are for the placement of needles or catheters for 
prostate brachytherapy, although not all are related to permanent 
brachytherapy source application.
    CPT code 77778 (Interstitial radiation source application; complex) 
reports the application of brachytherapy sources and, when billed with 
CPT code 55859 (or CPT code 55875 after January 1, 2007) for the same 
encounter, reports placement of the sources in the prostate. We have 
been told that application of brachytherapy sources to the prostate is 
estimated to be about 85 percent of all occurrences of CPT code 77778 
under the OPPS, consistent with our CY 2006 claims data used for CY 
2008 ratesetting. CPT code 77778 is also used to report the application 
of sources of brachytherapy to body sites other than the prostate.
    Historical coding, APC assignments, and payment rates for CPT codes 
55859 (CPT code 55875 beginning in CY 2007) and 77778 are shown below 
in Table 21.

                            Table 21.--Historical Payment Rates for Complex Interstitial Application of Brachytherapy Sources
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                         Payment
                                                                         rate for     APC for     Payment rate     APC for
                 OPPS CY                        Combination APC          CPT code    HCPCS code   for CPT codes   HCPCS code     Brachytherapy source
                                                                          77778        77778       55859/55875      55859
--------------------------------------------------------------------------------------------------------------------------------------------------------
2000....................................  N/A........................      $198.31     APC 0312         $848.04     APC 0162  Pass-through.
2001....................................  N/A........................       205.49     APC 0312          878.72     APC 0162  Pass-through.
2002....................................  N/A........................     6,344.67     APC 0312        2,068.23     APC 0163  Pass-through with pro rata
                                                                                                                               reduction.
2003 (prostate brachytherapy with iodine  G0261, APC 648, $5,154.34..          n/a          n/a             n/a          n/a  Packaged.
 sources).
2003 (prostate brachytherapy with         G0256, APC 649, $5,998.24..          n/a          n/a             n/a          n/a  Packaged.
 palladium sources).
2003 (not prostate brachytherapy, not     N/A........................     2,853.58     APC 0651        1,479.60     APC 0163  Separate payment based on
 including sources).                                                                                                           scaled median cost per
                                                                                                                               source.
2004....................................  N/A........................       558.24     APC 0651        1,848.55     APC 0163  Cost.
2005....................................  N/A........................     1,248.93     APC 0651        2,055.63     APC 0163  Cost.
2006....................................  N/A........................       666.21     APC 0651        1,993.35     APC 0163  Cost.
2007....................................  N/A........................     1,035.50     APC 0651        2,146.84     APC 0163  Cost.
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Payment rates for CPT code 77778, in particular, have fluctuated 
over the years. We have frequently been informed by the public that 
reliance on single procedure claims to set the median costs for these 
services results in use of only incorrectly coded claims for LDR 
prostate brachytherapy because, for application of brachytherapy 
sources to the prostate, a correctly coded claim is a multiple 
procedure claim. Specifically, we have been informed that a correctly 
coded claim for LDR prostate brachytherapy should include, for the same 
date of service, both CPT

[[Page 42680]]

codes 55859 and 77778, brachytherapy sources reported with Level II 
HCPCS codes, and typically separately coded imaging and radiation 
therapy planning services, and that we should use correctly coded 
claims to set the median for APC 0651 (Complex Interstitial Radiation 
Source Application) in particular (where CPT code 77778 is assigned). 
In presentations to the APC Panel in its March 2006 meeting, and in 
response to the CY 2006 and CY 2007 OPPS proposed rules, commenters 
urged us to set the payment rate for LDR prostate brachytherapy 
services using only multiple procedure claims. Specifically for CY 
2007, they urged us to sum the costs on multiple procedure claims 
containing CPT codes 77778 and 55859 (and no other separately payable 
services not on the bypass list) and, excluding the costs of sources, 
split the resulting aggregate median cost on the multiple procedure 
claim according to a preestablished attribution ratio between CPT codes 
77778 and 55859. They indicated that any claim for a brachytherapy 
service that did not also report a brachytherapy source should be 
considered to be incorrectly coded and thus not reflective of the 
hospital's resources required for the interstitial source application 
procedure. The presenters to the APC Panel believed that claims that 
did not contain both brachytherapy source and source application codes 
should be excluded from use in establishing the median cost for APC 
0651. They believed that hospitals that reported the brachytherapy 
sources on their claims were more likely to report complete charges for 
the associated brachytherapy source application procedure than 
hospitals that did not report the separately payable brachytherapy 
sources.
    As a result of those comments, for both CY 2006 and CY 2007, we 
used multiple procedure claims containing both CPT codes 55859 and 
77778 to determine a median cost for the totality of both services 
(with both packaging and bypassing of the other commonly furnished 
services). We compared the median calculated from this subset of claims 
reflecting the most common clinical scenario to the single bill median 
costs for CPT codes 55859 and 77778 as a method of determining whether 
the total payment to the hospital for both services furnished to 
provide LDR prostate brachytherapy would be reasonable. In both years, 
we found that the sum of the single bill medians was reasonably close 
to the median cost of both services from multiple claims when they were 
treated as a single procedure and the supporting services were either 
packaged or bypassed for purposes of calculating the median for the 
combined pair of codes. (We refer readers to the CY 2006 final rule 
with comment period (70 FR 68596) and the CY 2007 final rule with 
comment period (71 FR 68043) for specific discussion of these 
findings.) Hence, we concluded that the single bill median costs were 
reasonable and, for both the CY 2006 OPPS and CY 2007 OPPS, we based 
payment for CPT codes 55859 and 77778 on single procedure claims.
(b) Proposed Payment for LDR Prostate Brachytherapy
    For the CY 2008 OPPS, we are proposing to create a composite APC 
8001, titled ``LDR Prostate Brachytherapy Composite,'' that would 
provide one bundled payment for LDR prostate brachytherapy when the 
hospital bills both CPT codes 55875 and 77778 as component services 
provided during the same hospital encounter. It is shown in Addendum A 
to this proposed rule as APC 8001 (LDR Prostate Brachytherapy 
Composite). As discussed in detail in section VII. of this proposed 
rule, we are proposing to continue to pay sources of brachytherapy 
separately in accordance with the requirements of the statute.
    In the CY 2006 claims used to calculate the proposed CY 2008 median 
costs, CPT code 55859 was reported 14,083 times. The proposed rule 
median cost for CPT code 55859, calculated from 2,232 single and 
``pseudo'' single bills, is $2,328.56. The CY 2008 proposed rule median 
cost for APC 0163 (Level IV Cystourethroscopy and other Genitourinary 
Procedures) to which CPT code 55859 was assigned for CY 2006 and to 
which CPT code 55875 is assigned for CY 2007 is $2,322.30. In the set 
of claims used to calculate the median cost for APC 0651, to which CPT 
code 77778 is the only assigned service, CPT code 77778 was reported 
11,850 times. The CY 2008 proposed rule median cost for APC 0651 (and, 
therefore, for CPT code 77778) based on 339 single and ``pseudo'' 
single procedure bills is $969.73.
    In examining the claims data used to calculate the median costs for 
this proposed rule, we found 9,807 claims on which both CPT code 55859 
and CPT code 77778 were billed on the same date of service. These data 
suggest that LDR prostate brachytherapy constituted at least 70 percent 
of CY 2006 claims for CPT code 55859, with the remainder of claims 
representing the insertion of needles or catheters for high dose rate 
prostate brachytherapy or unusual clinical situations where the LDR 
sources were not applied in the same operative session as the insertion 
of the needles or catheters. These data are consistent with our 
understanding of current clinical practice for prostate brachytherapy, 
and we believe that those multiple claims are correctly coded claims 
for this common clinical scenario. Similarly, 83 percent of the claims 
for complex interstitial brachytherapy source application CPT code 
77778 also included the CPT code for inserting needles or catheters 
into the prostate, consistent with our understanding that the vast 
majority of cases of complex interstitial brachytherapy source 
application procedures are specifically for the treatment of prostate 
cancer, rather than other types of cancer.
    Using the proposed packaging approach for imaging supervision and 
interpretation services and guidance services for CY 2008, we were able 
to identify 1,343 claims, 14 percent of all OPPS claims that reported 
these two procedures on the same date, that contain both CPT codes 
55859 and 77778 on the same date of service and no other separately 
paid procedure code. We were not able to use more claims to develop 
this composite APC median cost because there are several radiation 
therapy planning codes that are commonly reported with CPT codes 55859 
and 77778 and that are both separately paid and not on the bypass list 
because the amount of their associated packaging exceeds the threshold 
for inclusion on the bypass list. A complete discussion of the bypass 
list under our CY 2008 packaging proposal is provided in section II.A. 
of this proposed rule.
    We packaged the costs of packaged revenue codes and packaged HCPCS 
codes into the sum of the costs for CPT codes 55859 and 77778 to derive 
a total proposed median cost of $3,127.35 for the composite LDR 
prostate brachytherapy service based upon the 1,343 claims that 
contained both CPT codes and no other separately paid procedure codes. 
This is reasonably comparable to $3,298.29, the sum of the CPT median 
costs we calculated using the single procedure bills for CPT codes 
55859 and 77778 (($2,328.56 plus $969.73). We believe that the 
difference between the composite APC median cost based upon those 
claims that contain both codes and the sum of the median costs for the 
APCs to which the two individual CPT codes map is minimal and may be 
attributable to efficiencies in furnishing the services together during 
a single encounter.

[[Page 42681]]

    We believe that creation of the composite APC for the payment of 
LDR prostate brachytherapy is consistent with the statute and with our 
desire to use more claims data for ratesetting, particularly data from 
correctly coded claims that reflect typical clinical practice, and to 
make payment for larger packages and bundles of services to provide 
enhanced incentives for efficiency and cost containment under the OPPS 
and to maximize hospital flexibility in managing resources.
    Under our proposal, hospitals that furnish LDR prostate 
brachytherapy would report CPT codes 55875 and 77778 and the codes for 
the applicable brachytherapy sources in the same manner that they 
currently report these items and services (in addition to reporting any 
other services provided), using the same HCPCS codes and reporting the 
same charges. We would require that hospitals report both CPT codes 
resulting in the composite APC payment on the same claim when they are 
furnished to a single Medicare beneficiary in the same facility on the 
same date of service, and we would make any necessary conforming 
changes to the billing instructions to ensure that they do not present 
an obstacle to correct reporting. We may implement edits to ensure that 
hospitals do not submit two separate claims for these two procedures 
when furnished on the same date in the same facility. When this 
combination of codes is reported, the OCE would assign the composite 
APC 8001 and the Pricer would pay based on the payment rate for the 
composite APC. The OCE would assign APC 0163 or APC 0651 only when both 
codes are not reported on the same claim with the same date of service, 
and we would expect this to be the atypical case. The composite APC 
would have a status indicator of ``T'' so that payment for other 
procedures also assigned to status indicator ``T'' with lower payment 
rates would be reduced by 50 percent when furnished on the same date of 
service as the composite service, in order to reflect the efficiency 
that occurs when multiple procedures are furnished to a Medicare 
beneficiary in a single operative session. We would not expect that the 
composite APC payment would be commonly reduced because we believe that 
it is unlikely that a higher paid procedure would be performed on the 
same date.
    We are proposing to continue to establish separate payment rates 
for APC 0651 (to which only CPT code 77778 is assigned) and for APC 
0163 (to which we are proposing to continue to assign CPT code 55875). 
In some cases, CPT 55875 may be reported for the insertion of needles 
or catheters for high dose rate prostate brachytherapy, and the low 
dose rate brachytherapy source application procedure (CPT code 77778) 
would not be reported. In high dose rate prostate brachytherapy, the 
sources are applied temporarily several times over a few days while the 
needles or catheters remain in the prostate, and the needles or 
catheters are removed only after all the treatment fractions have been 
completed. We have also been told by hospitals that, even when LDR 
prostate brachytherapy is planned, there are occasions in which the 
needles or catheters are inserted in one facility and the patient is 
moved to another facility for the application of the sources. In those 
cases, we would need to be able to appropriately pay the hospital that 
inserted the needles or catheters before the patient was discharged 
prior to source application. Moreover, there are cases in which the 
needles or catheters are inserted but it is not possible to proceed to 
the application of the sources and, therefore, the hospital would 
correctly report only CPT code 55875. Similarly, more than 10 
brachytherapy sources can be applied interstitially (as described by 
CPT code 77778) to sites other than the prostate and it is, therefore, 
necessary to have a separate payment rate for CPT code 77778. Hence, 
for CY 2008 we are proposing to continue to pay for CPT code 55875 (the 
successor to CPT code 55859) through APC 0163 and to pay for CPT code 
77778 through APC 0651 when the services are individually furnished 
other than on the same date of service in the same facility.
    In summary, we are proposing to establish a composite APC, shown in 
Addendum A as APC 8001, to provide payment for LDR prostate 
brachytherapy when the composite service, billed as CPT codes 55875 and 
77778, is furnished in a single hospital encounter and to base the 
payment for the composite APC on the median cost derived from claims 
that contain both codes. These two CPT codes are assigned to status 
indicator ``Q'' in Addendum B to this proposed rule to signify their 
conditionally packaged status, and their composite APC assignments are 
noted in Addendum M. This proposal would permit us to base payment on 
claims for the most common clinical scenario for interstitial radiation 
source application to the prostate. We note that this payment bundle 
would also include payment for the commonly associated imaging guidance 
services, which would be newly packaged under our proposed CY 2008 
packaging approach. Most importantly, this composite APC payment 
methodology that we are proposing would contribute to our goal of 
providing payment under the OPPS for a larger bundle of component 
services provided in a single hospital outpatient encounter, creating 
additional hospital incentives for efficiency and cost containment, 
while providing hospitals with the most flexibility to manage their 
resources.
(3) Proposed Cardiac Electrophysiologic Evaluation and Ablation 
Composite APC
(a) Background
    During its March 2007 meeting, members of the APC Panel indicated 
that the reason we found so few single bills for procedures assigned to 
APC 0087 (Cardiac Electrophysiologic Recording/Mapping), specifically 
72 of 11,834 or 0.61 percent of all proposed rule CY 2006 claims, is 
that most of the services assigned to APCs 0085 (Level II 
Electrophysiologic Evaluation), 0086 (Ablate Heart Dysrhythm Focus), 
and 0087 are performed in varying combinations with one another. 
Therefore, correctly coded claims would most often include multiple 
codes for component services that are reported with different CPT codes 
and that are now paid separately through different APCs. There would 
never be many single bills and those that are reported as single bills 
would likely represent atypical cases or incorrectly coded claims.
    We examined the combinations of services observed in our claims 
data across these three APCs to see whether there was the potential for 
handling the data differently so that we could use more claims data to 
set the payment rates for these procedures, particularly those services 
assigned to APC 0087 where we have had a persistent concern regarding 
the limited and reportedly unrepresentative single bills available for 
use in calculating the median cost according to our standard OPPS 
methodology. We initially developed and examined frequency 
distributions of unique combinations of codes on claims which contained 
at least one unit of any code assigned to APC 0085, 0086, or 0087 and 
then broadened these analysis to any combination of an 
electrophysiologic evaluation and ablation code.
    Our initial frequency distributions supported the APC Panel 
members' description of their experiences. We identified and enumerated 
the most commonly appearing unique occurrences (either single 
procedures or combinations) of codes for services

[[Page 42682]]

assigned to status indicator ``S,'' ``T,'' ``V,'' or ``X'' that 
contained at least one code assigned to APC 0085, 0086, or 0087. There 
were 7,379 claims in the top 100 occurrence types. Table 22 shows the 
10 most common unique occurrences from CY 2006 claims available for 
this proposed rule.

 Table 22.--Ten Most Frequently Occurring Unique Occurrences of Cardiac Electrophysiologic Evaluation, Mapping,
                          and Ablation Procedures and Other Separately Payable Services
----------------------------------------------------------------------------------------------------------------
                                                                                              CY 2007   CY 2007
         Combination  number           Frequency    HCPCS code        Short descriptor          APC        SI
----------------------------------------------------------------------------------------------------------------
1...................................          763        93620  Electrophysiology                0085         T
                                                                 evaluation.
2...................................          509        93609  Map tachycardia, add-on....      0087         T
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93621  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93623  Stimulation, pacing heart..      0087         T
                                                         93651  Ablate heart dysrhythm           0086         T
                                                                 focus.
3...................................          398        93609  Map tachycardia, add-on....      0087         T
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93621  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93651  Ablate heart dysrhythm           0086         T
                                                                 focus.
4...................................          381        93650  Ablate heart dysrhythm           0086         T
                                                                 focus.
5...................................          376        93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93623  Stimulation, pacing heart..      0087         T
6...................................          248        93005  Electrocardiogram, tracing.      0099         S
                                                         93609  Map tachycardia, add-on....      0087         T
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93621  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93623  Stimulation, pacing heart..      0087         T
                                                         93651  Ablate heart dysrhythm           0086         T
                                                                 focus.
7...................................          225        93005  Electrocardiogram, tracing.      0099         S
                                                         93609  Map tachycardia, add-on....      0087         T
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93621  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93651  Ablate heart dysrhythm           0086         T
                                                                 focus.
8...................................          225        93613  Electrophys map 3d, add-on.      0087         T
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93621  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93651  Ablate heart dysrhythm           0086         T
                                                                 focus.
9...................................          217        93005  Electrocardiogram, tracing.      0099         S
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
10..................................          185        93613  Electrophys map 3d, add-on.      0087         T
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93621  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93623  Stimulation, pacing heart..      0087         T
                                                         93651  Ablate heart dysrhythm           0086         T
                                                                 focus.
----------------------------------------------------------------------------------------------------------------

    Although the number of claims for each unique occurrence was 
modest, we were able to determine that there were certain combinations 
of codes that occurred most often together. Based on our review of the 
most frequently occurring combinations of codes on claims that also 
contained at least one code assigned to APC 0085, 0086 or 0087 and our 
clinical review of the codes, we proceeded to study combination claims 
that contained at least one code from group A for evaluation services 
and at least one code from group B for ablation services reported on 
the same date of service on an individual claim, as specified in Table 
23 below.

 Table 23.--Groups of Cardiac Electrophysiologic Evaluation and Ablation
                     Procedures for Further Analysis
------------------------------------------------------------------------
   Codes used in combinations: at
  least one in Group A and one in     HCPCS code  CY 2007 APC   CY 2007
              Group B                                              SI
------------------------------------------------------------------------
Group A:
    Electrophysiology evaluation...        93619         0085         T
    Electrophysiology evaluation...        93620         0085         T
Group B:
    Ablate heart dysrhythm focus...        93650         0086         T
    Ablate heart dysrhythm focus...        93651         0086         T
    Ablate heart dysrhythm focus...        93652         0086         T
------------------------------------------------------------------------

    When we studied claims that contained a code in group A and also a 
code in group B, we found that there were 5,118 claims that met these 
criteria, and that of these 5,118 claims, 4,552 (89 percent) contained 
both CPT code 93620 (Comprehensive electrophysiologic evaluation 
including insertion and repositioning of multiple

[[Page 42683]]

electrode catheters with induction or attempted induction of 
arrhythmia; with right atrial pacing and recording, right ventricular 
pacing and recording, His bundle recording) from APC 0085 and CPT code 
93651 (Intracardiac catheter ablation of arrhythmogenic focus; for 
treatment of supraventricular tachycardia by ablation of fast or slow 
atrioventricular pathways, accessory atrioventricular connections or 
other atrial foci, singly or in combination) from APC 0086 with the 
same date of service. Given that CPT code 93651 had a total frequency 
of 8,091, this means that more than 55 percent of the claims for CPT 
code 93651 also contained CPT code 93620. CPT code 93620 had a total 
frequency of 12,624, approximately 50 percent higher than the total 
frequency for CPT code 93651, which is consistent with our expectations 
because CPT code 93620 describes a diagnostic service and CPT code 
93651 is a treatment service that may be provided based upon the 
findings of the evaluation described by CPT code 93620. In addition to 
the codes for group A and group B services, the combination claims also 
contained costs for packaged services that were reported under revenue 
codes without HCPCS codes and under packaged HCPCS codes. As we discuss 
in considerable detail above, we lack a methodology that could be used 
to allocate these packaged costs to major separately paid procedures in 
a manner which gives us confidence that the costs would be attributed 
correctly. We have explored and will continue to explore an alternative 
strategy that would enable us to use these correctly coded multiple 
procedure claims for ratesetting.
    In our review of these claims, not only did we find a high number 
of claims on which there was one code from group A and one code from 
group B, but we also found that claims for procedures assigned to APC 
0087 for CY 2007 usually appeared on claims that contained a code from 
APC 0085 or APC 0086, or both. The most frequently appearing CPT codes 
that were assigned to APC 0087 for CY 2007 were, as shown above, 93609 
(Intraventricular and/or intra-atrial mapping of tachycardia site(s), 
with catheter manipulation to record from multiple sites to identify 
origin of tachycardia (List separately in addition to code for primary 
procedure)), 93613 (Intracardiac electrophysiologic 3-dimensional 
mapping (List separately in addition to code for primary procedure)), 
93621 (Comprehensive electrophysiologic evaluation including insertion 
and repositioning of multiple electrode catheters with induction or 
attempted induction of arrhythmia; with left atrial pacing and 
recording from coronary sinus or left atrium (List separately in 
addition to code for primary procedure)), 93622 (Comprehensive 
electrophysiologic evaluation including insertion and repositioning of 
multiple electrode catheters with induction or attempted induction of 
arrhythmia; with left ventricular pacing and recording (List separately 
in addition to code for primary procedure)), and 93623 (Programmed 
simulation and pacing after intravenous drug infusion (List separately 
in addition to code for primary procedure)). These codes are all CPT 
add-on codes that CPT indicates are to be reported in addition to the 
code for the primary procedure. Our clinical review of the services 
described by these five CPT codes determined that they are supportive 
dependent services that are provided most often as supplemental to 
procedures assigned to APCs 0085 and 0086. The procedures in APCs 0085 
and 0086 can be performed without these supportive add-on procedures, 
but these dependent services cannot be done except as a supplement to 
another electrophysiologic procedure. Therefore, we are proposing to 
unconditionally package all of these five CPT codes under the grouping 
of intraoperative services for the CY 2008 OPPS. We discuss the 
packaging of intraoperative services in general, including these 
services, above.
    However, packaging these supportive ancillary services that are so 
often reported with the cardiac electrophysiologic evaluation and 
ablation services does not enable us to use many more claims because, 
as we noted previously, the claims on which these codes most commonly 
appeared typically also contained at least one separately paid code 
from APC 0085 and one code from APC 0086. Although the most common 
combination of codes from APCs 0085 and 0086 is the pair of CPT codes 
93620 and 93651, there are numerous other combinations of services from 
APCs 0085 and 0086 that are performed and, while not as frequent, these 
combinations are also reflected in the multiple claims.
    In order to use more claims and adequately reflect the varied, 
common combinations of electrophysiologic evaluation and ablation CPT 
codes, we calculated a composite median cost from all claims containing 
at least one code from group A and at least one code from group B as if 
they were a single service. We selected multiple procedure claims that 
contained at least one code in group A and one code in group B on the 
same date of service and calculated a median cost from the total costs 
on these claims. Some claims had more than one code from each group. 
Although the claim was required to contain at least one code from each 
group to be included, the claim could also contain any number of codes 
from either group and any number of units of those codes. In addition, 
the costs of the five supportive intraoperative services previously 
assigned to APC 0087 that we identify above were packaged, as well as 
the costs of the other items and services proposed to be packaged for 
the CY 2008 OPPS. This selection process yielded 5,118 claims to use 
for the calculation. The proposed composite median cost for these 
claims using the CY 2008 proposed rule data is $8,528.83. We believe 
that this cost is attributable largely to the 4,552 claims that contain 
one unit each of CPT code 93620 and CPT code 93651 (and some unknown 
numbers and combinations of packaged services). In comparison, the sum 
of the CY 2008 proposed rule CPT code median costs for CPT code 93620 
(which is $3,111.76) and CPT code 93651 (which is $5,643.95) is 
$8,755.71. If the 50 percent multiple procedure discount is applied to 
the CPT code median cost for the lower cost procedure based on its 
assignment to an APC with a ``T'' status, the adjusted sum of the 
median costs is $7,199.83 ($5,643.95 + $1,555.88). These medians were 
calculated using only claims that contain correct devices and do not 
contain token charges or the ``FB'' modifier. We believe the 
significant positive difference between the composite and discounted 
costs still reflects efficiencies, as the sum of the discounted median 
costs does not take into account the cost of other procedures also 
provided that are assigned to APCs 0085 and 0086, while the composite 
median cost of $8,528.83 does, to some extent, reflect the cost of 
other multiple procedures in APCs 0085 and 0086 that were also reported 
on the claims used to develop the composite median cost. In addition, 
these two calculations are based upon two different sets of claims, 
single procedure claims in one case (which do not represent the way the 
service is typically furnished) and the specified subset of clinically 
common combination claims in the second case. Moreover, while the 50 
percent multiple procedure reduction is our best aggregate estimate of 
the overall degree of efficiency applicable to multiple surgeries, it 
may or may not be specifically appropriate to this particular 
combination of procedures.

[[Page 42684]]

    By selecting the multiple procedure claims that contained at least 
one code in each group, we were able to use many more claims than were 
available to establish the individual APC medians. The percents by CPT 
code for the composite configuration below in Table 24 represent the 
sum of the frequency of single bills used to set the medians for APCs 
0085 and 0086 with packaging of the five intraoperative services and 
the frequency of multiple bills used to set the medians for the 
composite claims containing at least one code from each group and with 
packaging of the costs of the five intraoperative services, divided by 
the total frequency of each CPT code.

  Table 24.--Percentage of Claims Used To Calculate Median Costs for Cardiac Electrophysiologic Evaluation and
                                               Ablation Procedures
----------------------------------------------------------------------------------------------------------------
                                                                          Standard configuration     Composite
                                                                            (with packaging of     configuration
                                                                         intraoperative services)      (with
                                                                        --------------------------  packaging of
                                                                                                       intra-
                                                                                                     operative
 Codes used in combinations: at least   HCPCS code  Proposed CY    SI                                services)
  one in group A and one in Group B                   2008 APC               CPT      Overall APC --------------
                                                                          percentage   percentage       CPT
                                                                          of single    of single   percentage of
                                                                            claims       claims      single and
                                                                                                    combination
                                                                                                       claims
----------------------------------------------------------------------------------------------------------------
Group A:
    Electrophysiology evaluation.....        93619         0085  T.....        38.99        25.47         63.96
    Electrophysiology evaluation.....        93620         0085  T.....        22.30        25.47         61.77
Group B:
    Ablate heart dysrhythm focus.....        93650         0085  T.....        39.58        25.47         52.50
    Ablate heart dysrhythm focus.....        93651         0086  T.....         4.59         4.68         63.30
    Ablate heart dysrhythm focus.....        93652         0086  T.....         7.53         4.68         58.78
----------------------------------------------------------------------------------------------------------------

Moreover, by packaging CPT codes 93609, 93613, 93621, 93622, and 93623, 
we use many more of the claims for these codes from the most common 
clinical scenarios than would otherwise be possible if the supportive 
intraoperative services were separately paid. Wherever any of these 
codes appears on a claim that can be used for median setting, the cost 
data for these codes are packaged in the calculation of the median cost 
for the separately paid services on the claim.
(b) Proposed Payment for Cardiac Electrophysiologic Evaluation and 
Ablation
    In view of our findings with regard to how often the codes in 
groups A and B appear together on the same claim, we are proposing to 
establish one composite APC, shown in Addendum A as APC 8000 (Cardiac 
Electrophysiologic Evaluation and Ablation Composite), for CY 2008 that 
would pay for a composite service made up of any number of services in 
groups A and B when at least one code from group A and at least one 
code from group B appear on the same claim with the same date of 
service. The five CPT codes involved in this composite APC are assigned 
to status indicator ``Q'' in Addendum B to this proposed rule to 
identify their conditionally packaged status, and their composite APC 
assignments are identified in Addendum M. We are proposing to use the 
composite median cost of $8,528.83 as the basis for establishing the 
relative weight for this newly created APC for the composite 
electrophysiologic evaluation and ablation service. Under this 
composite APC, unlike most other APCs, we would make a single payment 
for all services reported in groups A and B. We are proposing that 
hospitals would continue to code using CPT codes to report these 
services and that the OCE would recognize when the criteria for payment 
of the composite APC are met and would assign the composite APC instead 
of the single procedure APCs as currently occurs. The Pricer would make 
a single payment for the composite APC that would encompass the program 
payment for the code in group A, the code in group B, and any other 
codes reported in groups A or B, as well as the packaged services 
furnished on the same date of service. The proposed composite APC would 
have a status indicator of ``T'' so that payment for other procedures 
also assigned to status indicator ``T'' with lower payment rates would 
be reduced by 50 percent when furnished on the same date of service as 
the composite service, in order to reflect the efficiency that occurs 
when multiple procedures are furnished to a Medicare beneficiary in a 
single operative session. We would not expect that the proposed 
composite APC payment would be commonly reduced because we believe that 
it is unlikely that a higher paid procedure would be performed on the 
same date. We are proposing to continue to pay separately for other 
separately paid services that are not reported under the codes in 
groups A and B (such as chest x-rays and electrocardiograms).
    Moreover, where a service in group A is furnished on a date of 
service that is different from the date of service for a code in group 
B for the same beneficiary, we are proposing that payments would be 
made under the single procedure APCs and the composite APC would not 
apply. Given our CY 2008 proposal to unconditionally package payment 
for five cardiac electrophysiologic CPT codes as members of the 
category of intraoperative services that were previously assigned to 
APCs 0085 and 0087, we are also proposing to reconfigure APCs 0084 
through 0087, where many of the cardiac electrophysiologic procedures 
that will be separately paid when they are not paid according to the 
composite APC are assigned. Specifically, we are proposing to 
discontinue APC 0087, and reconfigure APCs 0084, 0085, and 0086, with 
proposed titles and median costs of Level I Electrophysiologic 
Procedures (APC 0084) at $647.41; Level II Electrophysiologic 
Procedures (APC 0085) at $3,059.46; and Level III Electrophysiologic 
Procedures (APC 0086) at $5,709.52, respectively. We refer readers to 
section IV.A.2. of this proposed rule for a discussion of

[[Page 42685]]

calculation of median costs for device-dependent APCs. We believe this 
reconfiguration improves the clinical and resource homogeneity of these 
APCs which would provide payment for cardiac electrophysiologic 
procedures that would be individually paid when they do not meet the 
criteria for payment of the composite APC.
    We believe that creation of the proposed composite APC for cardiac 
electrophysiologic evaluation and ablation services is the most 
efficient and effective way to use the claims data for the majority of 
these services and best represents the hospital resources associated 
with performing the common combinations of these services that are 
clinically typical. We believe that this proposed ratesetting 
methodology results in an appropriate median cost for the composite 
service when at least one evaluation service in group A is furnished on 
the same date as at least one ablation service in group B. This 
approach creates incentives for efficiency by providing a single 
payment for a larger bundle of major procedures when they are performed 
together, in contrast to continued separate payment for each of the 
individual procedures. We expect to develop additional composite APCs 
in the future as we learn more about major currently separately paid 
services that are commonly furnished together during the same hospital 
outpatient encounter.
e. Service-Specific Packaging Issues
    As a result of requests from the public, a Packaging Subcommittee 
to the APC Panel was established to review all the procedural CPT codes 
with a status indicator of ``N.'' Commenters to past rules have 
suggested that certain packaged services could be provided alone, 
without any other separately payable services on the claim, and 
requested that these codes not be assigned status indicator ``N.'' In 
deciding whether to package a service or pay for a code separately, we 
have historically considered a variety of factors, including whether 
the service is normally provided separately or in conjunction with 
other services; how likely it is for the costs of the packaged code to 
be appropriately mapped to the separately payable codes with which it 
was performed; and whether the expected cost of the service is 
relatively low. As discussed above regarding our proposed packaging 
approach for CY 2008, we have modified the historical considerations 
outlined above in developing our proposal for the CY 2008 OPPS. The 
Packaging Subcommittee discussed many HCPCS codes during the March 2007 
APC Panel meeting, prior to development of the proposed packaging 
approach discussed above, and we have summarized and responded to the 
APC Panel's packaging-related recommendations below. Three of the codes 
reviewed by the Packaging Subcommittee at the March 2007 APC Panel 
meeting are included in the seven categories of services identified for 
packaging under the CY 2008 OPPS. For those three codes, we 
specifically applied the proposed CY 2008 criteria for determining 
whether a code should be proposed as packaged or separately payable for 
CY 2008. Specifically, we determined whether the service is a dependent 
service falling into one of the seven specified categories that is 
always or almost always provided integral to an independent service. 
For those four codes that were reviewed during the March 2007 APC Panel 
meeting but that do not fit into any of the seven categories of codes 
that are part of our CY 2008 proposed packaging approach, we applied 
the packaging criteria described above that were historically used 
under the OPPS. Moreover, we took into consideration our interest in 
expanding the size of payment groups for component services to provide 
encounter-based and episode-of-care-based payment in the future in 
order to encourage hospital efficiency and provide hospitals with 
maximal flexibility to manage their resources.
    In accordance with a recommendation of the APC Panel, for the CY 
2007 OPPS, we implemented a new policy that designates certain codes as 
``special'' packaged codes, assigned to status indicator ``Q'' under 
the OPPS, where separate payment is provided if the code is reported 
without any other services that are separately payable under the OPPS 
on the same date of service. Otherwise, payment for the ``special'' 
packaged code is packaged into payment for the separately payable 
services provided by the hospital on the same date. We note that these 
``special'' packaged codes are a subset of those HCPCS codes that are 
assigned to status indicator ``Q,'' which means that their payment is 
conditionally packaged under the OPPS. We are proposing to update our 
criteria to determine packaged versus separate payment for ``special'' 
packaged HCPCS codes assigned to status indicator ``Q'' for CY 2008. 
For CY 2008, payment for ``special'' packaged codes would be packaged 
when these HCPCS codes are billed on the same date of service as a code 
assigned to status indicator ``S,'' ``T,'' ``V,'' or ``X.'' When one of 
the ``special'' packaged codes assigned to status indicator ``Q'' is 
billed on a date of service without a code that is assigned to any of 
the four status indicators noted above, the ``special'' packaged code 
assigned to status indicator ``Q'' would be separately payable.
    The Packaging Subcommittee identified areas for change for some 
currently packaged CPT codes that it believed could frequently be 
provided to patients as the sole service on a given date and that 
required significant hospital resources as determined from hospital 
claims data. Based on the comments received, additional issues, and new 
data that we shared with the Packaging Subcommittee concerning the 
packaging status of codes for CY 2008, the Packaging Subcommittee 
reviewed the packaging status of numerous HCPCS codes and reported its 
findings to the APC Panel at its March 2007 meeting. The APC Panel 
accepted the report of the Packaging Subcommittee, heard several 
presentations on certain packaged services, discussed the deliberations 
of the Packaging Subcommittee, and recommended that--
    1. CMS place CPT code 76937 (Ultrasound guidance for vascular 
access requiring ultrasound evaluation of potential access sites, 
documentation of selected vessel patency, concurrent realtime 
ultrasound visualization of vascular needle entry, with permanent 
recording and reporting (list separately in addition to code for 
primary procedure)) on the list of ``special'' packaged codes (status 
indicator ``Q''). (Recommendation 1)
    2. CMS evaluate providing separate payment for trauma activation 
when it is reported on a claim for an ED visit, regardless of the level 
of the emergency department visit. (Recommendation 2)
    3. CMS place CPT code 0175T (Computer aided detection (CAD) 
(computer algorithm analysis of digital image data for lesion 
detection) with further physician review for interpretation and report, 
with or without digitization of film radiographic images, chest 
radiograph(s), performed remote from primary interpretation) on the 
list of ``special'' packaged codes (status indicator ``Q''). 
(Recommendation 3)
    4. CMS place CPT code 0126T (Common carotid intima-media thickness 
(IMT) study for evaluation of atherosclerotic burden or coronary heart 
disease risk factor assessment) on the list of ``special'' packaged 
codes (status indicator ``Q'') and that CMS consider mapping the code 
to APC 340 (Minor Ancillary Procedures). (Recommendation 4)

[[Page 42686]]

    5. CMS place CPT code 0069T (Acoustic heart sound recording and 
computer analysis only) on the list of ``special'' packaged codes 
(status indicator ``Q'') and that CMS exclude APC 0096 (Non-Invasive 
Vascular Studies) as a potential placement for this CPT code. 
(Recommendation 5)
    6. CMS maintain the packaged status of HCPCS code A4306 (Disposable 
drug delivery system, flow rate of less than 50 ml per hour) and that 
CMS present additional data on this system to the APC Panel when 
available. (Recommendation 6)
    7. CMS reevaluate the packaged OPPS payment for CPT code 99186 
(Hypothermia; total body) based on current research and availability of 
new therapeutic modalities. (Recommendation 7)
    8. The Packaging Subcommittee remains active until the next APC 
Panel meeting. (Recommendation 8)
    We address each of these recommendations in turn in the discussion 
that follows.
Recommendation 1
    For CY 2008, we are proposing to maintain CPT code 76937 as a 
packaged service. We are not adopting the APC Panel's recommendation to 
pay separately for this code in some circumstances as a ``special'' 
packaged code. In the CY 2006 OPPS final rule with comment period (70 
FR 68544 through 68545), in response to several public comments, we 
reviewed in detail the claims data related to CPT code 76937. During 
its March 2006 APC Panel meeting, after reviewing data pertinent to CPT 
code 76937, the APC Panel recommended that CMS maintain the packaged 
status of this code for CY 2007, and we accepted that recommendation. 
During the March 2007 APC Panel meeting, after reviewing current data 
and listening to a public presentation, the Panel recommended that we 
treat this code as a ``special'' packaged code for CY 2008, noting that 
certain uncommon clinical scenarios could occur where it would be 
possible to bill this service alone on a claim, without any other 
separately payable OPPS services.
    We are proposing to maintain CPT code 76937 as an unconditionally 
packaged service for CY 2008, fully consistent with the proposed 
packaging approach for the CY 2008 OPPS, as discussed above. Because 
CPT code 76937 is a guidance procedure and we are proposing to package 
payment for all guidance procedures for CY 2008, we believe it is 
appropriate to maintain the unconditionally packaged status of this 
code, which is a CPT designated add-on procedure that we would expect 
to be generally provided only in association with other independent 
services. We applied the updated criteria for determining whether this 
service should receive packaged or separately payment under the CY 2008 
OPPS. Specifically, we determined that this service is a supportive 
ancillary service that is integral to an independent service, resulting 
in our CY 2008 proposal to packaged payment for the service.
    We discussed this code extensively in both the CY 2006 and CY 2007 
final rules with comment period (70 FR 68544 through 68545; 71 FR 67996 
through 67997). Our hospital claims data demonstrate that guidance 
services are used frequently for the insertion of vascular access 
devices, and we have no evidence that patients lack appropriate access 
to guidance services necessary for the safe insertion of vascular 
access devices in the hospital outpatient setting. Because we believe 
that ultrasound guidance would almost always be provided with one or 
more separately payable independent procedures, its costs would be 
appropriately bundled with the handful of vascular access device 
insertion procedures with which it is most commonly performed. We 
further believe that hospital staff chooses whether to use no guidance 
or fluoroscopic guidance or ultrasound guidance on an individual basis, 
depending on the clinical circumstances of the vascular access device 
insertion procedure.
    Therefore, we do not believe that CPT code 76937 is an appropriate 
candidate for designation as a ``special'' packaged code. The CY 2007 
CPT book indicates that this code is an add-on code and should be 
reported in addition to the code reported for the primary procedure. 
According to our CY 2006 claims data available for this proposed rule, 
this code was billed over 60,000 times, yet less than one-tenth of 1 
percent of all claims for the procedure were billed without any 
separately payable OPPS service on the claim. Because this code is 
provided alone only extremely rarely, we believe this code would not be 
appropriately treated as a ``special'' packaged code. Therefore, we are 
proposing to continue to unconditionally package CPT code 76937 for CY 
2008.
Recommendation 2
    For CY 2008, we are proposing to maintain the packaged status of 
revenue code 068x, trauma response, when the trauma response is 
provided without critical care services. During the August 2006 APC 
Panel meeting, the APC Panel encouraged CMS to pay differentially for 
critical care services provided with and without trauma activation. For 
CY 2007, as a result of the APC Panel's August 2006 discussion and our 
own data analysis, we finalized a policy to pay differentially for 
critical care provided with and without trauma activation. The CY 2007 
payment rate for critical care unassociated with trauma activation is 
$405.04 (APC 0617, Critical Care), while the payment rate for critical 
care associated with trauma activation is $899.58 (APC 0617 and APC 
0618 (Trauma Response with Critical Care)). During the March 2007 APC 
Panel meeting, a presenter requested that CMS also pay differentially 
for emergency department visits provided with and without trauma 
activation. Two organizations that submitted comment letters for the 
APC Panel's review specifically requested separate payment for revenue 
code 068x every time it appears on a claim, regardless of the other 
services that were billed on that claim. The APC Panel recommended that 
CMS evaluate providing separate payment for trauma activation when it 
is reported on a claim for an emergency department visit, regardless of 
the level of the emergency department visit.
    After accepting the APC Panel's recommendation and evaluating this 
issue, we continue to believe that, while it is currently appropriate 
to pay separately for trauma activation when billed in association with 
critical care services, it is also currently appropriate to maintain 
the packaged payment status of revenue code 068x when trauma response 
services are provided in association with both clinic and emergency 
department visits under the CY 2008 OPPS. As mentioned above, it is our 
general objective to expand the size of the payment groups under the 
OPPS to move toward encounter-based and episode-of-care-based payments 
in order to encourage maximum hospital efficiency with a focus on 
value-based purchasing. Because trauma activation in association with 
emergency department or clinic visits would always be provided in the 
same hospital outpatient encounter as the visit for care of the injured 
Medicare beneficiary, packaging payment for trauma activation when 
billed in association with both clinic and emergency department visits 
is most consistent with our proposed packaging approach. We are also 
concerned that unpackaging payment for trauma activation in those 
circumstances where the trauma response would be less likely to be 
essential to appropriately treating a

[[Page 42687]]

Medicare beneficiary would reduce the incentive for hospitals to 
provide the most efficient and cost-effective care. We note that, while 
we are proposing for CY 2008 to continue to provide separate payment 
for trauma activation in association with critical care services, we 
may reconsider this payment policy for future OPPS updates as we 
further develop encounter-based and episode-of-care-based payment 
approaches.
    Furthermore, continued packaged payment for trauma activation when 
unassociated with critical care is consistent with the principles of a 
prospective payment system, where hospitals receive payment based on 
the median cost related to all of the hospital resources associated 
with the main service provided. In various situations, each hospital's 
costs may be higher or lower than the median cost used to set payment 
rates. In light of our proposed packaging approach for the CY 2008 
OPPS, we believe it is particularly important not to make any changes 
in our payment policies for other services that are not fully aligned 
with promoting efficient, judicious, and deliberate care decisions by 
hospitals that allow them maximum flexibility to manage their resources 
through encouraging the most cost-effective use of hospital resources 
in providing the care necessary for the treatment of Medicare 
beneficiaries. Packaging payment encourages hospitals to establish 
protocols that ensure that services are furnished only when they are 
medically necessary and to carefully scrutinize the services ordered by 
practitioners to minimize unnecessary use of hospital resources.
    Therefore, we are adopting the APC Panel's recommendation that we 
evaluate providing separate payment for revenue code 068x when provided 
in association with emergency department visits. For CY 2008, after our 
thorough assessment, we are proposing to maintain the packaged status 
of revenue code 068x, except when revenue code 068x is billed in 
association with critical care services.
Recommendation 3
    For CY 2008, we are proposing to maintain the unconditionally 
packaged status of CPT codes 0174T (Computer aided detection (CAD) 
(computer algorithm analysis of digital image data for lesion 
detection) with further physician review for interpretation and report, 
with or without digitization of film radiographic images, chest 
radiograph(s), performed concurrent with primary interpretation) and 
0175T. These services involve the application of computer algorithms 
and classification technologies to chest x-ray images to acquire and 
display information regarding chest x-ray regions that may contain 
indications of cancer. CPT code 0152T (Computer aided detection 
(computer algorithm analysis of digital image data for lesion 
detection) with further physician review for interpretation, with or 
without digitization of film radiographic images; chest radiograph(s) 
(List separately in addition to code for primary procedure)), the 
predecessor code to CPT codes 0174T and 0175T, was indicated as an add-
on code to chest x-ray CPT codes for CY 2006, according to the AMA's CY 
2006 CPT book. However, on July 1, 2006, the AMA released to the public 
an update that deleted CPT codes 0152T and replaced it with the two new 
Category III CPT codes 0174T and 0175T.
    In its March 2006 presentation to the APC Panel, before the AMA had 
released the CY 2007 changes to CPT code 0152T, a presenter requested 
that we pay separately for this service and assign it to a New 
Technology APC with a payment rate of $15, based on its estimated cost, 
clinical considerations, and similarity to other image post processing 
services that are paid separately. We proposed to accept the APC 
Panel's recommendation to package CPT code 0152T for CY 2007.
    In its August 2006 presentation to the APC Panel, after the AMA had 
released the CY 2007 code changes, the same presenter requested that we 
assign both of the two new codes to a New Technology APC with a payment 
rate of $15. The APC Panel members discussed these codes extensively. 
They considered the possibility of treating CPT code 0175T as a 
``special'' packaged code, thereby assigning payment to the code only 
when it was performed by a hospital without any other separately 
payable OPPS service also provided on the same day. They questioned the 
meaning of the word ``remote'' in the code descriptor for CPT code 
0175T, noting that was unclear as to whether remote referred to time, 
geography, or a specific provider. They believed it was likely that a 
hospital without a CAD system that performed a chest x-ray and sent the 
x-ray to another hospital for performance of the CAD would be providing 
the CAD service under arrangement and, therefore, would be providing at 
least one other service (chest x-ray) that would be separately paid. 
Thus, even in these cases, payment for the CAD service could be 
appropriately packaged. After significant and lengthy deliberation, the 
APC Panel recommended that we package payment for both of the new CPT 
codes, 0174T and 0175T, for CY 2007.
    In its March 2007 presentation to the APC Panel, the same presenter 
requested that we pay separately for CPT codes 0174T and 0175T, mapping 
them to New Technology APC 1492, with a payment rate of $15. The 
presenter indicated that chest x-ray CAD is not a screening tool and 
should only be billed to Medicare when applied to chest x-rays 
suspicious for lung cancer. The presenter also explained that 
additional and distinct hospital resources are required for chest x-ray 
CAD that are not required for a standard chest x-ray. In addition, 
remote chest x-ray CAD described by CPT code 0175T can be performed at 
a different time or location or by a different provider than the chest 
x-ray service. The presenter expressed concern that if hospitals were 
not paid separately for this technology, hospitals would not be able to 
provide it, thereby limiting beneficiary access to chest x-ray CAD. The 
APC Panel recommended conditional packaging as a ``special'' packaged 
code for CPT code 0175T, but did not recommend a change to the 
unconditionally packaged status of CPT code 0174T. We are not adopting 
the APC Panel's recommendation for designation of CPT code 0175T as a 
``special'' packaged code under the CY 2008 OPPS.
    We believe that packaged payment for diagnostic chest x-ray CAD 
under a prospective payment methodology for outpatient hospital 
services is most appropriate. We are proposing to maintain CPT codes 
0174T and 0175T as unconditionally packaged services for CY 2008, fully 
consistent with the proposed packaging approach for the CY 2008 OPPS, 
as discussed above. Because CPT codes 0174T and 0175T are supportive 
ancillary services that fit into the ``image processing'' category, and 
we are proposing to package payment for all image processing services 
for CY 2008, we believe it is appropriate to maintain the packaged 
status of these codes. We applied the updated criteria for determining 
whether these two CAD services should receive packaged or separate 
payment. Specifically, we determined that this service is a dependent 
service that is integral to an independent service, in this case, the 
chest x-ray or other OPPS service that we would expect to be provided 
in addition to the CAD service.
    After hearing many public presentations and discussions regarding 
the use of chest x-ray CAD, we continue to believe that even the remote 
service would almost always be provided by a hospital either in 
conjunction with other separately payable services or

[[Page 42688]]

under arrangement. For example, if a physician orders a chest x-ray and 
CAD service to be performed at hospital A, and hospital A, which does 
not have the CAD technology, sends the chest-ray to hospital B for the 
performance of chest x-ray CAD, hospital B could only provide the CAD 
service if it were provided under arrangement, to avoid the OPPS 
unbundling prohibition. Assuming that the CAD service was provided 
under arrangement, hospital A would bill for the chest x-ray CAD that 
was performed by hospital B and would pay hospital B for the service 
provided. In that case, hospital A would also bill the chest x-ray 
service that it provided. In another scenario that has been described 
to us, if a physician were to send a patient to a hospital clinic with 
the patient's chest x-ray for consultation, we believe that the patient 
would likely receive a visit service, in addition to the chest x-ray 
CAD. Therefore, in both of these circumstances, payment for the chest 
x-ray CAD would be appropriately packaged into payment for the 
separately payable services with which it was provided.
    We also do not believe that CPT code 0175T should be treated as a 
``special'' packaged code. As discussed earlier in this section with 
regard to our packaging proposal for image processing services for CY 
2008, we are concerned with establishing payment policies that could 
encourage certain inefficient and more costly service patterns, 
particularly for those services that do not need to be provided as a 
face-to-face encounter with the patient. If we were to assign CPT code 
0175T to ``special'' packaged status, we would likely create an 
incentive for hospitals to perform chest x-ray CAD remotely, for 
example, several days after performance of the initial chest x-ray, 
rather than immediately following the chest x-ray on the same day, to 
enable the hospital to receive separate payment for the service. In CY 
2005, there were approximately 7.3 million claims for all chest x-ray 
services in the HOPD, so a payment policy that could induce such 
changes in service delivery would be problematic in light of our 
commitment to encouraging the most efficient and cost-effective care 
for Medicare beneficiaries. Creating such perverse payment incentives 
through conditional packaging is a particular problem for those 
services that do not need a face-to-face encounter with the patient. In 
fact, as part of our proposed CY 2008 packaging approach, we are also 
proposing to unconditionally package payment in CY 2008 for several 
other image processing services that are not always performed face-to-
face, including HCPCS code G0288 (Reconstruction, computer tomographic 
angiography of aorta for surgical planning for vascular surgery) and 
CPT code 76377 (3D rendering with interpretation and reporting of 
computed tomography, magnetic resource imaging, ultrasound, or other 
tomographic modality; requiring image postprocessing on an independent 
workstation).
    The proposed unconditionally packaged treatment of the two CPT 
codes for chest x-ray CAD is fully consistent with the proposed 
packaging approach for the CY 2008 OPPS, as discussed above, and the 
principles and incentives for efficiency inherent in a prospective 
payment system based on groups of services. Packaging these services 
creates incentives for providers to furnish services in the most cost-
effective way and provides them with the most flexibility to manage 
their resources. As stated above, packaging encourages hospitals to 
establish protocols that ensure that services are furnished only when 
they are medically necessary and to carefully scrutinize the services 
ordered by practitioners to minimize unnecessary use of hospital 
resources. Therefore, we are proposing to continue to unconditionally 
package payment for CPT codes 0174T and 0175T for CY 2008.
Recommendation 4
    For CY 2008, we are adopting the APC Panel's recommendation and 
proposing to add CPT code 0126T to the list of ``special'' packaged 
codes and assign this code to APC 0340 (Minor Ancillary Procedures).
    This service describes an ultrasound procedure that measures common 
carotid intima-media thickness to evaluate a patient's degree of 
atherosclerosis. This code became effective January 1, 2006. We 
received a comment to the CY 2007 proposed rule requesting that this 
code become separately payable for CY 2007. At that point, we had no 
cost data for the service and, as discussed in the CY 2007 OPPS/ASC 
final rule with comment period (71 FR 67998), we reviewed this code 
with the Packaging Subcommittee, as is our standard procedure for codes 
that we are asked to review during the comment period. The APC Panel 
noted that this service could sometimes be provided to a patient 
without any other separately payable services. Therefore, the APC Panel 
recommended that we add this code to the list of ``special'' packaged 
codes and pay for it separately when it is provided without any other 
separately payable services on the same day. For circumstances when 
this code is paid separately, the APC Panel recommended that we 
consider assigning this code to APC 0340.
    While we continue to believe that this procedure would not commonly 
be provided alone, we are adopting the APC Panel recommendation and are 
proposing to treat this code as a ``special'' packaged code subject to 
conditional packaging, mapping to APC 0340 for CY 2008 when it would be 
separately paid. This is fully consistent with the proposed packaging 
approach for the CY 2008 OPPS, as discussed above. Because CPT code 
0126T is almost always performed during another procedure, and we are 
proposing to package payment for all intraoperative procedures for CY 
2008, we believe it is appropriate to designate this CPT code as a 
``special'' packaged code. We applied the updated criteria for 
determining whether this service should receive packaged or separate 
payment. Specifically, we determined that this service is usually a 
dependent service that is integral to an independent service, but that 
it could sometimes be provided without an independent service.
    As with all ``special'' packaged codes, we will closely monitor 
cost data and frequency of separate payment for this procedure as soon 
as we have more claims data available.
Recommendation 5
    For CY 2008, we are proposing to maintain the packaged status of 
CPT code 0069T, and we are not adopting the APC Panel's recommendation 
to designate this service as a ``special'' packaged code. This service 
uses signal processing technology to detect, interpret, and document 
acoustical activities of the heart through special sensors applied to a 
patient's chest. This code was a new Category III CPT code implemented 
in the CY 2005 OPPS. CPT code 0069T was an add-on code to an 
electrocardiography (EKG) service for CYs 2005 and 2006. However, 
effective January 1, 2007, the AMA changed the code descriptor to 
remove the add-on code designation for CPT code 0069T. This code has 
been packaged under the OPPS since CY 2005.
    During the August 2005 APC Panel meeting, the APC Panel recommended 
packaging CPT code 0069T for CY 2005. In its March 2006 presentation to 
the APC Panel, a presenter requested that we pay separately for CPT 
code 0069T and assign it to APC 0099 (Electrocardiograms) based on its 
estimated cost and clinical characteristics. The presenter stated that

[[Page 42689]]

the acoustic heart sound recording and analysis service may be provided 
with or without a separately reportable electrocardiogram. Members of 
the APC Panel engaged in extensive discussion of clinical scenarios as 
they considered whether CPT code 0069T could or could not be 
appropriately reported alone or in conjunction with several different 
procedure codes. Ultimately, the APC Panel recommended assigning this 
service to a separately payable status indicator. However, during the 
August 2006 meeting, the APC Panel further discussed CMS' proposal to 
package payment for CPT code 0069T for CY 2007 and considered the CY 
2007 code descriptor change, finally recommending that CMS continue to 
package this code for CY 2007.
    During the March 2007 APC Panel meeting, the same presenter 
requested that we pay separately for this service and assign it to APC 
0096 (Non-Invasive Vascular Studies) or to APC 0097 (Cardiac and 
Ambulatory Blood Pressure Monitoring), with CY 2007 payment rates of 
$94.06 and $62.85, respectively. The presenter stated that the 
estimated true cost of this service lies between $62 and $94. The 
presenter clarified that this service is usually provided with an EKG, 
but noted that the test is sometimes provided without an EKG, according 
to its revised code descriptor for CY 2007. The presenter agreed that 
it would be rare for the acoustic heart sound procedure to be performed 
alone without any other separately payable OPPS services. The APC Panel 
recommended that we place CPT code on the list of ``special'' packaged 
codes and that we exclude APC 0096 as a potential placement for this 
CPT code.
    Because this service does not fit into one of the seven identified 
categories of packaged codes proposed for the CY 2008 OPPS, we followed 
our historical packaging guidelines to determine whether to maintain 
the packaged status of this code or to pay for it separately. Based on 
the clinical uses that were described during the March 2007 and earlier 
APC Panel meetings, APC Panel discussions, and our claims data review, 
we continue to believe that it is highly unlikely that CPT code 0069T 
would be performed in the HOPD as a sole service without other 
separately payable OPPS services. In addition, our data indicate that 
this service is estimated to require only minimal hospital resources. 
Based on CY 2006 claims, we had only 8 single claims for CPT code 
0069T, with a median line-item cost of $5.21, consistent with its low 
expected cost. Therefore, we believe that payment for CPT code 0069T is 
appropriately packaged because it would usually be closely linked to 
the performance of an EKG or other separately payable cardiac service, 
would rarely, if ever, be the only OPPS service provided to a patient 
in an encounter, and has a low estimated resource cost. The proposed 
packaged treatment of this code is consistent with the principles and 
incentives for efficiency inherent in a prospective payment system 
based on groups of services. Therefore, we are proposing to continue to 
package payment for CPT code 0069T for CY 2008.
Recommendation 6
    For CY 2008, we are proposing to adopt the APC Panel's 
recommendation and maintain the packaged status of HCPCS code A4306. As 
requested by the APC Panel, we will also present to the APC Panel 
additional data on this system when available.
    HCPCS code A4306 describes a disposable drug delivery system with a 
flow rate of less than 50 ml per hour. As discussed in a presentation 
at the March 2007 APC Panel meeting, there is a particular disposable 
drug delivery system that is specifically used to treat postoperative 
pain. Since the implementation of the OPPS, this code was assigned to 
status indicator ``A,'' indicating that it was payable according to 
another fee schedule, in this case, the Durable Medical Equipment (DME) 
fee schedule. There were discussions during CYs 2005 and 2006 between 
CMS and a manufacturer, and it was determined that this code should be 
removed from the DME fee schedule as this code does not describe DME. 
For CY 2007, HCPCS code A4306 is payable under the OPPS, with status 
indicator ``N'' indicating that its payment is unconditionally 
packaged.
    One presenter to the APC Panel requested that we pay separately for 
this supply under the OPPS. For CY 2007, we packaged payment for this 
code because it is considered to be a supply, and since the inception 
of the OPPS the established payment policy packages payment for 
supplies because they are directly related and integral to an 
independent service furnished under the OPPS.
    Our CY 2006 claims data indicate that HCPCS code A4306 was billed 
on OPPS claims 1,773 times, yielding a line-item median cost of 
approximately $3. The APC Panel and a presenter believe that this code 
may not always be appropriately billed by hospitals as the data also 
show that this code was billed together with computed tomography (CT) 
scans of the thorax, abdomen, and pelvis approximately 40 percent of 
the time that this supply was reported. The APC Panel speculated that 
this code may be currently reported when other types of drug delivery 
devices are utilized for nonsurgical procedures or for purposes other 
than the treatment of postoperative pain. Therefore, the APC Panel 
requested that we share additional data when available.
    In summary, because HCPCS code A4306 represents a supply and 
payment of supplies is packaged under the OPPS according to 
longstanding policy, we are proposing to maintain the packaged status 
of HCPCS code A4306 for CY 2008.
Recommendation 7
    For CY 2008, we are proposing to maintain the packaged status of 
CPT code 99186, consistent with the APC Panel's recommendation that we 
reevaluate the packaged OPPS payment for CPT code 99186 based on 
current research and the availability of new therapeutic modalities.
    This service describes induced total body hypothermia that is 
performed on some post-cardiac arrest patients to avoid or lessen brain 
damage. The service has been packaged since the implementation of the 
OPPS. One presenter to the APC Panel at the March 2007 meeting 
requested that this code be assigned a separately payable status 
indicator under the OPPS. The presenter expressed concern that 
hospitals that provide this service and subsequently transfer the 
patient to another hospital prior to admission are not adequately paid 
for their services.
    Because this service does not fit into one of the seven identified 
categories of packaged codes proposed for the CY 2008 OPPS, we followed 
our historical packaging guidelines to determine whether to maintain 
the packaged status of this code or to pay for it separately. Claims 
data indicate that this code was billed 39 times under the OPPS in CY 
2006 and was never billed without another separately payable service on 
the same date. The proposed CY 2008 median cost for this code is $35, 
with individual costs ranging from $17 to $69, likely reflecting the 
costs associated with traditional methods of inducing total body 
hypothermia, such as ice packs applied to the body. In fact, the 
presenter noted that a technologically advanced total body hypothermia 
system costs $30,000, with an additional cost of $1,600 per disposable 
body suit. As expected, our claims data show that this service was 
provided most frequently with high level emergency department visits 
and critical care services.

[[Page 42690]]

    We believe that the circumstances in which total body hypothermia 
would be provided to a Medicare beneficiary and billed under the OPPS 
are extremely rare, as patients requiring this therapy would almost 
always be admitted as inpatients if they survive. We believe that, in 
the uncommon situation where a patient presents to one hospital and 
then is cooled and transported to another hospital without admission to 
the first hospital, payment for the hypothermia service would be most 
appropriately packaged into payment for the many other separately 
payable services that it most likely accompanied and that would be paid 
to the first hospital under the OPPS.
    In addition, consistent with the principles and incentives for 
efficiency inherent in a prospective payment system based on groups of 
services, packaging payment for this procedure that is highly 
integrated with other services provided in the hospital outpatient 
encounter creates incentives for providers to furnish services in the 
most cost-effective way. In situations where there are a variety of 
supplies that could be used to furnish a service, some of which are 
more expensive than others, packaging encourages hospitals to use the 
most cost-effective item that meets the patient's needs.
Recommendation 8
    In response to the APC Panel's recommendation for the Packaging 
Subcommittee to remain active until the next APC meeting, we note that 
the APC Panel Packaging Subcommittee remains active, and additional 
issues and new data concerning the packaging status of codes will be 
shared for its consideration as information becomes available. We 
continue to encourage submission of common clinical scenarios involving 
currently packaged HCPCS codes to the Packaging Subcommittee for its 
ongoing review, and we also encourage recommendations of specific 
services or procedures whose payment would be most appropriately 
packaged under the OPPS. Additional detailed suggestions for the 
Packaging Subcommittee should be submitted to <a href="/cdn-cgi/l/email-protection#ecadbcafbc8d828980ac8f819fc284849fc28b839a"><span class="__cf_email__" data-cfemail="93d2c3d0c3f2fdf6ffd3f0fee0bdfbfbe0bdf4fce5">[email protected]</span></a>, 
with ``Packaging Subcommittee'' in the subject line.

B. Proposed Payment for Partial Hospitalization

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Partial Hospitalization'' at the beginning of your 
comment.)
1. Background
    Partial hospitalization is an intensive outpatient program of 
psychiatric services provided to patients as an alternative to 
inpatient psychiatric care for beneficiaries who have an acute mental 
illness. A partial hospitalization program (PHP) may be provided by a 
hospital to its outpatients or by a Medicare-certified community mental 
health center (CMHC). Section 1833(t)(1)(B)(i) of the Act provides the 
Secretary with the authority to designate the hospital outpatient 
services to be covered under the OPPS. The Medicare regulations at 42 
CFR 419.21 that implement this provision specify that payments under 
the OPPS will be made for partial hospitalization services furnished by 
CMHCs as well as those furnished to hospital outpatients. Section 
1833(t)(2)(C) of the Act requires that we establish relative payment 
weights based on median (or mean, at the election of the Secretary) 
hospital costs determined by 1996 claims data and data from the most 
recent available cost reports. Payment to providers under the OPPS for 
PHPs represents the provider's overhead costs associated with the 
program. Because a day of care is the unit that defines the structure 
and scheduling of partial hospitalization services, we established a 
per diem payment methodology for the PHP APC, effective for services 
furnished on or after August 1, 2000. For a detailed discussion, we 
refer readers to the April 7, 2000 OPPS final rule with comment period 
(65 FR 18452).
    Historically, the median per diem cost for CMHCs greatly exceeded 
the median per diem cost for hospital-based PHPs and has fluctuated 
significantly from year to year, while the median per diem cost for 
hospital-based PHPs has remained relatively constant ($200-$225). We 
believe that CMHCs may have increased and decreased their charges in 
response to Medicare payment policies. As discussed in more detail in 
section II.B.2. of this proposed rule and in the CY 2004 OPPS final 
rule with comment period (68 FR 63470), we also believe that some CMHCs 
manipulated their charges in order to inappropriately receive outlier 
payments.
    For CY 2005, the PHP per diem amount was based on 12 months of 
hospital and CMHC PHP claims data (for services furnished from January 
1, 2003, through December 31, 2003). We used data from all hospital 
bills reporting condition code 41, which identifies the claim as 
partial hospitalization, and all bills from CMHCs because CMHCs are 
Medicare providers only for the purpose of providing partial 
hospitalization services. We used CCRs from the most recently available 
hospital and CMHC cost reports to convert each provider's line-item 
charges as reported on bills to estimate the provider's cost for a day 
of PHP services. Per diem costs were then computed by summing the line-
item costs on each bill and dividing by the number of days on the bill.
    In the CY 2005 OPPS update, the CMHC median per diem cost was $310, 
the hospital-based PHP median per diem cost was $215, and the combined 
CMHC and hospital-based median per diem cost was $289. We believed that 
the reduction in the CY 2005 CMHC median per diem cost compared to 
prior years indicated that the use of updated CCRs had accounted for 
the previous increase in CMHC charges and represented a more accurate 
estimate of CMHC per diem costs for PHP.
    For the CY 2006 OPPS final rule with comment period, we analyzed 12 
months of the most current claims data available for hospital and CMHC 
PHP services furnished between January 1, 2004, and December 31, 2004. 
We also used the most currently available CCRs to estimate costs. The 
median per diem cost for CMHCs dropped to $154, while the median per 
diem cost for hospital-based PHPs was $201. Based on the CY 2004 claims 
data, the average charge per day for CMHCs was $760, considerably 
greater than hospital-based per day costs but significantly lower than 
what it was in CY 2003 ($1,184). We believed that a combination of 
reduced charges and slightly lower CCRs for CMHCs resulted in a 
significant decline in the CMHC median per diem cost between CY 2003 
and CY 2004.
    Following the methodology used for the CY 2005 OPPS update, the CY 
2006 OPPS updated combined hospital-based and CMHC median per diem cost 
was $161, a decrease of 44 percent compared to the CY 2005 combined 
median per diem amount.
    As we were concerned that this amount may not cover the cost for 
PHPs, as stated in the CY 2006 OPPS final rule with comment period (70 
FR 68548 and 68549), we applied a 15-percent reduction to the combined 
hospital-based and CMHC median per diem cost to establish the CY 2005 
PHP APC. (We refer readers to the CY 2006 OPPS final rule with comment 
period for a full discussion of how we established the CY 2006 PHP rate 
(70 FR 68548).) We stated our belief that a reduction in the CY 2005 
median per diem cost would strike an appropriate balance between using 
the best available data and providing adequate payment for a program 
that often spans 5-6 hours a

[[Page 42691]]

day. We stated that 15 percent was an appropriate reduction because it 
recognized decreases in median per diem costs in both the hospital data 
and the CMHC data, and also reduced the risk of any adverse impact on 
access to these services that might result from a large single-year 
rate reduction. However, we adopted this policy as a transitional 
measure, and stated in the CY 2006 OPPS final rule with comment period 
that we would continue to monitor CMHC costs and charges for these 
services and work with CMHCs to improve their reporting so that 
payments can be calculated based on better empirical data, consistent 
with the approach we have used to calculate payments in other areas of 
the OPPS (70 FR 68548).
    To apply this methodology for CY 2006, we reduced the CY 2005 
combined unscaled hospital-based and CMHC median per diem cost of $289 
by 15 percent, resulting in a combined median per diem cost of $245.65 
for CY 2006.
    For the CY 2007 final rule with comment period, we analyzed 12 
months of more current data for hospital and CMHC PHP claims for 
services furnished between January 1, 2005, and December 31, 2005. We 
also used the most currently available CCRs to estimate costs. Using 
these updated data, we recreated the analysis performed for the CY 2007 
proposed rule to determine if the significant factors we used in 
determining the proposed PHP rate had changed. The median per diem cost 
for CMHCs increased $8 to $173, while the median per diem cost for 
hospital-based PHPs decreased $19 to $190. The CY 2005 average charge 
per day for CMHCs was $675, similar to the figure noted in the CY 2007 
proposed rule ($673) but still significantly lower than what was noted 
as the average charge for CY 2003 ($1,184).
    The combined hospital-based and CMHC median per diem cost would 
have been $175 for CY 2007. Rather than allowing the PHP median per 
diem cost to drop to this level, we proposed to reduce the PHP median 
cost by 15 percent, similar to the methodology used for the CY 2006 
update. However, after considering all public comments received 
concerning the proposed CY 2007 PHP per diem rate and results obtained 
using the more current data, we modified our proposal to continue using 
the 15 percent reduction methodology as the basis for calculating the 
combined hospital based and CMHC median per diem cost for CY 2007. 
Instead, we made a 5 percent reduction to the CY 2006 median per diem 
rate to provide a transitional path to the per diem cost indicated by 
the data. We believed that this approach accounted for the downward 
direction of the data and addressed concerns raised by commenters about 
the magnitude of another 15 percent reduction in 1 year. Thus, to 
calculate the CY 2007 APC PHP per diem cost, we reduced $245.65 (the CY 
2005 combined hospital-based and CMHC median per diem cost of $289 
reduced by 15 percent) by 5 percent, which resulted in a combined per 
diem cost of $233.37.
2. Proposed PHP APC Update
    For the past 2 years, we were concerned that we did not have 
sufficient evidence to support using the median per diem cost produced 
by the most current year's PHP data. After extensive analysis, we now 
believe we have determined the appropriate level of cost for the type 
of day services that is being provided. This analysis included an 
examination of revenue-to-cost center mapping, refinements to the per 
diem methodology, and an in-depth analysis of the number of units of 
service per day.
    In the CY 2006 and CY 2007 OPPS updates, the data have produced 
median costs that we believe were too low to cover the cost of a 
program that typically spans 5 to 6 hours per day. However, we 
continued to observe a clear downward trend in the data. We stated that 
if the data continue to reflect a low PHP per diem cost in CY 2008, we 
expect to continue the transition of decreasing the PHP median per diem 
cost to an amount that is more reflective of the data.
    We received a comment on the CY 2007 proposed rates that CMS 
understated the PHP median cost by not using a hospital-specific CCR 
for partial hospitalization. In our response to this comment in the CY 
2007 OPPS/ASC final rule with comment period (71 FR 68000), we noted 
that, although most hospitals do not have a cost center for partial 
hospitalization, we used the CCR as specific to PHP as possible. The 
following CMS Web site contains the revenue-code-to-cost-center 
crosswalk: http://www.cms.hhs.gov/HospitalOutpatientPPS/03_crosswalk.asp#TopOfPage.
    This crosswalk indicates how charges on a claim are mapped to a 
cost center for the purpose of converting charges to cost. One or more 
cost centers are listed for most revenue codes that are used in the 
OPPS median calculations, starting with the most specific, and ending 
with the most general. Typically, we map the revenue code to the most 
specific cost center with a provider-specific CCR. However, if the 
hospital does not have a CCR for any of the listed cost centers, we 
consider the overall hospital CCR as the default. For partial 
hospitalization, the revenue center codes billed by PHPs are mapped to 
Primary Cost Center 3550 ``Psychiatric/Psychological Services''. If 
that cost center is not available, they are mapped to the Secondary 
Cost Center 6000 ``Clinic.'' We use the overall facility CCR for CMHCs 
because PHPs are CMHCs' only Medicare cost, and CMHCs do not have the 
same cost structure as hospitals. Therefore, for CMHCs, we use the CCR 
from the outpatient provider-specific file.
    Closer examination of the revenue-code-to-cost-center crosswalk 
revealed that 10 of the revenue center codes (shown in the table below) 
that are common among hospital based PHP claims did not map to a 
Primary Cost Center 3550 ``Psychiatric/Psychological Services'' or a 
Secondary Cost Center of 6000 ``Clinic.''

------------------------------------------------------------------------
       Revenue center code               Revenue center description
------------------------------------------------------------------------
0430.............................  Occupational Therapy.
0431.............................  Occupational Therapy: Visit charge.
0432.............................  Occupational Therapy: Hourly charge.
0433.............................  Occupational Therapy: Group rate.
0434.............................  Occupational Therapy: Evaluation/re-
                                    evaluation.
0439.............................  Occupational Therapy: Other
                                    occupational therapy.
0904.............................  Psychiatric/Psychological Treatment:
                                    Activity therapy.
0940.............................  Other Therapeutic Services.
0941.............................  Other Therapeutic Services:
                                    Recreation Rx.
0942.............................  Other Therapeutic Services: Education/
                                    training.
------------------------------------------------------------------------

    We believe these 10 revenue center codes did not map to either a 
Primary Cost Center 3550 ``Psychiatric/Psychological Services'' or a 
Secondary Cost Center 6000 ``Clinic'' because these codes may be used 
for services that are not PHP or psychiatric related. For example, many 
Occupational Therapy claims are not furnished to PHP patients and, 
therefore, should be appropriately mapped to a Primary Cost Center 5100 
``Occupation Therapy'' (the general Occupational Therapy Cost Center). 
Another example would be claims for Diabetes Education, which is also 
not furnished to PHP patients.
    In order to more accurately estimate costs for PHP claims, for 
purposes of our analysis, we remapped these 10 revenue center codes to 
a Primary Cost Center 3550 ``Psychiatric/Psychological Services'' or a 
Secondary Cost Center 6000 ``Clinic''. Once we remapped the

[[Page 42692]]

codes, we computed an alternate cost for each line item of the CY 2006 
hospital-based PHP claims. There are a total of 638,652 line items in 
the CY 2006 hospital-based PHP claims. Prior to remapping, there were 
282,871 line items where a default CCR was used to estimate costs. 
After the remapping, there were 141,682 line items left defaulting to 
the hospitals' overall CCR. While this remapping creates a more 
accurate estimate of PHP per diem costs for a significant number of 
claims, there was not a large change in the resulting median per diem 
cost. The median per diem costs for hospital-based PHPs increased by 
$5.20 (from $191.80 to $197).
    As part of our effort to produce the most accurate per diem cost 
estimate, we have reexamined our methodology for computing the PHP per 
diem cost. Section 1833(t)(2)(C) of the Act requires that we establish 
relative payment weights based on median (or mean, at the election of 
the Secretary) hospital costs determined by 1996 claims data and data 
from the most recent available cost reports. As explained in section 
II.B.1 of this proposed rule, payment to providers under OPPS for PHP 
services represents the provider's overhead costs associated with the 
program. Because a day of care is the unit that defines the structure 
and scheduling of partial hospitalization services, we established a 
per diem payment methodology for the PHP APC. Other than being a per 
diem payment, we use the general OPPS ratesetting methodology for 
determining median cost.
    As we have described in prior Federal Register notices, our current 
method for computing per diem costs is as follows: we use data from all 
hospital bills reporting condition code 41, which identifies the claim 
as partial hospitalization, and all bills from CMHCs. We use CCRs from 
the most recently available hospital and CMHC cost reports to convert 
each provider's line-item charges as reported on bills to estimate the 
provider's cost for a day of PHP services. Per diem costs are then 
computed by summing the line-item costs on each bill and dividing by 
the number of days of PHP care provided on the bill. These computed per 
diem costs are arrayed from lowest to highest and the middle value of 
the array is the median per diem cost.
    We have developed an alternate way to determine median cost by 
computing a separate per diem cost for each day rather than for each 
bill. Under this method, a cost is computed separately for each day of 
PHP care. When there are multiple days of care entered on a claim, a 
unique cost is computed for each day of care. All of these costs are 
then arrayed from lowest to highest and the middle value of the array 
would be the median per diem cost.
    We believe this alternative method of computing a per diem median 
cost produces a more accurate estimate because each day gets an equal 
weight towards computing the median. We have considered this 
alternative method for several years, but in light of the volatility of 
the data, we have not believed it would provide a reasonable and 
appropriate median per diem cost. In light of the stabilizing trend in 
the data, and in light of the robustness of recent data analysis, we 
now believe it is appropriate to propose the adoption of this method. 
We believe this method for computing a PHP per diem median cost more 
accurately reflects the costs of a PHP and uses all available PHP data. 
Therefore, for CY 2008, we are proposing to adopt this alternate method 
for computing PHP median per diem costs.
    As noted previously, for the past 2 years, the data have produced 
median costs that we believe were too low to cover the cost of a 
program that typically spans 5 to 6 hours per day. This length of day 
would include 5 or 6 services with a break for lunch. We looked at the 
number of units of service being provided in a day of care, as a 
possible explanation for the low per diem cost for PHP. Our analysis 
revealed that both hospital-based and CMHC PHPs have a significant 
number of days where less than 4 units of service were provided.
    Specifically, 64 percent of the days that CMHCs were paid were for 
days where 3 or less units of services were provided, and 34 percent of 
the days that hospital-based PHPs were paid were for days where 3 or 
less units of service were provided. We believe these findings are 
significant because they may explain a lower per diem cost. Therefore, 
based on these findings, we computed median per diem costs in two 
categories:
    (a) All days.
    (b) Days with 4 units of service or more (removing days with 3 
services or less).
    These median per diem costs were computed separately for CMHCs and 
hospital based PHPs and are shown in the table below:

------------------------------------------------------------------------
                                                              Hospital-
                                                   CMHCs      based PHPs
------------------------------------------------------------------------
All Days......................................         $178         $186
Days with 4 units or more.....................         $191         $218
------------------------------------------------------------------------

    As expected, excluding the low unit days resulted in a higher 
median per diem cost estimate. However, if the programs have many ``low 
unit days,'' their cost and Medicare payment should reflect this level 
of service. It would not be appropriate to set the PHP rate to exclude 
the ``low unit days'' because these days are covered PHP days. We 
believe the analysis of the number of units of service per day supports 
a lower per diem cost. Therefore, including all days supports the data 
trend towards a lower per diem cost and we believe more accurately 
reflects the costs of providing these PHP services.
    Although the minimum number of PHP services required in a PHP day 
is three, it was never our intention that this represented the typical 
number of services to be provided in a typical PHP day. Our intention 
was to cover days that consisted of only three services, generally 
because a patient was transitioning towards discharge. Rather than set 
separate rates for half-days and full-days, we believed it was 
appropriate to set one rate that would be paid for all PHP days, 
including those for patients transitioning towards discharge. We intend 
that the PHP benefit is for a full day, with shorter days only 
occurring while a patient transitions out of the PHP.
    However, as indicated in the data, many programs have these ``low 
unit days,'' and we believe their cost and Medicare payment should 
reflect this level of service. It would not be appropriate to set the 
PHP rate excluding the low unit days because these days are covered. 
Again, we believe the data support the estimated per diem cost under 
$200 that we have observed in the data.
    At this time, we believe the most appropriate payment rate for PHPs 
is computed using both hospital-based and CMHC PHP data, including the 
remapped data for all days, resulting in a median per diem cost of 
$178. Therefore, we are proposing a CY 2008 APC PHP per diem cost of 
$178.
3. Proposed Separate Threshold for Outlier Payments to CMHCs
    In the November 7, 2003 final rule with comment period (68 FR 
63469), we indicated that, given the difference in PHP charges between 
hospitals and CMHCs, we did not believe it was appropriate to make 
outlier payments to CMHCs using the outlier percentage target amount 
and threshold established for hospitals. There was a significant 
difference in the amount of outlier payments made to hospitals and 
CMHCs for PHP. In addition, further analysis indicated that using the 
same OPPS

[[Page 42693]]

outlier threshold for both hospitals and CMHCs did not limit outlier 
payments to high cost cases and resulted in excessive outlier payments 
to CMHCs. Therefore, beginning in CY 2004, we established a separate 
outlier threshold for CMHCs. For CYs 2004 and 2005, we designated a 
portion of the estimated 2.0 percent outlier target amount specifically 
for CMHCs, consistent with the percentage of projected payments to 
CMHCs under the OPPS in each of those years, excluding outlier 
payments. For CY 2006, we set the estimated outlier target at 1.0 
percent and allocated a portion of that 1.0 percent, 0.6 percent (or 
0.006 percent of total OPPS payments), to CMHCs for PHP services. For 
CY 2007, we set the estimated outlier target at 1.0 percent and 
allocated a portion of that 1.0 percent, an amount equal to 0.15 
percent of outlier payments and 0.0015 percent of total OPPS payments 
to CMHCS for PHP service outliers. The CY 2007 CMHC outlier threshold 
is met when the cost of furnishing services by a CMHC exceeds 3.40 
times the PHP APC payment amount. The CY 2007 OPPS outlier payment 
percentage is 50 percent of the amount of costs in excess of the 
threshold.
    The separate outlier threshold for CMHCs became effective January 
1, 2004, and has resulted in more commensurate outlier payments. In CY 
2004, the separate outlier threshold for CMHCs resulted in $1.8 million 
in outlier payments to CMHCs. In CY 2005, the separate outlier 
threshold for CMHCs resulted in $0.5 million in outlier payments to 
CMHCs. In contrast, in CY 2003, more than $30 million was paid to CMHCs 
in outlier payments. We believe this difference in outlier payments 
indicates that the separate outlier threshold for CMHCs has been 
successful in keeping outlier payments to CMHCs in line with the 
percentage of OPPS payments made to CMHCs.
    As noted in section II.G. of this proposed rule, for CY 2008, we 
are proposing to continue our policy of setting aside 1.0 percent of 
the aggregate total payments under the OPPS for outlier payments. We 
are proposing that a portion of that 1.0 percent, an amount equal to 
0.03 percent of outlier payments and 0.0003 percent of total OPPS 
payments, would be allocated to CMHCs for PHP service outliers. As 
discussed in section II.G. of this proposed rule, we again are 
proposing to set a dollar threshold in addition to an APC multiplier 
threshold for OPPS outlier payments. However, because the PHP is the 
only APC for which CMHCs may receive payment under the OPPS, we would 
not expect to redirect outlier payments by imposing a dollar threshold. 
Therefore, we are not proposing to set a dollar threshold for CMHC 
outliers. As noted above, we are proposing to set the outlier threshold 
for CMHCs for CY 2008 at 3.40 times the APC payment amount and the CY 
2008 outlier payment percentage applicable to costs in excess of the 
threshold at 50 percent.

C. Proposed Conversion Factor Update

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Conversion Factor'' at the beginning of your 
comment.)
    Section 1833(t)(3)(C)(ii) of the Act requires us to update the 
conversion factor used to determine payment rates under the OPPS on an 
annual basis. Section 1833(t)(3)(C)(iv) of the Act provides that, for 
CY 2008, the update is equal to the hospital inpatient market basket 
percentage increase applicable to hospital discharges under section 
1886(b)(3)(B)(iii) of the Act.
    The proposed hospital market basket increase for FY 2008 published 
in the IPPS proposed rule on May 3, 2007, is 3.3 percent (72 FR 24835). 
To set the OPPS proposed conversion factor for CY 2008, we increased 
the CY 2007 conversion factor of $61.468, as specified in the CY 2007 
OPPS/ASC final rule with comment period (71 FR 68003), by 3.3 percent.
    In accordance with section 1833(t)(9)(B) of the Act, we further 
adjusted the conversion factor for CY 2007 to ensure that the revisions 
that we are proposing to make to our updates for a revised wage index 
and rural adjustment are made on a budget neutral basis. We calculated 
an overall budget neutrality factor of 1.0025 for wage index changes by 
comparing total payments from our simulation model using the FY 2008 
IPPS proposed wage index values to those payments using the current (FY 
2007) IPPS wage index values. This adjustment reflects an adjustment of 
1.0009 for changes to the wage index and an additional 1.0016 to 
accommodate the IPPS budget neutrality adjustment for inclusion of the 
rural floor. As discussed further in section II.D. of this proposed 
rule, for the first time, the proposed FY 2008 IPPS wage indices 
include a blanket budget neutrality adjustment for including the rural 
floor provision, which previously had been applied to the IPPS 
standardized amount. For further discussion of this proposed policy in 
its entirety, we refer readers to the FY 2008 IPPS proposed rule (72 FR 
24787 through 24792). This proposed adjustment is specific to the IPPS. 
For the OPPS, we have increased the conversion factor by the 
proportional amount of the rural floor budget neutrality adjustment to 
accommodate this proposed change.
    We estimated the rural adjustment for CY 2008 to reflect the 
proposed extension of the adjustment to payment for brachytherapy 
sources as discussed in section II.F.2. of this proposed rule, but as 
the impact of the proposed extension was negligible, we did not change 
the proposed rural adjustment. Therefore, we calculated a budget 
neutrality factor of 1.000 for the rural adjustment. For CY 2008, we 
estimate that allowed pass through spending for both drugs and devices 
would equal approximately $54 million, which represents 0.15 percent of 
total OPPS projected spending for CY 2008. The proposed conversion 
factor also is adjusted by the difference between the 0.21 percent pass 
through dollars set aside in CY 2007 and the 0.15 percent estimate for 
CY 2008 pass through spending. Finally, proposed payments for outliers 
remain at 1.0 percent of total payments for CY 2008.
    The proposed market basket increase update factor of 3.3 percent 
for CY 2008, the required wage index and rural budget neutrality 
adjustment of approximately 1.0025, and the proposed adjustment of 0.06 
percent for the difference in the pass-through set aside result in a 
proposed standard OPPS conversion factor for CY 2008 of $63.693.

D. Proposed Wage Index Changes

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Wage Index'' at the beginning of your comment.)
    Section 1833(t)(2)(D) of the Act requires the Secretary to 
determine a wage adjustment factor to adjust, for geographic wage 
differences, the portion of the OPPS payment rate and the copayment 
standardized amount attributable to labor and labor related cost. Since 
the inception of the OPPS, CMS policy has been to wage adjust 60 
percent of the OPPS payment, based on a regression analysis that 
determined that approximately 60 percent of the costs of services paid 
under the OPPS were attributable to wage costs. We confirmed that this 
labor related share for outpatient services is still appropriate during 
our regression analysis for the payment adjustment for rural hospitals 
in the CY 2006 OPPS final rule with comment period (70 FR 68553). We 
are not proposing to revise this policy for the CY 2008 OPPS. We refer 
readers to section II.H. of this proposed rule for a description and 
example of how the wage index for a

[[Page 42694]]

particular hospital is used to determine the payment for the hospital. 
This adjustment must be made in a budget neutral manner. (As we have 
done in prior years, we are proposing to adopt the final IPPS wage 
indices for the OPPS and to extend these wage indices to hospitals that 
participate in the OPPS but not the IPPS (referred to in this section 
as ``non IPPS'' hospitals).)
    As discussed in section II.A. of this proposed rule, we standardize 
60 percent of estimated costs (labor-related costs) for geographic area 
wage variation using the IPPS pre-reclassified wage indices in order to 
remove the effects of differences in area wage levels in determining 
the national unadjusted OPPS payment rate and the copayment amount.
    As published in the original OPPS April 7, 2000 final rule with 
comment period (65 FR 18545), OPPS has consistently adopted the final 
IPPS wage indices as the wage indices for adjusting the OPPS standard 
payment amounts for labor market differences. Thus, the wage index that 
applies to a particular hospital under the IPPS will also apply to that 
hospital under the OPPS. As initially explained in the September 8, 
1998 OPPS proposed rule, we believed and continue to believe that using 
the IPPS wage index as the source of an adjustment factor for OPPS is 
reasonable and logical, given the inseparable, subordinate status of 
the hospital outpatient within the hospital overall. In accordance with 
section 1886(d)(3)(E) of the Act, the IPPS wage index is updated 
annually. In accordance with our established policy, we are proposing 
to use the final FY 2008 final version of these wage indices to 
determine the wage adjustments for the OPPS payment rate and copayment 
standardized amount that would be published in our final rule with 
comment period for CY 2008.
    We note that the proposed FY 2008 IPPS wage indices continue to 
reflect a number of changes implemented over the past few years as a 
result of the revised Office of Management and Budget (OMB) standards 
for defining geographic statistical areas, the implementation of an 
occupational mix adjustment as part of the wage index, wage adjustments 
provided for under Pub. L. 105-33 and Pub. L. 108-173, and 
clarification of our policy for multicampus hospitals. The following is 
a brief summary of the components of the proposed FY 2008 IPPS wage 
indices and any adjustments that we are proposing to apply to the OPPS 
for CY 2008. We refer the reader to the FY 2008 IPPS proposed rule (72 
FR 24776 through 24802) for a detailed discussion of the changes to the 
wage indices and to the correction notice to the FY 2008 IPPS proposed 
rule published in the Federal Register on June 7, 2007 (72 FR 31507). 
In this proposed rule, we are not reprinting the proposed FY 2008 IPPS 
wage indices referenced in the discussion below, with the exception of 
the out-migration wage adjustment table (Addendum L to this proposed 
rule). We also refer readers to the CMS Web site for the OPPS at http://www.cms.hhs.gov/providers/hopps. At this Web site, the reader will 
find a link to the proposed FY 2008 IPPS wage indices tables and to 
those tables as corrected in the correction notice to the FY 2008 IPPS 
proposed rule published in the Federal Register on June 7, 2007.
    1. The proposed continued use of the Core Based Statistical Areas 
(CBSAs) issued by the OMB as revised standards for designating 
geographical statistical areas based on the 2000 Census data, to define 
labor market areas for hospitals for purposes of the IPPS wage index. 
The OMB revised standards were published in the Federal Register on 
December 27, 2000 (65 FR 82235), and OMB announced the new CBSAs on 
June 6, 2003, through an OMB bulletin. In the FY 2005 IPPS final rule, 
CMS adopted the new OMB definitions for wage index purposes. In the FY 
2008 IPPS proposed rule, we again stated that hospitals located in 
Metropolitan Statistical Areas (MSAs) will be urban and hospitals that 
are located in Micropolitan Areas or outside CBSAs will be rural. We 
also reiterated our policy that when an MSA is divided into one or more 
Metropolitan Divisions, we use the Metropolitan Division for purposes 
of defining the boundaries of a particular labor market area. To help 
alleviate the decreased payments for previously urban hospitals that 
became rural under the new geographical definitions, we allowed these 
hospitals to maintain for the 3-year period from FY 2005 through FY 
2007, the wage index of the MSA where they previously had been located. 
This hold harmless provision expires after FY 2007. We adopted the same 
policy for OPPS, but because the OPPS operates on a calendar year, wage 
index policies are in effect through December 31, 2007. To be 
consistent with the IPPS, as proposed in the FY 2008 IPPS proposed 
rule, beginning in CY 2008 (January 1, 2008) under the OPPS, these 
hospitals will receive their statewide rural wage index. Hospitals paid 
under the IPPS are eligible to apply for reclassification in FY 2008.
    As noted above, for purposes of estimating an adjustment for the 
OPPS payment rates to accommodate geographic differences in labor costs 
in this proposed rule, we have used the wage indices identified in the 
FY 2008 IPPS proposed rule and as corrected in the June 7, 2007 
correction notice to the FY 2008 IPPS proposed rule, that are fully 
adjusted for differences in occupational mix using the entire 6-month 
survey data collected in 2006.
    2. The reclassifications of hospitals to geographic areas for 
purposes of the wage index. For purposes of the OPPS wage index, we are 
proposing to adopt all of the IPPS reclassifications for FY 2008, 
including reclassifications that the Medicare Geographic Classification 
Review Board (MGCRB) approved. We note that reclassifications under 
section 508 of Pub. L. 108-173 were set to terminate March 31, 2007. 
However, section 106(a) of the MIEA-TRHCA extended any geographic 
reclassifications of hospitals that were made under section 508 and 
that would expire on March 31, 2007 until September 30, 2007. On March 
23, 2007, we published a notice in the Federal Register (72 FR 13799) 
that indicated how we are implementing section 106 of the MIEA-TRHCA 
through September 30, 2007. Because the section 508 provision will 
expire on September 30, 2007, the OPPS wage index will not include any 
reclassifications under section 508 for CY 2008.
    3. The out-migration wage adjustment to the wage index. In the FY 
2008 IPPS proposed rule (72 FR 24798 through 24799), we discussed the 
out-migration adjustment under section 505 of Pub. L. 108-173 for 
counties under this adjustment. Hospitals paid under the IPPS located 
in the qualifying section 505 ``out-migration'' counties receive a wage 
index increase unless they have already been otherwise reclassified. We 
note that in the FY 2008 IPPS proposed rule, we propose using the post-
reclassified, rather than the pre-reclassified wage indices, in 
calculating the out-migration adjustment. (See the FY 2008 IPPS 
proposed rule for further information on the out-migration adjustment.) 
For OPPS purposes, we are proposing to continue our policy in CY 2008 
to allow non IPPS hospitals paid under the OPPS to qualify for the out-
migration adjustment if they are located in a section 505 out-migration 
county. Because non-IPPS hospitals cannot reclassify, they are eligible 
for the out migration wage adjustment. Table 4J published in the 
addendum to the FY 2008 IPPS proposed rule and as corrected in the June 
7, 2007 correction notice to the FY 2008 IPPS proposed rule identifies 
counties eligible for the out-migration adjustment. As stated earlier, 
we are reprinting the corrected

[[Page 42695]]

version of Table 4J in this proposed rule as Addendum L.
    4. Wage Index for Multicampus Hospitals. We also wish to clarify 
that the IPPS policy for multicampus wage index payments also applies 
to OPPS. As a result of the new labor market areas introduced in FY 
2005, there are hospitals with multiple campuses previously located in 
a single MSA that are now in more than one CBSA. A multicampus hospital 
is an integrated institution. For this reason, the multicampus hospital 
has one provider number and submits a single cost report that combines 
the total wages and hours of each of its campuses in the manner 
described in the FY 2008 IPPS proposed rule (72 FR 24783).
    In the FY 2008 IPPS proposed rule, we proposed to apportion wages 
and hours across multiple campuses using full-time equivalent (FTE) 
staff data in order to include wage data for the individual campuses of 
a multicampus hospital in its local wage index calculation. To the 
extent that a multicampus hospital system has associated outpatient 
facilities, we would expect the FTEs for those outpatient facilities to 
be included in the FTE estimate for the closest inpatient facility. As 
part of this policy, we would fully expect that an OPD that is part of 
a multicampus hospital system would receive a wage index based on the 
geographic location of the inpatient campus with which it is 
associated. This would include cases where one inpatient campus 
reclassified. Affiliated outpatient facilities would receive the 
reclassified wage index of the inpatient campus. For further discussion 
of the FY 2008 IPPS proposed multicampus hospital policy in its 
entirety, we refer readers to the FY 2008 IPPS proposed rule (72 FR 
24783 through 24784).
    5. Rural Floor Provision. Section 4410 of Pub. L. 105-33 provides 
that the area wage index applicable to any hospital that is located in 
an urban area of a State may not be less than the area wage index 
applicable to hospitals located in rural areas of the State (``the 
rural floor''). Table 4A in the FY 2008 IPPS proposed rule (72 FR 
24924), as corrected in the June 7, 2007 correction notice (72 FR 
31507), identifies urban areas where hospitals located in those areas 
are assigned the rural floor (noted by a superscript ``2''). For CY 
2008 under the OPPS, we are proposing to continue our policy to allow 
non-IPPS hospitals paid under the OPPS to receive the rural floor wage 
index when applicable under the IPPS for FY 2008. For the first time, 
the proposed FY 2008 IPPS wage indices include a blanket budget 
neutrality adjustment for including the rural floor provision, which 
previously had been applied to the IPPS standardized amount. For 
further discussion of this proposed policy in its entirety, we refer 
readers to the FY 2008 IPPS proposed rule (72 FR 24787 through 24792).
    We note that all changes to the wage index resulting from 
geographic labor market area reclassifications or other adjustments 
must be incorporated in a budget neutral manner. Accordingly, in 
calculating the OPPS budget neutrality estimates for CY 2008, in this 
proposed rule, we have included the wage index changes that would 
result from the MGCRB reclassifications, implementation of sections 
4410 of Pub. L. 105-33 and 505 of Pub. L. 108-173, and other 
refinements proposed in the FY 2008 IPPS proposed rule. For the CY 2008 
OPPS final rule, we are proposing to use the final FY 2008 IPPS wage 
indices, including the budget neutrality adjustment for the rural floor 
for calculating OPPS payment in CY 2008. We discuss how the proposed 
OPPS conversion factor compensates for the inclusion of this budget 
neutrality adjustment in the wage indices in the budget neutrality 
section (II.C.) of this proposed rule.

E. Proposed Statewide Average Default CCRs

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Statewide Cost-to Charge Ratios'' at the beginning 
of your comment.)
    CMS uses CCRs to determine outlier payments, payments for pass-
through devices, and monthly interim transitional corridor payments 
under the OPPS. Some hospitals do not have a valid CCR. These hospitals 
include, but are not limited to, hospitals that are new and have not 
yet submitted a cost report, hospitals that have a CCR that falls 
outside predetermined floor and ceiling thresholds for a valid CCR, or 
hospitals that have recently given up their all-inclusive rate status. 
Last year, we updated the default urban and rural CCRs for CY 2007 in 
our final rule with comment period (71 FR 68006 through 68009). In this 
proposed rule, we are proposing to update the default ratios for CY 
2008 using the most recent cost report data.
    We calculated the statewide default CCRs using the same overall 
CCRs that we use to adjust charges to costs on claims data. Table 25 
lists the proposed CY 2008 default urban and rural CCRs by State and 
compares them to last year's default CCRs. These CCRs are the ratio of 
total costs to total charges from each provider's most recently 
submitted cost report, for those cost centers relevant to outpatient 
services weighted by Medicare Part B charges. We also adjusted these 
ratios to reflect final settled status by applying the differential 
between settled to submitted costs and charges from the most recent 
pair of settled to submitted cost reports.
    For this proposed rule, 78.17 percent of the submitted cost reports 
represented data for CY 2005. We only used valid CCRs to calculate 
these default ratios. That is, we removed the CCRs for all-inclusive 
hospitals, CAHs, and hospitals in Guam, and the U.S. Virgin Islands, 
American Samoa, and the Northern Mariana Islands because these entities 
are not paid under the OPPS, or in the case of all-inclusive hospitals, 
because their CCRs are suspect. We further identified and removed any 
obvious error CCRs and trimmed any outliers. We limited the hospitals 
used in the calculation of the default CCRs to those hospitals that 
billed for services under the OPPS during CY 2006.
    Finally, we calculated an overall average CCR, weighted by a 
measure of volume for CY 2006, for each state except Maryland. This 
measure of volume is the total lines on claims and is the same one that 
we use in our impact tables. For Maryland, we used an overall weighted 
average CCR for all hospitals in the nation as a substitute for 
Maryland CCRs. Few providers in Maryland are eligible to receive 
payment under the OPPS, which limits the data available to calculate an 
accurate and representative CCR. The observed differences between last 
year's and this year's default statewide CCRs largely reflect a general 
decline in the ratio between costs and charges widely observed in the 
cost report data. However, observed increases in some areas suggest 
that the decline in CCRs is moderating. Further, the addition of 
weighting by Part B charges to the overall CCR in CY 2007 slightly 
increases the variability of the overall CCR calculation.
    As stated above, CMS uses default statewide CCRs for several groups 
of hospitals, including, but not limited to, hospitals that are new and 
have not yet submitted a cost report, hospitals that have a CCR that 
falls outside predetermined floor and ceiling thresholds for a valid 
CCR, and hospitals that have recently given up their all-inclusive rate 
status. Current OPPS policy also requires hospitals that experience a 
change of ownership, but that do not accept assignment of the previous 
hospital's provider agreement, to use the previous provider's CCR.

[[Page 42696]]

    For CY 2008, we are proposing to continue to apply this treatment 
of using the default statewide CCR, to include an entity that has not 
accepted assignment of an existing hospital's provider agreement in 
accordance with Sec.  489.18, and that has not yet submitted its first 
Medicare cost report. This policy is effective for hospitals 
experiencing a change of ownership on or after January 1, 2007. As 
stated in the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68006), we believe that a hospital that has not accepted assignment of 
an existing hospital's provider agreement is similar to a new hospital 
that will establish its own costs and charges. We also believe that the 
hospital that has chosen not to accept assignment may have different 
costs and charges than the existing hospital. Furthermore, we believe 
that the hospital should be provided time to establish its own costs 
and charges. Therefore, we are proposing to use the default statewide 
CCR to determine cost-based payments until the hospital has submitted 
its first Medicare cost report.

                               Table 25.--Proposed CY 2008 Statewide Average CCRs
----------------------------------------------------------------------------------------------------------------
                                                                                                     Previous
                                                                                    Proposed CY     default CCR
                   State                                 Rural/urban               2008 default    (CY 2007 OPPS
                                                                                        CCR         final rule)
----------------------------------------------------------------------------------------------------------------
ALASKA.....................................  RURAL..............................          0.5389          0.5337
ALASKA.....................................  URBAN..............................          0.3851          0.3830
ALABAMA....................................  RURAL..............................          0.2317          0.2321
ALABAMA....................................  URBAN..............................          0.2198          0.2228
ARKANSAS...................................  RURAL..............................          0.2660          0.2645
ARKANSAS...................................  URBAN..............................          0.2776          0.2749
ARIZONA....................................  RURAL..............................          0.2770          0.2823
ARIZONA....................................  URBAN..............................          0.2360          0.2323
CALIFORNIA.................................  RURAL..............................          0.2305          0.2463
CALIFORNIA.................................  URBAN..............................          0.2260          0.2324
COLORADO...................................  RURAL..............................          0.3677          0.3704
COLORADO...................................  URBAN..............................          0.2578          0.2672
CONNECTICUT................................  RURAL..............................          0.3888          0.3886
CONNECTICUT................................  URBAN..............................          0.3481          0.3491
DISTRICT OF COLUMBIA.......................  URBAN..............................          0.3364          0.3392
DELAWARE...................................  RURAL..............................          0.3192          0.3230
DELAWARE...................................  URBAN..............................          0.3952          0.3953
FLORIDA....................................  RURAL..............................          0.2175          0.2191
FLORIDA....................................  URBAN..............................          0.1985          0.1990
GEORGIA....................................  RURAL..............................          0.2842          0.2846
GEORGIA....................................  URBAN..............................          0.2786          0.2888
HAWAII.....................................  RURAL..............................          0.3781          0.3574
HAWAII.....................................  URBAN..............................          0.3171          0.3199
IOWA.......................................  RURAL..............................          0.3499          0.3489
IOWA.......................................  URBAN..............................          0.3379          0.3428
IDAHO......................................  RURAL..............................          0.4369          0.4360
IDAHO......................................  URBAN..............................          0.4097          0.4159
ILLINOIS...................................  RURAL..............................          0.2910          0.3082
ILLINOIS...................................  URBAN..............................          0.2812          0.2878
INDIANA....................................  RURAL..............................          0.3207          0.3160
INDIANA....................................  URBAN..............................          0.3155          0.3204
KANSAS.....................................  RURAL..............................          0.3201          0.3200
KANSAS.....................................  URBAN..............................          0.2466          0.2523
KENTUCKY...................................  RURAL..............................          0.2480          0.2508
KENTUCKY...................................  URBAN..............................          0.2666          0.2698
LOUISIANA..................................  RURAL..............................          0.2727          0.2808
LOUISIANA..................................  URBAN..............................          0.2842          0.2730
MARYLAND...................................  RURAL..............................          0.2924          0.3181
MARYLAND...................................  URBAN..............................          0.3140          0.2978
MASSACHUSETTS..............................  URBAN..............................          0.3466          0.3487
MAINE......................................  RURAL..............................          0.4580          0.4568
MAINE......................................  URBAN..............................          0.4261          0.4294
MICHIGAN...................................  RURAL..............................          0.3354          0.3461
MICHIGAN...................................  URBAN..............................          0.3272          0.3286
MINNESOTA..................................  RURAL..............................          0.5094          0.5085
MINNESOTA..................................  URBAN..............................          0.3452          0.3383
MISSOURI...................................  RURAL..............................          0.2916          0.2944
MISSOURI...................................  URBAN..............................          0.2977          0.3034
MISSISSIPPI................................  RURAL..............................          0.2820          0.2841
MISSISSIPPI................................  URBAN..............................          0.2300          0.2312
MONTANA....................................  RURAL..............................          0.4664          0.4392
MONTANA....................................  URBAN..............................          0.4646          0.4628
NORTH CAROLINA.............................  RURAL..............................          0.3007          0.3048
NORTH CAROLINA.............................  URBAN..............................          0.3580          0.3700
NORTH DAKOTA...............................  RURAL..............................          0.3831          0.3668
NORTH DAKOTA...............................  URBAN..............................          0.3842          0.3945
NEBRASKA...................................  RURAL..............................          0.3561          0.3756

[[Page 42697]]

 
NEBRASKA...................................  URBAN..............................          0.2832          0.2899
NEW HAMPSHIRE..............................  RURAL..............................          0.3646          0.3700
NEW HAMPSHIRE..............................  URBAN..............................          0.3217          0.3249
NEW JERSEY.................................  URBAN..............................          0.2908          0.2972
NEW MEXICO.................................  RURAL..............................          0.2759          0.2741
NEW MEXICO.................................  URBAN..............................          0.3691          0.3978
NEVADA.....................................  RURAL..............................          0.3370          0.3348
NEVADA.....................................  URBAN..............................          0.1949          0.2141
NEW YORK...................................  RURAL..............................          0.4210          0.4446
NEW YORK...................................  URBAN..............................          0.4177          0.4275
OHIO.......................................  RURAL..............................          0.3629          0.3689
OHIO.......................................  URBAN..............................          0.2760          0.2834
OKLAHOMA...................................  RURAL..............................          0.2874          0.2949
OKLAHOMA...................................  URBAN..............................          0.2517          0.2608
OREGON.....................................  RURAL..............................          0.3344          0.3438
OREGON.....................................  URBAN..............................          0.3899          0.4054
PENNSYLVANIA...............................  RURAL..............................          0.2980          0.3052
PENNSYLVANIA...............................  URBAN..............................          0.2448          0.2524
PUERTO RICO................................  URBAN..............................          0.4718          0.4689
RHODE ISLAND...............................  URBAN..............................          0.3085          0.3087
SOUTH CAROLINA.............................  RURAL..............................          0.2589          0.2546
SOUTH CAROLINA.............................  URBAN..............................          0.2563          0.2479
SOUTH DAKOTA...............................  RURAL..............................          0.3517          0.3479
SOUTH DAKOTA...............................  URBAN..............................          0.2918          0.3035
TENNESSEE..................................  RURAL..............................          0.2607          0.2648
TENNESSEE..................................  URBAN..............................          0.2514          0.2491
TEXAS......................................  RURAL..............................          0.2823          0.2891
TEXAS......................................  URBAN..............................          0.2495          0.2580
UTAH.......................................  RURAL..............................          0.4320          0.4410
UTAH.......................................  URBAN..............................          0.4218          0.4161
VIRGINIA...................................  RURAL..............................          0.2788          0.2821
VIRGINIA...................................  URBAN..............................          0.2789          0.2805
VERMONT....................................  RURAL..............................          0.4329          0.4325
VERMONT....................................  URBAN..............................          0.3401          0.3376
WASHINGTON.................................  RURAL..............................          0.3796          0.3742
WASHINGTON.................................  URBAN..............................          0.3574          0.3717
WISCONSIN..................................  RURAL..............................          0.3633          0.3670
WISCONSIN..................................  URBAN..............................          0.3648          0.3638
WEST VIRGINIA..............................  RURAL..............................          0.3134          0.3162
WEST VIRGINIA..............................  URBAN..............................          0.3677          0.3691
WYOMING....................................  RURAL..............................          0.4655          0.4714
WYOMING....................................  URBAN..............................          0.3592          0.3520
----------------------------------------------------------------------------------------------------------------

F. Proposed OPPS Payments to Certain Rural Hospitals

1. Hold Harmless Transitional Payment Changes Made by Pub. L. 109-171 
(DRA)
    (If you choose to comment on issues in this section, please include 
the caption ``Rural Hospital Hold Harmless Transitional Payments'' at 
the beginning of your comment.)
    When the OPPS was implemented, every provider was eligible to 
receive an additional payment adjustment (transitional corridor 
payment) if the payments it received for covered OPD services under the 
OPPS were less than the payments it would have received for the same 
services under the prior reasonable cost-based system. Section 
1833(t)(7) of the Act provides that the transitional corridor payments 
are temporary payments for most providers, with two exceptions, to ease 
their transition from the prior reasonable cost-based payment system to 
the OPPS system. Cancer hospitals and children's hospitals receive the 
transitional corridor payments on a permanent basis. Section 
1833(t)(7)(D)(i) of the Act originally provided for transitional 
corridor payments to rural hospitals with 100 or fewer beds for covered 
OPD services furnished before January 1, 2004. However, section 411 of 
Pub. L. 108-173 amended section 1833(t)(7)(D)(i) of the Act to extend 
these payments through December 31, 2005, for rural hospitals with 100 
or fewer beds. Section 411 also extended the transitional corridor 
payments to SCHs located in rural areas for services furnished during 
the period that begins with the provider's first cost reporting period 
beginning on or after January 1, 2004, and ends on December 31, 2005. 
Accordingly, the authority for making transitional corridor payments 
under section 1833(t)(7)(D)(i) of the Act, as amended by section 411 of 
Pub. L. 108-173, expired for rural hospitals having 100 or fewer beds 
and SCHs located in rural areas on December 31, 2005.
    Section 5105 of Pub. L. 109-171 reinstituted the hold harmless 
transitional outpatient payments (TOPs) for covered OPD services 
furnished on or after January 1, 2006, and before January 1, 2009, for 
rural hospitals having 100 or fewer beds that are not SCHs. When the 
OPPS payment is less than the payment the provider would have received 
under the previous

[[Page 42698]]

reasonable cost-based system, the amount of payment is increased by 95 
percent of the amount of the difference between those two payment 
systems for CY 2006, by 90 percent of the amount of that difference for 
CY 2007, and by 85 percent of the amount of that difference for CY 
2008.
    For CY 2006, we implemented section 5105 of Pub. L. 109-171 through 
Transmittal 877, issued on February 24, 2006. We did not specifically 
address whether TOPs payments apply to essential access community 
hospitals (EACHs), which are considered to be SCHs under section 
1886(d)(5)(D)(iii)(III) of the Act. Accordingly, under the statute, 
EACHs are treated as SCHs. Therefore, we believe that EACHs are not 
currently eligible for TOPs payment under Pub. L. 109-171. In the CY 
2007 OPPS/ASC final rule with comment period, we updated Sec.  
419.70(d) to reflect the requirements of Pub. L. 109 171 (71 FR 68010 
and 68228).
    2. Proposed Adjustment for Rural SCHs Implemented in CY 2006 
Related to Public Law 108-173 (MMA)
    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Rural SCH Payments'' at the beginning of your 
comment.)
    In the CY 2006 OPPS final rule with comment period (70 FR 68556), 
we finalized a payment increase for rural SCHs of 7.1 percent for all 
services and procedures paid under the OPPS, excluding drugs, 
biologicals, brachytherapy seeds, and services paid under pass-through 
payment policy in accordance with section 1833(t)(13)(B) of the Act, as 
added by section 411 of Pub. L. 108 173. Section 411 gave the Secretary 
the authority to make an adjustment to OPPS payments for rural 
hospitals, effective January 1, 2006, if justified by a study of the 
difference in costs by APC between hospitals in rural and urban areas. 
Our analysis showed a difference in costs only for rural SCHs and we 
implemented a payment adjustment for those hospitals beginning January 
1, 2006.
    Last year, we became aware that we did not specifically address 
whether the adjustment applies to EACHs, which are considered to be 
SCHs under section 1886(d)(5)(D)(iii)(III) of the Act. Thus, under the 
statute, EACHs are treated as SCHs. Currently, fewer than 10 hospitals 
are classified as EACHs. As of CY 1998, under section 4201(c) of Pub. 
L. 105-33, a hospital can no longer become newly classified as an EACH. 
Therefore, in the CY 2007 OPPS/ASC final rule with comment period for 
purposes of receiving this rural adjustment, we revised Sec.  419.43(g) 
to clarify that EACHs are also eligible to receive the rural SCH 
adjustment, assuming these entities otherwise meet the rural adjustment 
criteria (71 FR 68010 and 68227).
    This adjustment is budget neutral and applied before calculating 
outliers and coinsurance. As stated in the CY 2006 OPPS final rule with 
comment period (70 FR 68560), we would not reestablish the adjustment 
amount on an annual basis, but we might review the adjustment in the 
future and, if appropriate, would revise the adjustment.
    For CY 2008, we are proposing to continue our current policy of a 
budget neutral 7.1 percent payment increase for rural SCHs, including 
EACHs, for all services and procedures paid under the OPPS, excluding 
drugs, biologicals, and services paid under the pass-through payment 
policy in accordance with section 1833(t)(13)(B) of the Act. For CY 
2008, we are proposing to include brachytherapy sources in the group of 
services eligible for the 7.1 percent payment increase because we are 
proposing to pay them at prospective rates based on their median costs 
as calculated from historical claims data. Consequently, we are 
proposing to revise Sec.  419.43 to reflect our proposal to make 
brachytherapy sources eligible for the 7.1 percent payment increase for 
rural SCHs. We plan to reassess the 7.1 percent adjustment in the near 
future by examining differences between urban and rural costs using 
updated claims, cost, and provider information. In that process, we 
will include brachytherapy sources in each hospital's mix of services.

G. Proposed Hospital Outpatient Outlier Payments

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Outlier Payments'' at the beginning of your 
comment.)
    Currently, the OPPS pays outlier payments on a service-by-service 
basis. For CY 2007, the outlier threshold is met when the cost of 
furnishing a service or procedure by a hospital exceeds 1.75 times the 
APC payment amount and exceeds the APC payment rate plus a $1,825 
fixed-dollar threshold. We introduced a fixed-dollar threshold in CY 
2005 in addition to the traditional multiple threshold in order to 
better target outliers to those high cost and complex procedures where 
a very costly service could present a hospital with significant 
financial loss. If a provider meets both of these conditions, the 
multiple threshold and the fixed-dollar threshold, the outlier payment 
is calculated as 50 percent of the amount by which the cost of 
furnishing the service exceeds 1.75 times the APC payment rate.
    As explained in the CY 2007 OPPS/ASC final rule with comment period 
(71 FR 68011 through 68012), we set our projected target for aggregate 
outlier payments at 1.0 percent of aggregate total payments under the 
OPPS for CY 2007. The outlier thresholds were set so that estimated CY 
2007 aggregate outlier payments would equal 1.0 percent of aggregate 
total payments under the OPPS. In that final rule with comment period 
(71 FR 68010), we also published total outlier payments as a percent of 
total expenditures for CY 2005. In the past, we have received comments 
asking us to publish estimated outlier payments to provide a context 
for the proposed outlier thresholds for the update year. Our current 
estimate, using available CY 2006 claims, is that outlier payments for 
CY 2006 would be approximately 1.1 percent of total CY 2006 OPPS 
payment. Using the same set of claims and CY 2007 payment rates, we 
currently estimate that outlier payments for CY 2007 would be 
approximately 1.0 percent of total CY 2007 OPPS payments. We note that 
we provide estimated CY 2008 outlier payments by hospital for hospitals 
with claims included in the claims data that we used to model impacts 
on the CMS Web site in the Hospital Specific Impacts--Provider-Specific 
Data file on the CMS Web site at: http://www.cms.hhs.gov/HospitalOutpatientPPS/.
    For CY 2008, we are proposing to continue our policy of setting 
aside 1.0 percent of aggregate total payments under the OPPS for 
outlier payments. We are proposing that a portion of that 1.0 percent, 
0.03 percent, would be allocated to CMHCs for partial hospitalization 
program service outliers. This amount is the amount of estimated 
outlier payments resulting from the proposed CMHC outlier threshold of 
3.4 times the APC payment rate, as a proportion of all payments 
dedicated to outlier payments. For further discussion of CMHC outliers, 
we refer readers to section II.B.3. of this proposed rule.
    In order to ensure that estimated CY 2008 aggregate outlier 
payments would equal 1.0 percent of estimated aggregate total payments 
under the OPPS, we are proposing that the outlier threshold be set so 
that outlier payments would be triggered when the cost of furnishing a 
service or procedure by a hospital exceeds 1.75 times the APC payment 
amount and exceeds the APC payment rate plus a $2,000 fixed-dollar 
threshold. This proposed threshold reflects minor changes to the

[[Page 42699]]

methodology discussed below as well as APC recalibration, including 
changes due in part to the CY 2008 packaging proposal discussed in 
section II.A.4. of this proposed rule.
    We calculated the fixed-dollar threshold for this CY 2008 proposed 
rule using largely the same methodology as we did in CY 2007, except 
that we are proposing to adjust the overall CCRs to reflect the 
anticipated annual decline in overall CCRs, discussed below, and to use 
CCRs from the most recent update to the Outpatient Provider-Specific 
File (OPSF), rather than CCRs we calculate internally for ratesetting. 
In November 2006, we issued Transmittal 1030, ``Policy Changes to the 
Fiscal Intermediary (FI) Calculation of Hospital Outpatient Payment 
System (OPPS) and Community Mental Health Center (CMHC) Cost-to-Charge 
Ratios (CCRs),'' instructing fiscal intermediaries (or, if applicable, 
the MAC) to update the overall CCR calculation for outlier and other 
cost-based payments using the CCR calculation methodology that we 
finalized for CY 2007. As discussed in the CY 2007 proposed and final 
rules, this methodology aligned the fiscal intermediary's CCR 
calculation and the CCR calculation we previously used to model outlier 
thresholds by removing allied and nursing health costs for those 
hospitals with paramedical education programs from the fiscal 
intermediary's CCR calculation and weighting our ``traditional'' CCR 
calculation by total Medicare Part B charges. We believe that the OPSF 
best estimates the CCRs that fiscal intermediaries (or, if applicable, 
MAC) would use to determine outlier payments in CY 2008. For this 
proposed rule, we used the April update to the OPSF. We supplemented a 
CCR calculated internally for the handful of providers with claims in 
our claims dataset that were not listed in the April update to the 
OPSF.
    The claims that we use to model each OPPS update lag by 2 years. 
For this proposed rule, we used CY 2006 claims to model the CY 2008 
OPPS. In order to estimate CY 2008 outlier payments for this proposed 
rule, we inflated the charges on the CY 2006 claims using the same 
inflation factor of 1.1504 that we used to estimate the IPPS fixed 
dollar outlier threshold for the FY 2008 IPPS proposed rule. For 1 
year, the inflation factor is 1.0726. The methodology for determining 
this charge inflation factor was discussed in the FY 2008 IPPS proposed 
rule (72 FR 24837). As we stated in the CY 2005 OPPS final rule with 
comment period, we believe that the use of this charge inflation factor 
is appropriate for the OPPS because, with the exception of the routine 
service cost centers, hospitals use the same cost centers to capture 
costs and charges across inpatient and outpatient services (69 FR 
65845).
    In comments on the CY 2007 OPPS/ASC proposed rule, a commenter 
asked that CMS modify the charge methodology used to set the OPPS 
outlier threshold to account for the change in CCRs over time in a 
manner similar to that used for the FY 2007 IPPS. The commenter 
indicated that it would be appropriate to apply an inflation adjustment 
factor so that the CCRs that CMS uses to simulate OPPS outlier payments 
would more closely reflect the CCRs that would be used in CY 2007 to 
determine actual outlier payment. In the CY 2007 OPPS/ASC final rule 
with comment period, we expressed concern that cost increases between 
inpatient and outpatient departments could be different and indicated 
that we would study the issue and address any changes to the outlier 
methodology through future rulemaking (71 FR 68012).
    In assessing the possibility of utilizing a cost inflation 
adjustment for the OPPS, we determined that we could not calculate an 
OPPS-specific reliable cost per unit, comparable to the cost per 
discharge component of the IPPS calculation, because of variability in 
definition of an OPPS unit of service across calendar years. However, 
we also believe that the costs and charges reported under the 
applicable cost centers largely are commingled inpatient and outpatient 
costs and charges. Notwithstanding fairly accurate estimates of outlier 
payments as a percent of total payments over the past few years, as 
discussed above, we do not want to systematically overestimate the OPPS 
outlier threshold as could occur if we did not apply a CCR inflation 
adjustment factor. Therefore, we are proposing to apply the CCR 
inflation adjustment factor that is proposed to be applied for IPPS 
outlier calculation to the CCRs used to simulate the CY 2008 OPPS 
outlier payments that determine the fixed dollar threshold. 
Specifically, for CY 2008, we are proposing to apply an adjustment of 
0.9912 to the CCRs that are currently on the OPSF to trend them forward 
from CY 2007 to CY 2008. The methodology for calculating this 
adjustment is discussed in the FY 2008 IPPS proposed rule (72 FR 
24837).
    Therefore, for this CY 2008 proposed rule, we applied the overall 
CCRs from the April 2007 OPSF file after adjustment to approximate CY 
2008 CCRs (using the proposed CCR inflation adjustment factor of 
0.9912) to charges on CY 2006 claims that were adjusted to approximate 
CY 2008 charges (using the proposed charge inflation factor of 1.1504). 
We simulated aggregated CY 2008 outlier payments using these costs for 
several different fixed-dollar thresholds, holding the 1.75 multiple 
constant and assuming that outlier payment would continue to be made at 
50 percent of the amount by which the cost of furnishing the service 
would exceed 1.75 times the APC payment amount, until the total outlier 
payments equaled 1.0 percent of aggregated estimated total CY 2008 OPPS 
payments. We estimate that a proposed fixed dollar threshold of $2,000, 
combined with the proposed multiple threshold of 1.75 times the APC 
payment rate, would allocate 1.0 percent of aggregated total OPPS 
payments to outlier payments. We are proposing to continue to make an 
outlier payment that equals 50 percent of the amount by which the cost 
of furnishing the service exceeds 1.75 times the APC payment amount 
when both the 1.75 multiple threshold and the fixed dollar $2,000 
threshold are met. For CMHCs, if a CMHC provider's cost for partial 
hospitalization exceeds 3.4 times the payment rate for APC 0033, the 
outlier payment is calculated as 50 percent of the amount by which the 
cost exceeds 3.4 times the APC payment rate.

H. Calculation of the Proposed National Unadjusted Medicare Payment

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: National Unadjusted Medicare Payment'' at the 
beginning of your comment.)
    The basic methodology for determining prospective payment rates for 
OPD services under the OPPS is set forth in existing regulations at 
Sec.  419.31 and Sec.  419.32. The payment rate for services and 
procedures for which payment is made under the OPPS is the product of 
the conversion factor calculated in accordance with section II.C. of 
this proposed rule and the relative weight determined under section 
II.A. of this proposed rule. Therefore, the national unadjusted payment 
rate for each APC contained in Addendum A to this proposed rule and for 
HCPCS codes to which payment under the OPPS has been assigned in 
Addendum B to this proposed rule (Addendum B is provided as a 
convenience for readers) was calculated by multiplying the proposed CY 
2008 scaled weight for the APC by the proposed CY 2008 conversion 
factor.
    However, to determine the payment that will be made in a calendar 
year under the OPPS to a specific hospital for

[[Page 42700]]

an APC for a service that has a status indicator of ``S,'' ``T,'' 
``V,'' or ``X'' in a circumstance in which the multiple procedure 
discount does not apply, we take the following steps:
    Step 1. Calculate 60 percent (the labor-related portion) of the 
national unadjusted payment rate. Since the initial implementation of 
the OPPS, we have used 60 percent to represent our estimate of that 
portion of costs attributable, on average, to labor. (We refer readers 
to the April 7, 2000 final rule with comment period (65 FR 18496 
through 18497) for a detailed discussion of how we derived this 
percentage.) We confirmed that this labor-related share for hospital 
outpatient services is still appropriate during our regression analysis 
for the payment adjustment for rural hospitals in the CY 2006 OPPS 
final rule with comment period (70 FR 68553).
    Step 2. Determine the wage index area in which the hospital is 
located and identify the wage index level that applies to the specific 
hospital. The wage index values assigned to each area reflect the new 
geographic statistical areas as a result of revised OMB standards 
(urban and rural) to which hospitals are assigned for FY 2008 under the 
IPPS, reclassifications through the MCGRB, section 1886(d)(8)(B) 
``Lugar'' hospitals, and section 401 of Pub. L. 108-173. We note that 
the reclassifications of hospitals under the one-time appeals process 
under section 508 of Pub. L. 108-173 expires on September 30, 2007, and 
is no longer applicable in this determination of appropriate wage 
values for CY 2008 OPPS. The wage index values include the occupational 
mix adjustment described in section II.D. of this proposed rule that 
was developed for the proposed FY 2008 IPPS payment rates published in 
the Federal Register on May 3, 2007 (72 FR 24777 through 27782).
    Step 3. Adjust the wage index of hospitals located in certain 
qualifying counties that have a relatively high percentage of hospital 
employees who reside in the county, but who work in a different county 
with a higher wage index, in accordance with section 505 of Pub. L. 
108-173. Addendum L to this proposed rule contains the qualifying 
counties and the proposed wage index increase developed for the FY 2008 
IPPS as corrected in the June 7, 2007 correction notice to the FY 2008 
IPPS proposed rule (72 FR 31507). This step is to be followed only if 
the hospital has chosen not to accept reclassification under Step 2 
above.
    Step 4. Multiply the applicable wage index determined under Steps 2 
and 3 by the amount determined under Step 1 that represents the labor-
related portion of the national unadjusted payment rate.
    Step 5. Calculate 40 percent (the nonlabor-related portion) of the 
national unadjusted payment rate and add that amount to the resulting 
product of Step 4. The result is the wage index adjusted payment rate 
for the relevant wage index area.
    Step 6. If a provider is a SCH, as defined in Sec.  412.92, or an 
EACH, which is considered to be a SCH under section 
1886(d)(5)(D)(iii)(III) of the Act, and located in a rural area, as 
defined in Sec.  412.63(b), or is treated as being located in a rural 
area under Sec.  412.103, multiply the wage index adjusted payment rate 
by 1.071 to calculate the total payment.

I. Proposed Beneficiary Copayments

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Beneficiary Copayments'' at the beginning of your 
comment.)
1. Background
    Section 1833(t)(3)(B) of the Act requires the Secretary to set 
rules for determining copayment amounts to be paid by beneficiaries for 
covered OPD services. Section 1833(t)(8)(C)(ii) of the Act specifies 
that the Secretary must reduce the national unadjusted copayment amount 
for a covered OPD service (or group of such services) furnished in a 
year in a manner so that the effective copayment rate (determined on a 
national unadjusted basis) for that service in the year does not exceed 
specified percentages. For all services paid under the OPPS in CY 2008, 
and in calendar years thereafter, the specified percentage is 40 
percent of the APC payment rate (section 1833(t)(8)(C)(ii)(V) of the 
Act). Section 1833(t)(3)(B)(ii) of the Act provides that, for a covered 
OPD service (or group of such services) furnished in a year, the 
national unadjusted coinsurance amount cannot be less than 20 percent 
of the OPD fee schedule amount. Sections 1834(d)(2)(C)(ii) and 
(d)(3)(C)(ii) of the Act further requires that the coinsurance for 
screening flexible sigmoidoscopies and screening colonoscopies be equal 
to 25 percent of the payment amount. We have applied the 25-percent 
coinsurance to screening flexible sigmoidoscopies and screening 
colonoscopies since the beginning of the OPPS.
2. Proposed Copayment
    For CY 2008, we are proposing to determine copayment amounts for 
new and revised APCs using the same methodology that we implemented for 
CY 2004. (We refer readers to the November 7, 2003 OPPS final rule with 
comment period (68 FR 63458).) The proposed unadjusted copayment 
amounts for services payable under the OPPS that would be effective 
January 1, 2008, are shown in Addendum A and Addendum B to this 
proposed rule.
    We note that we have historically used standard rounding principles 
to establish a 20 percent copayment for those few circumstances where 
the copayment rate was between 19.5 and 20 percent using our 
established copayment rules. For example, the CY 2008 proposed payment 
and copayment amounts for APC 9228 (Tigecycline injection) are $0.91 
and $0.18, respectively. Twenty percent of $0.91 is $0.182. Because it 
would be impossible to set a copayment rate at exactly 20 percent in 
this case, that is, $0.182, we rounded the amount, using standard 
rounding principles, to $0.18. Also using standard rounding principles, 
19.78 percent ($0.18 as a percentage of $0.91) rounds to 20 percent and 
meets the statutory requirement of a copayment amount of at least 20 
percent. For CY 2008, APC 9046 (Iron Sucrose Injection) has a proposed 
payment amount and copayment amount of $0.37 and $0.08, respectively. 
Using our established copayment rules, 20 percent of $0.37 is $0.074. 
Normally, we would apply standard rounding principles to achieve an 
amount that is payable, here $0.07 rather than $0.074. However, if we 
were to set a copayment amount of $0.07, which is 18.9 percent of 
$0.37, we would not be setting a copayment rate that is at least 20 
percent of the OPPS payment rate. We believe that section 1833(t)(3)(B) 
of the Act requires us to set a copayment amount that is at least 20 
percent of the OPPS payment amount, not less than 20 percent. 
Therefore, we are proposing to set the copayment rate for APC 9046 at 
$0.08. Eight cents represents the lowest amount that we could set that 
would bring the copayment rate to 20 percent or, in this case, just 
above 20 percent. We are proposing to apply this same methodology in 
the future to instances where the application of our standard copayment 
methodology would result in a copayment amount that is under 20 percent 
and cannot be rounded, under standard rounding principles, to 20 
percent.
3. Calculation of a Proposed Adjusted Copayment Amount for an APC Group
    To calculate the OPPS adjusted copayment amount for an APC group, 
take the following steps:
    Step 1. Calculate the beneficiary payment percentage for the APC by

[[Page 42701]]

dividing the APC's national unadjusted copayment by its payment rate. 
For example, using APC 0001, $7.00 is 21 percent of $33.15.
    Step 2. Calculate the wage adjusted payment rate for the APC, for 
the provider in question, as indicated in section II.H. of this 
proposed rule. Calculate the rural adjustment for eligible providers as 
indicated in section II.H. of this proposed rule.
    Step 3. Multiply the percentage calculated in Step 1 by the payment 
rate calculated in Step 2. The result is the wage-adjusted copayment 
amount for the APC.
    The proposed unadjusted copayments for services payable under the 
OPPS that would be effective January 1, 2008, are shown in Addendum A 
and Addendum B to this proposed rule.

III. Proposed OPPS Ambulatory Payment Classification (APC) Group 
Policies

A. Proposed Treatment of New HCPCS and CPT Codes

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: New HCPCS and CPT Codes'' at the beginning of your 
comment.)
1. Proposed Treatment of New HCPCS Codes Included in the April and July 
Quarterly OPPS Updates for CY 2007
    For the July quarter of CY 2007, we created a total of 16 new Level 
II HCPCS codes, specifically C2638, C2639, C2640, C2641, C2642, C2643, 
C2698, C2699, C9728, Q4087, Q4088, Q4089, Q4090, Q4091, Q4092, and 
Q4095 that were not addressed in the CY 2007 OPPS/ASC final rule with 
comment period that updated the CY 2007 OPPS. We designated the payment 
status of these codes and added them through the July 2007 update 
(Change Request 5623, Transmittal 1259, dated June 1, 2007). There were 
no new Level II HCPCS codes for the April 2007 update. In this CY 2008 
OPPS/ASC proposed rule, we are soliciting public comment on the status 
indicators, APC assignments, and payment rates of these codes, which 
are listed in Table 26A and Table 26B of this proposed rule. Because of 
the timing of this proposed rule, the codes implemented through the 
July 2007 OPPS update are not included in Addendum B to this proposed 
rule. We are proposing to assign the new HCPCS codes for CY 2008 to the 
appropriate APCs with the proposed rates as displayed in the tables and 
incorporate them into our final rule with comment period for CY 2008, 
which is consistent with our annual APC updating policy.

                          Table 26A.--New Non-Drug HCPCS Codes Implemented in July 2007
----------------------------------------------------------------------------------------------------------------
                                                                            Proposed CY
                                             Proposed CY 2008  Proposed CY      2008
    HCPCS code          Long descriptor           status         2008 APC     payment      Implementation date
                                                 indicator                      rate
----------------------------------------------------------------------------------------------------------------
C2638............  Brachytherapy source,     K...............         2638      $ 42.86  July 1, 2007.
                    stranded, iodine-125,
                    per source.
C2639............  Brachytherapy source,     K...............         2639        31.91  July 1, 2007.
                    non-stranded, iodine-
                    125, per source.
C2640............  Brachytherapy source,     K...............         2640        62.24  July 1, 2007.
                    stranded, palladium-
                    103, per source.
C2641............  Brachytherapy source,     K...............         2641        45.29  July 1, 2007.
                    non-stranded, palladium-
                    103, per source.
C2642............  Brachytherapy source,     K...............         2642        97.72  July 1, 2007.
                    stranded, cesium-131,
                    per source.
C2643............  Brachytherapy source,     K...............         2643        51.35  July 1, 2007.
                    non stranded, cesium-
                    131, per source.
C2698............  Brachytherapy source,     K...............         2698        42.86  July 1, 2007.
                    stranded, not otherwise
                    specified, per source.
C2699............  Brachytherapy source,     K...............         2699        29.93  July 1, 2007.
                    non-stranded, not
                    otherwise specified,
                    per source.
C9728............  Placement of              T...............         0156       194.91  July 1, 2007.
                    interstitial device(s)
                    for radiation therapy/
                    surgery guidance (eg,
                    fiducial markers,
                    dosimeter), other than
                    prostate (any approach)
                    single or multiple.
----------------------------------------------------------------------------------------------------------------


                            Table 26B.--New Drug HCPCS Codes Implemented in July 2007
----------------------------------------------------------------------------------------------------------------
                                                                            Proposed CY
                                             Proposed CY 2008  Proposed CY      2008
    HCPCS code          Long descriptor           status         2008 APC     payment      Implementation date
                                                 indicator                      rate
----------------------------------------------------------------------------------------------------------------
Q4087............  Injection, immune         K...............         0943      $ 33.48  July 1, 2007.
                    globulin, (Octogam),
                    intravenous, non-
                    lyophilized, (e.g.
                    liquid), 500 mg.
Q4088............  Injection, immune         K...............         0944        31.20  July 1, 2007.
                    globulin, (Gammagard),
                    intravenous, non-
                    lyophilized, (e.g.
                    liquid), 500 mg.
Q4089............  Injection, rho(d) immune  K...............         0945        80.00  July 1, 2007.
                    globulin (human),
                    (Rhophylac),
                    intravenous, 100 iu.
Q4090............  Injection, hepatitis b    K...............         0946        64.74  July 1, 2007.
                    immune globulin
                    (Hepagam B),
                    intramuscular, 0.5 ml.
Q4091............  Injection, immune         K...............         0947        32.61  July 1, 2007.
                    globulin, (Flebogamma),
                    intravenous, non-
                    lyophilized, (e.g.
                    liquid), 500 mg.
Q4092............  Injection, immune         K...............         0948        31.86  July 1, 2007.
                    globulin, (Gamunex),
                    intravenous, non-
                    lyophilized, (e.g.
                    liquid), 500 mg.
Q4095............  Injection, zoledronic     K...............         0951       220.81  July 1, 2007.
                    acid (Reclast), 1 mg.
----------------------------------------------------------------------------------------------------------------

2. Proposed Treatment of New Category I and III CPT Codes and Level II 
HCPCS Codes
    As has been our practice in the past, we implement new Category I 
and III CPT codes and new Level II HCPCS codes, which are released in 
the summer through the fall of each year for annual updating, effective 
January 1, in the final rule updating the OPPS for the following 
calendar year. These codes are flagged with comment indicator ``NI'' in 
Addendum B to the OPPS/ASC final rule with comment period to indicate 
that we are assigning them an interim

[[Page 42702]]

payment status which is subject to public comment following publication 
of the final rule that implements the annual OPPS update. (We refer 
readers to the discussion immediately below concerning our policy for 
implementing new Category I and III mid-year CPT codes.) We are 
proposing to continue this recognition and process for CY 2008. New 
Category I and III CPT codes and new Level II HCPCS codes, effective 
January 1, 2008, will be listed in Addendum B to the CY 2008 OPPS/ASC 
final rule with comment period and designated using comment indicator 
``NI.'' The status indicator, the APC assignment, or both, for all such 
codes flagged with comment indicator ``NI'' will be open to public 
comment. We will respond to all comments received concerning these 
codes in a subsequent final rule.
    In addition, we are proposing to continue our policy of the last 2 
years of recognizing new mid-year CPT codes, generally Category III CPT 
codes, that the AMA releases in January for implementation the 
following July through the OPPS quarterly update process. Therefore, 
for CY 2008, we are proposing to include in Addendum B to the CY 2008 
OPPS/ASC final rule with comment period the new Category III CPT codes 
released in January 2007 for implementation on July 1, 2007 (through 
the OPPS quarterly update process) and the new Category III codes 
released in July 2007 for implementation on January 1, 2008. However, 
only those new Category III CPT codes implemented effective January 1, 
2008, will be flagged with comment indicator ``NI'' in Addendum B to 
the CY 2008 OPPS/ASC final rule with comment period, to indicate that 
we have assigned them an interim payment status which is subject to 
public comment. Category III CPT codes implemented in July 2007, which 
appear in Table 27 below, are subject to comment through this proposed 
rule, and their status will be finalized in the CY 2008 OPPS/ASC final 
rule with comment period.

                           Table 27.--Category III CPT Codes Implemented in July 2007
----------------------------------------------------------------------------------------------------------------
                                                         Proposed CY 2008 status
       HCPCS code                Long descriptor                 indicator             Proposed CY 2008 APC
----------------------------------------------------------------------------------------------------------------
0178T..................  Electrocardiogram, 64 leads or  B......................  Not applicable.
                          greater, with graphic
                          presentation and analysis;
                          with interpretation and
                          report.
0179T..................  Electrocardiogram, 64 leads or  X......................  0100.
                          greater, with graphic
                          presentation and analysis;
                          tracing and graphics only,
                          without interpretation and
                          report.
0180T..................  Electrocardiogram, 64 leads or  B......................  Not applicable.
                          greater, with graphic
                          presentation and analysis;
                          interpretation and report
                          only.
0181T..................  Corneal hysteresis              S......................  0230.
                          determination, by air impulse
                          stimulation, bilateral, with
                          interpretation and report.
0182T..................  High dose rate electronic       S......................  1519.
                          brachytherapy, per fraction.
----------------------------------------------------------------------------------------------------------------

B. Proposed Changes--Variations Within APCs

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: 2 Times Rule'' at the beginning of your comment.)
1. Background
    Section 1833(t)(2)(A) of the Act requires the Secretary to develop 
a classification system for covered hospital outpatient services. 
Section 1833(t)(2)(B) of the Act provides that this classification 
system may be composed of groups of services, so that services within 
each group are comparable clinically and with respect to the use of 
resources. In accordance with these provisions, we developed a grouping 
classification system, referred to as APCs, as set forth in Sec.  
419.31 of the regulations. We use Level I and Level II HCPCS codes and 
descriptors to identify and group the services within each APC. The 
APCs are organized such that each group is homogeneous both clinically 
and in terms of resource use. Using this classification system, we have 
established distinct groups of similar services, as well as medical 
visits. We also have developed separate APC groups for certain medical 
devices, drugs, biologicals, radiopharmaceuticals, and brachytherapy 
devices.
    We have packaged into payment for each procedure or service within 
an APC group the costs associated with those items or services that are 
directly related to and supportive of performing the main procedures or 
furnishing services. Therefore, we do not make separate payment for 
packaged items or services. For example, packaged items and services 
include: (1) Use of an operating, treatment, or procedure room; (2) use 
of a recovery room; (3) most observation services; (4) anesthesia; (5) 
medical/surgical supplies; (6) pharmaceuticals (other than those for 
which separate payment may be allowed under the provisions discussed in 
section V. of this proposed rule); and (7) incidental services such as 
venipuncture. Our proposed packaging approach for CY 2008 is discussed 
in section II.A.4. of this proposed rule.
    Under the OPPS, we pay for hospital outpatient services on a rate-
per-service or, as proposed for CY 2008, on a rate-per-encounter basis 
that varies according to the APC group to which the independent service 
or combination of services is assigned. Each APC weight represents the 
hospital median cost of the services included in that APC relative to 
the hospital median cost of the services included in APC 0606. The APC 
weights are scaled to APC 0606 because it is the middle level clinic 
visit APC (that is, where the Level 3 Clinic Visit HCPCS code of five 
levels of clinic visits is assigned), and because middle level clinic 
visits are among the most frequently furnished services in the hospital 
outpatient setting.
    Section 1833(t)(9)(A) of the Act requires the Secretary to review 
the components of the OPPS not less than annually and to revise the 
groups and relative payment weights and make other adjustments to take 
into account changes in medical practice, changes in technology, and 
the addition of new services, new cost data, and other relevant 
information and factors. Section 1833(t)(9)(A) of the Act, as amended 
by section 201(h) of the BBRA of 1999, also requires the Secretary, 
beginning in CY 2001, to consult with an outside panel of experts to 
review the APC groups and the relative payment weights (the APC Panel 
recommendations for specific services for the CY 2008 OPPS and our 
responses to them are discussed in the relevant specific sections 
throughout this proposed rule).

[[Page 42703]]

    Finally, as discussed earlier, section 1833(t)(2) of the Act 
provides that, subject to certain exceptions, the items and services 
within an APC group cannot be considered comparable with respect to the 
use of resources if the highest median (or mean cost, if elected by the 
Secretary) for an item or service in the group is more than 2 times 
greater than the lowest median cost for an item or service within the 
same group (referred to as the ``2 times rule''). We use the median 
cost of the item or service in implementing this provision. The statute 
authorizes the Secretary to make exceptions to the 2 times rule in 
unusual cases, such as low-volume items and services.
2. Application of the 2 Times Rule
    In accordance with section 1833(t)(2) of the Act and Sec.  419.31 
of the regulations, we annually review the items and services within an 
APC group to determine, with respect to comparability of the use of 
resources, if the median of the highest cost item or service within an 
APC group is more than 2 times greater than the median of the lowest 
cost item or service within that same group (``2 times rule''). We make 
exceptions to this limit on the variation of costs within each APC 
group in unusual cases such as low volume items and services.
    During the APC Panel's March 2007 meeting, we presented median cost 
and utilization data for services furnished during the period of 
January 1, 2006, through September 30, 2006, about which we had 
concerns or about which the public had raised concerns regarding their 
APC assignments, status indicator assignments, or payment rates. The 
discussions of most service-specific issues, the APC Panel 
recommendations if any, and our proposals for CY 2008 are contained 
principally in sections III.C. and III.D. of this proposed rule.
    In addition to the assignment of specific services to APCs that we 
discussed with the APC Panel, we also identified APCs with 2 times 
violations that were not specifically discussed with the APC Panel but 
for which we are proposing changes to their HCPCS codes' APC 
assignments in Addendum B to this proposed rule. In these cases, to 
eliminate a 2 times violation or to improve clinical and resource 
homogeneity, we are proposing to reassign the codes to APCs that 
contained services that were similar with regard to both their clinical 
and resource characteristics. We also are proposing to rename existing 
APCs, discontinue existing APCs, or create new clinical APCs to 
complement proposed HCPCS code reassignments. In many cases, the 
proposed HCPCS code reassignments and associated APC reconfigurations 
for CY 2008 included in this proposed rule are related to changes in 
median costs of services and APCs resulting from our proposed packaging 
approach for CY 2008, as discussed in section II.A.4. of this proposed 
rule. We also are proposing changes to the status indicators for some 
codes that are not specifically and separately discussed in this 
proposed rule. In these cases, we are proposing to change the status 
indicators for some codes because we believe that another status 
indicator more accurately describes their payment status from an OPPS 
perspective based on the policies that we are proposing for CY 2008.
    Addendum B to this proposed rule identifies with a comment 
indicator ``CH'' those HCPCS codes for which we are proposing a change 
to the APC assignment or status indicator as assigned in the April 2007 
Addendum B update.
3. Proposed Exceptions to the 2 Times Rule
    As discussed earlier, we may make exceptions to the 2 times limit 
on the variation of costs within each APC group in unusual cases such 
as low volume items and services. Taking into account the APC changes 
that we are proposing for CY 2008 based on the APC Panel 
recommendations discussed mainly in sections III.C. and III.D. of this 
proposed rule, the proposed changes to status indicators and APC 
assignments as identified in Addendum B to this proposed rule, and the 
use of CY 2006 claims data to calculate the median costs of procedures 
classified in the APCs, we reviewed all the APCs to determine which 
APCs would not satisfy the 2 times rule. We used the following criteria 
to decide whether to propose exceptions to the 2 times rule for 
affected APCs:
    <bullet> Resource homogeneity.
    <bullet> Clinical homogeneity.
    <bullet> Hospital concentration.
    <bullet> Frequency of service (volume).
    <bullet> Opportunity for upcoding and code fragments.
    For a detailed discussion of these criteria, we refer readers to 
the April 7, 2000 OPPS final rule with comment period (65 FR 18457).
    Table 28 lists the APCs that we are proposing to exempt from the 2 
times rule for CY 2008 based on the criteria cited above. For cases in 
which a recommendation by the APC Panel appeared to result in or allow 
a violation of the 2 times rule, we generally accepted the APC Panel's 
recommendation because those recommendations were based on explicit 
consideration of resource use, clinical homogeneity, hospital 
specialization, and the quality of the data used to determine the APC 
payment rates that we are proposing for CY 2008. The median costs for 
hospital outpatient services for these and all other APCs that were 
used in the development of this proposed rule can be found on the CMS 
Web site at: http://www.cms.hhs.gov.

   Table 28.--Proposed APC Exceptions to the 2 Times Rule for CY 2008
------------------------------------------------------------------------
               APC                               APC title
------------------------------------------------------------------------
0033.............................  Partial Hospitalization.
0043.............................  Closed Treatment Fracture Finger/Toe/
                                    Trunk.
0060.............................  Manipulation Therapy.
0080.............................  Diagnostic Cardiac Catheterization.
0093.............................  Vascular Reconstruction/Fistula
                                    Repair without Device.
0105.............................  Repair/Revision/Removal of
                                    Pacemakers, AICDs, or Vascular
                                    Devices.
0106.............................  Insertion/Replacement of Pacemaker
                                    Leads and/or Electrodes.
0109.............................  Removal/Repair of Implanted Devices.
0235.............................  Level I Posterior Segment Eye
                                    Procedures.
0251.............................  Level I ENT Procedures.
0260.............................  Level I Plain Film Except Teeth.
0278.............................  Diagnostic Urography.
0282.............................  Miscellaneous Computed Axial
                                    Tomography.
0303.............................  Treatment Device Construction.
0323.............................  Extended Individual Psychotherapy.
0330.............................  Dental Procedures.
0340.............................  Minor Ancillary Procedures.
0368.............................  Level II Pulmonary Tests.
0381.............................  Single Allergy Tests.
0409.............................  Red Blood Cell Tests.
0432.............................  Health and Behavior Services.
0438.............................  Level III Drug Administration.
0604.............................  Level 1 Hospital Clinic Visits.
0664.............................  Level I Proton Beam Radiation
                                    Therapy.
0688.............................  Revision/Removal of Neurostimulator
                                    Pulse Generator Receiver.
------------------------------------------------------------------------

C. New Technology APCs

    (If you choose to comment on issues in this section, please include 
the caption ``New Technology APCs'' at the beginning of your comment.)
1. Introduction
    In the November 30, 2001 final rule (66 FR 59903), we finalized 
changes to the time period a service was eligible for payment under a 
New Technology APC. Beginning in CY 2002, we retain services within New 
Technology APC groups until we gather sufficient claims data to enable 
us to assign the service

[[Page 42704]]

to a clinically appropriate APC. This policy allows us to move a 
service from a New Technology APC in less than 2 years if sufficient 
data are available. It also allows us to retain a service in a New 
Technology APC for more than 3 years if sufficient data upon which to 
base a decision for reassignment have not been collected.
    We note that the cost bands for New Technology APCs range from $0 
to $50 in increments of $10, from $50 to $100 in increments of $50, 
from $100 through $2,000 in increments of $100, and from $2,000 through 
$10,000 in increments of $500. These increments, which are in two 
parallel sets of New Technology APCs, one with status indicator ``S'' 
and the other with status indicator ``T,'' allow us to price new 
technology services more appropriately and consistently.
2. Proposed Movement of Procedures From New Technology APCs to Clinical 
APCs
    As we explained in the November 30, 2001 final rule (66 FR 59897), 
we generally keep a procedure in the New Technology APC to which it is 
initially assigned until we have collected data sufficient to enable us 
to move the procedure to a clinically appropriate APC. However, in 
cases where we find that our original New Technology APC assignment was 
based on inaccurate or inadequate information, or where the New 
Technology APCs are restructured, we may, based on more recent resource 
utilization information (including claims data) or the availability of 
refined New Technology APC cost bands, reassign the procedure or 
service to a different New Technology APC that most appropriately 
reflects its cost.
    At its March 2007 meeting, the APC Panel recommended that CMS keep 
services in New Technology APCs until sufficient data are available to 
assign them to clinical APCs, but for no longer than 2 years. We note 
that because of the potential for quarterly assignment of new services 
to New Technology APCs and the 2 year time lag in claims data for an 
OPPS update (that is, CY 2006 data are utilized for this CY 2008 OPPS 
rulemaking cycle), if we were to accept the APC Panel's recommendation, 
we would always reassign services from New Technology to clinical APCs 
based on 1 year or less of claims data. For example, if a new service 
was first assigned to a New Technology APC in July 2006, we would have 
6 months of data for purposes of CY 2008 rulemaking but, in order to 
ensure that the service was in a New Technology APC for no longer than 
2 years, we would need to move the service to a clinical APC for CY 
2008. While we might have sufficient claims data from 6 months of CY 
2006 to support a proposal for such a reassignment for CY 2008, we are 
not confident that this would always be the case for all new services, 
given our understanding of the dissemination of new technology 
procedures into medical practice and the diverse characteristics of new 
technology services that treat different clinical conditions. 
Therefore, we are not accepting the APC Panel's recommendation because 
we believe that accepting the recommendation would limit our ability to 
individually assess the OPPS treatment of each new technology service 
in the context of available hospital claims data. We are particularly 
concerned about continuing to provide appropriate payment for low 
volume new technology services that may be expected to continue to be 
low volume under the OPPS due to the prevalence of the target 
conditions in the Medicare population. We appreciate the APC Panel's 
thoughtful discussion of new technology services, and we agree with the 
APC Panel that it should be our priority to regularly reassign services 
from New Technology APCs to clinical APCs under the OPPS, so that they 
are treated like most other OPPS services for purposes of ratesetting 
once hospitals have had sufficient experience with providing and 
reporting the new services. Rather, consistent with our current policy, 
for CY 2008 we are proposing to retain services within New Technology 
APC groups until we gather sufficient claims data to enable us to 
assign the service to a clinically appropriate APC. The flexibility 
associated with this policy allows us to move a service from a New 
Technology APC in less than 2 years if sufficient data are available. 
It also allows us to retain a service in a New Technology APC for more 
than 2 years if sufficient hospital claims data upon which to base a 
decision for reassignment have not been collected.
    The procedures presented below represent services assigned to New 
Technology APCs for CY 2007 for which we believe we have sufficient 
data to reassign them to clinically appropriate APCs for CY 2008. 
Therefore, we are proposing to reassign them to clinically appropriate 
APCs as indicated specifically in our discussion and in Table 29 of 
this proposed rule.
a. Positron Emission Tomography (PET)/Computed Tomography (CT) Scans 
(New Technology APC 1511)
    (If you choose to comment on issues in this section, please include 
the caption ``PET/CT Scans'' at the beginning of your comment.)
    From August 2000 through April 2005, we paid separately for PET and 
CT scans. In CY 2004, the payment rate for nonmyocardial PET scans was 
$1,450, while it was $193 for typical diagnostic CT scans. Prior to CY 
2005, nonmyocardial PET and the PET portion of PET/CT scans were 
described by G-codes for billing to Medicare. Several commenters to the 
November 15, 2004 final rule with comment period (69 FR 65682) urged 
that we replace the G-codes for nonmyocardial PET and PET/CT scan 
procedures with the established CPT codes. These commenters stated that 
movement to the established CPT codes would greatly reduce the burden 
on hospitals of tracking and billing the G-codes which are not 
recognized by other payers and would allow for more uniform hospital 
billing of these scans. We agreed with the commenters that movement 
from the G-codes to the established CPT codes for nonmyocardial PET and 
PET/CT scans would allow for more uniform billing of these scans. As a 
result of a Medicare national coverage determination (Publication 100-
3, Medicare Claims Processing Manual section 220.6) that was made 
effective January 28, 2005, we discontinued numerous G-codes that 
described myocardial PET and nonmyocardial PET procedures and replaced 
them with the established CPT codes. The CY 2005 payment rate for 
concurrent PET/CT scans using the CPT codes 78814 (Tumor imaging, 
positron emission tomography (PET) with concurrently acquired computed 
tomography (CT) for attenuation correction and anatomical localization; 
limited area (eg, chest, head/neck); 78815 (Tumor imaging, positron 
emission tomography (PET) with concurrently acquired computed 
tomography (CT) for attenuation correction and anatomical localization; 
skull base to mid-thigh); and 78816 Tumor imaging, positron emission 
tomography (PET) with concurrently acquired computed tomography (CT) 
for attenuation correction and anatomical localization; whole body) was 
$1,250, which was $100 higher than the payment rate for PET scans 
alone. These PET/CT CPT codes were placed in New Technology APC 1514 
(New Technology--Level XIV, $1,200-$1,300) for CY 2005.
    We continued with these coding and payment methodologies in CY 
2006. For CY 2007, while we proposed to reassign both PET and PET/CT 
Scans to the same new clinical APC, we finalized a policy that 
reassigned conventional PET procedures to APC 0308 (Non-

[[Page 42705]]

Myocardial Positron Emission Tomography (PET) Imaging) with a final 
median cost of about $850. We also reassigned PET/CT services to a 
different New Technology APC for CY 2007, specifically New Technology 
APC 1511 (New Technology--Level XI, $900-$1000), thereby maintaining 
the historical payment differential of about $100 between PET and PET/
CT procedures. Furthermore, we stated in the CY 2007 OPPS/ASC final 
rule with comment period (71 FR 68022) that we would wait for a full 
year of CPT coded claims data prior to assigning the PET/CT services to 
a clinical APC and that maintaining a modest payment differential 
between PET and PET/CT procedures was warranted for CY 2007.
    For CY 2008, we are proposing the reassignment of concurrent PET/CT 
scans, specifically CPT codes 78814, 78815, and 78816, to a clinical 
APC because we believe we have adequate claims data from CY 2006 upon 
which to determine the median cost of performing these procedures. 
Based on our analysis of approximately 117,000 CY 2006 single claims, 
the median cost of PET/CT scans is $1,093.52. In comparison, the median 
cost of the nonmyocardial PET scans, as described by CPT codes 78608, 
78811, 78812, and 78813, is $1,093.51 based on our analysis of 
approximately 34,000 single claims from CY 2006. We note that a 
comparison of the median cost of PET/CT scans with the median cost of 
nonmyocardial PET scans, as derived from CY 2006 claims data, 
demonstrates that these costs are almost the same, thereby reflecting 
significant hospital resource equivalency between the two types of 
services. This result is not unexpected because many newer PET scanners 
also have the capability of rapidly acquiring CT images for attenuation 
correction and anatomical localization, sometimes with simultaneous 
image acquisition. The median costs for both PET and PET/CT scans are 
significantly higher for CY 2008 than for CY 2007 due to our CY 2008 
proposal to package payment for all diagnostic radiopharmaceuticals as 
described in section II.A.4. of this proposed rule that would package 
payment for the costs of the radiopharmaceuticals utilized similarly 
into the payment for both PET and PET/CT scans. We believe that our 
claims data accurately reflect the comparable hospital resources 
required to provide nonmyocardial PET and PET/CT procedures, and the 
scans have obvious clinical similarity as well. Therefore, for CY 2008 
we are proposing to reassign the CPT codes for PET/CT scans to the 
clinical APC where nonmyocardial PET scans are also assigned, 
specifically APC 0308, with a proposed median cost of $1,093.52.
    We note that we have been paying separately for fluorodeoxyglucose 
(FDG), the radiopharmaceutical described by HCPCS code A9552 (F18 fdg), 
that is commonly administered during nonmyocardial PET and PET/CT 
procedures. For CY 2008, consistent with our proposed packaging 
approach as discussed in section II.A.4. of this proposed rule, we are 
proposing to package payment for the diagnostic radiopharmaceutical FDG 
into payment for the associated PET and PET/CT procedures. Because FDG 
is the most commonly used radiopharmaceutical for both PET and PET/CT 
scans and our single claims for these procedures include FDG more than 
80 percent of the time, the packaging of this radiopharmaceutical fully 
maintains the clinical and resource homogeneity of the reconfigured APC 
0308 that we are proposing.
b. IVIG Preadministration-Related Services (New Technology APC 1502)
    (If you choose to comment on issues in this section, please include 
the caption ``IVIG Preadministration-Related Services'' at the 
beginning of your comment.)
    In CY 2006, we created the temporary HCPCS G-code G0332 (Services 
for intravenous infusion of immunoglobulin prior to administration 
(this service is to be billed in conjunction with administration of 
immunoglobulin)). Based on our estimate of the costs of this service in 
comparison with other services, HCPCS code G0332 was assigned to New 
Technology APC 1502 (New Technology--Level II, $50-$100), with a 
payment rate of $75 effective January 1, 2006. In the CY 2007 OPPS/APC 
final rule with comment period, we indicated our belief that it was 
appropriate to continue the temporary IVIG preadministration-related 
services payment through HCPCS code G0332 and its continued assignment 
to New Technology APC 1502 for CY 2007, in order to help ensure 
continued patient access to IVIG (71 FR 68092).
    For CY 2008, we are proposing to continue to provide separate 
payment for IVIG preadministration-related services through the 
assignment of HCPCS code G0332 to a clinical APC. This service has been 
assigned to a New Technology APC under the OPPS for 2 full years. As 
noted previously, under the OPPS, we retain services within New 
Technology APC groups where they are assigned according to our 
estimates of their costs until we gather sufficient claims data to 
enable us to assign the services to clinically appropriate APCs based 
on hospital resource costs as calculated from claims. According to our 
analysis of the hospital outpatient claims data, we believe we have 
adequate claims data from CY 2006 upon which to determine the median 
cost of performing IVIG preadministration related services and to 
reassign HCPCS code G0332 to an appropriate clinical APC for CY 2008. 
Our claims data for this high volume service show a total of over 
49,000 services performed, with about 48,000 single claims available 
for ratesetting. The median cost of this service according to our 
claims data is $38.52. Therefore, we are proposing to reassign HCPCS 
code G0332 to new clinical APC 0430 (Drug Preadministration-Related 
Services) with a median cost of $38.52 for CY 2008, where it would be 
the only service assigned to the APC at this time.
    We note that IVIG preadministration-related services are always 
provided in conjunction with other separately payable services such as 
drug administration services, and thus are well suited for packaging 
into the payment for the separately payable services. While at this 
time we have not made a determination about the appropriateness of 
continuing separate OPPS payment for HCPCS code G0332 after CY 2008, we 
would consider packaging payment for HCPCS code G0332 in future years 
if we determine separate payment is no longer warranted. We intend to 
reevaluate the appropriateness of separate payment for 
preadministration-related services for the CY 2009 OPPS rulemaking 
cycle, especially as we explore the potential for greater packaging and 
possible encounter-based or episode-based OPPS payment approaches.
c. Other Services in New Technology APCs
    (If you choose to comment on issues in this section, please include 
the caption ``Other Services in New Technology APCs'' at the beginning 
of your comment.)
    Other than the concurrent PET/CT and IVIG preadministration-related 
new technology services discussed in sections III.C.2.a. and III.C.2.b. 
of this proposed rule, there are five procedures currently assigned to 
New Technology APCs for CY 2007 for which we believe we also have data 
that are adequate to support their reassignment to clinical APCs. For 
CY 2008, we are proposing to reassign these procedures to clinically 
appropriate APCs, applying their CY 2006 claims data to develop their

[[Page 42706]]

clinical APC median costs upon which payments would be based. These 
procedures and their proposed APC assignments are displayed in Table 29 
below.

        Table 29.--Proposed CY 2008 APC Reassignments of Other New Technology Procedures to Clinical APCs
----------------------------------------------------------------------------------------------------------------
                                                             CY 2007 APC                             Proposed CY
   HCPCS code     Short descriptor  CY 2007 SI  CY 2007 APC    payment     Proposed CY  Proposed CY    2008 APC
                                                                 rate        2008 SI      2008 APC   median cost
----------------------------------------------------------------------------------------------------------------
19298..........  Place breast rad   S.........         1524       $3,250  T...........         0648    $3,416.66
                  tube/caths.
G0302..........  Pre-op service     S.........         1509          750  S...........         0209       727.48
                  LVRS complete.
G0303..........  Pre-op service     S.........         1507          550  S...........         0209       727.48
                  LVRS 10-15dos.
G0304..........  Pre-op service     S.........         1504          250  S...........         0213       147.68
                  LVRS 1-9 dos.
G0305..........  Post op service    S.........         1504          250  S...........         0213       147.68
                  LVRS min 6.
----------------------------------------------------------------------------------------------------------------

D. Proposed APC-Specific Policies

1. Hyperbaric Oxygen Therapy (APC 0659)
    (If you choose to comment on issues in this section, please include 
the caption ``Hyperbaric Oxygen Therapy'' at the beginning of your 
comment.)
    When hyperbaric oxygen therapy (HBOT) is prescribed for promoting 
the healing of chronic wounds, it typically is prescribed for 90 
minutes and billed using multiple units of HBOT on a single line or 
multiple occurrences of HBOT on a claim. In addition to the therapeutic 
time spent at full hyperbaric oxygen pressure, treatment involves 
additional time for achieving full pressure (descent), providing air 
breaks to prevent neurological and other complications from occurring 
during the course of treatment, and returning the patient to 
atmospheric pressure (ascent). The OPPS recognizes HCPCS code C1300 
(Hyperbaric oxygen under pressure, full body chamber, per 30 minute 
interval) for HBOT provided in the hospital outpatient setting.
    In the CY 2005 final rule with comment period (69 FR 65758 through 
65759), we finalized a ``per unit'' median cost calculation for APC 
0659 (Hyperbaric Oxygen) using only claims with multiple units or 
multiple occurrences of HCPCS code C1300 because delivery of a typical 
HBOT service requires more than 30 minutes. We observed that claims 
with only a single occurrence of the code were anomalies, either 
because they reflected terminated sessions or because they were 
incorrectly coded with a single unit. In the same rule, we also 
established that HBOT would not generally be furnished with additional 
services that might be packaged under the standard OPPS APC median cost 
methodology. This enabled us to use claims with multiple units or 
multiple occurrences. Finally, we also used each hospital's overall CCR 
to estimate costs for HCPCS code C1300 from billed charges rather than 
the CCR for the respiratory therapy cost center. Comments on the CY 
2005 proposed rule effectively demonstrated that hospitals report the 
costs and charges for HBOT in a wide variety of cost centers. We used 
this methodology to estimate payment for HBOT in CYs 2005, 2006, and 
2007. For CY 2008, we are proposing to continue using the same 
methodology to estimate a ``per unit'' median cost for HCPCS code C1300 
of $98.63 using 60,774 claims with multiple units or multiple 
occurrences.
    CY 2008 is the fourth year in which we would have a special 
methodology to develop the median cost for HBOT services that removed 
obviously erroneous claims and deviated from our standard methodology 
of using departmental CCRs, when available, to convert hospitals' 
charges to costs. Prior to CY 2005, our inclusion of significant 
numbers of miscoded claims in the median calculation for HBOT and our 
exclusion of the claims for multiple units of treatment, the typical 
scenario, resulted in payment rates that were artificially elevated. As 
explained earlier, beginning in CY 2005 and continuing through the 
present, we have adjusted the CCR used in the conversion of charges to 
costs for these services so that claims data would more accurately 
reflect the relative costs of the services. The median costs of HBOT 
calculated using this methodology have been reasonably stable for the 
last 4 years. We believe that this adjustment through use of the 
hospitals' overall CCRs is all that is necessary to yield a valid 
median cost for establishing a scaled weight for HBOT services. 
Therefore, for CY 2008, we are proposing to continue to use the same 
methodology that we have used since CY 2005 to estimate payment for 
HBOT.
2. Skin Repair Procedures (APCs 0024, 0025, 0027, and 0686)
    For CY 2006, the AMA made comprehensive changes, including code 
additions, deletions, and revisions, accompanied by new and revised 
introductory language, parenthetical notes, subheadings and cross-
references, to the Integumentary, Repair (Closure) subsection of 
surgery in the CPT book to facilitate more accurate reporting of skin 
grafts, skin replacements, skin substitutes, and local wound care. In 
particular, the section of the CPT book previously titled ``Free Skin 
Grafts'' and containing codes for skin replacement and skin substitute 
procedures was renamed, reorganized, and expanded. New and existing CPT 
codes related to skin replacement surgery and skin substitutes were 
organized into five subsections: Surgical Preparation, Autograft/Tissue 
Cultured Autograft, Acellular Dermal Replacement, Allograft/Tissue 
Cultured Allogeneic Skin Substitute, and Xenograft.
    As part of the CY 2006 CPT code update in the newly named ``Skin 
Replacement Surgery and Skin Substitutes'' section, certain codes were 
deleted that previously described skin allograft and tissue cultured 
and acellular skin substitute procedures, including CPT code 15342 
(Application of bilaminate skin substitute/neodermis; 25 sq cm), CPT 
code 15343 (Application of bilaminate skin substitute/neodermis; each 
additional 25 sq cm), CPT code 15350 (Application of allograft, skin; 
100 sq cm or less), and CPT code 15351 (Application of allograft, skin; 
each additional 100 sq cm). Thirty-seven new CPT codes were created in 
the ``Skin Replacement Surgery and Skin Substitutes'' section, and 
these codes received interim final status indicators and APC 
assignments in the CY 2006 OPPS final rule with comment period and were 
subject to comment.
    In considering the final CY 2007 APC assignments of these 37 ``Skin

[[Page 42707]]

Replacement Surgery and Skin Repair'' codes, we reviewed the 
recommendations made by the APC Panel at its March 2006 meeting; 
presentations made to the APC Panel; comments received on the CY 2007 
proposed rule; the CPT code descriptors, introductory explanations, 
cross-references, and parenthetical notes; the clinical characteristics 
of the procedures; and the code-specific median costs for all related 
CPT codes available from our CY 2005 claims data. A discussion of the 
final CY 2007 APC assignments of these procedures can be found in the 
CY 2007 OPPS/ASC final rule with comment period (71 FR 68054 through 
68057).
    We now have CY 2006 data for the surgical procedures assigned to 
the 4 CY 2007 skin repair APCs, including the 37 codes considered last 
year that were new for CY 2006. These APCs are: APC 0024 (Level I Skin 
Repair); APC 0025 (Level II Skin Repair); APC 0686 (Level III Skin 
Repair); and APC 0027 (Level IV Skin Repair). Based on CY 2006 data 
available for this proposed rule, the median costs for the APCs as 
configured for CY 2007 are approximately: $93 for APC 0024; $251 for 
APC 0025; $1,027 for APC 0686; and $1,340 for APC 0027. Both APCs 0024 
and 0025 have 2 times violations based on CY 2006 claims data. The 
HCPCS median costs of significant procedures in APC 0024 range from 
approximately $83 to $255. We note that a number of the procedures 
currently assigned to APC 0024 are very low volume, with few single 
claims available for ratesetting. Similarly, the median costs of the 
significant procedures in APC 0025 range from a low of $119 to a high 
of about $399. This APC also contains a number of low volume 
procedures, as well as some new CY 2007 CPT codes without CY 2006 
claims data. There is also some variation in the median costs of the 
HCPCS codes assigned to APCs 0686 and 0027, but no 2 times violations 
in these two APCs.
    At the March 2007 APC Panel meeting, we discussed with the APC 
Panel one possible reconfiguration of the skin repair APCs in order to 
address the 2 times violations in APCs 0024 and 0025 for CY 2008 by 
improving the resource homogeneity of the APCs, as well as ensuring 
their clinical homogeneity. We reviewed with the APC Panel the 
potential results associated with adding an additional level in this 
APC series and reallocating all of the procedures in the original four 
APCs among five new APCs, taking into account the frequency, resource 
utilization, and clinical characteristics of each procedure. We also 
gave particular attention to CPT code families in considering the 
clinical and resource homogeneity of each APC in the reconfigured 
series. The new configuration of APCs eliminates the 2 times violations 
that would otherwise exist in APCs 0024 and 0025. It also more 
accurately attributes higher cost procedures to the Levels IV and V 
APCs, which contain the surgical procedures of the greatest intensity 
and resource requirements, leading to a more balanced distribution of 
APC median costs across the five new APC levels.
    The APC Panel made a recommendation at its March 2007 meeting 
supporting CMS' reorganization of the skin repair APCs into five 
levels. This recommendation also asked CMS to give special 
consideration to the APC assignments of ``add-on'' codes; in the 
context of skin procedures, these are generally those CPT codes that 
report treatment of an additional body area and that are reported along 
with a primary procedure for treatment of the first body area. We are 
accepting the APC Panel's recommendation through this CY 2008 proposal 
to reconfigure the skin APCs into five levels, and we have reexamined 
the placement of each of the add-on codes within the framework of the 
five APCs. We agree with the APC Panel that, because these skin repair 
APCs are assigned to status indicator ``T'' so that add-on codes would 
typically be paid at 50 percent of their APC payment rate, these add-on 
codes bear special examination with respect to their median costs and 
their appropriate APC assignments. As a result, several CPT code 
placements from the draft configuration discussed with the Panel were 
changed for this proposal.
    In summary, for CY 2008 we are proposing to eliminate the four 
current skin repair APCs and replace them with five new APCs titled: 
APC 0133 (Level I Skin Repair); APC 0134 (Level II Skin Repair); APC 
0135 (Level III Skin Repair); APC 0136 (Level IV Skin Repair); and APC 
0137 (Level V Skin Repair). We are proposing to redistribute each of 
the procedures assigned to the current four levels of skin repair APCs 
into the five proposed APCs, with one exception. Specifically, we are 
proposing to reassign CPT code 15835 (Excision, excessive skin and 
subcutaneous tissue (including lipectomy); buttock) to APC 0022 (Level 
IV, Excision/Biopsy), where other CPT codes in its code family reside. 
The median costs of the five proposed APCs are $83.91 (APC 0133), 
$132.82 (APC 0134), $294.50 (APC 0135), $971.25 (APC 0136), and 
$1,316.85 (APC 0137). The proposed configurations of these new APCs are 
listed in Table 30 below.

        Table 30--Proposed CY 2008 Skin Repair APC Configurations
------------------------------------------------------------------------
                                                             Proposed CY
     HCPCS code           Short descriptor      Proposed CY    2008 APC
                                                  2008 APC   median cost
------------------------------------------------------------------------
11950..............  Therapy for contour               0133       $83.91
                      defects.
11951..............  Therapy for contour
                      defects.
11952..............  Therapy for contour
                      defects.
11954..............  Therapy for contour
                      defects.
12001..............  Repair superficial
                      wound(s).
12002..............  Repair superficial
                      wound(s).
12004..............  Repair superficial
                      wound(s).
12005..............  Repair superficial
                      wound(s).
12006..............  Repair superficial
                      wound(s).
12007..............  Repair superficial
                      wound(s).
12011..............  Repair superficial
                      wound(s).
12013..............  Repair superficial
                      wound(s).
12014..............  Repair superficial
                      wound(s).
12015..............  Repair superficial
                      wound(s).
12016..............  Repair superficial
                      wound(s).
12017..............  Repair superficial
                      wound(s).
12018..............  Repair superficial
                      wound(s).

[[Page 42708]]

 
12031..............  Layer closure of
                      wound(s).
12041..............  Layer closure of
                      wound(s).
12051..............  Layer closure of
                      wound(s).
12052..............  Layer closure of
                      wound(s).
12053..............  Layer closure of
                      wound(s).
15775..............  Hair transplant punch
                      grafts.
15776..............  Hair transplant punch
                      grafts.
11760..............  Repair of nail bed.......         0134      $132.82
11920..............  Correct skin color
                      defects.
11921..............  Correct skin color
                      defects.
11922..............  Correct skin color
                      defects.
12032..............  Layer closure of
                      wound(s).
12034..............  Layer closure of
                      wound(s).
12035..............  Layer closure of
                      wound(s).
12036..............  Layer closure of
                      wound(s).
12037..............  Layer closure of
                      wound(s).
12042..............  Layer closure of
                      wound(s).
12044..............  Layer closure of
                      wound(s).
12045..............  Layer closure of
                      wound(s).
12046..............  Layer closure of
                      wound(s).
12047..............  Layer closure of
                      wound(s).
12054..............  Layer closure of
                      wound(s).
12055..............  Layer closure of
                      wound(s).
12056..............  Layer closure of
                      wound(s).
12057..............  Layer closure of
                      wound(s).
13120..............  Repair of wound or
                      lesion.
13122..............  Repair wound/lesion add-
                      on.
13153..............  Repair wound/lesion add-
                      on.
15040..............  Harvest cultured skin
                      graft.
15170..............  Acell graft trunk/arms/
                      legs.
15171..............  Acell graft t/arm/leg add-
                      on.
15340..............  Apply cult skin
                      substitute.
15341..............  Apply cult skin sub add-
                      on.
15360..............  Apply cult derm sub, t/a/
                      l.
15361..............  Aply cult derm sub t/a/l
                      add.
15365..............  Apply cult derm sub f/n/
                      hf/g.
15366..............  Apply cult derm f/hf/g
                      add.
15819..............  Plastic surgery, neck.
12020..............  Closure of split wound...         0135      $294.50
12021..............  Closure of split wound.
13100..............  Repair of wound or
                      lesion.
13101..............  Repair of wound or
                      lesion.
13102..............  Repair wound/lesion add-
                      on.
13121..............  Repair of wound or
                      lesion.
13131..............  Repair of wound or
                      lesion.
13132..............  Repair of wound or
                      lesion.
13133..............  Repair wound/lesion add-
                      on.
13150..............  Repair of wound or
                      lesion.
13151..............  Repair of wound or
                      lesion.
13152..............  Repair of wound or
                      lesion.
15000..............  Wound prep, 1st 100 sq
                      cm.
15001..............  Wound prep, addl 100 sq
                      cm.
15002..............  Wnd prep, ch/inf, trk/arm/
                      lg.
15003..............  Wnd prep, ch/inf addl 100
                      cm.
15004..............  Wnd prep ch/inf, f/n/hf/
                      g.
15005..............  Wnd prep, f/n/hf/g, addl
                      cm.
15050..............  Skin pinch graft.
15110..............  Epidrm autogrft trnk/arm/
                      leg.
15111..............  Epidrm autogrft t/a/l add-
                      on.
15115..............  Epidrm a-grft face/nck/hf/
                      g.
15116..............  Epidrm a-grft f/n/hf/g
                      addl.
15150..............  Cult epiderm grft t/arm/
                      leg.
15151..............  Cult epiderm grft t/a/l
                      addl.
15152..............  Cult epiderm graft t/a/l
                      +%.
15155..............  Cult epiderm graft, f/n/
                      hf/g.
15156..............  Cult epidrm grft f/n/hfg
                      add.
15157..............  Cult epiderm grft f/n/hfg
                      +%.
15175..............  Acellular graft, f/n/hf/
                      g.
15176..............  Acell graft, f/n/hf/g add-
                      on.

[[Page 42709]]

 
15221..............  Skin full graft add-on.
15241..............  Skin full graft add-on.
15300..............  Apply skinallogrft, t/arm/
                      lg.
15301..............  Apply sknallogrft t/a/l
                      addl.
15320..............  Apply skin allogrft f/n/
                      hf/g.
15321..............  Apply sknallogrft f/n/hfg
                      add.
15330..............  Aply acell alogrft t/arm/
                      leg.
15331..............  Aply acell grft t/a/l add-
                      on.
15335..............  Apply acell graft, f/n/hf/
                      g.
15336..............  Apply acell grft f/n/hf/g
                      add.
15350..............  Skin homograft.
15351..............  Skin homograft add-on.
15400..............  Apply skin xenograft, t/a/
                      l.
15401..............  Apply skn xenogrft t/a/l
                      add.
15420..............  Apply skin xgraft, f/n/hf/
                      g.
15421..............  Apply skn xgrft f/n/hf/g
                      add.
15430..............  Apply acellular
                      xenograft.
15431..............  Apply acellular xgraft
                      add.
20926..............  Removal of tissue for
                      graft.
43887..............  Remove gastric port,
                      open.
11762..............  Reconstruction of nail            0136      $971.25
                      bed.
14000..............  Skin tissue
                      rearrangement.
14001..............  Skin tissue
                      rearrangement.
14020..............  Skin tissue
                      rearrangement.
14021..............  Skin tissue
                      rearrangement.
14040..............  Skin tissue
                      rearrangement.
14041..............  Skin tissue
                      rearrangement.
14060..............  Skin tissue
                      rearrangement.
14061..............  Skin tissue
                      rearrangement.
15130..............  Derm autograft, trnk/arm/
                      leg.
15131..............  Derm autograft t/a/l add-
                      on.
15135..............  Derm autograft face/nck/
                      hf/g.
15136..............  Derm autograft, f/n/hf/g
                      add.
15200..............  Skin full graft, trunk.
15201..............  Skin full graft trunk add-
                      on.
15220..............  Skin full graft sclp/arm/
                      leg.
15240..............  Skin full grft face/genit/
                      hf.
15260..............  Skin full graft een &
                      lips.
15261..............  Skin full graft add-on.
15740..............  Island pedicle flap
                      graft.
15936..............  Remove sacrum pressure
                      sore.
15952..............  Remove thigh pressure
                      sore.
15953..............  Remove thigh pressure
                      sore.
15956..............  Remove thigh pressure
                      sore.
15958..............  Remove thigh pressure
                      sore.
20920..............  Removal of fascia for
                      graft.
20922..............  Removal of fascia for
                      graft.
23921..............  Amputation follow-up
                      surgery.
25929..............  Amputation follow-up
                      surgery.
33222..............  Revise pocket, pacemaker.
33223..............  Revise pocket, pacing-
                      defib.
11960..............  Insert tissue expander(s)         0137    $1,316.85
13160..............  Late closure of wound.
14300..............  Skin tissue
                      rearrangement.
14350..............  Skin tissue
                      rearrangement.
15100..............  Skin splt grft, trnk/arm/
                      leg.
15101..............  Skin splt grft t/a/l, add-
                      on.
15120..............  Skn splt a-grft fac/nck/
                      hf/g.
15121..............  Skn splt a-grft f/n/hf/g
                      add.
15570..............  Form skin pedicle flap.
15572..............  Form skin pedicle flap.
15574..............  Form skin pedicle flap.
15576..............  Form skin pedicle flap.
15600..............  Skin graft.
15610..............  Skin graft.
15620..............  Skin graft.
15630..............  Skin graft.
15650..............  Transfer skin pedicle
                      flap.
15731..............  Forehead flap w/vasc
                      pedicle.

[[Page 42710]]

 
15732..............  Muscle-skin graft, head/
                      neck.
15734..............  Muscle-skin graft, trunk.
15736..............  Muscle-skin graft, arm.
15738..............  Muscle-skin graft, leg .
15750..............  Neurovascular pedicle
                      graft.
15760..............  Composite skin graft.
15770..............  Derma-fat-fascia graft.
15820..............  Revision of lower eyelid.
15821..............  Revision of lower eyelid.
15822..............  Revision of upper eyelid.
15823..............  Revision of upper eyelid.
15824..............  Removal of forehead
                      wrinkles.
15825..............  Removal of neck wrinkles.
15826..............  Removal of brow wrinkles.
15828..............  Removal of face wrinkles.
15829..............  Removal of skin wrinkles.
15840..............  Graft for face nerve
                      palsy.
15841..............  Graft for face nerve
                      palsy.
15842..............  Flap for face nerve
                      palsy.
15845..............  Skin and muscle repair,
                      face.
15876..............  Suction assisted
                      lipectomy.
15877..............  Suction assisted
                      lipectomy.
15878..............  Suction assisted
                      lipectomy.
15879..............  Suction assisted
                      lipectomy.
15922..............  Removal of tail bone
                      ulcer.
15934..............  Remove sacrum pressure
                      sore.
15935..............  Remove sacrum pressure
                      sore.
15937..............  Remove sacrum pressure
                      sore.
15944..............  Remove hip pressure sore.
15945..............  Remove hip pressure sore.
15946..............  Remove hip pressure sore.
20101..............  Explore wound, chest.
20102..............  Explore wound, abdomen.
20910..............  Remove cartilage for
                      graft.
20912..............  Remove cartilage for
                      graft.
43886..............  Revise gastric port,
                      open.
43888..............  Change gastric port,
                      open.
44312..............  Revision of ileostomy.
44340..............  Revision of colostomy
------------------------------------------------------------------------

3. Cardiac Computed Tomography and Computed Tomographic Angiography 
(APCs 0282, 0376, 0377, and 0398)
    (If you choose to comment on issues in this section, please include 
the caption ``Cardiac Computed Tomography and Computed Tomographic 
Angiography'' at the beginning of your comment.)
    Cardiac computed tomography (CCT) and cardiac computed tomography 
angiography (CCTA) are noninvasive diagnostic procedures that assist 
physicians in obtaining detailed images of coronary blood vessels. The 
data obtained from these procedures can be used for further diagnostic 
evaluations and/or appropriate therapy for coronary patients.
    Currently, there are eight Category III CPT codes that describe CCT 
and CCTA procedures. The CPT codes, which are shown in Table 31, are 
0144T through 0151T. These codes were new for CY 2006. In the CY 2006 
OPPS final rule with comment period, we assigned the CCT and CCTA 
procedure codes to interim APCs, which were subject to public comment. 
We received no comments on the interim APC assignments. Since January 
2006, the CCT and CCTA procedure codes have been assigned to four APCs, 
specifically, APC 0282 (Miscellaneous Computerized Axial Tomography), 
APC 0376 (Level II Cardiac Imaging), APC 0377 (Level III Cardiac 
Imaging), and APC 0398 (Level I Cardiac Imaging).
    In the CY 2007 OPPS/ASC proposed rule, we proposed to retain the 
existing APC assignments for the CCT and CCTA procedure codes. We 
received several comments on the proposed APCs assignments, which we 
addressed in the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68038 and 68039). Several of the commenters requested that we either 
not assign the CCT and CCTA procedures to any APCs or assign them to 
appropriate New Technology APCs. In addition, some commenters were also 
concerned that CCT and CCTA procedures were not clinically homogeneous 
with other procedures assigned to APCs 0282, 0376, 0377, and 0398, 
noting that the last three APCs previously contained only nuclear 
medicine cardiac imaging procedures.
    In the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68038), we indicated our belief that the clinical characteristics and 
expected resource use associated with the CCT and CCTA procedures were 
sufficiently similar to the other procedures assigned to APCs 0282, 
0376, 0377, and 0398 that we believed those APC assignments were 
appropriate. While several of those APCs also contained nuclear 
medicine imaging procedures, we had never designated those APCs as 
specific to

[[Page 42711]]

nuclear medicine procedures. Therefore, for CY 2007, we continued with 
the CY 2006 APC assignments for CPT codes 0144T through 0151T. We did 
not agree with the commenters that use of CT and CTA for cardiac 
studies was a new technology for which we had no relevant OPPS cost 
information that could be used to estimate hospital resources for these 
procedures. We also believed these services could be potentially 
covered hospital outpatient services, so that it would not be 
appropriate for us to depart from our standard OPPS policy and not 
assign them to APCs. As we indicated in our CY 2007 OPPS/ASC proposed 
rule (71 FR 49549), some Category III CPT codes describe services that 
we have determined to be similar in clinical characteristics and 
resource use to HCPCS codes assigned to existing clinical APCs. In 
these instances, we may assign the Category III CPT code to the 
appropriate clinical APC. Other Category III CPT codes describe 
services that we have determined are not compatible with an existing 
clinical APC, yet are appropriately provided in the hospital outpatient 
setting. In these cases, we may assign the Category III CPT code to 
what we estimate is an appropriately priced New Technology APC. In 
other cases, we may assign a Category III CPT code to one of several 
nonseparately payable status indicators, including ``N,'' ``C,'' 
``B,''' or ``E,''' which we believe is appropriate for the specific 
code. As we noted in the CY 2007 OPPS/ASC final rule with comment 
period, we believed that CCT and CCTA procedures were appropriate for 
separate payment under the OPPS should local contractors provide 
coverage for these procedures, and, therefore, they warranted status 
indicator and APC assignments that would provide separate payment under 
the OPPS (71 FR 68038).
    At its March 2007 meeting, the APC Panel recommended that CMS work 
with stakeholders to determine more appropriate APC placements for CCT 
and CCTA procedures. The APC Panel made no specific recommendations 
regarding the appropriate APC assignments for these services, although 
several different clinical APC configurations were discussed, along 
with the alternative of assigning these procedures to New Technology 
APCs.
    We note that we generally meet with interested organizations 
concerning their views about OPPS payment policy issues with respect to 
specific technologies or services. Following the publication of the CY 
2007 OPPS/ASC final rule with comment period, we received such 
information from interested individuals and organizations regarding the 
clinical and facility resource characteristics of CCT and CCTA 
procedures. We will consider the input of any individual or 
organization to the extent allowed by Federal law, including the 
Administrative Procedure Act (APA) and the FACA. We establish the OPPS 
payment rates for services through regulations, during our annual 
rulemaking cycle. We are required to consider the timely comments of 
interested organizations, establish the payment policies for the 
forthcoming year, and respond to the timely comments of all public 
commenters in the final rule in which we establish the payments for the 
forthcoming year.
    Analysis of our hospital data for claims submitted for CY 2006 
indicate that CCT and CCTA procedures are performed relatively 
frequently on Medicare patients. Our claims data show a total of over 
16,000 procedures performed, with about 11,000 single claims available 
for ratesetting. Based on our analysis of the robust hospital 
outpatient claims data, we believe we have adequate claims data from CY 
2006 upon which to determine the median costs of performing these 
procedures and to assign them to appropriate clinical APCs. We see no 
rationale for reassigning these procedures to New Technology APCs in CY 
2008, when we have claims-based cost information regarding these 
procedures, and they are clinically similar to other procedures paid 
under the OPPS.
    We acknowledge the concerns that have been expressed to us 
regarding the clinical homogeneity of APCs 0376, 0377, and 0398, where 
some of the CCT and CCTA are assigned for CY 2007 along with nuclear 
medicine cardiac imaging procedures. Because we are proposing to 
package payment for diagnostic radiopharmaceuticals into payment for 
diagnostic nuclear medicine procedures in CY 2008 as discussed in 
detail in section II.A.4. of this proposed rule, we believe that to 
ensure the clinical and resource homogeneity of APCs 0376, 0377, and 
0398 in CY 2008, it would be most appropriate to reassign the CCT and 
CCTA services currently residing in those APCs to other clinical APCs 
for CY 2008.
    Therefore, for CY 2008, we are proposing to assign the CCT and CCTA 
procedures to two clinical APCs, specifically new clinical APC 0383 
(Cardiac Computed Tomographic Imaging) and APC 0282, as shown in Table 
31. The proposed median cost of $313.81 for APC 0383 is based entirely 
on claims data for CPT codes 0145T, 0146T, 0147T, 0148T, 0149T, and 
0150T that describe CCT and CCTA services, a clinically homogeneous 
grouping of services. In addition, the individual median costs of these 
services range from a low of $276.50 to a high of $436.79, reflecting 
their hospital resource similarity as well. We are proposing to 
reassign the two other CCT CPT codes, specifically CPT codes 0144T and 
0151T, to APC 0282. The inclusion of these two codes in APC 0282 
results in a CY 2008 proposed APC median cost of $105.48.

                     Table 31.--Proposed CY 2008 APC Assignments of CCT and CCTA Procedures
----------------------------------------------------------------------------------------------------------------
                                                                                                     Proposed CY
   HCPCS code    Short descriptor   CY 2007 SI   CY 2007   CY 2007 APC    Proposed CY   Proposed CY    2008 APC
                                                   APC     median cost      2008 SI       2008 APC   median cost
----------------------------------------------------------------------------------------------------------------
0144T..........  CT heart wo dye;  S..........       0398      $252.17  S.............         0282      $105.48
                  qual calc.
0145T..........  CT heart w/wo     S..........       0376       304.52  S.............         0383       313.81
                  dye funct.
0146T..........  CCTA w/wo dye...  S..........       0376       304.52  S.............         0383       313.81
0147T..........  CCTA w/wo, quan   S..........       0376       304.52  S.............         0383       313.81
                  calcium.
0148T..........  CCTA w/wo, strxr  S..........       0377       397.29  S.............         0383       313.81
0149T..........  CCTA w/wo, strxr  S..........       0377       397.29  S.............         0383       313.81
                  quan calc.
0150T..........  CCTA w/wo,        S..........       0398       252.17  S.............         0383       313.81
                  disease strxr.
0151T..........  CT heart funct    S..........       0282        93.98  S.............         0282       105.48
                  add-on.
----------------------------------------------------------------------------------------------------------------


[[Page 42712]]

    4. Ultrasound Ablation of Uterine Fibroids With Magnetic Resonance 
Guidance (MRgFUS) (APCs 0195 and 0202)
    (If you choose to comment on issues in this section, please include 
the caption ``Ultrasound Ablation of Uterine Fibroids with Magnetic 
Resonance Guidance (MRgFUS)'' at the beginning of your comment.)
    Magnetic resonance guided focused ultrasound (MRgFUS) is a 
noninvasive surgical procedure that uses high intensity focused 
ultrasound waves to destroy tissue in combination with magnetic 
resonance imaging (MRI). Currently, the two Category III CPT codes for 
this procedure are 0071T (Focused ultrasound ablation of uterine 
leiomyomata, including MR guidance; total leiomyomata volume less than 
200 cc of tissue) and 0072T (Focused ultrasound ablation of uterine 
leiomyomata, including MR guidance; total leiomyomata volume greater or 
equal to 200 cc of tissue), which were implemented on January 1, 2005.
    In the CY 2006 OPPS proposed rule, we proposed to continue to 
assign both codes to APC 0193 (Level V Female Reproductive Proc). 
However, at the August 2005 APC Panel meeting, the APC Panel 
recommended that CMS work with stakeholders to assign CPT codes 0071T 
and 0072T to appropriate New Technology APCs. Based on our review of 
several factors, which included information presented at the August 
2005 APC Panel meeting, the comments received on the CY 2006 OPPS 
proposed rule, and our analysis of OPPS claims data for different 
procedures, we reassigned CPT code 0071T from APC 0193 to APC 0195 
(Level IX Female Reproductive Proc) and CPT code 0072T from APC 0193 to 
APC 0202 (Level X Female Reproductive Proc) effective January 1, 2006, 
to reflect the higher level of resources we estimated were required 
when performing the MRgFUS procedures.
    In the CY 2007 OPPS/ASC proposed rule, we proposed to continue to 
assign CPT code 0071T to APC 0195 and CPT code 0072T to APC 0202. We 
received comments on the CY 2007 proposed APC assignments recommending 
that we revise the APC assignments for CPT codes 0071T and 0072T. The 
commenters indicated that, while MRgFUS treats anatomical sites that 
are similar to other procedures assigned to APCs 0195 and 0202, the 
resources utilized differ dramatically. Several commenters recommended 
that the most appropriate APC assignment for the MRgFUS procedures 
would be APC 0127 (Level IV Stereotactic Radiosurgery), based on their 
analyses of the procedures' resource use and clinical characteristics.
    As we stated in both the CY 2006 OPPS final rule with comment 
period and the CY 2007 OPPS/ASC final rule with comment period, we 
believe that MRgFUS treatment bears a significant relationship to 
technologies already in use in hospital outpatient departments (70 FR 
68600 and 71 FR 68050, respectively). The use of focused ultrasound for 
thermal tissue ablation has been in development for decades, and the 
recent application of MRI to focused ultrasound therapy provides 
monitoring capabilities that may make the therapy more clinically 
useful. We continue to believe that, although MRgFUS therapy is 
relatively new, it is an integrated application of existing 
technologies (MRI and ultrasound), and its technology resembles other 
OPPS services that are assigned to clinical APCs for which we have 
significant OPPS claims data. In the CY 2007 OPPS/ASC final rule with 
comment period (71 FR 68050), we explained our belief that retaining 
MRgFUS procedures in clinical APCs with other female reproductive 
procedures would enable us both to set accurate payment rates and to 
maintain appropriate clinical homogeneity of the APCs. Furthermore, we 
did not agree with commenters that MRgFUS procedures shared sufficient 
clinical and resource characteristics with cobalt-based stereotactic 
radiosurgery (SRS) to reassign them to that particular clinical APC 
0127, where only the single specific SRS procedure was assigned for CY 
2007 and which had a CY 2007 APC median cost of $8,460.53. 
Consequently, in the CY 2007 OPPS/ASC final rule with comment period 
(71 FR 68051), we finalized payment for these procedures in APCs 0195 
and 0202 as proposed.
    Analysis of our hospital outpatient data for claims submitted for 
CY 2006 indicates that MRgFUS procedures are rarely performed on 
Medicare patients. As we stated in the CY 2006 OPPS final rule with 
comment period and CY 2007 OPPS/ASC final rule with comment period, 
because treatment of uterine fibroids is most common among women 
younger than 65 years of age, we do not expect that there ever will be 
many Medicare claims for the MRgFUS procedures (70 FR 68600 and 71 FR 
68050, respectively). For OPPS claims submitted from CY 2005 through CY 
2006, our claims data show that there were only two claims submitted 
for CPT code 0071T in CY 2005 and one in CY 2006. We have no hospital 
claims for CPT code 0072T from either of those years.
    At its March 2007 meeting, the APC Panel recommended that, for CY 
2008, CMS reassign CPT codes 0071T and 0072T from APCs 0195 and 0202 to 
APC 0067 (Level III Stereotactic Radiosurgery, MRgFUS, and MEG), which 
has a proposed APC median cost of $3,869.96 for CY 2008. The APC Panel 
discussed its general belief that while the MRgFUS procedures may not 
be performed frequently on Medicare patients, CMS should pay 
appropriately for the procedures to ensure access for Medicare 
beneficiaries. In addition, following discussion of the potential for 
reassignment of the CPT codes to New Technology APCs, the APC Panel 
specifically recommended that the procedures be assigned to a clinical 
APC at this point in their adoption into clinical practice, instead of 
a New Technology APC. Furthermore, since publication of the CY 2007 
OPPS/ASC final rule with comment period, we have received input from 
interested individuals and organizations regarding the clinical and 
resource characteristics of MRgFUS procedures. Based on our 
consideration of all information available to us regarding the 
necessary hospital resources for the MRgFUS procedures in comparison 
with other procedures for which we have historical hospital claims 
data, for CY 2008 we are proposing to accept the APC Panel's 
recommendation to reassign these services to clinical APC 0067, an APC 
that currently contains two linear accelerator-based stereotactic 
radiosurgery (SRS) procedures that are conducted in a single or first 
session, rather than procedures for subsequent SRS treatment fractions. 
We agree with the APC Panel that these SRS procedures share sufficient 
clinical and resource similarity with the MRgFUS services, including 
reliance on image guidance in a single treatment session to ablate 
abnormal tissue, to justify their assignment to the same clinical APC. 
Unlike the cobalt-based SRS service that we concluded in the CY 2007 
OPPS/ASC final rule with comment period was not similar to MRgFUS 
procedures based on clinical and resource considerations, these linear 
accelerator-based SRS procedures are not performed solely on 
intracranial lesions and generally do not require immobilization of the 
patient's head in a frame that is screwed into the skull, thereby 
exhibiting characteristics more consistent with MRgFUS treatments. In 
addition, based on our understanding of the MRgFUS procedures described 
by the two CPT codes which differ only in the volume of uterine 
leiomyomata treated, we believe it would be most

[[Page 42713]]

appropriate to assign both of these procedures to the same clinical 
APC, as recommended by the APC Panel. Therefore, for CY 2008 we are 
proposing to reassign CPT codes 0071T and 0072T to APC 0067, with a 
proposed APC median cost of $3,869.96, as reflected in Table 32.

                        Table 32.--Proposed CY 2008 APC Assignments of MRgFUS Procedures
----------------------------------------------------------------------------------------------------------------
                                                                                                     Proposed CY
   HCPCS code     Short descriptor  CY 2007 SI   CY 2007   CY 2007 APC    Proposed CY   Proposed CY    2008 APC
                                                   APC     median cost      2008 SI       2008 APC   median cost
----------------------------------------------------------------------------------------------------------------
0071T..........  U/s leiomyomata    T.........       0195    $1,742.20  S.............         0067    $3,869.96
                  ablate <200.
0072T..........  U/s leiomyomata    T.........       0202     2,534.46  S.............         0067     3,869.96
                  ablate >200.
----------------------------------------------------------------------------------------------------------------

5. Single Allergy Tests (APC 0381)
    (If you choose to comment on issues in this section, please include 
the caption ``Single Allergy Tests'' at the beginning of your comment.)
    For CY 2008, we are proposing to continue with our methodology of 
differentiating single allergy tests (``per test'') from multiple 
allergy tests (``per visit'') by assigning these services to two 
different APCs to provide accurate payments for these tests in CY 2008. 
Multiple allergy tests are currently assigned to APC 0370 (Allergy 
Tests) with a median cost calculated based on the standard OPPS 
methodology. We provided billing guidance in CY 2006 in Transmittal 804 
(issued on January 3, 2006) specifically clarifying that hospitals 
should report charges for the CPT codes that describe single allergy 
tests to reflect charges ``per test'' rather than ``per visit'' and 
should bill the appropriate number of units of these CPT codes to 
describe all of the tests provided. However, our CY 2006 claims data 
available for this CY 2008 proposed rule for APC 0381 (Single Allergy 
Tests) do not reflect improved and more consistent hospital billing 
practices of ``per test'' for single allergy tests. Using the CY 2006 
claims data, the median cost of APC 0381 calculated according to the 
standard single claims OPPS methodology is $66.17, significantly higher 
than the CY 2007 median cost of $16.43 for APC 0381 calculated 
according to the ``per unit'' methodology and greater than we would 
expect for these procedures that are to be reported ``per test'' with 
the appropriate number of units. Some claims for single allergy tests 
still appeared to include charges that represent a ``per visit'' 
charge, rather than a ``per test'' charge. Therefore, consistent with 
our payment policy for CYs 2006 and 2007, we are proposing to calculate 
a ``per unit'' median cost for APC 0381, based upon 276 CY 2006 claims 
containing multiple units or multiple occurrences of a single CPT code, 
where packaging on the claims is allocated equally to each unit of the 
CPT code. Using this methodology, we calculated a proposed median cost 
of $18.96 for APC 0381 for CY 2008. We will consider whether further 
instructions to hospitals for reporting these procedures would be 
beneficial, because we are concerned that our claims data for CY 2006 
reflect no apparent change in hospitals' billing practices following 
our January 2006 clarification. We remain hopeful that better and more 
accurate hospital reporting and charging practices for these single 
allergy test CPT codes in future years may allow us to calculate the 
median cost of APC 0381 using the standard OPPS process for future OPPS 
updates.
6. Myocardial Positron Emission Tomography (PET) Scans (APC 0307)
    (If you choose to comment on issues in this section, please include 
the caption ``Myocardial PET Scans'' at the beginning of your comment.)
    From August 2000 to December 31, 2005, under the OPPS, we assigned 
one clinical APC to all myocardial positron emission tomography (PET) 
scan procedures, which were reported with multiple G-codes through 
March 31, 2005. Under the OPPS, effective April 1, 2005, myocardial PET 
scans were reported with three CPT codes, specifically CPT codes 78459 
(Myocardial imaging, positron emission tomography (PET), metabolic 
evaluation), 78491 (Myocardial imaging, positron emission tomography 
(PET), perfusion; single study at rest or stress), and 78492 
(Myocardial imaging, positron emission tomography (PET), perfusion; 
multiple studies at rest and/or stress). From April 1, 2005 through 
December 31, 2005, these three CPT codes were assigned to one APC, 
specifically APC 0285 (Myocardial Positron Emission Tomography (PET), 
with a payment rate of $735.77. In CY 2006, in response to the public 
comments received on the CY 2006 OPPS proposed rule, and based on our 
claims information, myocardial PET services were assigned to two 
clinical APCs for the CY 2006 OPPS. The CPT codes for the single scans, 
specifically 78459 and 78491, were assigned to APC 0306 (Myocardial 
Positron Emission Tomography (PET) Imaging, Single Study, Metabolic 
Evaluation) with a payment rate of $800.55, and the multiple scan CPT 
code 78492 was assigned to APC 0307 (Myocardial Positron Emission 
Tomography (PET) Imaging, Multiple Studies) with a payment rate of 
$2,484.88, effective January 1, 2006. However, analysis of the CY 2005 
claims data that were used to set the payment rates for CY 2007 
revealed that when all the myocardial PET scan procedure codes were 
combined into a single clinical APC, as they were prior to CY 2006, the 
APC median cost for myocardial PET services was very similar to the 
median cost of their single CY 2005 clinical APC. Further, our analysis 
revealed that the updated differential median costs of the single and 
multiple study procedures no longer supported the two-level APC payment 
structure. Therefore, for CY 2007, CPT codes 78459, 78491, and 78492, 
were assigned to a single clinical APC, specifically APC 0307, which 
was renamed ``Myocardial Positron Emission Tomography (PET) Imaging,'' 
with a median cost of $726.98.
    At its March 2007 meeting, the APC Panel recommended that CMS 
reassign CPT code 78492 to its own clinical APC, to distinguish this 
multiple study procedure that the APC Panel believed would require 
greater hospital resources from less resource intensive single study 
procedures. However, we are not accepting the APC Panel's 
recommendation because, consistent with our observations from the CY 
2005 claims data, our updated CY 2006 claims data do not support the 
creation of a clinical APC for CPT code 78492 alone. Analysis of the 
latest CY 2006 claims data continues to support a single level APC 
payment structure for the myocardial PET scan procedures because very 
few single scan studies are performed and we believe single and 
multiple scan procedures are clinically

[[Page 42714]]

similar. Our claims data available for this proposed rule show a total 
of 2,547 procedures reported with the multiple scan CPT code 78492. 
Alternatively, our claims data show only a combined total of 249 
procedures reported with the single scan CPT codes 78459 and 78491, 
less than 10 percent of all studies reported. A similar distribution is 
observed in the single bills available for ratesetting.
    Similar to last year's findings, our claims data reveal that more 
hospitals are not only providing multiple myocardial PET scan services, 
but most myocardial PET scans are multiple studies. We believe that the 
assignment of CPT codes 78459, 78491, and 78492 to a single clinical 
APC for CY 2008 remains appropriate because the CY 2006 claims data do 
not support a resource differential among significant myocardial PET 
services that would necessitate the placement of single and multiple 
PET scan procedures into two separate clinical APCs. Therefore, we are 
proposing to continue to assign both the single and multiple myocardial 
PET scan procedure codes to APC 0307, with a proposed APC median cost 
of $2,677.71 for CY 2008. We note that the proposed CY 2008 median cost 
of APC 0307 is significantly higher than its CY 2007 median cost, in 
part because of our proposed CY 2008 packaging approach discussed in 
detail in section II.A.4. of this proposed rule that would package 
payment for diagnostic radiopharmaceuticals into the payment for their 
related diagnostic nuclear medicine studies, such as myocardial PET 
scans. We believe that the proposed median cost appropriately reflects 
the hospital resources associated with providing myocardial PET scans 
to Medicare beneficiaries in cost-efficient settings. Furthermore, we 
believe that the proposed CY 2008 OPPS payment rates are adequate to 
ensure appropriate access to these services for Medicare beneficiaries. 
The myocardial PET scan CPT codes and their proposed CY 2008 APC 
assignments are displayed in Table 33.

                      Table 33.--Proposed CY 2008 APC Assignments for Myocardial PET Scans
----------------------------------------------------------------------------------------------------------------
                                                                                                     Proposed CY
  HCPCS code    Short descriptor    CY 2007 SI    CY 2007   CY 2007 APC   Proposed CY   Proposed CY    2008 APC
                                                    APC     median cost     2008 SI       2008 APC   median cost
----------------------------------------------------------------------------------------------------------------
78459.........  Heart muscle      S............       0307      $726.98  S............         0307    $2,677.71
                 imaging (PET).
78491.........  Heart image       S............       0307       726.98  S............         0307     2,677.71
                 (pet), single.
78492.........  Heart image       S............       0307       726.98  S............         0307     2,677.71
                 (pet), multiple.
----------------------------------------------------------------------------------------------------------------

7. Implantation of Cardioverter-Defibrillators (APCs 0107 and 0108)
    (If you choose to comment on issues in this section, please include 
the caption ``Implantation of Cardioverter-Defibrillators'' at the 
beginning of your comment.)
    In CY 2003, we created four Level II HCPCS codes for implantation 
of single and dual chamber cardioverter-defibrillators (ICDs) with and 
without leads because, for the CY 2004 OPPS, we deleted the device 
HCPCS codes and there was no other way of determining whether the 
device being implanted was a single chamber or dual chamber device. We 
were concerned that the costs of inserting single versus dual chamber 
ICDs could be sufficiently different due to the two types of devices 
implanted such that separate APC assignments for the insertion 
procedures could be appropriate in the future. The HCPCS codes are 
G0297 (Insertion of single chamber pacing cardioverter defibrillator 
pulse generator); G0298 (Insertion of dual chamber pacing cardioverter 
defibrillator pulse generator); G0299 (Insertion or repositioning of 
electrode lead for single chamber pacing cardioverter defibrillator and 
insertion of pulse generator); and G0300 (Insertion or repositioning of 
electrode lead for dual chamber pacing cardioverter defibrillator and 
insertion of pulse generator). The pairs of codes were assigned to two 
different clinical APCs, depending on whether or not they included the 
possibility of electrode insertion, specifically APC 0107 (Insertion of 
Cardioverter-Defibrillator) and APC 0108 (Insertion/Replacement/Repair 
of Cardioverter-Defibrillator Leads).
    In the same year, the OPPS ceased to recognize for payment the two 
CPT codes for insertion of ICDs with or without ICD leads. These CPT 
codes are 33240 (Insertion of single or dual chamber pacing 
cardioverter-defibrillator pulse generator) and 33249 (Insertion or 
repositioning of electrode lead(s) for single or dual chamber pacing 
cardioverter-defibrillator and insertion of pulse generator).
    We reinstated the device category HCPCS codes on January 1, 2005. 
Moreover, since January 1, 2005, hospitals have been required to report 
devices they use or implant when there is a device code that describes 
the device. We began to edit to ensure that hospitals are correctly 
billing devices required for certain procedures in April 2005 and 
implemented the second phase of device edits on October 1, 2005. 
Therefore, we no longer need different procedural Level II HCPCS codes 
to identify whether hospitals inserted a single or dual chamber ICD 
device.
    At its March 2007 meeting, the APC Panel recommended that CMS 
delete the Level II HCPCS codes for implantation of cardioverter-
defibrillator pulse generators with or without repositioning or 
implantation of electrode lead(s) and authorize hospitals to report the 
CPT codes. The APC Panel indicated that the requirement for reporting 
device codes would enable CMS to continue to identify costs when 
different types of devices are implanted if that were to be necessary.
    We analyzed the median cost data associated with APCs 0107 and 0108 
as part of our preparation for the APC Panel discussion. While there is 
a difference in the median cost when a single chamber versus a dual 
chamber device is implanted, the difference has never been great enough 
to justify differential APC assignments for the procedures. See Table 
34 below for a historical summary of all single claim median costs. 
(For purposes of this analysis, we display the median costs for all 
single claims without regard to adjustment or to whether the claims 
meet various selection criteria; these are not the median costs on 
which payments were based.)
    Hospitals have consistently indicated that they would prefer to 
report the services furnished using the CPT codes that describe them, 
rather than the alphanumeric G-codes, because many private payers 
require that they bill the CPT codes. We also prefer to recognize CPT 
codes for procedures under the OPPS, when possible, to minimize the 
administrative coding burden on hospitals.

[[Page 42715]]

    We believe that the differences between the median costs for the 
two Level II HCPCS codes assigned to each APC (that is, G0297 and G0298 
for APC 0107 and G0299 and G0300 for APC 0108) do not currently support 
differential APC assignments for single and dual chamber ICD insertion 
procedures. The required device coding would allow us to continue to 
follow the different costs over time by examining subsets of ICD 
implantation procedure claims based on the type of device reported on 
the claims. Moreover, we are sensitive to the benefits of minimizing 
the reporting burden on hospitals. Therefore, for CY 2008 we are 
proposing to delete the Level II HCPCS codes for ICD insertion 
procedures and require hospitals to bill the appropriate CPT codes, 
along with the applicable device C-codes, for payment under the OPPS.

         Table 34.--Historical Unadjusted Median Cost Data from All Single Claims for APCs 0107 and 0108
----------------------------------------------------------------------------------------------------------------
                                  CY 2002 claims
                                   (includes 75%
                                    of  device     Unadjusted CY   Unadjusted CY   Unadjusted CY   Unadjusted CY
           HCPCS code                cost per       2003 claims     2004 claims     2005 claims     2006 claims
                                   manufacturer   (CY 2005 OPPS)  (CY 2006 OPPS)  (CY 2007 OPPS)  (CY 2008 OPPS)
                                    data)  (CY
                                    2004 OPPS)
----------------------------------------------------------------------------------------------------------------
APC 0107:
    33240.......................      $17,025.21      $12,102.28  ..............  ..............  ..............
    G0297.......................  ..............       11,886.42      $13,392.82      $10,821.06      $18,470.82
    G0298.......................  ..............       17,168.67       14,316.54       13,935.35       21,571.88
APC 0108:
    33249.......................      $28,685.29       17,330.96  ..............  ..............  ..............
    G0299.......................  ..............       18,561.51       18,425.79       21,367.99       23,060.55
    G0300.......................  ..............       21,006.03       19,306.96       23,680.34       26,204.89
----------------------------------------------------------------------------------------------------------------

8. Implantation of Spinal Neurostimulators (APC 0222)
    (If you choose to comment on issues in this section, please include 
the caption ``Implantation of Spinal Neurostimulators'' at the 
beginning of your comment.)
    The CPT code for insertion of a spinal neurostimulator (63685, 
Insertion or replacement of spinal neurostimulator pulse generation or 
receiver, direct or inductive coupling), which is assigned to APC 0222 
(Implantation of Neurological Device), is reported for both the 
insertion of a nonrechargeable neurostimulator and a rechargeable 
neurostimulator. The costs of a nonrechargeable neurostimulator from CY 
2005 claims are packaged into the payment for APC 0222 in CY 2007. We 
believe rechargeable neurostimulators are currently most commonly 
implanted for spinal neurostimulation, consistent with the information 
provided during our consideration of the device for pass through 
designation. However, in response to hospital requests we have recently 
expanded our procedure-to-device edits to allow device category code 
C1820 (Generator, neurostimulator (implantable), with rechargeable 
battery and charging system) to be reported with two other procedures. 
These procedures are CPT code 64590 (Insertion or replacement of 
peripheral neurostimulator pulse generator or receiver, direct or 
inductive coupling), assigned to APC 0222, and CPT code 61885 
(Insertion or replacement of cranial neurostimulator pulse generator or 
receiver, direct or inductive coupling; with connection to a single 
electrode array), assigned to APC 0039 (Level I Implantation of 
Neurostimulator).
    The rechargeable neurostimulator reported as device category code 
C1820 has received pass-through payment since January 1, 2006, and its 
pass-through status will expire on January 1, 2008, as discussed 
further in section IV.B. of this proposed rule. During the 2 years of 
pass-through payment when device category code C1820 has been paid at a 
hospital's charges reduced to cost using the overall hospital CCR, we 
have applied a device offset when device category code C1820 is 
reported with a CPT code assigned to APCs 0039 or 0222 in order to 
remove the costs of the predecessor nonrechargeable device from the 
cost-based payment of C1820. This device offset ensures that no 
duplicate device payment is made. As a general policy, under the OPPS 
we package payment for the costs of devices into the payment for the 
procedure in which they are used, unless those devices have OPPS pass-
through status, such as the case here.
    Review of our CY 2007 claims data for APC 0222 shows that the costs 
of the associated neurostimulator implantation procedures are higher 
when the rechargeable neurostimulator is implanted rather than the 
traditional nonrechargeable neurostimulator. We refer readers to Table 
35 below for the median costs of APC 0222 under different device 
packaging scenarios. However, the difference in costs is not so great 
that retaining the implantation of both types of devices for spinal or 
peripheral neurostimulation in APC 0222 would cause a 2 times 
violation, and thereby, justify creating a new clinical APC. In 
addition, to pay differentially would require us to establish one or 
more Level II HCPCS codes for reporting under the OPPS, because the 
three CPT codes for which device category code C1820 is currently an 
allowed device do not differentiate among the device implantation 
procedures based on the specific device used. The creation of special 
Level II HCPCS codes for OPPS reporting is generally undesirable, 
unless absolutely essential, because it increases hospital 
administrative burden as the codes may not be accepted by other payers. 
Establishing separate coding and payment would reduce the size of the 
APC payment groups in a year where we are proposing to increase 
packaging under the OPPS through expanded payment groups.
    We believe that the principles of a prospective payment system are 
best served by following our standard practice of retaining a single 
CPT code for neurostimulator implantation procedures that does not 
distinguish between rechargeable and nonrechargeable neurostimulators, 
into which the costs of both types of devices are packaged in 
relationship to their OPPS utilization. To the extent that the 
rechargeable neurostimulator may become the dominant device implanted 
over time for neurostimulation, the median costs of APCs 0222 and 0039 
would reflect the change in surgical practice in future years. In the 
meantime, with the rechargeable neurostimulator coming off pass-through 
status for CY 2008, by following our standard practice we would be 
increasing the size of the APC 0222 and

[[Page 42716]]

APC 0039 payment bundles for CY 2008, thereby encouraging hospitals to 
use resources most efficiently.
    Therefore, for CY 2008 we are proposing to package the costs of 
rechargeable neurostimulators into the payment for the CPT codes that 
describe the services furnished. Our proposed median cost for APC 0222 
is $12,161.64, upon which the CY 2008 payment rate for APC 0222 would 
be based. We believe this approach is the most administratively simple, 
consistent with OPPS packaging principles, and supportive of 
encouraging hospital efficiency, yet it also provides appropriate 
packaged payment for implantable neurostimulators. While we welcome 
public comment on this issue, we request that commenters address how 
this specific device implantation situation differs from many other 
scenarios under the OPPS, where relatively general HCPCS codes describe 
procedures that may utilize a variety of devices with different costs, 
and payment for those devices is packaged into the payment for the 
associated procedures.

          Table 35.--APC 0222 CY 2006 Data Based on Claims Reporting Different Neurostimulator Devices
----------------------------------------------------------------------------------------------------------------
                                                                                   CY 2006 pass
                                                                   CY 2006 count       edit,       CY 2006 pass
                     APC 0222 configurations                       of hospitals    nontoken, no        edit,
                                                                      billing        FB single     nontoken, no
                                                                                       bills      FB median cost
----------------------------------------------------------------------------------------------------------------
APC 0222, including claims with both rechargeable and                        868           2,830      $12,161.64
 nonrechargeable neurostimulators...............................
APC 0222A, including only claims with nonrechargeable                        781           2,412       11,607.75
 neurostimulators...............................................
APC 0222B, including only claims with rechargeable                           238             422       18,088.71
 neurostimulators...............................................
----------------------------------------------------------------------------------------------------------------

9. Stereotactic Radiosurgery (SRS) Treatment Delivery Services (APCs 
0065, 0066, and 0067)
    (If you choose to comment on issues in this section, please include 
the caption ``SRS Treatment Delivery Services'' at the beginning of 
your comment.)
    For CY 2007, the CPT Editorial Panel created four new SRS Category 
I CPT codes in the Radiation Oncology section of the 2007 CPT manual. 
Specifically, the CPT Editorial Panel created CPT codes 77371 
(Radiation treatment delivery, stereotactic radiosurgery (SRS) 
(complete course of treatment of cerebral lesion(s) consisting of 1 
session); multi-source Cobalt 60 based)); 77372 (Radiation treatment 
delivery, stereotactic radiosurgery (SRS) (complete course of treatment 
of cerebral lesion(s) consisting of 1 session); linear accelerator 
based)), 77373 (Stereotactic body radiation therapy, treatment 
delivery, per fraction to 1 or more lesions, including image guidance, 
entire course not to exceed 5 fractions); and 77435 (Stereotactic body 
radiation therapy, treatment management, per treatment course, to one 
or more lesions, including image guidance, entire course not to exceed 
5 fractions).
    Of the four CPT codes, CPT codes 77371 and 77435 were recognized 
under the OPPS effective January 1, 2007, while CPT codes 77372 and 
77373 were not. CPT code 77371 was assigned to the same APC and status 
indicator as its predecessor code, HCPCS code G0243 (Multi-source 
photon stereotactic radiosurgery, delivery including collimator changes 
and custom plugging, complete course of treatment, all lesions). For CY 
2007, CPT code 77371 was assigned to APC 0127 with a status indicator 
of ``S.'' Prior to CY 2007, CPT code 77435 was described under CPT code 
0083T (Stereotactic body radiation therapy, treatment management, per 
day), which was assigned to status indicator ``N'' in the OPPS. The CPT 
Editorial Panel decided to delete CPT code 0083T on December 31, 2006, 
and replaced it with CPT code 77435. Because the costs of SRS treatment 
management were already packaged into the OPPS payment rates for SRS 
treatment delivery, we assigned CPT code 77435 to status indicator 
``N'' which was the same status indicator that was assigned to its 
predecessor Category III CPT code (0083T), under the OPPS, effective 
January 1, 2007. We note that the OPPS treatment of these new CPT codes 
was open to comment in the CY 2007 OPPS/ASC final rule with comment 
period, and we will specifically respond to those comments, according 
to our usual practice, in the CY 2008 OPPS/ASC final rule with comment 
period.
    As we explained in the CY 2007 OPPS/ASC final rule with comment 
period (71 FR 68025), we did not recognize CPT codes 77372 and 77373 
because they do not accurately and specifically describe the HPCPCS G-
codes that we currently use for linear accelerator (LINAC)-based SRS 
treatment delivery services under the OPPS. During CY 2006, CPT code 
77372 was reported under one of two HCPCS codes, depending on the 
technology used, specifically, G0173 (Linear accelerator based 
stereotactic radiosurgery, complete course of therapy in one session) 
and G0339 (Image-guided robotic linear accelerator-based stereotactic 
radiosurgery, complete course of therapy in one session or first 
session of fractionated treatment). Because HCPCS codes G0173 and G0339 
are more specific in their descriptors than CPT code 77372, we decided 
to continue using HCPCS codes G0173 and G0339 under the OPPS for CY 
2007. For CY 2007, we assigned CPT code 77372 to status indicator ``B'' 
under the OPPS. In addition, during CY 2006, CPT code 77373 was 
reported under one of three HCPCS codes depending on the circumstances 
and technology used, specifically, G0251 (Linear accelerator-based 
stereotactic radiosurgery, delivery including collimator changes and 
custom plugging, fractionated treatment, all lesions, per session, 
maximum five sessions per course of treatment); G0339 (Image-guided 
robotic linear accelerator-based stereotactic radiosurgery, complete 
course of therapy in one session or first session of fractionated 
treatment); and G0340 (Image-guided robotic linear accelerator-based 
stereotactic radiosurgery, delivery including collimator changes and 
custom plugging, fractionated treatment, all lesions, per session, 
second through fifth sessions, maximum five sessions per course of 
treatment). Because HCPCS codes G0251, G0339, and G0340 are more 
specific in their descriptors than CPT code 77373 and are also assigned 
to different clinical APCs for CY 2007, we decided to continue 
recognizing HCPCS codes G0251, G0339, and G0340 under the OPPS for CY 
2007. Therefore, for CY 2007 we assigned CPT code 77373 to status 
indicator ``B'' under the OPPS.
    While we have had requests from certain specialty societies and 
other stakeholders that we recognize CPT codes 77372 and 77373 under 
the OPPS rather than continuing to use the current Level II HCPCS codes 
for hospital

[[Page 42717]]

outpatient facility reporting of these procedures, we have also heard 
from others that continued use of the G-codes under the OPPS is the 
most appropriate way to recognize the facility resource differences 
between different types of LINAC-based procedures. For the past several 
years, we have collected information through our claims data regarding 
the hospital costs associated with the planning and delivery of SRS 
services. As new technology emerged in the field of SRS several years 
ago, public commenters urged CMS to recognize cost differences 
associated with the various methods of SRS planning and delivery. 
Beginning in CY 2001, we established G-codes to capture any such cost 
variations associated with the various methods of planning and delivery 
of SRS. Based on comments received on the CY 2004 OPPS proposed rule 
regarding the G-codes used for SRS, we made some modifications to the 
coding for CY 2004 (68 FR 63431 and 63432). First, we received comments 
regarding the descriptors for HCPCS codes G0173 and G0251, indicating 
that these codes did not accurately distinguish image-guided robotic 
SRS systems from other forms of linear accelerator-based SRS systems to 
account for the cost variation in delivering these services. In 
response, for CY 2004 we modified the descriptor for G0173 and also 
created two HCPCS G-codes, G0339 and G0340, to describe complete and 
fractionated image-guided robotic linear accelerator-based SRS 
treatment. While all of these LINAC-based SRS procedures were 
originally assigned to New Technology APCs under the OPPS, we 
reassigned them to new clinical APCs for CY 2007 based on 2 full years 
of hospital claims data reflecting stable median costs based on 
significant volumes of single claims.
    HCPCS codes G0173, G0251, G0339, and G0340 are more specific in 
their descriptors than either CPT code 77372 or 77373. In addition, 
their hospital claims data continue to reflect significantly different 
hospital resources that would lead to violations of the 2 times rule 
were we to reassign certain procedures to the same clinical APCs in 
order to crosswalk the CY 2006 historical claims data for the 4 G-codes 
to develop the median costs of the APCs to which the 2 CPT codes would 
be assigned if we were to recognize them. Therefore, we believe that we 
should continue to use the G-codes for reporting LINAC-based SRS 
treatment delivery services for CY 2008 under the OPPS to ensure 
appropriate payment to hospitals for the different facility resources 
associated with providing these complex services. That is, we are 
proposing to continue to assign HCPCS codes G0173 and G0339 to APC 0067 
(Level III Stereotactic Radiosurgery, MRgFUS, and MEG), HCPCS code 
G0251 to APC 0065 (Level I Stereotactic Radiosurgery, MRgFUS, and MEG), 
and HCPCS code G0340 to APC 0066 (Level II Stereotactic Radiosurgery, 
MRgFUS, and MEG) for CY 2008.
    Since we first established the full group of SRS treatment delivery 
codes in CY 2004, we now have 3 years of hospital claims data 
reflecting the costs of each of these services. Based on our latest 
claims data from CY 2006, the proposed APC median cost for the complete 
course of therapy in one session or first fraction of image-guided, 
robotic LINAC-based SRS, as described by HCPCS codes G0173 and G0339 
respectively in APC 0067, is $3,869.96 based on 1,946 single claims 
available for ratesetting. The proposed CY 2008 APC median cost for 
each fractionated session of LINAC-based SRS, as described by HCPCS 
code G0251 in APC 0065, is $1,081.92 based on 1,938 single claims. The 
proposed CY 2008 APC median cost for the second through fifth sessions 
of image-guided, robotic LINAC-based fractionated SRS treatment, 
reported by HCPCS code G0340 in APC 0066, is $2,980.24 based on 5,209 
single claims.
    Therefore, for CY 2008, we are proposing to continue with the CY 
2007 HCPCS coding for LINAC-based SRS treatment delivery services under 
the OPPS. The LINAC based SRS codes and their CY 2008 proposed APC 
assignments are displayed in Table 36.

                               Table 36.--Proposed CY 2008 APC Assignments for LINAC-Based SRS Treatment Delivery Services
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                             Proposed CY
        HCPCS code               Short descriptor            CY 2007 SI       CY 2007 APC  CY 2007 APC    Proposed CY 2008 SI   Proposed CY    2008 APC
                                                                                           median cost                            2008 APC   median cost
--------------------------------------------------------------------------------------------------------------------------------------------------------
G0173.....................  Linear acc stereo radsur   S....................         0067    $3,872.87  S.....................         0067   $ 3,869.96
                             com.
G0251.....................  Linear acc based stero     S....................         0065     1,241.89  S.....................         0065     1,081.92
                             radio.
G0339.....................  Robot lin-radsurg com,     S....................         0067     3,872.87  S.....................         0067     3,869.96
                             first.
G0340.....................  Robt lin-radsurg fractx 2- S....................         0066     2,629.53  S.....................         0066     2,980.24
                             5.
--------------------------------------------------------------------------------------------------------------------------------------------------------

10. Blood Transfusion (APC 0110)
    (If you choose to comment on issues in this section, please include 
the caption ``Blood Transfusions'' at the beginning of your comment.)
    We have a longstanding policy under the OPPS that transfusion 
services are billed and paid on a per encounter basis and not by the 
number of units of blood products transfused (Internet Only Manual 100-
4, Chapter 4, Section 231.8). Under this policy, a transfusion APC 
payment is made to the OPPS provider for transfusing blood products 
once per day, regardless of the number of units or different types of 
blood products transfused. The OCE ensures only one payment for APC 
0110 (Transfusion), regardless of the number of units of CPT code 36430 
(Transfusion, blood or blood components) reported by the hospital on a 
single date of service. The CPT code 36430 descriptor does not include 
``per unit.'' Hence, the median cost for CPT code 36430, which is 
assigned to APC 0110, represents the costs of transfusion of blood or 
blood products on the same date of service, regardless of how many 
units of products are transfused. In addition, for payment of the 
transfusion service, the OCE also requires the claim to contain a Level 
II HCPCS P-code for a blood product on the same date of service as the 
transfusion procedure.
    At its March 2007 meeting, the APC Panel recommended that CMS 
investigate whether CPT code 36430 should identify when multiple units 
are transfused and trigger a discounted payment for the second and 
subsequent administration of additional units of blood or blood 
components. The APC Panel indicated that the current payment for 
transfusion services does not adequately pay hospitals for the costs of 
these complex services, and that payment on a per unit basis rather 
than on a per encounter basis would result in more accurate and 
appropriate payment.
    We do not agree with the APC Panel's recommendation, and we are 
proposing to not accept this recommendation for

[[Page 42718]]

the CY 2008 OPPS. We believe that our current policy of providing a 
single payment for blood transfusion, regardless of the number of units 
transfused, is most consistent with the goals of a prospective payment 
system to encourage and create incentives for efficiency in providing 
services. Payment for transfusion services on a per encounter basis 
encourages the transfusion of only those blood products that are 
necessary for the beneficiary's treatment during the hospital 
outpatient encounter. Moreover, the current median cost for the 
transfusion service, associated with the transfusion of all blood 
products furnished on a date of service, has been set based on the 
historical reporting of all charges for transfusion on the same date of 
service and, therefore, represents the full cost of an episode of 
transfusion, rather than the cost of transfusion of a single unit of 
blood or blood product. Given our proposed packaging approach for the 
CY 2008 OPPS, it would be inconsistent for us to revise our current 
transfusion payment policy to provide separate payment for each unit of 
blood product transfused, thereby reducing the size of the current 
transfusion payment bundle.
    Therefore, for CY 2008 we are proposing to maintain our current 
payment policy, which bases payment for transfusion on the costs of all 
transfusion services furnished on a single date of service and which 
examines hospital claims to ensure that payment is provided for only 
one unit of CPT code 36430 on a date of service. However, we remind 
hospitals that a claim for a single unit of CPT code 36430 should 
include charges for all of the hospital resource costs associated with 
the totality of transfusion services furnished on the date of service, 
so that the payment for one unit of APC 0110 is based on the costs of 
all transfusion services provided in a hospital outpatient encounter.
11. Screening Colonoscopies and Screening Flexible Sigmoidoscopies 
(APCs 0158 and 0159)
    (If you choose to comment on issues in this section, please include 
the caption ``Screening Colonoscopies and Screening Flexible 
Sigmoidoscopies'' at the beginning of your comment.)
    Since the implementation of the OPPS in August 2000, screening 
colonoscopies and screening flexible sigmoidoscopies have been paid 
separately. In the CY 2007 OPPS/ASC final rule with comment period (71 
FR 68013), we implemented certain changes associated with colorectal 
cancer screening services provided in HOPDs. First, section 5113 of 
Pub. L. 109-171 amended section 1833(b) of the Act to add colorectal 
cancer screening to the list of services for which the beneficiary 
deductible no longer applies. This provision applies to services 
furnished on or after January 1, 2007. Second, sections 1834(d)(2) and 
(d)(3) of the Act require Medicare to pay the lesser of the ASC or OPPS 
payment amount for screening flexible sigmoidoscopies and screening 
colonoscopies. For CY 2007, the OPPS payment for screening 
colonoscopies, HCPCS codes G0105 (Colorectal cancer screening; 
colonoscopy on individual at risk) and G0121 (Colorectal cancer 
screening; colonoscopy on individual not meeting criteria for high 
risk), developed in accordance with our standard OPPS ratesetting 
methodology, would have slightly exceeded the CY 2007 ASC payment of 
$446 for these procedures. Consistent with the requirements set forth 
in sections 1834(d)(2) and (d)(3) of the Act, the OPPS payment rates 
for HCPCS codes G0105 and G0121 were set equal to the CY 2007 ASC rate 
of $446 effective January 1, 2007. This requirement did not impact the 
OPPS payment rate for screening flexible sigmoidoscopies (G0104, 
Colorectal cancer screening; flexible sigmoidoscopy) because Medicare 
did not make payment to ASCs for screening flexible sigmoidoscopies in 
CY 2007, so there was no payment comparison to be made for those 
services.
    According to the final policy for the revised ASC payment system as 
described in the final rule for the revised ASC payment system 
published elsewhere in this issue of the Federal Register, ASCs will be 
paid for screening colonoscopies based on their ASC payment weights 
derived from the related OPPS APC payment weights and multiplied by the 
final ASC conversion factor (the product of the OPPS conversion factor 
and the ASC budget neutrality adjustment). As an office-based procedure 
added to the ASC list of covered surgical procedures for CY 2008, ASC 
payment for screening flexible sigmoidoscopies will be capped at the CY 
2008 MPFS nonfacility practice expense amount. Sections 1834(d)(2) and 
(d)(3) of the Act would then require that the CY 2008 OPPS payment 
rates for these procedures be set equal to their significantly lower 
ASC payment rates.
    However, we are proposing to use the equitable adjustment authority 
of section 1833(t)(2)(E) of the Act to adjust the OPPS payment rates 
for screening colonoscopies and screening flexible sigmoidoscopies. 
Section 1833(t)(2)E) of the Act provides that the Secretary shall 
establish adjustments, in a budget neutral manner, as determined to be 
necessary to ensure equitable payments under the OPPS. Sections 
1834(d)(2) and (d)(3) of the Act regarding payment for screening 
flexible sigmoidoscopies and screening colonoscopies under the OPPS and 
ASC payment systems were established by Congress in 1997, many years 
prior to the CY 2008 initial implementation of the revised ASC payment 
system. The payment policies of the revised ASC payment system, as 
summarized in section XVI. of this proposed rule, make fundamental 
changes to the methodology for developing ASC payment rates based on 
certain principles, specifically that the OPPS payment weight 
relativity is applicable to ASC procedures and that ASC costs are lower 
than HOPD costs for providing the same procedures, that contradict the 
original assumptions underlying these provisions. According to the 
findings of the GAO in its report, released on November 30, 2006, and 
entitled ``Medicare: Payment for Ambulatory Surgical Centers Should Be 
Based on the Hospital Outpatient Payment System'' (GAO-07-86), the 
payment groups of the OPPS accurately reflect the relative costs of 
procedures performed in ASCs just as well as they reflect the relative 
costs of the same procedures provided in HOPDs. Screening colonoscopies 
were among the top 20 ASC procedures in terms of volume whose costs 
were specifically studied by the GAO in its work that led to this 
conclusion. We see no clinical or hospital resource explanation for why 
the OPPS relative costs from CY 2006 OPPS claims data for screening 
flexible sigmoidoscopies and screening colonoscopies would not provide 
an appropriate basis for establishing their payment rates under both 
the OPPS and the revised ASC payment system, according to the standard 
ratesetting methodologies of each payment system for CY 2008. If we 
were to pay for these screening procedures under the OPPS according to 
their ASC rates in CY 2008, we would significantly distort their 
payment relativity in comparison with other OPPS services. We believe 
it would be inequitable to pay these screening services in HOPDs at 
their ASC rates for CY 2008, thereby ignoring the relativity of their 
costs in comparison with other OPPS services which have similar or 
different clinical and resource characteristics. Therefore, for CY 2008 
when we will be paying for screening colonoscopies and screening 
flexible sigmoidoscopies performed in ASCs based upon their standard 
revised ASC payment rates, we are proposing to

[[Page 42719]]

adjust the payment rates under the OPPS to pay for the procedures 
according to the standard OPPS payment rates. We believe that the 
application of sections 1834(d)(2) and (d)(3) of the Act produces 
inequitable results because of the revised ASC payment system to be 
implemented in CY 2008. We believe this proposal would provide the most 
appropriate payment for these procedures in the context of the 
contemporary payment policies of the OPPS and the revised ASC payment 
system.

IV. Proposed OPPS Payment for Devices

A. Proposed Treatment of Device-Dependent APCs

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Device-Dependent APCs'' at the beginning of your 
comment.)
1. Background
    Device-dependent APCs are populated by HCPCS codes that usually, 
but not always, require that a device be implanted or used to perform 
the procedure. For the CY 2002 OPPS, we used external data, in part, to 
establish the device-dependent APC medians used for weight setting. At 
that time, many devices were eligible for pass through payment. For the 
CY 2002 OPPS, we estimated that the total amount of pass-through 
payments would far exceed the limit imposed by statute. To reduce the 
amount of a pro rata adjustment to all pass-through items, we packaged 
75 percent of the cost of the devices, using external data furnished by 
commenters on the August 24, 2001 proposed rule and information 
furnished on applications for pass-through payment, into the median 
costs for the device-dependent APCs associated with these pass-through 
devices. The remaining 25 percent of the cost was considered to be pass 
through payment.
    In the CY 2003 OPPS, we determined APC medians for device-dependent 
APCs using a three-pronged approach. First, we used only claims with 
device codes on the claim to set the medians for these APCs. Second, we 
used external data, in part, to set the medians for selected device-
dependent APCs by blending that external data with claims data to 
establish the APC medians. Finally, we also adjusted the median for any 
APC (whether device-dependent or not) that declined more than 15 
percent. In addition, in the CY 2003 OPPS we deleted the device codes 
(``C'' codes) from the HCPCS file because we believed that hospitals 
would include the charges for the devices on their claims, 
notwithstanding the absence of specific codes for devices used.
    In the CY 2004 OPPS, we used only claims containing device codes to 
set the medians for device-dependent APCs and again used external data 
in a 50/50 blend with claims data to adjust medians for a few device-
dependent codes when it appeared that the adjustments were important to 
ensure access to care. However, hospital device code reporting was 
optional.
    In the CY 2005 OPPS, which was based on CY 2003 claims data, there 
were no device codes on the claims and, therefore, we could not use 
device-coded claims in median calculations as a proxy for completeness 
of the coding and charges on the claims. For the CY 2005 OPPS, we 
adjusted device-dependent APC medians for those device-dependent APCs 
for which the CY 2005 OPPS payment median was less than 95 percent of 
the CY 2004 OPPS payment median. In these cases, the CY 2005 OPPS 
payment median was adjusted to 95 percent of the CY 2004 OPPS payment 
median. We also reinstated the device codes and made the use of the 
device codes mandatory where an appropriate code exists to describe a 
device utilized in a procedure. In addition, we implemented HCPCS code 
edits to facilitate complete reporting of the charges for the devices 
used in the procedures assigned to the device-dependent APCs.
    In the CY 2006 OPPS, which was based on CY 2004 claims data, we set 
the median costs for device-dependent APCs for CY 2006 at the highest 
of: (1) The median cost of all single bills; (2) the median cost 
calculated using only claims that contained pertinent device codes and 
for which the device cost was greater than $1; or (3) 90 percent of the 
payment median that was used to set the CY 2005 payment rates. We set 
90 percent of the CY 2005 payment median as a floor rather than 85 
percent as proposed, in consideration of public comments that stated 
that a 15-percent reduction from the CY 2005 payment median was too 
large of a transitional step. We noted in our CY 2006 proposed rule 
that we viewed our proposed 85 percent payment adjustment as a 
transitional step from the adjusted medians of past years to the use of 
unadjusted medians based solely on hospital claims data with device 
codes in future years (70 FR 42714). We also incorporated, as part of 
our CY 2006 methodology, the recommendation of commenters to base 
payment on medians that were calculated using only claims that passed 
the device edits. As stated in the CY 2006 OPPS final rule with comment 
period (70 FR 68620), we believed that this policy provided a 
reasonable transition to full use of claims data in CY 2007, which 
would include device coding and device editing, while better moderating 
the amount of decline from the CY 2005 OPPS payment rates.
    For CY 2007, we based the device-dependent APC medians on CY 2005 
claims, the most current data available at that time. In CY 2005 we 
reinstated hospital reporting of device codes and made the reporting of 
device codes mandatory where an appropriate code exists to describe a 
device utilized. In CY 2005, we also implemented HCPCS code procedure-
to-device edits to facilitate complete reporting of the charges for the 
devices used in the procedures assigned to the device-dependent APCs. 
For CY 2007 ratesetting, we excluded claims for which the charge for a 
device was less than $1.01, in part to recognize hospital charging 
practices due to a recall of cardioverter-defibrillator and pacemaker 
pulse generators in CY 2005 for which the manufacturers provided 
replacement devices without cost to the beneficiary or hospital. We 
also found that there were other devices for which the token charge was 
less than $1.01, and we removed those claims from the set used to 
calculate the median costs of device-dependent APCs. In summary, for 
the CY 2007 OPPS we set the median costs for device-dependent APCs 
using only claims that passed the device edits and did not contain 
token charges for the devices. Therefore, the median costs for these 
APCs for CY 2007 were determined from claims data that generally 
represented the full cost of the required device.
2. Proposed Payment
    For this proposed rule, we calculated the median costs for device-
dependent APCs using three different sets of claims. We first 
calculated a median cost using all single procedure claims that 
contained appropriate device codes (where there are edits) for the 
procedure codes in those APCs. We then calculated a second median cost 
using only claims that contain allowed device HCPCS codes with charges 
for all device codes that were in excess of $1.00 (nontoken charge 
device claims). Third, we calculated the APC median cost based only 
upon nontoken charge device claims with correct devices that did not 
also contain the HCPCS modifier ``FB,'' reported in CY 2005 to identify 
that a procedure was performed using an item provided without cost to 
the provider, supplier, or practitioner, or where a credit was received 
for a

[[Page 42720]]

replaced device (examples include, but are not limited to, devices 
covered under warranty, devices replaced due to defects, and free 
samples).
    As expected, the median costs calculated based upon single 
procedure bills that met all three criteria, that is, correct devices, 
no token charges, and no ``FB'' modifier, were generally higher than 
the median costs calculated using all single bills. We believe that the 
claims that meet these three criteria (appropriate device codes, 
nontoken device charges, and no ``FB'' modifier) reflect the best 
estimated costs for these device-dependent APCs when the hospital pays 
the full cost of the device, and we are proposing to base our CY 2008 
median costs on the medians calculated based upon these claims.
    As a result of the effects of the proposed CY 2008 packaging 
approach discussed in detail in section II.A.4. of this proposed rule 
on median costs, we are proposing to make some changes to CY 2007 
device-dependent APCs for CY 2008. Specifically, we are proposing to 
delete APC 0081 (Noncoronary Angioplasty or Atherectomy); APC 0087 
(Cardiac Electrophysiologic Recording/Mapping); and APC 0670 (Level II 
Intravascular and Intracardiac Ultrasound and Flow Reserve) due to the 
migration of HCPCS codes to other APCs. Some of the HCPCS codes 
assigned to these APCs in CY 2007 would be unconditionally packaged for 
CY 2008. The median costs of the remaining HCPCS codes proposed for 
separate payment in CY 2008 were significantly different than CY 2007 
due to the proposed packaging of additional services. We believe that 
reconfiguration of the APCs is necessary to ensure that the HCPCS codes 
that would be separately paid in CY 2008 and that are assigned to these 
APCs in CY 2007 would be assigned to APCs that are homogeneous with 
regard to clinical characteristics and resource use in CY 2008. The 
APCs we are proposing for deletion ceased to be appropriate as a result 
of the reassignment of the HCPCS codes that we are proposing for 
continued separate payment in CY 2008.
    The following seven APCs remain device-dependent APCs for CY 2008, 
but we are proposing to reassign certain HCPCS codes mapped to these 
APCs for CY 2007 either to other APCs or among these APCs for CY 2008 
to ensure that, in view of the median costs that result from the 
proposed CY 2008 packaging approach, the HCPCS codes would be assigned 
to APCs that are homogeneous with regard to clinical characteristics 
and resource use for CY 2008: APC 0082 (Coronary Atherectomy); APC 0083 
(Coronary Angioplasty and Percutaneous Valvuloplasty); APC 0085 (Level 
II Electrophysiologic Evaluation); APC 0086 (Ablate Heart Dysrhythm 
Focus); APC 0115 (Cannula/Access Device Procedures); APC 0427 (Level 
III Tube Changes and Repositioning); and APC 0623 (Level III Vascular 
Access Procedures). We also are proposing to consider APC 0084 (Level I 
Electrophysiologic Procedures) to be a device-dependent APC for CY 2008 
because we are proposing to reassign many of the HCPCS codes that were 
previously in APCs 0086 and 0087 to APC 0084.
    As a result of the proposed APC reconfigurations resulting from 
HCPCS code migration, it is not appropriate to compare the proposed CY 
2008 OPPS median costs for these eight APCs to the CY 2007 final rule 
median costs that are the basis for the CY 2007 OPPS payment rates. 
When we compare the median costs for the other device-dependent APCs 
with stable proposed CY 2008 configurations in comparison with CY 2007, 
the median costs for 26 APCs increase, some of them by significant 
amounts, and the median costs for 5 APCs decrease. We believe that 
these median costs represent valid estimates of the relative costs of 
the services in these APCs, both with regard to the increases and the 
decreases that appear when the proposed CY 2008 median costs are 
compared to the CY 2007 median costs on which the payment rates for 
these APCs are based.
    The only decline of more than 10 percent is found in APC 0418 
(Insertion of Left Ventricular Pacing Electrode). In the case of APC 
0418, we have been told that the very large increases in costs that 
have occurred in the past several years for this APC were the result of 
claims where hospitals inserted an ICD at the time of insertion of the 
left ventricular lead but failed to bill for the ICD implantation 
procedure. This incorrect reporting led to our attributing the costs of 
the expensive ICD device to the median cost for the insertion of the 
left ventricular lead, instead of attributing the cost of the ICD to a 
HCPCS code for the implantation of the device. We believe that the 
decline in the median cost for APC 0418 is the result of improvements 
in provider billing and that the median cost we calculated from the CY 
2006 data is a reasonable estimate of the cost of the insertion of the 
left ventricular lead. Moreover, the relatively small number of single 
bills and the small number of providers furnishing the service (158 
hospitals) are likely to cause the median costs to vary more than for 
services furnished in greater volume by more hospitals. We note that we 
have put into place reverse device edits for CY 2007, where we require 
hospitals reporting certain implantable device HCPCS codes to also 
report an appropriate procedure for the device's use. We believe that 
these reverse device edits should improve our packaging of device costs 
into the appropriate procedures for future OPPS updates.
    We note that 12 of the APCs for which it is appropriate to compare 
the proposed CY 2008 APC medians to the CY 2007 final rule medians show 
increases that are greater than 10 percent. We have examined the data 
for these APCs and we believe that the increases are attributable to a 
combination of factors. In some of these cases, the single claims that 
were usable for establishing the median costs are a small percent of 
the total bills for the services assigned to the APC and, as we have 
stated previously, when small percentages of single bills are used, the 
APC median cost is likely to show greater fluctuation from year to 
year. In addition, CY 2006 claims, which are the basis for the CY 2008 
proposed rule data, were the first set of claims subject to procedure-
to-device edits for the entire calendar year. These edits were 
implemented to ensure that the charges for the necessary devices were 
reported on the claims. While this editing was phased in during CY 
2005, beginning in April and concluding in October, CY 2006 was the 
first full year of procedure-to-device edits and thus hospitals that 
had not previously routinely reported separate device codes and charges 
were required by the edits to do so for all claims submitted in CY 
2006. The reporting of device codes and charges for devices has 
historically resulted in increases in median costs for device-dependent 
APCs. Thus, we believe that the more complete claims data available for 
CY 2008 ratesetting likely contribute to the increased proposed median 
costs observed for some device dependent APCs.
    Furthermore, we believe that the proposed increases are also 
attributable, in part, to our proposal to package the costs of guidance 
services, intraoperative services, and imaging supervision and 
interpretation services into the payment for major independent 
procedures, as described in section II.A.4. of this proposed rule. For 
example, CPT code 36870 (Thrombectomy, percutaneous, arteriovenous 
fistula, autogenous or nonautogenous graft (includes mechanical 
thrombus extraction and intra-graft thrombolysis)) is the most commonly 
reported code in device-dependent APC 0653 (Vascular Reconstruction/
Fistula Repair with

[[Page 42721]]

Device), representing 25,805 bills of 26,138 total bills in the APC. 
CPT code 36870 appears with CPT code 75978 (Transluminal balloon 
angioplasty, venous (e.g. subclavian stenosis), radiological 
supervision and interpretation) 14,679 times and with CPT code 75790 
(Angiography, arteriovenous shunt (e.g. dialysis patient), radiological 
supervision and interpretation) 15,623 times in the CY 2006 claims 
data. We are proposing to package payment for both CPT codes 75978 and 
75790 for CY 2008. Moreover, 9 other CPT codes that we are proposing to 
package for CY 2008 appear with the independent CPT code 36870 more 
than 100 times each. Therefore, many of the claims for CPT code 36870 
proposed to be used for CY 2008 ratesetting include charges for both 
CPT codes 75790 and 75978 and also contain charges for other CPT codes 
we are proposing to package, as well as uncoded revenue code charges 
that are packaged. Therefore, it is not surprising that our proposed 
median cost for APC 0653 is about 30 percent higher than the CY 2007 
median cost for the same APC. Based on our review of patterns of 
services observed in our claims data for the device-dependent APCs and 
our clinical review of the procedures assigned to APCs that receive 
significant increases for CY 2008, we believe that the increases in the 
proposed median costs for certain device-dependent APCs for CY 2008 are 
consistent with our general expectations in the context of the 
comprehensive proposal for the CY 2008 OPPS.
    As we have stated in the past, some variation in relative costs 
from year to year is to be expected in a prospective payment system. We 
believe that this is particularly true for low volume device-dependent 
APCs because relatively small numbers of providers furnish the 
services; the total frequencies of services furnished are low (compared 
to commonly furnished services like visits); the number of single bills 
that are available for use in calculating the full median cost of a 
single unit of a service is also relatively small; and the selection of 
claims that contain appropriate devices, lack token charges for 
devices, and lack the ``FB'' modifier further reduces the pool of 
single bills that can be used to calculate the median cost. However, 
even in the case of these low volume device-dependent APCs, we continue 
to believe that the median costs calculated from the single bills that 
meet the three criteria represent the most valid estimated relative 
costs of these services to hospitals when they incur the full cost of 
the devices required to perform the procedures.
    Therefore, we are proposing to base the payment rates for CY 2008 
for all device dependent APCs on their median costs calculated using 
only single bills that meet the three selection criteria discussed in 
detail above. Table 37 below contains the proposed CY 2008 median costs 
for these APCs. We do not believe that any special payment policies are 
needed, as we believe that the claims data we are proposing to use for 
ratesetting will ensure that the costs of the implantable devices are 
adequately and appropriately reflected in the median costs for these 
device-dependent APCs.

                                           Table 37.--Proposed CY 2008 Median Costs for Device-Dependent APCs
 [Note that N/A indicates APCs for which the CY 2007 OPPS medians are not comparable to the CY 2008 medians, due to proposed HCPCS code migration for CY
                                                                         2008.]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                 Difference
                                                                                                      Proposed CY  Proposed CY   between CY    Count of
                                                                 CY 2007      CY 2007    Proposed CY   2008 pass    2008 pass    2007 final   providers
                                                                final rule   final rule   2008 post      edit,        edit,     rule median   billing in
        APC                 SI                APC title         pass edit,   pass edit,   cost total   nontoken,    nontoken,       and          the
                                                                 nontoken     nontoken    frequency      no FB        no FB     proposed CY  proposed CY
                                                                frequency   median cost                frequency   median cost  2008 median   2008 data
                                                                                                                                    cost
--------------------------------------------------------------------------------------------------------------------------------------------------------
0039..............  S................  Level I Implantation            680   $11,450.84         2893         1035   $12,421.82         8.48          262
                                        of Neurostimulator.
0040..............  S................  Percutaneous                   1402     3,457.00        12769         4663     4,010.44        16.01          994
                                        Implantation of
                                        Neurostimulator
                                        Electrodes, Excluding
                                        Cranial Nerve.
0061..............  S................  Laminectomy or                  265     5,145.22         2938         1268     5,115.78        -0.57          440
                                        Incision for
                                        Implantation of
                                        Neurostimulator
                                        Electrodes, Excluding
                                        Cranial Nerve.
0082..............  T................  Coronary or Non                 N/A          N/A        16464         4374     5,584.20          N/A          925
                                        Coronary Atherectomy.
0083..............  T................  Coronary or Non                 N/A          N/A       140944        37879     2,897.95          N/A         1706
                                        Coronary Angioplasty
                                        and Percutaneous
                                        Valvuloplasty.
0084..............  S................  Level I                         N/A          N/A         9703         6973       647.41          N/A          600
                                        Electrophysiologic
                                        Procedures.
0085..............  T................  Level II                        N/A          N/A        15791         3957     3,059.06          N/A          711
                                        Electrophysiologic
                                        Evaluation.

[[Page 42722]]

 
0086..............  T................  Level III                       N/A          N/A         8370          384     5,709.52          N/A          157
                                        Electrophysiologic
                                        Procedures.
0089..............  T................  Insertion/Replacement           388     7,557.38         3722          570     7,710.05          N/A          765
                                        of Permanent
                                        Pacemaker and
                                        Electrodes.
0090..............  T................  Insertion/Replacement           505     6,007.21         7426          524     6,279.63         4.53          314
                                        of Pacemaker Pulse
                                        Generator.
0104..............  T................  Transcatheter                   396     5,360.43         4638          565     5,599.90         4.47          200
                                        Placement of
                                        Intracoronary Stents.
0106..............  T................  Insertion/Replacement           427     3,138.16         3489          367     4,718.32        50.35          269
                                        of Pacemaker Leads
                                        and/or Electrodes.
0107..............  T................  Insertion of                    584    18,607.21         9772          448    22,213.36        19.38          230
                                        Cardioverter-
                                        Defibrillator.
0108..............  T................  Insertion/Replacement/         3045    23,205.37         8732         3267    25,352.27         9.25          585
                                        Repair of
                                        Cardioverter-
                                        Defibrillator Leads.
0115..............  T................  Cannula/Access Device           N/A          N/A         2489         1259     1,920.99          N/A          669
                                        Procedures.
0202..............  T................  Level VII Female               4451     2,627.08        17800        10043     2,719.11         3.50         1863
                                        Reproductive Proc.
0222..............  T................  Implantation of                2007    11,099.02         7957         2830    12,161.64         9.57          868
                                        Neurological Device.
0225..............  S................  Implantation of                  83    13,514.45         1544          239    13,928.36         3.06          159
                                        Neurostimulator
                                        Electrodes, Cranial
                                        Nerve.
0227..............  T................  Implantation of Drug            319    10,657.85         3350         1001    11,242.60         5.49          460
                                        Infusion Device.
0229..............  T................  Transcatherter                  882     4,184.15        53470         7225     5,642.77        34.86         1226
                                        Placement of
                                        Intravascular Shunts.
0259..............  T................  Level VI ENT                    472    25,351.03         1311          783    25,434.97         0.33          166
                                        Procedures.
0315..............  T................  Level II Implantation           516    14,845.73          807          648    16,532.22        11.36          195
                                        of Neurostimulator.
0384..............  T................  GI Procedures with             6574     1,402.31        21958         6895     1,587.03        13.17         1428
                                        Stents.
0385..............  S................  Level I Prosthetic              267     4,840.44          881          581     5,368.16        10.90          319
                                        Urological Procedures.
0386..............  S................  Level II Prosthetic            1788     8,395.82         4990         3346     9,045.78         7.74          862
                                        Urological Procedures.

[[Page 42723]]

 
0418..............  T................  Insertion of Left               169    18,777.92         4436          185    15,760.17       -16.07          158
                                        Ventricular Pacing
                                        Elect.
0425..............  T................  Level II Arthroplasty           410     6,550.59         1104          489     7,150.52         9.16          330
                                        with Prosthesis.
0427..............  T................  Level III Tube Changes          N/A          N/A        21092        11368       936.73          N/A         1255
                                        and Repositioning.
0622..............  T................  Level II Vascular             25264     1,385.14        55118        33637     1,542.90        11.39         2380
                                        Access Procedures.
0623..............  T................  Level III Vascular              N/A          N/A        66747        49861      1844.44          N/A         2701
                                        Access Procedures.
0625..............  T................  Level IV Vascular                20     5,100.26          479            8     5,492.89         7.70          154
                                        Access Procedures.
0648..............  T................  Level IV Breast                 286     3,130.45         2895          382     3,330.44         6.39          388
                                        Surgery.
0652..............  T................  Insertion of                   3676     1,805.28         5407         3138     1,997.86        10.67          996
                                        Intraperitoneal and
                                        Pleural Catheters.
0653..............  T................  Vascular                        702     1,978.84        26138         1573     2,584.62        30.61          682
                                        Reconstruction/
                                        Fistula Repair with
                                        Device.
0654..............  T................  Insertion/Replacement          1179     6,891.44        29645         1735     6,724.90        -2.42          625
                                        of a permanent dual
                                        chamber pacemaker.
0655..............  T................  Insertion/Replacement/          876     9,327.71        12769         1896     9,075.74        -2.70         1247
                                        Conversion of a
                                        permanent dual
                                        chamber pacemaker.
0656..............  T................  Transcatheter                  2700     6,618.18        24346         3148     7,478.29        13.00          378
                                        Placement of
                                        Intracoronary Drug-
                                        Eluting Stents.
0674..............  T................  Prostate Cryoablation.         1737     6,646.07         3182         1997     7,782.75        17.10          366
0680..............  S................  Insertion of Patient            972     4,436.69         2234         1465     4,506.93         1.58          689
                                        Activated Event
                                        Recorders.
0681..............  T................  Knee Arthroplasty.....          301    12,569.11          391          286    12,029.91        -4.29           57
--------------------------------------------------------------------------------------------------------------------------------------------------------

3. Proposed Payment When Devices Are Replaced with Partial Credit to 
the Hospital
    As we discuss above in the context of the calculation of median 
costs for device dependent APCs, in recent years there have been 
several field actions and recalls with regard to failure of implantable 
devices. In many of these cases, the manufacturers have offered 
replacement devices without cost to the hospital or credit for the 
device being replaced if the patient required a more expensive device. 
In order to ensure that the payment we are proposing for CY 2008 pays 
hospitals appropriately when they incur the full cost of the device, we 
have calculated the proposed median costs for device dependent APCs 
using only claims that contain the correct device code for the 
procedure. We are not using claims that contain token charges for these 
expensive devices or that contain the ``FB'' modifier, which would 
signify that the device was replaced without cost or with a full credit 
for the cost of the device being replaced. Similarly, to ensure 
equitable payment when the hospital receives a device without cost or 
receives a full credit for the cost of the device being replaced, for 
CY 2007 we implemented a payment policy that reduces the

[[Page 42724]]

payment for selected device-dependent APCs when the hospital receives 
certain replacement devices without cost or receives a full credit for 
the device being replaced (71 FR 68077).
    Subsequent to the issuance of the CY 2007 OPPS/ASC final rule with 
comment period, we had many inquiries from hospitals that asked whether 
the reduction would also apply in cases in which there was a partial 
credit for the cost of a device that failed or was otherwise covered 
under a manufacturer warranty. Those inquiring explained that cases of 
partial credit are the vast majority of cases involving devices that 
have failed or otherwise must be replaced under warranty. They 
indicated that in some cases the devices failed, and in other 
situations the patient's energy needs exceeded the capacity of the 
device and thus the device ceased to be useful before the end of the 
warranty period. They told us that a typical industry practice for some 
types of devices was to provide a 50 percent credit in cases of device 
failure (including battery depletion) under warranty if a device failed 
at 3 years of use (failure during the first 3 years would result in a 
full device credit) and to prorate the credit further over time between 
3 and 5 years after the initial device implantation, as the useful life 
of the device declined. As promulgated in the CY 2007 OPPS/ASC final 
rule with comment period and codified at Sec.  419.45, the CY 2007 
reduction policy does not apply to cases in which there is a partial 
credit toward the replacement of the device.
    In addition to our concern over the replacement of implantable 
devices at no cost to hospitals due to device recalls, device failure, 
or other clinical situations, we believe that it is equally as 
important that timely information be reported and analyzed regarding 
the performance and longevity of devices replaced in partial credit 
situations. This issue is particularly timely due to the recent recall 
of 73,000 ICDs and cardiac resynchronization therapy defibrillators 
(CRT-Ds) because of a faulty capacitor that can cause the batteries to 
deplete sooner than expected. In some cases, patients will require more 
frequent monitoring of their device function and early device 
replacement. (We refer readers to the Web site: http://www.fda.gov/cdrh/news for Questions and Answers posted April 20, 2007 on this 
recall.) Therefore, we believe that hospitals should report occurrences 
of devices being replaced under warranty or otherwise with a partial 
credit granted to the hospital so that we may be able to identify 
systematic failures of devices or device problems through claims 
analysis and so that we can make appropriate payment adjustments in 
these cases. Collecting data on a wider set of device replacements 
under full and partial credit situations would assist in developing 
comprehensive summary data, not just a subset of data related to 
devices replaced without cost or with a full credit to the hospital. We 
are mindful of the need to use our claims history where possible to 
promote early awareness of problems with implantable medical devices 
and to promote high quality medical care with regard to the devices and 
the services in which they are used.
    We also are concerned with the issue of the increased Medicare and 
beneficiary liability for the monitoring costs that are required as a 
result of the recall of these 73,000 devices (worldwide, with an 
unknown portion being applicable to Medicare beneficiaries). 
Specifically, the manufacturer of the devices that have been most 
recently recalled recommends that patients with the recalled device 
consult with their physician in each case and, in some cases, begin a 
routine of monthly evaluations. We would expect that not only could 
extra visits to physicians' offices or HOPDs be necessary, but 
additional diagnostic tests may also be needed to care for the 
beneficiaries who have the recalled devices. Thus, even when the device 
does not immediately require replacement, we are concerned that the 
potential greater costs to Medicare and to the beneficiary or his or 
her secondary payor for these unforeseen extra services may be 
substantial and burdensome. We will be actively assessing how we can 
identify additional health care costs and Medicare expenditures 
associated with device recall actions and exploring what actions could 
be appropriate in the case of these additional monitoring and related 
expenses. We welcome public comment on this issue to inform our future 
review and analyses.
    Moreover, the payment rates for the APCs into which the costs of 
the most expensive devices are packaged are set based on the assumption 
that the hospital incurs the full cost of the device. To continue to 
pay the full APC rate when the hospital receives a partial credit 
toward the cost of a very expensive device would result in excessive 
and inappropriate payment for the procedure and its packaged costs. 
Some hospitals have told us that they do not reduce their charges for 
the device being implanted or used in the procedure in cases in which 
they receive a partial credit for the device, even in cases in which 
the credit is for as much as 50 percent of the cost of an expensive 
device.
    Under the OPPS, we calculate the estimated costs on which the APC 
payment weights are based by applying a CCR to the charges for the 
device. When hospitals charge the full amount for the device, although 
they may have received a substantial credit towards its cost, our 
methodology may result in median costs that reflect the full costs of 
these devices in all cases, including those cases in which the hospital 
incurs much less than the full cost of the device. It is likely that 
the reduced hospital costs associated with steady, low volume warranty 
replacements of implantable devices may never be reflected in the CCRs 
used to adjust charges to costs for devices, because those CCRs are 
overwhelmed by the volume of other items attributed to the cost 
centers. Therefore, our median costs for device-dependent APCs would 
not reflect the reduced hospital costs associated with partial credit 
replacement procedures and would result in overpayment for the 
implantation procedures under the OPPS. Moreover, in these cases either 
the beneficiary or a secondary insurer also would pay a copayment that 
reflects the full cost of the device, although the hospital may have 
received a substantial credit under the warranty. We believe that both 
Medicare and the beneficiary should share in the savings that result 
from the partial credit that the hospital receives.
    We have considered how we might ensure that these cases of device 
failure or premature replacement are reported and appropriately taken 
into account in setting OPPS payment rates and beneficiary copayments. 
We are proposing to create a HCPCS modifier for CY 2008 that would be 
reported in all cases in which the hospital receives a partial credit 
toward the replacement of a medical device listed in Table 39 of this 
proposed rule. These devices are the same devices to which our policy 
governing payment when the device is furnished to the provider without 
cost or with full credit applies for CY 2008. As we discussed in the CY 
2007 OPPS/ASC final rule with comment period (71 FR 68071), we selected 
these devices because they have substantial device costs and because 
the device is implanted in the beneficiary at least temporarily and, 
therefore, can be associated with an individual beneficiary. This 
proposed policy would enhance our ability to track the replacement of 
these implantable medical devices and may permit us to identify trends 
in device failure or

[[Page 42725]]

limited longevity. Moreover, it would enable us to reduce the APC 
payment in cases in which the hospital receives a partial credit toward 
the cost of the replacement device being implanted. We believe that 
this is a logical extension of our policy regarding reduction of the 
APC payment in cases in which the provider furnishes the device without 
cost or with a full credit to the hospital.
    Specifically, as discussed in more detail below, we are proposing 
to reduce the payment for the APC into which the device cost is 
packaged by one half of the amount of the offset amount that would 
apply if the device were being replaced without cost or with full 
credit, but only where the amount of the device credit is greater than 
or equal to 20 percent of the cost of the new replacement device being 
implanted. We also are proposing to base the beneficiary's copayment on 
the reduced APC payment rate so that the beneficiary shares in the 
hospital's reduced costs. We believe that it is inequitable to set the 
payment rates for the procedures into which payment for these devices 
is packaged on the assumption that the hospital always incurs the full 
cost for these expensive devices but to not adjust the payment when the 
hospital receives a partial credit for a failed or otherwise replaced 
device. Accordingly, we believe that it is appropriate to make an 
equitable adjustment to the APC payment to ensure that the Medicare 
program payment made for the service and the beneficiary's liability 
are appropriate in these cases in which the hospital's device costs are 
significantly reduced. We are proposing changes to Sec. Sec.  419.45(a) 
and (b) to reflect our proposed policy of reducing the OPPS payment 
when partial credit for the device cost is received by the hospital for 
a failed or otherwise replaced device.
    Due to the absence of current reporting of the cases in which 
hospitals receive a partial credit for replaced devices and to our 
belief, based on conversations with hospital staff, that hospitals do 
not reduce their device charges to reflect the credits, we have no data 
for use to empirically determine by how much we should reduce the 
payment for the procedural APC into which the costs of these devices 
are packaged. However, device manufacturers and hospitals have told us 
that a common scenario is that, if a device fails 3 years after 
implantation, the hospital would receive a 50 percent credit towards a 
replacement device. Therefore, we are proposing to reduce the payment 
for these device-dependent APCs by half of the reduction that applies 
when the hospital receives a device without cost or receives a full 
credit for a device being replaced. That is, we are proposing to reduce 
the payment for the APC by half of the offset amount that represents 
the cost of the device packaged into the APC payment. In the absence of 
claims data on which to base a reduction factor, but taking into 
consideration what we have been told is common industry practice, we 
believe that reducing the amount of payment for the device-dependent 
APC by half of the estimated cost of the device packaging represents a 
reasonable and equitable reduction in these cases.
    We considered whether to propose to require hospitals to reduce 
their charges in proportion to the partial credit they receive for the 
device so that, in future years, we would have cost data reported 
consistently on which we could consider basing the amount of reduction 
to the payment for the procedure in cases of a partial device credit. 
However, we are concerned that such a requirement could impose an 
administrative burden on hospitals that would outweigh the potential 
benefit of a more accurate reduction to payment in these cases. We are 
requesting comments on the extent to which any administrative burden 
would be balanced or compensated for by the potential payment accuracy 
benefit of an empirically based reduction to payment in these cases.
    In addition, we are proposing to take this reduction only when the 
credit is for 20 percent or more of the cost of the new replacement 
device, so that the reduction is not taken in cases in which more than 
80 percent of the cost of the replacement device has been incurred by 
the hospital. We believe that the burden to hospitals of requiring that 
they report cases in which the partial credit for the device being 
replaced is less than 20 percent of the cost of the new replacement 
device is greater than the benefit to the Medicare program and the 
beneficiary. In addition, if the partial credit is less than 20 percent 
of the cost of the new replacement device, then we believe that 
reducing the APC payment for the device implantation procedure by 50 
percent of the packaged device cost would provide too low a payment to 
hospitals providing the necessary device replacement procedures. 
Therefore, we are proposing that the new HCPCS partial credit modifier 
would be reported and the partial credit reduction would be taken only 
in cases in which the credit is equal to or greater than 20 percent of 
the cost of the new replacement device.
    For example, using the proposed CY 2008 offset percents in Table 38 
below for illustration only, if a cochlear implant fails under warranty 
and must be replaced and the manufacturer provides the hospital a 45-
percent credit of the cost of the new device used in the implantation 
procedure, the hospital would bill CPT code 69930 (Cochlear device 
implantation, with or without mastoidectomy) with the new modifier for 
partial credit devices, and Medicare would reduce the payment to the 
hospital by 41.52 percent of the APC payment rate (50 percent of the 
proposed full offset rate of 83.03 percent that would apply if the 
device were replaced with no cost to the provider or at full credit for 
the device being replaced).
    Even in the absence of specific instructions from us to reduce the 
device charges in partial credit cases, we could monitor the charges 
that are submitted for devices reported with the proposed partial 
credit modifier to see if hospitals appear to be reflecting partial 
device credits in their charges for these implantable devices. We 
believe that we could use pattern analysis to determine if a hospital 
that is reporting the device with the partial credit modifier is 
charging at a lower rate for the same device when the modifier appears 
with the procedure in which the device is used than in cases without 
reporting of the modifier. If we find that hospitals are adjusting 
their charges to reflect the reduced costs of these devices, we will 
explore whether revising the amount of the reduction could be 
appropriate.
    In the course of exploring whether the current regulations apply to 
partial credit situations, inquirers have told us that they are 
concerned that hospitals may refrain from returning devices that fail 
under the warranty period to manufacturers if hospitals would then be 
required to report the partial credit to Medicare and would receive a 
reduced Medicare payment as a result. They told us that this hospital 
practice could delay manufacturers' learning vital information about 
device failures, longevity, and overall performance. Currently, many 
device manufacturers encourage the return to them of all implantable 
devices, once they are taken out of a patient's body for any reason, 
for evaluation of device performance and survival analysis, which 
estimates the probability that a device will not malfunction during a 
specified period of time. We do not believe that hospitals would 
refrain from returning a device removed from a patient to a 
manufacturer in order to justify not reporting the partial credit 
modifier to

[[Page 42726]]

Medicare. We believe that hospitals have a strong interest in ensuring 
that manufacturers know as soon as possible when there are problems 
with the devices provided to their patients, whether the result would 
be a full or partial credit for the failed device. In addition, we 
believe that hospitals, key participants in the broader health care 
system, are concerned with device performance, patient health, and 
health care quality from the broader public health perspective and are 
committed to appropriate reporting to improve the quality of future 
health care that leads to better health outcomes for patients. 
Moreover, we do not believe that hospitals would intentionally fail to 
report to Medicare the service furnished correctly and completely with 
the partial credit modifier when the modifier applies, because the 
hospital would then knowingly submit incorrect information on the 
claim.
    In summary, we are proposing to create a HCPCS modifier to be 
reported on a procedure code in Table 38 below if a device listed in 
Table 39 below is replaced with partial credit from the manufacturer 
that is greater than or equal to 20 percent of the cost of the 
replacement device and to reduce the payment for the procedure by 50 
percent of the amount of the estimated packaged cost of the device 
being replaced when the modifier is reported with a procedure code that 
is assigned to an APC in Table 38. We believe that this policy is 
necessary to pay equitably for these services when the hospital 
receives a partial credit for the cost of the device being implanted.
    We note that, of the proposed CY 2008 offset amounts shown in Table 
38 that were in effect for CY 2007, 13 decline slightly compared to the 
CY 2007 final rule offset amounts. Similarly, the proposed CY 2008 
offset amounts for eight of these APCs increase somewhat. As with 
changes in median costs, there may be several different factors that 
are responsible for the observed changes. With regard to the declines, 
we believe that it is possible that the increased packaging we are 
proposing for CY 2008 may cause the nondevice portion of an APC's 
median cost to increase and, therefore, could result in a decline in 
the device portion as a percent of total cost. Increases in the offset 
amounts may be caused by the increases observed in the CCRs, changes in 
the population of hospitals whose claims were used due to additional 
packaging, increased packaging of services that have significant device 
costs, higher costs of new devices, or greater efficiency in the 
implantation of devices, any of which could result in the device 
portion of the APC's median cost increasing as a percent of the total 
cost for the APC as compared to CY 2007. As with APC median costs, the 
offset amounts are expected to vary from year to year, and we do not 
see undue variation in the proposed CY 2008 offset amounts compared 
with the final CY 2007 offset amounts.
    The CY 2007 final payment policy when devices are replaced without 
cost or when a full credit for a replaced device is furnished to the 
hospital applies to those APCs that met three criteria as described in 
the CY 2007 OPPS/ASC final rule with comment period (71 FR 68072 
through 68077). Specifically, all procedures assigned to the selected 
APCs must require implantable devices that would be reported if device 
replacement procedures were performed, the required devices must be 
surgically inserted or implanted devices that remain in the patient's 
body after the conclusion of the procedures (at least temporarily), and 
the device offset amount must be significant, defined as exceeding 40 
percent of the APC cost. We also restricted the devices to which the 
APC payment adjustment would apply to a specific set of costly devices 
to ensure that the adjustment would not be triggered by the replacement 
of an inexpensive device whose cost would not constitute a significant 
proportion of the total payment rate for an APC.
    We examined the offset amounts calculated from the CY 2008 proposed 
rule data and the clinical characteristics of APCs to determine whether 
the APCs to which the no cost or full credit replacement policy applies 
in CY 2007 continue to meet the criteria for CY 2008 and to determine 
whether other APCs to which the policy does not apply in CY 2007 would 
meet the criteria for CY 2008. We concluded that one additional APC 
meets the criteria for inclusion under this policy and that one APC 
currently on the list ceases to meet the criteria. Specifically, we are 
proposing to add APC 0625 (Level IV Vascular Access Procedures) to the 
list of APCs to be adjusted in cases of full or partial credit for 
replaced devices and to add the device described by device code C1881 
(Dialysis access system (implantable)) that is implanted in a procedure 
assigned to APC 0625 to the list of devices to which this policy 
applies. We are proposing to add APC 0625 and device code C1881 for CY 
2008 because they meet the criteria for inclusion in this policy. In 
particular, the single surgical procedure (CPT code 36566 (Insertion of 
tunneled centrally inserted central venous access device, requiring two 
catheters via two separate venous access sites; with subcutaneous 
port(s)) assigned to APC 0625 always requires an implantable device 
that is reported, the proposed CY 2008 APC device offset percent is 
greater than 40 percent, and the device is of a type that is surgically 
implanted in the patient, where it remains at least temporarily. 
Furthermore, costly devices described by device code C1881 are 
implanted in the procedure assigned to APC 0625. We also found that APC 
0229 (Transcatheter Placement of Intravascular Shunts) ceases to meet 
the criteria because the device offset percent for this APC, when 
calculated from proposed rule data, is less than 40 percent. Moreover, 
we believe that the devices that would be implanted in the procedures 
assigned to this APC are not of a type that would be amenable to 
removal and replacement in a device recall or warranty situation. 
Therefore, we are proposing to remove APC 0229 from the list of APCs to 
which the no cost or full credit and proposed partial credit reduction 
policies are applicable for CY 2008.
    Table 38 presents the device offset amounts that we are proposing 
to apply to the specified APCs in cases of no cost or full or partial 
credit for replaced devices for the CY 2008 OPPS.

   Table 38.--Proposed Adjustments to APCs in Cases of No Cost or Full or Partial Credit for Replaced Devices
----------------------------------------------------------------------------------------------------------------
                                                                      CY 2007       Proposed CY     Proposed CY
                                                                   reduction for  2008 reduction  2008 reduction
       APC                 SI                  APC title            full credit      for full       for partial
                                                                       case         credit case     credit case
                                                                     (percent)       (percent)       (percent)
----------------------------------------------------------------------------------------------------------------
0039.............  S................  Level I Implantation of              78.85           82.15           41.07
                                       Neurostimulator.

[[Page 42727]]

 
0040.............  S................  Percutaneous Implantation            54.06           55.93           27.97
                                       of Neurostimulator
                                       Electrodes, Excluding
                                       Cranial Nerve.
0061.............  S................  Laminectomy or Incision              60.06           59.32           29.66
                                       for Implantation of
                                       Neurostimulator
                                       Electrodes, Excluding
                                       Cranial Nerve.
0089.............  T................  Insertion/Replacement of             77.11           74.02           37.01
                                       Permanent Pacemaker and
                                       Electrodes.
0090.............  T................  Insertion/Replacement of             74.74           75.54           37.77
                                       Pacemaker Pulse Generator.
0106.............  T................  Insertion/Replacement/               41.88           57.20           28.60
                                       Repair of Pacemaker and/
                                       or Electrodes.
0107.............  T................  Insertion of Cardioverter-           90.44           89.43           44.72
                                       Defibrillator.
0108.............  T................  Insertion/Replacement/               89.40           89.26           44.63
                                       Repair of Cardioverter-
                                       Defibrillator Leads.
0222.............  T................  Implantation of                      77.65           83.29           41.64
                                       Neurological Device.
0225.............  S................  Implantation of                      79.04           80.84           40.42
                                       Neurostimulator
                                       Electrodes, Cranial Nerve.
0227.............  T................  Implantation of Drug                 80.27           79.69           39.85
                                       Infusion Device.
0259.............  T................  Level VI ENT Procedures...           84.61           83.03           41.52
0315.............  T................  Level II Implantation of             76.03           86.23           43.12
                                       Neurostimulator.
0385.............  S................  Level I Prosthetic                   83.19           51.67           25.83
                                       Urological Procedures.
0386.............  S................  Level II Prosthetic                  61.16           61.98           30.99
                                       Urological Procedures.
0418.............  T................  Insertion of Left                    87.32           81.38           40.69
                                       Ventricular Pacing Elect.
0625.............  T................  Level IV Vascular Access               N/A           62.63           32.32
                                       Procedures.
0654.............  T................  Insertion/Replacement of a           77.35           75.86           37.93
                                       permanent dual chamber
                                       pacemaker.
0655.............  T................  Insertion/Replacement/               76.59           74.59           37.30
                                       Conversion of a permanent
                                       dual chamber pacemaker.
0680.............  S................  Insertion of Patient                 76.40           72.14           36.07
                                       Activated Event Recorders.
0681.............  T................  Knee Arthroplasty.........           73.37           73.27           36.64
----------------------------------------------------------------------------------------------------------------


Table 39.--Proposed Devices for Which the ``FB Modifier'' or New Partial
 Credit Modifier Must Be Reported With the Procedure Code When Furnished
    Without Cost/Full Credit or Partial Credit for a Replaced Device
------------------------------------------------------------------------
         Device HCPCS code                    Short descriptor
------------------------------------------------------------------------
C1721.............................  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.
C1881.............................  Dialysis access system.
C1882.............................  AICD, other than sing/dual.
C1891.............................  Infusion pump, non-prog, perm.
C1895.............................  Lead, AICD, endo dual coil.
C1896.............................  Lead, AICD, non sing/dual.
C1897.............................  Lead, neurostim, test kit.
C1898.............................  Lead, pmkr, other than trans.
C1899.............................  Lead, pmkr/AICD combination.
C1900.............................  Lead coronary venous.
C2619.............................  Pmkr, dual, non rate-resp.
C2620.............................  Pmkr, single, non rate-resp.
C2621.............................  Pmkr, other than sing/dual.
C2622.............................  Prosthesis, penile, non-inf.
C2626.............................  Infusion pump, non-prog, temp.
C2631.............................  Rep dev, urinary, w/o sling.
L8614.............................  Cochlear device/system.
------------------------------------------------------------------------

B. Pass-Through Payments for Devices

1. Expiration of Transitional Pass-Through Payments for Certain Devices
    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Expiring Device Pass-Through Payments'' at the 
beginning of your comment.)
a. Background
    Section 1833(t)(6)(B)(iii) of the Act requires that, under the 
OPPS, a category of devices be eligible for transitional pass-through 
payments for at least 2, but not more than 3, years. This period begins 
with the first date on which a transitional pass-through payment is 
made for any medical device that is described by the category. The 
device category codes became effective April 1, 2001, under the 
provisions of the BIPA. Prior to pass-through device categories, 
Medicare payments for pass-through devices under the OPPS were made on 
a brand-specific basis. All of the initial 97 category codes that were 
established as of April 1, 2001, have expired; 95 categories expired 
after CY 2002, and 2 categories expired after CY 2003. In addition, 
nine new categories have expired since their creation. The three 
categories listed in Table 40, along with their expected expiration 
dates, were established for pass-through payment in CY 2006 or CY 2007, 
as noted. Under our established policy, we base the expiration dates 
for the category codes on the date on which a category was first 
eligible for pass-through payment.
    Of these 3 device categories, there is 1 that would be eligible for 
pass-through payment for at least 2 years as of December 31, 2007; that 
is, device category code C1820 (Generator, neurostimulator 
(implantable), with rechargeable battery and charging system). In the 
CY 2007 OPPS/ASC final rule with comment period (71 FR 68078), we 
finalized our proposal to expire device category C1820 from pass-
through device payment after December 31, 2007.
    In the November 1, 2002 OPPS final rule, we established a policy 
for payment of devices included in pass-through categories that are due 
to expire (67 FR 66763). For CY 2003 through CY 2007, we packaged the 
costs of the

[[Page 42728]]

devices no longer eligible for pass-through payments into the costs of 
the procedures with which the devices were billed in the claims data 
used to set the payment rates for those years. Brachytherapy sources, 
which are now separately paid in accordance with section 1833(t)(2)(H) 
of the Act, are an exception to this established policy (with the 
exception of brachytherapy sources for prostate brachytherapy, which 
were packaged in the CY 2003 OPPS only).
b. Proposed Policy
    For CY 2008, we are implementing the final decision we discussed in 
the CY 2007 OPPS/ASC final rule with comment period that finalizes the 
expiration date for pass-through status for device category C1820. 
Therefore, as of January 1, 2008, we will discontinue pass-through 
payment for device category code C1820. In accordance with our 
established policy, we will package the costs of the device assigned to 
this device category into the costs of the procedures with which the 
device was billed in CY 2006, the year of hospital claims data used for 
this proposed OPPS update.
    In addition, the 2 device categories that were established for 
pass-through payment as of January 1, 2007, C1821 (Interspinous process 
distraction device (implantable)) and L8690 (Auditory osseointegrated 
device, includes all internal and external components), would be active 
categories for pass-through payment for 2 years as of December 31, 
2008. Therefore, we are proposing that these categories expire from 
pass-through device payment as of December 31, 2008.

                      Table 40.--Current Pass-Through Device Categories by Expiration Date
----------------------------------------------------------------------------------------------------------------
                                                                                      Date(s)       Expiration
               HCPCS code                        Category long descriptor            populated         date
----------------------------------------------------------------------------------------------------------------
C1820..................................  Generator, neurostimulator                       1/1/06        12/31/07
                                          (implantable).
C1821..................................  Interspinous process distraction device          1/1/07        12/31/08
                                          (implantable).
L8690..................................  Auditory osseointegrated device,                 1/1/07        12/31/08
                                          includes all internal and external
                                          components.
----------------------------------------------------------------------------------------------------------------

2. Proposed Provisions for Reducing Transitional Pass-Through Payments 
To Offset Costs Packaged Into APC Groups
    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Offset Costs'' at the beginning of your comment.)
a. Background
    In the November 30, 2001 OPPS final rule, we explained the 
methodology we used to estimate the portion of each APC payment rate 
that could reasonably be attributed to the cost of the associated 
devices that are eligible for pass-through payments (66 FR 59904). 
Beginning with the implementation of the CY 2002 OPPS quarterly update 
(April 1, 2002), we deducted from the pass-through payments for the 
identified devices an amount that reflected the portion of the APC 
payment amount that we determined was associated with the cost of the 
device, as required by section 1833(t)(6)(D)(ii) of the Act. In the 
November 1, 2002 interim final rule with comment period, we published 
the applicable offset amounts for CY 2003 (67 FR 66801).
    For the CY 2002 and CY 2003 OPPS updates, to estimate the portion 
of each APC payment rate that could reasonably be attributed to the 
cost of an associated device eligible for pass-through payment, we used 
claims data from the period used for recalibration of the APC rates. 
That is, for CY 2002 OPPS updating, we used CY 2000 claims data, and 
for CY 2003 OPPS updating, we used CY 2001 claims data. For CY 2002, we 
used median cost claims data based on specific revenue centers used for 
device related costs because device C-code cost data were not available 
until CY 2003. For CY 2003, we calculated a median cost for every APC 
based on single claims with device codes but without packaging the 
costs of associated C-codes for device categories that were billed with 
the APC. We then calculated a median cost for every APC based on single 
claims with the costs of the associated device category C-codes that 
were billed with the APC packaged into the median. Comparing the median 
APC cost without device packaging to the median APC cost including 
device packaging that was developed from the claims with device codes 
also reported enabled us to determine the percentage of the median APC 
cost that was attributable to the associated pass-through devices. By 
applying those percentages to the APC payment rates, we determined the 
applicable amount to be deducted from the pass-through payment, the 
''offset'' amount. We created an offset list comprised of any APC for 
which the device cost was at least 1 percent of the APC's cost.
    The offset list that we published for CY 2002 through CY 2004 was a 
list of offset amounts associated with those APCs with identified 
offset amounts developed using the methodology described above. As a 
rule, we do not know in advance which procedures residing in certain 
APCs may be billed with new device categories. Therefore, an offset 
amount was applied only when a new device category was billed with a 
HCPCS procedure code that was assigned to an APC appearing on the 
offset list.
    For CY 2004, we modified our policy for applying offsets to device 
pass-through payments. Specifically, we indicated that we would apply 
an offset to a new device category only when we could determine that an 
APC contains costs associated with the device. We continued our 
existing methodology for determining the offset amount, described 
earlier. We were able to use this methodology to establish the device 
offset amounts for CY 2004 because providers reported device codes 
(generally C-codes) on the CY 2002 claims used for the CY 2004 OPPS 
update. For the CY 2005 update to the OPPS, our data consisted of CY 
2003 claims that did not contain device codes and, therefore, for CY 
2005, we utilized the device percentages as developed for CY 2004. In 
the CY 2004 OPPS update, we reviewed the device categories eligible for 
continuing pass-through payment in CY 2004 to determine whether the 
costs associated with the device categories were packaged into the 
existing APCs. Based on our review of the data for the device 
categories existing in CY 2004, we determined that there were no close 
or identifiable costs associated with the devices relating to the 
respective APCs that were normally billed with them. Therefore, for 
those device categories, we set the offset amount to $0 for CY 2004. We 
continued this policy of setting the offset amount to $0 for the device 
categories that continued to receive pass-through payment in CY 2005.
    For the CY 2006 OPPS update, CY 2004 hospital claims were available 
for analysis. Hospitals billed device C-codes in CY 2004 on a voluntary 
basis.

[[Page 42729]]

We reviewed our CY 2004 data and found that the numbers of claims for 
services in many of the APCs for which we calculated device percentages 
using CY 2004 data were quite small. We also found that many of these 
APCs already had relatively few single claims available for median 
calculations compared with the total bill frequencies, because of our 
inability to use many multiple bills in establishing median costs for 
all APCs. In addition, we found that our claims demonstrated that 
relatively few hospitals specifically coded for devices utilized in CY 
2004. Thus, we were not confident that CY 2004 claims reporting device 
HCPCS codes represented the typical costs of all hospitals providing 
the services. Therefore, we did not use CY 2004 claims with device 
codes to calculate CY 2006 device offset amounts. In addition, we did 
not use the CY 2005 methodology, for which we utilized the device 
percentages as developed for CY 2004. Two years had passed since we 
developed the device offsets for CY 2004, and the device offsets 
originally calculated from CY 2002 hospital claims data may either have 
overestimated or underestimated the contributions of device costs to 
total procedural costs in the outpatient hospital environment of CY 
2006. In addition, a number of the APCs on the CY 2004 and CY 2005 
device offset percent lists were either no longer in existence or were 
so significantly reconfigured that the past device offsets likely did 
not apply.
    For CY 2006, we reviewed the single new device category 
established, C1820, to determine whether device costs associated with 
the new category were packaged into the existing APC structure based on 
partial CY 2005 claims data. Under our established policy, if we 
determine that the device costs associated with the new category are 
closely identifiable to device costs packaged into existing APCs, we 
set the offset amount for the new category to an amount greater than 
$0. Our review of the service indicated that the median cost for the 
applicable APC 0222 (Implantation of Neurological Device) contained 
costs for neurostimulators that were similar to neurostimulators 
described by the new device category C1820. Therefore, we determined 
that a device offset would be appropriate. We announced a CY 2006 
offset amount for that category in Program Transmittal No. 804, dated 
January 3, 2006. (We subsequently were informed that some rechargeable 
neurostimulators described by device category C1820 may also be used 
and billed with a CPT code that maps to APC 0039 (Level I Implantation 
of Neurostimulator). We announced an offset amount for device category 
C1820 when billed with a procedure code that maps to APC 0039, in 
Program Transmittal No. 1209, dated March 21, 2007.)
    For CY 2006, we used available partial year CY 2005 hospital claims 
data to calculate device percentages and potential offsets for CY 2006 
applications for new device categories. Effective January 1, 2005, we 
require hospitals to report device HCPCS codes and their charges when 
hospitals bill for services that utilize devices described by the 
existing device category codes. In addition, during CY 2005 we 
implemented device edits for many services that require devices and for 
which appropriate device category HCPCS codes exist. Therefore, we 
expected that the number of claims that included device codes and their 
respective costs to be much more robust and representative for CY 2005 
than for CY 2004.
    For CY 2007, we reviewed the two new device categories, C1821 and 
L8690, to determine whether device costs associated with the new 
categories were packaged into the existing APC structure based on CY 
2005 claims data. As indicated earlier, under our established policy, 
if we determine that the device costs associated with a new category 
are closely identifiable to device costs packaged into existing APCs, 
we set the offset amount for the new category to an amount greater than 
$0. Our review of the related services indicated that the median costs 
for the applicable APC 0256 (Level V ENT Procedures (for L8690)) and 
APC 0050 (Level II Musculoskeletal Procedures Except Hand and Foot (for 
C1821)) did not contain costs for devices that were similar to those 
described by the new device categories. Therefore, we set the 
respective offsets to $0.
    We believe that use of the most current claims data to establish 
offset amounts when they are needed to ensure appropriate payment is 
consistent with our stated policy; therefore, we are proposing to 
continue to do so for the CY 2008 OPPS. Specifically, if we create a 
new device category for payment in CY 2008, to calculate potential 
offsets we are proposing to examine the most current available claims 
data, including device costs, to determine whether device costs 
associated with the new category are already packaged into the existing 
APC structure, as indicated earlier. If we conclude that some related 
device costs are packaged into existing APCs, we are proposing to use 
the methodology described earlier and first used for the CY 2003 OPPS 
to determine an appropriate device offset percent for those APCs with 
which the new category would be reported.
b. Proposed Policy
    For CY 2008, we are proposing to continue to review each new device 
category on a case-by-case basis as we have done since CY 2004, to 
determine whether device costs associated with the new category are 
packaged into the existing APC structure. If we determine that, for any 
new device category, no device costs associated with the new category 
are packaged into existing APCs, we are proposing to continue our 
current policy of setting the offset amount for the new category to $0 
for CY 2008. There are currently two new device categories that will 
continue for pass through payment in CY 2008. These categories, 
described by HCPCS codes L8690 and C1821, currently have an offset 
amount equal to $0 because we could not identify device related costs 
in the procedural APCs we expect would be billed with either of the two 
categories L8690 or C1821, that is, in APC 0256 or APC 0050, 
respectively. We are proposing that the offsets for CY 2008 for L8690 
and C1821 remain set to $0, because we cannot identify device costs 
packaged in the related procedural APCs that are closely identifiable 
with these device categories, based on the claims data for CY 2006, the 
claims data year for our CY 2008 OPPS update.
    We are proposing to continue our existing policy of establishing 
new categories in any quarter when we determine that the criteria for 
granting pass through status for a device category are met. If we 
create a new device category and determine that our CY 2006 claims data 
contain a sufficient number of claims with identifiable costs 
associated with the new category of devices in any APC with which it is 
billed, we are proposing to establish an offset amount greater than $0 
and to reduce the transitional pass through payment for the device by 
the related procedural APC offset amount. If we determine that a device 
offset amount greater than $0 is appropriate for any new category that 
we create, we are proposing to announce the offset amount in the 
program transmittal that announces the new category.
    In summary, for CY 2008, we are proposing to use CY 2006 hospital 
claims data to calculate device percentages and potential offsets for 
new device categories established in CY 2008. We are proposing to 
publish through program transmittals any new or updated offsets that we 
calculate for CY 2008, corresponding to newly

[[Page 42730]]

created categories or existing categories eligible for pass-through 
payment, respectively.

V. Proposed OPPS Payment Changes for Drugs, Biologicals, and 
Radiopharmaceuticals

A. Proposed Transitional Pass-Through Payment for Additional Costs of 
Drugs and Biologicals
    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Pass-Through Drugs'' at the beginning of your 
comment.)
1. Background
    Section 1833(t)(6) of the Act provides for temporary additional 
payments or ``transitional pass-through payments'' for certain drugs 
and biological agents. As originally enacted by the Medicare, Medicaid, 
and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 (Pub. L. 106-
113), this provision requires the Secretary to make additional payments 
to hospitals for current orphan drugs, as designated under section 526 
of the Federal Food, Drug, and Cosmetic Act (Pub. L. 107-186); current 
drugs and biological agents and brachytherapy sources used for the 
treatment of cancer; and current radiopharmaceutical drugs and 
biological products. For those drugs and biological agents referred to 
as ``current,'' the transitional pass-through payment began on the 
first date the hospital OPPS was implemented (before enactment of the 
Medicare, Medicaid, and SCHIP BenefitsImprovement and Protection Act 
(BIPA) of 2000 (Pub. L. 106-554), on December 21, 2000).
    Transitional pass-through payments are also provided for certain 
``new'' drugs and biological agents that were not being paid for as an 
HOPD service as of December 31, 1996, and whose cost is ``not 
insignificant'' in relation to the OPPS payments for the procedures or 
services associated with the new drug or biological. Under the statute, 
transitional pass-through payments can be made for at least 2 years but 
not more than 3 years. Proposed CY 2008 pass-through drugs and 
biologicals are assigned status indicator ``G'' in Addenda A and B to 
this proposed rule.
    Section 1833(t)(6)(D)(i) of the Act specifies that the pass-through 
payment amount, in the case of a drug or biological, is the amount by 
which the amount determined under section 1842(o) (or, if the drug or 
biological is covered under a competitive acquisition contract under 
section 1847B, an amount determined by the Secretary equal to the 
average price for the drug or biological for all competitive 
acquisition areas and year established under such section as calculated 
and adjusted by the Secretary) for the drug or biological exceeds the 
portion of the otherwise applicable Medicare OPD fee schedule that the 
Secretary determines is associated with the drug or biological. This 
methodology for determining the pass-through payment amount is set 
forth in Sec.  419.64 of the regulations, which specifies that the 
pass-through payment equals the amount determined under section 1842(o) 
of the Act minus the portion of the APC payment that CMS determines is 
associated with the drug or biological. Section 1847A of the Act, as 
added by section 303(c) of Pub. L. 108-173, establishes the use of the 
average sales price (ASP) methodology as the basis for payment for 
drugs and biologicals described in section 1842(o)(1)(C) of the Act 
that are furnished on or after January 1, 2005. The ASP methodology 
uses several sources of data as a basis for payment, including ASP, 
wholesale acquisition cost (WAC), and average wholesale price (AWP). In 
this proposed rule, the term ``ASP methodology'' and ``ASP based'' are 
inclusive of all data sources and methodologies described therein. 
Additional information on the ASP methodology can be found on the CMS 
Web site at: http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01_overview.asp#TopOfPage.
    As noted above, section 1833(t)(6)(D)(i) of the Act also states 
that if a drug or biological is covered under a competitive acquisition 
contract under section 1847B of the Act, the payment rate is equal to 
the average price for the drug or biological for all competitive 
acquisition areas and the year established as calculated and adjusted 
by the Secretary. Section 1847B of the Act, as added by section 303(d) 
of Pub. L. 108-173, establishes the payment methodology for Medicare 
Part B drugs and biologicals under the competitive acquisition program 
(CAP). The Part B drug CAP was implemented July 1, 2006, and includes 
approximately 180 of the most commonPart B drugs provided in the 
physician's office setting. The list of drugs and biologicals covered 
under the Part B drug CAP, their associated payment rates and the Part 
B drug CAP pricing methodology can be found on the CMS Web site at 
http://www.cms.hhs.gov/CompetitiveAcquisforBios.
    For CYs 2005, 2006, and 2007, we estimated the OPPS pass-through 
payment amount for drugs and biologicals to be zero based on our 
interpretation that the ``otherwise applicable Medicare OPD fee 
schedule'' amount was equivalent to the amount to be paid for pass-
through drugs and biologicals under section 1842(o) of the Act (or 
section 1847B of the Act, if the drug or biological is covered under a 
competitive acquisition contract). We concluded for those years that 
the resulting difference between these two rates would be zero.
    The pass-through application and review process is explained on the 
CMS Web site at: http://www.cms.hhs.gov /HospitalOutpatientPPS/04--
passthrough--payment.asp.
2. Drugs and Biologicals With Expiring Pass-Through Status in CY 2007
    Section 1833(t)(6)(C)(i) of the Act specifies that the duration of 
transitional pass through payments for drugs and biologicals must be no 
less than 2 years and no longer than 3 years. In Table 41, we list the 
seven drugs and biologicals whose pass through status will expire on 
December 31, 2007, that meet that criterion.

        Table 41.--Proposed Drugs and Biologicals for Which Pass-Through Status Expires December 31, 2007
----------------------------------------------------------------------------------------------------------------
                                                                  CY 2007 and
            HCPCS code                   Short descriptor         proposed CY      CY 2007 SI      Proposed CY
                                                                   2008 APC                          2008 SI
----------------------------------------------------------------------------------------------------------------
J2278............................  Ziconotide injection.......            1694               G                K
J2503*...........................  Pegaptanib sodium injection            1697               G                K
J7311............................  Fluocinolone acetonide.....            9225               G                K
J8501............................  Oral aprepitant............            0868               G                K
J9027............................  Clofarabine injection......            1710               G                K
J9264*...........................  Paclitaxel protein bound...            1712               G                K
Q4079............................  Natalizumab injection......            9126               G               K
----------------------------------------------------------------------------------------------------------------
* Indicates that the drug was paid at a rate determined by the Part B drug CAP methodology while identified as
  pass-through under the OPPS.


[[Page 42731]]

3. Drugs and Biologicals with Proposed Pass-Through Status in CY 2008
    We are proposing to continue pass-through status in CY 2008 for 13 
drugs and biologicals. These items, which were approved for pass-
through status between April 1, 2006 and July 1, 2007, are listed in 
Table 42. The APCs and HCPCS codes for these drugs and biologicals 
listed in Table 42 are assigned status indicator ``G'' in Addenda A and 
B to this proposed rule.
    Section 1833(t)(6)(D)(i) of the Act sets the amount of pass-through 
payment for pass-through drugs and biologicals (the pass-through 
payment amount). The pass-through payment amount is the difference 
between the amount authorized under section 1842(o) of the Act (or, if 
the drug or biological is covered under a competitive acquisition 
contract under section 1847B, an amount determined by the Secretary 
equal to the average price for the drug or biological for all 
competitive acquisition areas and year established under such section 
as calculated and adjusted by the Secretary) and the portion of the 
otherwise applicable fee schedule amount that the Secretary determines 
is associated with the drug or biological. Given our CY 2008 proposal 
to provide payment for nonpass-through separately payable drugs and 
biologicals at ASP+5 percent as described further in section V.B.3 of 
this proposed rule, we believe it would be most consistent with the 
statute to provide payment for drugs and biologicals with pass through 
status that are not part of the Part B drug CAP at a rate of ASP+6 
percent, compared to ASP+5 percent as the otherwise applicable fee 
schedule portion associated with the drug or biological. The difference 
between ASP+6 percent and ASP+5 percent, therefore, would be the CY 
2008 pass-through payment amount for these drugs and biologicals. Thus, 
we are proposing for CY 2008 to pay for pass-through drugs and 
biologicals that are not part of the Part B drug CAP at ASP+6 percent, 
equivalent to the rate these drugs and biologicals would receive in the 
physician's office setting in CY 2008.
    Section 1842(o) of the Act also states that if a drug or biological 
is covered under a competitive acquisition contract under section 1847B 
of the Act, the payment rate is equal to the average price for the drug 
or biological for all competitive acquisition areas and year 
established as calculated and adjusted by the Secretary. For CY 2008, 
we are proposing to provide payment for drugs and biologicals with 
pass-through status that are offered under the Part B drug CAP at a 
rate equal to the Part B drug CAP rate. Therefore, considering ASP+5 
percent to be the otherwise applicable fee schedule portion associated 
with these drugs or biologicals, the difference between the Part B drug 
CAP rate and ASP+5 percent would be the pass-through payment amount for 
these drugs and biologicals. HCPCS codes that are offered under the CAP 
program as of April 1, 2007 are identified in Table 42 with an 
asterisk.
    In section V.B.3.b. of this proposed rule, we discuss our proposal 
to make separate payment in CY 2008 for new drugs and biologicals with 
a HCPCS code, consistent with the provisions of section 1842(o) of the 
Act, at a rate that is equivalent to the payment they would receive in 
a physician's office setting (or under section 1847B of the Act, if the 
drug or biological is covered under a competitive acquisition contract) 
only if we have received a pass-through application for the item and 
pass-through status has been subsequently granted. Otherwise, we are 
proposing to pay ASP+5 percent for these products in CY 2008.
    We are proposing to use payment rates based on the ASP data from 
the fourth quarter of CY 2006 for budget neutrality estimates, impact 
analyses, and completion of Addenda A and B to this proposed rule 
because these are the most recent data available to us at this time. 
These payment rates are also the basis for drug payments in the 
physician's office setting, effective April 1, 2007. As updated data 
will be available during the development of our final rule, we are 
proposing to use ASP data from the second quarter of 2007 (which are 
the basis for drug payments in the physician's office setting, 
effective October 1, 2007) in budget neutrality estimates, impact 
analyses, and completion of Addenda A and B to the CY 2008 OPPS/ASC 
final rule with comment period. In addition, we are proposing to update 
these pass-through payment rates on a quarterly basis on our Web site 
during CY 2008 if later quarter ASP submissions (or more recent WAC or 
AWP information, as applicable) indicate that adjustments to the 
payment rates for these pass-through drugs and biologicals are 
necessary. Although there are no pass-through radiopharmaceuticals at 
this time for CY 2008, the payment rate for a radiopharmaceutical with 
pass-through status would also be adjusted accordingly.
    If a drug that has been granted pass-through status for CY 2008 
becomes covered under the Part B drug CAP, we are proposing to make the 
appropriate adjustments to the payment rates for these drugs and 
biologicals on a quarterly basis. For drugs and biologicals that are 
currently covered under the CAP, we are proposing to use the payment 
rates calculated under that program that are in effect as of April 1, 
2007. We are proposing to update these payment rates if the rates 
change in the future.

Table 42.--Proposed Drugs and Biologicals With Pass-Through Status in CY
                                  2008
------------------------------------------------------------------------
                                         CY 2007 and      CY 2007 and
    HCPCS code       Short descriptor    proposed CY    proposed CY 2008
                                          2008 APC             SI
------------------------------------------------------------------------
C9232.............  Injection,                   9232  G
                     idursulfase.
C9233.............  Injection,                   9233  G
                     ranibizumab.
C9235.............  Injection,                   9235  G
                     panitumumab.
C9350.............  Porous collagen              9350  G
                     tube per cm.
C9351.............  Acellular derm               9351  G
                     tissue percm2.
J0129.............  Injection,                   9230  G
                     abatacept.
J0348.............  Anadulafungin                0760  G
                     injection.
J0894*............  Injection,                   9231  G
                     decitabine.
J1740.............  Injection                    9229  G
                     ibandronate
                     sodium.
J2248.............  Injection,                   9227  G
                     micafungin
                     sodium.
J3243.............  Injection,                   9228  G
                     tigecycline.
J3473.............  Hyaluronidase                0806  G
                     recombinant.
J9261.............  Nelarabine                   0825  G
                     injection.
------------------------------------------------------------------------
* Indicates that the drug is paid at a rate determined by the Part B
  drug CAP methodology while identified as pass-through under the OPPS.


[[Page 42732]]

B. Proposed Payment for Drugs, Biologicals, and Radiopharmaceuticals 
Without Pass-Through Status

1. Background
    Under the CY 2007 OPPS, we currently pay for drugs, biologicals, 
and radiopharmaceuticals that do not have pass-through status in one of 
two ways: packaged payment within the payment for the associated 
service or separate payment (individual APCs). We explained in the 
April 7, 2000 OPPS final rule with comment period (65 FR 18450) that we 
generally package the cost of drugs and radiopharmaceuticals into the 
APC payment rate for the procedure or treatment with which the products 
are usually furnished. Hospitals do not receive separate payment from 
Medicare for packaged items and supplies, and hospitals may not bill 
beneficiaries separately for any packaged items and supplies whose 
costs are recognized and paid within the national OPPS payment rate for 
the associated procedure or service. (Program Memorandum Transmittal A 
01 133, issued on November 20, 2001, explains in greater detail the 
rules regarding separate payment for packaged services.)
    Packaging costs into a single aggregate payment for a service, 
procedure, or episode of care is a fundamental principle that 
distinguishes a prospective payment system from a fee schedule. In 
general, packaging the costs of items and services into the payment for 
the primary procedure or service with which they are associated 
encourages hospital efficiencies and also enables hospitals to manage 
their resources with maximum flexibility.
    Section 1833(t)(16)(B) of the Act, as added by section 621(a)(2) of 
Pub. L. 108-173, sets the threshold for establishing separate APCs for 
drugs and biologicals at $50 per administration for CYs 2005 and 2006. 
Therefore, for CYs 2005 and 2006, we paid separately for drugs, 
biologicals, and radiopharmaceuticals whose per day cost exceeded $50 
and packaged the costs of drugs, biologicals, and radiopharmaceuticals 
whose per day cost was equal to or less than $50 into the procedures 
with which they were billed. For CY 2007, the packaging threshold for 
drugs, biologicals, and radiopharmaceuticals that are not new and do 
not have pass through status was established to be $55. The methodology 
used to establish the $55 threshold for CY 2007 and our proposed 
approach for future years are discussed in more detail in section 
V.B.2. of this proposed rule.
    In addition, for CY 2005 to CY 2007, we have provided an exemption 
to this packaging determination for oral and injectable 5HT3 forms of 
anti emetic products. We discuss in section V.B.2. of this proposed 
rule our proposed CY 2008 payment policy for anti emetic products.

2. Proposed Criteria for Packaging Payment for Drugs and Biologicals

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Packaging Drugs and Biologicals'' at the beginning 
of your comment.)
    As indicated above, in accordance with section 1833(t)(16)(B) of 
the Act, the threshold for establishing separate APCs for drugs and 
biologicals was set to $50 per administration during CYs 2005 and 2006. 
In CY 2007, we used the fourth quarter moving average Producer Price 
Index (PPI) levels for prescription preparations to trend the $50 
threshold forward from the third quarter of CY 2005 (when the Pub. L. 
108-173 mandated threshold became effective) to the third quarter of CY 
2007. We then rounded the resulting dollar amount to the nearest $5 
increment in order to determine the CY 2007 threshold adjustment amount 
of $55.
    Following the CY 2007 methodology (which is discussed in more 
detail in the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68085 through 68086)), we used updated fourth quarter moving average 
PPI levels to trend the $50 threshold forward from the third quarter of 
CY 2005 to the third quarter of CY 2008 and again rounded the resulting 
dollar amount ($57.78) to the nearest $5 increment, which yielded a 
figure of $60. In performing this calculation, we used the most up-to-
date forecasted, quarterly PPI estimates from CMS' Office of the 
Actuary (OACT). As actual inflation for past quarters replaced 
forecasted amounts, the PPI estimates for prior quarters have been 
revised (compared with those used in the CY 2007 OPPS/ASC proposed 
rule) and have been incorporated into our calculation for this CY 2008 
proposed rule. Based on the calculations described above, we are 
proposing a packaging threshold for CY 2008 of $60. As stated in the CY 
2007 OPPS/ASC final rule with comment period (71 FR 68086), we believe 
that packaging certain items is a fundamental component of a 
prospective payment system, that packaging these items does not lead to 
beneficiary access issues and does not create a problematic site of 
service differential, that the packaging threshold is reasonable based 
on the initial establishment in law of a $50 threshold for the CY 2005 
OPPS, that updating the $50 threshold is consistent with industry and 
government practices, and that the PPI is an appropriate mechanism to 
gauge Part B drug inflation. While we are not proposing for CY 2008 to 
change this established approach to establishing the general packaging 
threshold for drugs, biologicals, and radiopharmaceuticals, in view of 
our proposed packaging approach for the CY 2008 OPPS as outlined in 
section II.A.4. of this proposed rule and our desire to move the OPPS 
toward a more encounter-based and episode-based payment in the future, 
we will consider expanded packaging of payment for drugs, biologicals, 
and radiopharmaceuticals for a future OPPS update. We believe that 
consideration of expanded packaging for drugs and biologicals is 
particularly important given the substantial increase that has occurred 
in recent years in the proportion of HCPCS codes for drugs, 
biologicals, and radiopharmaceuticals that are paid separately, from 30 
percent in CY 2003 to 50 percent in CY 2007. We are proposing for CY 
2008 to expand the packaging of certain drugs and radiopharmaceuticals, 
specifically contrast agents and diagnostic radiopharmaceuticals as 
discussed in detail in section II.A.4. of this proposed rule. However, 
we believe that increased packaging of payment for drugs, biologicals, 
and radiopharmaceuticals more generally under the OPPS could provide 
significant incentives for hospital efficiency in adopting the most 
cost-effective approaches to patient care, while providing hospitals 
with maximum flexibility in managing their resources. Therefore, we are 
interested in public comments regarding recommended approaches to 
increase packaging of these products under the OPPS and issues we 
should consider as we evaluate alternative methodologies for the 
future.
    To determine their CY 2008 proposed packaging status, we calculated 
the per day cost of all drugs, biologicals, and radiopharmaceuticals 
that had a HCPCS code in CY 2006 and were paid (via packaged or 
separate payment) under the OPPS using claims data from January 1, 
2006, to December 31, 2006. In order to calculate the per day costs for 
drugs, biologicals, and radiopharmaceuticals to determine their 
packaging status in CY 2008, we are proposing to use the methodology 
that was described in detail in the CY 2006 OPPS proposed rule (70 FR 
42723 through 42724) and finalized in the CY 2006 OPPS final rule with 
comment period (70 FR 68636 through 70 FR 68638). To calculate the 
proposed CY

[[Page 42733]]

2008 per day costs, we used an estimated payment rate for each drug and 
biological of ASP+5 percent (which is the payment rate we are proposing 
for separately payable drugs and biologicals in CY 2008, as discussed 
in more detail subsequently). As noted in section V.A.3. of this 
proposed rule, we used the manufacturer submitted ASP data from the 
fourth quarter of CY 2006 (rates that were used for payment purposes in 
the physician's office setting, effective April 1, 2007). For items 
that did not have an ASP based payment rate, we used their mean unit 
cost derived from the CY 2006 hospital claims data to determine their 
per day cost. We packaged items with per day cost less than or equal to 
$60 and identified items with per day cost greater than $60 as 
separately payable. Consistent with our past practice, we crosswalked 
historical OPPS claims data from the CY 2006 HCPCS codes that were 
reported to the CY 2007 HCPCS codes that we display in Addendum B to 
this proposed rule for payment in CY 2008. We note that HCPCS code 
A9568 (Technetium Tc-99 arcitumomab, diagnostic, per study dose, up to 
45 millicuries), replaced HCPCS code A9549 (Technetium Tc-99 
arcitumomab, diagnostic, per study dose, up to 25 millicuries) 
beginning January 1, 2007. Our CY 2006 claims data indicate that HCPCS 
code A9549 was billed an average of one time per day. As we do not have 
claims data available for ratesetting purposes for HCPCS code A9568, we 
estimated the number of units per day to also be one.
    Our policy during previous cycles of the OPPS has been to use 
updated data to establish final determinations of the packaging status 
of drugs, biologicals, and radiopharmaceuticals. We note it is also our 
policy to make an annual packaging determination only when we develop 
the OPPS final rules. Only items that are identified as separately 
payable in the final rule will be subject to quarterly updates as 
discussed in section V.B.3. of this proposed rule. For our calculation 
of per day costs of drugs, biologicals, and radiopharmaceuticals in the 
CY 2008 OPPS/ASC final rule with comment period, we are proposing to 
use ASP data from the first quarter of CY 2007, which would be the 
basis for calculating payment rates for drugs and biologicals in the 
physician's office setting using the ASP methodology, effective July 1, 
2007, along with the updated hospital claims data from CY 2006.
    Consequently, the packaging status for drugs, biologicals, and 
radiopharmaceuticals for the final rule using the updated data may be 
different from their packaged status determined based on the data we 
are using for this proposed rule. Under such circumstances, we are 
proposing to apply the following policies to these drugs, biologicals, 
and radiopharmaceuticals whose relationship to the $60 threshold 
changes based on the final updated data:
    <bullet> Drugs, biologicals, and radiopharmaceuticals that were 
paid separately in CY 2007 and that are proposed for separate payment 
in CY 2008, and then have per day costs equal to or less than $60 based 
on the updated ASPs and hospital claims data used for the CY 2008 final 
rule with comment period, would continue to receive separate payment in 
CY 2008.
    <bullet> Drugs, biologicals, and radiopharmaceuticals that are 
packaged in CY 2007 and that are proposed for separate payment in CY 
2008, and then have per day costs equal to or less than $60 based on 
the updated ASPs and hospital claims data used for the CY 2008 final 
rule with comment period, would remain packaged in CY 2008.
    <bullet> Drugs, biologicals, and radiopharmaceuticals for which we 
are proposing packaged payment in CY 2008 but then had per day costs 
greater than $60 based on the updated ASPs and hospital claims data 
used for the CY 2008 final rule with comment period, would receive 
separate payment in CY 2008.
    We note that in sections II.A.4.c.(5) and (6) of this proposed rule 
that we are proposing to package payment for all diagnostic 
radiopharmaceuticals and contrast agents that would not otherwise be 
packaged according to the proposed CY 2008 packaging threshold for 
drugs, biologicals and radiopharmaceuticals. Tables 17 and 19 in 
sections II.A.4.c.(5) and (6) of this proposed rule list the diagnostic 
radiopharmaceuticals and contrast agents, respectively, that we are 
proposing to package in CY 2008. We discuss our reasons for treating 
diagnostic radiopharmaceuticals and contrast agents differently from 
other drugs, biologicals, and therapeutic radiopharmaceuticals below.
    For CY 2008, we also are proposing to continue exempting the oral 
and injectable forms of 5HT3 anti-emetic products from packaging, 
thereby making separate payment for all of the 5HT3 anti-emetic 
products. As we stated in the CY 2005 OPPS final rule with comment 
period (69 FR 65779 through 65780), it is our understanding that 
chemotherapy is very difficult for many patients to tolerate, as the 
side effects are often debilitating. In order for Medicare 
beneficiaries to achieve the maximum therapeutic benefit from 
chemotherapy and other therapies with side effects of nausea and 
vomiting, anti-emetic use is often an integral part of the treatment 
regimen. We believe that we should continue to ensure that Medicare 
payment rules do not impede a beneficiary's access to the particular 
anti-emetic that is most effective for him or her as determined by the 
beneficiary and his or her physician.

  Table 43.--Proposed Anti-Emetics to Exempt from Proposed CY 2008 $60
                           Packaging Threshold
------------------------------------------------------------------------
             HCPCS Code                        Short descriptor
------------------------------------------------------------------------
J1260...............................  Dolasetron mesylate
J1626...............................  Granisetron HCl injection
J2405...............................  Ondansetron HCl injection
J2469...............................  Palonosetron HCl
Q0166...............................  Granisetron HCl 1 mg oral
Q0179...............................  Ondansetron HCl 8 mg oral
Q0180...............................  Dolasetron mesylate oral
------------------------------------------------------------------------

3. Proposed Payment for Drugs and Biologicals Without Pass-Through 
Status That Are Not Packaged
    a. Payment for Specified Covered Outpatient Drugs
    (If you choose to comment on issues in this section, please include 
the caption OPPS: Specified Covered Outpatient Drugs'' at the beginning 
of your comment.)
    (1) Background
    Section 1833(t)(14) of the Act, as added by section 621(a)(1) of 
Pub. L. 108-173, requires special classification of certain separately 
paid radiopharmaceuticals, drugs, and biologicals and mandates specific 
payments for these items. Under section 1833(t)(14)(B)(i) of the Act, a 
``specified covered outpatient drug'' is a covered outpatient drug, as 
defined in section 1927(k)(2) of the Act, for which a separate APC 
exists and that either is a radiopharmaceutical agent or is a drug or 
biological for which payment was made on a pass through basis on or 
before December 31, 2002.
    Under section 1833(t)(14)(B)(ii) of the Act, certain drugs and 
biologicals are designated as exceptions and are not included in the 
definition of ``specified covered outpatient drugs.'' (SCODs) These 
exceptions are--
    <bullet> A drug or biological for which payment is first made on or 
after January 1, 2003, under the transitional pass-through payment 
provision in section 1833(t)(6) of the Act.
    <bullet> A drug or biological for which a temporary HCPCS code has 
not been assigned.

[[Page 42734]]

    <bullet> During CYs 2004 and 2005, an orphan drug (as designated by 
the Secretary).
    Section 1833(t)(14)(A)(iii) of the Act, as added by section 
621(a)(1) of Pub. L. 108 173, requires that payment for SCODs in CY 
2006 and subsequent years be equal to the average acquisition cost for 
the drug for that year as determined by the Secretary, subject to any 
adjustment for overhead costs and taking into account the hospital 
acquisition cost survey data collected by the Government Accountability 
Office (GAO) in CYs 2004 and 2005. If hospital acquisition cost data 
are not available, the law requires that payment be equal to payment 
rates established under the methodology described in section 1842(o), 
section 1847A, or section 1847B of the Act as calculated and adjusted 
by the Secretary as necessary.
    In establishing the CY 2006 payment rates, we evaluated the three 
data sources that were available to us for setting the CY 2006 payment 
rates for drugs and biologicals. As described in the CY 2006 OPPS final 
rule with comment period (70 FR 68639 through 68644), these data 
sources were the GAO reported average purchase prices for 55 specified 
covered outpatient drug categories for the period July 1, 2003, to June 
30, 2004, collected via a survey of 1,400 acute care Medicare-certified 
hospitals; ASP data; and mean costs derived from CY 2004 hospital 
claims data. For the CY 2006 OPPS final rule with comment period, we 
used ASP data from the second quarter of CY 2005, which were used to 
set payment rates for drugs and biologicals in the physician's office 
setting effective October 1, 2005, and updated claims data.
    In our data analysis for the CY 2006 OPPS final rule with comment 
period, we compared the payment rates for drugs and biologicals using 
data from all three sources described above. We estimated aggregate 
expenditures for all drugs and biologicals that would be separately 
payable in CY 2006 and for the 55 drugs and biologicals reported by the 
GAO using mean costs from the claims data, the GAO mean purchase 
prices, and the ASP-based payment amounts (ASP+6 percent in most 
cases), and then calculated the equivalent average ASP-based payment 
rate under each of the three payment methodologies. We excluded 
radiopharmaceuticals in our analysis because they were paid at hospital 
charges reduced to cost during CY 2006. The results based on updated 
ASP and claims data were published in Table 24 of the CY 2006 OPPS 
final rule with comment period. For a full discussion of our reasons 
for using these data, we refer readers to section V.B.3.a. of the CY 
2006 OPPS final rule with comment period (70 FR 68639 through 68644).
    As we noted in the CY 2006 OPPS final rule with comment period, 
findings from a MedPAC survey of hospital charging practices indicated 
that hospitals set charges for drugs, biologicals, and 
radiopharmaceuticals high enough to reflect their pharmacy handling 
costs as well as their acquisition costs. In consideration of this 
information, we stated in the CY 2006 OPPS final rule with comment 
period that payment rates derived from hospital claims data also 
included acquisition and pharmacy handling costs because they are 
derived directly from hospital charges (70 FR 68642). In CYs 2006 and 
2007, we finalized a policy of providing payment to HOPDs for drugs, 
biologicals, and associated pharmacy handling costs at a rate of ASP+6 
percent. In addition, in CY 2006 we had proposed to collect pharmacy 
overhead charge data via special pharmacy overhead HCPCS codes that 
hospitals would report. We did not finalize this proposal for CY 2006 
because of hospital concerns regarding the administrative burden 
associated with reporting pharmacy overhead with these special HCPCS 
codes (70 FR 68657 through 68665).
(2) Proposed Payment Policy
    The provision in section 1833(t)(14)(A)(iii) of the Act, as 
described above, continues to be applicable to determining payments for 
SCODs for CY 2008. This provision requires that in CY 2008 payment for 
SCODs be equal to the average acquisition cost for the drug for that 
year as determined by the Secretary, subject to any adjustment for 
overhead costs and taking into account the hospital acquisition cost 
survey data collected by the GAO in CYs 2004 and 2005. If hospital 
acquisition cost data are not available, the law requires that payment 
be equal to payment rates established under the methodology described 
in section 1842(o), section 1847A, or section 1847B of the Act as 
calculated and adjusted by the Secretary as necessary. In addition, 
section 1833(t)(14)(E)(ii) authorizes the Secretary to adjust APC 
weights for SCODs to take into account the MedPAC report relating to 
overhead and related expenses, such as pharmacy services and handling 
costs.
    During the March 2007 APC Panel meeting, the APC Panel recommended 
that CMS implement a three-phase plan to address OPPS payment for 
pharmacy overhead costs. The first phase of the recommended plan 
involves CMS working with interested stakeholders to develop a system 
of defining pharmacy overhead categories for outpatient drugs that 
require different levels of pharmacy resources. In addition, this phase 
includes a provision recommending that CMS provide payment for pharmacy 
overhead costs by setting payment rates for the developed categories 
through New Technology APCs, presumably while collecting hospital cost 
data on these services. The second phase of the recommended plan calls 
for CMS to review estimates of pharmacy overhead costs as identified by 
the GAO and MedPAC, and to consider external survey data from 
stakeholders. The third and final phase of the recommended plan calls 
for specific billing of pharmacy overhead costs using HCPCS codes 
(corresponding to the categories developed in phase one, with payment 
rates resulting from submitted hospital claims data) on the same claim 
as a drug administration service. The APC Panel recommended that the 
overhead payments be made in addition to the current ASP+6 percent 
payment rates for separately payable drugs and biologicals that do not 
have pass-through status. We also have met with interested stakeholders 
who have presented proposals similar to the APC Panel's recommended 
plan with various modifications to that recommendation, including 
suggestions for the assignment of specific drugs and biologicals to 
various overhead categories and potential overhead payment rates for 
such categories in the first phase of the APC Panel's recommended plan. 
In addition, some stakeholders have recommended that CMS conduct a 
survey of pharmacy overhead costs in the second phase of the APC 
Panel's recommended plan.
    While we appreciate the APC Panel's recommendation, as well as 
similar suggestions from other stakeholders, we are not proposing to 
adopt the APC Panel's recommendation for CY 2008. As discussed in 
section II.A.4. of this proposed rule, for CY 2008, we are proposing to 
expand packaging for a number of different groups of services. Given 
our belief that packaging can be helpful in promoting hospital 
efficiency and long-term cost containment, we do not believe it would 
be desirable to take steps that would ultimately lead to payment for 
pharmacy overhead costs being unpackaged under the OPPS. In addition, 
we note that the APC Panel recommended that CMS establish separate 
payment amounts for pharmacy overhead in addition to the current 
combined payment for drug acquisition

[[Page 42735]]

costs and pharmacy overhead of ASP+6 percent. As we discussed in the CY 
2006 OPPS final rule with comment period (70 FR 68657) and in the CY 
2007 OPPS/ASC final rule with comment period (71 FR 68089 through 
68092), findings from a MedPAC survey of hospital charging practices 
indicated that hospitals set charges for drugs, biologicals, and 
radiopharmaceuticals high enough to reflect their pharmacy handling 
costs as well as their acquisition costs. We believe that our payment 
rates for drug acquisition costs and pharmacy overhead should be 
determined based on the costs reflected in our claims data, as these 
costs reflect both acquisition costs and overhead costs. We also 
believe that establishing additional payment for pharmacy overhead 
beyond our proposed payment rates based on claims data would distort 
the relative relationship of costs across HOPD services, which is the 
basis of the OPPS.
    While we are not proposing to adopt the APC Panel's recommendation 
for CY 2008, we considered several other options for payment for drug 
acquisition costs and pharmacy overhead for CY 2008. First, we 
considered proposing again the methodology we had proposed for CY 2006, 
which involved the establishment of three drug overhead categories that 
hospitals would use to report pharmacy overhead charges associated with 
a drug provided in the HOPD. Until such data were available for 
ratesetting purposes, we considered continuing our CY 2007 methodology 
of bundling average hospital acquisition and pharmacy overhead 
payments. While this approach has the advantage of not paying 
separately for pharmacy overhead until we would have claims data on 
which to establish separate payment rates for drug acquisition costs 
and pharmacy overhead, its goal would still be to ultimately unpackage 
OPPS payment for pharmacy overhead. We have decided not to propose this 
option because we believe it is undesirable to take steps that would 
ultimately lead to pharmacy overhead being unpackaged at the same time 
that we are proposing measures to expand packaging under the OPPS and 
are considering moving toward more episode-based and encounter-based 
payment. Furthermore, we note that, as we considered this approach, we 
were mindful of the comments we received in response to our CY 2006 
proposed rule expressing concern about the additional administrative 
burden on staff and coders that this methodology might cause.
    Second, we considered continuing our CY 2007 methodology of 
providing a single bundled payment representing average hospital 
acquisition costs and associated pharmacy overhead costs. As stated 
previously, we believe that hospitals are including pharmacy overhead 
costs in their charges for drugs, consistent with MedPAC's findings. 
While we continue to believe that a combined payment amount for drug 
acquisition costs and pharmacy overhead based on our claims data is a 
reasonable methodology, adequately accounts for acquisition costs and 
overhead, and is consistent with our broader packaging efforts, we have 
decided to propose a slight variant of this approach for CY 2008 
instead.
    For CY 2008, we are proposing to continue our methodology of 
providing a combined payment rate for drug and biological acquisition 
costs and pharmacy overhead. However, in addition, we are proposing to 
instruct hospitals to remove the pharmacy overhead charge from the 
charge for the drug or biological and instead report the pharmacy 
overhead charge on an uncoded revenue code line on the claim beginning 
in CY 2008. This proposed change, from a CY 2007 policy where hospitals 
include pharmacy overhead in their charges for the drug or biological 
to a CY 2008 policy of including the pharmacy overhead charges on an 
uncoded revenue code line, would allow us to package pharmacy overhead 
costs for drugs and biologicals into payment for the associated 
procedure, likely a drug administration procedure, in future years when 
the CY 2008 claims data become available for ratesetting. We are 
proposing to apply this policy to the reporting of charges for all 
drugs and biologicals, including contrast agents, irrespective of the 
item's packaged or separately payable status for the CY 2008 OPPS. We 
are not proposing to apply this policy to the reporting of overhead 
charges for radiopharmaceuticals given the explicit instructions we 
gave hospitals beginning in CY 2006 to include the charges for 
radiopharmaceutical overhead and handling in the charges for the 
radiopharmaceutical product.
    This proposal would not change our current policy of packaging 
payment for pharmacy overhead with payment for another item or service. 
Rather, in future years it would only change the types of items or 
services with which pharmacy overhead is packaged. Once CY 2008 claims 
data become available for ratesetting, this proposal would lead to 
pharmacy overhead for separately payable drugs being packaged with 
payment for the associated procedure, likely a drug administration 
procedure, rather than the current policy where pharmacy overhead for 
separately payable drugs is packaged with the payment for the drug.
    We note that, in the case of current OPPS payment for packaged 
drugs, payment for both the drugs and their associated pharmacy 
overhead costs is already packaged into payment for the associated 
separately payable procedures, including drug administration services 
as discussed in detail in section II.A.1.b.(2) of this proposed rule. 
Packaging pharmacy overhead for separately payable drugs and 
biologicals into the payments for drug administration would enhance the 
accuracy of payments by packaging overhead for similar drugs into the 
commonly associated separately payable services, for example, by 
packaging the pharmacy overhead for a chemotherapy drug with the 
chemotherapy drug administration code also included on the claim. In 
addition, this methodology is consistent with the increased packaging 
efforts discussed earlier in this proposed rule. Because we would not 
expect to have claims data reflecting these reporting changes until CY 
2010, we are proposing to continue to provide a combined payment rate 
for acquisition costs and pharmacy overhead for separately payable 
drugs and biologicals in CY 2008 similar to the combined payment rate 
provided in CYs 2006 and 2007 that represents the average hospital 
acquisition cost and pharmacy overhead cost.
    Under our proposal, hospitals would be asked to report pharmacy 
overhead charges on an uncoded revenue code line. By having hospitals 
report pharmacy overhead on an uncoded revenue code line, they would 
have the flexibility to decide whether they reported a pharmacy 
overhead charge per drug or per episode of drug administration 
services. The pharmacy overhead charges reported through an uncoded 
revenue code line would be like any other charge for an uncoded revenue 
code line on the claim. For example, hospitals may already report 
charges for some drugs or pharmacy-related services through an uncoded 
revenue code charge. Our proposal would mean that hospitals would be 
reporting pharmacy overhead on an uncoded revenue code line, in 
addition to any drugs or pharmacy-related services that they may 
already be reporting in that manner. According to our standard OPPS 
ratesetting methodology, we would package all such uncoded revenue code 
lines on the claim to develop the median cost for the separately 
payable service with which the pharmacy charges are reported.

[[Page 42736]]

    We note that when we proposed establishing specific HCPCS codes for 
hospitals to report pharmacy overhead for CY 2006, commenters expressed 
a number of concerns about how this reporting and charging methodology 
would be different from the approach for other private payers. Some 
commenters voiced concern that while the proposal would have required 
hospitals to modify their billing systems to separate the pharmacy 
overhead charge from the drug charge for Medicare claims, hospitals 
would need to bill them as a single line item for other payers. Some 
commenters were concerned that this might require hospitals to charge 
Medicare differently from all other payers for the same services. With 
regard to our current proposal for CY 2008 to have hospitals report a 
charge for the drug and a charge for pharmacy overhead via an uncoded 
revenue code line, we believe our current approach is consistent with 
Medicare regulations. So long as hospitals provide the same total 
charge to all payers, it would be acceptable to report that charge as a 
line item for one payer and two (or more) line items for another payer.
    For this proposed rule, we evaluated two data sources that we have 
available to us for setting the CY 2008 payment rates for drugs and 
biologicals. The first source of drug pricing information that we have 
is the ASP data from the fourth quarter of CY 2006, which were used to 
set payment rates for drugs and biologicals in the physician's office 
setting, effective April 1, 2007. We have ASP-based prices for 
approximately 500 drugs and biologicals (including contrast agents) 
payable under the OPPS. However, we currently do not have any ASP data 
on radiopharmaceuticals.
    The second source of cost data that we have for drugs, biologicals, 
and radiopharmaceuticals is the mean and median costs derived from the 
CY 2006 hospital claims data. As section 1833(t)(14)(A)(iii) of the Act 
clearly specifies that payment for SCODs in CY 2008 be equal to the 
``average'' acquisition cost for the drug, we limited our analysis to 
the mean costs of drugs determined using the hospital claims data, 
instead of using median costs.
    In our data analysis, we compared the payment rates for drugs and 
biologicals using data from both sources described above. After 
determining the proposed CY 2008 packaging status of drugs and 
biologicals, we estimated aggregate expenditures for all drugs and 
biologicals (excluding radiopharmaceuticals) that would be separately 
payable in CY 2008 using mean costs from the hospital claims data and 
the ASP-based payment amounts, and calculated the equivalent average 
ASP-based payment rate under both payment methodologies.
    The results of our data analysis indicate that using mean unit cost 
to set the payment rates for the drugs and biologicals that would be 
separately payable in CY 2008 would be equivalent to basing their 
payment rates, on average, at ASP+5 percent. Therefore, we are 
proposing to continue to provide a bundled payment for CY 2008 at ASP+5 
percent while hospitals change their charge practices to bill pharmacy 
overhead charges on an uncoded revenue center line as discussed above. 
As stated previously, we believe that this methodology would continue 
to provide accurate payments for average acquisition costs of Part B 
drugs and pharmacy overhead costs during this transition. In addition, 
as described in section II.A.4. of this proposed rule, for contrast 
agents we are proposing a supplemental approach which would package 
payment for all contrast media under the CY 2008 OPPS, and our specific 
rationale for this modified approach is described in our discussion of 
payment for diagnostic radiopharmaceuticals included in section 
V.A.3.a.(4)(b) of this proposed rule.
(3) Proposed Payment for Blood Clotting Factors
    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Blood Clotting Factors'' at the beginning of your 
comment.)
    For CY 2007, we are providing payment for blood clotting factors 
under the OPPS at ASP+6 percent plus an additional payment for the 
furnishing fee that is also a part of the payment for blood clotting 
factors furnished in physicians' offices under Medicare Part B. The CY 
2007 updated furnishing fee is $0.152 per unit.
    For the CY 2008 OPPS, we are proposing to pay for blood clotting 
factors at ASP+5 percent and to continue our policy for payment of the 
furnishing fee using the updated amount for CY 2008 as presented in the 
CY 2008 MPFS final rule.
    We have consistently noted that we would update the payment amount 
for the furnishing fee each year (based on the consumer price index) so 
that the payment amount for the furnishing fee is equal to the 
furnishing fee payment amount noted in the MPFS final rule. As 
discussed in greater detail in the CY 2008 MPFS proposed rule, the CPI 
data for the 12 month period ending in June 2007 is not yet available. 
In the CY 2008 MPFS final rule, we will include the actual figure for 
the percent change in the CPI for medical care for the 12-month period 
ending June 2007, and the updated furnishing fee for CY 2008 we have 
calculated based on that figure.
    Because the furnishing fee update is based on the percentage 
increase in the CPI for medical care for the 12 month period ending 
with June of the previous year and the Bureau of Labor Statistics 
releases the applicable CPI data after the OPPS and MPFS proposed rules 
are published, we have not been able to include the actual updated 
furnishing fee in the CY 2006 through CY 2008 OPPS and MPFS proposed 
rules. Rather, we announced in these proposed rules that we intended to 
include the actual figure for the percent change in the applicable CPI, 
and the updated furnishing fee calculated based on that figure in the 
associated final rule. Given the timing of the availability of the 
applicable data and our timeframe for preparing proposed rules, this 
process is unavoidable and likely to remain unchanged in the future. We 
believe that including a discussion of the furnishing fee update in 
annual rulemaking does not provide an advantage over other means of 
announcing this information, so long as the current statutory update 
methodology continues in effect. We believe that the public's need for 
information and adequate notice regarding the updated furnishing fee 
can be better met by issuing program instructions which will eliminate 
the discussion of the furnishing fee update annually in rulemaking. In 
addition, by communicating the updated furnishing fee in program 
instruction, the actual figure for the percent change in the applicable 
CPI and the updated furnishing fee calculated based on that figure can 
be announced more timely than when included as part of the annual 
rulemaking process. Because the furnishing fee update process is 
statutorily determined and is based on an index that is not affected by 
administrative discretion or public comment, we do not believe our 
proposed means of communicating the update will adversely affect 
stakeholders or the public. Therefore, for CY 2009 and thereafter, 
until such time as the update methodology may be modified, we are 
proposing to announce the blood clotting furnishing fee using 
applicable program instructions and posting on the CMS Web site. For 
additional information and instructions on how to submit comments on 
this proposal, we refer readers to the CY 2008 MPFS proposed rule.

[[Page 42737]]

(4) Proposed Payment for Radiopharmaceuticals
(a) Background
    Section 303(h) of Pub. L. 108-173 exempted radiopharmaceuticals 
from ASP pricing in the physician's office setting. Beginning in the CY 
2005 OPPS final rule with comment period, we have exempted 
radiopharmaceutical manufacturers from reporting ASP data for payment 
purposes under the OPPS (for more information, we refer readers to the 
CY 2005 OPPS final rule with comment period and the CY 2006 OPPS final 
rule with comment period, 69 FR 65811 and 70 FR 68655, respectively). 
Consequently, we do not have ASP data for radiopharmaceuticals for 
consideration for CY 2008 OPPS ratesetting. In accordance with section 
1833(t)(14)(B)(i)(I) of the Act, radiopharmaceuticals are classified 
under the OPPS as SCODs. Accordingly, payments for radiopharmaceuticals 
are to be made at average acquisition cost as determined by the 
Secretary and subject to any adjustment for overhead costs. 
Radiopharmaceuticals are also subject to the policies affecting all 
similarly classified OPPS drugs and biologicals, such as pass-through 
payments and packaging determinations, discussed earlier in this 
proposed rule.
    For CYs 2006 and 2007, we used mean unit cost data from hospital 
claims to determine each radiopharmaceutical's packaging status, and 
implemented a temporary policy to pay for separately payable 
radiopharmaceuticals based on the hospital's charge for each 
radiopharmaceutical adjusted to cost using the hospital's overall CCR. 
This methodology was finalized as an interim proxy for average 
acquisition cost because of the unique circumstances associated with 
providing radiopharmaceutical products to Medicare beneficiaries. The 
single OPPS payment represented Medicare payment for both the 
acquisition cost of the radiopharmaceutical and its associated pharmacy 
overhead costs. We clearly stated in both the CY 2006 and CY 2007 OPPS 
final rules with comment period that we did not intend to maintain this 
methodology permanently (70 FR 68656 and 71 FR 68096, respectively), 
and that we would continue to actively seek other methodologies for 
setting payments for radiopharmaceuticals in future years.
    During the CY 2006 and CY 2007 rulemaking processes, we encouraged 
hospitals and the radiopharmaceutical stakeholders to assist us in 
developing a viable long-term prospective payment methodology for these 
products under the OPPS. We are pleased to note that we have had many 
discussions over this past year with interested parties regarding the 
availability and limitations of radiopharmaceutical cost data. In 
addition, we have received several suggestions from interested parties 
on how to structure future payment methodologies. Many of the proposals 
we have received have suggested that we consider differentiating 
radiopharmaceutical products into two different categories by cost, at 
least in part because stakeholders have speculated that charge 
compression leads to inappropriately low calculated costs for expensive 
radiopharmaceuticals. For CY 2008, we are making separate payment 
proposals for diagnostic radiopharmaceuticals and therapeutic 
radiopharmaceuticals. While we have not grouped radiopharmaceuticals 
based on cost, we note that the therapeutic radiopharmaceuticals 
typically are more expensive than the diagnostic radiopharmaceuticals. 
We identified all diagnostic radiopharmaceuticals specifically as those 
Level II HCPCS codes that include the term ``diagnostic'' along with a 
radiopharmaceutical in their long code descriptors. Therefore, we were 
able to distinguish therapeutic radiopharmaceuticals from diagnostic 
radiopharmaceuticals as those Level II HCPCS codes that have the term 
``therapeutic'' along with a radiopharmaceutical in their long code 
descriptors. We note that all radiopharmaceutical products fall into 
one category or the other; their use as a diagnostic 
radiopharmaceutical or therapeutic radiopharmaceutical is mutually 
exclusive.
(b) Proposed Payment for Diagnostic Radiopharmaceuticals
    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Payment for Diagnostic Radiopharmaceuticals'' at 
the beginning of your comment.)
    As discussed in section II.A.4. of this proposed rule, we are 
proposing to package payment for diagnostic radiopharmaceuticals and 
contrast agents with per day costs over $60 as part of our packaging 
proposal for CY 2008. Radiopharmaceuticals and contrast agents 
currently are defined as SCODs in section 1833(t)(14)(B) of the Act, 
and we currently package payment for diagnostic radiopharmaceuticals 
and contrast agents with per day costs of $55 or less. However, our 
proposal for CY 2008 also includes packaging payment for all diagnostic 
radiopharmaceuticals and contrast agents, regardless of their per day 
cost. Packaging costs into a single aggregate payment for a service, 
encounter, or episode of care is a fundamental principle that 
distinguishes a prospective payment system from a fee schedule. In 
general, packaging the costs of items and services into the payment for 
the primary procedure or service with which they are associated 
encourages hospital efficiencies and also enables hospitals to manage 
their resources with maximum flexibility. The proportion of drugs, 
biologicals, and radiopharmaceuticals that are separately paid has 
increased in recent years, from 30 percent of HCPCS codes for these 
products in CY 2003 to 50 percent in CY 2007, a pattern that has been 
noted previously for procedural services as well. Our proposal to 
package payment for diagnostic radiopharmaceuticals and contrast agents 
regardless of per day cost furthers the fundamental principles of a 
prospective payment system.
    We believe our proposal to treat diagnostic radiopharmaceuticals 
and contrast agents differently from other SCODs is appropriate for 
several reasons. First, the statutory requirement that we must pay 
separately for drugs and biologicals for which the per day cost exceeds 
$50 under section 1833(t)(16)(B) of the Act has expired. Therefore, we 
are not restricted to the extent to which we can package payment for 
SCODs and other drugs, nor are we required to treat all classes of 
drugs in the same manner with regard to whether they are packaged or 
separately paid. We have used this flexibility to make different 
packaging determinations for several years with regard to specific 
anti-emetic drugs. While we are proposing to continue to establish an 
updated cost threshold for packaging drugs, biologicals, and 
radiopharmaceuticals, we are also proposing an approach specific to 
diagnostic radiopharmaceuticals and contrast agents that would 
otherwise be separately paid.
    Second, we see diagnostic radiopharmaceuticals and contrast agents 
as functioning effectively as supplies that enable the provision of an 
independent service. More specifically, contrast agents are always 
provided in support of a diagnostic or therapeutic procedure that 
involves imaging and diagnostic radiopharmaceuticals are always 
provided in support of a diagnostic nuclear medicine scan. This is 
different from many other SCODs, for example, therapeutic 
radiopharmaceuticals, where the therapeutic radiopharmaceutical itself 
is the primary therapeutic modality. Given the inherent function of 
contrast agents and diagnostic radiopharmaceuticals as

[[Page 42738]]

supportive to the performance of an independent procedure, we view the 
packaging of payment for contrast agents and diagnostic 
radiopharmaceuticals as a logical initial step to expand packaging for 
SCODs. As we consider moving to additional encounter-based and episode-
based payment in future years, we may consider additional options for 
packaging more SCODs in the future.
    Third, section 1833(t)(14)(A)(iii) of the Act requires that payment 
for SCODs be set prospectively based on a measure of average hospital 
acquisition cost. While we have ASP data for contrast agents, the lack 
of ASP data as a source of average acquisition cost for 
radiopharmaceuticals and the varying inclusion of overhead and handling 
costs in the charge for a radiopharmaceutical resulted in payment for 
radiopharmaceuticals at charges reduced to cost on a temporary basis 
for CYs 2006 and 2007.
    We now believe our claims data offer an acceptable proxy for 
average hospital acquisition cost and associated handling and 
preparation costs for radiopharmaceuticals. We believe that hospitals 
have adapted to the CY 2006 coding changes for radiopharmaceuticals and 
responded to our instructions to include charges for 
radiopharmaceutical handling in their charges for the 
radiopharmaceutical products. This issue is discussed in greater detail 
under section V.B.3.a.(4)(c) of this proposed rule regarding our 
proposed CY 2008 payment methodology for therapeutic 
radiopharmaceuticals. We have relied on mean unit costs derived from 
our claims data as one proxy for average acquisition cost and pharmacy 
overhead, and we use these data to determine the packaging status for 
SCODs. However, in light of improved data for radiopharmaceuticals in 
the CY 2006 claims, we believe that the line item estimated cost for a 
diagnostic radiopharmaceutical in our claims data is a reasonable 
approximation of average acquisition and preparation and handling costs 
for diagnostic radiopharmaceuticals. Further, because the standard OPPS 
packaging methodology packages the total estimated cost for each 
radiopharmaceutical on each claim (including the full range costs 
observed on the claims) with the cost of associated nuclear medicine 
procedures for ratesetting, this packaging approach is consistent with 
considering the average cost for radiopharmaceuticals, rather than the 
median. We also note that we believe our improved claims data could 
support the establishment of separate, prospective payment rates for 
diagnostic radiopharmaceuticals with per day costs exceeding our 
general packaging threshold (analogous to our proposal for therapeutic 
radiopharmaceuticals). However, we are proposing to package all 
diagnostic radiopharmaceuticals because we believe additional packaging 
of payment for supportive and ancillary services, including diagnostic 
radiopharmaceuticals, would provide additional incentives for 
efficiency and greater flexibility for hospitals to manage their 
resources.
    In the case of contrast agents, while we have ASP data that can be 
a proxy for average hospital acquisition cost and associated handling 
and preparation costs, payment for almost all contrast agents would be 
packaged under the OPPS for CY 2008 based on the $60 per day packaging 
threshold. Therefore, as discussed in more detail in section 
V.B.3.a.(4) of this proposed rule, we believe it would be most 
appropriate to package payment for all contrast agents for CY 2008, to 
better provide for accurate payment for the associated tests and 
procedures that promotes hospital efficiency.
    In summary, we view diagnostic radiopharmaceuticals and contrast 
agents as ancillary and supportive of the diagnostic tests and 
therapeutic procedures in which they are used. In light of our 
authority to make different packaging determinations, and the improved 
reporting of hospital charges for radiopharmaceutical handling in the 
CY 2006 claims data, we propose to package payment for contrast agents 
and diagnostic radiopharmaceuticals for CY 2008.
(c) Proposed Payment for Therapeutic Radiopharmaceuticals
    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Payment for Therapeutic Radiopharmaceuticals'' at 
the beginning of your comment.)
    For CY 2008, we are proposing to continue separate payment for 
therapeutic radiopharmaceuticals that have a mean per day cost of more 
than $60, consistent with the packaging methodology applied to other 
nonpass-through drugs and biologicals. We believe that therapeutic 
radiopharmaceuticals are distinct from diagnostic radiopharmaceuticals 
because the primary purpose of providing a therapeutic 
radiopharmaceutical is the radiopharmaceutical treatment itself, 
whereas a diagnostic radiopharmaceutical is administered in support of 
the performance of a diagnostic nuclear medicine study that is the 
primary service. For separately payable therapeutic 
radiopharmaceuticals, we are proposing to establish CY 2008 payment 
rates based on their mean unit costs from our CY 2006 OPPS claims data.
    In the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68095), we again reiterated our intent to develop a suitable 
prospective payment methodology for radiopharmaceutical products paid 
under the OPPS in future years, beginning in CY 2008. Since the start 
of the temporary cost-based payment methodology for 
radiopharmaceuticals in CY 2006, we have met with several interested 
parties on this topic and have received several suggestions from these 
stakeholders regarding payment methodologies that we could employ for 
future use under the OPPS.
    In considering payment options for therapeutic radiopharmaceuticals 
for CY 2008, we examined several alternatives. First, we considered 
retaining the CY 2007 methodology of providing payment for therapeutic 
radiopharmaceuticals at a hospital's charges reduced to cost using the 
hospital's overall CCR. While this option would provide consistency in 
the payment methodology from year to year, we have noted on several 
occasions, including in the CY 2007 OPPS/ASC final rule with comment 
period and in various public forums such as the APC Panel meetings, 
that this methodology was not intended to be the basis of providing 
payment to hospitals for these products beyond CY 2007. Payment on a 
claim-specific cost basis is not consistent with the payment of items 
and services on a prospective basis under the OPPS and may lead to 
extremely high or low payments to hospitals for radiopharmaceuticals, 
even when those products would be expected to have relatively 
predictable and consistent acquisition and handling costs across 
individual clinical cases and hospitals. In addition, we have stated 
that we believe that using hospitals' overall CCRs to determine 
payments could result in an overstatement of radiopharmaceutical costs, 
which are likely reported in several cost centers, such as diagnostic 
radiology, that have lower CCRs than hospitals' overall CCRs (71 FR 
68095). For these reasons, we are not proposing to use this methodology 
to set their payment rates for CY 2008.
    The second option we considered, and are proposing, as a 
methodology for providing payment for therapeutic radiopharmaceuticals 
in CY 2008, is to establish prospective payment rates for

[[Page 42739]]

separately payable therapeutic radiopharmaceuticals using mean costs 
derived from the CY 2006 claims data, where the costs are determined 
using our standard methodology of applying hospital-specific 
departmental CCRs to radiopharmaceutical charges, defaulting to 
hospital-specific overall CCRs only if appropriate departmental CCRs 
are unavailable. As we stated in the CY 2007 OPPS/ASC proposed rule, we 
believe this methodology provides us with the most consistent, 
accurate, and efficient methodology for prospectively establishing 
payment rates for separately payable therapeutic radiopharmaceuticals 
(71 FR 49587). We believe that adopting prospective payment based on 
historical hospital claims data is appropriate because it serves as our 
most accurate available proxy for the average hospital acquisition cost 
of separately payable therapeutic radiopharmaceutical products. In 
addition, we have found that our general prospective payment 
methodology based on historical hospital claims data results in more 
consistent, predictable, and equitable payment amounts across hospitals 
and likely provides incentives to hospitals for efficiently and 
economically providing these outpatient services. Therefore, we expect 
that the hospital-specific payment variability found under a charge-
reduced-to-cost methodology would no longer affect these products under 
our CY 2008 proposal.
    Although we received comments to our CY 2007 proposed rule 
indicating that CY 2005 claims data used for that update did not 
incorporate associated overhead charges into the radiopharmaceutical 
charge, in the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68095) we stated that we expected that hospitals would have adapted to 
the CY 2006 HCPCS coding changes for some radiopharmaceuticals and 
responded to our instructions to include their charges for 
radiopharmaceutical handling in their charges for the 
radiopharmaceutical products so these costs would be reflected in the 
CY 2008 ratesetting process. This continues to be our expectation, and 
we believe that the CY 2006 claims data that we are using to set the CY 
2008 OPPS payment rates reflect both the radiopharmaceutical charge and 
associated overhead charges. As discussed at the March 2007 APC Panel 
meeting, our CY 2006 claims data show that a greater proportion of 
radiopharmaceuticals experienced an increase in their median costs from 
CY 2005 to CY 2006 than experienced a decrease. We indicated that this 
trend is consistent with the agency's expectations that hospitals would 
comply with our instructions to include charges for radiopharmaceutical 
handling in their charges for the radiopharmaceutical products for CY 
2006. Therefore, we believe that setting CY 2008 prospective payment 
rates based on CY 2006 hospital claims data as described above serves 
as an acceptable combined proxy for average hospital acquisition costs 
and radiopharmaceutical handling.
    During meetings with external stakeholders over the past year, we 
have been presented with several other suggestions regarding OPPS 
payment for therapeutic radiopharmaceuticals in CY 2008. One of these 
options included a suggestion that we employ alternative trimming 
methodologies in order to produce a claims-based mean cost that would 
more accurately reflect hospital purchase prices for these products. 
However, no specific trimming approaches for radiopharmaceuticals were 
offered for our consideration for CY 2008. We have chosen not to 
propose a methodology based on special OPPS data trimming for the CY 
2008 proposed payment of therapeutic radiopharmaceuticals for the 
following reasons. First, the OPPS has a standard data trimming 
methodology to calculate drug, biological, and radiopharmaceutical per 
day costs from hospital claims data. This includes both a specific trim 
on units for drugs, biologicals, and radiopharmaceuticals that is 
<plus-minus>3 standard deviations from the geometric mean, and a 
standard trim of any line-item with a cost per unit that is <plus-
minus>3 standard deviations from the geometric mean that is applied 
across all items and services. Both trims are conducted on the 
transformed variable, taking the natural log of both units and cost per 
unit, in order to trim evenly relative to the center of the 
distribution. Both units and costs per unit are never negative, and 
there are some therapeutic radiopharmaceuticals with very high units 
and costs per unit in our hospital claims data. These trims are 
conservative and typically eliminate only the most egregious 
observations, ones that could be due to erroneous reporting. For 
therapeutic radiopharmaceuticals, the unit trim alone removed all items 
that would have been eliminated under the cost trim, and with the 
exception of HCPCS code A9563 (Sodium phosphate P-32, therapeutic, per 
millicurie), this trim removed observations with unit costs below the 
mean unit cost listed in Table 44 below. That is, overall, the result 
of applying our trimming methodology increased the mean unit cost 
reported in Table 44.
    As a payment system based on relative payment weights, altering the 
trimming methodology for a particular set of services could unduly 
influence the relativity of the resulting payment weights for those 
particular services and could inappropriately redistribute payments in 
a budget neutral OPPS. We have no reason to believe that hospitals 
report costs differently for radiopharmaceuticals than they do for 
other items. As we discuss further in section II.A.1. of this proposed 
rule, what is important for setting appropriate payment rates under a 
prospective payment system is accuracy in estimating the relative 
costliness of services, and not the nominal value of the observed cost. 
Second, we are not convinced that employing an alternative trimming 
methodology would result in the most appropriate cost estimates for 
therapeutic radiopharmaceuticals. We believe that because hospitals 
were paid in CY 2006 for each therapeutic radiopharmaceutical they 
reported according to a claim-specific charge that was reduced to cost 
for payment, hospitals had an incentive to accurately account for the 
full costs of these products in establishing their charges. In 
addition, we have no way of knowing the specific clinical scenario that 
resulted in any given claim with certain reported units and charges for 
a therapeutic radiopharmaceutical. Therefore, we do not believe it 
would be appropriate to utilize a ratesetting methodology that could 
disregard correctly coded claims. While we appreciate this 
recommendation, we are not proposing a payment methodology that 
includes additional trimming of hospital claims data for therapeutic 
radiopharmaceutical products for CY 2008.
    Recommendations other than trimming have centered around providing 
CMS with external data on radiopharmaceutical costs. One specific 
recommendation that we received from interested stakeholders requested 
that we allow hospitals to submit their invoices to CMS. With the 
invoice information, CMS could establish a prospective payment rate for 
radiopharmaceuticals that would be calculated taking into consideration 
the total amount invoiced for the radiopharmaceutical, transportation 
costs, and applicable rebates. While this payment rate would not 
include payment for certain radiopharmaceutical overhead and handling 
costs, stakeholders suggested that these costs could be packaged into

[[Page 42740]]

the associated procedure payment rather than the payment for the 
radiopharmaceutical. Stakeholders also generally have recommended that 
we could collect external data from various sources (such as 
manufacturers, nuclear pharmacies, and others) to use for therapeutic 
radiopharmaceutical ratesetting purposes in CY 2008.
    We are not proposing a methodology using external data for CY 2008 
for the following reasons. First, any approach relying on external data 
has the same disadvantage previously discussed of differentially 
influencing the relativity of payment weights for radiopharmaceuticals 
in the budget neutral OPPS payment system, where we utilize a standard 
ratesetting methodology for other services. In addition, it is not 
clear that invoice information from hospitals or cost information from 
nuclear pharmacies would be more accurate than hospitals' costs for 
radiopharmaceuticals that we currently calculate based on hospitals' 
charges reduced to cost by application of a CCR, and such information 
would generally exclude the costs of the hospital's handling of the 
radiopharmaceuticals. However, we note that we do not currently 
identify separate costs for this radiopharmaceutical handling that we 
could then package into the costs of the associated diagnostic nuclear 
medicine studies and treatment procedures. Moreover, hospitals 
currently have the flexibility to set their charges for therapeutic 
radiopharmaceuticals, taking into account a variety of factors, 
including acquisition costs and transportation costs, so we believe it 
is likely that hospitals are already taking this information into 
consideration when establishing their charges. Further, we have already 
instructed hospitals to include overhead charges for 
radiopharmaceuticals in the charge for the radiopharmaceutical product. 
We have received several reports that hospitals have made these 
changes, when necessary, and that other changes are in process to 
conform to our instructions. A ratesetting approach based on external 
data would likely present a burden to those hospitals that have been 
working over the past 2 years to align their charging practices with 
our stated instructions. Adoption of any methodology systematically 
relying on external data also would be administratively burdensome for 
CMS because we would need to collect, process, and review external 
information to ensure that it was valid, reliable, and representative 
of a diverse group of hospitals so that it could be used to establish 
rates for all hospitals. For these reasons, we are not proposing to 
collect hospital invoices or otherwise rely on external data in order 
to establish prospective payment rates for therapeutic 
radiopharmaceuticals for CY 2008.
    The eight therapeutic radiopharmaceuticals that we are proposing to 
pay separately in CY 2008 under our proposed methodology of mean units 
costs calculated from CY 2006 hospitals claims are listed in Table 44 
below.

  Table 44.--Therapeutic Radiopharmaceuticals Proposed for Prospective
                           Payment in CY 2008
------------------------------------------------------------------------
                                                             Proposed CY
   HCPCS code    Short descriptor  Proposed CY  Proposed CY   2008 mean
                                     2008 APC     2008 SI        cost
------------------------------------------------------------------------
A9517..........  I131 iodide cap,  1064.......  K..........        $6.22
                  rx.
A9530..........  I131 iodide sol,  1150.......  K..........        11.74
                  rx.
A9543..........  Y90 ibritumomab,  1643.......  K..........    12,030.02
                  rx.
A9545..........  I131              1645.......  K..........     8,283.41
                  tositumomab, rx.
A9563..........  P32 Na phosphate  1675.......  K..........       118.02
A9564..........  P32 chromic       1676.......  K..........       122.17
                  phosphate.
A9600..........  Sr89 strontium..  0701.......  K..........       610.07
A9605..........  Sm 153 lexidronm  0702.......  K..........     1,446.05
------------------------------------------------------------------------

    We note that we have received anecdotal reports from some industry 
stakeholders asserting that the mean costs for the most expensive 
radiopharmaceuticals are understated in our claims data. We 
specifically invite comment on how the CY 2008 OPPS payment rates that 
we are proposing for therapeutic radiopharmaceuticals compare with the 
acquisition and associated handling costs of an efficient provider. We 
also are soliciting suggestions on approaches that could be adopted by 
Medicare or industry groups to promote improvements in hospital 
reporting of charges and costs for therapeutic radiopharmaceuticals to 
the extent that they are warranted and feasible. Some stakeholders have 
stated that charge compression may be adversely affecting our estimates 
of the mean cost for expensive radiopharmaceuticals. As discussed in 
more detail in section II.A.1 of this proposed rule, while we are not 
proposing to implement adjustments for charge compression for CY 2008 
based on the RTI Report, which focused only on inpatient charges, we 
are proposing steps to explore this issue further for the future. We 
are proposing to develop an all-charges model that would compare 
variation in CCRs with variation in charges to establish disaggregated 
CCRs that could be applied to both inpatient and outpatient charges. We 
are also proposing to evaluate the results of that methodology for 
purposes of determining whether the resulting disaggregated CCRs should 
be proposed for to adjust for charge compressions in developing the CY 
2009 OPPS payment rates.
    During its March 2007 meeting, the APC Panel made two 
recommendations regarding radiopharmaceuticals. First, the APC Panel 
recommended that CMS work with stakeholders on issues related to 
payment for radiopharmaceuticals, including evaluating claims data for 
different classes of radiopharmaceuticals and ensuring that a nuclear 
medicine procedure claim always includes at least one reported 
radiopharmaceutical agent. As discussed in section II.A.4. of this 
proposed rule, we are proposing to accept the APC Panel's 
recommendation, and we welcome public comment on the burden hospitals 
would experience should we require such precise reporting. We also are 
seeking comment specifically on the importance of such a requirement in 
light of our discussion in section II.A.4. of this proposed rule on the 
representation of radiopharmaceuticals in the single claims for 
diagnostic nuclear medicine procedures, the presence of uncoded revenue 
code charges specific to diagnostic radiopharmaceuticals on claims 
without

[[Page 42741]]

a coded radiopharmaceutical, and our proposal to package payment for 
all diagnostic radiopharmaceuticals for CY 2008.
    Second, the APC Panel recommended that we consider the use of 
external data and work with stakeholders to determine the correct code 
descriptor units for each radiopharmaceutical, including HCPCS code 
A9524 (Iodine I-131 iodinated serum albumin, diagnostic, per 5 
microcuries). We appreciate the APC Panel's recommendation. We are 
always open to meeting with interested stakeholders and examining any 
data they may provide to us. However, we are unable to accept the APC 
Panel's recommendation concerning the development of specific code 
descriptors because decisions regarding the creation of permanent HCPCS 
codes, including code descriptors, are coordinated by the National 
HCPCS Panel and are outside the scope of the OPPS. For further 
information on the HCPCS coding process, we refer readers to the CMS 
Web site at: http://www.cms.hhs.gov/MedHCPCSGenInfo/01_Overview.asp#TopOfPage. We encourage interested parties to submit 
requests for revisions of code descriptors to the National HCPCS Panel 
for its consideration.
b. Proposed Payment for Nonpass-Through Drugs, Biologicals, and 
Radiopharmaceuticals with HCPCS Codes, but without OPPS Hospital Claims 
Data
    (If you choose to comment on issues in this section, please include 
the caption OPPS: Nonpass-Through Coded Drugs, Biologicals, and 
Radiopharmaceuticals without Claims Data.)
    Pub. L. 108-173 does not address the OPPS payment in CY 2005 and 
after for drugs, biologicals, and radiopharmaceuticals that have 
assigned HCPCS codes, but that do not have a reference AWP or approval 
for payment as pass-through drugs or biologicals. Because there is no 
statutory provision that dictated payment for such drugs and 
biologicals in CY 2005, and because we had no hospital claims data to 
use in establishing a payment rate for them, we investigated several 
payment options for CY 2005 and discussed them in detail in the CY 2005 
OPPS final rule with comment period (69 FR 65797 through 65799).
    For CYs 2005, 2006, and 2007, we finalized our policy to provide 
separate payment for new drugs, biologicals, and radiopharmaceuticals 
with HCPCS codes, but which did not have pass through status at a rate 
that was equivalent to the payment they received in the physician's 
office setting, established in accordance with the ASP methodology.
    As discussed in the CY 2005 OPPS final rule with comment period (69 
FR 65797), and the CY 2006 OPPS final rule with comment period (70 FR 
68666), new drugs, biologicals, and radiopharmaceuticals may be 
expensive, and we are concerned that packaging these new items might 
jeopardize beneficiary access to them. In addition, we do not want to 
delay separate payment for these items solely because a pass-through 
application was not submitted. However, we note that for CY 2008 we are 
proposing to explicitly account for the pass-through payment amount 
associated with pass-through drugs and biologicals, in the context of 
our CY 2008 proposal for the payment of separately payable nonpass-
through drugs and biologicals at ASP+5 percent. Therefore, for CY 2008, 
we are proposing to provide payment for these new drugs and biologicals 
with HCPCS codes as of January 1, 2008, but which do not have pass-
through status and are without OPPS hospital claims data, at ASP+5 
percent, consistent with our proposed payment methodology for other 
nonpass-through drugs and biologicals. This proposal would ensure that 
we are treating new nonpass-through drugs and biologicals like other 
drugs and biologicals under the OPPS, unless they are granted pass-
through status. Only if they were pass-through drugs and biologicals 
would they receive a different payment for CY 2008, generally 
equivalent to the payment these drugs and biologicals would receive in 
the physician's office setting, consistent with the requirements of the 
statute.
    In accordance with the ASP methodology, in the absence of ASP data, 
we are proposing to continue the policy we implemented during CYs 2005, 
2006, and 2007 of using the WAC for the product to establish the 
initial payment rate. However, we note that if the WAC is also 
unavailable, we would make payment at 95 percent of the product's most 
recent AWP. We are also proposing to assign status indicator ``K'' to 
HCPCS codes for new drugs and biologicals for which we have not 
received a pass-through application. We further note that with respect 
to new items for which we do not have ASP data, once their ASP data 
become available in later quarter submissions, their payment rates 
under the OPPS will be adjusted so that the rates are based on the ASP 
methodology and set to ASP+5 percent. We are also proposing to base 
payment for new therapeutic radiopharmaceuticals with HCPCS codes as of 
January 1, 2008, but which do not have pass-through status, on the WACs 
for these products as ASP data for radiopharmaceuticals are not 
available. In addition, we note that if the WACs are also unavailable, 
we would make payment for the therapeutic radiopharmaceuticals at 95 
percent of their most recent AWPs. Analogous to new drugs and 
biologicals, we are proposing to assign status indicator ``K'' to HCPCS 
codes for new therapeutic radiopharmaceuticals for which we have not 
received a pass-through application. Consistent with other ASP-based 
payments, we are proposing to make any appropriate adjustments to the 
payment amounts for drugs and biologicals in the CY 2008 OPPS/ASC final 
rule with comment period and also on a quarterly basis on our Web site 
during CY 2008 if later quarter ASP submissions (or more recent WACs or 
AWPs) indicate that adjustments to the payment rates for these drugs 
and biologicals are necessary. The payment rates for new therapeutic 
radiopharmaceuticals would also be adjusted accordingly. We also are 
proposing to make appropriate adjustments to the payment rates for new 
drugs and biologicals in the event that they become covered under the 
CAP in the future. We note that the new CY 2008 HCPCS codes for drugs, 
biologicals, and therapeutic radiopharmaceuticals are not available at 
the time of the development of this proposed rule; however, they will 
be included in the CY 2008 OPPS/ASC final rule with comment period.
    There are several nonpass-through drugs and biologicals that were 
payable in CY 2006 and/or CY 2007 for which we do not have any CY 2006 
hospital claims data. In order to determine the packaging status of 
these items for CY 2008, we calculated an estimate of the per day cost 
of each of these items by multiplying the payment rate for each product 
based on ASP+5 percent, similar to other nonpass-through drugs and 
biologicals paid under the OPPS, by an estimated average number of 
units of each product that would typically be furnished to a patient 
during one administration in the hospital outpatient setting. We are 
proposing to package items for which we estimate the per administration 
cost to be less than or equal to $60, which is the general packaging 
threshold that we are proposing for drugs, biologicals, and 
radiopharmaceuticals in CY 2008. We are proposing to pay separately for 
items with an estimated per administration cost greater than $60 (with 
the

[[Page 42742]]

exception of diagnostic radiopharmaceuticals and contrast agents which 
we are proposing to package regardless of cost, as discussed in more 
detail above). We are proposing that the CY 2008 payment for separately 
payable items without CY 2006 claims data would be based on ASP+5 
percent, similar to other separately payable nonnpass-through drugs and 
biologcals under the OPPS. In accordance with the ASP methodology used 
in the physician office setting, in the absence of ASP data, we would 
use the WAC for the product to establish the initial payment rate. 
However, we note that if the WAC is also unavailable, we would make 
payment at 95 percent of the most recent AWP available.
    Table 45A below lists all of the nonpass-through drugs and 
biologicals without available CY 2006 claims data to which these 
policies would apply in CY 2008.

                          Table 45A.--Drugs and Biologicals Without CY 2006 Claims Data
----------------------------------------------------------------------------------------------------------------
                                                                           Estimated
                                                           ASP-Based    average number
        HCPCS code                Short descriptor          payment      of units per      Proposed CY 2008 SI
                                                              rate      administration
----------------------------------------------------------------------------------------------------------------
C9234.....................  Inj, alglucosidase alfa.....      $126.00               130  K
J0288.....................  Ampho b cholesteryl sulfate.        11.89                35  K
J0364.....................  Apomorphine hydrochloride...         2.96                 6  N
J1324.....................  Enfuvirtide injection.......        22.69               180  K
J1562.....................  Immune globulin subcutaneous        12.60               130  K
J2170.....................  Mecasermin injection........        11.81              15.6  K
J2315.....................  Naltrexone, depot form......         1.88               380  K
J3355.....................  Urofollitropin, 75 iu.......        50.22                 2  K
J7345.....................  Non-human, non-metab tissue.        35.76                16  K
J8650.....................  Nabilone oral...............        16.80                 6  K
J9261.....................  Nelarabine injection........        82.54              52.5  K
Q4085.....................  Euflexxa, inj...............       115.19                 1  K
----------------------------------------------------------------------------------------------------------------

    During the March 2007 APC Panel meeting, the APC Panel reiterated 
its August 2006 recommendation to allow hospitals to report all HCPCS 
codes for drugs. In general, OPPS recognizes the lowest available 
administrative dose of a drug if multiple HCPCS codes exist for the 
drug; for the remainder of the doses, we assign a status indicator 
``B'' indicating that another code exists for OPPS purposes. For 
example, if drug X has 2 HCPCS codes, 1 for a 1 ml dose and a second 
for a 5 ml dose, the OPPS would assign a payable status indicator to 
the 1 ml dose and status indicator ``B'' to the 5 ml dose. Hospitals 
would then need to bill the appropriate number of units for the 1 ml 
dose in order to receive payment under the OPPS. While we were not 
prepared to accept this recommendation when we developed the CY 2007 
OPP/ASC final rule with comment period, we indicated in that rule that 
we would continue to consider the APC Panel's recommendation for future 
OPPS updates (71 FR 68083 through 68084). After further consideration 
of this issue, we are now accepting the APC Panel's recommendation 
because we have concluded that recognizing all of these HCPCS codes for 
payment under the OPPS should not have a significant effect on our 
payment methodology for drugs. We are proposing to allow hospitals to 
submit claims by reporting any HCPCS code for a Part B drug that is 
covered under the OPPS, regardless of the unit determination in the 
HCPCS code descriptor, beginning in CY 2008. Stakeholders have told us 
that this policy would reduce the administrative burden associated with 
our current requirement that hospitals report drugs using only the 
HCPCS codes with the lowest increments in their code descriptors. 
Whenever possible, we seek to reduce hospitals' administrative burden 
in submitting claims for payment under the OPPS, and we appreciate the 
APC Panel's recommendation in this area.
    As these HCPCS codes were previously unrecognized in the OPPS, we 
do not have claims data to determine the appropriate packaging status. 
Therefore, we are proposing to assign these HCPCS codes the same status 
indicator as the associated recognized HCPCS code (that is, the lowest 
dose), as shown in Table 45B. We believe that this approach is the most 
appropriate and reasonable way to implement this proposed change 
without impacting payment. However, once claims data are available for 
these previously unrecognized HCPCS codes, we would determine the 
packaging status and resulting status indicator for each HCPCS code 
according to the general code-specific methodology for determining a 
code's packaging status for a given update year. We plan to closely 
follow our claims data to ensure that our annual packaging 
determinations for the different HCPCS codes describing the same drug 
do not create inappropriate payment incentives for hospitals to report 
certain HCPCS codes instead of others. In our analysis for this 
proposed rule, we also estimated the packaging status of these 
currently unrecognized HCPCS codes by adjusting the calculated average 
number of units per day for the associated recognized HCPCS code with 
claims data to account for the different dosage descriptors. We then 
multiplied this adjusted average number of units per day value by the 
most recent ASP data available for the unrecognized HCPCS code (listed 
in Table 45B). We note this methodology yielded the same packaging 
determinations and resulting status indicators for the currently 
unrecognized HCPCS codes for CY 2008 as for the recognized HCPCS code 
for the same drug.

[[Page 42743]]



           Table 45B.--Previously Unrecognized HCPCS Codes and Proposed Status Indicators for CY 2008
----------------------------------------------------------------------------------------------------------------
   HCPCS codes not                                               Fourth      Associated HCPCS
  recognized in CY       CY 2007 SI       Short descriptor     quarter CY   code recognized in  Proposed CY 2008
        2007                                                    2006 ASP         CY 2007               SI
----------------------------------------------------------------------------------------------------------------
J1470...............  B..............  Gamma globulin 2 CC         $23.66  J1460..............  K
                                        inj.
J1480...............  B..............  Gamma globulin 3 CC          35.47  ...................  K
                                        inj.
J1490...............  B..............  Gamma globulin 4 CC          47.31  ...................  K
                                        inj.
J1500...............  B..............  Gamma globulin 5 CC          59.14  ...................  K
                                        inj.
J1510...............  B..............  Gamma globulin 6 CC          71.02  ...................  K
                                        inj.
J1520...............  B..............  Gamma globulin 7 CC          82.72  ...................  K
                                        inj.
J1530...............  B..............  Gamma globulin 8 CC          94.62  ...................  K
                                        inj.
J1540...............  B..............  Gamma globulin 9 CC         106.54  ...................  K
                                        inj.
J1550...............  B..............  Gamma globulin 10 CC        118.27  ...................  K
                                        inj.
J1560...............  B..............  Gamma globulin > 10         118.24  ...................  K
                                        CC inj.
J8521...............  B..............  Capecitabine, oral,          13.18  J8520..............  K
                                        500 mg.
J9094...............  B..............  Cyclophosphamide              3.97  J9093..............  N
                                        lyophilized, 200 mg.
J9095...............  B..............  Cyclophosphamide              9.93  ...................  N
                                        lyophilized, 500 mg.
J9096...............  B..............  Cyclophosphamide             17.09  ...................  N
                                        lyophilized, 1g.
J9097...............  B..............  Cyclophosphamide             39.71  ...................  N
                                        lyophilized, 2g.
J9140...............  B..............  Dacarbazine 200 MG            9.34  J9130..............  N
                                        inj.
J9290...............  B..............  Mitomycin 20 MG inj..        68.52  J9280..............  K
J9291...............  B..............  Mitomycin 40 MG inj..       137.03  ...................  K
J9062...............  B..............  Cisplatin 50 MG              12.26  J9060..............  N
                                        injection.
J9080...............  B..............  Cyclophosphamide 200          3.83  J9070..............  N
                                        MG inj.
J9090...............  B..............  Cyclophosphamide 500         15.75  ...................  N
                                        MG inj.
J9091...............  B..............  Cyclophosphamide 1.0         19.17  ...................  N
                                        grm inj.
J9092...............  B..............  Cyclophosphamide 2.0         38.34  ...................  N
                                        grm inj.
J9110...............  B..............  Cytarabine hcl 500 MG         8.22  J9100..............  N
                                        inj.
J9182...............  B..............  Etoposide 100 MG inj.         5.13  J9181..............  N
J9260...............  B..............  Methotrexate sodium           2.59  J9250..............  N
                                        inj, 50 mg.
J9375...............  B..............  Vincristine sulfate 2        15.41  J9370..............  N
                                        MG inj.
J9380...............  B..............  Vincristine sulfate 5        38.52  ...................  N
                                        MG inj.
----------------------------------------------------------------------------------------------------------------

    There are seven drugs and biologicals, shown in Table 45C below, 
that were payable in CY 2006 for which we lack CY 2006 claims data and 
for which we are not able to determine the per day cost based on the 
ASP methodology. As we are unable to determine the packaging status and 
subsequent payment rates, if applicable, for these drugs and 
biologicals for CY 2008 based on the ASP methodology or claims data, we 
are proposing to package payment for these drugs and biologicals in CY 
2008.

  Table 45C.--Drugs and Biologicals Without Information on Per Day Cost
               That Are Proposed for Packaging in CY 2008
------------------------------------------------------------------------
       HCPCS code             Short descriptor       Proposed CY 2008 SI
------------------------------------------------------------------------
90393..................  Vaccina ig, im...........  N
90477..................  Adenovirus vaccine, type   N
                          7.
90581..................  Anthrax vaccine, sc......  N
90727..................  Plague vaccine, im.......  N
J0200..................  Alatrofloxacin mesylate..  N
J0395..................  Arbutamine HCl injection.  N
J1452..................  Intraocular Fomivirsen na  N
------------------------------------------------------------------------

VI. Proposed Estimate of OPPS Transitional Pass-Through Spending for 
Drugs, Biologicals, Radiopharmaceuticals, and Devices

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Estimated Transitional Pass-Through Spending'' at 
the beginning of your comment.)

A. Total Allowed Pass-Through Spending

    Section 1833(t)(6)(E) of the Act limits the total projected amount 
of transitional pass-through payments for drugs, biologicals, 
radiopharmaceuticals, and categories of devices for a given year to an 
``applicable percentage'' of projected total Medicare and beneficiary 
payments under the hospital OPPS. For a year before CY 2004, the 
applicable percentage was 2.5 percent; for CY 2004 and subsequent 
years, we specify the applicable percentage up to 2.0 percent.
    If we estimate before the beginning of the calendar year that the 
total amount of pass-through payments in that year would exceed the 
applicable percentage, section 1833(t)(6)(E)(iii) of the Act requires a 
uniform reduction in the amount of each of the transitional pass-
through payments made in that year to ensure that the limit is not 
exceeded. We make an estimate of pass-through spending to determine not 
only whether payments exceed the applicable percentage, but also to 
determine the appropriate reduction to the conversion factor for the 
projected level of pass-through spending in the following year.
    For devices, developing an estimate of pass-through spending in CY 
2008 entails estimating spending for two groups of items. The first 
group of items consists of those device categories that were eligible 
for pass-through payment in CY 2006 or CY 2007, or both years, and that 
would continue to be eligible for pass-through payment in CY 2008. The 
second group contains items that we know are newly eligible, or project 
would be newly eligible, for device

[[Page 42744]]

pass-through payment in the remainder of CY 2007 or beginning in CY 
2008.
    For drugs and biologicals, section 1833(t)(6)(D)(i) of the Act 
establishes the pass-through payment amount for drugs and biologicals 
eligible for pass-through payment as the amount by which the amount 
authorized under section 1842(o) of the Act (or, if the drug or 
biological is covered under a competitive acquisition contract under 
section 1847B, an amount determined by the Secretary equal to the 
average price for the drug or biological for all competitive 
acquisition areas and year established under such section as calculated 
and adjusted by the Secretary) exceeds the portion of the otherwise 
applicable fee schedule amount that the Secretary determines is 
associated with the drug or biological. Because we are proposing to pay 
for nonpass-through separately payable drugs and biologicals under the 
CY 2008 OPPS at the ASP+5 percent, which represents the otherwise 
applicable fee schedule amount associated with a pass-through drug or 
biological, while we would pay for pass-through drugs and biologicals 
at the ASP+6 percent or the Part B drug CAP rate, if applicable, our 
estimate of drug and biological pass-through payment for CY 2008 is not 
zero. Similar to estimates for devices, the first group of drugs and 
biologicals requiring a pass-through payment estimate consists of those 
products that were eligible for pass-through payment in CY 2006 or CY 
2007, or both years, and that would continue to be eligible for pass-
through payment in CY 2008. The second group contains products that we 
know are newly eligible, or project would be newly eligible, for drug 
or biological pass-through payment in the remainder of CY 2007 or 
beginning in CY 2008. The sum of the CY 2008 pass-through estimates for 
these two groups of drugs and biologicals would equal the total CY 2008 
pass-through spending estimate for drugs and biologicals with pass-
through status.

B. Proposed Estimate of Pass-Through Spending

    We are proposing to set the applicable percentage limit at 2.0 
percent of the total OPPS projected payments for CY 2008, consistent 
with our OPPS policy from CY 2004 through CY 2007.
    As we discuss in section IV.B. of this proposed rule there are two 
device categories receiving pass-through payment in CY 2007 that would 
continue for payment during CY 2008. In accordance with the methodology 
we have used to make estimates in previous years, in cases where we 
have relevant claims data for the procedures associated with a device 
category, we are proposing to project these data forward using 
inflation and utilization factors based on total growth in OPPS 
services as projected by CMS' Office of the Actuary (OACT) to estimate 
the upcoming year's pass-through spending for this first group of 
device categories. As we stated in the CY 2007 OPPS/ASC final rule with 
comment period (71 FR 68101), we may use an alternate growth factor for 
any specific device category based on our claims data or the device's 
clinical characteristics, or both. We developed estimated OPPS 
utilization of the procedures and costs associated with the two device 
categories continuing for pass-through payment into CY 2008, based upon 
examination of our historical claims data, information provided in the 
pass-through device category applications, and the devices' clinical 
characteristics. Based on these estimates, we estimate pass-through 
spending attributable to the first group (that is, the two device 
categories continuing in CY 2008) described above to be $18.1 million 
for CY 2008. The two device categories continuing in CY 2008, which are 
reflected in this $18.1 million estimate for CY 2008 pass-through 
spending, are listed in Table 46A.

     Table 46A.--Proposed CY 2008 Devices With Current Pass-Through
                   Categories Continuing Into CY 2008
------------------------------------------------------------------------
                                             Current pass-through device
      HCPCS code                APC                    category
------------------------------------------------------------------------
C1821................  1821................  Interspinous process
                                              distraction device
                                              (implantable).
L8690................  1032................  Auditory osseointegrated
                                              device, includes all
                                              internal and external
                                              components.
------------------------------------------------------------------------

    To estimate CY 2008 pass-through spending for device categories in 
the second group (that is, device categories that we know at the time 
of the development of this proposed rule would be newly eligible for 
pass-through payment in CY 2007 continuing into CY 2008 (of which there 
are none); additional device categories that we estimate could be 
approved for pass-through status subsequent to the development of this 
proposed rule and before January 1, 2008; and projections for new 
categories that could be established in the second through fourth 
quarters of CY 2008), we are proposing to use the following approach. 
In general, as described for the first group of device categories 
above, if we have relevant claims data, we may project these data 
forward using OACT inflation and utilization factors based on total 
growth in OPPS services, or we may use an alternate growth factor for 
any specific new device category based on our claims data or the 
device's clinical characteristics, or both. At this time, we anticipate 
that any new categories for January 1, 2008, would be determined after 
the publication of this proposed rule, but before publication of the CY 
2008 final rule with comment period. If we do not have any relevant CY 
2006 claims data upon which to base a spending estimate for CY 2008, we 
are proposing to use price information and utilization estimates from 
applicants. To account for the contingency of new device categories 
that we project could become eligible for pass-through status in the 
second, third, or fourth quarter of CY 2008, we are proposing to use 
the general methodology as described above, while also considering the 
most recent OPPS experience in approving new pass-through device 
categories.
    Therefore, we are proposing that the estimate of pass-through 
device spending in CY 2008 incorporate both CY 2008 estimates of pass-
through spending for device categories made effective January 1, 2007, 
and estimates for those device categories projected to be approved 
during subsequent quarters of CY 2007 and CY 2008.
    To estimate CY 2008 pass-through spending for drugs and biologicals 
in the first group, specifically those drugs and biologicals initially 
eligible for pass-through status in CY 2006 or CY 2007 and proposed for 
continuation of pass-through payment in CY 2008, we are proposing to 
utilize the most recent Medicare physician's office data regarding 
their utilization, information provided in the pass-through 
applications, historical hospital claims data, pharmaceutical industry 
information, and clinical information regarding the products, in order 
to project the CY 2008 OPPS utilization of the products. For the 13 
known drugs

[[Page 42745]]

and biologicals that are proposed for continuation of pass-through 
payment in CY 2008, we then estimated the total pass-through payment 
amount as the difference between ASP+6 percent or the Part B drug CAP 
rate, as applicable, and ASP+5 percent, aggregated across the projected 
CY 2008 OPPS utilization of these products. Based on these estimates, 
we estimate pass-through spending attributable to the first group (that 
is, the drugs and biological continuing with pass-through eligibility 
in CY 2008) described above to be about $1.3 million for CY 2008. This 
$1.3 million estimate of CY 2008 pass-through spending for the first 
group of pass-through drugs reflects the 13 current pass-through drugs 
that are continuing on pass-through status into CY 2008, which are 
listed in Table 46B.

   Table 46B.--Proposed CY 2008 Pass-Through Drugs With Current Pass-
                 Through Status Continuing Into CY 2008
------------------------------------------------------------------------
                                                            CY 2007 and
       HCPCS code                Short descriptor           proposed CY
                                                             2008 APC
------------------------------------------------------------------------
C9232...................  Injection, idursulfase........            9232
C9233...................  Injection, ranibizumab........            9233
C9235...................  Injection, panitumumab........            9235
C9350...................  Porous collagen tube per cm...            9350
C9351...................  Acellular derm tissue per cm2.            9351
J0129...................  Injection, abatacept..........            9230
J0348...................  Anadulafungin injection.......            0760
J0894*..................  Injection, decitabine.........            9231
J1740...................  Injection ibandronate sodium..            9229
J2248...................  Injection, micafungin sodium..            9227
J3243...................  Injection, tigecycline........            9228
J3473...................  Hyaluronidase recombinant.....            0806
J9261...................  Nelarabine injection..........            0825
------------------------------------------------------------------------

    To estimate CY 2008 pass-through spending for drugs and biologicals 
in the second group (that is, drugs and biologicals that we know at the 
time of the development of this proposed rule would be newly eligible 
for pass-through payment in CY 2007 continuing into CY 2008 (of which 
there are none); additional drugs and biologicals that we estimate 
could be approved for pass-through status subsequent to the development 
of this proposed rule and before January 1, 2008; and projections for 
new drugs and biologicals that could be initially eligible for pass-
through payment in the second through fourth quarters of CY 2008), we 
are proposing to use the following approach. At this time, we 
anticipate that any new drugs and biologicals for January 1, 2008, 
would be determined after the publication of this proposed rule, but 
before publication of the CY 2008 final rule with comment period. We 
are proposing to use utilization estimates from applicants, 
pharmaceutical industry data, and clinical information to base pass 
through spending estimates for these drugs and biologicals for CY 2008. 
To account for the contingency of new drugs and biologicals that we 
project could become eligible for pass through status in the second, 
third, or fourth quarter of CY 2008, we are proposing to use the 
general methodology as described above, while also considering the most 
recent OPPS experience in approving new pass-through drugs and 
biologicals. Based on these estimates, we estimate pass-through 
spending attributable to this second group of drugs and biologicals to 
be about $0.6 million for CY 2008.
    Therefore, we are proposing that the estimate of pass through drug 
and biological spending in CY 2008 incorporate both CY 2008 estimates 
of pass-through spending for drugs and biologicals with pass-through 
status in CY 2007 that would continue for CY 2008 and estimates for 
those drugs and biologicals projected to be approved during subsequent 
quarters of CY 2007 and CY 2008. The total estimate of pass-through 
spending for drugs and biologicals under the CY 2008 OPPS is nearly $2 
million.
    In the CY 2005 OPPS final rule with comment period (69 FR 65810), 
we indicated that we are accepting pass-through applications for new 
radiopharmaceuticals that are assigned a HCPCS code on or after January 
1, 2005. (Prior to this date, radiopharmaceuticals were not included in 
the category of drugs paid under the OPPS, and, therefore, were not 
eligible for pass-through status.) There are no radiopharmaceuticals 
that were eligible for pass-through payment in CY 2005 or at the time 
of publication of this proposed rule in CY 2007. In addition, we have 
no information identifying new radiopharmaceuticals to which a HCPCS 
code might be assigned on or after January 1, 2008, for which pass 
through payment status would be sought. We also have no data regarding 
payment for new radiopharmaceuticals with pass-through status under the 
methodology that we specified in the CY 2005 OPPS final rule with 
comment period. However, we do not believe that pass through spending 
for new radiopharmaceuticals in CY 2008 will be significant enough to 
materially affect our estimate of total pass-through spending in CY 
2008. Therefore, we are not including radiopharmaceuticals in our 
proposed estimate of pass through spending for CY 2008. We discuss the 
methodology for determining the CY 2008 payment amount for new 
radiopharmaceuticals without pass through status in section V.B.3.b. of 
this proposed rule.
    In accordance with the methodology described above, we estimate 
that total pass-through spending for the 2 device categories and 13 
drugs and biologicals that are continuing for pass-through payment into 
CY 2008 and those that first become eligible for pass-through status 
subsequent to this proposed rule in CY 2007 or during CY 2008 would 
equal approximately $54 million, which represents 0.15 percent of total 
OPPS projected payments for CY 2008.
    Because we estimate that pass-through spending in CY 2008 would not 
amount to 2.0 percent of total projected OPPS CY 2008 spending, we are 
proposing to return 1.85 percent of the pass-through pool to adjust the 
conversion factor, as we discuss in section II.C. of this proposed 
rule.

[[Page 42746]]

VII. Proposed Payment for Brachytherapy Sources

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Brachytherapy'' at the beginning of your comment.)

A. Background

    Section 1833(t)(2)(H) of the Act, as added by section 621(b)(2)(C) 
of Pub. L. 108-173, mandated the creation of separate groups of covered 
OPD services that classify brachytherapy devices separately from other 
services or groups of services. The additional groups must reflect the 
number, isotope, and radioactive intensity of the devices of 
brachytherapy furnished, including separate groups for palladium-103 
and iodine-125 devices.
    Section 1833(t)(16)(C) of the Act, as added by section 621(b)(1) of 
Pub. L. 108-173, established payment for devices of brachytherapy 
consisting of a seed or seeds (or radioactive source) based on a 
hospital's charges for the service, adjusted to cost. The period of 
payment under this provision is for brachytherapy sources furnished 
from January 1, 2004, through December 31, 2006. Under section 
1833(t)(16)(C) of the Act, charges for the brachytherapy devices may 
not be used in determining any outlier payments under the OPPS for that 
period of payment. Consistent with our practice under the OPPS to 
exclude items paid at cost from budget neutrality consideration, these 
items were excluded from budget neutrality for that time period as 
well.
    In the OPPS interim final rule with comment period published on 
January 6, 2004 (69 FR 827), we implemented sections 621(b)(1) and 
(b)(2)(C) of Pub. L. 108-173. In that rule, we stated that we would pay 
for the brachytherapy sources (that is, brachytherapy devices) listed 
in Table 4 of the interim final rule with comment period (69 FR 828) on 
a cost basis, as required by the statute. Since January 1, 2004, we 
have used status indicator ``H'' to denote nonpass through 
brachytherapy sources paid on a cost basis, a policy that we finalized 
in the CY 2005 final rule with comment period (69 FR 65838).
    Furthermore, we adopted a standard policy for brachytherapy code 
descriptors, beginning January 1, 2005. We included ``per source'' in 
the HCPCS code descriptors for all those brachytherapy source 
descriptors for which units of payment were not already delineated.
    Section 621(b)(3) of Pub. L. 108-173 required the GAO to conduct a 
study to determine appropriate payment amounts for devices of 
brachytherapy, and to submit a report on its study to the Congress and 
the Secretary, including recommendations on the appropriate payments 
for such devices. This report was due to Congress and to the Secretary 
no later than January 1, 2005. The GAO's final report, ``Medicare 
Outpatient Payments: Rates for Certain Radioactive Sources Used in 
Brachytherapy Could Be Set Prospectively'' (GAO-06-635), was published 
on July 24, 2006. We summarized and discussed the report's findings and 
recommendations in the CY 2007 OPPS/ASC final rule with comment period 
(71 FR 68103 through 68105). The GAO report principally recommended 
that we use OPPS historical claims data to determine prospective 
payment rates for two of the most frequently used brachytherapy 
sources, iodine-125 and palladium-103, and also recommended that we 
consider using claims data for the third source studied, high dose rate 
(HDR) iridium-192.
    The GAO report concluded that CMS could set prospective payment 
rates based on claims data for iodine and palladium sources, because 
the sources' unit costs are generally stable, both sources have 
identifiable unit costs that do not vary substantially and 
unpredictably over time, and reasonably accurate claims data are 
available. On the other hand, the GAO report explained that it was not 
able to determine a suitable methodology for paying separately for HDR 
iridium. The report noted that iridium is reused across multiple 
patients, making its unit cost more difficult to determine. However, 
the report also indicated that CMS has outpatient claims data from all 
hospitals that have used iridium and that in order to identify a 
suitable methodology for separate payment, CMS would be able to use 
these data to establish an average cost and evaluate whether that cost 
varies substantially and unpredictably.
    In our CY 2007 annual OPPS rulemaking, we proposed and finalized a 
policy of prospective payment based on median costs for the 11 
brachytherapy sources for which we had claims data. We based the 
prospective rates on median costs for each source from our CY 2005 
claims data (71 FR 68102 through 71 FR 68114). We also indicated that 
we would assign future new HCPCS codes for new brachytherapy sources to 
their own APCs, with prospective payment rates set based on our 
consideration of external data and other relevant information regarding 
the expected costs of the sources to hospitals (71 FR 68112). We 
changed the definition of status indicator ``K'' to ensure that ``K'' 
appropriately describes brachytherapy sources to accommodate the use of 
``K'' for prospective payment for brachytherapy sources (71 FR 68110).
    Subsequent to publication of the CY 2007 OPPS/ASC final rule with 
comment period, section 107(a) of the MIEA-TRHCA amended section 
1833(t)(16)(C) of the Act by extending the payment period for 
brachytherapy sources based on a hospital's charges adjusted to cost 
for one additional year. This requirement for cost-based payment ends 
after December 31, 2007. Therefore, we have continued payment for 
sources based on charges reduced to cost through CY 2007. We also have 
continued using status indicator ``H'' to denote nonpass through 
brachytherapy sources paid on a cost basis as a result of enactment of 
this provision rather than using status indicator ``K'' to denote 
prospective payment for nonpass-through brachytherapy sources, as 
finalized in the CY 2007 OPPS/ASC final rule with comment period.
    Section 107(b)(1) of the MIEA-TRHCA amended section 1833(t)(2)(H) 
of the Act by adding a requirement for the establishment of separate 
payment groups for ``stranded and non-stranded'' brachytherapy devices 
beginning July 1, 2007. Section 107(b)(2) of the MIEA TRHCA authorized 
the Secretary to implement this new requirement by ``program 
instruction or otherwise.'' This new requirement is in addition to the 
requirement for separate payment groups based on the number, isotope, 
and radioactive intensity of brachytherapy devices previously 
established by section 1833(t)(2)(H) of the Act. We note that 
commenters on the CY 2007 proposed rule asserted that stranded sources, 
which they described as embedded into the stranded suture material and 
separated within the strand by material of an absorbable nature at 
specified intervals, had greater production costs than non-stranded 
sources (71 FR 68113 through 68114).
    As a result of the statutory requirement to create separate groups 
for stranded and non-stranded sources as of July 1, 2007, we 
established several coding changes via program transmittal, effective 
July 1, 2007 (Program Transmittal No. 1259, dated June 1, 2007). From 
comments to our CY 2007 proposed rule and industry input, we are 
currently aware of three sources that are currently available in 
stranded and non-stranded forms: iodine-125; palladium-103; and cesium-
131.
    Therefore, in Program Transmittal No. 1259, we created six new 
HCPCS codes to differentiate the stranded and non-stranded versions of 
these three sources.

[[Page 42747]]

These six new HCPCS codes replace the three prior brachytherapy source 
HCPCS codes for iodine, palladium and cesium (C1718, C1720, and C2633, 
all of which are deleted as of July 1, 2007), respectively, effective 
July 1, 2007. In this program transmittal, we also provided specific 
billing instructions to hospitals on how to report stranded sources. We 
instructed providers, when billing for stranded sources, to bill the 
number of units of the appropriate source HCPCS C-code according to the 
number of brachytherapy sources in the strands and specifically not to 
bill as one unit per strand. If a hospital applies both stranded and 
non-stranded sources to a patient in a single treatment, the hospital 
should bill the stranded and non-stranded sources separately, according 
to the differentiated HCPCS codes listed in the table found in that 
program transmittal and included in Table 48 below. We expect that 
these instructions will clearly indicate how hospitals are to bill for 
stranded and non-stranded brachytherapy sources, and that hospital 
reporting of sources according to these instructions will promote 
accurate claims data for the various source codes in the future. In 
Program Transmittal No. 1259, we also added the term ``non-stranded'' 
to the descriptors for all sources that currently have only non-
stranded versions of a source.
    In Program Transmittal No. 1259, we indicated that if we receive 
information that any of the other sources now designated as non-
stranded are marketed as a stranded source, we will create coding 
information for the stranded source. We also established two ``Not 
Otherwise Specified'' (NOS) codes for billing stranded and non-stranded 
sources that are not yet known to us and for which we do not have 
source-specific codes. If a hospital purchases an FDA-approved and 
marketed radioactive source consisting of a radioactive isotope 
(consistent with our definition of a brachytherapy source eligible for 
separate payment as discussed below), for which we do not yet have a 
separate source code established, it should bill such sources using the 
appropriate NOS code listed in Program Transmittal No. 1259, that is, 
C2698 (Brachytherapy source, stranded, not otherwise specified, per 
source) for stranded NOS sources, or C2699 (Brachytherapy source, non 
stranded, not otherwise specified, per source) for non-stranded NOS 
sources, which are also listed in Table 48 below. For example, if a new 
FDA-approved stranded source comes onto the market and there is 
currently only a billing code for the non stranded source, the hospital 
should bill the stranded source under C2698 (stranded NOS source) until 
a specific stranded billing code for the source is established.
    In Program Transmittal No. 1259, we reiterated our longstanding 
policy that hospitals and other parties are invited to submit 
recommendations to us for new HCPCS codes to describe new sources 
consisting of a radioactive isotope, including a detailed rationale to 
support recommended new sources. We will continue to endeavor to add 
new brachytherapy source codes and descriptors to our systems for 
payment on a quarterly basis. Such recommendations should be directed 
to the Division of Outpatient care, Mail Stop C4-05-17, Centers for 
Medicare and Medicaid Services, 7500 Security Boulevard, Baltimore, MD 
21244.
    Finally, we note that in the CY 2007 OPPS/ASC final rule with 
comment period, we established a definition for brachytherapy source 
for which separate payment under section 1833(t)(2)(H) of the Act is 
required (71 FR 68113). We considered the definition of ``brachytherapy 
source'' in the context of current medical practice and in regard to 
the language in section 1833(t)(2)(H) of the Act, which refers to 
brachytherapy sources as ``a seed or seeds (or radioactive source).'' 
We believed that this provision of the Act mandating separate payment 
refers to sources that are themselves radioactive, meaning that the 
source contains a radioactive isotope. Furthermore, we indicated that 
the statutory language is likewise clear that devices of brachytherapy 
paid separately must reflect the number, isotope, and radioactive 
intensity of such devices furnished. Accordingly, we further believed 
that section 1833(t)(2)(H) of the Act applies only to radioactive 
devices of brachytherapy. In the CY 2007 OPPS/ASC final rule with 
comment period, we also stated that we would not consider specific 
devices, beams of radiation, or equipment that do not constitute 
separate sources that utilize radioactive isotopes to deliver radiation 
to be brachytherapy sources for separate payment, as such items do not 
meet the statutory requirements provided in section 1833(t)(2)(H) of 
the Act (71 FR 68113).

B. Proposed Payments for Brachytherapy Sources

    As indicated above, the provision to pay for brachytherapy sources 
at charges reduced to cost expires after December 31, 2007, in 
accordance with section 1833(t) (16)(C) of the Act, as amended by 
section 107(a) of the MIEA-TRHCA. However, under section 1833(t)(2)(H) 
of the Act, we are still required to create APC groupings that classify 
devices of brachytherapy separately from other services or groups of 
services in a manner reflecting the number, isotope, and radioactive 
intensity of the devices of brachytherapy furnished. In addition, 
section 1833(t)(2)(H) of the Act, as amended by section 107(b)(1) of 
the MIEA-TRHCA, requires separate payment groups based on stranded and 
non-stranded brachytherapy devices on or after July 1, 2007.
    We are proposing to pay separately for each of the sources listed 
in Table 48 below on a prospective basis for CY 2008, with payment 
rates to be determined using the CY 2006 claims-based median cost per 
source for each brachytherapy device. Consistent with our policy 
regarding APC payments made on a prospective basis, we are proposing 
that the cost of brachytherapy sources be subject to the outlier 
provision of section 1833(t)(5) of the Act. As indicated in section 
II.A.2. of this proposed rule, for CY 2008 we are proposing specific 
prospective payment rates for brachytherapy sources, which will be 
subject to scaling for budget neutrality.
    We believe that adopting prospective payment for brachytherapy 
sources is appropriate for a number of reasons. The general OPPS 
payment methodology is a prospective payment system using median costs 
based on claims data. This prospective payment methodology results in 
more consistent, predictable and equitable payment amounts per source 
across hospitals, and it prevents some of the extremely high and low 
payment amounts found under a charges reduced to cost methodology. The 
proposed prospective payment would also provide hospitals with 
incentives for efficiency in the provision of brachytherapy services to 
Medicare beneficiaries. Moreover, the proposed approach is consistent 
with our payment methodology for the vast majority of items and 
services paid under the OPPS. Indeed, section 1833(t)(2)(C) of the Act 
requires us to establish prospective payment rates for the OPPS system 
based on median costs (or mean costs if elected by the Secretary). As 
of CY 2007, only pass-through devices, radiopharmaceuticals, and 
brachytherapy sources were paid at charges reduced to cost. Based on 
the proposals in this CY 2008 proposed rule, only pass-through devices 
would continue to be paid at charges reduced to cost for CY 2008. We 
note that section 107(a) of the MIEA-TRHCA specifically extended the 
payment period for brachytherapy sources based on a

[[Page 42748]]

hospital's charges adjusted to cost for only one additional year, CY 
2007.
    Analysis of the CY 2006 claims data suggests that the estimated 
median cost under the proposed prospective payment approach is higher 
than the estimated median payment amount under a charges reduced to 
cost methodology for most brachytherapy sources. We note that estimated 
median cost under the proposed approach is calculated based on the 
relevant department CCR whereas payments under a charge reduced to cost 
methodology are calculated based on each hospital's overall CCR. As 
shown in Table 47, for 9 of the 11 brachytherapy HCPCS codes that were 
in existence in CY 2006 and had claims data, the estimated median cost 
based on the departmental CCR is higher than the median estimated 
payment under the charges reduced to cost methodology.

Table 47.--Comparison of CY 2006 Estimated Median Payments under Charges
               Reduced to Costs and Estimated Median Costs
------------------------------------------------------------------------
                                       CY 2006 median
                                          estimated      CY 2006 median
  CY 2006 HCPCS      CY 2006 short     payment charges   cost (based on
      code            descriptor       reduced to cost    departmental
                                          (based on           CCR)
                                        overall CCR)
------------------------------------------------------------------------
C1716...........  Brachytx source,              $29.30            $31.56
                   Gold 198.
C1717...........  Brachytx source,              143.20            171.26
                   HDR Ir-192.
C1718...........  Brachytx source,               31.41             37.71
                   Iodine 125.
C1719...........  Brachytx                       18.75             56.69
                   source,Non-HDR Ir-
                   192.
C1720...........  Brachytx source,               46.90             55.05
                   Palladium 103.
C2616...........  Brachytx source,           10,811.30         11,796.07
                   Yttrium-90.
C2632...........  Brachytx sol, I-               21.80             28.27
                   125, per mCi.
C2633...........  Brachytx source,               63.67             63.61
                   Cesium-131.
C2634...........  Brachytx source,               26.03             29.56
                   HA, I-125.
C2635...........  Brachytx source,               40.85             46.48
                   HA, P-103.
C2636...........  Brachytx linear                56.39            36.64
                   source, P-103.
------------------------------------------------------------------------
Note: The short descriptions for some of the HCPCS codes in this table
  were revised after CY 2006. See Table 48 for the current long
  descriptions.

    With the proposed adoption of prospective payment for brachytherapy 
sources, there would be opportunities for hospitals to receive 
additional payments under certain circumstances through the outlier 
provisions and the 7.1 percent rural adjustment. As noted previously, 
consistent with our policy regarding APC payments made on a prospective 
basis, we are proposing that the cost of brachytherapy sources be 
subject to the outlier provision of section 1833(t)(5) of the Act. 
Therefore, the source could receive an outlier payment, if the costs of 
furnishing brachytherapy sources exceed the outlier threshold. Also, as 
noted in section II.F. of this proposed rule, as a result of our CY 
2008 proposal to pay prospectively for brachytherapy sources, we also 
are proposing to include brachytherapy payments in the group of 
services eligible for the 7.1 percent payment increase for rural SCHs, 
including EACHs.
    We are proposing a payment methodology for separately paid 
brachytherapy sources for CY 2008 based upon their median unit costs 
calculated using CY 2006 claims data. Because we are required to create 
separate APC groups for stranded and non stranded sources and because 
our CY 2006 billing codes do not differentiate stranded and non-
stranded sources, we are proposing to make certain assumptions when we 
estimate the median costs for stranded and non-stranded (low activity) 
iodine-125, palladium-103, and cesium-131 based on our CY 2006 
aggregate claims data. As stated above, commenters to our CY 2007 
proposed rule stated that the cost of stranded iodine, palladium and 
cesium sources are higher than non-stranded versions of these sources 
but provided no data. Given the reported cost differences between 
stranded and non-stranded sources and the statutory requirement that we 
establish separate payment groups for stranded and non-stranded 
sources, we believe it is appropriate to establish different stranded 
and non-stranded payment rates for iodine-125, palladium-103, and 
cesium-131 sources. However, in order to establish separate stranded 
and non-stranded payment rates for these three sources, we are 
proposing to make the following assumptions in our calculation of their 
median costs. Assuming that the reportedly lower cost non-stranded 
sources would be unlikely to be in the top 20 percent of the cost 
distribution in our aggregate (stranded and non-stranded) CY 2006 
claims data, we are proposing to calculate the median cost for these 3 
non-stranded sources based on the bottom 80 percent of the cost 
distribution in our aggregate claims data for each source. Likewise, 
assuming that the reportedly higher cost stranded sources would be 
unlikely to be in the bottom 20 percent of the cost distribution in our 
aggregate CY 2006 claims data, we are proposing to calculate the median 
cost for these 3 stranded sources based on the top 80 percent of the 
cost distribution for our aggregate data. This approach to calculating 
median costs for stranded and non-stranded iodine-125, palladium-103, 
and cesium-131 sources results in proposed Medicare payment rates based 
on the 60th percentile of our aggregate data for stranded sources and 
the 40th percentile of our aggregate data for non-stranded sources, 
which, after examining the range of our cost data for these sources, 
appear to provide a reasonable cost differential between stranded and 
non-stranded sources, until we have claims data reported separately for 
stranded and non-stranded sources.
    We are proposing this approach for stranded and non-stranded 
iodine-125, palladium-103, and cesium-131 sources as a transitional 
measure, until we have sufficient claims data for separately coded 
stranded and non-stranded sources upon which to calculate the median 
costs for these sources specifically. (The first partial year claims 
data for separately coded stranded and non-stranded sources will be 
available in CY 2007 claims data for ratesetting in CY 2009.) This 
methodology has the benefits of a prospective payment methodology 
discussed above and complies with the

[[Page 42749]]

requirements of the MIEA-TRHCA to recognize separate payment for 
stranded and non-stranded sources.
    Furthermore, we are proposing to pay the two NOS codes, C2698 and 
C2699, based on a rate equal to the lowest stranded or non-stranded 
prospective payment rate for such sources, respectively, paid on a per 
source basis (as opposed, for example, to per mci). This payment 
methodology for NOS sources provides payment to a hospital for new 
sources, while encouraging interested parties to quickly bring new 
sources to our attention, so specific coding and payment can be 
established. As noted earlier, we may establish new brachytherapy 
source codes on a quarterly basis.
    Because brachytherapy sources will no longer be paid on the basis 
of their charges reduced to cost after December 31, 2007, we are 
proposing to discontinue our use of payment status indicator ``H'' for 
APCs assigned to brachytherapy sources. For CY 2008, we are proposing 
to use status indicator ``K'' for all brachytherapy source APCs. As 
indicated earlier, the definition of status indicator ``K'' was changed 
for CY 2007 to accommodate prospective payment for brachytherapy 
sources.
    For CY 2008, we also are proposing to implement the policy we 
established in the CY 2007 OPPS/ASC final rule with comment period 
(which was superseded by section 107 of the MIEA-TRHCA) regarding 
payment for new brachytherapy sources for which we have no claims data. 
As discussed above, we are proposing to assign future new HCPCS codes 
for new brachytherapy sources to their own APCs, with prospective 
payment rates set based on our consideration of external data and other 
relevant information regarding the expected costs of the sources to 
hospitals. Because we are proposing to pay prospectively for 
brachytherapy sources beginning in CY 2008, we are proposing to 
implement this policy beginning in CY 2008.
    There is currently one brachytherapy source, Ytterbium-169 (HCPCS 
C2637, Brachytherapy Source, Ytterbium-169, per source), which has its 
own HCPCS code, but for which we believe we lack claims data on its 
costs. In the CY 2007 OPPS/ASC proposed rule (71 FR 49598 through 
49599), we indicated that it was our understanding that Ytterbium-169 
had not yet been marketed, and furthermore that we had no CY 2005 
claims data, external data, or other information on its pricing on 
which to base its payment rate for CY 2007. In response to the CY 2007 
proposed rule, we received no cost data or other information that we 
could use to establish an informed prospective payment rate for 
Ytterbium-169. Therefore, in the CY 2007 OPPS/ASC final rule with 
comment period (71 FR 68112), we finalized a policy of assigning HCPCS 
code C2637, Ytterbium-169, with the nonpayable status indicator ''B'' 
and indicated that if we later receive relevant information, we could 
establish a payable status indicator and appropriate payment rate for 
the Ytterbium source in a future OPPS quarterly update. This policy was 
superceded by section 107(a) of the MIEA-TRHCA, which required payment 
for brachytherapy sources in CY 2007 based on charges reduced to costs. 
For this CY 2008 proposed rule, we believe that we continue to lack 
claims data or other information on the costs of Ytterbium-169 on which 
to base an informed prospective payment rate. Our CY 2006 claims data 
show three claims for HCPCS code C2637, Ytterbium-169, with a median 
cost of $718.08. We believe these three claims may be incorrectly coded 
claims that do not represent claims for Ytterbium-169, as the 
manufacturer of Ytterbium-commented on the CY 2007 OPPS proposed rule 
that Ytterbium-169 would first become available for market in 2007. 
Consequently, at this time, we are proposing to not recognize HCPCS 
code C2637, and again we are assigning it to status indicator ``B'' 
under the OPPS for CY 2008. However, if in public comments to this 
proposed rule or later in CY 2007 or CY 2008, we receive relevant and 
reliable information on the hospital cost for Ytterbium-169 and 
information that this source is being marketed, we would propose to 
establish a prospective payment rate for Ytterbium-169 in the CY 2008 
final rule or in a quarterly OPPS update, respectively.
    Table 48 includes a complete listing of the HCPCS codes, long 
descriptors, and APC assignments that we currently use for 
brachytherapy sources paid under the OPPS as of July 1, 2007, and the 
status indicators, estimated median costs, and payment rates that we 
are proposing for CY 2008. We note that some of the HCPCS codes for 
which we are proposing payment rates for CY 2008 are not shown in 
Addendum B of this proposed rule because that addendum is based on 
HCPCS codes effective as of April 2007. As indicated earlier, there are 
some brachytherapy source HCPCS codes that were added as of July 1, 
2007. While these HCPCS codes are not shown in Addendum B, the proposed 
payment rates for all brachytherapy sources are shown in Table 48.
    While we are inviting public comment on all aspects of this CY 2008 
proposal, we particularly encourage comment on our proposed median 
costs estimates for stranded and non-stranded iodine-125, palladium-
103, and cesium-131, including the submission of any available 
information or data on cost differences between stranded and non 
stranded sources. We also are interested in receiving information 
regarding the historical and current relative market share for stranded 
versus non-stranded sources, particularly as used in the care of 
Medicare beneficiaries and with respect to brachytherapy treatments for 
different clinical conditions.

                    Table 48.--Proposed Separately Payable Brachytherapy Sources for CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                                 Proposed CY
                                                                    Proposed CY      2008      Proposed CY 2008
      HCPCS code               Long descriptor             APC      2008 median    payment     status indicator
                                                                        cost         rate
----------------------------------------------------------------------------------------------------------------
A9527.................  Iodine I-125, sodium iodide           2632       $28.27       $28.62  K
                         solution, therapeutic, per
                         millicurie.
C1716.................  Brachytherapy source, non-            1716        31.56        31.95  K
                         stranded, Gold-198, per
                         source.
C1717.................  Brachytherapy source, non-            1717       171.26       173.40  K
                         stranded, High Dose Rate
                         Iridium-192, per source.
C1719.................  Brachytherapy source, non-            1719        56.69        57.40  K
                         stranded, Non-High Dose Rate
                         Iridium-192, per source.
C2616.................  Brachytherapy source, non-            2616    11,796.07    11,943.79  K
                         stranded, Yttrium-90, per
                         source.
C2634.................  Brachytherapy source, non-            2634        29.56        29.93  K
                         stranded, High Activity,
                         Iodine-125, greater than
                         1.01 mCi (NIST), per source.

[[Page 42750]]

 
C2635.................  Brachytherapy source, non-            2635        46.48        47.06  K
                         stranded, High Activity,
                         Palladium-103, greater than
                         2.2 mCi (NIST), per source.
C2636.................  Brachytherapy linear source,          2636        36.64        37.09  K
                         non-stranded, Palladium-103,
                         per 1MM.
C2637.................  Brachytherapy source, non-            2637          N/A          N/A  B
                         stranded, Ytterbium-169, per
                         source.
C2638.................  Brachytherapy source,                 2638       *42.33        42.86  K
                         stranded, Iodine-125, per
                         source.
C2639.................  Brachytherapy source, non-            2639      **31.51        31.91  K
                         stranded, Iodine-125, per
                         source.
C2640.................  Brachytherapy source,                 2640       *61.47        62.24  K
                         stranded, Palladium-103, per
                         source.
C2641.................  Brachytherapy source, non-            2641      **44.73        45.29  K
                         stranded, Palladium-103, per
                         source.
C2642.................  Brachytherapy source,                 2642       *96.52        97.72  K
                         stranded, Cesium-131, per
                         source.
C2643.................  Brachytherapy source, non-            2643      **50.72        51.35  K
                         stranded, Cesium-131, per
                         source.
C2698.................  Brachytherapy source,                 2698        42.33        42.86  K
                         stranded, not otherwise
                         specified, per source.
C2699.................  Brachytherapy source, non-            2699        29.56        29.93  K
                         stranded, not otherwise
                         specified, per source.
----------------------------------------------------------------------------------------------------------------
* Estimated median cost for stranded version is based on the 60th percentile of the aggregate (stranded and non
  stranded) claims data for this source.
** Estimated median cost for non-stranded version is based on the 40th percentile of the aggregate (stranded and
  non stranded) claims data for this source.

VIII. Proposed OPPS Drug Administration Coding and Payment

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Drug Administration'' at the beginning of your 
comment.)

A. Background

    In CY 2005, in response to the recommendations made by commenters 
and the hospital industry, OPPS transitioned to the use of CPT codes 
for drug administration services. (For information on coding for drug 
administration services prior to CY 2005, see 71 FR 68115.) These CPT 
codes allowed for more specific reporting of services, especially 
regarding the number of hours for an infusion, and provided consistency 
in coding between Medicare and other payers. However, at that time, we 
did not have any data to revise the CY 2005 per-visit APC payment 
structure for infusion services. In order to collect data for future 
ratesetting purposes, we implemented claims processing logic that 
collapsed payments for drug administration services and paid a single 
APC amount for those services for each visit, unless a modifier was 
used to identify drug administration services provided in a separate 
encounter on the same day. Hospitals were instructed to bill all 
applicable CPT codes for drug administration services provided in a 
HOPD, without regard to whether or not the CPT code would receive a 
separate APC payment during OPPS claims processing.
    While hospitals just began adopting CPT codes for outpatient drug 
administration services in CY 2005, physicians paid under the MPFS were 
using HCPCS G-codes in CY 2005 to report office-based drug 
administration services. These G-codes were developed in anticipation 
of substantial revisions to the drug administration CPT codes by the 
CPT Editorial Panel that were expected for CY 2006.
    In CY 2006, as anticipated, the CPT Editorial Panel revised its 
coding structure for drug administration services, incorporating new 
concepts such as initial, sequential, and concurrent services into a 
structure that previously distinguished services based on type of 
administration (chemotherapy/nonchemotherapy), method of administration 
(injection/infusion/push), and for infusion services, first hour and 
additional hours. For CY 2006, we implemented 20 of the 33 CY 2006 drug 
administration CPT codes that did not reflect the concepts of initial, 
sequential, and concurrent services, and we created 6 new HCPCS C-codes 
that generally paralleled the CY 2005 CPT codes for the same services. 
We chose not to implement the full set of CY 2006 CPT codes because of 
our concerns regarding the interface between the complex claims 
processing logic required for correct payments and hospitals' 
challenges in correctly coding their claims to receive accurate 
payments for these services.
    For CY 2007, as a result of comments to our proposed rule and 
feedback from the hospital community and the APC Panel, we implemented 
the full set of CPT codes, including the concepts of initial, 
sequential and concurrent. In addition, the CY 2007 update process 
offered us the first opportunity to consider data gathered from the use 
of CY 2005 CPT codes for purposes of ratesetting. For CY 2007, we used 
CY 2005 claims data to implement a six-level APC structure for drug 
administration services. We assigned all CY 2007 HCPCS codes for drug 
administration services to six new drug administration APCs (as listed 
in Table 34 of the CY 2007 OPPS/ASC final rule with comment period), 
with payment rates based on median costs for the APCs as calculated 
from CY 2005 claims data. In that final rule, we provided a crosswalk 
that illustrated how we performed our annual payment rate update 
methodology for these services using CY 2005 data.
    As indicated in the CY 2007 OPPS/ASC final rule with comment period 
(71 FR 68122), because the newly recognized CPT codes discriminate 
among services more specifically than the CY 2006 C-codes, as was the 
case when the OPPS transitioned from more general Q-codes to more 
specific CPT codes for the reporting of drug administration services in 
CY 2005, for a period of 2 years drug administration services will be 
paid based on the costs of their predecessor HCPCS codes until updated 
data are available for review.

B. Proposed Coding and Payment for Drug Administration Services

    During the March 2007 APC Panel meeting, the APC Panel recommended 
that CMS pay separately for CPT code 90768 (Intravenous infusion, for 
therapy, prophylaxis, or diagnosis (specify substance or drug); 
concurrent infusion (list separately in addition to code for primary 
procedure)) at the same rate as CPT code 90767 (Intravenous infusion, 
for therapy, prophylaxis, or diagnosis (specify substance or drug); 
additional sequential infusion, up to 1 hour (list

[[Page 42751]]

separately in addition to code for primary procedure)).
    As discussed in section II.A.4. of this proposed rule, in deciding 
whether to package a service or pay for it separately, we consider a 
variety of factors, including whether the service is normally provided 
separately or in conjunction with other services; how likely it is for 
the costs of the packaged code to be appropriately mapped to the 
separately payable codes with which it was performed; and whether the 
expected cost of the service is relatively low. As we discussed in the 
CY 2007 OPPS/ASC final rule with comment period (71 FR 68122), CPT code 
90768 was first introduced in CY 2007 and consistent with our 
established ratesetting methodology, we do not anticipate OPPS hospital 
claims data from CY 2007 to be available for ratesetting purposes until 
CY 2009. In addition, as the services identified with CPT code 90768 
were provided in previous years, it is our determination that these 
costs are already represented in our currently available hospital 
claims data. Payment for these services was provided in previous years 
through the billing of more general drug administration codes. Although 
more exhaustive codes for drug administration services are now 
available, this does not indicate that these services did not receive 
OPPS payments in previous years.
    As data are not available for drug administration services for 
purposes of CY 2008 ratesetting, and as we believe that the costs for 
the drug administration services identified by CPT code 90768 are 
included in our hospital claims data used for ratesetting purposes, we 
are not accepting the APC Panel's recommendation to provide a separate 
APC payment for this service. Furthermore, we note that in section 
II.A.4. of this proposed rule, we have proposed to expand packaging of 
certain (nondrug administration) services. We believe that continuing 
to package CPT code 90786 is consistent with these broader efforts.
    For CY 2008, we examined CY 2006 claims data available for this 
proposed rule and continue to believe the CY 2007 drug administration 
APC configuration reflects clinically and resource homogeneous 
groupings of procedures. We note that there is a violation of the 2 
times rule in APC 0438 (Level III Drug Administration) as proposed for 
CY 2008. The violation is related to the comparatively low median cost 
of CPT code 90773 (Therapeutic, prophylactic or diagnostic injection 
(specify substance or drug); intra-arterial) for which we have a 
significantly greater number of CY 2006 single claims available for 
ratesetting than previous years. The CY 2005 predecessor code for this 
service, CPT code 90783 (Therapeutic, prophylactic or diagnostic 
injection (specify material injected); intra-arterial), had a higher 
median cost that was more similar to the costs of other services also 
assigned to APC 0438. We continue to believe that this intra-arterial 
injection procedure is similar from both clinical and hospital resource 
perspectives to the related intravenous push injection procedures that 
are assigned to the same clinical APC and, therefore, we are proposing 
to except APC 0438 from the 2 times rule for CY 2008. We continue to 
ask hospitals to report all CPT drug administration codes, and we 
expect hospitals to report CPT codes consistently with CPT coding 
guidelines and applicable instructions.
    We note that in this section of the CY 2007 proposed rule we 
discussed IVIG preadministration-related services; for CY 2008, this 
topic is discussed in section III.C.2.b. of this proposed rule.

IX. Proposed Hospital Coding and Payments for Visits

A. Background

    Currently, CMS instructs hospitals to use the CY 2007 CPT codes, as 
well as six HCPCS codes that became effective January 1, 2007, to 
report clinic and emergency department visits and critical care 
services on claims paid under the OPPS. The codes are listed below in 
Table 49.

   Table 49.--CY 2007 CPT Evaluation and Management (E/M) and Level II
  HCPCS Codes Used To Report Clinic and Emergency Department Visits and
                         Critical Care Services
------------------------------------------------------------------------
      HCPCS code                           Descriptor
------------------------------------------------------------------------
                        Clinic Visit HCPCS Codes
------------------------------------------------------------------------
99201.................  Office or other outpatient visit for the
                         evaluation and management of a new patient
                         (Level 1).
99202.................  Office or other outpatient visit for the
                         evaluation and management of a new patient
                         (Level 2).
99203.................  Office or other outpatient visit for the
                         evaluation and management of a new patient
                         (Level 3).
99204.................  Office or other outpatient visit for the
                         evaluation and management of a new patient
                         (Level 4).
99205.................  Office or other outpatient visit for the
                         evaluation and management of a new patient
                         (Level 5).
99211.................  Office or other outpatient visit for the
                         evaluation and management of an established
                         patient (Level 1).
99212.................  Office or other outpatient visit for the
                         evaluation and management of an established
                         patient (Level 2).
99213.................  Office or other outpatient visit for the
                         evaluation and management of an established
                         patient (Level 3).
99214.................  Office or other outpatient visit for the
                         evaluation and management of an established
                         patient (Level 4).
99215.................  Office or other outpatient visit for the
                         evaluation and management of an established
                         patient (Level 5).
99241.................  Office consultation for a new or established
                         patient (Level 1).
99242.................  Office consultation for a new or established
                         patient (Level 2).
99243.................  Office consultation for a new or established
                         patient (Level 3).
99244.................  Office consultation for a new or established
                         patient (Level 4).
99245.................  Office consultation for a new or established
                         patient (Level 5).
------------------------------------------------------------------------
                 Emergency Department Visit HCPCS Codes
------------------------------------------------------------------------
99281.................  Emergency department visit for the evaluation
                         and management of a patient (Level 1).
99282.................  Emergency department visit for the evaluation
                         and management of a patient (Level 2).
99283.................  Emergency department visit for the evaluation
                         and management of a patient (Level 3).
99284.................  Emergency department visit for the evaluation
                         and management of a patient (Level 4).
99285.................  Emergency department visit for the evaluation
                         and management of a patient (Level 5).
G0380.................  Type B emergency department visit (Level 1).
G0381.................  Type B emergency department visit (Level 2).
G0382.................  Type B emergency department visit (Level 3).

[[Page 42752]]

 
G0383.................  Type B emergency department visit (Level 4).
G0384.................  Type B emergency department visit (Level 5).
------------------------------------------------------------------------
                   Critical Care Services HCPCS Codes
------------------------------------------------------------------------
99291.................  Critical care, evaluation and management of the
                         critically ill or critically injured patient;
                         first 30-74 minutes.
99292.................  Each additional 30 minutes.
G0390.................  Trauma response associated with hospital
                         critical care services.
------------------------------------------------------------------------

    Presently, there are three types of visit codes to describe three 
types of services: Clinic visits, emergency department visits, and 
critical care services. CPT indicates that office or other outpatient 
visit codes are used to report E/M services provided in the physician's 
office or in an outpatient or other ambulatory facility. For OPPS 
purposes, we refer to these as clinic visit codes. CPT also indicates 
that emergency department visit codes are used to report E/M services 
provided in the emergency department, defined as an ``organized 
hospital-based facility for the provision of unscheduled episodic 
services to patients who present for immediate medical attention. The 
facility must be available 24 hours a day.'' For OPPS purposes, we 
refer to these as emergency department visit codes that specifically 
apply to the reporting of visits to Type A emergency departments on or 
after January 1, 2007, as discussed in further detail later in this 
section. We established five new Level II HCPCS codes to report visits 
to Type B emergency departments beginning in CY 2007 because there are 
currently no CPT codes that fully describe services provided in this 
type of facility. CPT defines critical care services as the ``direct 
delivery by a physician(s) of medical care for a critically ill or 
critically injured patient.'' It also states that ``critical care is 
usually, but not always, given in a critical care area, such as * * * 
the emergency care facility.'' In addition to reporting critical care 
services, hospitals may utilize the new HCPCS code G0390 for the 
reporting of a trauma response in association with critical care 
services for the CY 2007 OPPS.
    The majority of CPT code descriptors are applicable to both 
physician and facility resources associated with specific services. 
However, we have acknowledged from the beginning of the OPPS that we 
believe that CPT E/M codes were defined to reflect the activities of 
physicians and do not necessarily describe well the range and mix of 
services provided by hospitals during visits of clinic and emergency 
department patients and critical care encounters. In the April 7, 2000 
OPPS final rule with comment period (65 FR 18434), we instructed 
hospitals to report facility resources for clinic and emergency 
department visits using CPT E/M codes and to develop internal hospital 
guidelines to determine what level of visit to report for each patient. 
While awaiting the development of a national set of facility-specific 
codes and guidelines, we have advised hospitals that each hospital's 
internal guidelines should follow the intent of the CPT code 
descriptors, in that the guidelines should be designed to reasonably 
relate the intensity of hospital resources to the different levels of 
effort represented by the codes.
    Critical care services are considered to be outpatient visits, and 
our current payment policy for trauma activation ties separate payment 
to the reporting of hospital critical care services. We are not 
proposing to change our OPPS payment policy for critical care services 
for CY 2008, and our CY 2008 proposal for payment of trauma activation 
is described in section II.A.4. of this proposed rule. Therefore, we 
will no longer include references to critical care services in the 
sections below that describe hospital outpatient visits.

B. Proposed Policies for Hospital Outpatient Visits

1. Clinic Visits: New and Established Patient Visits and Consultations
    As discussed earlier, the majority of all CPT code descriptors are 
applicable to both physician and facility resources associated with 
specific services. However, we believe that CPT E/M codes were defined 
to reflect the activities of physicians and do not describe well the 
range and mix of services provided by hospitals during visits of clinic 
and emergency department patients. While awaiting the development of a 
national set of guidelines, we have advised hospitals that each 
hospital's internal guidelines should follow the intent of the CPT code 
descriptors, in that the guidelines should be designed to reasonably 
relate the intensity of hospital resources to the different levels of 
effort represented by the codes. In the CY 2007 OPPS/ASC proposed rule 
(71 FR 49607), we proposed to establish five new codes to replace 
hospitals' reporting of the CPT clinic visit E/M codes for new and 
established patients listed in Table 49 above. In the CY 2007 OPPS/ASC 
final rule with comment period (71 FR 68127 through 68128), we 
specified that we would not create new codes to replace existing CPT E/
M codes for reporting hospital visits until national guidelines are 
developed, in response to commenters who were concerned about 
implementing hospital-specific Level II HCPCS codes without national 
guidelines. We also discussed our intention to reconsider whether G-
codes would be appropriate for the OPPS once national guidelines are 
established.
    In that same rule (71 FR 68138), we finalized our proposal to pay 
clinic visits at five payment rates, rather than three payment rates. 
Prior to CY 2007, under the OPPS, outpatient visits provided by 
hospitals were paid at three payment levels for clinic visits, even 
though hospitals reported five resource-based coding levels of clinic 
visits using CPT E/M codes. Because the three payment rates for clinic 
visits were based on five levels of CPT codes, in general the two 
lowest levels of CPT codes (Levels 1 and 2) were assigned to the low 
level visit APC and the two highest levels of CPT codes (Levels 4 and 
5) were assigned to the high level visit APC, while the single middle 
level CPT code (Level 3) was assigned to the mid-level visit APC. 
Historical hospital claims data have generally reflected significantly 
different median costs for the two levels of services assigned to the 
low and high level visit APCs. We noted that payment at only three 
levels may not be the most accurate method of payment for those very 
common

[[Page 42753]]

hospital levels of visits that clearly demonstrated differential 
hospital resources. Consequently, for the CY 2007 OPPS, we mapped the 
data from the CY 2005 CPT E/M codes and other HCPCS codes assigned 
previously to the three clinic visit APCs to five new clinic visit APCs 
to develop median costs for these APCs. We mapped the CPT E/M codes and 
other HCPCS codes to the clinic visit APCs based on their median costs 
and clinical homogeneity considerations. Table 50, which includes the 
median costs based on CY 2006 claims data processed through December 
31, 2006, displays the HCPCS code and APC median costs at the five 
payment levels that we are proposing for the CY 2008 OPPS.

  Table 50.--Proposed Assignment of Claims Data From CY 2006 CPT E/M and Level II HCPCS Codes To Visit APCs for
                                                     CY 2008
----------------------------------------------------------------------------------------------------------------
                                                  Proposed CY     APC service
        CY 2008 APC title          CY 2008 APC     2008 APC        frequency     HCPCS code    Short descriptor
                                                    median         (million)
----------------------------------------------------------------------------------------------------------------
Level 1 Hospital Clinic Visits...         0604          $52.72            3.8         92012  Eye exam
                                                                                              established pat.
                                                                                      99201  Office/outpatient
                                                                                              visit, new (Level
                                                                                              1).
                                                                                      99211  Office/outpatient
                                                                                              visit, est (Level
                                                                                              1).
                                                                                      99241  Office consultation
                                                                                              (Level 1).
                                                                                      G0101  CA screen; pelvic/
                                                                                              breast exam.
                                                                                      G0245  Initial foot exam
                                                                                              pt lops.
                                                                                      G0379  Direct admit
                                                                                              hospital observ.
Level 2 Hospital Clinic Visits...         0605          $63.01            7.3         90862  Medication
                                                                                              management.
                                                                                      92002  Eye exam, new
                                                                                              patient.
                                                                                      92014  Eye exam and
                                                                                              treatment.
                                                                                      99202  Office/outpatient
                                                                                              visit, new (Level
                                                                                              2).
                                                                                      99212  Office/outpatient
                                                                                              visit, est (Level
                                                                                              2).
                                                                                      99213  Office/outpatient
                                                                                              visit, est (Level
                                                                                              3).
                                                                                      99242  Office Consultation
                                                                                              (Level 2).
                                                                                      99243  Office Consultation
                                                                                              (Level 3).
                                                                                      99431  Initial care,
                                                                                              normal newborn.
                                                                                      G0246  Followup eval of
                                                                                              foot pt lop.
                                                                                      G0344  Initial preventive
                                                                                              exam.
                                                                                      M0064  Visit for drug
                                                                                              monitoring.
Level 3 Hospital Clinic Visits...         0606          $85.96            2.9         92004  Eye exam, new
                                                                                              patient.
                                                                                      99203  Office/outpatient
                                                                                              visit, new (Level
                                                                                              3).
                                                                                      99214  Office/outpatient
                                                                                              visit, est (Level
                                                                                              4).
                                                                                      99244  Office consultation
                                                                                              (Level 4).
Level 4 Hospital Clinic Visits...         0607         $108.08             .8         99204  Office/outpatient
                                                                                              visit, new (Level
                                                                                              4).
                                                                                      99215  Office/outpatient
                                                                                              visit, est (Level
                                                                                              5).
                                                                                      99245  Office consultation
                                                                                              (Level 5).
Level 5 Hospital Clinic Visits...         0608         $138.88             .08        99205  Office/outpatient
                                                                                              visit, new (Level
                                                                                              5).
                                                                                      G0175  OPPS service, sched
                                                                                              team conf.
----------------------------------------------------------------------------------------------------------------
 

    In the CY 2007 OPPS/ASC proposed rule (71 FR 49617), we solicited 
comment as to whether a distinction between new and established visits 
was necessary because we were planning to transition to G-codes and did 
not want to unnecessarily create codes for both new and established 
patients. The AMA defines an established patient as ``one who has 
received professional services from the physician or another physician 
of the same specialty who belongs to the same group practice, within 
the past 3 years.'' To apply this definition to hospital visits, we 
stated in the April 7, 2000 final rule with comment period (65 FR 
18451) that the meanings of ``new'' and ``established'' pertain to 
whether or not the patient already has a hospital medical record 
number. If the patient has a hospital medical record that was created 
within the past 3 years, that patient is considered an established 
patient to the hospital. The same patient could be ``new'' to the 
physician but an ``established'' patient to the hospital. The opposite 
could be true if the physician has a longstanding relationship with the 
patient, in which case the patient would be an ``established'' patient 
with respect to the physician and a ``new'' patient to the hospital.
    Some commenters who responded to prior OPPS rules have stated that 
the hospital resources used for new and established patients to provide 
a specific level of service are very similar, and that it is 
unnecessary and burdensome from a coding perspective to distinguish 
between the two types of visits. On the other hand, other commenters 
have noted, and CY 2005 and CY 2006 claims data have shown, that it may 
be appropriate to continue using different codes for new and 
established patients because of the observed median cost differences in 
the claims data. In addition, during the March 2007 APC Panel meeting, 
the Observation and Visit Subcommittee of the APC Panel discussed 
whether the coding distinction between new and established patient 
visits is necessary. Ultimately, the APC Panel recommended that CMS 
eliminate the ``new'' and ``established'' patient distinctions in the 
reporting of hospital clinic visits. During its discussion, the APC 
Panel suggested that hospitals bill the appropriate level clinic visit 
code according to the resources expended while treating the 
beneficiary, based on each hospital's internal guidelines. The APC 
Panel also suggested that each hospital's internal guidelines reflect 
resource cost differences (if a difference exists) between new and 
established patients. For example, a visit that involves certain 
interventions may be coded as Level 3 for a new patient and Level 2 for 
an established patient. The APC Panel also made another recommendation 
which is contingent upon CMS adopting its recommendation

[[Page 42754]]

to eliminate the new and established patient distinction reporting 
requirement. That is, the APC Panel further recommended that CMS map 
each of the five levels of outpatient clinic visit codes (which do not 
distinguish between new and established patients) to five separate 
APCs, thereby paying at five payment rates. For example, the APC Panel 
recommended mapping the Level 1 patient visit to the Level 1 Clinic 
Visit APC, mapping the Level 2 patient visit to the Level 2 Clinic 
Visit APC, and mapping the Level 3 patient visit to the Level 3 Clinic 
Visit APC. In the current and proposed clinic visit APC configuration, 
as indicated in Table 50, the APC level assignment does not always 
correspond to the visit level described by each code. For example, CPT 
99213 is a Level 3 clinic visit code for an established patient, which 
would seem to logically map to the Level 3 Clinic Visit APC. However, 
because CPT 99213 has a proposed median cost of $64.73, we mapped this 
code to the Level 2 Clinic Visit APC, which has a proposed median cost 
of $63.01. The APC Panel indicated that its recommendation would ensure 
that each visit level would receive its own payment rate, rather than 
both the Level 2 and 3 patient visit codes receiving the same payment 
rate.
    During CY 2006 and earlier, there was no payment difference between 
new and established patient visits of the same level, as both were 
always mapped to the same clinical APC. However, hospital claims data 
regarding the median costs of the specific CPT clinic visit E/M codes 
consistently indicate that new patients are more resource-intensive 
than established patients across all visit levels. The CY 2006 claims 
data confirm that the cost difference between new and established 
patient visits increases as the visit level increases.
    In both the CY 2007 OPPS/ASC proposed and final rules (71 FR 49617 
and 71 FR 68128), respectively, we encouraged public comment that 
discussed the potential differences in hospital clinic resource 
consumption between new and established patient visits. We received 
only a few comments related to this distinction in response to the CY 
2007 OPPS/ASC proposed rule and even fewer comments in response to the 
CY 2007 OPPS/ASC final rule with comment period. For CY 2008, because 
hospitals will be reporting CPT E/M codes for clinic visits, which 
distinguish between new and established patients, and because we see 
meaningful and consistent cost differences between visits for new and 
established patients, we are proposing to continue to recognize the CPT 
codes for new and established patient clinic visits under the OPPS, 
consistent with their CPT code descriptors. Further, we are not 
adopting the recommendation of the APC Panel to eliminate this 
differentiation for the reasons noted. We are proposing to reexamine 
whether the coding distinction between new and established patient 
visits is necessary as we consider national guidelines. We continue to 
encourage public comment about hospitals' experiences with assigning 
visit levels to new and established patients according to their own 
internal guidelines.
    Table 51 lists the CY 2008 proposed median costs of new and 
established patient clinic visit codes which are based on CY 2006 
claims data processed through December 31, 2006.

 Table 51.--Proposed CY 2008 Median Costs of New and Established Patient
                             Visit CPT Codes
------------------------------------------------------------------------
                                      Proposed CY 2008  Proposed CY 2008
                                         new patient       established
         Clinic visit level             visit median      patient visit
                                            cost           median cost
------------------------------------------------------------------------
Level 1.............................            $56.08            $50.70
Level 2.............................             63.18             58.84
Level 3.............................             74.99             64.73
Level 4.............................            109.12             84.17
Level 5.............................            138.06            102.89
------------------------------------------------------------------------

    As noted above, the APC Panel also recommended that CMS map each 
level of patient visits to its corresponding APC, thereby paying at 
five payment levels. The APC Panel members noted that this mapping 
system would eliminate any payment incentive to distinguish between new 
and established patients but would ensure five payment levels.
    For CY 2008, we are proposing to map the clinic visit codes for new 
patients to the five Clinic Visit APCs, one code to each level, based 
on the hospital resources observed in historical claims data as they 
are mapped for CY 2007 and in accordance with the APC Panel's 
recommendation. However, for CY 2008, we are proposing to maintain the 
CY 2007 mapping for the clinic visit codes for established patients. As 
indicated in Table 51 above, we are proposing to map the Level 1 
established patient visit to the Level 1 Clinic Visit APC, which 
results in the Level 1 Clinic Visit APC containing both the Level 1 new 
and established patient visit codes, in accordance with the APC Panel 
recommendation. Similarly, we are proposing to map both the Level 2 new 
and established patient visit codes to the Level 2 Clinic Visit APC. 
However, we also are proposing to map the Level 3 established patient 
visit code to the Level 2 Clinic Visit APC because our cost data 
indicate that the costs associated with a Level 3 established patient 
visit most closely resemble the costs associated with the Level 2 
Clinic Visit APC and the Level 2 new and established patient visits. If 
CPT code 99213 for an established Level 3 clinic visit was mapped to 
the Level 3 Clinic Visit APC, which has a proposed median cost of 
$85.96, we would significantly overpay CPT 99213 every time it was 
billed. We are proposing to map the Level 3 new patient visit to the 
Level 3 Clinic Visit APC, consistent with the APC Panel recommendation. 
We are proposing to map the Level 4 established patient visit to the 
Level 3 Clinic Visit APC and the Level 5 established patient visit to 
the Level 4 Clinic Visit APC. The only CPT E/M code that we are 
proposing to map to the Level 5 Clinic Visit APC for CY 2008 payment is 
the Level 5 new patient visit. These APC assignments that we are 
proposing for CY 2008, consistent with the CY 2007 APC assignments, 
were determined for each HCPCS code based on CY 2008 proposed rule 
median cost data and clinical considerations. We are not persuaded by 
the APC Panel recommendation, which would require us to ignore 
significant cost differences based on resource data that are clinically 
consistent and instead map each code to its corresponding level APC.

[[Page 42755]]

    Historical cost data for these frequently provided services are 
extremely consistent. In addition, from a clinical perspective, we 
believe that in some cases, in the context of a five level structure 
for visit reporting, the hospital resources required for a given visit 
level may only be slightly different from those used for a visit that 
is one level higher or lower. For example, it is not surprising that 
particularly among visits for established patients in the middle of the 
range, such as a Level 2 established patient visit and a Level 3 
established patient visit, the hospital resource costs calculated from 
claims data are similar because these patients would often utilize 
reasonably comparable hospital resources.
    We performed data analyses to determine how the median costs of the 
clinic visit APCs would change if we fully adopted the APC Panel's 
recommendation and mapped all of the new and established patient visit 
codes to the corresponding level of clinic visit APC. Our results are 
shown in Table 52.

  Table 52.--CY 2008 Median Cost Comparison of Clinic Visit APCs in Two
                        Different Configurations
------------------------------------------------------------------------
                                                         APC median cost
                                       APC median cost       in the
                 APC                   in the proposed   recommended APC
                                           CY 2008            panel
                                        configuration     configuration
------------------------------------------------------------------------
Level 1 Clinic Visit................               $53               $53
Level 2 Clinic Visit................                63                60
Level 3 Clinic Visit................                86                66
Level 4 Clinic Visit................               108                88
Level 5 Clinic Visit................               139               110
------------------------------------------------------------------------

    The APC median cost distribution does not improve when mapping each 
new and established patient visit code to its corresponding level of 
APC. In fact, the APC Panel's recommended configuration results in 
lower payment rates for the Levels 2 through 5 Clinic Visit APCs, and 
an identical payment rate for the Level 1 Clinic Visit APC because our 
proposed mapping and the APC Panel's recommendation for this APC are 
the same. In general, under the OPPS, we rely on resource cost data 
calculated from hospital claims data to determine appropriate APC 
mapping of HCPCS codes and to set payment rates. While we acknowledge 
that it might be more predictable for hospitals to receive the same 
payment rate for new and established patients of the same visit level, 
robust cost data clearly indicate that this would not be the most 
accurate payment method. Historical hospital cost data indicate that 
new patient visits are costlier than established patient visits of the 
same level, a finding that is consistent with the perspective of our 
medical advisors. Because we are proposing that hospitals continue to 
use CPT E/M codes to report clinic visits for CY 2008, including 
separate codes for new and established patients, we see no reason to 
adjust the clinic visit APC configurations. Therefore, for CY 2008, we 
are proposing to map the CPT E/M codes and other Level II HCPCS codes 
to the Clinic Visit APCs as configured in Table 50 and not fully adopt 
the APC Panel's recommendation to map each code to its corresponding 
APC level. We will reexamine using the claims data for CY 2009 OPPS 
ratesetting and will also reconsider whether this mapping is 
appropriate in the future as we continue to work on developing national 
guidelines.
    The APC Panel also recommended that CMS not recognize the CPT 
consultation codes: CPT 99241 (Office consultation for a new or 
established patient (Level 1)), CPT 99242 (Office consultation for a 
new or established patient (Level 2)), CPT 99243 (Office consultation 
for a new or established patient (Level 3)), CPT 99244 (Office 
consultation for a new or established patient (Level 4)), and CPT 99245 
(Office consultation for a new or established patient (Level 5)). The 
APC Panel recommended that CMS instruct hospitals to build consultation 
services into their internal hospital guidelines related to reporting 
outpatient clinic visit levels based on the complexity and resources 
used for these outpatient visits.
    CPT defines a consultation as ``a type of service provided by a 
physician whose opinion or advice regarding evaluation and/or 
management of a specific problem is requested by another physician or 
other appropriate source.'' CPT recognizes two subcategories of 
consultations, specifically office or other outpatient and inpatient 
consultations, although only the office consultations would be 
applicable under the OPPS. Nevertheless, the differentiation of 
consultations from new and established patient clinic visits would 
appear to be clinically unnecessary under the OPPS in order to provide 
proper OPPS payment for hospital outpatient visits.
    In the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68128), we noted our belief that it may be unnecessary for hospitals to 
report consultation CPT codes if either a new or established patient 
visit code accurately describes the service provided. We stated that we 
were particularly interested in hearing whether consultation codes are 
a useful measure of hospital resource use under the OPPS, and how 
consultation visits are different, from a hospital resource 
perspective, from new patient visits and established patient visits. We 
observed that we did not want to create an incentive for hospitals to 
bill a consultation code instead of a new or established patient code 
because we did not believe that consultation codes necessarily 
reflected different resource utilization than either new or established 
patient codes (71 FR 68138). Therefore, for CY 2007, we finalized a 
payment policy that assigned the consultation code to the same clinical 
APC as the established patient visit code for each level of service. 
For example, CPT code 99242, the Level 2 consultation code is mapped to 
APC 0605 (Level 2 Clinic Visits), which is where CPT code 99212, the 
Level 2 established patient code, is mapped for CY 2007. Moving the 
consultation codes to the same APC as the corresponding established 
patient visit code eliminated any incentive for hospitals to bill a 
consultation code instead of a new or established patient code.

   Table 53.--CY 2008 Median Costs and Frequencies of CPT Consultation
                               Visit Codes
------------------------------------------------------------------------
                Code descriptor                 Median cost   Frequency
------------------------------------------------------------------------
Level 1 Consultation..........................       $66.48       62,000

[[Page 42756]]

 
Level 2 Consultation..........................        65.78       73,000
Level 3 Consultation..........................        81.95      155,000
Level 4 Consultation..........................       109.96      176,000
Level 5 Consultation..........................       139.61       94,000
------------------------------------------------------------------------

    Consultation services are provided with much less frequency than 
all levels of established patient visits and low level new patient 
visits but are provided more frequently than high level new patient 
visits. The median costs for consultation codes are generally similar 
to or slightly higher than the corresponding median costs of the same 
level of new patient visits.
    Aside from the APC Panel recommendation, we have received few 
comments from the public related to this issue. We continue to believe 
that consultation codes are unnecessary and superfluous in the hospital 
outpatient setting because hospitals could appropriately bill either a 
new or established patient visit code, instead of a consultation, as 
appropriate in these cases. In the interest of simplifying billing, for 
CY 2008, we are proposing to assign status indicator ``B'' to the 
consultation codes (that is, not paid under the OPPS) and instruct 
hospitals to bill a new or established visit code instead of an office 
consultation code, thereby adopting the APC Panel's recommendation not 
to recognize these consultation codes. As appropriate, hospitals may 
build consultation services into their internal hospital guidelines 
related to reporting clinic visit levels based on the complexity and 
resources used for these visits.
    In summary, for CY 2008, we are proposing that hospitals continue 
to use the CPT codes to bill for clinic visits and to distinguish 
between new and established patient visits. For CY 2008, the CPT codes 
for new and established visits would continue to be payable under the 
OPPS, but we would reconsider in the future whether there should be a 
distinction between new and established patient visits as we continue 
to work on developing national guidelines. For CY 2008, we are 
proposing to change the status of the consultation codes so that these 
codes are no longer recognized for payment under the OPPS.
2. Emergency Department Visits
    As described above, CPT defines an emergency department as ``an 
organized hospital based facility for the provision of unscheduled 
episodic services to patients who present for immediate medical 
attention. The facility must be available 24 hours a day.'' Prior to CY 
2007, under the OPPS, we restricted the billing of emergency department 
CPT codes to services furnished at facilities that met this CPT 
definition. Facilities open less than 24 hours a day should not report 
the emergency department CPT codes.
    Sections 1866(a)(1)(I), 1866(a)(1)(N), and 1867 of the Act impose 
specific obligations on Medicare-participating hospitals and CAHs that 
offer emergency services. These obligations concern individuals who 
come to a hospital's dedicated emergency department and request 
examination or treatment for medical conditions, and apply to all of 
these individuals, regardless of whether or not they are beneficiaries 
of any program under the Act. Section 1867(h) of the Act specifically 
prohibits a delay in providing required screening or stabilization 
services in order to inquire about the individual's payment method or 
insurance status. Section 1867(d) of the Act provides for the 
imposition of civil monetary penalties on hospitals and physicians 
responsible for failing to meet the provisions listed above. These 
provisions, taken together, are frequently referred to as the Emergency 
Medical Treatment and Labor Act (EMTALA). EMTALA was passed in 1986 as 
part of the Consolidated Omnibus Budget Reconciliation Act of 1985, 
Pub. L. 99-272 (COBRA).
    Section 489.24 of the EMTALA regulations defines ``dedicated 
emergency department'' as any department or facility of the hospital, 
regardless of whether it is located on or off the main hospital campus, 
that meets at least one of the following requirements: (1) It is 
licensed by the State in which it is located under applicable State law 
as an emergency room or emergency department; (2) It is held out to the 
public (by name, posted signs, advertising, or other means) as a place 
that provides care for emergency medical conditions on an urgent basis 
without requiring a previously scheduled appointment; or (3) During the 
calendar year immediately preceding the calendar year in which a 
determination under the regulations is being made, based on a 
representative sample of patient visits that occurred during that 
calendar year, it provides at least one-third of all of its outpatient 
visits for the treatment of emergency medical conditions on an urgent 
basis without requiring a previously scheduled appointment.
    We believe that every emergency department that meets the CPT 
definition of emergency department also qualifies as a dedicated 
emergency department under EMTALA. However, we are aware that there are 
some departments or facilities of hospitals that meet the definition of 
a dedicated emergency department under the EMTALA regulations but that 
do not meet the more restrictive CPT definition of an emergency 
department. For example, a hospital department or facility that meets 
the definition of a dedicated emergency department may not be available 
24 hours a day, 7 days a week. Nevertheless, hospitals with such 
departments or facilities incur EMTALA obligations with respect to an 
individual who presents to the department and requests, or has 
requested on his or her behalf, examination or treatment for an 
emergency medical condition. However, because they did not meet the CPT 
requirements for reporting emergency visit E/M codes, prior to CY 2007, 
these facilities were required to bill clinic visit codes for the 
services they furnished under the OPPS. We had no way to distinguish in 
our hospital claims data the costs of visits provided in dedicated 
emergency departments that did not meet the CPT definition of emergency 
department from the costs of clinic visits.
    Some hospitals requested that they be permitted to bill emergency 
department visit codes under the OPPS for services furnished in a 
facility that met the CPT definition for reporting emergency department 
visit E/M codes, except that they were not available 24 hours a day. 
These hospitals believed that their resource costs were more similar to 
those of emergency departments that met the CPT definition than they 
were to the resource costs of clinics. Representatives of such 
facilities argued that emergency department visit payments would be 
more appropriate, on the grounds that their facilities treated patients 
with emergency conditions whose costs exceeded the resources reflected 
in the clinic visit APC payments, even though these emergency 
departments were not available 24 hours per day. In addition, these 
hospital representatives indicated that their facilities had EMTALA 
obligations and should, therefore, be able to receive emergency 
department visit payments. While these emergency departments may have 
provided a broader range and intensity of hospital

[[Page 42757]]

services and required significant resources to assure their 
availability and capabilities in comparison with typical hospital 
outpatient clinics, the fact that they did not operate with all 
capabilities full-time suggested that hospital resources associated 
with visits to emergency departments or facilities available less than 
24 hours a day might not be as great as the resources associated with 
emergency departments or facilities that were available 24 hours a day 
and that fully met the CPT definition.
    To determine whether visits to emergency departments or facilities 
(referred to as Type B emergency departments) that incur EMTALA 
obligations but do not meet more prescriptive expectations that are 
consistent with the CPT definition of an emergency department (referred 
to as Type A emergency departments) have different resource costs than 
visits to either clinics or Type A emergency departments, in the CY 
2007 OPPS/ASC final rule with comment period (71 FR 68132), we 
finalized a set of five G-codes for use by hospitals to report visits 
to all entities that meet the definition of a dedicated emergency 
department under the EMTALA regulations in Sec.  489.24 but that are 
not Type A emergency departments, as described in Table 54 below. These 
codes are called ``Type B emergency department visit codes.'' We 
believed the creation of G-codes for Type B emergency departments was 
necessary because there were no CPT codes that fully described this 
type of facility. If we were to continue instructing Type B emergency 
departments to bill clinic visit codes, we would have no way to track 
resource costs for Type B emergency department visits as distinct from 
clinic visits. In that rule we explained that these new G-codes would 
serve as a vehicle to capture median cost and resource differences 
among visits provided by Type A emergency departments, Type B emergency 
departments, and clinics (71 FR 68132).

   Table 54.--CY 2007 Final Level II HCPCS Codes to be Used To Report
  Emergency Department Visits Provided in Type B Emergency Departments
------------------------------------------------------------------------
      HCPCS code            Short descriptor         Long descriptor
------------------------------------------------------------------------
G0380.................  Lev 1 hosp type B ED     Level 1 hospital
                         visit.                   emergency department
                                                  visit provided in a
                                                  Type B emergency
                                                  department. (The ED
                                                  must meet at least one
                                                  of the following
                                                  requirements: (1) It
                                                  is licensed by the
                                                  State in which it is
                                                  located under
                                                  applicable State law
                                                  as an emergency room
                                                  or emergency
                                                  department; (2) It is
                                                  held out to the public
                                                  (by name, posted
                                                  signs, advertising, or
                                                  other means) as a
                                                  place that provides
                                                  care for emergency
                                                  medical conditions on
                                                  an urgent basis
                                                  without requiring a
                                                  previously scheduled
                                                  appointment; or (3)
                                                  During the calendar
                                                  year immediately
                                                  preceding the calendar
                                                  year in which a
                                                  determination under
                                                  this section is being
                                                  made, based on a
                                                  representative sample
                                                  of patient visits that
                                                  occurred during that
                                                  calendar year, it
                                                  provides at least one-
                                                  third of all of its
                                                  outpatient visits for
                                                  the treatment of
                                                  emergency medical
                                                  conditions on an
                                                  urgent basis without
                                                  requiring a previously
                                                  scheduled
                                                  appointment).
G0381.................  Lev 2 hosp type B ED     Level 2 hospital
                         visit.                   emergency department
                                                  visit provided in a
                                                  Type B emergency
                                                  department. (The ED
                                                  must meet at least one
                                                  of the following
                                                  requirements: (1) It
                                                  is licensed by the
                                                  State in which it is
                                                  located under
                                                  applicable State law
                                                  as an emergency room
                                                  or emergency
                                                  department; (2) It is
                                                  held out to the public
                                                  (by name, posted
                                                  signs, advertising, or
                                                  other means) as a
                                                  place that provides
                                                  care for emergency
                                                  medical conditions on
                                                  an urgent basis
                                                  without requiring a
                                                  previously scheduled
                                                  appointment; or (3)
                                                  During the calendar
                                                  year immediately
                                                  preceding the calendar
                                                  year in which a
                                                  determination under
                                                  this section is being
                                                  made, based on a
                                                  representative sample
                                                  of patient visits that
                                                  occurred during that
                                                  calendar year, it
                                                  provides at least one-
                                                  third of all of its
                                                  outpatient visits for
                                                  the treatment of
                                                  emergency medical
                                                  conditions on an
                                                  urgent basis without
                                                  requiring a previously
                                                  scheduled
                                                  appointment).
G0382.................  Lev 3 hosp type B ED     Level 3 hospital
                         visit.                   emergency department
                                                  visit provided in a
                                                  Type B emergency
                                                  department. (The ED
                                                  must meet at least one
                                                  of the following
                                                  requirements: (1) It
                                                  is licensed by the
                                                  State in which it is
                                                  located under
                                                  applicable State law
                                                  as an emergency room
                                                  or emergency
                                                  department; (2) It is
                                                  held out to the public
                                                  (by name, posted
                                                  signs, advertising, or
                                                  other means) as a
                                                  place that provides
                                                  care for emergency
                                                  medical conditions on
                                                  an urgent basis
                                                  without requiring a
                                                  previously scheduled
                                                  appointment; or (3)
                                                  During the calendar
                                                  year immediately
                                                  preceding the calendar
                                                  year in which a
                                                  determination under
                                                  this section is being
                                                  made, based on a
                                                  representative sample
                                                  of patient visits that
                                                  occurred during that
                                                  calendar year, it
                                                  provides at least one-
                                                  third of all of its
                                                  outpatient visits for
                                                  the treatment of
                                                  emergency medical
                                                  conditions on an
                                                  urgent basis without
                                                  requiring a previously
                                                  scheduled
                                                  appointment).

[[Page 42758]]

 
G0383.................  Lev 4 hosp type B ED     Level 4 hospital
                         visit.                   emergency department
                                                  visit provided in a
                                                  Type B emergency
                                                  department. (The ED
                                                  must meet at least one
                                                  of the following
                                                  requirements: (1) It
                                                  is licensed by the
                                                  State in which it is
                                                  located under
                                                  applicable State law
                                                  as an emergency room
                                                  or emergency
                                                  department; (2) It is
                                                  held out to the public
                                                  (by name, posted
                                                  signs, advertising, or
                                                  other means) as a
                                                  place that provides
                                                  care for emergency
                                                  medical conditions on
                                                  an urgent basis
                                                  without requiring a
                                                  previously scheduled
                                                  appointment; or (3)
                                                  During the calendar
                                                  year immediately
                                                  preceding the calendar
                                                  year in which a
                                                  determination under
                                                  this section is being
                                                  made, based on a
                                                  representative sample
                                                  of patient visits that
                                                  occurred during that
                                                  calendar year, it
                                                  provides at least one-
                                                  third of all of its
                                                  outpatient visits for
                                                  the treatment of
                                                  emergency medical
                                                  conditions on an
                                                  urgent basis without
                                                  requiring a previously
                                                  scheduled
                                                  appointment).
G0384.................  Lev 5 hosp type B ED     Level 5 hospital
                         visit.                   emergency department
                                                  visit provided in a
                                                  Type B emergency
                                                  department. (The ED
                                                  must meet at least one
                                                  of the following
                                                  requirements: (1) It
                                                  is licensed by the
                                                  State in which it is
                                                  located under
                                                  applicable State law
                                                  as an emergency room
                                                  or emergency
                                                  department; (2) It is
                                                  held out to the public
                                                  (by name, posted
                                                  signs, advertising, or
                                                  other means) as a
                                                  place that provides
                                                  care for emergency
                                                  medical conditions on
                                                  an urgent basis
                                                  without requiring a
                                                  previously scheduled
                                                  appointment; or (3)
                                                  During the calendar
                                                  year immediately
                                                  preceding the calendar
                                                  year in which a
                                                  determination under
                                                  this section is being
                                                  made, based on a
                                                  representative sample
                                                  of patient visits that
                                                  occurred during that
                                                  calendar year, it
                                                  provides at least one-
                                                  third of all of its
                                                  outpatient visits for
                                                  the treatment of
                                                  emergency medical
                                                  conditions on an
                                                  urgent basis without
                                                  requiring a previously
                                                  scheduled
                                                  appointment).
------------------------------------------------------------------------

    For CY 2007, we assigned the five new Type B emergency department 
visit codes for services provided in a Type B emergency department to 
the five newly-established Clinic Visit APCs, 0604, 0605, 0606, 0607, 
and 0608 (71 FR 68140). This payment policy for Type B emergency 
department visits is similar to our previous policy which required 
services furnished in emergency departments that had an EMTALA 
obligation but did not meet the CPT definition of emergency department 
to be reported using CPT clinic visit E/M codes, resulting in payments 
based upon clinic visit APCs. As mentioned above, CPT and CMS required 
an emergency department to be open 24 hours per day in order for it to 
be eligible to bill emergency department E/M codes. While maintaining 
the same payment policy for Type B emergency department visits in CY 
2007, we believe the reporting of specific G-codes for emergency 
department visits provided in Type B emergency departments would permit 
us to specifically collect and analyze the hospital resource costs of 
visits to these facilities in order to determine in the future whether 
a proposal of an alternative payment policy might be warranted. We 
expected hospitals to adjust their charges appropriately to reflect 
differences in Type A and Type B emergency departments. The OPPS 
rulemaking cycle for CY 2009 will be the first year that we will have 
cost data for these new Type B emergency department HCPCS codes 
available for analysis.
    In the CY 2007 OPPS/ASC proposed rule (71 FR 49609), we proposed to 
create five G-codes to be reported by the subset of provider-based 
emergency departments or facilities of the hospital, called Type A 
emergency departments, that are available to provide services 24 hours 
a day, 7 days per week and meet one or both of the following 
requirements related to the EMTALA definition of a dedicated emergency 
department, specifically: (1) It is licensed by the State in which it 
is located under the applicable State law as an emergency room or 
emergency department; or (2) It is held out to the public (by name, 
posted signs, advertising, or other means) as a place that provides 
care for emergency medical conditions on an urgent basis without 
requiring a previously scheduled appointment. These codes were called 
``Type A emergency visit codes'' and were proposed to replace 
hospitals' reporting of the CPT emergency department visit E/M codes 
listed in Table 49 above. Our intention was to allow hospital-based 
emergency departments or facilities that were historically 
appropriately reporting CPT emergency department visit E/M codes to 
bill these new Type A emergency department visit codes. In the CY 2007 
OPP/ASC, final rule with comment period (71 FR 68132), we postponed 
finalizing G-codes to replace CPT codes for Type A emergency department 
visits until national guidelines are established, and stated that we 
would again consider their possible utility once the national 
guidelines are adopted. However, for CY 2007, we finalized the 
definition of Type A emergency departments to distinguish them from 
Type B emergency departments. For CY 2007 (71 FR 68140), we assigned 
the five CPT E/M emergency department visit codes for services provided 
in a Type A emergency departments to the five newly-created Emergency 
Department Visit APCs, 0609, 0613, 0614, 0615, and 0616.
    We believe that our distinction between Type A and Type B emergency 
departments refined and clarified the CPT definition of ``emergency 
department'' for use in the hospital

[[Page 42759]]

context. As we have previously noted, the CPT codes were defined to 
reflect the activities of physicians and do not always describe well 
the range and mix of services provided by hospitals during visits of 
emergency department patients. For example, one feature that 
distinguishes Type A hospital emergency departments from other 
departments of the hospital is that Type A emergency departments do not 
generally provide scheduled care, but rather regularly operate to 
provide immediately available unscheduled services.
    We were pleased that the majority of commenters to the CY 2007 
OPPS/ASC proposed rule agreed with our general distinction between Type 
A and Type B emergency departments. We note that after the publication 
of the CY 2007 OPP/ASC final rule with comment period, numerous readers 
requested clarification about one paragraph that appeared in that final 
rule. The paragraph is reprinted below (71 FR 68132).

    ``We are aware that hospitals operate many types of facilities 
which they view in aggregate as an integrated healthcare system. For 
purposes of determining EMTALA obligations, under Sec.  489.24(b) of 
the regulations, each hospital is evaluated individually to 
determine its own particular obligations. As we have discussed 
previously, hospital facilities or departments of the hospital that 
meet the definition of a dedicated emergency department consistent 
with the EMTALA regulations may bill Type A emergency department 
codes (CPT emergency department visit codes) or Type B emergency 
department codes (HCPCS G-codes), depending on whether or not the 
dedicated emergency department meets the definition of a Type A 
emergency department, which includes operating 24 hours per day, 7 
days a week. For purposes of determining whether to bill Type A or 
Type B emergency department codes, each hospital must be evaluated 
individually and should make a decision specific to each area of the 
hospital to determine which codes would be appropriate. Where a 
hospital maintains a separately identifiable area or part of a 
facility which does not operate on the same schedule (that is, 24 
hours per day, 7 days a week) as its emergency department, that area 
or facility would not be considered an integral part of the 
emergency department that operates 24 hours per day, 7 days a week 
for purposes of determining its emergency department type for 
reporting emergency visit services. Instead, the facility or area 
would be evaluated separately to determine whether it is a Type A 
emergency department, Type B emergency department, or clinic. We 
would expect the hospital providing services in such facilities or 
areas to evaluate the status of those areas and bill accordingly. In 
general, it is not appropriate to consider a satellite emergency 
department or an area of the emergency department as if it were 
available 24 hours a day simply because the main emergency 
department is available 24 hours a day. It may be appropriate for a 
Type A emergency department to `carve out' portions of the emergency 
department that are not available 24 hours a day, where visits would 
be more appropriately billed with Type B emergency department 
codes.''

    In response to the questions we received, we posted on the CMS Web 
site a ``Frequently Asked Questions'' list that described various 
examples of treating an emergency department as either a Type A 
emergency department or a Type B emergency department. In each case, 
the posted answer stated that hospitals should contact their fiscal 
intermediary to ensure that the fiscal intermediary and the hospital 
are in agreement regarding the emergency room status as either Type A 
or Type B. The response to the posted examples has been positive and 
the number of inquiries we are receiving has subsided.
    Notwithstanding our subsequent clarification, we are not proposing 
to modify the definitions of Type A or Type B emergency departments for 
CY 2008 because we believe that our current definition accurately 
distinguishes between these two types of emergency departments. While 
we will not know definitively until CY 2009 how the costs of services 
provided in Type A emergency departments differ from the costs of 
services provided in Type B emergency departments, we believe that our 
current distinction between Type A and B emergency departments is 
appropriate and is most likely to capture any resource cost differences 
between the two types of emergency departments. However, we are 
specifically soliciting public comment regarding any additional 
operational clarifications that we could provide to assist hospitals in 
determining whether an emergency department is considered to be Type A 
or Type B.
    We specifically indicated for CY 2007 that hospitals should 
individually consider separately identifiable areas or parts of 
facilities that did not operate on the same schedule as the main 
emergency department that was open 24 hours a day, 7 days per week to 
determine the appropriate codes for reporting services provided in 
those separately identifiable areas. Because we consider the main 
distinguishing feature between Type A and Type B emergency departments 
to be the full-time versus part-time availability of staffed areas for 
emergency medical care, not the process of care or the site of care (on 
the hospital's main campus or offsite), our final CY 2007 policy 
explained that hospitals needed to assess separately identifiable areas 
individually for their status as Type A or Type B emergency 
departments. We are interested specifically in comments that describe 
how this policy could be further clarified in light of hospitals' 
operational responsibility to efficiently provide emergency services, 
holding constant the definitions that were developed for CY 2007 and 
described above. We do not believe a policy change in the reporting of 
these Type A and Type B emergency department codes would be appropriate 
for CY 2008, in light of our desire to capture consistent and accurate 
hospital cost data by HCPCS code for consideration for the CY 2009 
OPPS. For CY 2008, we are proposing that Type A emergency department 
visits would continue to be paid based on the five Emergency Department 
Visit APCs, while Type B emergency department visits would continue to 
be paid based on the five Clinic Visit APCs.

C. Proposed Visit Reporting Guidelines

1. Background
    As described in section IX.A. of this proposed rule, since April 7, 
2000, we have instructed hospitals to report facility resources for 
clinic and emergency department outpatient hospital visits using the 
CPT E/M codes and to develop internal hospital guidelines for reporting 
the appropriate visit level.
    During the January 2002 APC Panel meeting, the APC Panel 
recommended that CMS adopt the American College of Emergency Physicians 
(ACEP) intervention-based guidelines for facility coding of emergency 
department visits and develop guidelines for clinic visits that are 
modeled on the ACEP guidelines.
    In the August 9, 2002 OPPS proposed rule (67 FR 52133), we proposed 
10 new G-codes (Levels 1-5 Facility Emergency Services and Levels 1-5 
Facility Clinic Services) for use in the OPPS to report hospital 
visits, with the goal of ultimately applying national guidelines to 
these codes and discontinuing the use of CPT E/M codes under the OPPS. 
We also solicited public comments regarding national guidelines for 
hospital coding of emergency department and clinic visits. We discussed 
different types of models, reflecting on the advantages and 
disadvantages of each. We reviewed in detail the considerations around 
various discrete types of specific guidelines, including guidelines 
based on staff interventions, based upon staff time spent with the 
patient, based on resource intensity point scoring, and

[[Page 42760]]

based on severity acuity point scoring related to patient complexity. 
In that proposed rule, we also stated that we were concerned about 
counting separately paid services (for example, intravenous infusions, 
x-rays, electrocardiograms, and laboratory tests) as ``interventions'' 
or including their associated ``staff time'' in determining the level 
of service. We believed that the level of service should be determined 
by resource consumption that is not otherwise captured in payments for 
other separately payable services.
    In response to comments, in the November 1, 2002 OPPS final rule 
(67 FR 66793), we stated that we would not create new codes to replace 
existing CPT E/M codes for reporting hospital visits until national 
guidelines are developed. We noted that an independent panel of experts 
would be an appropriate forum to develop codes and guidelines that are 
simple to understand and implement. We explained that organizations 
such as the American Hospital Association (AHA) and the American Health 
Information Management Association (AHIMA) had such expertise and would 
be capable of creating hospital visit guidelines and providing ongoing 
provider education. We also articulated a set of principles that any 
national guidelines for facility visit coding should satisfy, including 
that coding guidelines should be based on facility resources, should be 
clear to facilitate accurate payments and be usable for compliance 
purposes and audits, should meet HIPAA requirements, should only 
require documentation that is clinically necessary for patient care, 
and should not facilitate upcoding or gaming. We stated that the 
distribution of codes reported for each type of hospital outpatient 
visit (clinic or emergency department) should result in a normal curve. 
We concluded that we believed the most appropriate forum for 
development of code definitions and guidelines was an independent 
expert panel that would make recommendations to CMS.
    The AHA and AHIMA originally supported the ACEP model for emergency 
department visit coding. However, we expressed concern that the ACEP 
guidelines allowed counting of separately payable services in 
determining a service level, which could result in the double counting 
of hospital resources in establishing visit payment rates and payment 
rates for those separately payable services. Subsequently, on their own 
initiative, the AHA and AHIMA formed an independent expert panel, the 
Hospital Evaluation and Management Coding Panel, comprised of members 
with coding, health information management, documentation, billing, 
nursing, finance, auditing, and medical experience. This panel included 
representatives from the AHA, AHIMA, ACEP, Emergency Nurses 
Association, and American Organization of Nurse Executives. CMS and AMA 
representatives observed the meetings. On June 24, 2003, the AHA and 
AHIMA submitted their recommended guidelines, hereafter referred to as 
the AHA/AHIMA guidelines, for reporting three levels of hospital clinic 
and emergency department visits and a single level of critical care 
services to CMS, with the hope that CMS would publish the guidelines in 
the CY 2004 OPPS proposed rule. The AHA and AHIMA acknowledged that 
``continued refinement will be required as in all coding systems. The 
Panel * * * looks forward to working with CMS to incorporate any 
recommendations raised during the public comment period'' (AHA/AHIMA 
guidelines report, page 9). The AHA and AHIMA indicated that the 
guidelines were field-tested several times by panel members at 
different stages of their development. The guidelines are based on an 
intervention model, where the levels are determined by the numbers and 
types of interventions performed by nursing or ancillary hospital 
staff. Higher levels of services are reported as the number and/or 
complexity of staff interventions increase.
    Although we did not publish the guidelines, the AHA and AHIMA 
released the guidelines through their Web sites. Consequently, we 
received numerous comments from providers and associations, some in 
favor and some opposed to the guidelines. We undertook a critical 
review of the recommendations from the AHA and AHIMA and made some 
modifications to the guidelines based on comments we received from 
other hospitals and associations on the AHA/AHIMA guidelines, clinical 
review, and changing payment policies under the OPPS regarding some 
separately payable services.
    In an attempt to validate the modified AHA/AHIMA guidelines and 
examine the distribution of services that would result from their 
application to hospital clinic and emergency department visits paid 
under the OPPS, we contracted for a study that began in September 2004 
and concluded in September 2005 to retrospectively code, under the 
modified AHA/AHIMA guidelines, hospital visits by reviewing hospital 
visit medical chart documentation gathered through the Comprehensive 
Error Rate Testing (CERT) work. While a review of documentation and 
assignment of visit levels based on the modified AHA/AHIMA guidelines 
to 12,500 clinic and emergency department visits was initially planned, 
the study was terminated after a pilot review of only 750 visits. The 
contractor identified a number of elements in the guidelines that were 
difficult for coders to interpret, poorly defined, nonspecific, or 
regularly unavailable in the medical records. The contractor's coders 
were unable to determine any level for about 25 percent of the clinic 
cases and about 20 percent of the emergency cases reviewed. The only 
agreement observed between the levels reported on the claims and levels 
according to the modified AHA/AHIMA guidelines was the classification 
of Level 1 services, where the review supported the level on the claims 
54 to 70 percent of the time. In addition, the vast majority of the 
clinic and emergency department visits reviewed were assigned to Level 
1 during the review. Based on these findings, we believed that it was 
not necessary to review additional records after the initial sample. 
The contractor advised that multiple terms in the guidelines required 
clearer definition and believed that more examples would be helpful. 
Although we believe that all of the visit documentation for each case 
was available for the contractor's review, we were unable to determine 
definitively that this was the case. Thus, there is some possibility 
that the contractor's assignments would have differed if additional 
documentation from the medical records were available for the visits. 
In summary, while testing of the modified AHA/AHIMA guidelines was 
helpful in illuminating areas of the guidelines that would benefit from 
refinement, we were unable to draw conclusions about the relationship 
between the distribution of current hospital reporting of visits using 
CPT E/M codes that are assigned according to each hospital's internal 
guidelines and the distribution of codes under the AHA/AHIMA 
guidelines, nor were we able to demonstrate a normal distribution of 
visit levels under the modified AHA/AHIMA guidelines. In CY 2007, we 
posted to the CMS Web site a summary of the contractor's report.
    Despite the inconclusive findings from the validation study, after 
reviewing the AHA/AHIMA guidelines, as well as approximately a dozen 
other guidelines for outpatient visits submitted by various hospitals 
and hospital associations, we stated in the CY 2007 OPPS/ASC final rule 
with

[[Page 42761]]

comment period (71 FR 68141) that we believed that the AHA/AHIMA 
guidelines are the most appropriate and well-developed guidelines for 
use in the OPPS of which we are aware. Our particular interest in these 
guidelines is based upon the broad-based input into their development, 
the desire for CMS to move to promulgate national outpatient hospital 
visit coding guidelines in the near future, and full consideration of 
the characteristics of alternative types of guidelines. We also believe 
that hospitals would react favorably to guidelines developed and 
supported by the AHA and AHIMA, national organizations that have great 
interest in hospital coding and payment issues, and possess significant 
medical, technical and practical expertise due to their broad 
membership, which includes hospitals and health information management 
professionals. Anecdotally, we have been told that a number of 
hospitals are successfully utilizing the AHA/AHIMA guidelines to report 
levels of hospital visits. However, other organizations have expressed 
concern that the AHA/AHIMA guidelines may result in a significant 
redistribution of hospital visits to higher levels, reducing the 
ability of the OPPS to discriminate among the hospital resources 
required for various different levels of visits. We, too, remain 
concerned about the potential redistributive effect on OPPS payments 
for other services or among levels of hospital visits when national 
guidelines for outpatient visit coding are adopted. We recognize that 
there may be difficulty crosswalking historical hospital claims data 
from current CPT E/M codes reported based on individual internal 
hospital guidelines to payments for any new coding system developed, in 
order to provide appropriate payment levels for hospital visits 
reported based on national guidelines in the future.
    There are several types of concerns with the AHA/AHIMA guidelines 
that have been identified based upon extensive staff review and 
contractor use of the guidelines during the validation study. We 
believe the AHA/AHIMA guidelines would require refinement prior to 
their adoption by the OPPS, as well as continued refinement over time 
after their implementation. Our modified version of the AHA/AHIMA 
guidelines provides some possibilities for addressing certain issues. 
Our eight general areas of concern regarding the AHA/AHIMA model are 
reviewed below. In addition, we have posted to the CMS Web site both 
the original AHA/AHIMA guidelines and our modified draft version.
    We continue to commit that we would provide a minimum of 6 to 12 
months notice to hospitals prior to implementation of national 
guidelines to provide sufficient time for providers to make the 
necessary systems changes and educate their staff.
2. CY 2007 Work on Visit Guidelines
    There are several areas of the AHA/AHIMA guidelines that we 
identified in the CY 2007 OPPS/ASC final rule with comment period that 
would require refinement and further input from the public prior to 
implementation as national guidelines. These areas include the need for 
five rather than three levels of codes for clinic and emergency 
department visits to accommodate the current five levels of OPPS 
payment; clarification of documentation that would support certain 
interventions; reconsideration of the inclusion of separately payable 
services as proxies for hospital resources used in visits; examination 
of the valuing of certain interventions; assessment of the need for 
modifications to address the different clinical characteristics of 
specialty clinic visits; consistency with the Americans with 
Disabilities Act; reevaluation of the way in which additional hospital 
resources required for the treatment of new patients are captured; and 
recommendations for guidelines for the reporting of visits to Type B 
emergency departments.
    We have had a number of meetings and discussions with interested 
stakeholders over the past several months regarding the AHA/AHIMA 
guidelines, the CMS modified draft version, the contractor pilot work 
to test the guidelines, the concerns we identified in the CY 2007 OPPS/
ASC final rule, and alternative guidelines. We are aware that the AHA 
and AHIMA are having an ongoing dialogue with members of their Hospital 
Evaluation and Management Coding Panel and reviewing their previously 
recommended model guidelines as well as other models currently in use. 
We have not received any additional suggestions or modifications from 
the AHA and AHIMA to date. We have received a number of new suggestions 
for guidelines from other stakeholders, including individual hospitals 
and associations, that have engaged in a variety of data collection and 
pilot application activities in preparing their recommendations. For 
example, one wound care organization created and presented an 
independent model that could apply to certain specialty clinics. The 
organization claimed that several hospital outpatient specialty clinics 
had already successfully implemented these as their internal 
guidelines, but requested that CMS designate them as the national wound 
care clinic guidelines. One provider group tested several sets of 
guidelines that resembled the ACEP model and compared the results 
across a set of hospitals. This provider group believes that an ACEP-
type model would be the most successful type of national guidelines, 
assuming that the guidelines were flexible in serving as a guide to 
visit level reporting. While using several varieties of ACEP-type 
guidelines in different hospitals, the group noted that across 
hospitals a specific intervention was almost always assigned to the 
same clinic visit level. The group concluded that this indicated that 
the ACEP model and its variations could likely be successfully 
implemented as national guidelines. Another association reviewed and 
tested the CMS modified AHA/AHIMA guidelines that were posted to the 
CMS Web site. This association found it cumbersome to assign the Level 
2 and Level 4 Clinic Visit codes because those levels could only be 
assigned when a certain number of interventions and/or contributory 
factors were performed. The association suggested changes to the CMS 
modified AHA/AHIMA guidelines for ease of use and application to 
specialty clinics, particularly oncology clinics. One developer of 
national clinic and emergency department visit guidelines noted that 
many hospitals had successfully used the presenting problem-based 
guidelines that it had created. The developer noted that its system was 
easy to use, produced consistent coding decisions resulting in a normal 
distribution of visits, and even served as a tool to track 
effectiveness and efficiency.
    We appreciate the thoughtful information that has been provided to 
us so far regarding hospitals' experiences and the insightful responses 
by the public to our concerns about the AHA/AHIMA model. We are 
currently actively engaged in evaluating and comparing various 
guideline models and suggestions that have been provided to us, and we 
continue to welcome additional public input on this important and 
complex area of the OPPS. The public input we have received continues 
to reflect a wide variety of perspectives on the types and content of 
the guidelines different commenters recommend that we should implement 
nationally for the OPPS, and no single approach appears to be broadly 
endorsed by the stakeholder

[[Page 42762]]

community. In addition, commenters have described the successful 
application of many types of internal hospital guidelines with diverse 
characteristics for the reporting of hospital clinic and emergency 
department visit levels that they believe accurately capture the 
required hospital resources.
3. Proposed Visit Guidelines
    We performed data analyses with the goal of studying the current 
distribution of each level of clinic and emergency department visit 
codes billed nationally, as well as the distribution among various 
classes of hospitals. We analyzed frequency data from claims with dates 
of service from March 1, 2002, through December 31, 2006, including 
those claims that were processed through December 31, 2006. To 
determine the national clinic visit distribution, we reviewed frequency 
data for each level of new patient visits, established patient visits, 
and consultation codes. To determine the national emergency department 
visit distribution, we reviewed frequency data for the five CPT 
emergency department visit codes. We did not include the five G-codes 
that describe Type B emergency departments because they became 
effective January 1, 2007, and we do not yet have a full year of 
frequency data for those codes.
    The clinic visit data, displayed below in Figure 1, revealed a 
fairly normal national distribution of clinic visits, with the curve 
somewhat skewed to the left, consistent with our previous analysis of 
these data in CY 2002 (67 FR 66791). In addition, the visit 
distributions have been quite stable over the past 5 years.

BILLING CODE 4120-01-P
[GRAPHIC] [TIFF OMITTED] TP02AU07.000

    The graph shown in Figure 1 indicates that hospitals, on average, 
are billing all five levels of visit codes with varying frequency, in a 
consistent pattern over time. It is striking to note how similar the 
annual distributions appear from CY 2002 through CY 2006. We are not 
surprised that hospitals report a relatively high proportion of low 
level visits, given the typical clinical care provided in HOPDs during 
these visits. Many Medicare patients are evaluated regularly in clinics 
by hospitals' clinical staff to determine the status of their chronic 
medical

[[Page 42763]]

conditions and determine adjustments to treatment plans, and those 
visits may frequently be reported as a low level visit if that is 
consistent with the hospital's internal guidelines and fiscal 
intermediary instructions. Some patients may receive minor services 
during low level visits that are not described by more specific HCPCS 
codes. We note that, in general, billing a visit in addition to another 
service merely because the patient interacted with hospital staff or 
spent time in a room for that service is inappropriate. If a visit and 
another service are both billed, such as chemotherapy, a diagnostic 
test, or a surgical procedure, the visit must be separately 
identifiable from the other service because the resources used to 
provide nonvisit services, including staff time, equipment, supplies, 
among others, are captured in the line item for that service. We 
believe that hospitals by and large are abiding by this guidance 
because more than 90 percent of the CY 2006 claims for Level 1 
established patient visits available for this proposed rule are single 
claims.
    We also examined the billing patterns for various classes of 
hospitals, grouped by the hospital categories shown in the impact table 
(Table 67) in section XXII.B. of this proposed rule, to see how the 
clinic visit distributions of levels billed for these various 
categories compared to the national distribution of clinic visit 
levels. For these subcategories, we specifically focused on the number 
of established patient visits billed at each level. Generally, the 
distribution for major teaching hospitals, minor teaching hospitals, 
and nonteaching hospitals looked remarkably similar to the national 
distribution of established patient visits. Nonteaching hospitals 
tended to bill a greater proportion of Level 1 and 2 patient visits as 
compared to major teaching hospitals, as would be expected if their 
general patient acuity was slightly lower. Nonteaching hospitals 
include many community hospitals that treat a wide variety of patients, 
likely including a larger proportion of patients with minor ailments. 
Major teaching hospitals reported a slightly higher proportion of Level 
4 and 5 visits. This too correlates well with our knowledge of the 
patient case-mix of large teaching hospitals, which tend to treat a 
higher proportion of very sick patients than nonteaching hospitals. The 
distributions for urban and rural hospitals also closely resembled the 
national distribution, including the rural SCH visit level 
distribution. The smallest rural hospitals predictably reported a 
higher proportion of Level 1 and 2 visit codes and a lower proportion 
of higher level visit codes, as compared to the national average, 
consistent with their generally lower case-mix severity.
    The national emergency department visit data, displayed below in 
Figure 2, similarly revealed a normal national distribution of 
emergency department visit levels that was even more symmetrical than 
the national clinic visit distribution. The national distributions have 
been stable over the past 5 years as well.
BILLING CODE 4120-01-P

[[Page 42764]]

[GRAPHIC] [TIFF OMITTED] TP02AU07.001

BILLING CODE 4120-01-C
    We also looked at various classes of hospitals, grouped by the 
hospital categories that we show in the impact table (Table 67) in 
section XXII. of this proposed rule to see how the emergency department 
visit distributions of levels billed by hospitals in each of these 
various categories compared to the national distribution of emergency 
department visit levels. The emergency department visit distributions 
for major teaching hospitals, minor teaching hospitals, and nonteaching 
hospitals were almost identical to the national distribution of 
emergency department visits. No significant differences were noted. The 
emergency department visit distributions for urban and rural hospitals 
also closely resembled the national distribution of emergency 
department visits. Rural hospitals in the aggregate reported slightly 
higher proportions of Level 2 and 3 emergency department visits than 
the national average and slightly fewer Level 4 and 5 visits. When 
subdividing rural hospitals into groupings based on size, the 
distribution for small, medium, and large rural hospitals closely 
mirrored the national average distribution. Large rural hospitals 
tended to report higher level emergency department visits than smaller 
rural hospitals. All of these observations regarding the patterns of 
reporting for rural hospitals are consistent with our expectations for 
care delivery of those hospitals.
    Overall, both the clinic and emergency department visit 
distributions indicate that hospitals are billing consistently over 
time and in a manner that distinguishes between visit levels, resulting 
in relatively normal distributions nationally for the OPPS, as well as 
for smaller classes of hospitals. These analyses are generally 
consistent with our understanding of the clinical and resource 
characteristics of different levels of hospital outpatient clinic and 
emergency department visits.
    We specifically are inviting public comment as to whether a 
pressing need for national guidelines continues at this point in the 
maturation of the OPPS or if the current system where hospitals create 
and apply their own internal guidelines to report visits is currently 
more practical and appropriately flexible for hospitals. Although we 
have reiterated our goal since CY 2000 of creating national guidelines, 
this complex undertaking for these important and common hospital 
services is proving more challenging than we initially thought as we 
receive new and expanded information from the public on current 
hospital reporting practices that lead to appropriate

[[Page 42765]]

payment for the hospital resources associated with clinic and emergency 
department visits. Many hospitals have worked diligently and carefully 
to develop and implement their own internal guidelines that reflect the 
scope and types of services they provide throughout the hospital 
outpatient system. Based on public comments, as well as our own 
knowledge of how clinics operate, it seems unlikely that one set of 
straightforward national guidelines could apply to the reporting of 
visits in all hospitals and specialty clinics. In addition, the stable 
distribution of clinic and emergency department visits reported under 
the OPPS over the past several years indicates that hospitals, both 
nationally in the aggregate and grouped by specific hospital classes, 
are generally billing in an appropriate and consistent manner as we 
would expect in a system that accurately distinguishes among different 
levels of service based on the associated hospital resources.
    Therefore, while we continue to evaluate the information and input 
we have received from the public during CY 2007, as well as invite 
comments on this proposed rule regarding the necessity and feasibility 
of implementing different types of national guidelines, we are not 
proposing to implement national visit guidelines for clinic or 
emergency department visits for CY 2008. Instead, hospitals will 
continue to report visits during CY 2008 according to their own 
internal hospital guidelines.
    In the absence of national guidelines, we would continue to 
regularly reevaluate patterns of hospital outpatient visit reporting at 
varying levels of disaggregation below the national level to ensure 
that hospitals continue to bill appropriately and differentially for 
these services. In addition, we expect that hospitals' internal 
guidelines will comport with the principles listed below.
    <bullet> The coding guidelines should follow the intent of the CPT 
code descriptor in that the guidelines should be designed to reasonably 
relate the intensity of hospital resources to the different levels of 
effort represented by the code (65 FR 18451).
    <bullet> The coding guidelines should be based on hospital facility 
resources. The guidelines should not be based on physician resources 
(67 FR 66792).
    <bullet> The coding guidelines should be clear to facilitate 
accurate payments and be usable for compliance purposes and audits (67 
FR 66792).
    <bullet> The coding guidelines should meet the HIPAA requirements 
(67 FR 66792).
    <bullet> The coding guidelines should only require documentation 
that is clinically necessary for patient care (67 FR 66792).
    <bullet> The coding guidelines should not facilitate upcoding or 
gaming (67 FR 66792)
    We also are proposing the following five additional principles that 
should apply to hospital specific guidelines, based on our evolving 
understanding of the important issues addressed by many hospitals in 
developing their internal guidelines that now have been used for a 
number of years. We believe it is reasonable at this time to elaborate 
upon the standards for hospitals' internal guidelines that we are 
proposing to apply in CY 2008, based on our knowledge of hospitals' 
experiences to date with guidelines for visits.
    <bullet> The coding guidelines should be written or recorded, well-
documented and provide the basis for selection of a specific code.
    <bullet> The coding guidelines should be applied consistently 
across patients in the clinic or emergency department to which they 
apply.
    <bullet> The coding guidelines should not change with great 
frequency.
    <bullet> The coding guidelines should be readily available for 
fiscal intermediary (or, if applicable, MAC) review.
    <bullet> The coding guidelines should result in coding decisions 
that could be verified by other hospital staff, as well as outside 
sources.
    We are inviting comment on these principles, specifically, whether 
hospitals' guidelines currently meet these principles, how difficult it 
would be for hospitals' guidelines to meet these principles if they do 
not meet them already, and whether hospitals believe that certain 
standards should be added or removed. We considered stating that a 
hospital must use one set of emergency department visit guidelines for 
all emergency departments in the hospital, but thought that some 
departments that might be considered emergency departments, such as the 
obstetrics department, may find it more practical and appropriate to 
use a different set of guidelines than the general emergency 
department. Similarly, we find it possible that various specialty 
clinics in a hospital could have their own set of guidelines, specific 
to the services offered in those specialty clinics. However, if 
different guidelines are implemented for different clinics, hospitals 
should ensure that these guidelines reflect comparable resource use at 
each level to the other clinic guidelines that the hospital may apply.
    We appreciate all the comments we have received in the past from 
the public on visit guidelines, and we encourage continued submission 
of comments at any time that will assist us and other stakeholders 
interested in the development of national guidelines. Until national 
guidelines are established, hospitals should continue using their own 
internal guidelines. We would not expect individual hospitals to 
necessarily experience a normal distribution of visit levels across 
their claims, although we would expect a normal distribution across all 
hospitals as observed currently and as we would expect if national 
guidelines were implemented. We understand that, based on different 
patterns of care, we could expect that a small community hospital might 
provide more low level services than high level services, while an 
academic medical center or trauma center might provide more high level 
services than low level services. We would also expect national 
guidelines to provide for five levels of coding, to parallel the five 
payment levels that currently exist.
    We hope to receive additional input from stakeholders over the 
upcoming months to address whether there is a definite contemporary 
need for national guidelines, given their potential to redistribute 
payment under the OPPS and the currently reassuring observed patterns 
of OPPS visit services. While we understand the interest of some 
hospitals in our moving quickly to promulgate national guidelines that 
will ensure standardized reporting of outpatient hospital visit levels, 
we believe that the issues identified both by us and others that may 
arise are important and require serious consideration prior to the 
implementation of national guidelines. Because of our commitment to 
provide hospitals with 6-12 months notice prior to implementation of 
national guidelines, we would not implement national guidelines prior 
to CY 2009. Our goal is to ensure that OPPS national or hospital-
specific visit guidelines continue to facilitate consistent and 
accurate reporting of hospital outpatient visits, in a manner that is 
resource-based and supportive of appropriate OPPS payments for the 
efficient and effective provision of visits in hospital outpatient 
settings.

X. Proposed OPPS Payment for Blood and Blood Products

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Blood and Blood Products'' at the beginning of your 
comment.)

[[Page 42766]]

A. Background

    Since the implementation of the OPPS in August 2000, separate 
payments have been made for blood and blood products through APCs 
rather than packaging them into payments for the procedures with which 
they were administered. Hospital payments for the costs of blood and 
blood products, as well as the costs of collecting, processing, and 
storing blood and blood products, are made through the OPPS payments 
for specific blood product APCs. On April 12, 2001, CMS issued the 
original billing guidance for blood products to hospitals (Program 
Transmittal A-01-50). In response to requests for clarification of 
these instructions, CMS issued Program Transmittal 496 on March 4, 
2005. The comprehensive billing guidelines in Program Transmittal 496 
also addressed specific concerns and issues related to billing for 
blood-related services, which the public had brought to our attention.
    In the CY 2000 OPPS, payments for blood and blood products were 
established based on external data provided by commenters due to 
limited Medicare claims data. From the CY 2000 OPPS to the CY 2002 
OPPS, payment rates for blood and blood products were updated for 
inflation. For the CY 2003 OPPS, as described in the November 1, 2002 
final rule with comment period (67 FR 66773), we applied a special 
adjustment methodology to blood and blood products that had significant 
reductions in payment rates from the CY 2002 OPPS to the CY 2003 OPPS, 
when median costs were first calculated from hospital claims. Using the 
adjustment methodology, we limited the decrease in payment rates for 
blood and blood products to approximately 15 percent. For the CY 2004 
OPPS, as recommended by the APC Panel, we froze payment rates for blood 
and blood products at CY 2003 levels as we studied concerns raised by 
commenters and presenters at the August 2003 and February 2004 APC 
Panel meetings.
    For the CY 2005 OPPS, we established new APCs that allowed each 
blood product to be assigned to its own separate APC, as several of the 
previous blood product APCs contained multiple blood products with no 
clinical homogeneity or whose product specific median costs may not 
have been similar. Some of the blood product HCPCS codes were 
reassigned to the new APCs (Table 34 of the November 15, 2004 final 
rule with comment period (69 FR 65819)).
    We also noted in the November 15, 2004 final rule with comment 
period that public comments on previous OPPS rules had stated that the 
CCRs that were used to adjust charges to costs for blood products in 
past years were too low. Past commenters indicated that this approach 
resulted in an underestimation of the true hospital costs for blood and 
blood products. In response to these comments and the APC Panel 
recommendations from its February 2004 and September 2004 meetings, we 
conducted a thorough analysis of the CY 2003 claims (used to calculate 
the CY 2005 APC payment rates) to compare CCRs between those hospitals 
reporting a blood-specific cost center and those hospitals defaulting 
to the overall hospital CCR in the conversion of their blood product 
charges to costs. As a result of this analysis, we observed a 
significant difference in CCRs utilized for conversion of blood product 
charges to costs for those hospitals with and without blood-specific 
cost centers. The median hospital blood-specific CCR was almost two 
times the median overall hospital CCR. As discussed in the November 15, 
2004 final rule with comment period, we applied a special methodology 
for hospitals not reporting a blood-specific cost center, which 
simulated a blood-specific CCR for each hospital that we then used to 
convert charges to costs for blood products. Thus, we developed 
simulated medians for all blood and blood products based on CY 2003 
hospital claims data (69 FR 65816).
    For the CY 2005 OPPS, we also identified a subset of blood products 
that had less than 1,000 units billed in CY 2003. For these low-volume 
blood products, we based the CY 2005 OPPS payment rate on a 50/50 blend 
of the CY 2004 OPPS product-specific OPPS median costs and the CY 2005 
OPPS simulated medians based on the application of blood-specific CCRs 
to all claims. We were concerned that, given the low frequency in which 
these products were billed, a few occurrences of coding or billing 
errors may have led to significant variability in the median 
calculation. The claims data may not have captured the complete costs 
of these products to hospitals as fully as possible. This low-volume 
adjustment methodology also allowed us to further study the issues 
raised by commenters and by presenters at the September 2004 APC Panel 
meeting, without putting beneficiary access to these low volume blood 
products at risk. We have adopted the use of this modified CCR process 
for calculating unadjusted median costs for blood and blood products 
each year since the CY 2005 OPPS.
    Overall, median costs from CY 2003 (used for the CY 2005 OPPS) to 
CY 2004 (used for the CY 2006 OPPS) were relatively stable, with a few 
significant increases and decreases from the CY 2005 adjusted median 
costs for some specific blood products. For the CY 2006 OPPS, we 
adopted a payment adjustment policy that limited significant decreases 
in APC payment rates for blood and blood products from the CY 2005 OPPS 
to the CY 2006 OPPS to not more than 5 percent. We applied this 
adjustment to 11 blood and blood product APCs for the CY 2006 OPPS, 
which we identified in Table 33 of the CY 2006 OPPS final rule with 
comment period (70 FR 68687). For the CY 2006 OPPS, we set the final 
median costs for blood and blood products at the greater of: (1) The 
simulated median costs calculated from the CY 2004 claims data; or (2) 
95 percent of the CY 2005 OPPS adjusted median costs for these 
products, as reflected in Table 33 published in the CY 2006 OPPS final 
rule with comment period.
    In the CY 2007 OPPS, we established payment rates for blood and 
blood products by using the same simulation methodology described in 
the November 15, 2004 final rule with comment period (69 FR 65816), 
which utilizes hospital-specific actual or simulated CCRs for blood 
cost centers to convert hospital charges for blood and blood products 
to costs. However, we provided a payment transition for those blood 
products for which the difference between their CY 2006 adjusted median 
cost and their CY 2007 simulated median cost was greater than 25 
percent. Specifically, we set the CY 2007 median costs upon which 
payments for blood and blood products are based at the higher of the CY 
2007 unadjusted simulated median cost or 75 percent of the CY 2006 
adjusted median cost on which the CY 2006 payment is based.

B. Proposed Payment for Blood and Blood Products

    We are proposing to set the payment rates for blood and blood 
products for CY 2008 at the unadjusted median cost for these products, 
calculated using the hospital specific simulated blood CCR for each 
hospital that does not have a blood cost center. For this proposed 
rule, we calculated median costs for blood and blood products using 
claims for services furnished on or after January 1, 2006, and before 
January 1, 2007, and using the actual or simulated CCRs from the most 
recently available hospital cost reports. The median costs derived from 
this data process are relatively stable compared to the median costs on 
which payment is based for CY 2007. (See Table 55 below.) Of the 34 
blood and blood products, median costs increase for 24

[[Page 42767]]

products and decline for 10 products compared to the adjusted medians 
on which payment is based in CY 2007. Products with the largest 
declines are, like the products with the greatest increases, mostly 
those products with low volume use in the hospital outpatient setting. 
The products whose costs decline more than 5 percent account for less 
than 1 percent of the total volume of blood and blood products in the 
claims used to calculate the proposed rates. No product's median cost 
declines by more than 18 percent in the proposed rule data, and thus no 
product shows a decline that would have resulted in an adjustment under 
the final policy in place for CY 2007. The products whose median costs 
increase account for 79 percent of the total volume of blood and blood 
products in the claims used to calculate the proposed rates. We note 
that CY 2006 claims are the first OPPS claims that represent a full 
year of hospitals' reporting consistent with our detailed blood billing 
guidelines issued in CY 2005. We are reassured by the relatively stable 
or slightly increasing median costs from CY 2005 to CY 2006 claims data 
for most blood products, a pattern that we believe may reflect more 
accurate and complete hospital reporting and charging practices for 
these products. Consistent with our billing guidelines, hospitals may 
now be taking into consideration all appropriate costs associated with 
providing blood and blood products in charging for those products under 
the OPPS.
    As we indicated in the CY 2007 OPPS/ASC final rule with comment 
period (71 FR 68147), we believe that the simulated CCR methodology 
results in accurate reflections of the relative estimated costs of 
these products for hospitals without blood cost centers and, therefore, 
for these products in general. Our 1-year adjustment to the median 
costs for CY 2007, where the median costs for blood and blood products 
decreased by more than 25 percent from the CY 2006 adjusted median 
costs, was intended to provide a reasonable transition to use of the 
simulated median costs for payment of blood and blood products under 
the OPPS without further adjustment. The medians that result from the 
use of the simulated CCR process and the CY 2006 claims generally 
result in median costs that we believe provide an appropriate basis for 
the relative weights on which the CY 2008 payments for blood and blood 
products would be based. Therefore, we are proposing to use the median 
costs derived from the application of blood cost center CCRs for those 
hospitals that have blood cost centers or simulated blood cost center 
CCRs for those hospitals that do not have blood cost centers as the 
basis for the CY 2008 payments for blood and blood products without 
further adjustment.

                      Table 55.--Proposed CY 2008 Median Costs for Blood and Blood Products
----------------------------------------------------------------------------------------------------------------
                                                                            CY 2007 payment   Difference between
                                                                           median: higher of   proposed CY 2008
                                                             Proposed CY     CY 2007 OPPS        simulated CCR
                                                Proposed CY      2008        simulated CCR     median unit cost
      HCPCS code*           Short descriptor     2008 units   simulated    median unit cost       and CY 2007
                                                              CCR median   or 75% of CY 2006  adjusted simulated
                                                              unit cost     adjusted median     CCR median unit
                                                                               unit cost        cost (percent)
----------------------------------------------------------------------------------------------------------------
P9010..................  Whole blood for              2,467      $279.14             $131.21             112.74%
                          transfusion.
P9011..................  Blood split unit.....          288       133.59              136.42               -2.07
P9012..................  Cryoprecipitate each         4,941        43.05               48.31              -10.89
                          unit.
P9016..................  RBC leukocytes             558,488       186.14              174.71                6.54
                          reduced.
P9017..................  Plasma 1 donor frz w/       40,750        68.58               69.80               -1.75
                          in 8 hr.
P9019..................  Platelets, each unit.       18,466        68.15               58.61               16.28
P9020*.................  Plaelet rich plasma            708       338.08              208.07               62.49
                          unit.
P9021..................  Red blood cells unit.      139,030       127.97              128.78               -0.63
P9022..................  Washed red blood             2,220       264.78              209.79               26.21
                          cells unit.
P9023*.................  Frozen plasma,                 343        75.37               57.11               31.97
                          pooled, sd.
P9031..................  Platelets leukocytes        16,471       108.24               94.53               14.50
                          reduced.
P9032..................  Platelets, irradiated        8,889       130.48              128.81                1.30
P9033..................  Platelets                    4,401       127.57              124.60                2.38
                          leukoreduced irrad.
P9034..................  Platelets, pheresis..        8,844       442.89              450.29               -1.64
P9035..................  Platelet pheres             44,607       502.95              485.89                3.51
                          leukoreduced.
P9036..................  Platelet pheresis            1,263       440.81              416.08                5.94
                          irradiated.
P9037..................  Plate pheres                22,378       631.62              613.39                2.97
                          leukoredu irrad.
P9038..................  RBC irradiated.......        4,967       209.22              195.85                6.83
P9039..................  RBC deglycerolized...          831       364.46              356.22                2.31
P9040..................  RBC leukoreduced            69,722       240.24              216.29               11.07
                          irradiated.
P9043*.................  Plasma protein fract,           21        90.53               50.96               77.67
                          5%, 50ml.
P9044..................  Cryoprecipitate              4,352        82.60               81.91                0.84
                          reduced plasma.
P9048*.................  Plasmaprotein fract,           508       245.39              236.78                3.64
                          5%, 250ml.
P9050*.................  Granulocytes,                   12       978.29              745.98               31.14
                          pheresis unit.
P9051*.................  Blood, l/r, cmv-neg..        3,377       150.12              155.79               -3.64
P9052..................  Platelets, hla-m, l/         1,618       608.71              667.70               -8.83
                          r, unit.
P9053..................  Plt, pher, l/r cmv-          1,437       678.13              701.26               -3.30
                          neg, irr.
P9054..................  Blood, l/r, froz/              584       210.86              209.82                0.50
                          degly/wash.
P9055*.................  Plt, aph/pher, l/r,            789       490.13              394.50               24.24
                          cmv-neg.
P9056..................  Blood, l/r,                  3,634       153.31              143.44                6.88
                          irradiated.
P9057..................  RBC, frz/deg/wsh, l/           112       406.96              493.32              -17.51
                          r, irrad.
P9058..................  RBC, l/r, cmv-neg,           3,151       291.16              260.65               11.71
                          irrad.
P9059..................  Plasma, frz between 8-       2,820        78.35               76.32                2.66
                          24hour.
P9060..................  Fr frz plasma donor            192        73.17               74.06               -1.20
                          retested.
----------------------------------------------------------------------------------------------------------------
*Indicates payment median for CY 2007 at 75 percent of the CY 2006 adjusted median.


[[Page 42768]]

XI. Proposed OPPS Payment for Observation Services

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Observation Services'' at the beginning of your 
comment.)
    Observation care is a well-defined set of specific, clinically 
appropriate services that include ongoing short-term treatment, 
assessment, and reassessment before a decision can be made regarding 
whether patients will require further treatment as hospital inpatients 
or if they are able to be discharged from the hospital. Observation 
status is commonly assigned to patients with unexpectedly prolonged 
recovery after surgery and to patients who present to the emergency 
department and who then require a significant period of treatment or 
monitoring before a decision is made concerning their next placement.
    Payment for all observation care under the OPPS was packaged prior 
to CY 2002. Since CY 2002, separate payment of a single unit of an 
observation APC for an episode of observation care has been provided in 
limited circumstances. Effective for services furnished on or after 
April 1, 2002, separate payment for observation was made if the 
beneficiary had chest pain, asthma, or congestive heart failure and met 
additional criteria for diagnostic testing, minimum and maximum limits 
to observation care time, physician care, and documentation in the 
medical record (66 FR 59879). Payment for observation care that did not 
meet these specified criteria was packaged. Between CY 2003 and CY 
2006, several more changes were made to the OPPS policy regarding 
separate payment for observation care, such as: clarification that 
observation is not separately payable when billed with ``T'' status 
procedures on the day of or day before observation care; development of 
specific Level II HCPCS codes for hospital observation care and direct 
admission to observation care; and removal of the initially established 
diagnostic testing requirements for separately payable observation (67 
FR 66794, 69 FR 65828, and 70 FR 68688). Throughout this time period, 
we maintained separate payment for observation care only for the three 
specified medical conditions, and OPPS payment for observation for all 
other clinical conditions remained packaged.
    Since January 1, 2006, hospitals have reported observation services 
based on an hourly unit of care using HCPCS code G0378 (Hospital 
observation services, per hour). This code has a status indicator of 
``Q'' under the CY 2007 OPPS, meaning that the OPPS claims processing 
logic determines whether the observation is packaged or separately 
payable. The OCE's current logic determines whether observation 
services billed under HCPCS code G0378 is separately payable through 
APC 0339 (Observation), or whether payment for observation services 
will be packaged into the payment for other separately payable services 
provided by the hospital in the same encounter based on criteria 
discussed below. Also since January 1, 2006, hospitals have reported 
HCPCS code G0379 (Direct admission of patient for hospital observation 
care) for a direct admission of a patient to observation care. The OPPS 
pays separately for that direct admission reported under HCPCS code 
G0379 in situations where payment for the actual observation services 
reported under HCPCS G0378 are packaged and where the direct admission 
meets certain other criteria. The OCE logic determines when HCPCS code 
G0379 is separately payable under the OPPS.
    For CY 2007, we continued to apply the criteria for separate 
payment for observation care and the coding and payment methodology for 
observation care that were implemented in CY 2006. Observation care is 
reported using HCPCS code G0378 and observation that meets the criteria 
for separate payment maps to APC 0339 (Observation). The current 
criteria for separate payment for observation (APC 0339) are:

A. Diagnosis Requirements

    1. The beneficiary must have one of three medical conditions: 
congestive heart failure (CHF), chest pain, or asthma.
    2. Qualifying ICD-9-CM diagnosis codes must be reported in Form 
Locator (FL) 76, Patient Reason for Visit, or FL 67, principal 
diagnosis, or both in order for the hospital to receive separate 
payment for APC 0339. If a qualifying ICD-9-CM diagnosis code(s) is 
reported in the secondary diagnosis field, but is not reported in 
either the Patient Reason for Visit field (FL 76) or in the principal 
diagnosis field (FL 67), separate payment for APC 0339 is not allowed.

B. Observation Time

    1. Observation time must be documented in the medical record.
    2. A beneficiary's time in observation (and hospital billing) 
begins with the beneficiary's admission to an observation bed.
    3. A beneficiary's time in observation (and hospital billing) ends 
when all clinical or medical interventions have been completed, 
including followup care furnished by hospital staff and physicians that 
may take place after a physician has ordered the patient be released or 
admitted as an inpatient.
    4. The number of units reported with HCPCS code G0378 must equal or 
exceed 8 hours.

C. Additional Hospital Services

    1. The claim for observation services must include one of the 
following services in addition to the reported observation services. 
The additional services listed below must have a line item date of 
service on the same day or the day before the date reported for 
observation:
    <bullet> An emergency department visit (APC 0609, 0613, 0614, 0615, 
or 0616); or
    <bullet> A clinic visit (APC 0604, 0605, 0606, 0607, or 0608); or
    <bullet> Critical care (APC 0617); or
    <bullet> Direct admission to observation reported with HCPCS code 
G0379 (APC 0604).
    2. No procedure with a ``T'' status indicator can be reported on 
the same day or day before observation care is provided.

D. Physician Evaluation

    1. The beneficiary must be in the care of a physician during the 
period of observation, as documented in the medical record by 
admission, discharge, and other appropriate progress notes that are 
timed, written, and signed by the physician.
    2. The medical record must include documentation that the physician 
explicitly assessed patient risk to determine that the beneficiary 
would benefit from observation care.
    The CY 2007 list of diagnoses eligible as a criterion for separate 
payment for observation services may be found in Table 44 of the CY 
2007 OPPS/ASC final rule with comment period (71 FR 68152).
    For CY 2007, we made one minor change in payment for direct 
admission to observation. As part of the changes in APC assignments and 
payments for clinic and emergency department visits, low level clinic 
visits were moved from APC 0600 (Low Level Clinic Visits) to APC 0604 
(Level 1 Clinic Visits), with a CY 2007 payment rate of $50.66. Under 
the circumstances where direct admission to observation is separately 
payable, we finalized our CY 2007 assignment of HCPCS code G0379 to APC 
0604, consistent with its CY 2006 placement in the APC for Low Level 
Clinic Visits.
    During the APC Panel's August 2006 meeting, the Observation 
Subcommittee made several recommendations regarding observation 
services. The first

[[Page 42769]]

of these was that CMS should consider adding syncope and dehydration as 
diagnoses for which observation services would qualify for separate 
payment. Second, the Observation Subcommittee recommended that CMS 
perform claims analyses and present data that would allow CMS to 
consider revising criteria for separately payable observation care when 
certain procedures that are assigned status indicator ``T,'' for 
example, insertion of a bladder catheter or laceration repair, are 
reported on the same claim with an emergency department visit and 
observation care, and all other criteria for separate observation 
payment (for example, qualifying diagnosis code, number of hours) are 
met. The Panel also voted to change the name of the Observation 
Subcommittee to the Observation and Visit Subcommittee, based on the 
Panel's interest in expanding the scope of that subcommittee's work.
    In response to August 2006 APC Panel recommendations and public 
comments to the CY 2007 proposed rule, we stated in the CY 2007 OPPS/
ASC final rule with comment period that we intended to perform a series 
of analyses over the upcoming year to explore the potential effects of 
adding syncope and dehydration as qualifying diagnoses for separately 
payable observation care, as well as the possibility of allowing 
separate observation payment for claims for observation care that also 
include specific minor or routine procedures that have ``T'' status 
indicators (71 FR 68150).
    At the March 2007 meeting of the APC Panel, we discussed with the 
Observation and Visit Subcommittee and the full Panel the results of 
the requested data analyses regarding syncope and dehydration, as well 
as the occurrences of claims for observation care that also include 
specific minor or routine procedures that have ``T'' status indicators. 
With respect to the diagnosis analyses, the data presented to the 
Subcommittee and Panel (consisting of partial year 2006 claims data 
that are less complete than the claims data available for this proposed 
rule) showed that there were 136,977 claims for separately payable 
observation services for the currently eligible conditions of chest 
pain, asthma, and congestive heart failure, with a median cost of $453. 
The frequency of claims for observation services for the diagnoses of 
syncope and dehydration, when all other criteria for separate payment 
of observation services (other than diagnosis) were met, was 46,961 
claims, with a somewhat lower median cost of $416. The effect of adding 
both syncope and dehydration to the current diagnoses eligible for 
separate payment would be to lower the median for APC 0339 slightly to 
$443, using the early partial 2006 data presented to the Subcommittee 
and Panel. For the study of ``T'' status procedures in relation to 
observation, we identified relatively few instances (5,162) where 
observation met all of the criteria for separate payment, including the 
current three conditions of CHF, asthma, chest pain, except for the 
presence of a ``T'' status procedure. Of these claims, very few had any 
significant frequency. The most common procedures are those relating to 
heart catheterization, angioplasty procedures, and endoscopies. As we 
have stated in the past, we believe that the observation services in 
these cases may be related to these procedures and we have no way of 
discerning from our data whether the procedure happened before or after 
the observation services.
    The APC Panel made three recommendations related to these topics. 
First, the Panel recommended that CMS add syncope and dehydration to 
the list of clinical conditions eligible for separate observation 
payment. Second, the Panel recommended that CMS continue to evaluate 
the types of diagnostic conditions that might qualify for separate 
observation payment in the future. Third, the Panel recommended that 
CMS make no changes to the criteria for separate observation payment 
related to the performance of ``T'' status procedures. However, the 
Panel added that if CMS added syncope and dehydration to the list of 
conditions eligible for separate observation payment, the Panel 
requested that CMS reexamine the claims data once CMS collects a year 
of observation claims data, including the additional conditions, so the 
Panel could reconsider this recommendation at a future meeting.
    We have also taken into consideration the June 2006 IOM Report 
entitled, ``Hospital-Based Emergency Care: At the Breaking Point.'' 
This report encourages hospitals to apply tools to improve the flow of 
patients through emergency departments, especially through the use of 
observation units (clinical decision units). The IOM report also 
recommends that separate OPPS payment should be made for all conditions 
for which observation is indicated.
    We appreciate the continued work and dedication of the Observation 
and Visit Subcommittee and the APC Panel, along with the findings and 
recommendations of the IOM. However, in light of the broader CY 2008 
OPPS proposal to move toward expanded packaging of payment for 
supportive, dependent HOPD services, we are not accepting the Panel's 
recommendation related to adding syncope and dehydration to the list of 
diagnoses eligible for separate payment or to consider other clinical 
conditions for separate payment for observation care. We are proposing 
to package all observation services (reported with HCPCS code G0378) as 
part of the proposed changes to packaged services discussed previously 
in section II.A.4. of this proposed rule. Because we are proposing to 
package payment for all observation services, we are not proposing to 
adopt the Panel's recommendation to study claims data for separately 
payable observation care (including claims for observation for syncope 
and dehydration) that also include specific minor or routine procedures 
that have ``T'' status indicators. We agree with the APC Panel and the 
IOM that there is currently no compelling rationale for a different 
OPPS payment approach for observation care for only three specific 
clinical conditions. We recognize that observation care may play an 
important role in the treatment of many Medicare beneficiaries in the 
HOPD, decreasing the need for short inpatient admissions and ensuring 
safe discharges of patients to their homes. Therefore, we believe that 
our proposed CY 2008 payment policy that would package payment for all 
observation services consistently for Medicare beneficiaries regardless 
of their diagnoses is the most appropriate approach in every case of 
observation care. This proposed methodology encourages hospital 
efficiency and provides a consistent payment policy that allows 
hospitals to thoughtfully plan for the role of observation services in 
the emergency and postsurgical care of patients with many different 
clinical conditions.
    As discussed in section II.A.4. of this proposed rule, observation 
care is one of seven categories of services for which we are proposing 
to make packaged payment in CY 2008. In view of the recent rapid growth 
in HOPD services, we are proposing to move toward larger payment 
packages and bundles under the OPPS because we believe that packaging 
creates incentives for providers to furnish services in the most 
efficient way by maximizing their flexibility to manage their 
resources, thereby encouraging cost containment. A detailed discussion 
of this proposal and our rationale for packaging observation care may 
be found in the section referenced above.
    We are proposing to package observation care reported with HCPCS 
code G0378 for CY 2008 because the

[[Page 42770]]

facility portion of observation care is supportive and ancillary to 
other primary services being furnished in the HOPD. Payment for 
observation will be made as part of the payment for the separately 
payable independent services with which it is billed. As part of this 
proposal, we would change the status indicator for HCPCS code G0378 
from ``Q'' to ``N.'' Although we would discontinue recognizing the 
criteria for separate payment related to hospital visits and qualifying 
conditions, we would retain as general reporting requirements the 
criteria related to physician evaluation, documentation and observation 
beginning and ending time because those are more general requirements 
that help to ensure proper reporting of observation on hospital claims. 
The criteria for reporting of observation services under HCPCS code 
G0378 that we are proposing to retain are:

A. Observation Time

    1. Observation time must be documented in the medical record.
    2. A beneficiary's time in observation (and hospital billing) 
begins with the beneficiary's admission to an observation bed.
    3. A beneficiary's time in observation (and hospital billing) ends 
when all clinical or medical interventions have been completed, 
including followup care furnished by hospital staff and physicians that 
may take place after a physician has ordered the patient be released or 
admitted as an inpatient.

B. Physician Evaluation

    1. The beneficiary must be in the care of a physician during the 
period of observation, as documented in the medical record by 
admission, discharge, and other appropriate progress notes that are 
timed, written, and signed by the physician.
    2. The medical record must include documentation that the physician 
explicitly assessed patient risk to determine that the beneficiary 
would benefit from observation care.
    We refer readers to section II.A.4. of this proposed rule for 
further detailed background on our proposal to package these seven 
categories of services and for a specific discussion of observation 
services.
    Direct admission to observation (HCPCS code G0379, Direct admission 
of patient for hospital observation care) is assigned to APC 0604 
(Level 1 Hospital Clinic Visits) when the criteria are met for separate 
payment. For CY 2008, the proposed median cost of APC 0604 is $52.58. 
We are proposing to continue the current coding and payment methodology 
for direct admission to observation, with the exception of the prior 
requirement that HCPCS code G0379 is only eligible for separate payment 
if observation care reported with HCPCS code G0378 does not qualify for 
separate payment. That requirement would no longer be applicable, given 
our CY 2008 proposal to provide packaged payment for all observation 
care. Hospitals report HCPCS code G0379 when a patient is admitted 
directly to observation care after being seen by a physician in the 
community. Thus, for CY 2008, we are proposing that in order to receive 
separate payment for a direct admission into observation (APC 00604), 
the claim must show:
    1. Both HCPCS codes G0378 (Hospital observation services, per hr) 
and G0379 (Direct admission of patient for hospital observation care) 
with the same date of service.
    2. That no services with a status indicator ``T'' or ``V'' or 
Critical Care (APC 0617) were provided on the same day of service as 
HCPCS code G0379.
    Even though we are proposing to package payment for all observation 
services reported by HCPCS code G0378, we believe it is necessary to 
continue the OCE claims processing logic in order to make appropriate 
payment for direct admission.
    In summary, we are proposing to package payment for observation 
care reported with HCPCS code G0378 for CY 2008. Payment for 
observation would be made as part of the payment for the separately 
payable independent services with which it is billed. As part of this 
proposal, we would change the status indicator for HCPCS Code G0378 
from ``Q'' to ``N.'' In addition, we would discontinue recognizing the 
criteria for separate payment related to hospital visits and ``T'' 
status procedures, minimum number of hours, and qualifying diagnoses. 
However, we would retain as general requirements the criteria related 
to physician evaluation, documentation, and observation beginning and 
ending time. Those are more general requirements that ensure the proper 
reporting of observation care on correctly coded hospital claims that 
reflect the charges associated with all hospital resources utilized to 
provide the reported services. We are proposing to continue the coding 
and payment methodology for direct admission to observation status, as 
reported using HCPCS code G0379, with the exception of the prior 
requirement that HCPCS code G0379 is only eligible for separate payment 
if observation care reported under HCPCS code G0378 does not qualify 
for separate payment (since this requirement would no longer be 
applicable).

XII. Proposed Procedures That Will Be Paid Only as Inpatient Procedures

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Inpatient Procedures'' at the beginning of your 
comment.)

A. Background

    Section 1833(t)(1)(B)(i) of the Act gives the Secretary broad 
authority to determine the services to be covered and paid for under 
the OPPS. Before implementation of the OPPS in August 2000, Medicare 
paid reasonable costs for services provided in the outpatient 
department. The claims submitted were subject to medical review by the 
fiscal intermediaries to determine the appropriateness of providing 
certain services in the outpatient setting. We did not specify in 
regulations those services that were appropriate to provide only in the 
inpatient setting and that, therefore, should be payable only when 
provided in that setting.
    In the April 7, 2000 final rule with comment period, we identified 
procedures that are typically provided only in an inpatient setting 
and, therefore, would not be paid by Medicare under the OPPS (65 FR 
18455). These procedures comprise what is referred to as the 
``inpatient list.'' The inpatient list specifies those services that 
are only paid when provided in an inpatient setting because of the 
nature of the procedure, the need for at least 24 hours of 
postoperative recovery time or monitoring before the patient can be 
safely discharged, or the underlying physical condition of the patient. 
As we discussed in the April 7, 2000 final rule with comment period (65 
FR 18455) and the November 30, 2001 final rule (66 FR 59856), we use 
the following criteria when reviewing procedures to determine whether 
or not they should be moved from the inpatient list and assigned to an 
APC group for payment under the OPPS:
    <bullet> Most outpatient departments are equipped to provide the 
services to the Medicare population.
    <bullet> The simplest procedure described by the code may be 
performed in most outpatient departments.
    <bullet> The procedure is related to codes that we have already 
removed from the inpatient list.
    In the November 1, 2002 final rule with comment period (67 FR 
66741), we added the following criteria for use in reviewing procedures 
to determine whether they should be removed from the inpatient list and 
assigned to an

[[Page 42771]]

APC group for payment under the OPPS:
    <bullet> We have determined that the procedure is being performed 
in numerous hospitals on an outpatient basis; or
    <bullet> We have determined that the procedure can be appropriately 
and safely performed in an ASC and is on the list of approved ASC 
procedures or proposed by us for addition to the ASC list.
    We believe that these additional criteria help us to identify 
procedures that are appropriate for removal from the inpatient list.

B. Proposed Changes to the Inpatient List

    For the CY 2008 OPPS, we used the same methodology as described in 
the November 15, 2004 final rule with comment period (69 FR 65835) to 
identify a subset of procedures currently on the inpatient list that 
are being widely performed on an outpatient basis. These procedures 
were then clinically reviewed for possible removal from the inpatient 
list. We solicited input from the APC Panel on the appropriateness of 
removing 14 procedures from the OPPS inpatient list at its March 2007 
meeting. Prior to publishing this OPPS proposed rule, we received one 
other candidate HCPCS code for removal from the OPPS inpatient list 
based on a recommendation from the public that was presented to the APC 
Panel during its meeting on March 8, 2007. The APC Panel recommended 
that 13 of the 14 procedures that CMS identified for possible removal 
be removed from the OPPS inpatient list. It also recommended that CMS 
obtain additional utilization data about 1 of the 14 procedures 
identified for possible removal from the OPPS inpatient list, 
specifically CPT code 64818 (Sympathectomy, lumbar); and for another 
procedure presented for possible removal from the OPPS inpatient list 
by the public, specifically, CPT code 20660 (Application of cranial 
tongs caliper, or stereotactic frame, including removal (separate 
procedure)). The APC Panel requested that CMS provide that additional 
information to the APC Panel at its next meeting.
    Therefore, we are proposing to accept the APC Panel's 
recommendation to remove the 13 procedures from the OPPS inpatient list 
for CY 2008 and to assign them to clinically appropriate APCs as shown 
in Table 56. We also are accepting the recommendation from the APC 
Panel to gather additional utilization information for CPT codes 20660 
and 64818, which we will provide to the APC Panel at its next meeting.

   Table 56.--Proposed HCPCS Codes for Removal From Inpatient List and
               Their Proposed APC Assignments for CY 2008
------------------------------------------------------------------------
                                                Proposed CY  Proposed CY
       HCPCS code           Long descriptor       2008 APC     2008  SI
------------------------------------------------------------------------
21360..................  Open treatment of             0254            T
                          depressed malar
                          fracture, including
                          zygomatic arch and
                          malar tripod.
21365..................  Open treatment of             0256            T
                          complicated (eg,
                          comminuted or
                          involving cranial
                          nerve foramina)
                          fracture(s) of malar
                          area, including
                          zygomatic arch and
                          malar tripod; with
                          internal fixation
                          and multiple
                          surgical approaches.
21385..................  Open treatment of             0256            T
                          orbital floor
                          blowout fracture;
                          transantral approach
                          (Caldwell-Luc type
                          operation).
25931..................  Transmetacarpal               0049            T
                          amputation; re-
                          amputation.
27006..................  Tenotomy, abductors           0050            T
                          and/or extensor(s)
                          of hip, open
                          (separate procedure).
27720..................  Repair of nonunion or         0063            T
                          malunion, tibia;
                          without graft, (eg,
                          compression
                          technique).
27722..................  Repair of nonunion or         0064            T
                          malunion, tibia;
                          with sliding graft.
50580..................  Renal endoscopy               0161            T
                          through nephrotomy
                          or pyelotomy, with
                          or without
                          irrigation,
                          instillation or
                          ureteropyelography,
                          exclusive of
                          radiologic service;
                          with removal of
                          foreign body or
                          calculus.
51535..................  Cystotomy for                 0162            T
                          excision, incision,
                          or repair of
                          ureterocele.
58805..................  Drainage of ovarian           0195            T
                          cyst(s), unilateral
                          or bilateral,
                          (separate
                          procedure);
                          abdominal approach.
60271..................  Thyroidectomy,                0256            T
                          including substernal
                          thyroid; cervical
                          approach.
61770..................  Stereotactic                  0221            T
                          localization,
                          including burr
                          hole(s), with
                          insertion of
                          catheter(s) or
                          probe(s) for
                          placement of
                          radiation source.
69970..................  Removal of tumor,             0256            T
                          temporal bone.
------------------------------------------------------------------------

XIII. Proposed Nonrecurring Technical and Policy Changes

A. Outpatient Hospital Services and Supplies Incident to a Physician 
Service

    (If you choose to comment on issues in this section, please include 
the caption ``Hospital Services Incident to a Physician Service'' at 
the beginning of your comment.)
    We are proposing to make a technical change to Sec. Sec.  
410.27(a)(1)(iii) and (f) of the regulations relating to outpatient 
hospital services and supplies incident to a physician service to 
remove an outdated reference to ``designation of a department of a 
provider'' by CMS and replace it with language that conforms to current 
policy under the provider based rules as stated in Sec.  413.65 of the 
regulations. We are proposing to remove from both paragraphs 
(a)(1)(iii) and (f) the phrase ``at a location (other than an RHC or an 
FQHC) that CMS designates as a department of a provider under Sec.  
413.65 of this chapter'' and replace it with ``at a department of a 
provider, as defined in Sec.  413.65(a)(2) of this subchapter, that has 
provider-based status in relation to a hospital under Sec.  413.65 of 
this subchapter.''
    Section 410.27 was codified in the April 7, 2000 OPPS final rule 
with comment period. The provider based rules at Sec.  413.65 were also 
codified in the April 7, 2000 rule, but were subsequently amended in 
the August 1, 2002 IPPS final rule (67 FR 50078 through 50096 and 50114 
through 50118). This proposed deletion of the reference in Sec. Sec.  
410.27(a)(1)(iii) and (f) to CMS ``designating'' a department of a 
provider under Sec.  413.65 would make those sections consistent with 
the 2002 amendments to the provider-based rules, in that under the 
amended provider-based rules, a main provider is no longer required to 
ask CMS to make a determination that a facility or organization is 
provider-based before the main provider can bill for services of the 
facility as if the facility were provider-based, or before the main 
provider can include the costs of those services in its cost report.
    We also remind hospitals of the requirements of Sec.  410.27 
concerning

[[Page 42772]]

services and supplies furnished incident to a physician's service to 
hospital outpatients. Section 410.27 applies to all ``incident to'' 
services covered under section 1861(s)(2)(B) of the Act. This provision 
does not apply to services covered under other benefit categories, such 
as clinical diagnostic laboratory services covered under section 
1833(h)(1) of the Act or diagnostic services covered under section 
1861(s)(2)(C) of the Act. Section 410.27(a)(1) currently states that 
Medicare Part B pays for hospital services and supplies furnished 
incident to a physician service to outpatients, including drugs and 
biologicals that cannot be self-administered, if they are furnished by 
or under arrangements made by a participating hospital, except in the 
case of a resident of a skilled nursing facility as provided in Sec.  
411.15(p); as an integral though incidental part of a physician's 
services; and in the hospital or at a location (other than a rural 
health clinic or a Federally qualified health center) that CMS 
designates as a department of a provider under Sec.  413.65.
    We recognize that hospitals consider a variety of business models 
in their efforts to supply efficient and high quality health care 
services to Medicare beneficiaries and the general public, and we 
support such efforts to the extent that they comply with all applicable 
laws and regulations, including, but not limited to, the Stark law and 
other anti-kickback laws. Recently, we have received an increasing 
number of questions about a number of hypothetical business 
arrangements between hospitals and other entities, including ASCs. We 
remind hospitals contemplating various business models that involve 
``incident to'' services provided to hospital outpatients to consider 
the requirements of Sec.  410.27. Under Sec.  410.27, ``incident to'' 
services that are provided to hospital outpatients must be furnished in 
the hospital or at a department of a provider as described in more 
detail earlier in our proposed technical update to Sec. Sec.  
410.27(a)(1)(iii) and (f).
    With regard to potential for ASCs to provide ``incident to'' 
services under arrangements with HOPDs, we note that the provider-based 
rules set forth at Sec.  413.65 do not apply to ASCs. In addition, our 
longstanding policy codified at Sec.  416.30(f) for ASCs operated by 
hospitals requires that ``the ASC participates and is paid only as an 
ASC, without the option of converting to or being paid as a hospital 
outpatient department, unless CMS determines there is good cause to do 
otherwise.'' We do not believe good cause exists such that a Medicare-
certified ASC would be able to provide ``incident to'' services under 
arrangement to hospital outpatients under Sec.  410.27. Section 410.27 
contains longstanding policy codified in the CY 2000 OPPS final rule 
with comment period and applies to all ``incident to'' services covered 
under section1861(s)(2)(B) of the Act. While the hypothetical example 
we discussed above involves ASCs providing services under arrangement 
to an HOPD, the provision of Sec.  410.27 applies more broadly to all 
``incident to'' services provided either directly or under arrangements 
made by the hospital with another entity.

B. Interrupted Procedures

    (If you choose to comment on issues in this section, please include 
the caption ``Interrupted Procedures'' at the beginning of your 
comment.)
    Currently, when a procedure is interrupted after its initiation or 
the administration of anesthesia, hospitals append modifier 74 
(Discontinued outpatient procedure after anesthesia administration) to 
the interrupted procedure, and the full OPPS payment for the procedure 
is made. In addition, when a procedure requiring anesthesia is 
discontinued after the beneficiary is prepared for the procedure and 
taken to the room where the procedure is to be performed, but before 
the administration of anesthesia, hospitals currently append modifier 
73 (Discontinued outpatient procedure prior to anesthesia 
administration) to the discontinued procedure and receive 50 percent of 
the OPPS payment for the planned procedure. Hospitals also report 
modifier 52 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. Under the OPPS, we 
apply a 50-percent reduction to the facility payment for interrupted 
procedures and services reported with modifier 52.
    We are proposing to amend Sec.  419.44 (Payment reductions for 
surgical procedures) to more accurately reflect the current OPPS 
payment policy for interrupted procedures. First, we are proposing to 
make a technical conforming change to the title of Sec.  419.44 by 
removing the word ``surgical,'' in order to encompass all the 
procedures performed in HOPDs. Second, we are proposing to change the 
heading of Sec.  419.44(b) from ``Terminated procedures'' to 
``Interrupted procedures.'' We are proposing to make further technical 
conforming changes to paragraphs (b)(1) and (b)(2) by removing the 
words ``surgical'' to encompass all the procedures performed in HOPDs. 
Finally, we are proposing to add a new paragraph (b)(3) to reflect the 
current policy of the application of a 50-percent reduction to the OPPS 
payment when a hospital reports modifier 52 for interrupted or 
discontinued services that do not require anesthesia.

C. Transitional Adjustments--Hold Harmless Provisions

    (If you choose to comment on issues in this section, please include 
the caption ``Transitional Adjustments--Hold Harmless:'' at the 
beginning of your comment.)
    Section 419.70(d) of the regulations relating to transitional 
adjustments to payments for covered outpatient services furnished by 
small rural hospitals and SCHs located in rural areas contains two 
outdated cross-references to Sec.  412.63(b) (the definition of a 
hospital located in a ``rural area''). Several years ago, we made Sec.  
412.63 applicable from FY 1984 through FY 2004 and established a new 
Sec.  412.64, effective for FY 2005 and subsequent fiscal years, to 
incorporate provisions to reflect our adoption of OMB's revised CBSAs 
as geographic area applicable under Medicare. We are proposing to make 
a technical correction to the regulations by replacing the cross-
reference to Sec.  412.63(b) in Sec. Sec.  419.70(d)(1)(i), (d)(2)(i), 
and (d)(4)(ii) with the more current applicable cross-reference to 
Sec.  412.64(b).

D. Reporting of Wound Care Services

    (If you choose to comment on issues in this section, please include 
the caption ``Wound Care Services'' at the beginning of your comment.)
    Section 1834(k) of the Act, as added by section 4541 of the BBA, 
requires payment under a prospective payment system for all outpatient 
therapy services, that is, physical therapy services, speech-language 
pathology services, and occupational therapy services. As provided 
under section 1834(k)(5) of the Act, we created a therapy code list 
based on a uniform coding system (that is, the HCPCS) to identify and 
track these outpatient therapy services paid under the MPFS. We provide 
this list of therapy codes along with their respective designation in 
the Medicare Claims Processing Manual Pub. 100-04, Chapter 5, section 
20. Two of the designations that we use in that manual denote whether 
the listed therapy code is an ``always therapy'' service or a 
``sometimes therapy'' service. We define an ``always

[[Page 42773]]

therapy'' service as a service that must be performed by a qualified 
therapist under a certified therapy plan of care, and a ``sometimes 
therapy'' service as a service that may be performed by an individual 
outside of a certified therapy plan of care.
    In the CY 2006 OPPS final rule with comment period (70 FR 68617), 
we stated that the following CPT codes were classified as ``sometimes 
therapy'' services that may be appropriately provided under either a 
certified therapy plan of care or without a certified therapy plan of 
care: 97597 (Removal of devitalized tissue from wound(s), selective 
debridement, without anesthesia (eg, high pressure waterjet with/
without suction, sharp selective debridement with scissors, scalpel and 
forceps) with or without topical application(s) for ongoing care, may 
include use of a whirlpool, per session; total wound(s) surface area 
less than or equal to 20 square centimeters); 97598 (Removal of 
devitalized tissue from wound(s), selective debridement, without 
anesthesia (eg, high pressure waterjet with/without suction, sharp 
selective debridement with scissors, scalpel and forceps) with or 
without topical application(s) for ongoing care, may include use of a 
whirlpool, per session; total wound(s) surface area greater than 20 
square centimeters); 97602 (Removal of revitalized tissue from 
wound(s), non-selective debridement, without anesthesia (eg, wet-to-
moist dressings, enzymatic, abrasion) including topical application(s), 
wound assessment, and instruction(s) for ongoing care, per session), 
97605 (Negative pressure wound therapy (eg, vacuum assisted drainage 
collection), including topical application(s), wound assessment, and 
instruction(s) for ongoing care, per session; total wound(s) surface 
area less than or equal to 50 square centimeters); and 97606 (Negative 
pressure wound therapy (eg, vacuum assisted drainage collection), 
including topical application(s), wound assessment, and instruction(s) 
for ongoing care, per session; total wound(s) surface area greater than 
50 square centimeters). We further stated that hospitals would receive 
separate payment under the OPPS when they bill for wound care services 
described by CPT codes 97597, 97598, 97602, 97605, and 97606 that are 
furnished to hospital outpatients by individuals independent of a 
therapy plan of care. In contrast, when such services are performed by 
a qualified therapist under a certified therapy plan of care, providers 
should attach an appropriate therapy modifier (that is, GP for physical 
therapy, GO for occupational therapy, and GN for speech language 
pathology) or report their charges under a therapy revenue code (that 
is, 0420, 0430, or 0440), or both, to receive payment under the MPFS. 
The OCE logic assigns these services to the appropriate APC for payment 
under the OPPS if the services are not provided under a certified 
therapy plan of care, or will direct contractors to the MPFS 
established payment rates if the services are identified on hospital 
claims with a therapy modifier or therapy revenue code as therapy 
services.
    For CY 2008, we are proposing to revise the list of therapy revenue 
codes that may be reported with CPT codes 97597, 97598, 97602, 97605, 
and 97606 to designate them as services that are performed by a 
qualified therapist under a certified therapy plan of care, and thus 
payable under the MPFS, to be consistent with the current billing 
practices of hospitals and to ensure that we are making separate 
payment under the OPPS only in appropriate situations. We are proposing 
to revise the list of therapy revenue codes for reporting these five 
CPT wound care codes as therapy services to include all revenue codes 
in the 042X series, which incorporates all revenue codes that begin 
with 042, such as 0420, 0421, 0422, 0423, 0424, and 0429; the 043X 
series, which includes all revenue codes that begin with 043, such as 
0430, 0431, 0432, 0434, and 0439; and the 044X series, which includes 
all revenue codes that begin with 044, such as 0440, 0441, 0442, 0443, 
0444, and 0449. Therefore, for CY 2008 we are proposing that when 
services reported with CPT codes 97597, 97598, 97602, 97605, and 97606 
are performed by a qualified therapist under a certified therapy plan 
of care, providers should attach an appropriate therapy modifier (that 
is, GP for physical therapy, GO for occupational therapy, and GN for 
speech-language pathology) or report their charge under a therapy 
revenue code (that is, 042X, 043X, or 044X), or both, to receive 
payment under the MPFS. Under other circumstances, hospitals would 
receive separate payment under the OPPS when they bill for wound care 
services described by CPT codes 97597, 97598, 97602, 97605, and 97606 
that are furnished to hospital outpatients by individuals independent 
of a certified therapy plan of care.

E. Reporting of Cardiac Rehabilitation Services

    (If you choose to comment on issues in this section, please include 
the caption ``Cardiac Rehabilitation Services'' at the beginning of 
your comment.)
    Since the initiation of the OPPS, Medicare has paid for cardiac 
rehabilitation services in HOPDs using CPT code 93797 (Physician 
services for outpatient cardiac rehabilitation, without continuous ECG 
monitoring (per session)) and CPT code 93798 (Physician services for 
outpatient cardiac rehabilitation, with continuous ECG monitoring (per 
session)). Both codes are assigned to status indicator ``S'' and are 
currently mapped to APC 0095 (Cardiac Rehabilitation) for payment.
    For CY 2008, we are proposing to discontinue recognizing the 
current CPT codes for cardiac rehabilitation services and to establish 
two new Level II HCPCS codes that we believe are more appropriate for 
specifically reporting cardiac rehabilitation services under the OPPS. 
The proposed HCPCS codes are: GXXX1 (Physician services for outpatient 
cardiac rehabilitation; without continuous ECG monitoring (per hour)) 
and GXXX2 (Physician services for outpatient cardiac rehabilitation; 
with continuous ECG monitoring (per hour)). In contrast with the 
current CPT codes, we believe the descriptors of these proposed G-codes 
more specifically reflect the way cardiac rehabilitation services are 
provided in HOPDs so that reporting would be more straightforward for 
hospitals and would result in more accurate data for OPPS ratesetting 
in 2 years. Consistent with the current APC assignments of the cardiac 
rehabilitation CPT codes, we are proposing to assign these new HCPCS 
codes to APC 0095 for CY 2008, with a status indicator of ``S.'' 
Accordingly, we are proposing to change the status indicators for CPT 
codes 93797 and 93798 from ``S'' to ``B'' to indicate that alternative 
codes (GXXX1 and GXXX2) for cardiac rehabilitation services are 
recognized for payment under the OPPS.

F. Reporting of Bone Marrow and Stem Cell Processing Services

    (If you choose to comment on issues in this section, please include 
the caption ``Bone Marrow and Stem Cell Processing Services'' at the 
beginning of your comment.)
    The OPPS currently recognizes HCPCS code G0267 (Bone marrow or 
peripheral stem cell harvest, modification or treatment to eliminate 
cell type(s)) for depletion services for hematopoietic progenitor 
cells, instead of the more specific CPT codes that describe these 
services, including CPT codes 38210 (Transplant preparation of 
hematopoietic progenitor cells; specific

[[Page 42774]]

cell depletion within harvest, T-cell depletion); 38211 (Transplant 
preparation of hematopoietic progenitor cells; tumor cell depletion); 
38212 (Transplant preparation of hematopoietic progenitor cells; red 
blood cell removal); 38213 (Transplant preparation of hematopoietic 
progenitor cells; platelet depletion); 38214 (Transplant preparation of 
hematopoietic progenitor cells; plasma (volume) depletion); and 38215 
(Transplant preparation of hematopoietic progenitor cells; cell 
concentration in plasma, mononuclear, of buffy coat layer). These six 
CPT codes are currently assigned to status indicator ``B,'' while HCPCS 
code G0267 is assigned to APC 0110 (Transfusion) for payment, with a 
status indicator of ``S.''
    For CY 2008, we are proposing to continue to assign the historical 
claims data for HCPCS code G0267 to APC 0110. In addition, we are 
proposing to discontinue recognizing HCPCS code G0267 for CY 2008, 
assigning it to status indicator ``B,'' and to recognize the six more 
specific CPT codes, which we are proposing to also assign to APC 0110 
with a status indicator of ``S.'' Historically, under the OPPS we 
recognized the single G-code rather than the CPT codes for the 
individual transplant cell preparation services because we believed 
that the services would be uncommonly provided to Medicare 
beneficiaries in the outpatient setting and would likely require 
similar resources, so that distinguishing among the services would not 
be necessary to ensure appropriate OPPS payment. Stakeholders have 
brought to our attention that the current hospital resources associated 
with the six different bone marrow and stem cell processing procedures 
described by these CPT codes may vary widely. While we recognize that 
the services currently reported with G0267 under the OPPS are not 
common HOPD procedures, the total volume of these procedures has been 
increasing over the past several years. Therefore, we believe that 
recognizing these six CPT codes for bone marrow and stem cell 
processing services would yield more specific claims data and enable us 
to pay more appropriately for these services in the future. Consistent 
with our general OPPS practice, we are proposing to assign the newly 
recognized CPT codes to the clinical APC that is most appropriate based 
on historical claims data for the predecessor HCPCS code until we have 
more specific hospital resource data available to assess the specific 
CPT codes for possible reassignment.
    In addition, we are proposing to discontinue recognition of HCPCS 
code G0265 (Cyropreservation, freezing and storage of cells for 
therapeutic use) and G0266 (Thawing and expansion of frozen cells for 
therapeutic use), currently assigned to status indicator ``A'' under 
the OPPS and paid according to the Medicare Clinical Laboratory Fee 
Schedule (CLFS), by assigning them to status indicator ``B'' for CY 
2008. We are proposing to recognize, instead, CPT codes 38207 
(Transplant preparation of hematopoietic progenitor cells; 
cryopreservation and storage); 38208 (Transplant preparation of 
hematopoietic progenitor cells; thawing of previously frozen harvest, 
without washing); and 38209 (Transplant preparation of hematopoietic 
progenitor cells; thawing of previously frozen harvest, with washing) 
for payment under the OPPS because we believe they are similar to blood 
processing services that are currently paid under the OPPS, not under 
the CLFS. We are proposing to assign the single cryopreservation and 
two thawing CPT codes to APC 0344 (Level IV Pathology) based on their 
clinical characteristics and resource costs from historical hospital 
claims data for HCPCS codes G0265 and G0266, which would have been 
assigned to the same clinical APC if they were paid under the OPPS. 
Although HCPCS code G0265 and G0266 have not historically been paid 
under the OPPS, we have a small number of HOPD single claims from CY 
2006 for these two predecessor HCPCS codes (when they were paid off the 
CLFS), respectively, and similar laboratory tissue cryopreservation and 
thawing services also are proposed for assignment to APC 0344 under the 
CY 2008 OPPS. We believe this proposal would allow us to pay 
appropriately for all of these bone marrow and stem cell processing 
services and to collect more specific hospital resource data.

XIV. Proposed OPPS Payment Status and Comment Indicators

A. Proposed Payment Status Indicator Definitions

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Status Indicators'' at the beginning of your 
comment.)
    The OPPS payment status indicators (SIs) that we assign to HCPCS 
codes and APCs play an important role in determining payment for 
services under the OPPS. They indicate whether a service represented by 
a HCPCS code is payable under the OPPS or another payment system and 
also whether particular OPPS policies apply to the code. Our proposed 
CY 2008 status indicator assignments for APCs and HCPCS codes are shown 
in Addendum A and Addendum B, respectively, to this proposed rule. We 
are proposing to use the status indicators and definitions that are 
listed in Addendum D1, which we discuss below in greater detail.
1. Proposed Payment Status Indicators to Designate Services That Are 
Paid under the OPPS

 
------------------------------------------------------------------------
                                                         OPPS payment
            Indicator              Item/code/service        status
------------------------------------------------------------------------
G...............................  Pass-Through Drugs  Paid under OPPS;
                                   and Biologicals.    Separate APC
                                                       payment includes
                                                       pass through
                                                       amount.
H...............................  Pass-Through        Separate cost-
                                   Device Categories.  based pass-
                                                       through payment;
                                                       Not subject to
                                                       coinsurance.
K...............................  (1) Non-Pass-       (1) Paid under
                                   Through Drugs and   OPPS; Separate
                                   Biologicals.        APC payment.
                                  (2) Therapeutic     (2) Paid under
                                   Radiopharmaceutic   OPPS; Separate
                                   als.                APC payment.
                                  (3) Brachytherapy   (3) Paid under
                                   Sources.            OPPS; Separate
                                                       APC payment.
                                  (4) Blood and       (4) Paid under
                                   Blood Products.     OPPS; Separate
                                                       APC payment.
N...............................  Items and Services  Paid under OPPS;
                                   Packaged into APC   Payment is
                                   Rates.              packaged into
                                                       payment for other
                                                       services,
                                                       including
                                                       outliers.
                                                       Therefore, there
                                                       is no separate
                                                       APC payment.
P...............................  Partial             Paid under OPPS;
                                   Hospitalization.    Per diem APC
                                                       payment.

[[Page 42775]]

 
Q...............................  Packaged Services   Paid under OPPS;
                                   Subject to          Addendum B
                                   Separate Payment    displays APC
                                   Under OPPS          assignments when
                                   Payment Criteria..  services are
                                                       separately
                                                       payable.
                                                      (1) Separate APC
                                                       payment based on
                                                       OPPS payment
                                                       criteria.
                                                      (2) If criteria
                                                       are not met,
                                                       payment is
                                                       packaged into
                                                       payment for other
                                                       services,
                                                       including
                                                       outliers.
                                                       Therefore, there
                                                       is no separate
                                                       APC payment.
S...............................  Significant         Paid under OPPS;
                                   Procedure, Not      Separate APC
                                   Discounted when     payment.
                                   Multiple.
T...............................  Significant         Paid under OPPS;
                                   Procedure,          Separate APC
                                   Multiple            payment.
                                   Reduction Applies.
V...............................  Clinic or           Paid under OPPS;
                                   Emergency           Separate APC
                                   Department Visit.   payment.
X...............................  Ancillary Services  Paid under OPPS;
                                                       Separate APC
                                                       payment.
------------------------------------------------------------------------

    As stated in section VII.A. of this proposed rule, subsequent to 
the publication of the CY 2007 OPPS/ASC final rule with comment period, 
section 107(a) of the MIEA TRHCA extended the payment period for 
brachytherapy sources paid under the OPPS based on a hospital's charges 
adjusted to cost under section 1833(t)(16)(C) of the Act for one 
additional year. This requirement for cost-based payment ends after 
December 31, 2007. Therefore, we have continued the OPPS cost-based 
payment for brachytherapy sources through CY 2007, and have continued 
using status indicator ``H'' to designate nonpass-through brachytherapy 
sources paid on a cost basis.
    As discussed in section VII.B. of this proposed rule, we are 
proposing to implement prospective payment for brachytherapy sources 
paid under the OPPS in CY 2008. In accordance with this proposal, we 
also are proposing to discontinue our use of payment status indicator 
``H'' for APCs assigned to brachytherapy sources. As indicated in 
section VII.B. of this proposed rule for CY 2008, we are proposing to 
use payment status indicator ``K'' to designate all brachytherapy 
source APCs that will be paid under the OPPS.
    As discussed in section V.B.3.a.(4) of this proposed rule, we are 
proposing to implement prospective payment for separately payable 
therapeutic radiopharmaceuticals under the OPPS in CY 2008. In 
accordance with this proposal, we also are proposing to discontinue our 
use of payment status indicator ``H'' for APCs assigned to separately 
payable therapeutic radiopharmaceuticals. For CY 2008, we are proposing 
to use payment status indicator ``K'' to designate separately payable 
therapeutic radiopharmaceuticals that will be paid under the OPPS.
2. Proposed Payment Status Indicators to Designate Services That Are 
Paid Under a Payment System Other Than the OPPS

----------------------------------------------------------------------------------------------------------------
        Indicator                       Item/code/service                         OPPS Payment Status
----------------------------------------------------------------------------------------------------------------
A........................  Services furnished to a hospital            Not paid under OPPS. Paid by fiscal
                            outpatient that are paid under a fee        intermediaries under a fee schedule or
                            schedule or payment system other than       payment system other than OPPS.
                            OPPS, for example:
                           <bullet> Ambulance Services                 .........................................
                           <bullet> Clinical Diagnostic Laboratory     .........................................
                            Services
                           <bullet> Non-Implantable Prosthetic and     .........................................
                            Orthotic Devices
                           <bullet> EPO for ESRD Patients              .........................................
                           <bullet> Physical, Occupational, and        .........................................
                            Speech Therapy
                           <bullet> Routine Dialysis Services for      .........................................
                            ESRD Patients Provided in a Certified
                            Dialysis Unit of a Hospital
                           <bullet> Diagnostic Mammography             .........................................
                           <bullet> Screening Mammography              .........................................
C........................  Inpatient Procedures......................  Not paid under OPPS. Admit patient. Bill
                                                                        as inpatient.
F........................  Corneal Tissue Acquisition; Certain CRNA    Not paid under OPPS. Paid at reasonable
                            Services; and Hepatitis B Vaccines.         cost.
L........................  Influenza Vaccine; Pneumococcal Pneumonia   Not paid under OPPS. Paid at reasonable
                            Vaccine.                                    cost; Not subject to deductible or
                                                                        coinsurance.
M........................  Items and Services Not Billable to the      Not paid under OPPS.
                            Fiscal Intermediary.
Y........................  Non-Implantable Durable Medical Equipment.  Not paid under OPPS. All institutional
                                                                        providers other than home health
                                                                        agencies bill to DMERC.
----------------------------------------------------------------------------------------------------------------

3. Proposed Payment Status Indicators to Designate Services That Are 
Not Recognized Under the OPPS But That May Be Recognized by Other 
Institutional Providers

[[Page 42776]]



----------------------------------------------------------------------------------------------------------------
        Indicator                       Item/code/service                         OPPS Payment Status
----------------------------------------------------------------------------------------------------------------
B........................  Codes that are not recognized by OPPS when  Not paid under OPPS.
                            submitted on an outpatient hospital Part   <bullet> May be paid by intermediaries
                            B bill type (12x and13x).                   when submitted on a different bill type,
                                                                        for example, 75x (CORF), but not paid
                                                                        under OPPS.
                                                                       <bullet> An alternate code that is
                                                                        recognized by OPPS when submitted on an
                                                                        outpatient hospital Part B bill type
                                                                        (12x and 13x) may be available.
----------------------------------------------------------------------------------------------------------------

4. Proposed Payment Status Indicators to Designate Services That Are 
Not Payable by Medicare

----------------------------------------------------------------------------------------------------------------
        Indicator                       Item/code/service                         OPPS Payment Status
----------------------------------------------------------------------------------------------------------------
D........................  Discontinued Codes........................  Not paid under OPPS or any other Medicare
                                                                        payment system.
E........................  Items, Codes, and Services:...............  Not paid under OPPS or any other Medicare
                                                                        payment system.
                           <bullet> That are not covered by Medicare
                            based on statutory exclusion
                           <bullet> That are not covered by Medicare
                            for reasons other than statutory
                            exclusion
                           <bullet> That are not recognized by
                            Medicare but for which an alternate code
                            for the same item or service may be
                            available
                           <bullet> For which separate payment is not
                            provided by Medicare
----------------------------------------------------------------------------------------------------------------

    To address providers' broader interests and to make the published 
Addendum B more convenient for public use, we are displaying in 
Addendum B to this proposed rule all active HCPCS codes that describe 
items or services that are: (1) Payable under the OPPS; (2) paid under 
a payment system other than the OPPS; (3) not recognized under the OPPS 
but that may be recognized by other institutional providers; and (4) 
not payable by Medicare. The status indicators that we are proposing 
for CY 2008 for these items and services are listed in the tables 
above.
    A complete listing of HCPCS codes with proposed payment status 
indicators and APC assignments for CY 2008 is also available 
electronically on the CMS Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp#TopOfPage.

B. Proposed Comment Indicator Definitions

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Comment Indicators'' at the beginning of your 
comment.)
    In the November 15, 2004 final rule with comment period (69 FR 
65827 and 65828), we made final our policy to use two comment 
indicators to identify in an OPPS final rule the assignment status of a 
specific HCPCS code to an APC and the timeframe when comments on the 
HCPCS APC assignment would be accepted. These two comment indicators 
are listed below.
    <bullet> ``NF''--New code, final APC assignment; Comments were 
accepted on a proposed APC assignment in the Proposed Rule; APC 
assignment is no longer open to comment.
    <bullet> ``NI''--New code, interim APC assignment; Comments will be 
accepted on the interim APC assignment for the new code.
    In the November 10, 2005 final rule with comment period (70 FR 
68702 and 68703), we adopted a new comment indicator:
    <bullet> ``CH''--Active HCPCS codes in current and next calendar 
year; status indicator and/or APC assignment have changed.
    We implemented comment indicator ``CH'' to designate a change in 
payment status indicator and/or APC assignment for HCPCS codes in 
Addendum B of the CY 2006 final rule with comment period. We also 
stated that codes flagged with the ``CH'' indicator in that final rule 
would not be open to comment because the changes generally were 
previously subject to comment during the proposed rule comment period. 
For CY 2008, we are proposing to continue that policy in the CY 2008 
OPPS/ASC final rule with comment period. When used in an OPPS final 
rule, the ``CH'' indicator is only intended to facilitate the public's 
review of changes made from one calendar year to another. We are 
proposing to use the ``CH'' indicator in the CY 2008 OPPS/ASC final 
rule with comment period to indicate HCPCS codes for which the status 
indicator or APC assignment, or both, would change in CY 2008 compared 
to their assignment as of December 31, 2007.
    However, only HCPCS codes with comment indicator ``NI'' in the CY 
2008 OPPS/ASC final rule with comment period would be subject to 
comment during the comment period for the final rule with comment 
period.
    We are using the ``CH'' indicator in this proposed rule to call 
attention to proposed changes in the payment status indicator and/or 
APC assignment for HCPCS codes for CY 2008. The use of the comment 
indicator ``CH'' in association with a composite APC indicates that the 
configuration of the composite APC is proposed for change in this 
proposed rule.
    In this proposed rule, the ``CH'' indicator is appended to HCPCS 
codes for which we have proposed changes in the payment status 
indicator and/or APC assignment for CY 2008 compared to their 
assignment as of June 30, 2007. We believe that using the ``CH'' 
indicator in this proposed rule will facilitate the public's review of 
the changes that we are proposing to make final in CY 2008. Use of the 
``CH'' indicator in this proposed rule is significant because it 
highlights changes that are subject to comment during the proposed rule 
comment period.
    We are proposing to terminate comment indicator ``NF'' because its 
use is no longer relevant in the final rule(s). The two comment 
indicators, ``NI'' and ``CH,'' that we are proposing to continue using 
in CY 2008 and their definitions are listed in Addendum D2 to this 
proposed rule.

[[Page 42777]]

XV. OPPS Policy and Payment Recommendations

A. MedPAC Recommendations

    The MedPAC submits reports to Congress in March and June that 
summarize payment policy recommendations. The March 2007 MedPAC report 
included the following recommendation relating specifically to the 
hospital OPPS:
    Recommendation 2A-1: The Congress should increase payment rates for 
the outpatient prospective payment system in 2008 by the projected 
rate-of-increase in the hospital market basket index, concurrent with 
the implementation of a quality incentive payment program.
    CMS Response: We are proposing to increase the payment rates for 
the CY 2008 OPPS by the projected rate-of-increase in the hospital 
market basket index (as discussed in section II.C. of this proposed 
rule) and to implement, effective for CY 2009, the reduction in the 
annual update factor by 2.0 percentage points for subsection (d) 
hospitals that do not meet the outpatient hospital quality reporting 
required by section 1833(t)(17) of the Act, as added by section 109(b) 
of the MIEA-TRHCA. Our proposal for implementing the hospital quality 
reporting measures for the CY 2008 OPPS is discussed in detail in 
section XVII. of this proposed rule.

B. APC Panel Recommendations

    Recommendations made by the APC Panel at its March 2007 meeting are 
discussed in sections of this proposed rule that correspond to topics 
addressed by the APC Panel. Minutes of the APC Panel's March 7-9, 2007 
meeting are available on the CMS Web site at: http://www.cms.hhs.gov/FACA/05_AdvisoryPanelonAmbulatoryPaymentClassification Groups.asp.

XVI. Proposed Update of the Revised Ambulatory Surgical Center Payment 
System

A. Legislative and Regulatory Authority for the ASC Payment System

    Section 1832(a)(2)(F)(i) of the Act provides that benefits under 
the Medicare Part B include payment for facility services furnished in 
connection with surgical procedures specified by the Secretary that are 
performed in an 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.
    To establish the reasonable estimated allowances for ASC facility 
services, section 1833(i)(2)(A)(i) of the Act required us to take into 
account the audited costs incurred by ASCs to perform a procedure, in 
accordance with a survey. 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 141(b) of the Social Security Act Amendments of 1994, Pub. 
L. 103-432, requires us to establish a process for reviewing the 
appropriateness of the payment amount provided under section 
1833(i)(2)(A)(iii) of the Act for intraocular lenses (IOLs) that belong 
to a class of new technology intraocular lenses (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).
    Section 626(b) of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003, Pub. L. 108-173, repealed the requirement 
formerly found in section 1833(i)(2)(A) of the Act that the Secretary 
conduct a survey of ASC costs for purposes of updating ASC payment 
rates and required the Secretary to implement a revised ASC payment 
system, to be effective not later than January 1, 2008.
    Section 5103 of the DRA, Pub. L. 109-171, amended section 
1833(i)(2) of the Act by adding a new subparagraph (E) to place a 
limitation on payments for surgical procedures in ASCs. The amended 
language provides that if the standard overhead amount under section 
1833(i)(2)(A) of the Act for an ASC facility service for such surgical 
procedures, without application of any geographic adjustment, exceeds 
the Medicare payment amount under the hospital 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 (see the final rule for the 
revised ASC payment system published elsewhere in this issue of the 
Federal Register).
    Section 109(b) of the MIEA-TRHCA, Pub. L.109-432, amended section 
1833(i) of the Act, in part, by adding new clause (iv) to paragraph 
(2)(D) and by also adding new paragraph (7)(A), which provides that the 
Secretary may reduce the annual ASC update by 2 percentage points if an 
ASC fails to submit data as required by the Secretary on selected 
measures of quality of care, including medication errors. Section 
109(b) of MIEA-TRCHA requires that certain quality of care reporting 
requirements mandated for hospitals paid under the OPPS by section 
109(a) of the MIEA-TRCHA be applied in a similar manner to ASCs unless 
otherwise specified by the Secretary. We refer readers to sections 
XVII.A. and H. of this proposed rule for further discussion of this 
provision and our plans for future ASC implementation

B. Rulemaking for the Revised ASC Payment System

    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 Pub. L. 108-173. 
The proposal included, among other things, revisions to the ASC list of 
covered surgical procedures for CY 2008 and the payment methodology for 
the items and services furnished by the ASC.
    We are publishing elsewhere in this issue of the Federal Register 
the final rule for the revised ASC payment system, effective January 1, 
2008, hereinafter referred to as the July 2007 final rule for the 
revised ASC payment system. In that final rule, we established that we 
would address two components of the ASC payment system annually as part 
of the OPPS rulemaking cycle. 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, CAH, or 
an HOPD and to review and update the list of ASC procedures at least 
every 2 years.
    In the July 2007 final rule for the revised ASC payment system, we 
also adopted the method we will use to set payment rates for ASC 
services furnished in association with covered surgical procedures. 
Updating covered surgical procedures and covered ancillary services, as 
well as their payment rates, in association with the annual OPPS 
rulemaking cycle is particularly important because the OPPS relative 
payment weights and rates will be used as the basis for the payment of 
most covered surgical

[[Page 42778]]

procedures and covered ancillary services under the revised ASC payment 
system. This joint update process will ensure that the ASC updates 
occur in a regular, predictable, and timely manner. The final rule 
included applicable regulatory changes to 42 CFR Parts 410 and 416.
    In this CY 2008 OPPS/ASC proposed rule, we are proposing to update 
the revised ASC payment system for CY 2008, along with the OPPS. We are 
also proposing to revise the regulations to make practice expense 
payment to physicians who perform noncovered ASC procedures in ASCs 
based on the facility practice expense (PE) relative value units (RVUs) 
and to exclude covered ancillary radiology services and covered 
ancillary drugs and biologicals from the categories of designated 
health services (DHS) that are subject to the physician self-referral 
prohibition.

C. Revisions to the ASC Payment System Effective January 1, 2008

1. Covered Surgical Procedures Under the Revised ASC Payment System
a. Definition of Surgical Procedure
    In order to delineate the scope of procedures that constitute 
``outpatient surgical procedures'' for payment under the revised ASC 
payment system, in the July 2007 final rule for the revised ASC payment 
system, we clarified what we consider to be a ``surgical'' procedure. 
Under the ASC payment system existing through CY 2007, we define a 
surgical procedure as any procedure described within the range of 
Category I CPT codes that the CPT Editorial Panel of the AMA defines as 
``surgery'' (CPT codes 10000 through 69999). Under the revised payment 
system, we continue to define surgery using that standard. We also 
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 or are clinically similar to 
procedures in the CPT surgical range that we have determined do not 
pose a significant safety risk and that we would not expect to require 
an overnight stay when performed in ASCs. Having established what we 
consider to be a ``surgical procedure,'' we defined criteria that 
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.
b. Identification of Surgical Procedures Eligible for Payment Under the 
Revised ASC Payment System
    ASC ``covered surgical procedures'' are those surgical procedures 
for which payment is made under the revised ASC payment system. Our 
final policy for identifying surgical procedures eligible for ASC 
payment excludes those surgical procedures that are on the OPPS 
inpatient list, procedures that are packaged under the OPPS, CPT 
unlisted surgical procedure codes, and surgical procedures that are not 
recognized for payment under the OPPS. Further, we 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 (overnight 
stay), and all surgical procedures that could pose a significant safety 
risk to Medicare beneficiaries. The criteria used under the revised ASC 
payment system to identify procedures that could pose a significant 
safety risk when performed in an ASC include those 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; or commonly require systemic 
thrombolytic therapy. These criteria for evaluating surgical procedures 
are set forth in Sec.  416.166(c).
c. Payment for Covered Surgical Procedures Under the Revised ASC 
Payment System
(1) General Policies
    To make payment for most covered surgical procedures, we utilize 
the OPPS 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, by applying a uniform 
ASC conversion factor to the ASC payment weights. For the first year of 
the revised ASC payment system, we adopted the OPPS relative payment 
weights as the ASC relative payment weights for most covered surgical 
procedures.
    For future years, we will update the ASC relative payment weights 
annually using the 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 amounts are less than the rates 
calculated under the standard methodology of the revised ASC payment 
system.
    Just as we scale the OPPS relative payment weights each year to 
ensure that the OPPS is budget neutral from one year to the next, we 
will rescale relative weights each year for the revised ASC payment 
system. The purpose of scaling the relative weights is to ensure that 
the estimated aggregate payments under the ASC 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. 
Rescaling enables us to compensate for the effects of changes in the 
OPPS relative payment weights from year to year for services that are 
not performed in ASCs (for example, due to sudden increases or 
decreases in the costs of hospital outpatient emergency department 
visits) that could inappropriately cause the estimated ASC expenditures 
to increase or decrease as a function of those changes.
    To establish the budget neutrality adjustment for the revised ASC 
payment system, we used a model that accounts for the migration of 
surgical procedures between ASCs, physicians' offices, and HOPDs as 
discussed in the July 2007 final rule for the revised ASC payment 
system. The budget neutrality adjustment for CY 2008 is based on 
updated proposed CY 2008 OPPS and MPFS rates, along with updated 
utilization data. The estimated ASC CY 2008 budget neutrality 
adjustment factor is multiplied by the proposed OPPS conversion factor 
to establish the proposed ASC conversion factor. The standard ASC 
payment for most of the covered surgical procedures displayed in 
Addendum AA of this proposed rule is calculated as the product of that 
proposed ASC conversion factor multiplied by the proposed OPPS relative 
payment weight for each separately payable procedure. A more detailed 
discussion of the methodology is provided in section XVI.L. of this 
proposed rule.
    Beginning in CY 2010, we will update the ASC conversion factor for 
the revised ASC payment system 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

[[Page 42779]]

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.
(2) Office-Based Procedures
    Among the procedures newly identified as covered surgical 
procedures for payment in ASCs beginning in CY 2008 are many procedures 
that are performed most of the time in physicians' offices. These 
procedures neither pose a significant safety risk nor are they expected 
to require an overnight stay when performed in ASCs, and they generally 
require a lower level of resource intensity than do most other ASC 
covered surgical procedures. For those reasons, in the July 2007 final 
rule for the revised ASC payment system, we adopted a policy to include 
them as covered surgical procedures but to ensure that payment for the 
facility resources associated with the procedures identified as 
``office-based'' would not be greater when provided in ASCs than when 
furnished in physicians' offices.
    Under the revised ASC payment system, we cap payment for office-
based surgical procedures for which ASC payment would first be allowed 
beginning in CY 2008 or later years at the lesser of the MPFS 
nonfacility practice PE RVU 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 PE RVU amount, we will implement the cap, as appropriate, 
once a MPFS nonfacility PE RVU amount is available. Once procedures are 
finalized as being office-based procedures, they remain designated as 
office-based. We may propose that additional HCPCS codes be classified 
as office-based in a proposed rule for an annual ASC update after 
review of the most recent available utilization data. We consider for 
additional designation as office-based those procedures newly paid in 
ASCs in CY 2008 or later years that our review concludes are performed 
predominantly (more than 50 percent of the time) in physicians' 
offices, based on our consideration of volume and site of service 
utilization data for the procedures, as well as clinical information 
and comparable data for related procedures, if appropriate.
    Procedures designated as office-based for CY 2008 are identified in 
Addendum AA to this proposed rule and assigned payment indicators 
``P2'' (Office-based surgical procedures 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). 
Those procedures for which the designation as office-based is newly 
proposed for CY 2008 are identified in Addendum AA with comment 
indicator ``CH'' and those for which the payment indicator is a 
temporary designation are marked by an asterisk. The temporary 
designation means that the office-based payment indicator (``P2,'' `` 
P3,'' or ``R2'') assigned to the procedure is temporary because the 
code is a new HCPCS code for which we have insufficient data upon which 
to base a proposal for a final decision regarding the code's office-
based status. The temporary designation will be reevaluated by CMS when 
there are data upon which to base a proposal for a final payment 
indicator. The remainder of the office-based procedure designations was 
finalized in the July 2007 final rule for the revised ASC payment 
system.
(3) Device-Intensive Procedures
    Under the final policy of the revised ASC payment system, we use a 
modified payment methodology to establish the ASC payment rates for 
device-intensive procedures. We identify device-intensive procedures as 
covered surgical procedures that, under the OPPS, are assigned to those 
device-dependent APCs for which the ``device offset percentage'' is 
greater than 50 percent of the APC's median cost. The device offset 
percentage is our best estimate of the percentage of device cost that 
is included in an APC payment under the OPPS. The CY 2008 proposed 
device-dependent APCs and device offset percentages are discussed in 
section IV.A. of this proposed rule.
    According to the final ASC policy, payment for implantable devices 
is packaged into payment for the covered surgical procedures, but we 
utilize a modified ASC methodology based on OPPS data to establish 
payment rates for the device-intensive procedures under the revised ASC 
payment system. According to that modified payment methodology, we 
apply the OPPS device offset percentage to the OPPS national unadjusted 
payment to determine the device cost included in the OPPS payment rate 
for a device-intensive ASC covered surgical procedure, which we then 
set as equal to the device portion of the national unadjusted ASC 
payment rate for the procedure. We then calculate the service portion 
of the ASC payment for device-intensive procedures by applying the 
uniform ASC conversion factor to the service (nondevice) portion of the 
OPPS relative payment weight for the device-intensive procedure. 
Finally, we 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. For example, if the OPPS device offset 
percentage for the procedure is 80 percent and the OPPS national 
unadjusted payment is $100, the device cost included in that payment is 
$80. Under the ASC payment system, we also would pay $80 for the device 
portion of the procedure but the service portion of the OPPS payment, 
$20, would be adjusted by the budget neutrality adjustment factor (for 
example, using the proposed budget neutrality factor, the calculation 
would be: $20 x 0.65 = $13) and, if it is subject to the transition (as 
set forth in section XVI.C.1.c.(5) of this proposed rule), it would 
also be adjusted accordingly. If the procedure in the example is not 
subject to the transition, its CY 2008 payment would be equal to $93 
($80 + $13). This example illustrates the contributions of the device 
and service payment amounts to the national unadjusted ASC payment 
rate; payment to an ASC for the device-intensive service would be 
subject to the 50 percent geographic adjustment.
    We also 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. A full discussion of that policy may be found in section 
XVI.F. of this proposed rule.
(4) Multiple and Interrupted Procedure Discounting
    Under the revised ASC payment system, we discount payment for 
certain multiple and interrupted procedures performed in ASCs. While 
most covered surgical procedures will be subject to a 50-percent 
reduction in ASC payment for the lower paying procedure when more than 
one procedure is performed in a single operative session, those covered 
surgical procedures that we are proposing to exempt from the multiple 
procedure reduction in ASCs because they are proposed to not be subject 
to this reduction under the OPPS are identified in Addendum AA to this

[[Page 42780]]

proposed rule. 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. Procedures requiring 
anesthesia that are terminated after administration of anesthesia or 
initiation of the procedure will be reported with modifier 74, and the 
ASC payment for the covered surgical procedure will be made at 100 
percent of the established payment rate. Procedures and services not 
requiring anesthesia that are partially reduced or discontinued at the 
physician's discretion are reported with modifier 52, and the ASC 
payment for the covered surgical procedure or covered ancillary service 
is reduced by 50 percent.
(5) Transition to Revised ASC Payment Rates
    Under the revised ASC payment system, we are providing a payment 
transition of 4 years for all services on the CY 2007 ASC list of 
covered surgical procedures. Beginning in CY 2008, 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 revised ASC 
payment rates calculated under the final methodology of the revised 
payment system. While we do not subject the device payment portion of 
the total ASC payment for a device-intensive procedure to the 
transition policy, we transition the service payment portion of the 
total ASC payment for the procedure over the 4 year phase-in period. 
Procedures new to ASC payment for CY 2008 or later calendar years 
receive payments determined according to the final methodology of the 
revised ASC payment system, without a transition.
    ASC covered surgical procedures listed in Addendum AA to this 
proposed rule that are subject to the transition are assigned 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 proposed rule that 
are not subject to the transition are assigned payment indicators 
``G2'' (Nonoffice-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).
2. Covered Ancillary Services Under the Revised ASC Payment System
a. General Policies
    As described in Sec.  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 Sec.  416.2, ASC services 
include both facility services, which are defined as 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.
    Under the final policy of the revised ASC payment system, covered 
ancillary services are allowed separate payment. Covered ancillary 
services are defined at Sec.  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.
    We continue to consider to be outside the scope of ASC services, as 
set forth in Sec.  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.
b. Payment Policies for Specific Items and Services
(1) Radiology Services
    Under the revised ASC payment system, we make separate payment to 
ASCs for ancillary radiology services designated as separately payable 
under the OPPS, when those radiology services are provided in the ASC 
integral to the performance of a covered surgical procedure provided on 
the same day. ASC payment for those ancillary services is at the lower 
of the rate developed according to the standard methodology of the 
revised ASC payment system or the MPFS nonfacility PE RVU amount 
(specifically for the technical component (TC) if the service is 
assigned a TC under the MPFS). No separate payment is made for those 
ancillary services that are designated as packaged 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. Payment under the revised ASC payment system for these 
ancillary radiology services is subject to geographic adjustment, like 
payment for ASC surgical procedures. Only the ASC can receive payment 
for the facility resources required to provide the ancillary radiology 
services, and ASCs are no longer able to bill as independent diagnostic 
testing facility (IDTF) suppliers 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. Because the 
packaging status of radiology services under the revised ASC payment 
system parallels the OPPS, any changes to the packaging of radiology 
services under the OPPS would also occur under the revised ASC payment 
system.
    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 applies to all radiology services that are 
separately

[[Page 42781]]

payable under the OPPS in that same calendar year. A listing that 
includes all radiology services that we are proposing for separate 
payment under the CY 2008 ASC payment system because they would be 
separately payable under the proposed CY 2008 OPPS may be found in 
Addendum BB to this proposed rule. Separately paid radiology services 
are assigned 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 surgical procedure 
on ASC list; payment based on MPFS nonfacility PE RVUs). Payment for 
ancillary radiology services that are packaged under the OPPS is 
packaged under the revised ASC payment system, and these services are 
identified in Addendum BB to this proposed rule with payment indicator 
``N1'' (Packaged service/item; no separate payment made). ASC payment 
for these radiology services is not subject to the 4-year transition.
(2) Brachytherapy Sources
    Under the revised ASC payment system, we provide separate payment 
to ASCs for brachytherapy sources as covered ancillary services when 
they are implanted in conjunction with covered surgical procedures 
billed by ASCs. The application of the brachytherapy sources is 
integrally related to the surgical procedures for insertion of 
brachytherapy needles and catheters. 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 specifically do not include payment 
for brachytherapy sources. The ASC brachytherapy source payment rate 
for a given calendar year is the same as the OPPS payment rate for that 
year, without application of the ASC budget neutrality adjustment or, 
if specific OPPS prospective payment rates are unavailable, ASC 
payments for brachytherapy sources are contractor-priced. In addition, 
consistent with the payment of brachytherapy sources under the OPPS, 
the ASC payment rates for brachytherapy sources are not adjusted for 
geographic wage differences. Some Level II HCPCS codes and their 
proposed payment rates for brachytherapy sources for the CY 2008 
revised ASC payment system, the same as those proposed for the CY 2008 
OPPS, are included in Addendum BB to this proposed rule. Brachytherapy 
sources are assigned payment indicator ``H2'' (Brachytherapy source 
paid separately when provided integral to a surgical procedure on ASC 
list; payment based on OPPS rate). We note that the brachytherapy 
source payment indicator has changed for this proposed rule from the 
July 2007 final rule for the revised ASC payment system, in which 
sources were designated with payment indicator H4, defined as 
``Brachytherapy source paid separately when provided integral to a 
surgical procedure on ASC list; payment contractor-priced.'' During CY 
2007, brachytherapy source payment is made under the OPPS, according to 
the statute, at charges adjusted to cost. In order to be consistent 
with that OPPS policy under the revised ASC payment system, our policy 
is to pay for brachytherapy sources under the revised ASC payment 
system using contractor-based pricing because we have no CCR data for 
ASCs that would enable us to pay at charges adjusted to cost like we do 
under the OPPS. However, the CY 2008 proposal for OPPS payment of 
brachytherapy sources, as described in section VII. of this proposed 
rule, proposes payment at prospective rates calculated from historical 
claims data and, therefore, the proposed ASC payment for brachytherapy 
sources would be at those same rates. The HCPCS codes for all 
brachytherapy sources and their proposed ASC payment amounts and ASC 
payment indicators are listed in Table 57 below.

                 Table 57.--Proposed CY 2008 Payments for Brachytherapy Sources Provided in ASCs
----------------------------------------------------------------------------------------------------------------
                                                                                                   Proposed  CY
             HCPCS code                        Short descriptor          ASC  payment  indicator     2008 ASC
                                                                                                   payment rate
----------------------------------------------------------------------------------------------------------------
A9527...............................  Iodine I-125 sodium iodide.......  H2.....................          $28.62
C1716...............................  Brachytx, non-str, Gold-198......  H2.....................           31.95
C1717...............................  Brachytx, non-str, HDR Ir-192....  H2.....................          173.40
C1719...............................  Brachytx, NS, Non-HDR Ir-192.....  H2.....................           57.40
C2616...............................  Brachytx, non-str,Yttrium-90.....  H2.....................       11,943.79
C2634...............................  Brachytx, non-str, HA, I-125.....  H2.....................           29.93
C2635...............................  Brachytx, non-str, HA, P-103.....  H2.....................           47.06
C2636...............................  Brachy linear, non-str, P-103....  H2.....................           37.09
C2638...............................  Brachytx, stranded, I-125........  H2.....................           42.86
C2639...............................  Brachytx, non-stranded, I-125....  H2.....................           31.91
C2640...............................  Brachytx, stranded, P-103........  H2.....................           62.24
C2641...............................  Brachytx, non-stranded, P-103....  H2.....................           45.29
C2642...............................  Brachytx, stranded, C-131........  H2.....................           97.72
C2643...............................  Brachytx, non-stranded, C-131....  H2.....................           51.35
C2698...............................  Brachytx, stranded, NOS..........  H2.....................           42.46
C2699...............................  Brachytx, non-stranded, NOS......  H2.....................           29.93
----------------------------------------------------------------------------------------------------------------

    The brachytherapy source HCPCS codes listed in Table 57 are not all 
included in Addendum BB to this proposed rule because they were new in 
July 2007, and Addendum BB reflects only those codes available for the 
April 2007 update to the OPPS. Although the proposed ASC payment rates 
for the new brachytherapy source HCPCS codes implemented under the OPPS 
in July 2007 are not displayed in Addendum BB to this proposed rule, 
they will be included in Addendum BB to the CY 2008 OPPS/ASC final rule 
with comment period and their final payment will be effective under the 
revised ASC payment system, beginning January 1, 2008.
(3) Drugs and Biologicals
    Under the revised ASC payment system, we pay separately for all 
drugs and biologicals that are separately paid under the OPPS, when 
they are provided integral to a covered surgical procedure that is 
billed by the ASC to Medicare. We specify that a drug or biological is 
integral to a covered

[[Page 42782]]

surgical procedure if it is required for the successful performance of 
the surgery and is provided to the beneficiary in the ASC immediately 
preceding, during, or immediately following the covered surgical 
procedure. Payments for separately payable drugs and biologicals under 
the revised ASC payment system for a calendar year are equal to the 
OPPS payment rates for that same year, without application of the ASC 
budget neutrality adjustment. In addition, consistent with the payment 
of drugs and biologicals under the OPPS, the ASC payment rates for 
these items are not adjusted for geographic wage differences.
    A list of the drugs and biologicals that we are proposing for 
separate payment under the CY 2008 revised ASC payment system and their 
proposed payment rates are included in Addendum BB to the proposed 
rule. Separately paid drugs and biologicals are assigned 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 we are proposing to package 
payment into the ASC payment for the covered surgical procedure in CY 
2008 because we are proposing to package under the OPPS for CY 2008, 
are also listed in Addendum BB, where they are assigned payment 
indicator ``N1'' (Packaged service/item; no separate payment made).
(4) Implantable Devices with Pass-Through Status under the OPPS
    Under the revised ASC payment system, we provide separate payment 
at contractor-priced rates for devices that are included in device 
categories with pass-through status under the OPPS when the devices are 
an integral part of a covered surgical procedure. As we have specified 
for drugs, biologicals, and ancillary radiology services, a pass-
through device would be considered integral to the covered surgical 
procedure when it is required for the successful performance of the 
procedure; is provided in the ASC immediately before, during, or 
immediately following the covered surgical procedure; and is billed by 
the ASC on the same day as the covered surgical procedure.
    In the future, new device categories may be established that will 
have OPPS pass through status during all or a portion of any calendar 
year. For CY 2008, there are two device categories with OPPS pass-
through status that are proposed to continue in that status under the 
OPPS for CY 2008, specifically HCPCS code C1821 (Interspinous process 
distraction device (implantable)), and HCPCS code L8690 (Auditory 
osseointegrated device, includes all internal and external components). 
We note that only the surgical procedures associated with the 
implantation of HCPCS code L8690 are ASC covered surgical procedures 
for CY 2008. As under the OPPS, ASC payment for pass-through devices is 
not subject to the geographic wage adjustment.
    The proposed pass-through device category HCPCS codes are included 
in Addendum BB to this proposed rule and are assigned 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 receive packaged payment because they do not 
have OPPS pass-through status are also listed in Addendum BB to this 
proposed rule, where they are assigned payment indicator ``N1'' 
(Packaged service/item; no separate payment made).
    The associated non-device facility resources for the device 
implantation procedures are paid through the ASC surgical procedure 
service payment, based upon the payment weight for the non-device 
portion of the related OPPS APC payment weight.
(5) Corneal Tissue Acquisition
    Under the revised ASC payment system, we pay separately for corneal 
tissue procurement provided integral to the performance of an ASC 
covered surgical procedure based on invoice costs. The HCPCS code for 
corneal tissue acquisition, V2785 (Processing, preserving and 
transporting corneal tissue), is listed in Addendum BB to this proposed 
rule, and it is assigned payment indicator ``F4'' (Corneal tissue 
processing; paid at reasonable cost).
3. General Payment Policies
a. Geographic Adjustment
    Under the revised ASC payment system policy, we utilize 50 percent 
as the labor related share. Fifty percent is significantly higher than 
the labor-related share used for the ASC payment system through CY 2007 
(34.45 percent) 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.
    Consistent with the OPPS, we apply to ASC payments 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 the labor-related portion of the national ASC payment rates 
for geographic wage differences. b. Beneficiary Coinsurance
    Under the revised ASC payment system, beneficiary coinsurance 
remains at 20 percent for ASC services, except for screening flexible 
sigmoidoscopy and screening colonoscopy procedures. The coinsurance for 
screening colonoscopies and screening flexible sigmoidoscopies is 25 
percent, as required by section 1834(d) of the Act, with no deductible 
for those services under the revised ASC payment system.

D. Proposed Treatment of New HCPCS Codes

1. Treatment of New CY 2008 Category I and III CPT Codes and Level II 
HCPCS Codes
    We finalized a policy in the July 2007 final rule for the revised 
ASC payment system to evaluate each year all new HCPCS codes that 
describe surgical procedures to make preliminary determinations 
regarding whether or not they meet the criteria for payment in the ASC 
setting and, if so, whether they are office-based procedures. In the 
absence of claims data that indicate where procedures described by new 
codes are being performed and reflect the facility resources required 
to perform them, we decided to use other available information to make 
our interim decisions regarding assignment of payment indicators for 
the new codes. The other data available to us include our clinical 
advisors' judgment, data regarding predecessor and related 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 will publish in 
the annual OPPS/ASC payment update final rule the interim ASC 
determinations for the new codes to be effective January 1 of the 
update year. The interim payment indicators assigned to new codes under 
the revised ASC payment system will be subject to comment in that final 
rule. We will respond to those comments in the OPPS/ASC update final 
rule for the following calendar year, just as we currently respond to 
OPPS comments about APC and status indicator assignments for new 
procedure codes in the OPPS update final rule for the year following 
publication of the code's interim OPPS treatment.
    After our review of public comments and in the absence of 
physicians' claims data, our determination that a new code

[[Page 42783]]

is an office based procedure and is, thereby, subject to the payment 
limitation, would remain temporary and subject to review, until there 
are adequate data available to assess the procedure's predominant sites 
of service. Using those data, if we confirm our determination that the 
new code is office-based after taking into account the most recent 
available volume and utilization data for the procedure code and/or, if 
appropriate, the clinical characteristics, utilization, and volume of 
related codes, the code would be assigned permanently to the list of 
office-based procedures subject to the ASC payment limitation.
    New HCPCS codes for ASC implementation on January 1, 2008, will be 
designated in Addenda AA and BB to the OPPS/ASC final rule with comment 
period with comment indicator ``NI.'' The ``NI'' comment indicator is 
used to identify those HCPCS codes for which the assigned ASC payment 
indicator is subject to public comment. (We refer readers to section 
XVI.J. of this proposed rule for discussion of ASC payment and comment 
indicators.)
2. Proposed Treatment of New Mid-Year Category III CPT Codes
    Twice each year, the AMA issues Category III CPT codes, which the 
AMA defines as temporary codes for emerging technology, services, and 
procedures. The AMA established Category III CPT codes to allow 
collection of data specific to the service described by the code which 
otherwise could only be reported using a Category I CPT unlisted code. 
The AMA releases Category III CPT codes in January, for implementation 
beginning the following July, and in July, for implementation beginning 
the following January.
    CMS provides a predictable quarterly update for the OPPS occurring 
throughout each calendar year (January, April, July, and October), and 
the final payment policies of the revised ASC payment system parallel, 
in many cases, the OPPS treatment of HCPCS codes. As discussed in the 
July 2007 final rule for the revised ASC payment system, we will 
provide a quarterly ASC update for each calendar quarter to recognize 
newly created HCPCS codes for ASC payment and to update the payment 
rates for separately paid drugs and biologicals based on the most 
recently submitted ASP data.
    Under the OPPS and MPFS, CMS allows Category III CPT codes that are 
released by the AMA in January to be effective beginning July of the 
same calendar year in which they are issued, rather than deferring 
implementation of those codes to the following calendar year update of 
the payment systems, as is the case for the Category III codes that are 
released in July by the AMA for implementation in January of the 
upcoming calendar year. Therefore, in contrast to the Category I CPT 
codes that are issued only once annually and that CMS recognizes as 
effective under the MPFS and OPPS each January for the new calendar 
year, new Category III CPT codes are made effective under the MPFS and 
OPPS biannually. In order to be consistent in this regard across the 
three payment systems, we are proposing to adopt that same policy under 
the revised ASC payment system.
    Some of the new Category III CPT codes may describe services that 
our medical advisors determine directly crosswalk or are clinically 
similar to HCPCS codes that describe ASC covered surgical procedures. 
In those instances, we may allow ASC payment for the new Category III 
CPT code as a covered surgical procedure. Similarly, the new code may 
represent an ancillary service that directly crosswalks or is 
clinically similar to those for which separate ASC payment is allowed 
when it is performed integral to a covered surgical procedure, and the 
new code also may be determined to be eligible for ASC payment as a 
covered ancillary service.
    Therefore, beginning in CY 2008, we are proposing to include in the 
July update to the ASC payment system, the ASC payment indicators for 
new Category III CPT codes that the AMA releases in January, and that 
we determine are appropriate ASC covered surgical procedures or covered 
ancillary services for implementation, as payable in ASCs beginning in 
July of the same year. Likewise, as described above, we would implement 
annually for payment in the January update of the ASC payment system 
any of the Category III CPT codes that the AMA released the previous 
July, along with new Category I CPT codes that are determined to be 
appropriate for ASC payment. Interim ASC payment indicators will be 
assigned to those new mid-year Category III CPT codes that are released 
in January for implementation in July of a given calendar year, and the 
interim ASC indicators will be open to comment in the OPPS/ASC proposed 
rule for the following calendar year and their status will be made 
final in the update year's final rule.
    Of the Category III CPT codes the AMA released January 1, 2007, we 
have determined that only one is appropriate for payment in ASCs as a 
covered ancillary radiology service. The new CPT code is 0182T (High 
dose rate electronic brachytherapy, per fraction), and we are proposing 
to assign it to the list of covered ancillary services with payment 
indicator ``Z2'' as noted in Table 58 below for payment in ASCs 
beginning January 1, 2008. This service has no MPFS nonfacility PE RVUs 
assigned to it. Therefore, we are proposing that its CY 2008 ASC 
payment be calculated according to the standard ASC payment system 
methodology, based on the code's OPPS relative payment weight.
    We do not believe that any of the other Category III CPT codes 
released in January 2007 for implementation in July 2007 meet the 
criteria for inclusion on the ASC list of covered surgical procedures 
or covered ancillary services because they do not directly crosswalk 
and are not clinically similar to established covered ASC services.

          Table 58.--Category III CPT Code Implemented in July 2007and Proposed for CY 2008 ASC Payment
----------------------------------------------------------------------------------------------------------------
                                                                                           Proposed CY 2008 ASC
            HCPCS code                                Long descriptor                       Payment Indicator
----------------------------------------------------------------------------------------------------------------
0182T.............................  High dose rate electronic brachytherapy, per         Z2
                                     fraction.
----------------------------------------------------------------------------------------------------------------


[[Page 42784]]

3. Proposed Treatment of Level II HCPCS Codes Released on a Quarterly 
Basis
    In addition to the Category III CPT codes that are released twice 
each year, new Level II HCPCS codes may be created more frequently and 
are implemented for the MPFS and OPPS on a quarterly basis. Level II 
HCPCS codes are most commonly created for the purpose of reporting new 
drugs and biologicals but also are created for reporting some surgical 
procedures and other services for which payment may be made under the 
revised ASC payment system, as it is under the OPPS.
    We base the ASC payment policies for covered surgical procedures, 
drugs, biologicals, and certain other covered ancillary services 
integral to ASC covered surgical procedures on the OPPS and, therefore, 
we are proposing to update the coding and payment for the services in 
ASCs at the same time that the OPPS is updated. In order to maintain 
consistency across the OPPS and ASC payment systems, as discussed in 
the July 2007 final rule for the revised ASC payment system, we are 
proposing to recognize newly created Level II HCPCS codes under the 
revised ASC payment system for payment on a quarterly basis, consistent 
with the quarterly updates to the OPPS. CMS provides a predictable 
quarterly update for the OPPS occurring throughout each calendar year 
(January, April, July, and October). As discussed in the July 2007 
final rule for the revised ASC payment system, we will provide a 
quarterly ASC update for each calendar quarter to recognize newly 
created Level II HCPCS codes for ASC payment and to update the payment 
rates for separately paid drugs and biologicals based on the most 
recently submitted ASP data.
    We are proposing to update the lists of covered surgical procedures 
and ancillary services that qualify for separate payment in ASCs in CY 
2008 by adding 8 new Level II HCPCS codes that were implemented in the 
OPPS in July 2007 and that were not addressed in the CY 2007 OPPS/ASC 
final rule with comment period. Because of the timing of this proposed 
rule, the new Level II HCPCS codes implemented through the July 2007 
OPPS update are not included in Addendum BB to this proposed rule and 
there were no Level II HCPCS codes included in the April OPPS update 
that were eligible for payment under the OPPS. The new CY 2007 Level II 
HCPCS codes we are proposing for ASC payment beginning in January 2008 
are listed in Table 59. Beginning in CY 2008, with implementation of 
the revised ASC payment system, the Level II HCPCS codes describing new 
procedures, drugs and biologicals would be made payable in ASCs in the 
same calendar quarter as they are initially paid under the OPPS.
    We are proposing to assign payment indicator K2 to the 7 new codes 
for drugs to indicate that separate payment would be made for those 
drugs when they are provided to beneficiaries in ASCs integral to 
covered surgical procedures. We are proposing to include new Level II 
HCPCS code C9728 (Placement of interstitial device(s) for radiation/
surgery guidance (e.g., fiducial markers, dosimeter), other than 
prostate (any approach), single or multiple) as a covered surgical 
procedure with payment indicator ``R2'' because it is clinically 
similar to CPT code 55876 (Placement of interstitial device(s) for 
radiation therapy guidance (e.g., fiducial markers, dosimeter), 
prostate (via needle, any approach), single or multiple) that we have 
included on the list of covered surgical procedures with payment 
indicator of ``P3.'' While we believe both procedures are office-based, 
there are currently no nonfacility PE RVUs available for the Level II 
HCPCS code C9728, which was initially established in response to a New 
Technology APC application under the OPPS, and, therefore, its payment 
indicator is ``R2.''

  Table 59.--Level II HCPCS Codes Implemented under the OPPS in April or July 2007 and Proposed for CY 2008 ASC
                                                     Payment
----------------------------------------------------------------------------------------------------------------
                                                                                          Proposed CY 2008 ASC
             HCPCS code                               Short descriptor                      payment indicator
----------------------------------------------------------------------------------------------------------------
C9728...............................  Place device/marker, non prostate...............  R2
Q4087...............................  Octagam injection...............................  K2
Q4088...............................  Gammagard liquid injection......................  K2
Q4089...............................  Rhophylac injection.............................  K2
Q4090...............................  HepaGam B IM injection..........................  K2
Q4091...............................  Flebogamma injection............................  K2
Q4092...............................  Gamunex injection...............................  K2
Q4095...............................  Reclast injection...............................  K2
----------------------------------------------------------------------------------------------------------------

    In summary, beginning in CY 2008 with implementation of the revised 
ASC payment system, we are proposing to implement new Level II HCPCS 
codes for ASC payment on a quarterly basis each year and new Category 
III CPT codes on a semi annual basis, to parallel the policies under 
the MPFS and OPPS for the recognition of those codes. Also, consistent 
with the MPFS and OPPS policies, our final policy with regard to 
Category I CPT codes is to publish the new codes and interim payment 
indicators annually in the OPPS/ASC final rule with comment period.

E. Proposed Updates to Covered Surgical Procedures and Covered 
Ancillary Services

1. Identification of Covered Surgical Procedures
a. General Policies
    We published Addendum AA to the July 2007 final rule for the 
revised ASC payment system as an illustrative list of covered surgical 
procedures and payment rates for the revised ASC payment system to be 
implemented January 1, 2008. The final rule established our policies 
for determining which procedures are eligible to be considered ASC 
covered surgical procedures and, of those, which are excluded from ASC 
payment because they pose a significant risk to beneficiary safety or 
would be expected to require an overnight stay. We adopted a definition 
of surgical procedure for the revised ASC payment system as those 
procedures described by all Category I CPT codes in the surgical range 
from 10000 through 69999 except unlisted procedure codes, as well as 
those Category III CPT codes and Level II

[[Page 42785]]

HCPCS codes that crosswalk or are clinically similar to ASC covered 
surgical procedures.
    Section 1833(i)(1) of the Act requires us to review and update the 
list of ASC procedures at least every 2 years. We finalized our policy 
to update the ASC list of covered surgical procedures annually, in 
conjunction with annual proposed and final rulemaking to update the 
OPPS and ASC payment systems. Each year we undertake a review of 
excluded procedures, new procedures, and procedures for which there is 
revised coding to identify any that we believe are appropriate for 
coverage in ASCs because they do not pose significant risks to 
beneficiary safety and would not be expected to require overnight 
stays.
    In the July 2007 final rule for the revised ASC payment system, we 
finalized the addition of 793 new covered surgical procedures for 
payment under the revised ASC payment system beginning in CY 2008. We 
are proposing to remove 13 procedures from the OPPS inpatient list and, 
of those 13, we believe that 3 are safe for performance in ASCs. 
Therefore, at this time, we are proposing to add these three additional 
new surgical procedures to the ASC list of covered surgical procedures 
eligible for Medicare ASC payment in CY 2008. The proposed procedures 
and their ASC payment indicators are displayed in Table 60.

                Table 60.--Procedures Proposed as New ASC Covered Surgical Procedures for CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                                          Proposed ASC payment
             HCPCS code                               Short descriptor                          indicator
----------------------------------------------------------------------------------------------------------------
25931...............................  Amputation follow-up surgery....................  G2
50580...............................  Kidney endoscopy & treatment....................  G2
58805...............................  Drainage of ovarian cyst(s).....................  G2
----------------------------------------------------------------------------------------------------------------

    In this proposed rule, we are soliciting commenters' 
recommendations regarding additional surgical procedures that they 
believe should not be excluded from ASC payment beginning in CY 2008. 
We specifically encourage commenters to provide evidence, to the extent 
possible, to support their recommendations regarding procedures and 
services they believe should not be excluded from ASC payment.
b. Proposed Change in Designation of Covered Surgical Procedures as 
Office-Based
    According to our final policy for the revised ASC payment system, 
we designate as office-based procedures that are added to the ASC list 
of covered surgical procedures in CY 2008 or later years and that we 
determine are predominantly performed in physicians' offices based on 
consideration of 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.
    The list of codes that we identified as office-based in the July 
2007 final rule for the revised ASC payment system took into account 
the most recent available CY 2005 volume and utilization data for each 
individual procedure code or related codes. In that rule, we finalized 
our policy 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 and to exempt all procedures on the CY 2007 ASC list 
from application of the office based classification. We believe that 
the resulting list accurately reflected Medicare practice patterns and 
was clinically consistent. In Addendum AA to the July 2007 final rule 
for the revised ASC payment system, each of the office-based procedures 
is identified by payment indicator ``P2,'' ``P3,'' or ``R2,'' depending 
on whether we estimated it would be paid according to the standard ASC 
payment methodology based on its OPPS relative payment weight or at the 
MPFS nonfacility PE RVU amount.
    Consistent with our final ASC policy to review and update annually 
the surgical procedures for which ASC payment is made and to identify 
new procedures that may be appropriate for ASC payment, in developing 
this proposed rule we reviewed the CY 2006 utilization data for all 
those surgical procedures newly added for ASC payment in CY 2008 that 
were assigned payment indicator ``G2'' as nonoffice-based additions in 
the July 2007 final rule for the revised ASC payment system. We based 
our evaluation of the potential designation of a procedure as office-
based on the most recent available volume and utilization data for each 
individual procedure code and/or, as appropriate, the clinical 
characteristics, utilization, and volume of related codes. As a result 
of that review, we identified 19 procedures assigned payment indicator 
``G2'' in the July 2007 final rule for the revised ASC payment system 
that we are proposing to assign to the office-based procedure list with 
payment indicator ``P2,'' ``P3,'' or ``R2,'' as appropriate. We refer 
readers to Addendum DD1 to this proposed rule for the definitions of 
the ASC payment indicators.
    We will consider comments submitted timely on the proposed 
designation of these 19 new procedures as office-based for CY 2008. For 
example, in the July 2007 final rule for the revised ASC payment 
system, payment indicator ``G2'' was assigned to CPT code 64650 
(Chemodenervation of eccrine glands; both axillae). After reviewing 
more recent CY 2006 data, we discovered that the procedure is performed 
predominantly in physicians' offices and we believe the procedure 
should be designated as an office-based procedure. Therefore, we are 
proposing to assign payment indicator ``P3'' to CPT code 64650, 
effective for CY 2008. In this proposed rule, we are proposing to 
assign an office-based payment indicator for CPT code 64650 and 18 
other procedures, as displayed in Table 61.

[[Page 42786]]



         Table 61.--Proposed CY 2008 New Designations of ASC Covered Surgical Procedures as Office-Based
----------------------------------------------------------------------------------------------------------------
                                                                               ASC Payment
                                                                            Indicator in July   Proposed CY 2008
          HCPCS code                         Short descriptor                 2007 ASC Final      ASC payment
                                                                                   Rule            indicator
----------------------------------------------------------------------------------------------------------------
24640.........................  Treat elbow dislocation...................  G2...............  P3
26641.........................  Treat thumb dislocation...................  G2...............  P2
26670.........................  Treat hand dislocation....................  G2...............  P2
26700.........................  Treat knuckle dislocation.................  G2...............  P2
26775.........................  Treat finger dislocation..................  G2...............  P3
28630.........................  Treat toe dislocation.....................  G2...............  P3
28660.........................  Treat toe dislocation.....................  G2...............  P3
28890.........................  High energy eswt, plantar fascia..........  G2...............  P3
29035.........................  Application of body cast..................  G2...............  P2
29305.........................  Application of hip cast...................  G2...............  P2
29325.........................  Application of hip casts..................  G2...............  P2
29505.........................  Application, long leg splint..............  G2...............  P3
29515.........................  Application lower leg splint..............  G2...............  P3
36469.........................  Injection(s), spider veins................  G2...............  R2
46505.........................  Chemodenervation anal misc................  G2...............  P3
62292.........................  Injection into disk lesion................  G2...............  R2
64447.........................  Nblock inj fem, single....................  G2...............  R2
64650.........................  Chemodenerv, eccrine glands...............  G2...............  P3
64653.........................  Chemodenerv, eccrine glands...............  G2...............  P3
----------------------------------------------------------------------------------------------------------------

    We also reviewed the five procedures that were assigned temporary 
office-based payment indicators in the July 2007 final rule for the 
revised ASC payment system. Those codes are listed in Table 62 below. 
Using the most recent data available, we believe there are adequate 
claims data for two of the procedures upon which to base assignment of 
permanent office-based payment indicators. Table 62 shows that we are 
proposing to assign CPT code 36598 (Contrast injection(s) for 
radioisotope evaluation of existing central venous access device, 
including fluoroscopy, image documentation and report) permanently to 
the office-based list and assign it to payment indicator ``P3'' for CY 
2008. In accordance with the CY 2008 OPPS proposal to package payment 
for CPT code 58110 (Endometrial sampling (biopsy) performed in 
conjunction with colposcopy), we are also proposing to package payment 
for this procedure under the ASC payment system and assign it payment 
indicator ``N1'' as indicated in Table 62.
    We are proposing to maintain the temporary office-based payment 
indicator assignments for the other three procedures listed in Table 
62. We have only a few claims for CPT code 0099T (Implantation of 
intrastromal corneal ring segments) and no claims for 0124T 
(Conjunctival incision with posterior juxtascleral placement of 
pharmacological agent (does not include supply of medication)) or CPT 
code 55876 (Placement of interstitial device(s) for radiation therapy 
guidance (e.g., fiduciary markers, dosimeter), prostate (via needle, 
any approach), single or multiple). We continue to believe these 
procedures are predominantly office-based. Therefore, we are not 
proposing to make any change to the temporary office-based designation 
of these procedures at this time.

 Table 62.--Proposed Payment Indicators for Procedures Assigned Temporary Office-Based Payment Indicators in the
                                            July 2007 ASC Final Rule
----------------------------------------------------------------------------------------------------------------
                                                                                             Proposed Final CY
                                                                                              2008 ASC Payment
                                                                       Temporary Office      Indicator (or * if
                                                                        Based Payment         HCPCS code will
           HCPCS Code                     Short descriptor            Indicator in July        continue with
                                                                     2007 ASC Final Rule     temporary office-
                                                                                            based assignment for
                                                                                                  CY 2008)
----------------------------------------------------------------------------------------------------------------
0099T..........................  Implant corneal ring.............  R2...................  *
0124T..........................  Conjunctival drug placement......  R2...................  *
36598..........................  Inj w/fluor, eval cv device......  P2...................  P3
55876..........................  Place rt device/marker, pros.....  P3...................  *
58110..........................  Bx done w/colposcopy add-on......  P3...................  N1
----------------------------------------------------------------------------------------------------------------


[[Page 42787]]

c. Proposed Changes to Designation of Covered Surgical Procedures as 
Device-Intensive
    As explained in section XVI.C. of this proposed rule, we adopted a 
modified payment methodology for calculating the ASC payment rates for 
ASC covered surgical procedures that are assigned to the subset of 
device-dependent APCs under the OPPS with a device offset percentage 
greater than 50 percent under the OPPS to ensure that payment for the 
procedure is adequate to provide packaged payment for the high-cost 
implantable devices used in those procedures. In the July 2007 final 
rule for the revised ASC payment system, we identified 24 procedures 
that were on the CY 2007 ASC list of covered surgical procedures that 
would be subject to this policy, as well as 15 new ASC covered surgical 
procedures for CY 2008 to which we expected the final policy to apply.
    As a result of the proposed CY 2008 reconfiguration of several 
device-dependent APCs under the OPPS and the proposed updated APC 
device offset percentages, we are proposing to designate as device-
intensive for ASC payment in CY 2008 an additional 10 ASC covered 
surgical procedures. We are also proposing to remove 4 procedures from 
their estimated designation as device-intensive because we are 
proposing to recognize CPT codes instead of Level II HCPCS codes for 
ICD implantation.procedures as discussed in section III.D.7. of this 
proposed rule. In the July 2007 final rule for the revised ASC payment 
system, either payment indicator ``H8'' or ``J8'' was assigned to the 
procedures that we estimated would be designated as device-intensive 
procedures for CY 2008. As displayed in Table 63 below, we are 
proposing to assign payment indicators ``H8'' or ``J8,'' as 
appropriate, to the covered surgical procedures included in the table 
so that the payment for these surgical procedures would be made 
consistent with our final revised ASC payment system payment policy for 
device-intensive procedures that are identified according to their APC 
assignments under the OPPS.

  Table 63.--Proposed ASC Covered Surgical Procedures Proposed for Designation as Device-Intensive for CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                                                    Proposed CY
                                                                                                   2008 device-
               HCPCS code                            Short descriptor               Proposed CY    dependent APC
                                                                                   2008 OPPS APC      offset
                                                                                                    percentage
----------------------------------------------------------------------------------------------------------------
33206..................................  Insertion of heart pacemaker...........            0089           74.02
33207..................................  Insertion of heart pacemaker...........            0089           74.02
33208..................................  Insertion of heart pacemaker...........            0655           74.59
33210..................................  Insertion of heart electrode...........            0106           57.20
33211..................................  Insertion of heart electrode...........            0106           57.20
33212..................................  Insertion of pulse generator...........            0090           75.54
33213..................................  Insertion of pulse generator...........            0654           75.86
33214..................................  Upgrade of pacemaker system............            0655           74.59
33216..................................  Insert lead pace-defib, one............            0106           57.20
33217..................................  Insert lead pace-defib, dual...........            0106           57.20
33224..................................  Insert pacing lead & connect...........            0418           81.38
33225..................................  Lventric pacing lead add-on............            0418           81.38
33240..................................  Insert pulse generator.................            0107           89.43
33249..................................  Eltrd/insert pace-defib................            0108           89.26
33282..................................  Implant pat-active ht record...........            0680           72.14
36566..................................  Insert tunneled cv cath................            0625           62.63
53440..................................  Male sling procedure...................            0385           51.67
53444..................................  Insert tandem cuff.....................            0385           51.67
53445..................................  Insert uro/ves nck sphincter...........            0386           61.98
53447..................................  Remove/replace ur sphincter............            0386           61.98
54400..................................  Insert semi-rigid prosthesis...........            0385           51.67
54401..................................  Insert self-contd prosthesis...........            0386           61.98
54405..................................  Insert multi-comp penis pros...........            0386           61.98
54410..................................  Remove/replace penis prosth............            0386           61.98
54416..................................  Remv/repl penis contain pros...........            0386           61.98
55873..................................  Cryoablate prostate....................            0674           59.34
61885..................................  Insrt/redo neurostim 1 array...........            0039           82.15
61886..................................  Implant neurostim arrays...............            0315           86.23
62361..................................  Implant spine infusion pump............            0227           79.69
62362..................................  Implant spine infusion pump............            0227           79.69
63650..................................  Implant neuroelectrodes................            0040           55.93
63655..................................  Implant neuroelectrodes................            0061           59.32
63685..................................  Insrt/redo spine n generator...........            0222           83.29
64553..................................  Implant neuroelectrodes................            0225           80.84
64555..................................  Implant neuroelectrodes................            0040           55.93
64560..................................  Implant neuroelectrodes................            0040           55.93
64561..................................  Implant neuroelectrodes................            0040           55.93
64565..................................  Implant neuroelectrodes................            0040           55.93
64573..................................  Implant neuroelectrodes................            0225           80.84
64575..................................  Implant neuroelectrodes................            0061           59.32
64577..................................  Implant neuroelectrodes................            0061           59.32
64580..................................  Implant neuroelectrodes................            0061           59.32
64581..................................  Implant neuroelectrodes................            0061           59.32
64590..................................  Insrt/redo pn/gastr stimul.............            0222           83.29
69930..................................  Implant cochlear device................            0259           83.03
----------------------------------------------------------------------------------------------------------------


[[Page 42788]]

2. Proposed Changes for Identification of Covered Ancillary Services
    In the July 2007 final rule for the revised ASC payment system, we 
set forth our policy to make separate ASC payments for certain 
ancillary services, for which separate payment is made under the OPPS, 
when they are provided integral to ASC covered surgical procedures. 
Under the revised ASC payment system, we exclude from the scope of ASC 
facility services, for which payment is packaged into the ASC payment 
for the covered surgical procedure, the following ancillary services 
that are integral to a covered surgical procedure: brachytherapy 
sources; certain implantable items that have pass-through status under 
the OPPS; certain items and services that we designate as contractor-
priced, including, but not limited to, 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. These covered ancillary services are 
specified in Sec.  416.164(b) and fall within the scope of ASC 
services, so they are eligible for separate ASC payment.
    In this proposed rule, we are proposing to make changes to the list 
of covered ancillary services eligible for separate ASC payment, as 
proposed in Addendum BB to this proposed rule, to comport with their 
proposed treatment under the OPPS according to the final payment 
policies of the revised ASC payment system, and to add new Category III 
CPT code 0182T (High dose rate electronic brachytherapy, per fraction), 
as discussed in section XVI.D.2 of this proposed rule.

F. Proposed Payment for Covered Surgical Procedures and Covered 
Ancillary Services

1. Proposed Payment for Covered Surgical Procedures
a. Proposed Update to Payment Rates
    Our final payment policy for covered surgical procedures under the 
revised ASC payment system is described in section XVI.C. of this 
proposed rule. For CY 2008, payment for procedures with payment 
indicator ``G2'' will be calculated by multiplying the ASC relative 
payment weight for the procedure by the final ASC conversion factor. 
For those procedures with payment indicator ``A2,'' a blended rate will 
be used that is comprised of 25 percent of the revised ASC payment rate 
added to 75 percent of the CY 2007 payment rate. Special payment 
policies apply to covered surgical procedures identified as office-
based or device-intensive.
    The payment amounts provided in Addendum AA to the July 2007 final 
rule for the revised ASC payment system were illustrative only, and we 
are proposing to update them in this proposed rule. We are not 
proposing to make any changes to the final policies established in the 
July 2007 final rule for the revised ASC payment system related to the 
methodology for developing the relative payment weights and rates. The 
differences in the payment rates for covered surgical procedures with 
``G2'' and ``A2'' payment indicators, reflected in Addendum AA to this 
proposed rule, compared with the July 2007 final rule for the revised 
ASC payment system are due to our use of updated CY 2006 utilization 
data, proposed payment policy changes for the CY 2008 OPPS, including 
APC reassignments and changes to packaged services, and the proposed 
OPPS update factor.
    We also are proposing to update the payment amounts for the office-
based procedures in this rule. Using the most recent available MPFS and 
OPPS data, including the proposed CY 2008 rates, we compared the 
estimated CY 2008 rate for each of the office-based procedures 
calculated according to the standard methodology of the revised ASC 
payment system and to the MPFS nonfacility PE RVUs to determine which 
is the lower payment amount that, therefore, is the rate we are 
proposing for payment of the procedure according to the final policy of 
the revised ASC payment system. The proposed update to the rates 
results in changes to the payment indicators, as well as the rates, for 
several of the office-based procedures. For example, a procedure with 
payment indicator ``P2'' in the July 2007 final rule for the revised 
ASC payment system may be assigned payment indicator ``P3'' in this 
proposed rule, depending on the outcome of that rate comparison.
    In addition, we are proposing to update the payment amounts for the 
device intensive procedures in this rule, based on the CY 2008 OPPS 
proposal and updated OPPS claims data.
b. Payment Policies When Devices Are Replaced at No Cost or With Credit
(1) Policy When Devices Are Replaced at No Cost or With Full Credit
    Our final ASC policy with regard to payment for costly devices 
implanted in ASCs is fully consistent with the current OPPS policy. The 
ASC policy includes adoption of the OPPS policy for payment to 
providers when a device is replaced without cost or with full credit 
for the cost of the device being replaced, for those ASC covered 
surgical procedures that are assigned to APCs under the OPPS to which 
this policy applies. In the case of no cost or full credit cases under 
the OPPS, we reduce the APC payment to the hospital by the device 
offset amount that we estimate represents the cost of the device. 
Therefore, in accordance with the OPPS policy implemented in CY 2007, 
and the ASC policy as finalized in the July 2007 final rule for the 
revised ASC payment system, beginning in CY 2008, we reduce the amount 
of payment made to ASCs for certain covered surgical procedures when 
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 provide the same amount of payment reduction based on the 
device offset amount in ASCs that would apply under the OPPS for 
performance of those procedures under the same circumstances. 
Specifically, when a procedure that is listed in Table 64 below is 
performed in an ASC and the case involves implantation of a no cost or 
full credit device listed in Table 65, the ASC must report the HCPCS 
``FB'' modifier on the line with the covered surgical procedure code to 
indicate that an implantable device in Table 65 was furnished without 
cost. The devices listed in Table 65 are the same proposed devices to 
which the policy applies under the OPPS, and the procedures listed in 
Table 64 are those ASC covered surgical procedures assigned to proposed 
APCs under the OPPS to which the policy applies.
    As finalized in the July 2007 final rule for the revised ASC 
payment system, when the ``FB'' modifier is reported with a procedure 
code that is listed in Table 64, the contractor reduces the ASC payment 
by the amount of payment that we 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.
(2) Proposed Policy When Implantable Devices Are Replaced With Partial 
Credit
    Consistent with our CY 2008 OPPS proposal discussed in section 
IV.A.3. of this proposed rule, we are proposing to reduce the ASC 
payment by one half of the device offset amount for certain surgical 
procedures into which the device cost is packaged, when an ASC receives 
a partial credit toward replacement of an implantable device.

[[Page 42789]]

This partial payment reduction would apply to covered surgical 
procedures in which the amount of the device credit is greater than or 
equal to 20 percent of the cost of the new replacement device being 
implanted.
    We also are proposing to base the beneficiary's coinsurance on the 
reduced ASC payment rate so that the beneficiary shares the benefit of 
the ASC's reduced costs. This proposed policy is set forth in proposed 
new Sec.  416.179(b)(2).
    We have no OPPS data to empirically determine by how much we should 
reduce the payment for ASC surgical procedures into which the costs of 
these devices are packaged. Device manufacturers and hospitals have 
told us that a common scenario is that, if a device fails 3 years after 
implantation, the hospital would receive a 50 percent credit towards a 
replacement device. We do not believe that hospitals reduce their 
device charges to reflect the credits that may have been received, so 
the lower facility costs associated with these partial credit scenarios 
would likely not be reflected in our proposed OPPS rates for these 
device-dependent procedures. Therefore, we are proposing under the OPPS 
to reduce the payment for the relevant device-dependent APCs and, under 
the revised ASC payment system, to reduce the payment for those ASC 
covered surgical procedures assigned to those APCs under the OPPS by 
half of the reduction that applies when the hospital or ASC receives a 
device without cost or receives a full credit for a device being 
replaced. That is, we are proposing to reduce the payments by half of 
the offset amount that represents the cost of the device packaged into 
the procedure payment. In the absence of OPPS claims data on which to 
base a reduction factor, but taking into consideration what we have 
been told is common industry practice, we believe that reducing the 
amount of payment for the device-dependent APC and the related ASC 
covered surgical procedure by half of the estimated cost of the device 
packaging represents a reasonable reduction in these cases.
    Moreover, we are proposing to take this reduction only when the 
credit is for 20 percent or more of the cost of the new replacement 
device, so that the reduction is not taken in cases in which more than 
80 percent of the cost of the replacement device has been incurred by 
the facility. If the partial credit is less than 20 percent of the cost 
of the new replacement device, we believe that reducing the payment for 
the device implantation procedure by 50 percent of the packaged device 
cost would provide too low a payment for necessary device replacement 
procedures. This proposed policy is discussed in section IV.A. of this 
proposed rule for the OPPS and is fully consistent with the proposed FY 
2008 Medicare payment policy for hospital inpatient services and the 
proposed CY 2008 policy for hospital outpatient services.
    Therefore, we are proposing that the new HCPCS partial credit 
modifier would be reported and the partial credit reduction would be 
taken only in cases in which the device credit is equal to or greater 
than 20 percent of the cost of the new replacement device. The partial 
credit reduction modifier would be reported in all cases in which the 
ASC receives a partial credit toward the replacement of a medical 
device listed in Table 65 when used in a surgical procedure listed in 
Table 64. The proposed policy related to partial device credits applies 
to the same devices and procedures to which our policy governing 
payment when the device is furnished to the ASC without cost or with 
full credit applies. We selected these devices because they have 
substantial costs and because each device is implanted in one 
beneficiary at least temporarily and, therefore, can be associated with 
an individual beneficiary. Moreover, we believe that this policy is a 
logical extension of our established policy regarding reduction of the 
ASC payment in cases in which the facility furnishes the device without 
cost or with a full credit to the ASC and ensures that beneficiary and 
Medicare payments are appropriate and consistent with costs incurred by 
ASCs.
    This partial device credit policy that we are proposing would 
enhance our ability to track the replacement of these implantable 
medical devices and may enable us to identify patterns of device 
failure or limited longevity early in their natural history so that 
appropriate strategies to reduce future problems for our beneficiaries 
may be developed. We also are mindful of the opportunity to use our 
claims history data to promote high quality medical care with regard to 
the devices and the services in which they are used. Collecting data on 
a wider set of device replacements under full and partial credit 
situations in all sites of outpatient surgery, including ASCs, would 
assist in developing comprehensive summary data, not just a subset of 
data related to devices replaced without cost or with a full credit to 
facilities.

 Table 64.--Proposed Adjustments to Payments for ASC Covered Surgical Procedures in CY 2008 in Cases of Devices
                      Reported Without Cost or for Which Full or Partial Credit Is Received
----------------------------------------------------------------------------------------------------------------
                                                                                                      50 Percent
                                                                                        Proposed CY  of proposed
                                                  Proposed CY                            2008 OPPS     CY 2008
      HCPCS code            Short descriptor       2008 OPPS          APC title            offset        OPPS
                                                      APC                                percentage     offset
                                                                                                      percentage
----------------------------------------------------------------------------------------------------------------
61885.................  Insrt/redo neurostim 1           0039  Level I Implantation of        82.15        41.07
                         array.                                 Neurostimulator.
63560.................  Implant neuroelectrodes.         0040  Percutaneous                   55.93        27.97
64555.................  Implant neuroelectrodes.                Implantation of
64560.................  Implant neuroelectrodes.                Neurostimulator
64561.................  Implant neuroelectrodes.                Electrodes, Excluding
                                                                Cranial Nerve.
63655.................  Implant neuroelectrodes.         0061  Laminectomy or Incision        59.32        29.66
64575.................  Implant neuroelectrodes.                for Implantation of
64577.................  Implant neuroelectrodes.                Neurostimulator
64580.................  Implant neuroelectrodes.                Electrodes, Excluding
64581.................  Implant neuroelectrodes.                Cranial Nerve.
33206.................  Insertion of heart                089  Insertion/Replacement          74.02        37.01
33207.................   pacemaker.                             of Permanent Pacemaker
                        Insertion of heart                      and Electrodes.
                         pacemaker.
33212.................  Insertion of pulse               0090  Insertion/Replacement          75.54        37.77
                         generator.                             of Pacemaker Pulse
                                                                Generator.

[[Page 42790]]

 
33210.................  Insertion of heart               0106  Insertion/Replacement/         57.20        28.60
33211.................   electrode.                             Repair of Pacemaker
33216.................  Insertion of heart                      and/or Electrodes.
33217.................   electrode.
                        Insert lead pace-defib,
                         one.
                        Insert lead pace-defib,
                         dual.
33240.................  Insert pulse generator..         0107  Insertion of                   89.43        44.72
                                                                Cardioverter-
                                                                Defibrillator.
33249.................  Eltrd/insert pace-defib.         0108  Insertion/Replacement/         89.26        44.63
                                                                Repair of Cardioverter-
                                                                Defibrillator Leads.
63685.................  Insrt/redo spine n               0222  Implantation of                83.29        41.64
64590.................   generator.                             Neurological Device.
                        Insrt/redo perph n
                         generator.
64553.................  Implant neuroelectrodes.         0225  Implantation of                80.84        40.42
64573.................  Implant neuroelectrodes.                Neurostimulator
                                                                Electrodes, Cranial
                                                                Nerve.
62361.................  Implant spine infusion           0227  Implantation of Drug           79.69        39.85
62362.................   pump.                                  Infusion Device.
                        Implant spine infusion
                         pump.
69930.................  Implant cochlear device.         0259  Level VI ENT Procedures        83.03        41.52
61886.................  Implant neurostim arrays         0315  Level II Implantation          86.23        43.12
                                                                of Neurostimulator.
53440.................  Male sling procedure....         0385  Level I Prosthetic             51.67        25.83
53444.................  Insert tandem cuff......                Urological Procedures.
54400.................  Insert semi-rigid
                         prosthesis.
53445.................  Insert uro/ves nck               0386  Level II Prosthetic            61.98        30.99
53447.................   sphincter.                             Urological Procedures.
54401.................  Remove/replace ur
54405.................   sphincter.
54410.................  Insert self-contd
54416.................   prosthesis.
                        Insert multi-comp penis
                         pros.
                        Remove/replace penis
                         prosth.
                        Remv/repl penis contain
                         pros.
33224.................  Insert pacing lead &             0418  Insertion of Left              81.38        40.69
33225.................   connect.                               Ventricular Pacing
                        L ventric pacing lead                   Elect.
                         add-on.
36566.................  Insert tunneled cv cath.         0625  Level IV Vascular              62.63        32.32
                                                                Access Procedures.
33213.................  Insertion of pulse               0654  Insertion/Replacement          75.86        37.93
                         generator.                             of a permanent dual
                                                                chamber pacemaker.
33214.................  Upgrade of pacemaker             0655  Insertion/Replacement/         74.59        37.30
33208.................   system.                                Conversion of a
                        Insertion of heart                      permanent dual chamber
                         pacemaker.                             pacemaker.
33282.................  Implant pat-active ht            0680  Insertion of Patient           72.14        36.07
                         record.                                Activated Event
                                                                Recorders.
----------------------------------------------------------------------------------------------------------------


 Table 65.--Proposed Devices for Which the ``FB'' or New HCPCS Modifier
 Must Be Reported With the Procedure Code When Furnished Without Cost or
              for Which Full or Partial Credit Is Received
------------------------------------------------------------------------
         Device HCPCS code                    Short descriptor
------------------------------------------------------------------------
C1721.............................  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, neurostimulators.
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.
C1881.............................  Dialysis access system.
C1882.............................  AICD, other than sing/dual.
C1891.............................  Infusion pump, non-prog, perm.
C1895.............................  Lead, AICD, endo dual coil.
C1896.............................  Lead, AICD, non sing/dual.
C1897.............................  Lead, neurostim, test kit.
C1898.............................  Lead, pmkr, other than trans.
C1899.............................  Lead, pmkr/AICD combination.
C1900.............................  Lead coronary venous.
C2619.............................  Pmkr, dual, non rate-resp.
C2620.............................  Pmkr, single, non rate-resp.
C2621.............................  Pmkr, other than sing/dual.
C2622.............................  Prosthesis, penile, non-inf.
C2626.............................  Infusion pump, non-prog, temp.
C2631.............................  Rep dev, urinary, w/o sling.
L8614.............................  Cochlear device/system.
------------------------------------------------------------------------

2. Proposed Payment for Covered Ancillary Services
    Our final CY 2008 payment policies under the revised ASC payment 
system for covered ancillary services vary according to the particular 
type of service and its payment policy under the OPPS. Our overall 
policy provides for separate ASC payment for certain ancillary services 
integrally related to the provision of ASC covered surgical procedures 
if those services are paid separately under the OPPS. Thus, we 
established a policy to align ASC payment bundles with those under the 
OPPS. Specifically, our final ASC payment policies would provide 
separate ASC payment for brachytherapy sources and drugs and 
biologicals that are separately paid under the OPPS at the OPPS rates, 
while we would pay for radiology services at the lower of the MPFS 
nonfacility PE RVU (or technical component) amount or the rate 
calculated according to the standard methodology of the revised ASC 
payment system based on the

[[Page 42791]]

OPPS relative payment weight for the service.
    As evidenced by our final policies for 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 only for 
those ancillary services that are paid separately under the OPPS, we 
also are proposing to package into the ASC payment for covered surgical 
procedures the costs of those ancillary services that are proposed to 
be packaged under the OPPS for CY 2008. Certain covered ancillary 
services that we are proposing to package for the CY 2008 OPPS were 
assigned payment indicator ``Z2'' or ``Z3'' in the July 2007 final rule 
for the revised ASC payment system, but they are assigned payment 
indicator ``N1'' in Addendum BB to this proposed rule. We refer readers 
to section II.A.4 of this proposed rule for a description of the CY 
2008 OPPS packaging approach that we also are proposing to adopt in 
ASCs and that would package ASC payment for certain covered ancillary 
services. In addition, proposed OPPS payments for brachytherapy sources 
and separately payable drugs and biologicals are discussed in sections 
VII.B. and V. of this proposed rule, respectively. Other separately 
paid covered ancillary services in ASCs, specifically corneal tissue 
acquisition and devices with OPPS pass-through status, do not have 
prospectively established ASC payment rates according to the final 
policies of the revised ASC payment system. Payments for devices with 
pass-through status under the OPPS, for which separate payment would be 
made to ASCs at contractor-priced rates, are discussed in detail in 
section VI. of this proposed rule.

G. Physician Payment for Procedures and Services Provided in ASCs

    If you choose to comment on issues in this section, please include 
the caption ``Physician Payment for Procedures and Services Provided in 
ASCs'' at the beginning of your comment.)
    Under current policy, when physicians perform surgical procedures 
in ASCs that are included on the ASC list of covered surgical 
procedures, they are paid under the MPFS for the PE component using the 
facility PE RVUs. This is appropriate because the surgical procedures 
are those for which Medicare allows facility payment to ASCs. However, 
when physicians perform surgical procedures in ASCs that are not 
included on the ASC list of covered surgical procedures and for which 
Medicare does not allow facility payments to ASCs, physicians are paid 
for the PE component at the higher nonfacility PE RVUs (unless a 
nonfacility rate does not exist, in which case Medicare pays the 
physician at the facility rate). These policies are set forth in Sec.  
414.22(b)(5)(i)(A) and (B), respectively. Furthermore, physician 
payment for nonsurgical services provided in ASCs, for which no 
facility payment is made to ASCs under the existing ASC payment system, 
varies based on local Medicare contractor policy. Some contractors pay 
physicians only for the professional component (PC) of the service and 
others make payment to the physician for the technical component (TC) 
as well. Under the current policy, as described in the CY 2002 
Physician Fee Schedule final rule with comment period (66 FR 55264), 
Medicare payment to the physician for a noncovered surgical procedure 
performed in an ASC constitutes payment in full.This is so even if the 
physician is paid the facility rate (because there is no nonfacility 
rate). In this case, there is no beneficiary liability other than the 
deductible and copayment for the physician's services.
    According to the policy adopted in the July 2007 final rule for the 
revised ASC payment system, Medicare will make facility payments to 
ASCs for all covered surgical procedures except those that could pose a 
significant risk to beneficiary safety or would be expected to require 
active medical monitoring and care at midnight following the procedure 
(that is, an overnight stay). The revised policy will result in a 
significant expansion in the number and type of surgical procedures for 
which Medicare will make an ASC facility payment. The final payment 
policy for the revised ASC payment system also allows separate payments 
to ASCs for certain covered ancillary services (for example, some 
drugs, brachytherapy sources, and certain radiology services) that are 
provided integral to an ASC covered surgical procedure. According to 
the final policy, when covered ancillary services are integral to the 
successful performance of a covered surgical procedure and are 
performed on the same day as the covered surgery, immediately before, 
during or following the procedure, Medicare will allow separate ASC 
payment for those services.
    The revised ASC payment system is based on the APC groups and 
payment weights of the OPPS. We believe ASCs are facilities that are 
similar, insofar as the delivery of surgical and related nonsurgical 
services, to HOPDs. Specifically, when services are provided in ASCs, 
the ASC, not the physician, bears responsibility for the facility costs 
associated with the service. This situation parallels the hospital 
facility resource responsibility for hospital outpatient services. 
Therefore, we believe it would be more appropriate for physicians to be 
paid for all services furnished in ASCs just as they would be paid for 
all services furnished in the hospital outpatient setting. In addition, 
because we have adopted a final policy for the revised ASC payment 
system that identifies and excludes from ASC payment only those 
procedures that could pose a significant risk to beneficiary safety or 
would be expected to require an overnight stay, we believe that it 
would be incongruous with the revised ASC payment system methodology to 
continue to pay the higher nonfacility rate to physicians who furnish 
excluded ASC procedures. Because these excluded procedures have been 
specifically identified by CMS as procedures that could pose a 
significant risk to beneficiary safety or would be expected to require 
an overnight stay, we do not believe it would be appropriate to provide 
payment based on the higher nonfacility PE RVUs to physicians who 
furnish them. In fact, we do not expect that the excluded procedures 
will be performed in ASCs after the revised ASC payment system is 
implemented on January 1, 2008. Therefore, we are proposing to revise 
Sec.  414.22(b)(5)(i)(A) and (B) to reflect this proposed policy.
    We believe that the proposed revised policy would provide 
appropriate payment to physicians for services provided in the ASC 
facility setting and would encourage the most appropriate utilization 
of ASCs. For procedures that are not excluded from coverage under the 
revised ASC payment system, the ASC would be paid for the covered 
surgical procedure and associated covered ancillary services, and the 
physician would be paid for the professional work and facility PE 
associated with performing the procedure. In the case of noncovered 
surgical procedures or other noncovered services provided in ASCs, 
Medicare would make no payment to the ASC under the revised ASC payment 
system and no payment to the physician under the MPFS for the facility 
resources associated with providing those services. Although the 
current MPFS payment policy provides payment to the physician for some 
facility costs as if the service were being furnished in a

[[Page 42792]]

physician's office, according to the final policy of the revised 
payment system, these services would not be covered ASC services. These 
services have been excluded from ASC payment for safety reasons, 
because they are expected to require an overnight stay, or because they 
are not surgical procedures, and they would not be covered by Medicare 
either directly, under the ASC payment system, or indirectly, through 
PE payments to the physicians who perform them.
    In summary, under the proposed policy, physicians would receive 
payment for all surgical and nonsurgical services furnished in ASCs 
based on the facility PE RVUs and excluding the TC payment, if 
applicable, consistent with physician payment for HOPD services. 
Medicare would make no payment for facility services to ASCs or 
physicians for procedures or services that are performed in ASCs but 
that are excluded from the list of covered ASC surgical procedures or 
that are not covered ancillary services. While physicians would be paid 
for these services based on the facility PE RVUs, physicians would no 
longer receive the additional payment for the associated facility 
resources.
    Consistent with the current OPPS payment policy that prohibits 
facility payments to the hospital for noncovered services (such as 
those surgical procedures on the OPPS inpatient list) and makes the 
beneficiary liable for those charges, this proposed policy would make 
beneficiaries responsible for the ASC charges for noncovered services 
furnished to them in ASCs.

H. Proposed Changes to Definitions of ``Radiology and Certain Other 
Imaging Services'' and ``Outpatient Prescription Drugs

    In section 1877(h)(6) of the Act, the Congress defined the 
``designated health services'' (DHS) that are subject to the physician 
self-referral prohibition to include 11 broad categories of services. 
In our regulations at Sec.  411.351, we define each of the 11 DHS 
categories, including ``radiology and certain other imaging services.'' 
In addition, we have clarified that the term ``designated health 
services'' excludes ``services that are reimbursed by Medicare as part 
of a composite rate (for example, ASC services or SNF Part A 
services)'' except to the extent that the DHS categories are themselves 
payable through a composite rate. In the definition of ``radiology and 
certain other imaging services'' at Sec.  411.351, we exclude 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 because we do not believe that a physician would 
inappropriately subject a Medicare patient to such a procedure. In 
addition, the definition of ``radiology and certain other imaging 
services'' excludes radiology services that are integral to the 
performance of a nonradiological medical procedure and performed during 
the nonradiological medical procedure or immediately following the 
nonradiological medical procedure when necessary to confirm placement 
of an item placed during the nonradiological medical procedure. 
Radiology and certain other imaging services performed before a 
nonradiological medical procedure are DHS subject to the physician 
self-referral prohibition.
    Taken together, these provisions effectively exclude from the 
physician self-referral prohibition referrals for radiology services 
that are paid through the ASC composite payment rate, as well as any 
other radiology services that are integral to the performance of an ASC 
covered surgical procedure, that are paid separately, and that are 
performed in the ASC during the surgical procedure or immediately after 
the surgical procedure if required to confirm placement of an item 
placed during the nonradiological medical procedure. (For physician 
self-referral purposes, we have considered radiology services that are 
performed while the patient is still in the operating room to confirm 
that ASC surgery is effective to be performed during the surgical 
procedure.)
    Through CY 2007, most radiology services performed as integral to 
ASC surgical procedures were either included in the ASC payment rate or 
were provided and billed by a separate entity. Effective beginning CY 
2008, the revised ASC payment system will cover a greater variety of 
surgical procedures performed in an ASC and make separate payments 
(outside the ASC composite rate) for certain radiology services 
performed in an ASC that are integral to a covered surgical procedure 
and performed immediately before, during, or immediately after surgery. 
Consequently, under the revised ASC payment system, we expect that more 
radiology procedures would be performed in ASCs, and more of those 
services would be subject to the physician self-referral prohibition to 
the extent that those services are paid outside the ASC composite rate 
and are performed either immediately before an ASC procedure or during 
or immediately after an ASC procedure for a purpose other than to 
confirm placement of an item inserted during the ASC procedure.
    We are proposing to revise the physician self-referral definition 
of ``radiology and certain other imaging services'' at Sec.  411.351 to 
exclude those radiology and imaging services that are ``covered 
ancillary services'' (as defined at new Sec.  416.164(b)) for which 
separate payment is made under the revised ASC payment system. That is, 
we propose that those radiology and imaging procedures that are 
integral to a covered ASC surgical procedure and that are performed 
immediately before, during, or immediately following the surgical 
procedure shall not constitute ``radiology and certain other imaging 
procedures'' for purposes of the physician self-referral law. If we do 
not revise the definition of radiology and certain other imaging 
services for physician self-referral purposes to exclude such 
radiological procedures, the physician self-referral law would prohibit 
an ASC from billing Medicare for such separately payable radiology 
services rendered to patients who had been referred by a physician with 
an ownership or investment interest in, or compensation relationship 
with, the ASC, unless an exception applies. Although there are a number 
of compensation exceptions that may be applicable, there are very few 
applicable ownership or investment exceptions. Thus, many physicians 
would not be able to refer Medicare patients to ASCs in which they have 
an ownership interest. We believe that this outcome would be burdensome 
to our beneficiaries and contrary to Medicare policies that support 
appropriate surgery in ASCs, and we further believe that our proposed 
revision to the definition of ``radiology and certain other imaging 
services'' would not pose a risk of program or patient abuse.
    Under our proposal, the DHS category of ``radiology and certain 
other imaging services'' would continue to include those radiology and 
imaging services that are not paid for under the revised ASC payment 
system (that is, those radiology and imaging services that are 
``excluded services'' as defined at new Sec.  416.164(c)). For example, 
radiology and imaging services that are necessary for the performance 
of a covered surgical procedure, but are not integral to, a covered 
surgical procedure, such as preoperative studies not performed 
immediately before surgery, would be paid for under Part 414 of our 
regulations and would continue to be considered DHS.
    For the reasons that we believe warrant our revising the definition 
of ``radiology and certain other imaging

[[Page 42793]]

services'' at Sec.  411.351, we also propose to exclude from the 
definition of ``outpatient prescription drugs'' at Sec.  411.351, drugs 
that are ``covered ancillary services'' as defined at new Sec.  
416.164(b) under the revised ASC payment system. These drugs are 
furnished, for example, during the immediate postoperative recovery 
period to a patient to reduce suffering from nausea or pain. Under the 
revised ASC payment system, an ASC would be permitted to furnish and 
bill separately for such outpatient prescription drugs, as appropriate. 
Under our proposal, such drugs would not constitute DHS. However, the 
physician self-referral provisions would continue to prohibit an ASC 
from furnishing outpatient prescription drugs for use in the patient's 
home.
    For clarity, we would also make a technical correction to paragraph 
(2) of the definition of ``radiology and certain other imaging 
services'' at Sec.  411.351. This paragraph currently excludes 
``radiology procedures'' that are integral to the performance of a 
``nonradiological procedure.'' We would revise paragraph (2) to exclude 
``radiology and certain other imaging services'' that are integral to 
the performance of ``a medical procedure that is not identified on the 
List of CPT/HCPCS Codes as a `radiology or certain other imaging 
service.' '' We would revise the language of paragraph (2) because we 
believe that, neither radiology services, nor certain other imaging 
services should constitute DHS if they are integral to the performance 
of a medical procedure that is neither a radiology service nor a 
certain other imaging service. We believe that this change would not 
result in any risk of program or patient abuse.

I. New Technology Intraocular Lenses

1. Background
    At the inception of the ASC benefit on September 7, 1982, Medicare 
paid 80 percent of the reasonable charge for IOLs supplied for 
insertion concurrent with or following cataract surgery performed in an 
ASC (47 FR 34082, August 5, 1982). Section 4063(b) of OBRA 1987, Public 
Law 100-203, amended the Act to mandate that we include payment for an 
IOL furnished by an ASC for insertion during or following cataract 
surgery as part of the ASC facility fee for insertion of the IOL, and 
that the facility fee include payment that is reasonable and related to 
the cost of acquiring the class of lens involved in the procedure.
    Section 4151(c)(3) of the Omnibus Budget Reconciliation Act of 1990 
(OBRA 1990), Public Law 101-508, froze the IOL payment amount at $200 
for IOLs furnished by ASCs in conjunction with surgery performed during 
the period beginning November 5, 1990 and ending December 31, 1992. We 
continued paying an IOL allowance of $200 from January 1, 1993, through 
December 31, 1993.
    Section 13533 of the Omnibus Budget Reconciliation Act of 1993 
(OBRA 1993), Public Law 103-66, mandated that payment for an IOL 
furnished by an ASC be equal to $150 beginning January 1, 1994, through 
December 31, 1998. Section 141(b)(1) of the Social Security Act 
Amendments of 1994 (SSAA 1994), Public Law 103 432, required us to 
develop and implement a process under which interested parties may 
request a review of the appropriateness of the payment amount for 
insertion of an IOL, to ensure that the facility fee for the procedure 
includes payment that is reasonable and related to the cost of 
acquiring a lens that belongs to a class of NTIOLs.
    In the February 8, 1990 Federal Register (55 FR 4526), we published 
a final notice entitled ``Revision of Ambulatory Surgery Center Payment 
Rate Methodology,'' which implemented Medicare payment for an IOL 
furnished at an ASC as part of the ASC facility fee for insertion of 
the IOL. In the June 16, 1999 Federal Register (64 FR 32198), we 
published a final rule entitled ``Adjustment in Payment Amounts for New 
Technology Intraocular Lenses Furnished by Ambulatory Surgical 
Centers,'' to add Subpart F (Sec. Sec.  416.180 through 416.200) to 42 
CFR Part 416, which established a process for adjusting payment amounts 
for insertion of a class of NTIOLs furnished by ASCs.
    Since June 16, 1999, we have issued a series of Federal Register 
notices to list lenses for which we received requests for an NTIOL 
payment adjustment and to solicit comments on those requests, or to 
announce the lenses that we have determined meet the criteria and 
definition of NTIOLs. We last published a Federal Register notice 
pertaining specifically to NTIOLs on April 28, 2006 (71 FR 25176).
2. Changes to the NTIOL Determination Process Finalized for CY 2008
    In the CY 2007 OPPS/ASC final rule with comment period, we 
finalized our proposal to update and streamline the process for 
recognizing IOLs inserted during or subsequent to cataract extraction 
as belonging to a new, active NTIOL class that is qualified for a 
payment adjustment. The following is a summary of the changes beginning 
for CY 2008 that were finalized in the CY 2007 OPPS/ASC final rule with 
comment period (71 FR 68176 through 68181).
    We modified the historical process of using separate Federal 
Register notices to notify the public of requests to review lenses for 
membership in new NTIOL classes, to solicit public comment on requests, 
and to notify the public of CMS' determinations concerning lenses 
assigned to classes of NTIOLs for which an ASC payment adjustment would 
be made. In the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68176), we specified that these NTIOL-related notifications would be 
fully integrated into the annual notice and comment rulemaking cycle 
for updating the ASC payment rates, the specific payment system in 
which NTIOL payment adjustments are made. Our final policy for updating 
the revised ASC payment system to be implemented in January 2008 will 
utilize an annual update process in coordination with notice and 
comment rulemaking for the OPPS. Aligning the NTIOL process with this 
annual update will promote coordination and efficiency, thereby 
streamlining and expediting the NTIOL notification, comment, and review 
process.
    Specifically, we established the following process:
    <bullet> We will announce annually in the Federal Register document 
that proposes the update of ASC payment rates for the following 
calendar year, a list of all requests to establish new NTIOL classes 
accepted for review during the calendar year in which the proposal is 
published and the deadline for submission of public comments regarding 
those requests. The deadline for receipt of public comments will be 30 
days following publication of the list of requests.
    <bullet> In the Federal Register document that finalizes the update 
of ASC payment rates for the following calendar year, we will--
    + Provide a list of determinations made as a result of our review 
of all requests and public comments; and
    + Publish the deadline for submitting requests for review in the 
following calendar year.
    In determining whether a lens belongs to a new class of NTIOLs and 
whether the ASC payment amount for insertion of that lens in 
conjunction with cataract surgery is appropriate, we expect that the 
insertion of the candidate IOL would result in significantly improved 
clinical outcomes compared to currently available IOLs. In addition, to 
establish a new NTIOL class, the candidate lens must be distinguishable 
from lenses

[[Page 42794]]

already approved as members of active or expired classes of NTIOLs that 
share a predominant characteristic associated with improved clinical 
outcomes that was identified for each class. In the CY 2007 final rule, 
we finalized our proposal to base our determinations on consideration 
of the following factors:
    <bullet> The IOL must have been approved by the FDA and claims of 
specific clinical benefits and/or lens characteristics with established 
clinical relevance in comparison with currently available IOLs must 
have been approved by the FDA for use in labeling and advertising.
    <bullet> The IOL is not described by an active or expired NTIOL 
class; that is, it does not share the predominant, class-defining 
characteristic associated with improved clinical outcomes with 
designated members of an active or expired NTIOL class.
    <bullet> Evidence demonstrates that use of the IOL results in 
measurable, clinically meaningful, improved outcomes in comparison with 
use of currently available IOLs. According to the statute, and 
consistent with previous examples provided by CMS, superior outcomes 
that would be considered include the following:
    + Reduced risk of intraoperative or postoperative complication or 
trauma;
    + Accelerated postoperative recovery;
    + Reduced induced astigmatism;
    + Improved postoperative visual acuity;
    + More stable postoperative vision;
    + Other comparable clinical advantages, such as--
    ++ Reduced dependence on other eyewear (for example, spectacles, 
contact lenses, and reading glasses);
    ++ Decreased rate of subsequent diagnostic or therapeutic 
interventions, such as the need for YAG laser treatment;
    ++ Decreased incidence of subsequent IOL exchange;
    ++ Decreased blurred vision, glare, other quantifiable symptom or 
vision deficiency.
    For a request to be considered complete, we require submission of 
the information that is found in the guidance document entitled 
``Application Process and Information Requirements for Requests for a 
New Class of New Technology Intraocular Lens (NTIOL)'' posted on the 
CMS Web site at: http://cms.hhs.gov/ASCPayment/05_NTIOLs.asp#TopOfPage.
    As stated in the CY 2007 OPPS/ASC final rule with comment period 
(71 FR 68180), there are three possible outcomes from our review of a 
request for determination of a new NTIOL class. As appropriate, for 
each completed request for a candidate IOL that is received by the 
established deadline, one of the following determinations would be 
announced annually in the final rule updating the ASC payment rates for 
the next calendar year:
    <bullet> The request for a payment adjustment is approved for the 
IOL for 5 full years as a member of a new NTIOL class described by a 
new HCPCS code.
    <bullet> The request for a payment adjustment is approved for the 
IOL for the balance of time remaining as a member of an active NTIOL 
class.
    <bullet> The request for a payment adjustment is not approved.
    We also discussed our plan to summarize briefly in the final rule 
the evidence that was reviewed, the public comments, and the basis for 
our determinations. We established that when a new NTIOL class is 
created, we would identify the predominant characteristic of NTIOLs in 
that class that sets them apart from other IOLs (including those 
previously approved as members of other expired or active NTIOL 
classes) and is associated with improved clinical outcomes. The date of 
implementation of a payment adjustment in the case of approval of an 
IOL as a member of a new NTIOL class would be set prospectively as of 
30 days after publication of the ASC payment update final rule, 
consistent with the statutory requirement. The date of implementation 
of a payment adjustment in the case of approval of a lens as a member 
of an active NTIOL class would be set prospectively as of the 
publication date of the ASC payment update final rule.
3. NTIOL Application Process for CY 2008 Payment Adjustment
    To provide process and information requirements for applications 
requesting a review of the appropriateness of the payment amount for 
insertion of an IOL to ensure that the ASC payment for covered surgical 
procedures includes payment that is reasonable and related to the cost 
of acquiring a lens that is approved as belonging to a new class of 
NTIOLs, in the winter of CY 2007 we posted the guidance document to the 
CMS Web site regarding such requests as described above. We did not 
receive any review requests by the deadline of April 1, 2007 in 
response to the announcement made in the CY 2007 OPPS/ASC final rule 
with comment period (71 FR 68181) soliciting CY 2008 requests for 
review of the appropriateness of the payment amount for new classes of 
NTIOLs furnished in ASCs.
    We note that we have also issued a guidance document entitled 
``Revised Process for Recognizing Intraocular Lenses Furnished by 
Ambulatory Surgery Centers (ASCs) as Belonging to an Active Subset of 
New Technology Intraocular Lenses (NTIOLs).'' This guidance document 
can be accessed on the CMS Web site at: http://www.cms.hhs.gov/ASCPayment/05_NTIOLs.asp.
    This guidance document provides specific details regarding requests 
for recognition of IOLs as belonging to an existing, active NTIOL 
class, the review process, and information required for a request to 
review. Currently, there is one active NTIOL class whose defining 
characteristic is the reduction of spherical aberration. CMS accepts 
requests throughout the year to review the appropriateness of 
recognizing an IOL as a member of an active class of NTIOLs. That is, 
review of candidate lenses for membership in an existing, active NTIOL 
class is ongoing and not limited to the annual review process that 
applies to the establishment of new NTIOL classes. We ordinarily would 
complete the review of such a request within 90 days of receipt, and 
upon completion of our review, we would notify the requestor of our 
determination and post on the CMS Web site notification of a lens newly 
approved for a payment adjustment as an NTIOL belonging to an active 
NTIOL class when furnished in an ASC.
4. Classes of NTIOLs Approved for Payment Adjustment
    Since implementation of the process for adjustment of payment 
amounts for NTIOLs that was established in the June 16, 1999 Federal 
Register, we have approved three classes of NTIOLs, as shown in the 
following table:

----------------------------------------------------------------------------------------------------------------
                                             $50 approved for
   NTIOL category         HCPCS code      services furnished on  NTIOL characteristic      IOLs eligible for
                                                 or after                                      adjustment
----------------------------------------------------------------------------------------------------------------
1..................  Q1001..............  May 18, 2000, through  Multifocal..........  Allergan AMO Array
                                           May 18, 2005.                                Multifocal lens, model
                                                                                        SA40N.

[[Page 42795]]

 
2..................  Q1002..............  May 18, 2000, through  Reduction in          STAAR Surgical Elastic
                                           May 18, 2005.          Preexisting           Ultraviolet-Absorbing
                                                                  Astigmatism.          Silicone Posterior
                                                                                        Chamber IOL with Toric
                                                                                        Optic, models AA4203T,
                                                                                        AA4203TF, and AA4203TL.
3..................  Q1003..............  February 27, 2006,     Reduced Spherical     Advanced Medical Optics
                                           through February 26,   Aberration.           (AMO) Tecnis[reg] IOL
                                           2011.                                        models Z9000, Z9001,
                                                                                        Z9002, and ZA9003; Alcon
                                                                                        Acrysof[supreg] IQ Model
                                                                                        SN60WF; Bausch & Lomb
                                                                                        Sofport AO models
                                                                                        LI61AOV, and LI61AOV.
----------------------------------------------------------------------------------------------------------------

5. Payment Adjustment
    The current payment adjustment for a 5-year period from the 
implementation date of a new NTIOL class is $50. In the CY 2007 OPPS/
ASC final rule with comment period, we revised Sec.  416.200(a) through 
(c) to clarify how the IOL payment adjustment will be made and how an 
NTIOL will be paid after expiration of the payment adjustment, as well 
as made minor editorial changes to Sec.  416.200(d). For CY 2008, we 
are not proposing to revise the current payment adjustment amount, but 
we reiterate our intention, as stated in the CY 2007 final rule, to 
reevaluate whether or not the ASC payment rates established for 
cataract surgery with IOL insertion are appropriate when a lens 
determined to be an NTIOL is furnished after we have implemented the 
revised ASC payment system in CY 2008.
6. Proposed CY 2008 ASC Payment for Insertion of IOLs
    In accordance with the final policies of the revised ASC payment 
system for CY 2008, payment for IOL insertion services will be 
established according to the standard payment methodology of the 
revised payment system, which applies the ASC budget neutrality 
adjustment to the OPPS conversion factor to calculate an ASC conversion 
factor that is then multiplied by the ASC payment weight for the 
surgical procedure to implant the IOL. CY 2008 ASC payment for the cost 
of a conventional lens will be packaged into the payment for the 
associated covered surgical procedure performed by the ASC. The 
proposed CY 2008 ASC payment rates for IOL insertion procedures are 
included in Table 66.

  Table 66.--Insertion of IOL Procedures and Their Proposed CY 2008 ASC
                              Payment Rates
------------------------------------------------------------------------
                                                             Proposed CY
        HCPCS code                  Long descriptor            2008 ASC
                                                               payment
------------------------------------------------------------------------
66983....................  Intracapsular cataract                $980.43
                            extraction with insertion of
                            intraocular lens prosthesis
                            (one stage procedure).
66984....................  Extracapsular cataract removal         980.43
                            with insertion of intraocular
                            lens prosthesis (one stage
                            procedure), manual or
                            mechanical technique (eg,
                            irrigation and aspiration or
                            phacoemulsification).
66985....................  Insertion of intraocular lens          870.18
                            prosthesis (secondary implant),
                            not associated with concurrent
                            cataract removal.
66986....................  Exchange of intraocular lens....       870.18
------------------------------------------------------------------------

J. Proposed ASC Payment and Comment Indicators

    In addition to the payment indicators that we introduced in the 
July 2007 final rule for the revised ASC payment system, we also are 
introducing comment indicators for the ASC payment system in this 
proposed rule. We created Addendum DD1 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 define in Addendum D1 to the 
annual OPPS proposed and final rules, 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 
designations as device-intensive; their designations as office-based 
and the corresponding ASC payment methodology; and their 
classifications as separately payable radiology services, brachytherapy 
sources, OPPS pass-through devices, corneal tissue acquisition 
services, drugs or biologicals, or NTIOLs.
    We have also created new Addendum DD2 to this proposed rule that 
lists the ASC comment indicators. Like the comment indicators used in 
the OPPS, the ASC comment indicators to be used in Addenda AA and BB to 
the OPPS/ASC final rule with comment period will serve to identify, for 
the revised ASC payment system, the status of a specific HCPCS code and 
its payment indicator with respect to the timeframe when comments would 
be accepted. The comment indicator ``NI'' will be used in the final 
rule to indicate new HCPCS codes for which the interim payment 
indicator assigned is subject to comment in the final rule.
    The changes for CY 2008 that we are proposing to the payment 
indicators assigned to HCPCS codes for procedures and services in the 
July 2007 final rule for the revised ASC payment system are identified 
with a ``CH'' in Addenda AA and BB to this proposed rule and are 
subject to comment during the 60-day comment period provided for this 
proposed rule. ``CH'' will be used in Addenda AA and BB to the CY 2008 
OPPS/ASC final rule with comment period to indicate that a new payment 
indicator (in comparison with that in the July 2007 final rule for the 
revised ASC payment system) has been assigned to an active HCPCS code 
in the current and next calendar year; that an active HCPCS code has 
been added to the list of procedures or services payable in ASCs; or 
that an active HCPCS code will be deleted at the end of the current 
calendar year. These ``CH'' comment indicators that will be published 
in the CY 2008 OPPS/ASC final rule with comment period will be provided 
to alert our readers that a change has been made since the July 2007 
final rule for the revised ASC payment system, but do not indicate that 
the change is subject to comment. The full definitions for the comment 
indicators are provided in Addendum DD2 to this proposed rule.

[[Page 42796]]

K. ASC Policy and Payment Recommendations

    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 the July 2007 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 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.
    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. The 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. 
The ASC-to-APC median cost ratio is a comparison of the median cost of 
each of the 20 surgical procedures with the highest ASC claims volume 
to the median cost of the APC group in which it would be placed under 
the OPPS, while the OPPS-to-APC cost ratio is a comparison of the 
median cost of each of those same procedures under the OPPS with the 
median cost of its assigned APC group. These patterns demonstrated that 
the APC groups reflect the relative costs of procedures performed by 
ASCs like they do for procedures performed in HOPDs 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 are 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.

L. Proposed Calculation of the ASC Conversion Factor and ASC Payment 
Rates

1. Overview
    As discussed in section XVI.C. of this proposed rule, we finalized 
our policy 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 in the July 2007 final rule for the 
ASC revised payment system. In that rule, we made final our proposal to 
set the ASC relative payment weight for certain office-based surgical 
procedures so that the national unadjusted ASC payment rate does not 
exceed the MPFS unadjusted nonfacility PE RVU amount. Our final policy 
is to calculate ASC payment rates by multiplying the ASC relative 
payment weights by the ASC conversion factor. In the July 2007 final 
rule for the revised ASC payment system, our estimate of the CY 2008 
budget neutral ASC conversion factor was $42.542. In this proposed 
rule, the proposed ASC conversion factor for CY 2008 is $41.400. This 
new estimate of the ASC conversion factor differs from the estimate in 
the July 2007 final rule for the revised ASC payment system for a 
number of reasons, including: (1) Use of the proposed OPPS relative 
payment weights for CY 2008; (2) use of the proposed MPFS nonfacility 
practice expense payment amounts for CY 2008; and (3) use of updated 
utilization data from CY 2006. Specific details regarding our final 
methodology for estimating the CY 2008 ASC conversion factor may be 
found in the July 2007 final rule for the revised ASC payment system.
    We were not able to provide the final CY 2008 ASC conversion factor 
in the July 2007 final rule for the revised ASC payment system because 
the final CY 2008 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 the time we 
are publishing the July 2007 final rule for the ASC revised payment 
system elsewhere in this issue of the Federal Register. In this 
proposed rule, we use the final methodology described in the July 2007 
final rule for the revised ASC payment system to calculate the proposed 
CY 2008 ASC conversion factor and proposed ASC relative payment weights 
and rates that will be made final in the CY 2008 OPPS/ASC final rule 
with comment period.
2. Budget Neutrality Requirement
    Section 626(b) of Pub. L. 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 July 2007 final rule for the revised ASC 
payment system, the ASC conversion factor is

[[Page 42797]]

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 is 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 Pub. L. 109-171.
    We note that we considered the term ``expenditures'' in the context 
of section 626(b) of the Pub. L. 108-173 budget neutrality requirement 
to mean expenditures from the Medicare Part B Trust Fund. We did not 
consider expenditures to include beneficiary coinsurance and 
copayments.
3. Calculation of the ASC Payment Rates for CY 2008
    The following is a step-by-step illustration of the final budget 
neutrality adjustment calculation as finalized in the July 2007 final 
rule for the revised ASC payment system and as applied to updated data 
available for this proposed rule.
    The final methodology for establishing budget neutrality under the 
revised ASC payment system takes into account a 4-year transition to 
full implementation of the revised payment rates and the effects of 
several assumptions regarding migration of services across ASCs, HOPDs, 
and physicians' offices. Payments during the 4-year transition to the 
fully implemented revised ASC payment rates will be based on a blend of 
the CY 2007 ASC payment rates and the revised ASC payment rates at 75/
25 in CY 2008, 50/50 in CY 2009, and 25/75 in CY 2010, with payment at 
100 percent of the revised ASC payment rates in 2011. The methodology 
assumes no net cost or savings to Medicare from the migration of 
existing ASC services among ASCs, HOPDs, and physicians' offices. It 
includes assumptions that 15 percent of physicians' office utilization 
for new ASC procedures, specifically those first added for ASC payment 
beginning in CY 2008, will migrate to ASCs over a 4-year period (3.75 
percent each year) and that 25 percent of the new procedures' HOPD 
utilization will migrate over the first 2 years under the revised 
payment system (12.5 percent each year) and accounts for the Medicare 
costs and savings associated with that movement. A detailed explanation 
of the model may be found in section V.C. of the July 2007 final rule 
for the revised ASC payment system.
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 proposed 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 occur 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. the July 2007 
final rule for the revised ASC payment system).
    (b) For each new ASC procedure, we multiply the results of Step 
1(a) by the proposed 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 proposed CY 2008 physician in-office payment rates. 
``Physician in-office payment rate'' is equal to the proposed MPFS 
nonfacility practice expense RVUs multiplied by the proposed 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 proposed 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 (71 FR 68243 through 68283) and take into account 
the OPPS cap on payment for ASC services as required by section 5103 of 
Pub. L. 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 the July 
2007 final rule for the revised ASC payment system).
    (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 proposed 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 the July 2007 final rule for the revised 
ASC payment system).
    Step 7: Migration of new ASC office-based procedures from 
physicians' offices to ASCs is valued based on proposed CY 2008 OPPS 
payment rates capped at the proposed 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 proposed CY 2008 OPPS rate for the procedure; or
    (2) The proposed 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.

[[Page 42798]]

    Step 8: Migration of new ASC procedures not determined to be 
office-based from physicians' offices to ASCs is valued using the 
proposed 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 proposed 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 proposed CY 2008 MPFS physician out-of-office 
payment rate. ``Physician out-of-office payment rate'' is equal to the 
proposed facility practice expense RVUs multiplied by the proposed CY 
2008 MPFS conversion factor.
    (a) For each new ASC procedure, we multiply the results of Step 
2(a) from above by the proposed 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 proposed CY 2008 
OPPS payment rates.
    To estimate the aggregate amount of expenditures that would be made 
in CY 2008, we use proposed 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 of covered surgical procedures by the proposed 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 Proposed 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 proposed 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.
    The application of the above methodology to the data available for 
this proposed rule results in an estimated budget neutrality adjustment 
of 0.65. This number differs from the estimated budget neutrality 
adjustment of 0.67 for the July 2007 final rule for the revised ASC 
payment system that was based on CY 2005 utilization and CY 2007 OPPS 
and MPFS payment rates. The proposed budget neutrality adjustment for 
CY 2008 reflects updated data, including CY 2006 utilization and 
proposed CY 2008 OPPS and MPFS payment rates. The CY 2008 budget 
neutrality adjustment for the revised ASC payment system, calculated 
based on the methodology outlined above, will be finalized in the CY 
2008 OPPS/ASC final rule with comment period.
d. Calculation of the Proposed CY 2008 ASC Payment Rates
    After developing the proposed CY 2008 budget neutrality adjustment 
of 0.65 according to the policies established in the July 2007 final 
rule for the revised ASC payment system, to determine the proposed CY 
2008 ASC conversion factor, we multiplied the proposed CY 2008 OPPS 
conversion factor by the proposed ASC budget neutrality adjustment. The 
proposed CY 2008 OPPS conversion factor is $63.693 and multiplying that 
by the 0.65 budget neutrality adjustment yields our proposed CY 2008 
ASC conversion factor of $41.400. To determine the proposed fully 
implemented ASC payment rates for this proposed 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 multiplied 
the proposed ASC conversion factor by the proposed ASC relative payment 
weight for each procedure or service. As further discussed in section 
XVI.C. of this proposed 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, 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 calculated the proposed 
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 proposed CY 2008 ASC payment 
rate developed according to the methodology of the revised ASC payment 
system, applying the special transition treatment to device-intensive 
procedures as discussed in section XVI.C of this proposed rule. See 
Addenda AA and BB to this proposed rule for the proposed 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.
4. Calculation of the ASC Payment Rates for CY 2009 and Future Years
a. Updating the ASC Relative Payment Weights
    In the July 2007 final rule for the revised ASC payment system, we 
finalized our policy to update the ASC relative payment weights in the 
revised ASC payment system each year using the national OPPS relative 
payment weights (and MPFS nonfacility PE RVU amounts, as applicable) 
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

[[Page 42799]]

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. As we noted in the July 
2007 final rule for the revised ASC payment system, 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.
b. 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, as discussed 
in the July 2007 final rule for the ASC revised payment system, we 
adopted a final policy to update the ASC conversion factor using the 
CPI-U in order to adjust ASC payment rates for inflation. We will 
implement the annual updates 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.

XVII. Reporting Quality Data for Annual Payment Rate Updates

    (If you choose to comment on issues in this section, please include 
the caption ``Quality Data'' at the beginning of your comment.)

A. Background

1. Reporting Hospital Outpatient Quality Data for Annual Payment Update
    Section 109(a) of the MIEA-TRHCA (Pub. L. 109-432) amended section 
1833(t) of the Act by adding a new subsection (17) that affects the 
payment rate update applicable to OPPS payments for services furnished 
by hospitals in outpatient settings on or after January 1, 2009. New 
section 1833(t)(17)(A) of the Act, which applies to hospitals as 
defined under section 1886(d)(1)(B) of the Act, requires that hospitals 
that fail to report data required for the quality measures selected by 
the Secretary in the form and manner required by the Secretary under 
section 1833(t)(17)(B) of the Act will incur a reduction in their 
annual payment update factor by 2.0 percentage points. New section 
1833(t)(17)(B) of the Act requires that hospitals submit quality data 
in a form and manner, and at a time that the Secretary specifies. New 
sections 1833(t)(17)(C)(i) and (ii) of the Act require the Secretary to 
develop measures appropriate for the measurement of the quality of care 
(including medication errors) furnished by hospitals in outpatient 
settings and that these measures reflect consensus among affected 
parties and, to the extent feasible and practicable, include measures 
set forth by one or more national consensus building entities. The 
Secretary is not prevented from selecting measures that are the same as 
(or a subset of) the measures for which data are required to be 
submitted under section 1886(b)(3)(B)(viii) of the Act for the IPPS 
Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) 
program. New section 1833(t)(17)(D) of the Act, gives the Secretary the 
authority to replace measures or indicators as appropriate, such as 
when all hospitals are effectively in compliance or when the measures 
or indicators have been subsequently shown not to represent the best 
clinical practice. New section 1833(t)(17)(E) of the Act, requires the 
Secretary to establish procedures for making data submitted available 
to the public. Such procedures must give hospitals the opportunity to 
review data before these data are released.
    In the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68189), we indicated our intent to establish, in CY 2009, an OPPS 
RHQDAPU program modeled after the current IPPS RHQDAPU program in CY 
2009. We stated our belief that the quality of hospital outpatient 
services would be most appropriately and fairly rewarded through the 
reporting of quality measures developed specifically for application in 
the hospital outpatient setting. We agreed with the commenters that 
assessment of hospital outpatient performance would ultimately be most 
appropriately based on reporting of hospital outpatient measures 
developed specifically for this purpose. We stated our intent to 
condition the full OPPS payment rate update beginning in CY 2009 based 
upon hospital reporting of quality data beginning in CY 2008, using 
effective measures of the quality of hospital outpatient care that have 
been carefully developed and evaluated, and endorsed as appropriate, 
with significant input from stakeholders.
    The amendments to the Act made by section 109(a) of the MIEA-TRHCA 
are consistent with our intent and direction outlined in the CY 2007 
OPPS/ASC final rule with comment period. Under these amendments, we are 
now statutorily required to establish a program under which hospitals 
will report data on the quality of hospital outpatient care using 
standardized measures of care to receive the full annual update to the 
OPPS payment rate, effective for payments beginning in CY 2009. We will 
refer to the program established under these amendments as the Hospital 
Outpatient Quality Data Reporting Program (HOP QDRP).
    In reviewing the measures currently available for care in the 
hospital outpatient settings, we continue to believe that it would be 
most appropriate and desirable to use measures that have been 
specifically developed for application in the hospital outpatient 
setting. Although we still believe that hospitals generally function as 
integrated systems in inpatient and outpatient settings, we do not 
believe it is appropriate to use participation in the IPPS RHQDAPU 
program for the purpose of implementing section 1833(t)(17) of the Act 
in the hospital outpatient setting. Nonetheless, section 
1833(t)(17)(C)(ii) of the Act indicates that the Secretary is not 
prevented ``from selecting measures that are the same as (or a subset 
of) the measures for which data are required to be submitted'' under 
the IPPS RHQDAPU program. In this proposed rule, we are proposing to 
establish a separate reporting program and proposing quality measures 
that are appropriate for measuring hospital outpatient quality of care, 
that reflect consensus among affected parties, and are set forth by one 
or more of the national consensus building entities.

[[Page 42800]]

2. Reporting ASC Quality Data for Annual Payment Increase
    Section 109(b) of the MIEA-TRHCA, Pub. L. 109-432 amended section 
1833(i) of the Act by adding new sections 1833(i)(2)(D)(iv) and 
1833(i)(7) to the Act. These amendments may affect ASC payments for 
services furnished in ASC settings on or after January 1, 2009. New 
section 1833(i)(2)(D)(iv) of the Act authorizes the Secretary to 
implement the revised payment system for services furnished in ASCs 
(established under section 1833(i)(2)(D) of the Act), ``so as to 
provide for a reduction in any annual payment increase for failure to 
report on quality measures.''
    New section 1833(i)(7)(A) of the Act authorizes the Secretary to 
provide that any ASC that fails to report data required for the quality 
measures selected by the Secretary in the form and manner required by 
the Secretary under new section 1833(i)(7) of the Act will incur a 
reduction in any annual payment increase of 2.0 percentage points. New 
section 1833(i)(7)(A) of the Act also specifies that a reduction for 
one year cannot be taken into account in computing the ASC update for a 
subsequent year.
    New section 1833(i)(7)(B) of the Act provides that, ``except as the 
Secretary may otherwise provide,'' the hospital outpatient quality data 
provisions of section 1833(t)(17)(B) through (E) of the Act, summarized 
above, shall apply to ASCs.
    We refer readers to section XVII.H. of this proposed rule for a 
discussion of our intent to introduce implementation of this provision 
in a later rulemaking.

B. Proposed Hospital Outpatient Measures

    For the initial implementation of the HOP QDRP, we have identified 
10 quality measures that we believe are both applicable to care 
provided in hospital outpatient settings and likely to be sufficiently 
developed to permit data collection consistent with the timeframes 
defined by statute. These measures address care provided to a large 
number of adult patients in hospital outpatient settings, across a 
diverse set of conditions, and were selected for the initial set of HOP 
QDRP measures based on their relevance as a set to all hospitals.
    The first five of these measures capture the quality of outpatient 
care in hospital emergency departments (EDs), specifically for those 
adult patients with acute myocardial infarction (AMI) who are treated 
and then transferred to another facility for further care. These 
patients receive many of the same interventions as patients who are 
evaluated and admitted at the same facility, whose care is currently 
assessed in measures that are endorsed by the National Quality Forum 
(NQF). NQF is a voluntary consensus standard-setting organization 
established to standardize health care quality measurement and 
reporting through its consensus development process. Moreover, these 
are also inpatient AMI measures that have long been reported under the 
IPPS RHQDAPU program, and are published on the Hospital Compare Web 
site at: http://www.HospitalCompare.hhs.gov. Transferred AMI patients 
historically have not been included with the directly-admitted patients 
for purposes of the calculation of the inpatient AMI measures because 
of differences in data collection and reporting for the two groups. 
With the input of provider and practitioner experts in the field, we 
have developed specifications for related emergency department transfer 
measures that, while consistent with the measure specifications for the 
related hospital inpatient measures, reflect the unique operational and 
clinical aspects of care in hospital outpatient settings. The processes 
of care encompassed by these measures address care on arrival, the 
promptness of interventions, and discharge care for patients presenting 
to a hospital with an AMI.
    In addition to the five ED-AMI measures, we have identified five 
quality measures that are directly related to conditions treated or 
interventions provided in hospital outpatient settings and that we 
believe are also appropriate and fully developed for use in the HOP 
QDRP. While currently specified in a form that assesses the care 
provided by physicians, these measures are also directly relevant to 
assessing care at the facility level. CMS is currently engaged in 
reviewing, and where appropriate, revising these measure specifications 
so that they explicitly assess care provided in hospital outpatient 
settings. The five measures include one measure related to treatment of 
heart failure, two measures related to surgical care improvement, one 
measure addressing treatment of community acquired pneumonia, and one 
measure related to diabetes care.
    Specifically, in order for hospitals to receive the full OPPS 
payment update for services furnished in CY 2009, we are proposing to 
require that hospital outpatient settings submit data on the following 
10 measures, effective with hospital outpatient services furnished on 
or after January 1, 2008:
    <bullet> ED-AMI-1--Aspirin at Arrival
    <bullet> ED-AMI-2--Median Time to Fibrinolysis
    <bullet> ED-AMI-3--Fibrinolytic Therapy Received Within 30 Minutes 
of Arrival
    <bullet> ED-AMI-4--Median Time to Electrocardiogram (ECG)
    <bullet> ED-AMI-5--Median Time to Transfer for Primary PCI
    <bullet> PQRI <greek-i>5: Heart Failure: Angiotensin-Converting 
Enzyme (ACE) Inhibitor or
    <bullet> Angiotensin Receptor Blocker (ARB) Therapy for Left 
Ventricular Systolic Dysfunction (LVSD)
    <bullet> PQRI <greek-i>20 Perioperative Care: Timing of Antibiotic 
Prophylaxis
    <bullet> PQRI <greek-i>21 Perioperative Care: Selection of 
Prophylactic Antibiotic
    <bullet> PQRI <greek-i>59: Empiric Antibiotic for Community-
Acquired Pneumonia
    <bullet> PQRI <greek-i>1: Hemoglobin A1c Poor Control in Type 1 or 
2 Diabetes Mellitus
    As required by statute, consensus was reached by affected parties, 
as the measures were identified as appropriate for reporting on 
hospital outpatient care in collaboration with professionals and 
providers with experience in hospital outpatient settings as well as 
with the Hospital Quality Alliance (HQA), a hospital-industry led, 
public-private collaboration established to promote public reporting on 
hospital quality of care. CMS is currently finalizing the 
specifications for these 10 measures and expects to release these 
specifications to the public by Fall 2007. In addition, CMS expects to 
submit these measures for endorsement by the NQF.
    Nine of the ten measures are process measures, while one measure--
Hemoglobin A1c >9.0 percent--is an intermediate outcome measure that 
has not been risk-adjusted. While poor quality of care can lead to poor 
diabetes control and elevated A1c levels, CMS recognizes the importance 
of compliance with prescribed treatment regimen in improving diabetes 
control and A1c levels. Patients with comorbidities or diabetes 
complications may experience challenges controlling their diabetes and 
may have higher A1c levels. Therefore, CMS specifically requests 
comments on this intermediate outcome measure and how to balance the 
desire for improved quality of care with individual patient challenges 
that may affect results.
    CMS believes that an A1c level higher than 9.0 percent represents a 
level of control that is sufficiently poor enough that it should not 
result in any unintended consequences. The scientific literature would 
suggest that an A1c level of 8.0 percent or less might represent the 
best control that could be expected for some patients: therefore, CMS 
believes that an A1c level of > 9.0

[[Page 42801]]

percent represents a level of control that is poor enough that risk-
adjustment is not warranted. Additionally, this A1c measure has been 
endorsed by the National Quality Forum (NQF) in 2006. One of the 
criteria for evaluation of measures within the NQF process is 
``scientific acceptability,'' which includes appropriate risk-
adjustment. Some measures are not endorsed by NQF if risk-adjustment is 
determined to be appropriate and is found to be inadequate. CMS 
believes that additional risk-adjustment is not necessary because the 
NQF endorsed this measure. We invite public comment on our rationale 
for choosing a diabetes outcome measures.

C. Other Proposed Hospital Outpatient Measures

    In addition to the 10 measures identified above, we are considering 
a number of other possible quality measures for use in assessing the 
care of services provided by hospital outpatient settings, for the 
determination of CY 2010 or subsequent calendar year payments. These 
measures are, for the most part, either currently in use or were 
developed for use in settings other than hospital outpatient. However, 
we believe that these measures are applicable to the hospital 
outpatient settings.
    These measures have not received formal review by either the HQA or 
the NQF as measures of HOP performance. As noted in the chart, however, 
the inpatient or ambulatory versions of these measures have all been 
either recommended by an NQF-subgroup for endorsement, are pending 
endorsement by the NQF, or are currently endorsed by the NQF. The 
measures present the diversity of services and clinical topics provided 
to adult patients in hospital outpatient settings. The measures address 
some aspects of care provided to cancer patients, patients presenting 
with diabetes, pneumonia, chest pains, syncope, or depression, and 
patients receiving services related to bones, eyes, and problems 
associated with aging. While some of the measures relate to acute care 
provided in a hospital outpatient setting, others assess care that a 
hospital outpatient clinic might provide on an ongoing basis. We are 
interested in receiving comments from the public concerning all 
dimensions of these measures.
    We expect that once the HOP QDRP is established, we will expand the 
set of measures on which hospital outpatient settings must report data. 
We are interested in receiving comments concerning the relative 
priority that should be assigned to each of the measures or topics 
identified in the list below, as well as any additional measures, 
measure sets, or topics that should be developed for future reporting.
    We would like to note that, while we are committed to identifying 
measures that are relevant to care in hospital outpatient settings, it 
is also our intent to develop, where feasible, hospital outpatient 
measures that are ``harmonized'' with measures for assessing comparable 
inpatient and ambulatory care--that is, measures that are similar in 
both the care that is assessed and the manner in which data are 
collected, regardless of the setting. The goal of harmonization is to 
assure that comparable care in different care settings can be evaluated 
in similar ways, which further assures that quality measurement and 
improvement can focus more on the needs of a patient with a particular 
condition than on the specific program or policy attributes of the 
setting at which the care is provided.
    Therefore, we are seeking public comment on the following 30 
additional measures, which have been identified as hospital outpatient-
appropriate measures and are under consideration for inclusion in the 
HOP QDRP measure set, for CY 2010 or subsequent calendar years:

------------------------------------------------------------------------
                                 NQF endorsed for
                                   inpatient or
            Measure                 ambulatory          Description
                                     setting
------------------------------------------------------------------------
1 PQRI <greek-i>2 Low Density   Endorsed 2006....  Percentage of
 Lipoprotein Control in Type 1                      patients aged 18-75
 or 2 Diabetes Mellitus.                            years with diabetes
                                                    (type 1 or type 2)
                                                    who had most recent
                                                    LDL-C level in
                                                    control (less than
                                                    100 mg/dl).
2 PQRI <greek-i>3 High Blood    Endorsed 2006....  Percentage of
 Pressure Control in Type 1 or                      patients aged 18-75
 2 Diabetes Mellitus.                               years with diabetes
                                                    (type 1 or type 2)
                                                    who had most recent
                                                    blood pressure in
                                                    control (less than
                                                    140/80 mm Hg).
3 PQRI <greek-i>4 Screening     2 year             Percentage of
 for Fall Risk.                  Endorsement        patients aged 65
                                 until May 8,       years and older who
                                 2009.              were screened for
                                                    fall risk (2 or more
                                                    falls in the past
                                                    year or any fall
                                                    with injury in the
                                                    past year) at least
                                                    once within 12
                                                    months.
4 PQRI <greek-i>9               Endorsed 2006....  Percentage of
 Antidepressant Medication                          patients aged 18
 During Acute Phase for                             years and older
 Patient with New Episode of                        diagnosed with new
 Major Depression.                                  episode of major
                                                    depressive disorder
                                                    (MDD) and documented
                                                    as treated with
                                                    antidepressant
                                                    medication during
                                                    the entire 84-day
                                                    (12 week) acute
                                                    treatment phase.
5 PQRI <greek-i>10 Stroke and   2 year             Percentage of
 Stroke Rehabilitation:          Endorsement        patients aged 18
 Computed Tomography (CT) or     until May 8,       years and older with
 Magnetic Resonance Imaging      2009.              a diagnosis of
 (MRI) Reports.                                     ischemic stroke or
                                                    transient ischemic
                                                    attack (TIA) or
                                                    intracranial
                                                    hemorrhage
                                                    undergoing CT or MRI
                                                    of the brain within
                                                    24 hours of arrival
                                                    to the hospital
                                                    whose final report
                                                    of the CT or MRI
                                                    includes
                                                    documentation of the
                                                    presence or absence
                                                    of each of the
                                                    following:
                                                    hemorrhage and mass
                                                    lesion and acute
                                                    infarction.
6 PQRI <greek-i>11 Stroke and   2 year             Percentage of
 Stroke Rehabilitation:          Endorsement        patients aged 18
 Carotid Imaging Reports.        until May 8,       years and older with
                                 2009.              a diagnosis of
                                                    ischemic stroke or
                                                    transient ischemic
                                                    attack (TIA) whose
                                                    final reports of the
                                                    carotid imaging
                                                    studies performed,
                                                    with
                                                    characterization of
                                                    internal carotid
                                                    stenosis in the 30-
                                                    99% range, include
                                                    reference to
                                                    measurements of
                                                    distal internal
                                                    carotid diameter as
                                                    the denominator for
                                                    stenosis
                                                    measurement.
7 PQRI <greek-i>24              2 year             Percentage of
 Osteoporosis: Communication     Endorsement        patients aged 50
 with the Physician Managing     until May 8,       years and older
 Ongoing Care Post Fracture.     2009.              treated for a hip,
                                                    spine or distal
                                                    radial fracture with
                                                    documentation of
                                                    communication with
                                                    the physician
                                                    managing the
                                                    patient's ongoing
                                                    care that a fracture
                                                    occurred and that
                                                    the patient was or
                                                    should be tested or
                                                    treated for
                                                    osteoporosis.

[[Page 42802]]

 
8 PQRI <greek-i>46 Medication   2 year             Percentage of
 Reconciliation.                 Endorsement        patients aged 65
                                 until May 8,       years and older
                                 2009.              discharged from any
                                                    inpatient facility
                                                    (e.g., hospital
                                                    skilled nursing
                                                    facility, or
                                                    rehabilitation
                                                    facility) and seen
                                                    within 60 days
                                                    following discharge
                                                    in the office by the
                                                    physician providing
                                                    on-going care who
                                                    had a reconciliation
                                                    of the discharge
                                                    medications with the
                                                    current medication
                                                    list in the medical
                                                    record documented.
9 PQRI <greek-i>53 Asthma       Endorsed 2006....  Percentage of
 Pharmacological Therapy.                           patients aged 5 to
                                                    40 with a diagnosis
                                                    of mild, moderate,
                                                    or severe persistent
                                                    asthma who were
                                                    prescribed either
                                                    the preferred long-
                                                    term control
                                                    medication (inhaled
                                                    corticosteroid) or
                                                    an acceptable
                                                    alternative
                                                    treatment.
10 PQRI <greek-i>58 Assessment  2 year             Percentage of
 of Mental Status for            Endorsement        patients aged 18
 Community-acquired Pneumonia.   until May 8,       years and older with
                                 2009.              a diagnosis of
                                                    community-acquired
                                                    bacterial pneumonia
                                                    with mental status
                                                    assessed.
11 Radiation therapy is         Endorsed May 9,    Radiation therapy to
 administered within 1 year of   2007.              the breast initiated
 diagnosis for women under age                      within 1 year of
 70 receiving breast                                date of diagnosis.
 conserving surgery for breast
 cancer.
12 Adjuvant chemotherapy is     Endorsed May 9,    Consideration or
 considered or administered      2007.              administration of
 within 4 months of surgery to                      chemotherapy
 patients under the age of 80                       initiated within 4
 with AJCC III (lymph node                          months of date of
 positive) colon cancer.                            diagnosis.
13 Adjuvant hormonal therapy..  Endorsed May 9,    Cancer--Breast--consi
                                 2007.              deration or
                                                    administration of
                                                    accompanying
                                                    hormonal therapy for
                                                    treatment of breast
                                                    cancer.
14 Needle biopsy to establish   Endorsed May 9,    Patient whose date of
 diagnosis of cancer precedes    2007.              needle biopsy
 surgical excision/resection.                       precedes the date of
                                                    surgery.
15 Osteo-02: Screening or       2 year             Bone and joint
 Therapy for Women Aged 65       Endorsement        conditions
 years and Older.                until May 8,       (osteoporosis)--Scre
                                 2009.              ening or therapy for
                                                    women aged 65 years
                                                    and older.
16 Osteo-03: Management         2 year             Bone and joint
 following fracture.             Endorsement        conditions
                                 until May 8,       (osteoporosis)--Mana
                                 2009.              gement following
                                                    fracture.
17 Osteo-04: Pharmacologic      2 year             Bone and joint
 Therapy.                        Endorsement        conditions
                                 until May 8,       (osteoporosis)--Phar
                                 2009.              macologic therapy.
18 EC-01: Electrocardiogram     2 year             Percentage of
 (ECG) for Patients with Non-    Endorsement        patients aged 40
 Traumatic Chest Pain.           until May 8,       years and older with
                                 2009.              an emergency
                                                    department discharge
                                                    diagnosis of
                                                    nontraumatic chest
                                                    pain who had an
                                                    electrocardiogram
                                                    (ECG).
19 EC-03: ECG Performed for     2 year             Percentage of
 Patients with Syncope.          Endorsement        patients aged 18 to
                                 until May 8,       60 years with an
                                 2009.              emergency department
                                                    discharge diagnosis
                                                    of syncope who had
                                                    an ECG performed.
20 EC-04: Vital Signs Recorded  2 year             Percentage of
 and Reviewed for Patients       Endorsement        patients aged 18
 with Community-Acquired         until May 8,       years and older with
 Bacterial Pneumonia.            2009.              a diagnosis of
                                                    community-acquired
                                                    bacterial pneumonia
                                                    with vital signs
                                                    recorded and
                                                    reviewed.
21 Eye-01: Primary Open Angle   2 year             Primary open angle
 Glaucoma--Optic Nerve           Endorsement        glaucoma--optic
 Evaluation.                     until May 8,       nerve evaluation.
                                 2009.
22 Eye-02: Age-Related Macular  Recommended for    Age-related macular
 Degeneration--Antioxidant       Endorsement.       degeneration--antiox
 Supplement Prescribed/                             idant supplement
 Recommended.                                       prescribed/
                                                    recommended.
23 Eye-03: Age-Related Macular  2 year             Age-related macular
 Degeneration--Dilated Macular   Endorsement        degeneration--dilate
 Examination.                    until May 8,       d macular
                                 2009.              examination.
24 Eye-07: Diabetic             2 year             Documentation of
 Retinopathy--Documentation of   Endorsement        presence or absence
 Presence or Absence of          until May 8,       of macular edema and
 Macular Edema and Level of      2009.              level of severity of
 Severity of Retinopathy.                           retinopathy.
25 EYE-08: Diabetic             2 year             Communication with
 Retinopathy--Communication      Endorsement        the physician
 with the Physician Managing     until May 8,       managing ongoing
 Ongoing Diabetes Care.          2009.              diabetes care.
26 GI-09: Colonoscopy for       Recommended for    Colonoscopy for polyp
 Polyp Surveillance--            Endorsement.       surveillance--descri
 Description of Polyp                               ption of polyp
 Characteristics.                                   characteristics.
27 GER-02: Advance Care Plan..  Recommended for    Advance care plan.
                                 Endorsement.

[[Page 42803]]

 
28 GER-03: Urinary              2 year             Assessment of
 Incontinence--Assessment of     Endorsement        presence or absence
 Presence or Absence of          until May 8,       of urinary
 Urinary Incontinence in Women   2009.              incontinence in
 Aged 65 Years and Older.                           women aged 65 years
                                                    and older.
29 GER-04: Urinary              2 year             Characterization of
 Incontinence--Characterizatio   Endorsement        urinary incontinence
 n of Urinary Incontinence in    until May 8,       in women aged 65
 Women Aged 65 Years and Older.  2009.              years and older.
30 GER-05: Urinary              2 year             Plan of care for
 Incontinence--Plan of Care      Endorsement        urinary incontinence
 for Urinary Incontinence in     until May 8,       in women aged 65
 Women Aged 65 Years and Older.  2009.              years and older.
------------------------------------------------------------------------

    While we are soliciting comments on these 30 additional measures 
for inclusion in the HOP QDRP for CY 2010 or subsequent calendar years, 
we also welcome comments on whether any of these additional measures 
should be included effective for services furnished on or after January 
1, 2008 for the CY 2009 update.

D. Proposed Implementation of the HOP QDRP

    For purposes of CY 2009 payments, we would require hospitals to 
begin to submit data on the 10 measures that we have identified under 
section XVII.B. of this proposed rule. While we would expect to focus 
on these 10 measures and will consider comments on them for the CY 2009 
payment year, we will also consider the comments received from the 
public on the list of 30 additional measures cited above in developing 
the final lists of measures for future payment years.
    As with the hemoglobin A1c diabetes intermediate outcome measure 
described in XVII.B of this preamble, we invite public comment on the 
two diabetes intermediate outcome measures proposed in this list of 30 
additional measures--i.e., good control of blood pressure (less than 
140/80 mm Hg) and LDL-C levels (less than 100 mg/dl). We invite comment 
on whether the use of these outcome measures will result in unintended 
consequences.
    As described below, procedures for submission of hospital 
outpatient quality information will mirror as closely as possible all 
procedures for submission of inpatient quality information. The 
inpatient procedures are identified on the QualityNet Web site, at 
http://www.qualitynet.org. As required by new section 1833(t)(17)(E) of 
the Act, we will develop procedures to publicly report the measure 
results obtained under the HOP QDRP. Hospitals will have an opportunity 
to review the information that is to be made available to the public 
prior to its being made public.
    We believe that assuring that Medicare beneficiaries receive the 
care they need and that such services are of appropriately high quality 
are the necessary initial steps to the incorporation of value-based 
purchasing into the OPPS. We seek to encourage care that is both 
efficient and of high quality in the hospital outpatient setting. We 
plan to work quickly and collaboratively with the hospital community to 
develop and implement quality measures for the OPPS that are fully and 
specifically reflective of the quality of hospital outpatient services.
    We welcome the suggestion of other additional measures and topics 
relevant to the hospital outpatient setting for future development of 
the measure set, particularly measures from other settings (such as 
hospital inpatient, physician office, and emergency care settings) that 
would contribute to better coordination and harmonization of high 
quality patient care.

E. Proposed Requirements for HOP Quality Data Reporting for CY 2009 and 
Subsequent Calendar Years

    To participate in the HOP QDRP for CY 2009 and subsequent calendar 
years, hospitals must meet administrative, data collection and 
submission, and data validation requirements. Hospitals not 
participating in the program or that withdraw from the program will not 
receive the full OPPS payment rate update. Instead, in accordance with 
the law, those hospitals would receive a reduction of 2.0 percentage 
points in their updates for the affected payment year.
    Hospitals not meeting the requirements of the HOP QDRP also will 
not receive the full OPPS payment rate update. Instead, in accordance 
with the law, those hospitals also would receive a reduction of 2.0 
percentage points in their payment update factor for the affected 
payment year.
    Proposed requirements for participation in the HOP QDRP are:
1. Administrative Requirements
    To participate in the HOP QDRP, the hospital must complete several 
administrative steps. These steps, as in the current IPPS RHQDAPU 
program, require the hospital to:
    <bullet> Identify a QualityNet Exchange administrator who follows 
the registration process and submits the information through the CMS-
designated contractor. The same person may be the QualityNet Exchange 
administrator for both the IPPS RHQDAPU program and the HOP QDRP. This 
designation must be kept current and must be done, regardless of 
whether the hospital submits data directly to the CMS designated 
contractor or uses a vendor for transmission of data.
    <bullet> Register with the QualityNet Exchange, regardless of the 
method used for data submission.
    <bullet> Complete the Notice of Participation form. All hospitals 
must send the form to a CMS-designated contractor no later than 
November 15, 2007 for the CY 2009 HOP QDRP. At this time, the 
participation form for the HOP QDRP is separate from the IPPS RHQDAPU 
program and completing a submission form for each program is required. 
Agreeing to participate includes acknowledging that the data submitted 
to the CMS designated contractor will be submitted to CMS and may be 
shared with a CMS contractor or contractors supporting the 
implementation of this program.
    Hospitals not wishing to participate must submit a nonparticipation 
form. Hospitals that have completed a notice of participation form and 
subsequently wish to stop participating must submit a withdrawal form.

[[Page 42804]]

    To reduce the burden on hospitals, once a hospital has indicated 
its intent to participate or not participate, we will consider the 
hospital to be in that status (either a participant or nonparticipant) 
until the hospital indicates a change in status by submitting a notice 
of participation or a withdrawal form.
2. Data Collection and Submission Requirements
    We are proposing that, to be eligible for the full OPPS payment 
update in CY 2009 and subsequent years, hospitals must:
    <bullet> Collect data required for the finalized set of measures, 
beginning with the specifications of the finalized set of measures that 
will be identified in the CY 2008 OPPS/ASC final rule (for payment 
updates for CY 2009 services) and that will be published and maintained 
in a specifications manual to be found on the Web site at: http://www.qualitynet.org.
    <bullet> Submit the data according to a data submission schedule 
that will be available on the QualityNet Exchange Web site. We propose 
to have HOP data submitted through the QualityNet Exchange secure Web 
site ( https://www.qnetexchange.org). This Web site meets or exceeds 
all current Health Insurance Portability and Accountability Act 
requirements. The submission deadline for January 2008 discharges will 
be May 31, 2008. Except for January 2008 discharges, submission 
deadlines will be 4 months after the last day of the calendar quarter. 
Data must be submitted to the CMS designated contractor using either 
the CMS Abstraction and Reporting Tool for Outpatient Department 
measures (CART-OPD) or another third-party vendor that has a tool which 
has met the measure specification requirements for data transmission to 
the QualityNet Exchange.
    Hospitals must submit quality data through the CMS contractor's 
secure Web site. We will provide more detailed information about the 
Web site in the CY 2008 OPPS/ASC final rule, as we anticipate awarding 
the contract to design and manage the OPPS Clinical Warehouse before 
that final CY 2008 OPPS/ASC final rule is published. We expect the CMS 
contractor's Web site to meet or exceed all current Health Insurance 
Portability and Accountability Act requirements for security of 
personal health information.
    The OPPS Clinical Warehouse will submit the data to CMS on behalf 
of the hospitals. While the CMS contract for managing the OPPS Clinical 
Warehouse was not awarded prior to publishing this proposed rule, it is 
possible that a QIO contractor (or subcontractor) would manage the OPPS 
Clinical Warehouse. Because the information in the OPPS Clinical 
Warehouse also may be considered QIO information, it may be subject to 
the stringent QIO confidentiality regulations in 42 CFR part 480.
    For purposes of the CY 2009 annual payment update, we are proposing 
to require hospitals to submit data, for the finalized set of measures, 
beginning with services furnished on or after January 1, 2008. The 
deadline for submission of data for January 2008 discharges will be 4 
months from the last day of the month, May 31, 2008. The deadline for 
submission for February-March 2008 discharges would be August 1, 2008. 
Thereafter, participating hospitals would be required to submit 
quarterly data on finalized measures 4 months from the last day of the 
calendar quarter for as long as the hospitals participated in the HOP 
QDRP. The deadline for April-June 2008 discharges, for example, would 
be November 1, 2009.
    Hospitals will be expected to submit data under the HOP QDRP on 
outpatient episodes of care to which the required measures apply. For 
the purposes of the HOP QDRP, an outpatient episode of care is defined 
as care provided to a patient who has not been admitted as an inpatient 
but who is registered on the hospital's medical records as an 
outpatient and receives services (rather than supplies alone) directly 
from the hospital. Every effort will be made to assure that data 
elements common to both inpatient and outpatient settings are defined 
consistently (such as ``time of arrival''). However, HOP QDRP quality 
data, not quality data required to be submitted for a patient treated 
under the IPPS RHQDAPU program, would be submitted under the HOP QDRP.
    To be accepted by the CMS designated contractor, submissions would, 
at a minimum, need to be accurate, timely, and complete. Data are 
considered to have been ``accepted'' by the CMS designated contractor, 
for purposes of determining eligibility for the full payment rate 
update, only when data are submitted prior to the reporting deadline 
and after they have passed all CMS designated contractor edits.
    <bullet> Submit complete and accurate data. A ``complete'' 
submission is determined based on sampling criteria that will be 
published and maintained in a specifications manual to be found on the 
Web site at http://www.qualitynet.org, and must correspond to both the 
aggregate number of cases submitted by a hospital and the number of 
Medicare claims it submits for payment. To be considered ``accurate'', 
submissions must pass validation.
    <bullet> Submit the aggregate numbers of outpatient episodes of 
care which were eligible for submission under the HOP QRDP. These 
numbers would indicate the number of outpatient episodes of care in the 
universe to which sampling criteria are applied.
    New hospitals are expected to begin reporting data as soon as 
possible, but no later than beginning with services provided the first 
day of the calendar quarter immediately following a hospital's receipt 
of its Medicare provider number and the hospital's timely completion of 
the administrative requirements for participating in the HOP QDRP.
3. HOP QDRP Validation Requirements
    We would require that data submitted under this program meet 
validation requirements. The proposed validation requirements are 
similar to FY 2006 IPPS RHQDAPU program validation requirement (the 
initial year validation requirement was added to the IPPS RHQDAPU 
program) and include independent reabstraction of medical record data 
elements by a clinical data abstraction center (CDAC). The CMS 
contractor will randomly select 5 medical records from all January 2008 
discharge cases successfully submitted to the OPPS Clinical Warehouse. 
The CDAC will mail requests to the hospitals to send the selected 
medical records to the CDAC within 30 calendar days. The CDAC will 
independently reabstract the medical record data elements. We will 
provide abstraction feedback to all hospitals on abstracted data 
elements.
    We are proposing the following chart audit validation requirements 
for full CY 2009 payment updates:
    <bullet> Apply to January 2008 discharges only.
    <bullet> Require submission of 5 charts sampled from each hospital.
    <bullet> Establish a passing threshold of 80 percent reliability 
reflecting the accuracy of submitted data elements used to calculate 
quality measures.
    <bullet> Use an upper bound of 95 percent confidence interval to 
measure accuracy.
    <bullet> Incorporate clustering of variability at the chart level 
into the confidence interval.
    Validation is intended to provide some assurance of the accuracy of 
the hospital abstracted data. We have specifically chosen these 
validation requirements and thresholds to allow this assurance, provide 
sufficient time to fully process validation data, and minimize the 
burden on hospitals.

[[Page 42805]]

    To receive the full OPPS payment rate update in CY 2009, the 
hospital must pass our validation requirement of a minimum of 80 
percent reliability, based upon our chart-audit validation process, for 
the January 2008 discharges. The 80-percent reliability threshold is 
consistent with the inpatient RHQDAPU validation reliability threshold. 
Based on our previous RHQDAPU experience, we believe that this 
threshold is reasonable and attainable by the vast majority of 
hospitals. Several of the measures used in the OPPS HOP QDRP are 
similar in construction to inpatient measures used in the current 
RHQDAPU program. Based on the similar nature of the inpatient and 
outpatient measure sets, we believe that the 80-percent reliability 
threshold is applicable in the OPPS HOP QDRP.
    These data are due to the CMS designated contractor by May 31, 
2008. We will use confidence intervals, as discussed below, to 
determine if a hospital has achieved an 80-percent reliability. The use 
of confidence intervals would allow us to establish an appropriate 
range below the 80 percent reliability threshold that would demonstrate 
a sufficient level of reliability to allow the data to still be 
considered validated. We note that, for both timing and burden reasons, 
we are proposing to apply the validation requirements only to January 
2008 discharges for purposes of determining eligibility for the full CY 
2009 OPPS payment rate update. However, hospitals would still be 
required to submit data for subsequent time periods.
    We will use January 2008 discharges to estimate the hospitals' 
validation score for the CY 2009 validation proposed requirement. The 
timeframe for data collection, abstraction, and validation tasks total 
about nine to ten months between patient discharges to completion of 
validation appeals. We believe that using later discharges for the CY 
2009 annual payment update would adversely impact CMS' ability to 
complete these tasks and apply the results to the CY 2009 annual 
payment update.
    Based on our proposed methodology, the confidence interval will be 
slightly wider than is currently utilized for the IPPS RHQDAPU program 
due to the smaller sample size. However, given this is the first year 
of the HOP QDRP, we believe this is appropriate. We would estimate the 
percent reliability based upon a review of five charts and then 
calculate the upper 95 percent confidence limit for that estimate. If 
this upper limit is above the required 80 percent reliability 
threshold, the hospital data would be considered validated. We are 
proposing to use the design-specific estimate of the variance for the 
confidence interval calculation, which, in this case, is a single stage 
cluster sample, with unequal cluster sizes. (For reference, see 
Cochran, William G. (1977) Sampling Techniques, John Wiley & Sons, New 
York, chapter 3, section 3.12.) Each sampled medical record is 
considered as a cluster for variance estimation purposes, as 
documentation and abstraction errors are believed to be clustered 
within specific medical records.

F. Publication of HOP QDRP Data Collected

    New section 1833(t)(17)(E) of the Act requires that the Secretary 
establish procedures to make data collected under this program 
available to the public and to report the quality measures on the CMS 
Web site. Our intent is to make this information public in CY 2009 by 
posting it on the CMS Web site. Participating hospitals will be granted 
the opportunity to preview this information prior to its public posting 
as we have recorded it.

G. Proposed Attestation Requirement for Future Payment Years

    CMS also solicits comments on whether to implement an HOP QDRP 
attestation requirement in CY 2010 and subsequent payment years similar 
to the proposed attestation requirement in the IPPS RHQDAPU program set 
out in the FY 2008 IPPS proposed rule (72 FR 24808). Hospitals would be 
required to submit a written form to a CMS contractor indicating that 
they formally attest to the accuracy and completeness of their data, 
including the volume of data submitted to the OPPS Data Warehouse. We 
anticipate that the attestation form submission deadlines would 
parallel the HOP QDRP periodic data submission deadlines.

H. HOP QDRP Reconsiderations

    When the IPPS RHQDAPU program was initially implemented, it did not 
include a reconsideration submission process for hospitals. 
Subsequently, we received many requests for reconsideration of those 
payment decisions, and as a result, identified a process by which 
participating hospitals would submit requests for reconsideration. We 
anticipate similar concerns with the HOP QDRP and, therefore, we are 
proposing to establish a reconsideration process for the HOP QDRP for 
those hospitals that fail to meet the CY 2009 HOP QDRP requirements. 
The procedural details of that process will be posted to the QualityNet 
Exchange Web site, http://www.qnetexchange.org. In this proposed rule, 
we are seeking public comment specifically on the need for a structured 
reconsideration process for CY 2009 and subsequent calendar years. We 
also request comment on what such a process should entail. For example, 
such a process, if established, could include--
    <bullet> A limited time, such as 30 days from the public release of 
the decision, for requesting a reconsideration;
    <bullet> Specific individuals or functions in a hospital 
organization that can request such a reconsideration and that would be 
notified of its outcome;
    <bullet> The specific factors that CMS will consider in such a 
reconsideration, such as an inability to submit data timely due to CMS 
systems failures;
    <bullet> Specific requirements for submitting a reconsideration 
request, such as a written request for reconsideration specifically 
stating all reasons and factors why the hospital believes it did meet 
the HOP QDRP program requirements;
    <bullet> Suggestions regarding the type of entity that should 
conduct the reconsideration process; and
    <bullet> The timeframe, such as 60 days, for CMS to provide its 
reconsideration decision to the hospital.
    We also are requesting comments on the reasons for not establishing 
such a reconsideration process. We plan to establish procedures that 
are as similar as possible to those used by the IPPS RHQDAPU program 
should we finalize our proposal to implement a reconsideration process 
for HOP QDRP.

I. Reporting of ASC Quality Data

    As discussed above, section 109(b) of the MIEA-TRHCA (Pub. L. 109- 
432) amended section 1833(i) of the Act by redesignating clause (iv) as 
clause (v), adding new section 1833(i)(2)(D)(iv), and adding new 
section 1833(i)(7) to the Act. These amendments authorize the Secretary 
to require ASCs to submit data on quality measures and to reduce the 
annual increase in a year by 2.0 percentage points for ASCs that fail 
to do so. These provisions permit, but do not require, the Secretary to 
require ASCs to submit such data and to reduce any annual increase for 
non-compliant ASCs.
    We are not proposing to introduce quality measures for reporting in 
ASCs for CY 2008 as we are for the OPPS as described in sections 
XVII.B. through H. of this proposed rule. While we believe that 
promoting high quality care in the ASC setting through quality 
reporting is highly desirable and fully in line with

[[Page 42806]]

our efforts under other payment systems, we also believe that the 
transition to the revised payment system in CY 2008 poses such a 
significant challenge to ASCs that it would be most appropriate to 
allow some experience with the revised payment system before 
introducing other new requirements. Implementation of quality reporting 
at this time would require systems changes and other accommodations by 
ASCs, facilities which do not have prior experience with quality 
reporting as hospitals already have for inpatient quality measures, at 
a time when they are implementing a significantly revised payment 
system. We believe that our CY 2008 proposal to implement quality 
reporting for HOPs prior to establishing quality reporting for ASCs 
would allow time for ASCs to adjust to the changes in payment and case-
mix that are anticipated under the revised payment system. We would 
also gain experience with quality measurement in the ambulatory setting 
in order to identify the most appropriate measures for quality 
reporting in ASCs prior to the introduction of the requirement in ASCs. 
We intend to implement the provisions of section 109(b) of the MIEA-
TRHCA, Pub. L. 109-432, in a future rulemaking.

XVIII. Proposed Changes Affecting Critical Access Hospitals (CAHs) and 
Hospital Conditions of Participation (CoPs)

A. Proposed Changes Affecting CAHs

    (If you choose to comment on the issues in this section, please 
include the caption ``Necessary Provider CAHs'' at the beginning of 
your comment.)
1. Background
    CAHs are subject to different participation requirements than are 
hospitals. Among other requirements, a CAH must be located in a rural 
area (or an area treated as rural), and, under Sec.  485.610(c), must 
meet an additional distance-related location requirement. Under this 
requirement, a CAH must be located at least 35-miles (or, in the case 
of mountainous terrain or in areas with only secondary roads, 15-miles) 
from the nearest hospital or other CAH. In addition, CAHs receive 
payment for services furnished to Medicare beneficiaries differently. 
CAHs receive cost-based payment for 101 percent of their reasonable 
costs.
    Prior to January 1, 2006, States were permitted to waive the CAH 
minimum distance eligibility requirement by certifying that a CAH was a 
necessary provider. Approximately 850 current CAHs entered the program 
on the basis of a necessary provider designation. The criteria used to 
qualify a CAH as a necessary provider were established by each State in 
its Medicare Rural Hospital Flexibility Program (MRHFP). The State's 
MRHFP rural health care plan contains the necessary assurances that the 
plan was developed to further the goals of the statute and regulations 
to ensure access to essential health care services for rural residents. 
The statute and regulations give some discretion and flexibility within 
a Federal framework for a State to designate CAHs. States, in 
consultation with their hospital associations and Offices of Rural 
Health, have defined those CAHs that provide necessary services to a 
particular patient community in the event that the facility did not 
meet the required 35-mile (or, in the case of mountainous terrain or in 
areas with only secondary roads, 15-mile) distance requirement from the 
nearest hospital or CAH. Each State's criteria are different, but the 
criteria share certain similarities and all define a necessary provider 
related to the facility location.
    However, section 405(h)(1) of Pub. L. 108-173 amended section 
1820(c)(2)(B)(i)(II) of the Act by adding language that ended States' 
authority to waive the location requirement for a CAH by certifying the 
CAH as a necessary provider, effective January 1, 2006. In addition, 
section 405(h)(2) of Pub. L. 108-173 amended section 1820(h) of the Act 
to include a grandfathering provision for CAHs that were certified as 
necessary providers prior to January 1, 2006. We incorporated these 
amendments in Sec.  485.610(c) of our regulations in the FY 2005 IPPS 
final rule (69 FR 49220). Because those regulations did not address the 
situation where the grandfathered CAH is no longer the same facility 
due to relocation, in the FY 2006 IPPS final rule (70 FR 47490), we 
amended Sec.  485.610 of our regulations to add a new Sec.  485.610(d) 
that addressed the relocation criteria a necessary provider CAH has to 
meet to retain its necessary provider designation.
    Additional circumstances concerning CAHs with existing necessary 
provider designations have come to our attention that we believe also 
need to be addressed. Specifically, we have learned that some CAHs with 
grandfathered necessary provider designations are co-located with other 
hospitals, which typically are PPS-excluded inpatient psychiatric 
facilities or inpatient rehabilitation facilities. We are also aware 
that there is interest in the creation or acquisition by CAHs with 
necessary provider designation of off-campus facilities that they do 
not believe would be subject to CAH location requirements.
    For the reasons noted below, we are taking a proactive approach by 
proposing a change in the regulation to be consistent with our belief 
that the intent of the CAH program is to maintain hospital-level 
services in rural communities while ensuring access to care. We believe 
that this proposed change to the regulations will help to maintain the 
integrity of the MRHFP within the statutory requirements.
2. Co-Location of Necessary Provider CAHs
    Some necessary provider CAHs are co-located with other hospitals, 
particularly specialty psychiatric and or rehabilitation hospitals. 
Prior to the enactment of section 405(g) of Pub. L. 108-173, it is 
understandable that a State MRHFP might have allowed co-location of a 
CAH with a necessary provider designation with the specialized services 
of a psychiatric and/or an inpatient rehabilitation hospital. The State 
may have believed that beneficiary access to care would be enhanced 
through the provision of both CAH and these specialized services at the 
same location, and the CAH itself might have had difficulty in 
providing such services within its permitted bed limits. However, 
section 405 of Pub. L. 108 173 included several provisions that permit 
CAHs themselves to address such access to care issues.
    Specifically, section 405(e) of Pub. L. 108-173 amended sections 
1820(c)(2)(B)(iii) and 1820(f) of the Act to increase the permitted 
number of CAH inpatient beds from 15 to 25. In addition, section 405(g) 
of Pub. L. 108-173 added section 1820(c)(2)(E) to the Act, which 
permits a CAH to operate distinct part inpatient psychiatric and/or 
rehabilitation units, each subject to a 10-bed limit that is not 
included as part of the CAH's 25-bed limit. Therefore, a CAH can 
operate a 45-bed facility addressing a wide range of needs in the rural 
community it serves. We believe that CAHs seeking to provide access to 
specialized services should avail themselves of the statutory 
provisions governing distinct part units in CAHs rather than making 
arrangements with other hospital providers to share space at the CAH 
location.
    In light of these changes to the statute, we are proposing to no 
longer allow a necessary provider CAH to enter into co-location 
arrangements between CAHs and hospitals unless such arrangements were 
in effect on or before January 1, 2008 and the type and scope of 
services offered by the facility co-located with

[[Page 42807]]

the necessary provider CAH do not change. We believe that this 
restriction will help to ensure that the current necessary services 
will remain in the community. Further, we are proposing to clarify that 
a change of ownership of the CAH, when the new owners assume the 
original provider agreement, does not constitute a new co-location 
arrangement and, thereby, under our proposal, a necessary provider CAH 
would be permitted to continue under an existing co-location 
arrangement.
    We are concerned that, without this change, there may be situations 
where more necessary provider CAHs will co-locate with PPS hospitals. 
Currently, co-location arrangements seem to involve psychiatric or 
rehabilitation hospitals. We are concerned about co-location by a 
necessary provider CAHs with a short-term acute care hospital, 
including a physician-owned specialty hospital. We also cannot rule out 
a scenario where two necessary provider CAHs could co-locate after 
relocation. We believe the co-location of a necessary provider CAH with 
another hospital or necessary provider CAH is not consistent with the 
CAH statutory framework that establishes requirements for a CAH to be a 
certain minimum distance from other hospitals or CAHs. We believe that 
the elimination of States' authority to designate necessary provider 
CAHs and the ability for CAHs to operate psychiatric and rehabilitation 
units should provide sufficient flexibility for necessary provider CAHs 
to operate within the statutory framework without engaging in 
additional arrangements.
    We also are clarifying in this proposed rule that under certain 
circumstances, a change of ownership of any of the facilities (either 
the CAH or the existing co-located facility) with a co-location 
arrangement that was in effect before January 1, 2008, will not be 
considered to be a new co-location arrangement. If a change of 
ownership should occur in a CAH with a grandfathered co-location 
arrangement on or after January 1, 2008, we note the provider agreement 
is generally automatically assigned to the new owner, unless the new 
owner rejects assignment of the provider agreement or assignment of the 
provider agreement is otherwise not made. If the new owner does not get 
assignment of the provider agreement, the new owner would have to go 
through the same enrollment process as any other new provider; that is, 
enrolling with the fiscal intermediary (or if applicable, the MAC), 
applying for participation, undergoing the Office of Civil Rights 
clearance and an initial certification survey that meets all the 
current Medicare conditions (see State Operations Manual 3210) to 
obtain CAH status. Thus, grandfathered necessary provider CAH status, 
including grandfathered co-location arrangements, would not transfer to 
a new CAH owner who does not assume the provider agreement from the 
previous owner. To obtain CAH designation, the new provider would have 
to comply with all the CAH designation requirements, including the 
location requirements relative to other providers, that is, more than a 
35-mile drive (or 15 miles in areas of mountainous terrain or secondary 
roads).
3. Provider-Based Facilities of CAHs
    We have consistently taken the position that the intent of the CAH 
program is to keep hospital-level services in rural communities, 
thereby ensuring access to care (FY 2006 IPPS final rule (70 FR 
47469)). A CAH is permitted to create or acquire an off-campus 
location, including a distinct part unit that satisfies the location 
criteria for a CAH and operates under the CAH's provider agreement 
under the provider-based rules at 42 CFR 413.65. We note that, under 
section 1820(c)(2)(B)(i)(II) of the Act, a CAH does not have to meet 
the distance requirements relative to other hospitals or CAHs if it was 
certified prior to January 1, 2006, as a necessary provider by the 
State. We stated in the FY 2006 IPPS final rule (70 FR 47472), when 
addressing the relocation criteria for a necessary provider CAH, that 
the ``necessary provider'' designation is specific to the physical 
location(s) of the CAH in existence at the time of the designation. We 
believe the necessary provider CAH designation cannot be considered to 
extend to any new facilities not in existence when the CAH received its 
original necessary provider designation. Accordingly, we believe the 
creation of any new location that would cause any part of the CAH to be 
situated at a location not in compliance with the distance requirements 
at 42 CFR 485.610 would cause the entire CAH to violate the distance 
requirements.
    Of the approximately 1,300 CAHs, 453 CAHs have health clinics, 81 
have psychiatric units, and 20 have rehabilitation units. We do not 
know how many of the existing clinics and distinct part units are at 
off-site locations. However, we are concerned with CAHs creating or 
acquiring off-campus locations, including distinct part psychiatric and 
rehabilitation units, that do not comply with the CAH location 
requirement relative to other facilities. Therefore, when such off-
campus facilities are created by a CAH with a necessary provider 
designation, there is no reason to assume that the distance exemption 
given to the CAH should be extended without qualification to any 
location for that CAH's off-campus facilities. Accordingly, any CAH 
off-campus locations must satisfy the current statutory CAH distance 
requirements, without exception and regardless of whether the main 
provider CAH is a necessary provider CAH.
    Therefore, we are proposing to clarify that if a necessary provider 
CAH, or a CAH that does not have a necessary provider designation, 
operates a provider-based facility as defined in Sec.  413.65(a)(2), or 
a psychiatric or rehabilitation distinct part unit as defined in Sec.  
485.647 that was created or acquired on or after January 1, 2008, it 
must comply with the distance requirement of a 35-mile drive to the 
nearest hospital or CAH (or 15 miles in the case of mountainous terrain 
or in areas with only secondary roads).
4. Termination of Provider Agreement
    In the event that a CAH with a necessary provider designation 
enters into a co-location arrangement after January 1, 2008, or 
acquires or creates an off-campus facility after January 1, 2008, that 
does not satisfy the CAH distance requirements in Sec.  485.610(c), we 
are proposing to terminate that CAH's provider agreement, in accordance 
with the provisions of Sec.  489.53(a)(3). The necessary provider CAH 
could avoid termination by converting to a hospital that is paid under 
the IPPS, assuming that the facility satisfies all requirements for 
participation as a hospital in the Medicare program under the 
provisions in 42 CFR Part 482. We also note that if the necessary 
provider CAH corrects the situation that led to the noncompliance, a 
termination action will not be triggered. A CAH that is not a necessary 
provider CAH could not have a co-location situation due to the distance 
requirements it is required to meet at 485.610 (c).
5. Proposed Regulation Changes
    We are proposing to amend Sec.  485.610 by adding a new paragraph 
(e) to address situations under our proposal relating to off-campus and 
co-location requirements for CAHs with a necessary provider 
designation.

B. Proposed Revisions to Hospital CoPs

    (If you choose to comment on the issues in this section, please 
include the caption ``Hospital CoPs'' at the beginning of your 
comment.)

[[Page 42808]]

1. Background
    On November 27, 2006, we published a final rule in the Federal 
Register entitled ``Medicare and Medicaid Programs; Hospital Conditions 
of Participation: Requirements for History and Physical Examinations; 
Authentication of Verbal Orders; Securing Medications; and 
Postanesthesia Evaluations'' (71 FR 68672). In that final rule (also 
frequently referred to as the ``Carve-out rule''), we finalized 
changes, which were based on timely public comments submitted on the 
proposed rule published in the March 25, 2005 Federal Register (70 FR 
15266), to four of the current requirements (or conditions of 
participation (CoPs)) that hospitals must meet to participate in the 
Medicare and Medicaid programs. Specifically, that final rule revised 
and updated our CoP requirements for: completion of the history and 
physical examination in the Medical staff and the Medical record 
services CoPs; authentication of verbal orders in the Nursing services 
and the Medical record services CoPs; securing medications in the 
Pharmaceutical services CoP; and, completion of the postanesthesia 
evaluation in the Anesthesia services CoP. This action was initiated in 
response to broad criticism from the medical community that the then-
current requirements governing these areas were burdensome and did not 
reflect current practice.
    Since this final rule became effective on January 26, 2007, we have 
received a great number of comments and questions from providers about 
the timeframe requirements (for both the initial medical history and 
physical examination and its update) as well as about the 
postanesthesia evaluation requirements. In both areas, commenters have 
sought clarification on the application of these requirements for 
patients undergoing outpatient surgeries and procedures. While the new 
requirements contained in the Carve-out rule provide hospitals greater 
flexibility in ensuring the quality of inpatient care, the issues 
surrounding outpatient care in the hospital setting, particularly with 
regard to outpatient surgeries and procedures, are not clear. After 
conducting a thorough review of the hospital CoPs and the interpretive 
guidelines, we have isolated the relevant issues regarding outpatient 
care and are proposing revisions to the current regulations to address 
these concerns.
    According to the most recent data, 30 million surgical procedures 
are performed each year in the United States with over 60 percent done 
as outpatient procedures and another 10 to 15 percent performed on a 
same-day admission basis. These figures combined translate to 
approximately 21 million surgical procedures performed each year in the 
U.S. on patients who are admitted to the hospital on the day of their 
procedure. A majority of these patients are also discharged from the 
hospital the same day that they are admitted. It is unclear whether 
these numbers also include other procedures, such as diagnostic ones, 
which also require anesthesia services, and which include all of the 
risks to patient safety inherent in such procedures. In either case, 
significant numbers of patients undergo surgeries and other procedures 
each year as either outpatients or same-day admission patients.
    The current requirements for the completion of the medical history 
and physical examination are found in the regulations at Sec.  482.22 
(Medical staff CoP), Sec.  482.24 (Medical record services CoP), and 
Sec.  482.51 (Surgical services CoP). We believe that these 
requirements do not adequately address the patient who is admitted for 
outpatient or same-day surgery or a procedure requiring anesthesia 
services. The standards at Sec.  482.22(c), Medical staff bylaws, and 
Sec.  482.24(c), Content of record, both contain requirements for a 
medical history and physical examination, and an update of the medical 
history and physical examination documenting any changes in a patient's 
condition if the medical history and physical examination was completed 
within 30 days before admission, to be completed and documented within 
24 hours after admission. Under the Surgical services CoP at Sec.  
482.51(b)(1), there is a provision that requires a complete history and 
physical workup to be in the chart of every patient prior to surgery. 
However, there is currently no requirement for an updated examination 
of the patient, including any changes to the patient's condition, to be 
completed and documented after admission or registration, and prior to 
any surgery or procedure being performed. For patients who are admitted 
as inpatients for surgery to be performed in the next day or so, this 
does not pose a problem. These inpatients will be followed while in the 
hospital with both daily progress and nursing notes made in their 
medical record. In addition, as required under the current regulations, 
these patients will also have an updated examination for any changes in 
their condition within 24 hours after their admission.
    As evidenced by the numbers of outpatient and same day admission 
inpatient procedures discussed above, procedures that were once done 
only on an inpatient basis are now routinely performed in outpatient 
settings. Therefore, the patient is not admitted or registered as an 
outpatient until the day of the procedure. Often this admission or 
registration is just hours before the procedure is performed. In 
addition, there are many patients who are admitted as inpatients on the 
same day that they are scheduled for more complex procedures, which 
will then require postoperative hospital stays. However, for patients 
admitted or registered for outpatient procedures as well as for those 
patients admitted on the same day as their surgery, there is currently 
no mechanism to ensure that these patients are examined for any changes 
in their condition prior to undergoing a procedure. Paragraph (b)(1) of 
Sec.  482.51 currently requires that every patient have a complete 
medical history and physical examination documented in the chart prior 
to surgery, except in emergencies. However, the timeframe requirements 
for this medical history and physical examination contained under both 
Sec.  482.22(c)(5) and Sec.  482.24(c) (2)(i)(A) allow for a medical 
history and physical examination that may be as much as 30 days old. 
Without a requirement that an updated examination be completed after 
admission and prior to surgery or other procedure, any changes in a 
patient's condition would most likely be missed by hospital staff. 
Failing to identify changes in a patient's condition prior to surgery 
may adversely impact not only the procedure but also consequently, and 
perhaps more significantly, the outcome of the procedure for the 
patient.
    We are proposing revisions to Sec. Sec.  482.22, 482.24, and 482.51 
that would require an updated examination, including any changes in a 
patient's condition, to be completed and documented for each patient 
after admission or registration and prior to surgery or to a procedure 
requiring anesthesia services. These revisions would ensure that any 
changes in the patient's condition are discovered before a procedure is 
performed. With the most up-to-date information regarding a patient's 
condition readily available to hospital staff prior to a procedure, the 
risks to patient safety should be minimized and a poor outcome for the 
patient would be avoided. However, under these proposed requirements, 
it is not our intent to include those minor procedures that only 
require the administration of local anesthetics, as might be the case 
for procedures such as

[[Page 42809]]

biopsies of skin lesions or suturing of noncomplex lacerations.
    Conversely, the current requirements at Sec.  482.52, Anesthesia 
services, still distinguish between inpatients and outpatients with 
regard to postanesthesia evaluation, with the requirements for 
outpatient evaluation actually being less stringent than those for 
inpatients. When the current hospital regulations were originally 
written in 1986, these differences in regulatory oversight may have 
been entirely appropriate. At that time there were still very clear 
differences between inpatient and outpatient procedures, with inpatient 
procedures (and the anesthesia services required) considered much more 
serious and complex in nature. Since that time, there has been a 
gradual blurring of the distinctions between what were previously 
termed ``inpatient'' procedures and those that were classified as 
``outpatient'' procedures. Procedures that were once done only on an 
inpatient basis are now routinely performed in outpatient settings. 
While advances in medical technology and surgical technique have 
allowed for this shift, the complexity and seriousness of these 
procedures still remain as do the risks to patient health and safety. 
Along with the increased complexity and types of outpatient procedures 
being performed today, come the higher levels of sedation and 
anesthesia required for these procedures. Thus, distinctions between 
inpatients and outpatients in the requirements for postanesthesia 
evaluations are less relevant than ever.
    In addition, the current language regarding the completion and 
documentation of an evaluation ``within 48 hours after surgery'' 
assumes that all patients receiving anesthesia services have undergone 
surgery. It also assumes that they have not been discharged from the 
hospital prior to the end of this 48-hour timeframe and that they are 
still available for evaluation. Many patients who have received 
anesthesia services (either general anesthesia or monitored anesthesia 
care) have undergone diagnostic or therapeutic procedures as opposed to 
surgical ones and are discharged within hours after such procedures. 
Diagnostic and therapeutic procedures that require anesthesia services 
(either general anesthesia or monitored anesthesia care) include 
esophagogastroduodenoscopy (EGD), colonoscopy, endoscopic retrograde 
cholangiopancreatography (ERCP), and electroconvulsive therapy (ECT). 
Furthermore, and as noted above, even those patients who have undergone 
inpatient surgical procedures are often discharged well before 48 hours 
after surgery.
    Therefore, we are proposing revisions to Sec.  482.52(b) that would 
ensure that all patients who have received anesthesia services, 
regardless of inpatient or outpatient status, have a postanesthesia 
evaluation completed and documented by an individual qualified to 
administer anesthesia before they are discharged or transferred from 
the postanesthesia recovery area.
    Finally, in our review of the CoPs, we discovered a cross-reference 
under Sec.  482.23, Nursing services, that is no longer valid. We are 
taking the opportunity in this proposed rule to correct this error 
through a technical amendment.
2. Provisions of the Proposed Regulations
a. Proposed Timeframes for Completion of the Medical History and 
Physical Examination
    The proposed revisions to Sec.  482.22(c)(5) would retain the 
requirement that the medical staff bylaws include a requirement that a 
medical history and physical examination be completed no more than 30 
days before or 24 hours after admission for each patient. We are 
proposing to revise this provision to include the requirement that the 
completion and documentation of the medical history and physical 
examination (and the updated examination) would also be required prior 
to surgery or a procedure requiring anesthesia services.
    We also are proposing to retain the current provision that the 
medical staff bylaws contain a requirement for the completion and 
documentation of an updated examination within 24 hours after admission 
(when the medical history and physical examination has been completed 
within 30 days before admission). However, we are proposing to delete 
the language regarding the placement of the medical history and 
physical examination and the updated examination in the medical record 
within 24 hours after admission because we believe that the proposed 
language requiring not only the completion, but also the documentation, 
of both the medical history and physical examination and the updated 
examination, achieves this purpose. In addition, requirements for the 
physical placement of the medical history and physical examination and 
the updated examination in the patient's medical record are currently, 
and more appropriately, contained under the ``Medical record services'' 
CoP at Sec.  482.24(c)(2), which we are proposing to retain under this 
rule.
    Further, we are proposing to separate the requirements for the 
medical history and physical examination and for the updated 
examination under two provisions at Sec.  482.22(c)(5)(i) and Sec.  
482.22(c)(5)(ii), respectively. At Sec.  482.22(c)(5)(i), we are 
proposing to retain the current requirement that the medical history 
and physical examination be completed by a physician (as defined in 
section 1861(r) of the Act), an oromaxillofacial surgeon, or other 
qualified individual in accordance with State law and hospital policy. 
However, we are proposing to add the words ``and documented'' after 
``be completed'' as well as ``licensed'' after ``qualified'' to further 
clarify this requirement. In addition, we are proposing to revise Sec.  
482.22(c)(5)(ii) to require that the updated examination of the patient 
must be completed and documented by the same individuals as proposed 
above. We also are proposing to add the words ``or registration'' to 
follow ``after admission'' to reflect differences in terminology that 
may exist with the admission of patients for outpatient procedures. We 
are proposing this revision here as well as in Sec.  482.24 and Sec.  
482.51, where appropriate.
    We are proposing to revise the words ``for any changes in the 
patient's condition'' to ``including any changes in the patient's 
condition'' at both Sec.  482.22(c)(5) and Sec.  482.24(c)(2)(i)(B).
    Under Sec.  482.24(c), Content of record, we are proposing to 
revise both Sec.  482.24(c)(2)(i)(A) and Sec.  482.24(c)(2)(i)(B) by 
adding the language ``but prior to surgery or a procedure requiring 
anesthesia services'' with regard to both the completion and the 
documentation of the medical history and physical examination and the 
updated examination.
    We are proposing to revise the Surgical services CoP at Sec.  
482.51(b)(1) by deleting the language regarding medical histories and 
physical examinations that have been dictated but which are not yet 
recorded in the patient's chart. Our overall intent in this proposed 
rule is to require that the most current information regarding a 
patient's condition be available to the hospital staff prior to surgery 
or a procedure requiring anesthesia services so that risks to patient 
safety can be minimized and potential adverse outcomes can be avoided.
    We are proposing to retain the language regarding the requirement 
for a medical history and physical examination prior to surgery, except 
in

[[Page 42810]]

the case of emergencies, and are proposing to extend this to a 
requirement for an updated examination. We are proposing to divide the 
requirements for the medical history physical examination and the 
updated examination under two separate provisions at Sec.  
482.51(b)(1)(i) and Sec.  482.51(b)(1)(ii) in the Surgical services 
CoP.
b. Proposed Requirements for Preanesthesia and Postanesthesia 
Evaluations
    At Sec.  482.52(b)(1), under the ``Delivery of services'' standard 
of the ``Anesthesia services'' CoP, we are proposing to revise the 
requirement for a preanesthesia evaluation to include the language ``or 
a procedure requiring anesthesia services'' to include the range of 
procedures that require anesthesia services, but that are not 
necessarily surgical in nature. We also are proposing to add this 
language under Sec.  482.52(b)(3) for the postanesthesia evaluation 
requirement.
    Further, we are proposing to revise this standard by deleting both 
the words ``with respect to inpatients'' at Sec.  482.52(b)(3) and the 
entire provision at Sec.  482.52(b)(4), which are the current 
requirements for postanesthesia evaluations for patients. We are 
proposing to revise Sec.  482.52(b)(3) by requiring that the 
postanesthesia evaluation be completed and documented before discharge 
or transfer from the postanesthesia recovery area. As discussed above, 
the intent of this section of the proposed rule is to eliminate the 
distinctions currently found in the regulations between inpatients and 
outpatients with regard to anesthesia services.
c. Proposed Technical Amendment to Nursing Services CoP
    We are proposing to revise the cross-reference to Sec.  405.1910(c) 
currently found under the nursing services CoP at Sec.  482.23(b)(1) as 
this citation has been changed and is no longer valid. We are proposing 
a technical amendment to this provision to correct the cross-reference 
to Sec.  488.54(c).

XIX. Files Available to the Public Via the Internet

A. Information in Addenda Related to the Revised CY 2008 Hospital OPPS

    Addenda A and B to this proposed rule provide various data 
pertaining to the CY 2008 payment for items and services under the 
OPPS. Addendum A, a complete list of all APCs payable under the OPPS, 
and Addendum B, a complete list of all active HCPCS codes regardless of 
their assigned payment status or comment indicators under the OPPS, 
will be available to the public by clicking ``Addendum A and Addendum B 
Updates'' on the CMS Web site at: http://www.cms.hhs.gov/HospitalOutpatientPPS/.
    For the convenience of the public, we are also including on the CMS 
Web site a table that displays the HCPCS data in Addendum B sorted by 
APC assignment, identified as Addendum C.
    Addendum D1 defines payment status indicators that are used in 
Addenda A and B. Addendum D2 defines comment indicators that are used 
in Addendum B. Addendum E lists HCPCS codes that are only payable as 
inpatient procedures and are not payable under the OPPS. Addendum L 
contains the out-migration wage adjustment for CY 2008. Addendum M 
lists the HCPCS codes that are members of a composite APC and 
identifies the composite APC to which they are assigned. This addendum 
also identifies the status indicator for the code and a change 
indicator if there has been a change in the code's status with regard 
to its membership in the composite APC. Each of the HCPCS codes 
included in Addendum M has a single procedure payment APC, listed in 
Addendum B, to which it is assigned when the criteria for assignment to 
the composite APC are not met. When the criteria for payment of the 
code through the composite APC are met, one unit of the composite APC 
payment is paid, thereby providing packaged payment for all services 
that are assigned to the composite APC according to the specific OCE 
logic that applies to the APC. We refer readers to the discussion of 
composite APCs in section II.A.4.d. of this proposed rule for a 
complete description of the proposed composite APCs.
    Those addenda and other supporting OPPS data files are available on 
the CMS Web site at: http://www.cms.hhs.gov/HospitalOutpatientPPS.

B. Information in Addenda Related to the Revised CY 2008 ASC Payment 
System

    Addenda AA, BB, DD1, and DD2 to this proposed rule provide various 
data pertaining to the ASC covered surgical procedures and the covered 
ancillary services for which ASCs may receive separate payment 
beginning in CY 2008 when the ancillary service provided in the ASC is 
integral to a covered surgical procedure and provided immediately 
before, during, or immediately following the covered surgical 
procedure. All relative payment weights and payment rates are proposed 
and exemplify the results of applying the revised ASC payment system 
methodology established in the final rule for the revised ASC payment 
system published elsewhere in this issue of the Federal Register, to 
the proposed CY 2008 OPPS and MPFS ratesetting information.
    Addendum DD1 defines the payment indicators that are used in 
Addenda AA and BB to this proposed rule. Addenda AA and BB provide 
payment information regarding covered surgical procedures and covered 
ancillary services under the revised ASC payment system. Addendum DD2 
defines the comment indicators that we are proposing to use to provide 
additional information about the status of ASC covered surgical 
procedures and covered ancillary services. Those addenda and other 
supporting ASC data files are included on the CMS Web site at: http://www.cms.hhs.gov/ASCPayment/ in a format that can be easily downloaded 
and manipulated. The final ASC relative weights and payment rates for 
CY 2008 will be published in the CY 2008 OPPS/ASC final rule with 
comment period, and related data files will be included on the CMS Web 
site as noted above. MPSF data files are located at http://www.cms.hhs.gov/PhysicianFeeSched/.
    The links to all of the FY 2008 IPPS wage index related tables 
(that would be used for the CY 2008 OPPS) from the FY 2008 IPPS 
proposed rule (72 FR 24851 through 24960) and to the correction notice 
for the FY 2008 IPPS proposed rule that was published in the Federal 
Register on June 7, 2007 (72 FR 31507) are accessible on the CMS Web 
site at: http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp#TopOfPage
    For additional assistance, contact Chuck Braver, (410) 786-6719.

XX. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995, we are required to 
provide 60-day notice in the Federal Register and solicit public 
comment before a collection of information requirement is submitted to 
the Office of Management and Budget (OMB) for review and approval. In 
order to fairly evaluate whether an information collection should be 
approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act 
of 1995 (PRA) requires that we solicit comment on the following issues:
    <bullet> The need for the information collection and its usefulness 
in carrying out the proper functions of our agency.
    <bullet> The accuracy of our estimate of the information collection 
burden.

[[Page 42811]]

    <bullet> The quality, utility, and clarity of the information to be 
collected.
    <bullet> Recommendations to minimize the information collection 
burden on the affected public, including automated collection 
techniques.
    We are soliciting public comment on each of these issues for the 
following sections included in this proposed rule that contain 
information collection requirements.

Section 419.43(h) Adjustment to national program payment and 
beneficiary co-payment amounts: Applicable adjustments to conversion 
factor for CY 2009 and for subsequent calendar years

    Section 419.43(h) requires hospitals, in order to qualify for the 
full annual update, to submit quality data to CMS, as specified by CMS. 
In this proposed rule, we are proposing the specific requirements 
related to the data that must be submitted for the update for CY 2009. 
The burden associated with this section is the time and effort 
associated with collecting and submitting the data, completing 
participating forms and submitting charts for chart audit validation. 
We estimate that there will be approximately 3,500 respondents per 
year.
    For hospitals to collect and submit the information on the required 
measures, we estimate it will take 30 minutes per sampled case. 
Further, based on an estimated ten percent sample size and estimated 
populations of 2.5-5 million outpatient visits per measure, we estimate 
a total of 1,800,000 cases per year. In addition, we estimate that 
completing participation forms with require approximately 4 hours per 
hospital per year. We expect the burden for all of these hospitals to 
total 914,000 hours per year.
    For CY 2009. our validation process requires participating 
hospitals to submit 5 charts. The burden associated with this 
requirement is the time and effort associated with collecting, copying, 
and submitting these charts. It will take approximately 2 hours per 
hospital to submit the 5 charts. There will be a total of approximately 
17,500 charts (3,500 hospitals x 5 charts per hospital) submitted by 
the hospitals to CMS for a total burden of 7,000 hours. Therefore, the 
total burden for all hospitals would be 921,000 hours per year.

Section 482.22 Condition of participation: Medical staff

    Proposed Sec.  482.22(c)(5)(i) would require that a medical history 
and physical examination be completed and documented no more than 30 
days before or 24 hours after admission or registration, but prior to 
surgery or a procedure requiring anesthesia services, for each patient 
by a physician (as defined in section 1861(r) of the Act), an 
oromaxillofacial surgeon, or other qualified licensed individual in 
accordance with State law and hospital policy.
    The burden associated with this proposed requirement is the time 
and effort it would take for medical staff to document the patient's 
medical history and the results of a physical examination. While the 
burden associated with this proposed requirement is subject to the PRA, 
we believe the burden is exempt as defined in 5 CFR 1320.3(b) (2) 
because the time, effort, and financial resources necessary to comply 
with the requirement would be incurred by persons in the normal course 
of their activities.
    Proposed Sec.  482.22(c)(5)(ii) would require that an updated 
examination of the patient, including any changes in the patient's 
condition, be completed and documented within 24 hours after admission 
or registration, but prior to surgery or a procedure requiring 
anesthesia services, when the medical history and physical examination 
are completed within 30 days before admission or registration. The 
updated examination must also be completed and documented by the same 
individuals as required under proposed Sec.  482.22(c)(5)(i).
    The burden associated with this proposed requirement is the time 
and effort it would take for medical staff to document any changes in 
the patient's condition. While the burden associated with this proposed 
requirement is subject to the PRA, we believe the burden is exempt as 
defined in 5 CFR 1320.3(b)(2) because the time, effort, and financial 
resources necessary to comply with the requirement would be incurred by 
persons in the normal course of their activities.

Section 482.24 Condition of participation: Medical record services

    Proposed Sec.  482.24(c)(2)(i) would require evidence of:
    (1) A medical history and physical examination completed and 
documented no more than 30 days before or 24 hours after admission or 
registration, but prior to surgery or a procedure requiring anesthesia 
services. The medical history and physical examination must be placed 
in the patient's medical record within 24 hours after admission or 
registration, but prior to surgery or a procedure requiring anesthesia.
    (2) An updated examination of the patient, including any changes in 
the patient's condition, when the medical history and physical 
examination are completed within 30 days before admission or 
registration. Documentation of the updated examination must be placed 
in the patient's medical record within 24 hours after admission or 
registration, but prior to surgery or a procedure requiring anesthesia 
services.
    While the burden associated with these two proposed requirements is 
subject to the PRA, we believe the burden is exempt as defined in 5 CFR 
1320.3(b)(2) because the time, effort, and financial resources 
necessary to comply with the requirement would be incurred by persons 
in the normal course of their activities.

Section 482.51 Condition of participation: Surgical services

    Proposed Sec.  482.51(b)(1) would require medical staff, prior to 
surgery or a procedure requiring anesthesia services, and except in the 
case of emergencies, to document no more than 30 days before or 24 
hours after admission or registration a patient's medical history, the 
results of the patient's physical examination, and any changes in the 
patient's condition.
    While the burden associated with these proposed requirements is 
subject to the PRA, we believe the burden is exempt as defined in 5 CFR 
1320.3(b)(2) because the time, effort, and financial resources 
necessary to comply with the requirement would be incurred by persons 
in the normal course of their activities.

Section 482.52 Condition of participation: Anesthesia services

    Proposed Sec.  482.52(b)(1) would require a preanesthesia 
evaluation to be completed and documented by an individual qualified to 
administer anesthesia, performed within 48 hours prior to surgery or a 
procedure requiring anesthesia services. Proposed Sec.  482.52(b)(3) 
would require a postanesthesia evaluation to be completed and 
documented by an individual qualified to administer anesthesia, after 
surgery or a procedure requiring anesthesia services, but before 
discharge or transfer from the postanesthesia recovery area.
    While the burden associated with these requirements is subject to 
the PRA, we believe the burden is exempt as defined in 5 CFR 
1320.3(b)(2) because the time, effort, and financial resources 
necessary to comply with the requirement would be incurred by

[[Page 42812]]

persons in the normal course of their activities.
    We have submitted a copy of this proposed rule to OMB for its 
review of the information collection requirements described above. 
These requirements are not effective until they have been approved by 
OMB.
    If you comment on these information collection and recordkeeping 
requirements, please mail copies directly to the following:

Centers for Medicare & Medicaid Services, Office of Strategic 
Operations and Regulatory Affairs, Division of Regulations Development, 
Attn: Melissa Musotto, (CMS-1392-P), Room C4-26-05, 7500 Security 
Boulevard, Baltimore, MD 21244-1850; and
Office of Information and Regulatory Affairs, Office of Management and 
Budget, Room 10235, New Executive Office Building, Washington, DC 
20503, Attn: Carolyn Lovett, CMS Desk Officer, CMS-1392-P, <a href="/cdn-cgi/l/email-protection#bbd8dac9d4d7c2d5e4d7d4cddecfcffbd4d6d995ded4cb95dcd4cd"><span class="__cf_email__" data-cfemail="56353724393a2f38093a392033222216393b347833392678313920">[email protected]</span></a>. Fax (202) 395-6974.

XXI. Response to Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments we receive 
by the date and time specified in the DATES section of this proposed 
rule, and, when we proceed with a subsequent document(s), we will 
respond to those comments in the preamble to that document(s).

XXII. Regulatory Impact Analysis

A. Overall Impact

    (If you choose to comment on issues in this section, please include 
the caption ``Impact'' at the beginning of your comment.)
    We have examined the impacts of this proposed rule as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review), 
the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-
354), section 1102(b) of the Social Security Act, the Unfunded Mandates 
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
1. Executive Order 12866
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more in any 1 year).
    We estimate that the effects of the OPPS provisions that would be 
implemented by this proposed rule would result in expenditures 
exceeding $100 million in any 1 year. We estimate the total increase 
(from changes in this proposed rule as well as enrollment, utilization, 
and case-mix changes) in expenditures under the OPPS for CY 2008 
compared to CY 2007 to be approximately $3.3 billion.
    We estimate that implementing the revised ASC payment system in CY 
2008 based on the July 2007 final rule for the revised ASC payment 
system and the proposals in this CY 2008 OPPS/ASC proposed rule (such 
as adding 4 procedures to the ASC list of covered surgical procedures 
and designating 19 additional procedures as office-based) will have no 
net effect on Medicare expenditures in CY 2008 compared to the level of 
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 XXII.C. of this proposed rule.
    While we estimate that there will be no net change in Medicare 
expenditures in CY 2008 as a result of implementing the revised ASC 
payment system and the proposed ASC provisions of this proposed rule, 
we estimate that the revised system will result in savings of $200 
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 that there will be a total increase in Medicare 
payments to ASCs of approximately $240 million for CY 2008 compared to 
Medicare expenditures that would have occurred in the absence of the 
revised payment system. These additional payments to ASCs of 
approximately $240 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, as described in 
detail in section XVI.L. of this proposed rule.
    Our estimate in this proposed rule of 5-year savings as a result of 
the revised ASC payment system and our estimate of additional payments 
to ASCs in CY 2008 differ slightly from the estimates presented in the 
July 2007 final rule for the revised ASC payment system. The ASC budget 
neutrality adjustment and the resulting savings estimates in the July 
2007 final rule are calculated using CY 2005 utilization data, the 
current CY 2007 OPPS relative weights with an estimated update factor 
for CY 2008, and the CY 2007 MPFS PE RVUs trended forwarded to CY 2008. 
The ASC budget neutrality adjustment and the resulting savings 
estimates in this proposed rule are calculated using the newly 
available CY 2006 utilization data, the CY 2008 OPPS relative payment 
weights proposed in this proposed rule, and and the CY 2008 MPFS PE 
RVUs proposed in the CY 2008 MPFS proposed rule (72 FR 38234 through 
38361). As we indicated in the July 2007 final rule, the estimates in 
that rule are meant to be illustrative of the final policies only, in 
large part because they use the existing CY 2007 OPPS relative payment 
weights and the existing CY 2007 MPFS PE RVUs to estimate the CY 2008 
values. Since the savings estimates in this proposed rule are based on 
the actual proposed CY 2008 OPPS relative payment weights that have 
just become available in this proposed rule and the actual proposed CY 
2008 MPFS PE RVUs that recently became available in the CY 2008 MPFS 
proposed rule, the estimates in this proposed rule based on that newly 
available information represent our best estimates at this time. Our 
final budget neutrality adjustment and savings estimates will be 
provided in the CY 2008 OPPS/ASC final rule.
    This proposed rule is an economically significant rule under 
Executive Order 12866, and a major rule under 5 U.S.C. 804(2).
2. Regulatory Flexibility Act (RFA)
    The RFA requires agencies to determine whether a rule would have a 
significant economic impact on a substantial number of small entities. 
For purposes of the RFA, small entities include small businesses, 
nonprofit organizations, and small governmental jurisdictions. Most 
hospitals and most other providers and suppliers are small entities, 
either by nonprofit status or by having average annual revenues of $31 
million or less.
    For purposes of the RFA, we have determined that approximately 37 
percent of hospitals and 73 percent of ASCs would be considered small 
entities according to the Small Business Administration (SBA) size 
standards. We do not have data available to calculate the percentages 
of entities in the pharmaceutical preparation, manufacturing, 
biological products, or medical instrument industries that

[[Page 42813]]

would be considered to be small entities according to the SBA size 
standards. For the pharmaceutical preparation manufacturing industry 
(NAICS 325412), the size standard is 750 or fewer employees. For 
biological products (except diagnostic) (NAICS 325414), the standard 
size is 500 or fewer employees, and for surgical and medical instrument 
manufacturing (NAICS 339112), the standard is 500 or fewer employees 
(see the standards Web site at: http//www.sba.gov/idc/groups/public/documents/serv_sstd_tablepdf.pdf). Individuals and States are not 
included in the definition of a small entity.
    Not-for-profit organizations are also considered to be small 
entities under the RFA. There are 2,146 voluntary hospitals that we 
consider to be not for-profit organizations to which this proposed rule 
applies.
3. Small Rural Hospitals
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. With 
the exception of hospitals located in certain New England counties, for 
purposes of section 1102(b) of the Act, we previously defined a small 
rural hospital as a hospital with fewer than 100 beds that is located 
outside of a Metropolitan Statistical Area (MSA) (or New England County 
Metropolitan Area (NECMA)). However, under the new labor market 
definitions that we adopted in the CY 2005 final rule with comment 
period (consistent with the FY 2005 IPPS final rule), we no longer 
employ NECMAs to define urban areas in New England. Therefore, we now 
define a small rural hospital as a hospital with fewer than 100 beds 
that is located outside of an MSA. Section 601(g) of the Social 
Security Amendments of 1983 (Pub. L. 98-21) designated hospitals in 
certain New England counties as belonging to the adjacent NECMA. Thus, 
for purposes of the OPPS, we classify these hospitals as urban 
hospitals. We believe that the changes to the OPPS in this proposed 
rule would affect both a substantial number of rural hospitals as well 
as other classes of hospitals and that the effects on some may be 
significant. The changes to the ASC payment system for CY 2008 will 
have no effect on small rural hospitals. Therefore, we conclude that 
this proposed rule would have a significant impact on a substantial 
number of small 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 
proposed rule would not mandate any requirements for State, local, or 
tribal government, nor would 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 proposed rule in accordance with Executive 
Order 13132, Federalism, and have determined that it would not have an 
impact on the rights, roles, and responsibilities of State, local or 
tribal governments. As reflected in Table 67, we estimate that OPPS 
payments to governmental hospitals (including State and local 
governmental hospitals) would increase by 3.6 percent under this 
proposed rule. The provisions related to payments to ASCs in CY 2008 
would not affect payments to government hospitals.

B. Effects of OPPS Changes in This Proposed Rule

    (If you choose to comment on issues in this section, please include 
the comment ``OPPS Impact'' at the beginning of your comment.)
    We are proposing to make several changes to the OPPS that are 
required by the statute. We are required under section 
1833(t)(3)(C)(ii) of the Act to update annually the conversion factor 
used to determine the APC payment rates. We are also required under 
section 1833(t)(9)(A) of the Act to revise, not less often than 
annually, the wage index and other adjustments. In addition, we must 
review the clinical integrity of payment groups and weights at least 
annually. Accordingly, in this proposed rule, we are proposing to 
update the conversion factor and the wage index adjustment for hospital 
outpatient services furnished beginning January 1, 2008, as we discuss 
in sections II.C. and II.D., respectively, of this proposed rule. We 
also are proposing to revise the relative APC payment weights using 
claims data from January 1, 2006, through December 31, 2006, and 
updated cost report information. In response to a provision in Pub. L. 
108-173 that we analyze the cost of outpatient services in rural 
hospitals relative to urban hospitals, we are proposing to continue 
increased payments to rural SCHs, including EACHs. Section II.F. of 
this proposed rule provides greater detail on this rural adjustment. 
Finally, we are proposing to remove one device category, HCPCS code 
C1820 (Generator, neurostimulator, (implantable), with rechargeable 
battery and charging system), from pass-through payment status in CY 
2008.
    Under this proposed rule, the update change to the conversion 
factor as provided by statute would increase total OPPS payments by 3.3 
percent in CY 2008. The one-time wage reclassification under section 
508 expires September 30, 2007, and therefore is not contemplated in 
this proposed rule. The proposed changes to the APC weights including 
the changes that would result from the proposal to expand packaging, 
changes to the wage indices, the continuation of a payment adjustment 
for rural SCHs and EACHs would not increase OPPS payments because these 
changes to the OPPS are budget neutral. However, these proposed updates 
do change the distribution of payments within the budget neutral system 
as shown in Table 67 and described in more detail in this section.
1. Alternatives Considered
    Alternatives to the changes we are proposing to make and the 
reasons that we have chosen the options are discussed throughout this 
proposed rule. Some of the major issues discussed in this proposed rule 
and the options considered are discussed below.
a. Alternatives Considered for the Packaging Proposals for CY 2008 OPPS
    In section II.A.4.c. of this proposed rule, we are proposing to 
package payment for the following seven categories of ancillary 
supportive services into payment for the independent service with which 
they are billed. We are also proposing to pay for low dose rate 
prostate brachytherapy and cardiac electrophysiology evaluation and 
ablation services under composite APCs in which a single payment is 
made for multiple major services that are commonly performed on the 
same date. We discuss each category of services that we propose to 
package and each set of services for which we propose a composite APC 
below:

[[Page 42814]]

(1) Guidance Services
    We are proposing to package payment for supportive guidance 
services into the payment for the independent procedure to which the 
guidance service is ancillary and supportive. In the case of one 
particular guidance procedure, which would usually be provided in 
conjunction with another independent procedure but may occasionally be 
provided without another independent service on the same date of 
service, we propose to permit separate payment if the service is billed 
without an independent procedure on the same date of service. We refer 
readers to section II.A.4.c.(1) of this proposed rule for the complete 
discussion of this proposal. We considered several policy options for 
the payment of guidance services in CY 2008.
    The first alternative we considered was to propose no changes to 
packaging for the CY 2008 OPPS. Under this alternative, codes that were 
packaged for CY 2007 would remain packaged for CY 2008 and codes that 
were separately paid for CY 2007 would remain separately paid for CY 
2008. There are a number of CPT codes that describe independent 
surgical procedures for which the code descriptors indicate that 
guidance is included in the code reported for the surgical procedure if 
it is used and, therefore, for which the OPPS already makes packaged 
payment for the associated guidance service. With a number of guidance 
services already packaged, we did not select this option in part 
because we did not want to create financial incentives for hospitals to 
use one form of guidance instead of another or to use guidance all the 
time, even if a procedure could be safely provided without guidance. 
Furthermore, we believe this alternative would not provide additional 
incentives for hospitals to utilize the most cost-effective and 
clinically advantageous method of guidance that is appropriate in each 
situation.
    The second alternative we considered was to package the costs of 
guidance services in all cases, without regard to the possibility of 
the service being furnished without an independent service on the same 
date of service. We did not select this alternative because we believe 
that in the case of one particular guidance procedure, the procedure 
may sometimes be appropriately furnished without other independent 
services on the same date and in these cases, we believe that there 
should be separate payment for the guidance service.
    The third alternative we considered, and the alternative we 
selected, was to always package payment for most supportive guidance 
services, while allowing separate payment for one particular guidance 
service when that guidance service is furnished without an independent 
service. When guidance services are furnished as an ancillary and 
supportive adjunct to an independent procedure, we are proposing to 
package payment for all guidance procedures. When one specific guidance 
service (which is occasionally not provided in conjunction with an 
independent procedure on the same date of service) is not provided on 
the same date as an independent procedure, we would pay separately for 
that service. We believe that this alternative would provide the most 
appropriate incentives to control volume and spending for these 
services, without discouraging the performance of the service in those 
infrequent cases when one particular guidance service is provided 
without an independent procedure.
(2) Image Processing
    We are proposing to package payment for image processing services 
into the payment for the major independent service to which the image 
processing service is ancillary and supportive. We refer readers to 
section II.A.4.(c)(2) of this proposed rule for the complete discussion 
of this proposal. We considered several policy options for the payment 
of image processing services in CY 2008.
    The first alternative we considered was to propose no changes to 
packaging for CY 2008 OPPS. Under this alternative, codes that were 
packaged for CY 2007 would remain packaged for CY 2008 and codes that 
were separately paid for CY 2007 would remain separately paid for CY 
2008. We did not select this alternative because we believe it would 
not provide additional incentives for hospitals to utilize the most 
cost-effective and clinically advantageous image processing services 
that are appropriate in each situation.
    The second alternative we considered was to package the costs of 
image processing services in cases in which the image processing 
service is furnished on the same date as an independent service to 
which the image processing service is ancillary and supportive but to 
pay separately for the image processing service when it is furnished 
without an independent service on the same date of service. We did not 
select this alternative because it would not have provided substantial 
additional incentives for hospitals to utilize image processing in the 
most cost-effective and clinically advantageous manner.
    The third alternative we considered, and ultimately selected, was 
to package payment for the costs of image processing services in all 
cases, without regard to the possibility of the service being furnished 
without an independent service on the same date of service. While an 
image processing service is not necessarily provided on the same date 
of service as the independent procedure to which it is ancillary and 
supportive, providing separate payment for each imaging processing 
service whenever it is performed is not consistent with encouraging 
value-based purchasing under the OPPS. We believe it is important to 
package payment for supportive dependent services that accompany 
independent procedures but that may not need to be provided face-to-
face with the patient in the same encounter as the independent service. 
Packaging encourages hospitals to establish protocols that ensure that 
services are furnished only when they are medically necessary and to 
carefully scrutinize the services ordered by practitioners to minimize 
unnecessary use of hospital resources. We also note that our standard 
methodology to calculate median costs packages the costs of dependent 
services with the costs of independent services on ``natural'' single 
claims across different dates of service, so we are confident that we 
would capture the costs of the supportive image processing services for 
ratesetting, even if they were provided on a different date than the 
independent procedure. Therefore, we believe that this alternative 
would provide additional appropriate incentives to control volume and 
spending for these services, without discouraging the use of the 
service in those infrequent cases when it is provided with an 
independent procedure but on a different date of service.
(3) Intraoperative Services
    We are proposing to package payment for intraoperative services 
into the payment for the independent procedure to which the 
intraoperative service is ancillary and supportive. In the case of one 
intraoperative service, which would usually be provided in conjunction 
with another independent procedure but may occasionally be provided 
without another independent service on the same date of service, we 
propose to permit separate payment if the service is billed without an 
independent procedure on the same date of service. We refer readers to 
section II.A.4.c.(3) of this proposed rule for the complete discussion 
of this proposal. We

[[Page 42815]]

considered several policy options for the payment of intraoperative 
services in CY 2008.
    The first alternative we considered was to propose no changes to 
packaging for CY 2008 OPPS. Under this alternative, codes that were 
packaged for CY 2007 would remain packaged for CY 2008 and codes that 
were separately paid for CY 2007 would remain separately paid for CY 
2008. We did not select this alternative because we believe it would 
not provide additional incentives for hospitals to utilize the most 
cost-effective and clinically advantageous intraoperative services that 
are appropriate in each situation.
    The second alternative we considered was to package payment for the 
costs of intraoperative services in all cases, without regard to the 
possibility of the service being furnished without an independent 
service on the same date of service. We did not select this alternative 
because we believe that in the case of one particular intraoperative 
procedure, the procedure may sometimes be appropriately furnished 
without other independent services on the same date and in these cases, 
we believe that there should be separate payment for the intraoperative 
service.
    The third alternative we considered, and ultimately selected, was 
to unconditionally package the costs of intraoperative services in all 
cases except one, to allow for the possibility of this one commonly 
intraoperative service being furnished without an independent service 
on the same date of service. We believe that there is some possibility 
that this procedure could be appropriately performed without another 
independent procedure on the same date of service. We do not believe 
this to be true of the other intraoperative services that we propose to 
unconditionally package. We selected this alternative because we 
thought it unlikely that intraoperative services other than the one 
particular service would ever be provided without an independent 
service. Packaging encourages hospitals to establish protocols that 
ensure that services are furnished only when they are medically 
necessary and to carefully scrutinize the services ordered by 
practitioners to minimize unnecessary use of hospital resources. We 
believe that this is the most appropriate alternative because, in 
general, it creates additional incentives for hospitals to provide 
intraoperative services only when both medically necessary and cost 
efficient for the individual patient. Therefore, we believe that this 
alternative would provide the most appropriate incentives to control 
volume and spending for these services.
(4) Imaging Supervision and Interpretation Services
    We are proposing to package payment for imaging supervision and 
interpretation services into the payment for the independent service to 
which the imaging supervision and interpretation service is ancillary 
and supportive. For some imaging supervision and interpretation 
services, we are proposing to permit separate payment if the service is 
the only separately paid service billed for the date of service. We 
refer readers to section II.A.4.c.(4) of this proposed rule for the 
complete discussion of this proposal. We considered several policy 
options for the payment of imaging supervision and interpretation 
services in CY 2008.
    The first alternative we considered was to propose no changes to 
packaging for CY 2008 OPPS. Under this alternative, codes that were 
packaged for CY 2007 would remain packaged and codes that were 
separately paid for CY 2007 would remain separately paid for CY 2008. 
We did not select this alternative because we believe it would not 
provide additional incentives for hospitals to utilize the most cost-
effective and clinically advantageous radiological supervision and 
interpretation services that are appropriate in each situation.
    The second alternative we considered was to package the costs of 
imaging supervision and interpretation services in all cases, without 
regard to the possibility of the service being furnished without an 
independent separately payable service on the same date of service. 
This alternative might substantially reduce the financial incentive to 
furnish the service because separate payment would never be made in any 
case for the service, even when it was furnished without a separately 
payable service on the same date of service. We did not select this 
alternative because we believe that some of the imaging supervision and 
interpretation services may occasionally be furnished in conjunction 
with other services that are currently packaged under the OPPS. In 
these circumstances, if we were to unconditionally package payment for 
these imaging supervision and interpretation services, hospitals would 
receive no payment at all for providing the imaging supervision and 
interpretation service and the other minor procedure(s).
    The third alternative we considered, and the alternative we 
selected, was to unconditionally package imaging supervision and 
interpretation procedures that we believe are always integral to and 
dependent upon an independent separately payable procedure, but to 
conditionally package payment for those imaging supervision and 
interpretation services that we believe are sometimes furnished without 
another separately payable service on the same date. We believe that 
this alternative is the most appropriate choice because it creates 
additional incentives for hospitals to provide services only when 
medically necessary to the individual patient when the supervision and 
interpretation services is furnished as an ancillary and supportive 
adjunct to the independent procedure. We would pay separately for some 
imaging supervision and interpretation services in those cases, which 
our data show are limited, where they are not furnished on the same 
date as another separately paid procedure. Therefore, we believe that 
this alternative would provide the most appropriate incentives to 
control volume and spending for these services, without discouraging 
the performance of the services in those relatively infrequent cases 
when they are the only services furnished.
(5) Diagnostic Radiopharmaceuticals
    We are proposing to package payment for diagnostic 
radiopharmaceuticals into the payment for their associated nuclear 
medicine procedures. We refer readers to section II.A.4.c.(5) of this 
proposed rule for the complete discussion of this proposal. We 
considered several policy options for the payment of diagnostic 
radiopharmaceuticals in CY 2008.
    The first alternative we considered was to propose no changes to 
our packaging methodology for diagnostic radiopharmaceuticals in the CY 
2008 OPPS. Under this alternative, diagnostic radiopharmaceuticals with 
a mean per-day cost of $60 or under would be packaged into the payment 
for associated procedures present on the claim. Diagnostic 
radiopharmaceuticals with a per-day cost over $60 would receive 
separate payment. We did not select this alternative because we believe 
it would not provide additional incentives for hospitals to utilize the 
most cost-effective and clinically advantageous diagnostic 
radiopharmaceuticals that are appropriate in each situation.
    The second alternative we considered was to package the costs of 
diagnostic radiopharmaceuticals in cases in which the diagnostic 
radiopharmaceutical is furnished on the same date as an independent 
service to which the diagnostic radiopharmaceutical is ancillary and 
supportive but to pay

[[Page 42816]]

separately for the diagnostic radiopharmaceutical when it is furnished 
without an independent service on the same date of service. We did not 
select this alternative because diagnostic radiopharmaceuticals are 
always intended to be used with a diagnostic nuclear medicine 
procedure. Our claims data indicate that diagnostic 
radiopharmaceuticals are infrequently provided on a different date of 
service from a nuclear medicine procedure. Since our standard OPPS 
ratesetting methodology packages costs across dates of service on 
``natural'' single claims, we believe that our standard methodology 
adequately captures the costs of diagnostic radiopharmaceuticals 
associated with diagnostic nuclear medicine procedures that are not 
provided on the same date of service.
    The third alternative we considered, and the alternative we 
selected, was to package the costs of diagnostic radiopharmaceuticals 
with their associated nuclear medicine procedures. Packaging the costs 
of supportive items and services into the payment for the independent 
procedure or service with which they are associated encourages 
additional hospital efficiencies and enables hospitals to better manage 
their resources with maximum flexibility. Diagnostic 
radiopharmaceuticals are always intended to be used with a diagnostic 
nuclear medicine procedure, and are, therefore, particularly well 
suited for packaging under the OPPS for the reasons identified in 
section II.A.4.c.(5) of this proposed rule.
(6) Contrast Media
    We are proposing to package payment for contrast media into their 
associated independent diagnostic and therapeutic procedures. We refer 
readers to section II.A.4.c.(6) of this proposed rule for the complete 
discussion of this proposal. We considered several policy options for 
the payment of contrast media in CY 2008.
    The first alternative we considered was to propose no changes to 
our packaging methodology for contrast media in the CY 2008 OPPS. Under 
this alternative, contrast media with a mean per-day cost of $60 or 
under would be packaged into the payment for associated procedures 
present on the claim. Contrast media with a per-day cost over $60 would 
receive separate payment. We did not select this alternative because we 
believe it would not provide additional incentives for hospitals to 
utilize contrast media in the most cost-effective and clinically 
advantageous manner. With most contrast media already packaged based on 
our proposed $60 packaging threshold, this alternative would 
potentially maintain inconsistent payment incentives across similar 
products.
    The second alternative we considered was to package the costs of 
contrast media in cases in which the contrast medium is furnished on 
the same date as an independent service but to pay separately for the 
contrast medium when it is furnished without an independent service on 
the same date of service. We did not select this alternative because we 
thought it unlikely that contrast media would ever be provided without 
an independent service on the same date of service.
    The third alternative we considered, and the alternative we 
selected, was to unconditionally package the costs of contrast media 
with their associated independent diagnostic and therapeutic 
procedures. The vast majority of contrast media would currently be 
packaged under the proposed $60 packaging threshold. Given that most 
contrast agents would already be packaged under the OPPS in CY 2008, we 
believe it would be desirable to package payment for the remaining 
contrast agents as this approach promotes additional efficiency and 
results in a more consistent payment policy across products that may be 
used in many of the same independent procedures.
(7) Observation Services
    We are proposing to package payment for all observation care, 
reported under HCPCS code G0378 (Hospital observation services, per 
hour) for CY 2008. Payment for observation would be packaged as part of 
the payment for the separately payable services with which it is 
billed. We refer readers to section II.A.4.c.(7) of this proposed rule 
for the complete discussion of this proposal. We considered several 
policy options for the payment of observation services in CY 2008.
    The first alternative we considered was to propose no changes to 
payment of observation services for the CY 2008 OPPS. Since January 1, 
2006, hospitals have reported observation services based on an hourly 
unit of care using HCPCS code G0378. This code has a status indicator 
of ``Q'' under the CY 2007 OPPS, meaning that the OPPS claims 
processing logic determines whether the observation is packaged or 
separately payable. The OCE's current logic determines whether 
observation care billed under G0378 is separately payable through APC 
0339 (Observation), or whether payment for observation services would 
be packaged into the payment for other separately payable services 
provided by the hospital in the same encounter based on criteria 
discussed in more detail in section II.A.4.c.(7) of this proposed rule. 
For CY 2007, we continued to apply the criteria for separate payment 
for observation care and the coding and payment methodology for 
observation care that were implemented in CY 2006. We did not select 
this alternative because the current criteria for separate payment for 
observation services treat payment for observation care for various 
clinical conditions differently and may provide disincentives for 
efficiency. In addition, there has been substantial growth in program 
expenditures for hospital outpatient services under the OPPS in recent 
years, a trend that is reflected in the rapidly increasing volume of 
claims for separately payable observation services. This alternative 
would not provide additional incentives for hospitals to utilize 
observation services in the most cost-effective and clinically 
advantageous manner.
    The second alternative we considered was to accept the APC Panel's 
recommendations to add syncope and dehydration to the list of diagnoses 
eligible for separate payment or to consider other clinical conditions 
for separate payment for observation care. We believe that in certain 
circumstances observation could be appropriate for patients with a 
range of diagnoses. Both the APC Panel and numerous commenters to prior 
OPPS proposed rules have confirmed their agreement with this 
perspective. However, as packaging payment provides additional 
desirable incentives for more efficient delivery of health care and 
provides hospitals with significant flexibility to manage their 
resources, we believe it is most appropriate to treat observation care 
for all diagnoses similarly by packaging its costs into payment for the 
separately payable procedures with which the observation is associated. 
Consequently, we did not select this alternative to expand separate 
observation payment to additional diagnoses.
    The third alternative we considered, and the alternative we 
selected, was to package payment for all observation services reported 
with CPT code G0378 under the CY 2008 OPPS. We believe this is the most 
appropriate alternative within the context of our proposed packaging 
approach because observation is always provided as a supportive service 
in conjunction with other independent separately payable hospital 
outpatient services such as an emergency department visit, surgical 
procedure, or another separately payable service, and thus its costs 
can

[[Page 42817]]

be packaged into the OPPS payment for such services. We believe that 
packaging payment into larger payment bundles creates incentives for 
providers to furnish services in the most efficient way that meets the 
needs of the patient, encouraging long-term cost containment. With 
approximately 70 percent of the occurrences of observation care billed 
under the OPPS currently packaged, this alternative would extend the 
incentives for efficiency already present for the vast majority of 
observation care that is already packaged under the OPPS to the 
remaining 30 percent of observation care for which we currently make 
separate payment. (8) Composite APCs
    We are proposing to establish two composite APCs for CY 2008 OPPS. 
A composite APC is an APC that provides a single payment for several 
independent services when they are furnished on the same date of 
service. Composite APCs are intended to establish APC payment rates for 
combinations of services that are frequently furnished together so that 
the multiple procedure claims on which they are submitted may be used 
to set the payment rates for them and so that the payment for the 
services provides greater incentives for efficient use of hospital 
resources. Specifically, we are proposing to establish composite APCs 
for low dose rate prostate brachytherapy (which would be paid when CPT 
codes 55875 (Transperineal placement of needles or catheters into 
prostate for interstitial radioelement application, with or without 
cystoscopy) and 77778 (Interstitial radiation source application; 
complex) are billed with the same date of service) and for cardiac 
electrophysiology evaluation and ablation services (which would be paid 
when at least one designated electrophysiology evaluation service is 
billed on the same date as at least one designated cardiac ablation 
service). We refer readers to sections II.A.4.d.(2) and II.A.4.d.(3) of 
this proposed rule for a detailed discussion of the proposals for these 
APCs. We note that we will continue to pay individual services under 
their single procedure APCs as we have in the past, in recognition that 
there are clinical circumstances in which the combinations of services 
proposed for payment through the composite APCs are not furnished on 
the same date. We considered two alternatives with regard to the 
proposal to create composite APCs.
    The first alternative we considered was to make no change to how we 
pay for these services. If we were to make no change, we could continue 
to pay separately for each service. The payment rates would continue to 
be based on single procedure claims, which we have been told by 
stakeholders do not represent the typical treatment scenario. 
Interested parties have repeatedly told us, and our examination of 
claims data supports, that these services are typically furnished in 
combination with one another and, therefore, this may suggest that the 
use of single procedure claims to establish the median costs that form 
the basis for payment for these services may result in our using 
clinically unusual or incorrectly coded claims as the basis for 
payment.
    The second alternative we considered, and the alternative we 
selected, is to propose to create composite APCs for these services 
which are commonly furnished in combination with one another and to 
make a single payment for the multiple services specified in the 
composite APC at a prospectively established rate based on the total 
cost of the combination of services furnished. This alternative 
responds to public comments that multiple procedure claims for these 
services that we have heretofore been unable to use for ratesetting 
reflect the most common treatment scenarios. It also provides 
additional incentives for efficient provision of services by bundling 
payment for multiple services into a single payment. Composite APCs 
enable us to use more of our claims data and to use single procedure 
claims only to set payment rates for the uncommon circumstances in 
which a particular service is not furnished in combination with other 
related independent services. Therefore, we are proposing to establish 
two composite APCs for the CY 2008 OPPS.
b. Partial Device Credits
    We are proposing to reduce payment by 50 percent of the device 
offset amount for specified APCs when hospitals report that they have 
received a credit for a replacement device of greater than or equal to 
20 percent of the cost of the new replacement device being implanted, 
if the device is on a list of specified devices. We refer readers to 
section IV.A.3. of this proposed rule for a complete discussion of this 
proposal. This is an extension of the current policy that reduces the 
APC payment by the full device offset amount when the hospital receives 
a replacement device without cost or receives a credit for the full 
cost of the device being replaced. We considered several alternatives 
in developing this partial device credit proposal for CY 2008.
    The first alternative we considered was to make no change to the 
current policy. Under this alternative, Medicare and the beneficiary 
would continue to pay the full APC rate, which is calculated using only 
claims for which the full cost of a device is billed by the hospital, 
even if the hospital received a substantial credit towards the cost of 
the replacement device. We did not select this alternative because we 
believe that, as long as the APC payment amount is initially 
established to reflect the full cost of the device when there is no 
credit, there should be a reduction in the Medicare payment amount when 
the hospital receives a substantial credit toward cost of the 
replacement device. Similarly, we believe that the beneficiary cost 
sharing should be based on an amount that also reflects the credit.
    The second alternative we considered was to extend the current 
policy to cases of partial credit without change. This would reduce the 
payment in all cases in which the hospital received a credit by the 
full offset amount for the APC, that is, by 100 percent of the 
estimated device cost contained in the APC. We considered this 
alternative because, in our discussions with hospitals about partial 
credits for devices, they advised us that hospitals generally charge 
the same amount for a device regardless of whether they receive a 
significant amount in credit towards the cost of that device. Hence, in 
such a case the costs that are packaged into the APC payment for the 
applicable procedure contain the same amount of device cost as if the 
hospital incurred the full cost of the device. We did not select this 
alternative because we did not believe it was appropriate to reduce the 
payment to the hospital by the full cost of a device if the hospital 
only received a partial credit, and not a full credit, towards the cost 
of the device.
    The third alternative, which we are proposing, is to reduce the APC 
payment by 50 percent of the offset amount (that would be applied if 
the hospital received full credit) in cases in which the hospital 
receives a partial credit of 20 percent or more of the cost of the new 
replacement device being implanted. Moreover, we are proposing to 
require hospitals to report a new modifier when the hospital receives a 
partial credit that is 20 percent or more of the cost of the device 
being replaced. We are proposing this alternative because we believe 
that this approach provides an appropriate and equitable payment to the 
hospital from Medicare and, depending on the service, may reduce the 
beneficiary's cost sharing for the service.

[[Page 42818]]

c. Brachytherapy Sources
    Pursuant to sections 1833(t)(2)(H) and 1833(t)(16)(C) of the Act, 
we paid for brachytherapy sources furnished from January 1, 2004 
through December 31, 2006 on a per source basis at an amount equal to 
the hospital's charge adjusted to cost by application of the hospital-
specific overall CCR. Moreover, pursuant to section 107(a) of the MIEA-
TRHCA, which amended section 1833(t)(16)(C) of the Act by extending the 
payment period for brachytherapy sources based on a hospital's charges 
adjusted to cost, we are paying for brachytherapy sources using the 
charges adjusted to cost methodology through December 31, 2007. Section 
107(b)(1) of the MIEA-TRHCA amended section 1833(t)(2)(H) of the Act, 
by adding a requirement for the establishment of separate payment 
groups for ``stranded and non stranded'' brachytherapy devices 
beginning July 1, 2007. In section VII. B. of this proposed rule, we 
are proposing prospective payment for all brachytherapy sources, 
including separate payment for stranded and non-stranded versions of 
sources currently known to us, that is, iodine-125, palladium-103 and 
cesium-131. For each of the sources for which we have information that 
only non-stranded source versions are marketed, we are proposing to pay 
based on the median cost per source based on our CY 2006 claims data. 
For sources for which we have information that both stranded and non-
stranded versions are marketed and for which our CY 2006 billing codes 
do not differentiate stranded and non-stranded sources, we are 
proposing to base payment for stranded and non-stranded brachytherapy 
sources on the 60th percentile and 40th percentile of our claims data, 
respectively, for CY 2008. We discuss each option we considered below.
    The first alternative we considered was to pay for each source of 
brachytherapy based on our CY 2006 median costs, with the exception of 
the 3 sources for which we do not have separately reported cost data 
for their stranded and non-stranded versions, i.e., iodine-125, 
palladium-103, and cesium-131. Under this option, for these six 
stranded and non-stranded sources, we considered payment based on 
hospital charges reduced to cost for CY 2008. This approach would be a 
step toward prospective payment for brachytherapy sources, as the 
sources that only have non-stranded versions would receive prospective 
payment consistent with the overall OPPS methodology. However, payment 
for stranded and non-stranded iodine-125, palladium-103 and cesium-131 
would deviate from the overall OPPS framework for prospective payment 
and from the proposed prospective payment of the non-stranded only 
sources specifically. This approach would subject similar items that 
are essential to brachytherapy treatments to different payment 
methodologies and could potentially create financial incentives for the 
use of some products over others.
    The second alternative we considered was to continue making 
payments for all sources based on hospital charges reduced to cost. 
Although hospitals are familiar with this payment methodology and this 
methodology would be consistent with the requirement that brachytherapy 
sources be paid separately, we believe that to continue to pay on this 
basis would be inconsistent with the general methodology of a 
prospective payment system and would provide no incentive for hospitals 
to provide brachytherapy treatments in the most cost-effective and 
clinically advantageous manner.
    The third alternative we considered, and the alternative we 
selected, is to propose prospective payment for each brachytherapy 
source based on its median costs. For the sources which only have non-
stranded versions, we are proposing to use our standard median cost 
methodology. For the three sources which have stranded and non-stranded 
versions and for which we do not yet have separately reported stranded 
and non-stranded claims data, we are proposing to calculate the median 
costs based on the assumption that the reportedly lower cost non-
stranded sources would be unlikely to be in the top 20 percent of the 
cost distribution of our aggregate CY 2006 claims data for each 
respective source, and on the assumption that the reportedly higher 
cost stranded sources would be unlikely to be in the bottom 20 percent 
of the CY 2006 cost distribution for each source. This approach to 
calculating median costs for stranded and non-stranded iodine-125, 
palladium-103, and cesium-131 sources results in proposed Medicare 
payment rates based on the 60th percentile of our aggregate data for 
stranded sources and the 40th percentile of our aggregate data for non-
stranded sources. This methodology provides for separate payment of all 
sources, including stranded and non-stranded sources, recognizes a cost 
differential between stranded and non-stranded sources, is consistent 
with our prospective payment methodology for setting payment rates for 
other services, and is consistent with the expiration of the 
requirement of the MIEA-TRHCA that payment for brachytherapy sources be 
made at charges reduced to cost through December 31, 2007.
2. Limitations of Our Analysis
    The distributional impacts presented here are the projected effects 
of the policy changes on various hospital groups. We estimate the 
effects of individual policy changes by estimating payments per 
service, while holding all other payment policies constant. We use the 
best data available but do not attempt to predict behavioral responses 
to our policy changes. In addition, we do not make adjustments for 
future changes in variables such as service volume, service-mix, or 
number of encounters. As we have done in previous rules, we are 
soliciting comments and information about the anticipated effect of the 
proposed changes on hospitals and our methodology for estimating them. 
We discuss below several specific limitations of our analysis.
    One limitation of our analysis is our inability to estimate 
behavioral responses to our proposal to increase packaging and our 
proposal to pay for multiple procedures based on one composite payment 
rate. Specifically, it is possible that there could be a behavioral 
response to our proposals to package guidance services, image 
processing services, intraoperative services, imaging supervision and 
interpretation services, diagnostic radiopharmaceuticals, contrast 
agents, and observation services, and to pay some services using 
composite APCs when the services are furnished in specified 
combinations. However, we are unable to estimate what the effect of the 
behavioral response may be on payment to hospitals. We refer readers to 
section II.A.4. of this proposed rule for further discussion of the 
proposed packaging approach. The purpose of packaging these services 
and creating composite APCs is to remove financial incentives to 
furnish additional services and, instead, to provide greater incentives 
for hospitals to assess the most cost-effective and appropriate means 
to furnish necessary services. In addition, we expect that hospitals 
will negotiate for lower prices from suppliers to maximize the margin 
between their cost of providing services and the Medicare payment for 
the services. We recognize that it is also possible that hospitals 
could change behavior in a manner that seeks to overcome any reductions 
in total payments by ceasing to provide certain packaged services on 
the same date of service and instead requiring patients to receive 
those services on different dates of service or at different locations, 
so as to either

[[Page 42819]]

receive separate additional payment for services that would otherwise 
be packaged or to not incur the additional costs of those services. We 
believe that this will be uncommon for several reasons. We anticipate 
that hospitals would continue to provide care that is aligned with the 
best interests of the patient. In the vast majority of cases for the 
services that are newly proposed for unconditional packaging in CY 
2008, the services would need to be provided in the same facility and 
during the same encounter as the independent procedure they support. 
Furthermore, in the case of conditionally packaged services, we note 
that the supportive services that we have included in our packaging 
proposals are typically services that are provided during or shortly 
preceding the independent procedure to which they are ancillary and 
supportive, and thus it is unlikely that the supportive service that is 
packaged and the independent procedure would be performed in different 
locations. However, we are unable to quantify the extent to which such 
behavioral change may impact Medicare payments to hospitals.
    Secondly, we are not able to estimate the impact on hospitals of 
our proposal to reduce payment when a hospital receives a partial 
credit for a medical device that fails while under warranty or 
otherwise. We do not currently require hospitals to notify us when they 
received a partial credit for a device for which they are billing. In 
addition, hospitals have informed us that hospitals generally do not 
currently reduce the charge for a device when they receive a partial 
credit toward the device for which they are billing Medicare. 
Therefore, we have no means of knowing the frequency with which this 
happens or the extent to which hospitals' costs for the devices being 
replaced are reduced as a result of the partial credits and cannot 
estimate the impact of the proposed policy on hospital payments under 
OPPS in CY 2008.
    Third, we are unable to estimate the extent to which hospitals will 
incur no cost for devices or will receive full credits for devices 
being replaced as a result of the failure of the device. In CY 2006, 
hospitals reported the ``FB'' modifier on codes for devices that they 
received without cost or for which they received a full credit. 
However, we are unable to forecast the extent to which the frequency or 
the type of device for which this occurred in CY 2006 will recur for CY 
2008. We believe that most of these occurrences were the result of 
specific activity that we have no reason to believe will occur in CY 
2008 at the same frequency at which it occurred in CY 2006, and hence 
we have made no estimates of how such activity may impact payments to 
hospitals.
    Fourth, for purposes of this impact analysis, for those 
brachytherapy sources with proposed new codes to distinguish between 
stranded and non-stranded version, we assumed that half of the 
brachytherapy sources that hospitals will use in CY 2008 will be 
stranded sources and that half of them will be non-stranded sources. 
The statute requires us to pay for stranded and non stranded sources 
through different APC groups, but given the lack of separately reported 
claims data for stranded and non-stranded sources, for the purposes of 
this impact analysis, we made this assumption. We welcome data that 
would provide the expected CY 2008 ratio of stranded sources to non-
stranded sources for purposes of the CY 2008 final rule impact 
analysis.
    The final limitation of our analysis is that we cannot predict the 
utilization of new CY 2007 CPT codes that replace existing CY 2006 CPT 
codes for which we have cost data on which we base the proposed CY 2008 
OPPS payment rates. In years past, we have estimated the impact of 
these code changes as if the deleted codes would continue to exist for 
the applicable year for which we were estimating impacts. For this 
proposed rule, we applied the AMA's estimates of new code utilization 
which are used for the MPFS proposed rule. However, we do not know 
whether these estimates of physician utilization are equally applicable 
to outpatient hospital services. We request comments regarding whether 
it is appropriate for us to use the AMA estimates of utilization for 
new codes in the estimation of the impact of proposed CY 2008 payments 
on hospitals.
3. Estimated Impacts of This Proposed Rule on Hospitals and CMHCs
    Table 67 below shows the estimated impacts of this proposed rule on 
hospitals. Historically, the first line of the impact table, which 
estimates the change in payments to all hospitals, has always included 
cancer and children's hospitals, which are held harmless to their pre-
BBA payment to cost ratio. This year, for the first time, we are also 
including CMHCs in the first line that includes all providers because 
we included CMHCs in our weight scaler estimate. We are not showing the 
estimated impact of the proposed changes on CMHCs alone because CMHCs 
bill only one service under the OPPS, partial hospitalization, and each 
CMHC can, therefore easily estimate the impact of the proposed changes 
by referencing payment for APC 0033 in Addendum A to this proposed 
rule.
    The estimated increase in the total payments made under the OPPS is 
limited by the increase to the conversion factor set under the 
methodology in the statute. The distributional impacts presented do not 
include assumptions about changes in volume and service-mix. The 
enactment of Pub. L. 108-173 on December 8, 2003, provided for the 
additional payment outside of the budget neutrality requirement for 
wage indices for specific hospitals reclassified under section 508. The 
amounts attributable to this reclassification are incorporated into the 
CY 2007 estimates but because section 508 expires for CY 2008 rates, no 
additional payments under section 508 are considered for CY 2008 in 
this impact analysis.
    Table 67 shows the estimated redistribution of hospital and CMHC 
payments among providers as a result of APC reconfiguration and 
recalibration without the proposal to expand packaging; APC 
reconfiguration and recalibration including the proposal to expand 
packaging; wage indices and continuation of the adjustment for rural 
SCHs and EACHs with extension to brachytherapy sources in CY 2008; the 
estimated distribution of increased payments in CY 2008 resulting from 
the combined impact of the APC recalibration with the proposal to 
expand packaging, wage effects, the rural SCH and EACH adjustment, and 
the market basket update to the conversion factor; and, finally, 
estimated payments considering all payments for CY 2008 relative to all 
payments for CY 2007, including the impact of expiring wage provisions 
of section 508, changes in the outlier threshold, and changes to the 
pass-through estimate. Because updates to the conversion factor, 
including the update of the market basket and the addition of money not 
dedicated to pass-through payments, are applied uniformly, observed 
redistributions of payments in the impact table for hospitals largely 
depend on the mix of services furnished by a hospital (for example, how 
the APCs for the hospital's most frequently furnished services would 
change), the impact of the wage index changes on the hospital, and the 
impact of the payment adjustment for rural SCHs, including EACHs. 
However, total payments made under this system and the extent to which 
this proposed rule would redistribute money during implementation also 
would depend on changes in volume, practice patterns, and the mix of 
services billed between

[[Page 42820]]

CY 2007 and CY 2008, which CMS cannot forecast.
    Overall, the proposed OPPS rates for CY 2008 would have a positive 
effect for providers paid under the OPPS, resulting in a 3.3 percent 
increase in Medicare payments. Removing cancer and children's hospitals 
because their payments are held harmless to the pre-BBA ratio between 
payment and cost, and CMHCs, suggests that changes would result in a 
3.5 percent increase in Medicare payments to all other hospitals, 
exclusive of transitional pass-through payments.
    To illustrate the impact of the proposed CY 2008 changes, our 
analysis begins with a baseline simulation model that uses the final CY 
2007 weights, the FY 2007 final post-reclassification IPPS wage 
indices, and the final CY 2007 conversion factor. Column 2A in Table 67 
shows the independent effect of changes resulting from the proposed 
reclassification of services among APC groups and the proposed 
recalibration of APC weights without the proposed changes to packaging, 
based on 12 months of CY 2006 hospital OPPS claims data and more recent 
cost report data. We modeled the independent effect of APC 
recalibration by varying only the weights, the final CY 2007 weights 
versus the estimated CY 2008 weights without expanded packaging in our 
baseline model, and calculating the percent difference in payments. 
Column 2B in Table 67 shows the independent effect of changes resulting 
from the proposed packaging approach, including the proposed creation 
of composite APCs 8000 and 8001, based on 12 months of CY 2006 hospital 
OPPS claims data and more recent cost report data. We modeled the 
independent effect of APC recalibration by varying only the weights in 
the baseline model, the proposed CY 2008 weights without packaging and 
CY 2008 weights with expanded packaging, and calculating the percent 
difference in payments relative to the CY 2007 base used in Column 2A 
in order to show the packaging proposal's additive effect. Column 2B 
also reflects the independent effect of changes resulting from APC 
reclassification and recalibration changes and changes in multiple 
procedure discount patterns that occur as a result of the proposed 
changes to packaging. When services were packaged as proposed, the 
resulting median costs at the HCPCS code level often changed, requiring 
migration of HCPCS codes to different APCs to address violations of the 
two times rule (that is, to ensure that the HCPCS codes within the APC 
remained homogeneous with regard to clinical and resource 
characteristics). The placement of the HCPCS code in a new APC as a 
result of the effect of the proposed packaging approach often changed 
the APC median cost. Furthermore, changing the cost of a service 
subject to the multiple procedure discount policy, as well as packaging 
some services previously subject to the multiple procedure discount 
policy, changed the relative weight ranking of services on a claim 
subject to the multiple procedure discount policy, significantly 
changing discounting patterns in some cases.
    Column 2 reflects the combined effects of APC reclassification and 
recalibration changes attributable to changes resulting from the 
proposed reclassification of services codes among APC groups and the 
proposed recalibration of APC weights without the proposed packaging 
approach in addition to all APC reclassification and recalibration 
changes attributable to the proposed packaging approach. We modeled the 
independent effect of all APC recalibration by varying only the weights 
in the baseline model, the final CY 2007 weights versus the proposed CY 
2008 weights, and calculating the percent difference in payments.
    Column 3 reflects the independent effects of updated wage indices, 
including the new occupational mix data described in the FY 2008 IPPS 
final rule, and the proposed 7.1 percent rural adjustment for SCHs and 
EACHs with extension to brachytherapy sources. The OPPS wage index for 
CY 2008 includes the budget neutrality adjustment for the rural floor, 
as discussed in section II.D. of this proposed rule. We modeled the 
independent effect of updating the wage index and the rural adjustment 
by varying only the wage index, using the proposed CY 2008 scaled 
weights, and a CY 2007 conversion factor that included a budget 
neutrality adjustment for changes in wage effects and the rural 
adjustment between CY 2007 and CY 2008.
    Column 4 demonstrates the combined ``budget neutral'' impact of 
proposed APC recalibration with the packaging proposal (that is, Column 
2), the wage index update and the proposed adjustment for rural SCHs 
and EACHs on various classes of hospitals (that is, Column 3), as well 
as the impact of updating the conversion factor with the market basket 
update. We modeled the independent effect of the proposed budget 
neutrality adjustments and the proposed market basket update by using 
the weights and wage indices for each year, and using a CY 2007 
conversion factor that included the proposed market basket update and 
budget neutrality adjustments for differences in wages and the 
adjustment for rural SCHs and EACHs.
    Finally, Column 5 depicts the full impact of the proposed CY 2008 
policy on each hospital group by including the effect of all the 
proposed changes for CY 2008 (including the APC reconfiguration and 
recalibration with the packaging changes shown in Column 2) and 
comparing them to all estimated payments in CY 2007, including changes 
to the wage index under section 508 of Pub. L. 108-173 and expiring in 
September 2007. Column 5 shows the combined budget neutral effects of 
Columns 2 through 4, plus the impact of the proposed change to the 
fixed outlier threshold from $1,825 to $2,000, expiring section 508 
reclassification wage index increases, and the impact of changing the 
percentage of total payments dedicated to transitional pass through 
payments. We estimate that these cumulative changes increase payments 
by 3.3 percent.
    We modeled the independent effect of all changes in Column 5 using 
the final weights for CY 2007 and the proposed weights for CY 2008. We 
used the final conversion factor for CY 2007 of $61.468 and the 
proposed CY 2008 conversion factor of $63.693. Column 5 also contains 
simulated outlier payments for each year. We used the charge inflation 
factor used in the FY 2008 IPPS proposed rule of 7.26 percent (1.0726) 
to increase individual costs on the CY 2006 claims to reflect CY 2007 
dollars, and we used the most recent overall CCR in the April 
Outpatient Provider-Specific File. Using the CY 2006 claims and a 7.26 
percent charge inflation factor, we currently estimate that actual 
outlier payments for CY 2007, using a multiple threshold of 1.75 and a 
fixed-dollar threshold of $1,825 would be approximately 1.0 (0.96) 
percent of total payments. Outlier payments of 0.96 percent appear in 
the CY 2007 comparison in Column 5. We used the same set of claims and 
a charge inflation factor of 15.04 percent (1.1504) and the CCRs on the 
April Outpatient Provider-Specific File with an adjustment of 0.9912 to 
reflect relative changes in cost and charge inflation between CY 2007 
and CY 2008 to model the CY 2008 outliers at 1.0 percent of total 
payments using a multiple threshold of 1.75 and a fixed dollar 
threshold of $2,000.
Column 1: Total Number of Hospitals
    The first line in Column 1 in Table 67 shows the total number of 
providers (4,171), including cancer and children's hospitals and CMHCs 
for which we were able to use CY 2006 hospital

[[Page 42821]]

outpatient claims to model CY 2007 and CY 2008 payments by classes of 
hospitals. We excluded all hospitals for which we could not accurately 
estimate CY 2007 or CY 2008 payment and entities that are not paid 
under the OPPS. The latter entities include CAHs, all-inclusive 
hospitals, and hospitals located in Guam, the U.S. Virgin Islands, 
Northern Mariana Islands, American Samoa, and the State of Maryland. 
This process is discussed in greater detail in section II.A. of this 
proposed rule. At this time, we are unable to calculate a 
disproportionate share (DSH) variable for hospitals not participating 
in the IPPS. Hospitals for which we do not have a DSH variable are 
grouped separately and generally include psychiatric hospitals, 
rehabilitation hospitals, and LTCHs. We show the total number (3,911) 
of OPPS hospitals, excluding the hold-harmless cancer and children's 
hospitals, and CMHCs, on the second line of the table. We excluded 
cancer and children's hospitals because section 1833(t)(7)(D) of the 
Act permanently holds harmless cancer hospitals and children's 
hospitals to a proportion of their pre-BBA payment relative to their 
pre-BBA costs and, therefore, we removed them from our impact analyses. 
We excluded CMHCs, because they only bill one service under the OPPS, 
and thus they can easily determine the impact of the proposed changes.
Column 2A: APC Recalibration Prior to the Packaging Proposal
    This column estimates what the effects of APC reconfiguration and 
recalibration would be if we were not to finalize the proposed 
packaging changes. The effects described in this column reflect updated 
cost report and claims data, as well as policy changes not related to 
proposed additional packaging, including APC Panel recommendations and 
proposed payment for brachytherapy sources. We assumed that 
radiopharmaceuticals would be paid prospectively based on their mean 
unit cost. In general, the combined effects of the APC reclassification 
and recalibration without the packaging proposal for hospitals in 
Column 2A are similar to the effects of APC recalibration in recent 
years. The 0.3 percent increase for all hospitals reflects the 
redistribution of lost partial hospitalization per diem payment from 
CMHCs to other hospitals. For example, overall, these changes would 
increase payments to urban hospitals by 0.3 percent. We estimate that 
large urban hospitals would see a 0.2 percent increase, while ``other'' 
urban hospitals experience an increase of 0.5 percent.
    Overall, rural hospitals would show a modest 0.2 percent increase 
as a result of proposed changes to the APC structure that would occur 
without the proposed changes in packaging. In general, rural hospitals 
with 101 or more beds would experience increases greater than rural 
hospitals with 100 beds or fewer. Similarly, rural hospitals that bill 
greater than 10,999 lines (that is, total payable claim lines in CY 
2006) would experience increases greater than rural hospitals that bill 
10,999 lines and fewer. Urban and rural hospitals that bill Medicare 
fewer than 5,000 lines would see reductions of 10.7 percent and 8.1 
percent respectively, due to the proposed reduction in payment for 
partial hospitalization (APC 0033) for CY 2008 and due to the 
limitation on the aggregate total OPPS payment per day for mental 
health services to the per diem payment for partial hospitalization 
(APC 0034).
    Among teaching hospitals, the largest observed impacts resulting 
from proposed APC recalibration include an increase of 0.5 percent for 
minor teaching hospitals and an increase of 0.1 percent for major 
teaching hospitals.
    Classifying hospitals by type of ownership suggests that 
proprietary hospitals would not experience any change in payment, 
governmental hospitals would experience an increase of 0.2 percent, and 
voluntary hospitals would experience an increase of 0.4 percent.
Column 2B: APC Recalibration and Addition of the Packaging Proposal
    This column estimates what the additional, independent effects of 
APC reconfiguration and recalibration, and resulting changes in 
discounting patterns, would be with the expanded packaging and all 
other changes that we propose for CY 2008. Significant changes not 
related to packaging were addressed in column 2A. In general, the 
packaging proposal redistributes payments from larger and urban 
hospitals to smaller and rural hospitals that provide fewer packaged 
services and fewer of the independent services into which the 
supportive services were packaged. Overall, these additional changes 
would decrease payments to urban hospitals by 0.1 percent. We estimate 
that urban hospitals that bill less than 11,000 lines would see an 
increase of slightly over 1 percent, while urban hospitals that bill at 
least 11,000 lines or more would experience less of an increase or a 
small decrease.
    Overall, rural hospitals would show a modest 0.4 percent increase 
as a result of proposed changes to packaging. Rural hospitals with 150 
or more beds would experience decreases while smaller rural hospitals 
would experience increases in payment.
    Among teaching hospitals, the largest observed impacts resulting 
from the proposed packaging include a decrease of 0.4 percent for minor 
teaching hospitals and an increase of 0.3 percent for major teaching 
hospitals.
    Classifying hospitals by type of ownership suggests that 
proprietary hospitals would decrease 0.2 percent, and governmental and 
voluntary hospitals would experience no change.
Column 2: Combination of Columns 2A and 2B
    This column shows the combined effects of proposed policies other 
than the proposed changes to packaging (for example, changes to payment 
for brachytherapy sources and therapeutic radiopharmaceuticals), which 
are reflected in part in column 2A with the additional changes to 
reconfiguration and recalibration that would be made if we were to 
finalize the packaging proposal (Column 2B). In many cases, the 
redistribution created by the reduction in the partial hospitalization 
payment offsets other recalibration losses. Overall, these changes 
would increase payments to urban hospitals by 0.2 percent. We estimate 
that both large urban hospitals and other urban hospitals would see a 
0.2 percent increase in payments attributable to all recalibration.
    Overall, rural hospitals would show a modest 0.6 percent increase 
as a result of proposed changes to the APC structure and the packaging 
proposal. Rural hospitals with 200 or more beds would experience 
decreases while smaller rural hospitals would experience increases in 
payment.
    Among teaching hospitals, the largest observed impacts resulting 
from proposed APC recalibration and the packaging proposal include an 
increase of 0.5 percent for major teaching hospitals and an increase of 
0.1 percent for minor teaching hospitals.
    Classifying hospitals by type of ownership suggests that 
proprietary hospitals would decrease 0.2 percent, governmental 
hospitals would increase by 0.2 percent, and voluntary hospitals would 
increase by 0.4 percent.
Column 3: New Wage Indices and the Effect of the Rural Adjustment
    This column estimates impact of applying the proposed IPPS FY 2008 
wage indices for CY 2008, continuing the rural adjustment for CY 2008, 
and extending the rural adjustment to

[[Page 42822]]

include brachytherapy sources. Overall, these changes would not change 
the payments to urban hospitals. Overall, rural hospitals would show no 
change as a result of proposed changes to the wage indices and the 
continuation of the rural adjustment.
    Among teaching hospitals, the largest observed impacts resulting 
from proposed changes to the wage indices and the continuation of the 
rural adjustment include a decrease of 0.2 percent for major teaching 
hospitals and no change for minor teaching hospitals.
    Classifying hospitals by type of ownership suggests that 
proprietary hospitals would gain 0.2 percent, government hospitals 
would experience an increase of 0.1 percent, and voluntary hospitals 
would experience no change.
Column 4: All Budget Neutrality Changes and Market Basket Update
    The addition of the proposed market update alleviates any negative 
impacts on payments for CY 2008 created by the proposed budget 
neutrality adjustments made in Columns 2 and 3, with the exception of 
urban and rural hospitals with the lowest volume of services and 
hospitals not paid under the IPPS, including psychiatric hospitals, 
rehabilitation hospitals, and LTCHs (DSH not available). In many 
instances, the redistribution of payments created by APC recalibration 
offsets those introduced by updating the wage indices.
    Overall, these changes would increase payments to urban hospitals 
by 3.5 percent. We estimate that both large urban hospitals and other 
urban hospitals would see a 3.5 percent increase. In contrast, small 
urban hospitals that bill fewer than 5000 lines per year would 
experience a decrease in payment of 6 percent, largely as a result of 
the proposed decreases in payment for partial hospitalization and 
mental health services appearing in Column 2A.
    Overall, rural hospitals would show a 3.9 percent increase as a 
result of proposed market basket update. Rural hospitals that bill less 
than 5,000 lines would see a 4.2 percent decrease, also as a result of 
proposed decreases in payment for partial hospitalization appearing in 
Column 2A. Rural hospitals that bill more than 5,000 lines would 
experience increases.
    Among teaching hospitals, the largest observed impacts resulting 
from the proposed market basket update include an increase of 3.6 
percent for major teaching hospitals and an increase of 3.4 percent for 
minor teaching hospitals.
    Classifying hospitals by type of ownership suggests that 
proprietary hospitals would gain 3.3 percent, government hospitals 
would experience an increase of 3.6 percent, and voluntary hospitals 
would experience an increase of 3.6 percent.
Column 5: All Proposed Changes for CY 2008
    Column 5 compares all proposed changes for CY 2008 to final payment 
for CY 2007 and includes the expiring section 508 reclassification wage 
indices, the proposed change in the outlier threshold, and the 
difference in pass through estimates which are not included in the 
combined percentages shown in Column 4. Overall, we estimate that 
providers would gain 3.3 percent under this proposed rule in CY 2008 
relative to total spending in CY 2007. The 3.3 percent for all 
providers in Column 5 is rounded from 3.26 percent, which reflects the 
3.3 percent market basket increase, plus 0.06 percent for the change in 
the pass-through estimate between CY 2007 and CY 2008, plus 0.04 
percent for the difference in estimated outlier payments between CY 
2007 and CY 2008, less 0.14 percent for expiring 508 wage payments. 
When we exclude cancer and children's hospitals (which are held 
harmless to their pre-OPPS costs), and CMHCs, the gain becomes 3.5 
percent.
    The combined effect of all proposed changes for CY 2008 would 
increase payments to urban hospitals by 3.5 percent. We estimate that 
large urban hospitals would see a 3.5 percent increase, while ``other'' 
urban hospitals experience an increase of 3.4 percent. Urban hospitals 
that bill less than 5,000 lines experience a decrease of 5.4 percent, 
up from 6.0 percent in column 4 due to increases in outlier payments 
for partial hospitalization.
    Overall, rural hospitals would show a 3.8 percent increase as a 
result of the combined effects of all proposed changes for CY 2008. 
Rural hospitals that bill less than 5,000 lines experience a decrease 
of 3.0 percent, which is less than the 4.2 percent in column 4 due to 
an increase in outlier payments for partial hospitalization. All rural 
hospitals that bill greater than 5,000 lines experience increases 
ranging from 3.3 percent to 4.9 percent.
    Among teaching hospitals, the largest observed impacts resulting 
from the combined effects of all proposed changes include an increase 
of 3.5 percent for major teaching hospitals and an increase of 3.3 
percent for minor teaching hospitals.
    Classifying hospitals by type of ownership suggests that 
proprietary hospitals would gain 3.4 percent, government hospitals 
would experience an increase of 3.6 percent, and voluntary hospitals 
would experience an increase of 3.5 percent.

                            Table 67.--Proposed Impact of Changes for CY 2008 Hospital Outpatient Prospective Payment System
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                     APC changes
                                                                     ------------------------------------------   New wage     Comb (cols
                                                          Number of     Prior to                                  index and     2,3) with    All changes
                                                          hospitals     packaging     Packaging    Comb (cols       rural        update
                                                                        proposal      proposal       2A,2B)      adjustment
                                                                 (1)          (2A)          (2B)           (2)           (3)           (4)           (5)
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                   Proposed Impact of CY 2008 Hospital Outpatient Prospective Payment System Changes
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL PROVIDERS*........................................          4171           0.0           0.0           0.0           0.0           3.3           3.3
ALL HOSPITALS.........................................          3911           0.3           0.0           0.3           0.0           3.6           3.5
(excludes hospitals held harmless and CMHCs)
URBAN HOSPITALS.......................................          2916           0.3          -0.1           0.2           0.0           3.5           3.5
    LARGE URBAN (GT 1 MILL.)..........................          1591           0.2           0.1           0.2           0.0           3.5           3.5
    OTHER URBAN (LE 1 MILL.)..........................          1325           0.5          -0.3           0.2           0.0           3.5           3.4
RURAL HOSPITALS.......................................           995           0.2           0.4           0.6           0.0           3.9           3.8
    SOLE COMMUNITY....................................           410           0.3           0.4           0.7           0.2           4.2           3.9

[[Page 42823]]

 
    OTHER RURAL.......................................           585           0.2           0.4           0.5          -0.2           3.7           3.8
BEDS (URBAN):
    0-99 BEDS.........................................           947          -0.2           0.5           0.3           0.1           3.7           3.7
    100-199 BEDS......................................           917           0.1           0.1           0.2           0.0           3.5           3.4
    200-299 BEDS......................................           469           0.5          -0.2           0.3          -0.1           3.6           3.5
    300-499 BEDS......................................           409           0.4          -0.2           0.2           0.1           3.6           3.6
    500 + BEDS........................................           174           0.4          -0.3           0.1           0.0           3.4           3.3
BEDS (RURAL):
    0-49 BEDS***......................................           345           0.1           1.2           1.4          -0.1           4.6           4.5
    50-100 BEDS***....................................           383           0.1           0.9           1.0           0.2           4.5           4.5
    101-149 BEDS......................................           159           0.3           0.4           0.7           0.0           4.0           4.0
    150-199 BEDS......................................            64           0.4          -0.3           0.1          -0.6           2.7           2.7
    200 + BEDS........................................            44           0.3          -0.7          -0.5           0.1           2.9           2.6
VOLUME (URBAN):
    LT 5,000 Lines....................................           591         -10.7           1.4          -9.3           0.0          -6.0          -5.4
    5,000-10,999 Lines................................           165          -1.6           1.2          -0.3           0.1           3.1           3.0
    11,000-20,999 Lines...............................           269          -0.5           0.6           0.1           0.1           3.6           3.7
    21,000-42,999 Lines...............................           545           0.3           0.3           0.6           0.2           4.0           4.0
    GT 42,999 Lines...................................          1346           0.4          -0.2           0.2           0.0           3.5           3.5
VOLUME (RURAL):
    LT 5,000 Lines....................................            82          -8.1           1.3          -6.8          -0.6          -4.2          -3.0
    5,000-10,999 Lines................................           104           0.0           1.2           1.2           0.3           4.9           4.8
    11,000-20,999 Lines...............................           208           0.3           1.3           1.6           0.1           5.0           4.8
    21,000-42,999 Lines...............................           310           0.3           1.1           1.4           0.2           4.9           4.9
    GT 42,999 Lines...................................           291           0.2           0.0           0.2          -0.1           3.4           3.3
REGION (URBAN):
    NEW ENGLAND.......................................           157           0.0           0.8           0.8          -0.1           4.0           3.8
    MIDDLE ATLANTIC...................................           378           0.4           0.6           1.0          -0.4           3.9           3.5
    SOUTH ATLANTIC....................................           454           0.4          -0.4           0.0           0.1           3.5           3.5
    EAST NORTH CENT...................................           461           0.5          -0.2           0.3          -0.2           3.4           3.2
    EAST SOUTH CENT...................................           195           0.7          -0.6           0.1           0.1           3.4           3.5
    WEST NORTH CENT...................................           187           0.4          -0.2           0.2           0.3           3.8           3.8
    WEST SOUTH CENT...................................           464           0.5          -0.8          -0.3          -0.2           2.8           2.9
    MOUNTAIN..........................................           181           0.6          -0.1           0.5           0.0           3.8           3.9
    PACIFIC...........................................           388          -0.4           0.2          -0.3           0.6           3.6           3.7
    PUERTO RICO.......................................            51           1.0           0.3           1.2          -0.2           4.4           4.4
REGION (RURAL):
    NEW ENGLAND.......................................            21           0.0           0.9           0.8          -0.5           3.6           3.7
    MIDDLE ATLANTIC...................................            70           0.1           0.8           0.8           0.0           4.2           4.2
    SOUTH ATLANTIC....................................           171           0.2           0.4           0.6          -0.2           3.7           3.8
    EAST NORTH CENT...................................           126           0.2           0.3           0.5           0.0           3.8           3.4
    EAST SOUTH CENT...................................           177           0.2          -0.1           0.1          -0.1           3.3           3.4
    WEST NORTH CENT...................................           116           0.3           0.2           0.5           0.1           3.9           3.6
    WEST SOUTH CENT...................................           198           0.2           0.1           0.4          -0.6           3.0           3.2
    MOUNTAIN..........................................            78           0.4           1.3           1.7           0.7           5.7           5.5
    PACIFIC...........................................            38           0.4           0.9           1.3           1.8           6.4           6.0
TEACHING STATUS:
    NON-TEACHING......................................          2889           0.3           0.0           0.3           0.1           3.7           3.7
    MINOR.............................................           739           0.5          -0.4           0.1           0.0           3.4           3.3
    MAJOR.............................................           283           0.1           0.3           0.5          -0.2           3.6           3.5
DSH PATIENT PERCENT:
    .0................................................            10           2.8           2.2           5.0           0.0           8.4           8.3
    GT 0-0.10.........................................           394           0.6           0.1           0.6          -0.1           3.8           3.8
    0.10-0.16.........................................           467           0.5          -0.1           0.4          -0.1           3.6           3.4
    0.16-0.23.........................................           764           0.4          -0.1           0.3           0.1           3.7           3.6
    0.23-0.35.........................................           955           0.4          -0.1           0.3           0.0           3.6           3.6
    GE 0.35...........................................           757           0.0           0.1           0.1           0.1           3.5           3.6
    DSH NOT AVAILABLE**...............................           564         -10.7           0.8          -9.9           0.2          -6.4          -6.0
URBAN TEACHING/DSH:
    TEACHING & DSH....................................           916           0.4          -0.1           0.3          -0.1           3.5           3.4
    NO TEACHING/DSH...................................          1455           0.4          -0.1           0.3           0.1           3.7           3.7
    NO TEACHING/NO DSH................................             9           2.8           2.2           5.0           0.0           8.4           8.3
    DSH NOT AVAILABLE\2\..............................           536         -10.7           0.8          -9.9           0.3          -6.4          -5.9
TYPE OF OWNERSHIP:
    VOLUNTARY.........................................          2146           0.4           0.0           0.4           0.0           3.6           3.5

[[Page 42824]]

 
    PROPRIETARY.......................................          1179           0.0          -0.2          -0.2           0.2           3.3           3.4
    GOVERNMENT........................................           586           0.2           0.0           0.2           0.1           3.6          3.6
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column (1) shows total providers.
Column (2A) shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups resulting from updated 2006 claims data and
  implementation of policies not related to packaging, such as proposed payment for brachytherapy sources.
Column (2B) shows the impact of changes resulting from the packaging proposal and any resulting changes to APC recalibration and discounting patterns.
Column (2) shows the combined impact of all APC reconfiguration and recalibration changes in columns 2A and 2B.
Column (3) shows the budget neutral impact of updating the wage index and rural adjustment by applying the FY 2008 hospital inpatient wage index and
  extending the rural adjustment to brachytherapy sources.
Column (4) shows the impact of all budget neutrality adjustments and the addition of the market basket update.
Column (5) shows the additional adjustments to the conversion factor resulting from the change in the pass-through estimate and outlier payments. This
  column also shows the impact of the expiring 508 wage reclassification, which ends in September 2007
* These 4,171 providers include children and cancer hospitals, which are held harmless to pre-BBA payment to cost ratios, and Community Mental Health
  Centers.
** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care
  hospitals.
*** Section 1833(t)(7)(D) of the Act specifies that rural hospitals with 100 or fewer beds (that are not also sole community hospitals) receive
  additional payment for covered hospital outpatient services furnished during CY 2008 for which the prospective payment system amount is less than the
  pre-BBA amount. The amount of payment is increased by 85 percent of that difference for CY 2008.

4. Estimated Effect of This Proposed Rule on Beneficiaries
    For services for which the beneficiary pays a copayment of 20 
percent of the payment rate, the beneficiary share of payment would 
increase for services for which the OPPS payments would rise and would 
decrease for services for which the OPPS payments would fall. For 
example, for an electrocardiogram (APC 0099), the minimum unadjusted 
copayment in CY 2007 was $4.66. In this proposed rule, the minimum 
unadjusted copayment for APC 0099 is $4.98 because the OPPS payment for 
the service would increase under this proposed rule. In another 
example, for a Level IV Needle Biopsy (APC 0037), in the CY 2007 OPPS, 
the national unadjusted copayment was $228.76, and the minimum 
unadjusted copayment was $126.20. In this proposed rule, the national 
unadjusted copayment for APC 0037 is $228.70. The minimum unadjusted 
copayment for APC 0037 is $177.83, or 20 percent of the payment for APC 
0037. The minimum unadjusted copayment would rise because the payment 
rate for APC 0037 would rise. In all cases, the statute limits 
beneficiary liability for copayment for a service to the inpatient 
hospital deductible for the applicable year. For CY 2007, the inpatient 
deductible is $992.
    In order to better understand the impact of changes in copayment on 
beneficiaries, we modeled the percent change in total copayment 
liability using CY 2006 claims. We estimate, using the claims of the 
4,171 hospitals and CMHCs on which our modeling is based, that total 
beneficiary liability for copayments would decline as an overall 
percentage of total payments from 26.6 percent in CY 2007 to 25.6 
percent in CY 2008. This estimated decline in beneficiary liability is 
a consequence of the APC recalibration and reconfiguration we are 
proposing to make for CY 2008.
    With respect to partial hospitalization, the copayment in CY 2007 
of $46.95 would decline to $35.98 under this proposed rule as a result 
of the proposed decline in the per diem payment for partial 
hospitalization from $234.73 in CY 2007 to $179.88 for CY 2008.
5. Conclusion
    The changes in this proposed rule would affect all classes of 
hospitals. Some classes of hospitals experience significant gains and 
others less significant gains, but almost all classes of hospitals 
would experience positive updates in OPPS payments in CY 2008. Table 67 
demonstrates the estimated distributional impact of the OPPS budget 
neutrality requirements and an additional 3.3 percent increase in 
payments for CY 2008, after considering all proposed changes to APC 
reconfiguration and recalibration, including those resulting from the 
proposal to expand packaging and the proposal to pay for brachytherapy 
sources on a prospective payment basis, as well as the proposed market 
basket increase, and the estimated cost of outliers and proposed 
changes to the pass through estimate. The accompanying discussion, in 
combination with the rest of this proposed rule constitutes a 
regulatory impact analysis.
6. Accounting Statement
    As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in Table 68, we have 
prepared an accounting statement showing the CY 2008 estimated hospital 
OPPS incurred benefit impact associated with the estimated CY 2008 
outpatient hospital market basket update shown in this proposed rule, 
based on the 2007 Trustees' Report baseline. This estimate only 
reflects the effect of the statutorily required market basket update 
and does not take into account potential enrollment, utilization, or 
case-mix changes. All estimated impacts are classified as transfers.

[[Page 42825]]



    TABLE 68.--Accounting Statement: CY 2008 Estimated Hospital OPPS
Incurred Benefit Impact Associated with the Estimated CY 2008 Outpatient
                      Hospital Market Basket Update
                              [in billions]
------------------------------------------------------------------------
               Category                            Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers.......  $0.8
From Whom To Whom?...................  Federal Government to outpatient
                                        hospitals and other providers
                                        who receive payment under the
                                        hospital OPPS.
------------------------------------------------------------------------

*COM019**COM019*C. Effects of ASC Payment System Changes in This 
Proposed Rule

    (If you choose to comment on issues in this section, please include 
the caption ``ASC Impact'' at the beginning of your comment.)
    We are publishing elsewhere in this issue of the Federal Register 
the final rule for the revised ASC payment system, effective January 1, 
2008. In the July 2007 final rule for the revised ASC payment system, 
we adopted the method we will use to set payment rates for ASC services 
furnished in association with covered surgical procedures and covered 
ancillary procedures beginning January 1, 2008. In that final rule, we 
established that the OPPS relative payment weights and payment rates 
will be used as the basis for the payment of most covered surgical 
procedures and covered ancillary services under the revised ASC payment 
system.
    In the July 2007 final rule for the revised ASC payment system, we 
also established that we would update the ASC payment system annually 
as part of the OPPS rulemaking cycle. As part of the annual OPPS 
rulemaking cycle, we indicated we would update the ASC covered surgical 
procedures and covered ancillary services, as well as their payment 
rates. Such an update is very important because the OPPS relative 
payment weights and rates will be used as the basis for the payment of 
most covered surgical procedures and covered ancillary services under 
the revised ASC payment system. This joint update process will ensure 
that the ASC updates occur in a regular, predictable, and timely 
manner, and that the ASC payment rates immediately reflect the updated 
OPPS relative payment weights.
    In this CY 2008 OPPS/ASC proposed rule, we are proposing to update 
the revised ASC payment system for CY 2008 to reflect the proposed CY 
2008 OPPS relative payment weights and rates, as well as update the 
list of covered surgical and covered ancillary services. We are also 
proposing to revise the regulations to make practice expense payment to 
physicians who perform noncovered ASC procedures in ASCs based on the 
MPFS facility PE RVUs and to exclude covered ancillary radiology 
services and covered ancillary drugs and biologicals from the 
categories of DHS that are subject to the physician self-referral 
prohibition.
    The revised Medicare ASC payment system that we are implementing 
beginning January 1, 2008 could have a far-reaching effect on the 
provision of outpatient surgical services for a number of years to come 
for several reasons. First, the list of procedures that will be 
eligible for payment under the revised ASC payment system is greatly 
expanded from the list of surgical procedures eligible for payment 
under the ASC payment system in CY 2007 and earlier years. In addition, 
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, that is, the APC groups that are the unit of payment 
in 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 
Pub. L. 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 calculated to 
result in the same amount of aggregate Medicare expenditures in CY 2008 
as we estimate would have been made if the revised payment system were 
not implemented.
    The effects of the expanded number 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 the July 2007 final rule for the revised ASC payment system, we 
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 utilization data projected forward to 
CY 2008. In that final rule, we indicated that these estimates were 
illustrative and that the CY 2008 ASC payment rates and budget 
neutrality factor would be proposed in the CY 2008 OPPS/ASC proposed 
rule based on the methodology for calculating budget neutrality 
established in the July 2007 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 accord with the methodology for calculating budget neutrality 
established in the July 2007 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.
    Our final methodology for calculating the budget neutrality 
adjustment factor established in the July 2007 final rule considered 
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. Both 
the estimated budget neutrality adjustment factor presented in the July 
2007 final rule and the budget neutrality adjustment factor proposed in 
this rule are based on that methodology, which takes into account 
projected migration. In the final model, we assume 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

[[Page 42826]]

of new ASC procedures would migrate to ASCs.
    We estimate that the revised ASC payment system 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 (non-office) 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
    Alternatives to the changes we are making and the reasons that we 
have chosen the options are discussed throughout this proposed rule. 
Some of the major issues discussed in this proposed rule and the 
options considered are discussed below.
a. Office-Based Procedures
    According to our final policy for the revised ASC payment system, 
we designate as office-based those procedures that are added to the ASC 
list of covered surgical procedures in CY 2008 or later years and that 
we determine are predominantly performed in physicians' offices based 
on consideration of 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 
establish payment for procedures designated as office-based at the 
lesser of the MPFS nonfacility PE RVU amount or the ASC rate developed 
according to the standard methodology of the revised ASC payment 
system. In the July 2007 final rule for the revised ASC payment system, 
we designated a number of procedures as office-based, based on our 
evaluation of the most recent available CY 2005 volume and utilization 
data for each individual procedure code and/or related codes. In 
developing this proposed rule, we reviewed the newly available CY 2006 
utilization data for all those surgical procedures newly added for ASC 
payment in CY 2008 that were assigned payment indicator ``G2'' as non-
office-based additions in the July 2007 final rule for the revised ASC 
payment system. Based on this analysis, we are proposing to designate 
19 additional procedures as office-based for CY 2008. We considered two 
alternatives in developing this proposal.
    The first alternative we considered was to make no change to the 
current policy for these 19 procedures. This would mean that we would 
continue to pay these procedures at the standard ASC payment rate 
developed according to the standard methodology of the revised ASC 
payment system. We did not select this alternative because our analysis 
of the most recently available utilization data for these services and 
related procedures indicates that these 19 procedures could be 
considered to be predominantly performed in physicians' offices. We 
were concerned that if these services were not designated as office-
based, it could create financial incentives for these procedures to 
shift from physicians' offices to ASCs for reasons unrelated to the 
most appropriate setting for surgical care.
    The second alternative we considered, and the alternative we 
selected, is to propose to designate 19 additional procedures as 
office-based for CY 2008. We selected this alternative because our 
claims data indicate that these procedures could be considered to be 
predominantly performed in physicians' offices. We believe that 
designating these procedures as office-based, which results in the ASC 
payment rate for these procedures being capped at the physician office 
rate (that is, the MPFS nonfacility practice PE RVU amount), if 
applicable, is an appropriate step to ensure that Medicare payment 
policy does not create financial incentives for such procedures to 
shift unnecessarily from physicians' offices to ASCs.
b. Partial Device Credits
    We are proposing to reduce the ASC payment by one half of the 
device offset amount for certain surgical procedures into which the 
device cost is packaged, when an ASC receives a partial credit toward 
replacement of specific implantable devices. This partial payment 
reduction would apply when the amount of the device credit is greater 
than or equal to 20 percent of the cost of the new replacement device 
being implanted. Under this proposed policy, both the Medicare payment 
to the ASC and the beneficiary coinsurance liability would be reduced 
when an ASC receives a partial device credit. This proposal is an 
extension of the policy established in the final rule for the revised 
ASC payment system, which reduces the ASC payment by the full device 
offset amount for certain devices when the ASC receives a replacement 
device without cost or receives a credit for the full cost of the 
device being replaced. This partial device credit proposal for ASCs 
mirrors the partial device credit proposal for the OPPS in this 
proposed rule. We considered several alternatives in developing this 
partial device credit proposal for CY 2008.
    The first alternative we considered was to make no change to the 
current policy. Under this alternative, Medicare and the beneficiary 
would continue to pay the ASC the full payment rate for the device 
implantation procedure even if the ASC received a substantial credit 
towards the cost of the replacement device. The ASC payment for the 
device implantation procedure is based on the OPPS relative weight for 
the procedure, which is calculated using only OPPS claims for which the 
full cost of a device is billed. We did not select this alternative 
because we believe that, as long as the ASC payment amount is 
established based on an OPPS relative weight that is calculated using 
only claims that reflect the full cost of the device when there is no 
credit, there should be a reduction in the Medicare payment amount when 
the ASC receives a substantial credit toward cost of the replacement 
device. Similarly, we

[[Page 42827]]

believe that the beneficiary cost sharing should be based on an amount 
that also reflects the credit.
    The second alternative we considered was to extend the current no 
cost/full credit reduction policy to cases of partial credit without 
change. This would reduce the payment in all cases in which the ASC 
received a credit by the full offset amount for the device implantation 
procedure, that is, by 100 percent of the estimated device cost 
included in the procedure payment rate. We did not select this 
alternative because we did not believe it was appropriate to reduce the 
payment to the ASC by the full cost of a device if the ASC only 
received a partial credit, and not a full credit, towards the cost of 
the device.
    The third alternative, which we are proposing, is to reduce the ASC 
procedure payment by 50 percent of the offset amount (that would be 
applied if the ASC received full credit) in cases in which the ASC 
receives a partial credit greater than or equal to 20 percent of the 
cost of the new replacement device being implanted. Moreover, we are 
proposing to require the ASC to report a new modifier when the ASC 
receives a partial credit that is equal to or greater than 20 percent 
of the cost of the device being replaced. We are proposing this 
alternative because we believe that this approach provides an 
appropriate and equitable payment to the ASC from Medicare and will 
reduce the beneficiary's cost sharing for the service.
c. Payment to Physicians for Services Not on the ASC List of Covered 
Surgical Procedures
    Under current policy, when physicians perform surgical procedures 
in ASCs that are included on the ASC list of covered surgical 
procedures, they are paid under the MPFS for the PE component using the 
facility PE RVUs. When physicians perform surgical procedures in ASCs 
that are not included on the ASC list of covered surgical procedures 
and for which Medicare does not allow facility payments to ASCs, 
physicians currently are paid for the PE component at the higher 
nonfacility rate (unless a nonfacility rate does not exist in which 
case Medicare pays the facility rate). In this proposed rule, we are 
proposing that regardless of whether a procedure is on the ASC list of 
covered surgical procedures, a physician performing that procedure in 
an ASC would receive payment based on the facility PE RVUs and 
excluding the technical component (TC) payment, if applicable. We 
considered two alternatives in developing this proposal.
    The first alternative we considered was to make no change to the 
current policy concerning physician payment for services performed in 
ASCs that are not on the ASC list of covered surgical procedures. Under 
current policy, the physician is paid the higher nonfacility PE amount 
when the physician performs a service in an ASC that is not on the ASC 
list of covered surgical procedures (unless a nonfacility rate does not 
exist in which case Medicare pays the facility rate). In the final rule 
for the revised ASC payment system, we adopted a final policy that 
identifies and excludes from ASC payment only those procedures that 
could pose a significant risk to beneficiary safety or would be 
expected to require an overnight stay. Because these excluded 
procedures have been specifically identified by CMS as procedures that 
could pose a significant risk to beneficiary safety or would be 
expected to require an overnight stay, we do not believe it would be 
appropriate to provide payment based on the higher nonfacility PE RVUs 
to physicians who furnish them as we do not believe these procedures 
are safe for performance in an ASC. Consequently, we did not select 
this alternative.
    The second alternative that we considered, and that we selected, 
was to propose that a physician performing a procedure in an ASC would 
receive payment based on the facility PE RVUs and excluding the TC 
payment, if applicable, regardless of whether a procedure is on the ASC 
list of covered surgical procedures. We selected this alternative for 
several reasons. We believe ASCs are facilities that are similar, 
insofar as the delivery of surgical and related nonsurgical services, 
to HOPDs. Specifically, when services are provided in ASCs, the ASC, 
not the physician, bears responsibility for the facility costs 
associated with the service. This situation parallels the hospital 
facility resource responsibility for hospital outpatient services. 
Therefore, we believe it would be more appropriate for physicians to be 
paid for all services furnished in ASCs just as they would be paid for 
all services furnished in the hospital outpatient setting. In addition, 
because we have adopted a final policy for the revised ASC payment 
system that identifies and excludes from ASC payment only those 
procedures that could pose a significant risk to beneficiary safety or 
would be expected to require an overnight stay, we believe that it 
would be incongruous with the revised ASC payment system methodology to 
continue to pay the higher nonfacility rate to physicians who furnish 
excluded ASC 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 2006 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 proposed 
payments for ASC services coincide with the resources required by ASCs 
to provide those services.
    A third limitation of our analysis is our inability to predict 
changes in service mix between CY 2006 and CY 2008 with precision. The 
aggregated impact tables below are based upon a methodology that 
assumes no changes in service mix with respect to the CY 2006 ASC data 
used for this proposed 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 specialties as ASCs adjust to 
proposed payment rates. However, we are unable to accurately project 
such changes at a disaggregated level. Clearly, individual ASCs will 
experience changes in payment that differ from the aggregated estimated 
changes presented 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 classes of 
specialty ASCs, on physicians, and on beneficiaries. We anticipate 
improving the accuracy of estimated impacts over time.

[[Page 42828]]

3. Estimated Effects of This Proposed Rule on ASCs
a. Payment to 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. The 
following discussion presents two tables that provide estimates of the 
impact of the revised ASC payment system on Medicare payments to ASC 
for current ASC services, assuming the same mix of services as offered 
by ASCs in our CY 2006 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. A third table highlights 
changes in payment rates between this CY 2008 proposed rule and those 
in the July 2007 final rule for the revised ASC payment system for 
procedures estimated to receive the most payment in CY 2008 under the 
existing payment system.
    In section XVI.C. of this proposed rule, we reiterate the 
transition of 4 years, 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 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, we will transition 
the blend 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, we will 
pay ASCs for covered surgical procedures on the CY 2007 ASC list at the 
fully implemented revised ASC payment rates. We will not transition 
payment for procedures that were not included on the ASC list of 
covered surgical procedures in CY 2007; we will pay these procedures as 
at the fully implemented ASC rate, beginning in CY 2008.
    Table 69 shows the impact of the revised payment system by surgical 
specialty group. We have aggregated the surgical HCPCS codes by 
specialty group and estimated the effect on aggregated payment for 
surgical specialty groups, considering separately the proposed CY 2008 
transitional rate and the proposed fully implemented revised payment 
rate discussed above. 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 69.
    <bullet> Column 1--Surgical Specialty Group indicates the surgical 
specialties into which ASC procedures are grouped. We used the CPT code 
range definitions and Level II HCPCS codes and Category III CPT codes, 
as appropriate, to account for all surgical procedures to which the 
proposed Medicare program payments are attributed.
    <bullet> 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 
2006 ASC utilization multiplied by a factor of 1.176 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 estimated CY 2008 payment amounts are 
expressed in millions of dollars.
    <bullet> 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 proposed changes in the ASC payment rates for CY 
2008 under the 75/25 blend of the CY 2007 ASC payment rate and the CY 
2008 revised ASC payment rate.
    <bullet> 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 proposed 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 2011.
    Table 69 depicts estimated proposed changes to ASCs' payments at 
the surgical specialty group level. For all but gastrointestinal 
procedures, if an ASC offers the same mix of services in CY 2008 that 
is reflected in our national CY 2006 claims data, proposed Medicare 
payments to the ASC for services in that surgical specialty group are 
expected to increase under the revised payment system. If the revised 
payment system was 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 
Medicare payments for current ASC procedures shown in Table 69, it is 
important to note that estimated CY 2008 payments to ASCs are estimated 
to increase by more than $240 million in CY 2008 due to projected 
migration of new ASC services from HOPDs and physician offices to ASC. 
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.

[[Page 42829]]



  Table 69.--Estimated CY 2008 Impact of the Revised ASC Payment System on Estimated Aggregate Proposed CY 2008
Medicare Program Payments Under the 75/25 Transition Blend and Without a Transition, By Surgical Specialty Group
----------------------------------------------------------------------------------------------------------------
                                                                                                   Estimated CY
                                                                   Estimated CY    Estimated CY    2008 percent
                                                                     2008 ASC      2008 percent   change without
                    Surgical specialty group                       payments (in     change with     transition
                                                                     millions)    transition (75/     (fully
                                                                                     25 blend)     implemented)
(1)                                                                          (2)             (3)             (4)
----------------------------------------------------------------------------------------------------------------
Eye and ocular adnexa...........................................          $1,205               1               5
Digestive system................................................             661              -4             -14
Nervous system..................................................             251               3              -2
Musculoskeletal system..........................................             148              25             100
Integumentary system............................................              81               8              34
Genitourinary system............................................              68              12              46
Respiratory system..............................................              19              18              72
Cardiovascular system...........................................               7              25              98
Auditory system.................................................               4              24              83
Hemic and lymphatic systems.....................................               2              32             129
Other systems...................................................             0.1              29             116
----------------------------------------------------------------------------------------------------------------

    Table 70 below shows the estimated impact of the revised payment 
system on proposed 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 program payment.
    <bullet> Column 1--HCPCS code
    <bullet> Column 2--Short Descriptor of the HCPCS code
    <bullet> 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 2006 
ASC utilization multiplied by a factor of 1.176 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 estimated CY 2008 payment amounts are expressed in 
millions of dollars.
    <bullet> Column 4--CY 2008 Proposed 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 proposed 
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 CY 2008 revised ASC payment rate.
    <bullet> Column 5--CY 2008 Proposed 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 proposed 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 2011.

 Table 70.--Estimated CY 2008 Impact of Proposed Revised ASC Payment System on Aggregate Payments for Procedures
                      With the Highest Estimated CY 2008 Payments Under the Current System
----------------------------------------------------------------------------------------------------------------
                                                                                                   Estimated CY
                                                                                                   2008 percent
                                                                   Estimated CY    Estimated CY       changes
           HCPCS code                    Short Descriptor            2008 ASC      2008 percent       without
                                                                   payments  (in  change  (75/25    transition
                                                                     millions)        blend)          (fully
                                                                                                   implemented)
(1)                               (2)...........................             (3)             (4)             (5)
----------------------------------------------------------------------------------------------------------------
66984...........................  Cataract surg w/iol, 1 stage..            $981               1               3
43239...........................  Upper GI endoscopy, biopsy....             143              -5             -19
45378...........................  Diagnostic colonoscopy........             133              -4             -16
45380...........................  Colonoscopy and biopsy........             110              -4             -16
66821...........................  After cataract laser surgery..              87              -8             -31
45385...........................  Lesion removal colonoscopy....              87              -4             -16
62311...........................  Inject spine l/s (cd).........              70              -3             -11
64483...........................  Inj foramen epidural l/s......              42              -3             -11
66982...........................  Cataract surgery, complex.....              37               1               3
45384...........................  Lesion remove colonoscopy.....              36              -4             -16
15823...........................  Revision of upper eyelid......              35               5              21
G0121...........................  Colon ca scrn not hi rsk ind..              34              -6             -26
G0105...........................  Colorectal scrn; hi risk ind..              27              -6             -26
64476...........................  Inj paravertebral l/s ADD-on..              24             -12             -48
64475...........................  Inj paravertebral l/s.........              24              -3             -11

[[Page 42830]]

 
43235...........................  Uppr gi endoscopy, diagnosis..              23               2               8
52000...........................  Cystoscopy....................              21              -6             -24
67904...........................  Repair eyelid defect..........              16               7              26
64721...........................  Carpal tunnel surgery.........              15              18              72
29881...........................  Knee arthroscopy/surgery......              15              23              94
43248...........................  Uppr gi endoscopy/guide wire..              14              -5             -19
62310...........................  Inject spine c/t..............              12              -3             -11
64484...........................  Inj foramen epidural ADD-on...              11              -3             -11
29880...........................  Knee arthroscopy/surgery......              11              23              94
G0260...........................  Inj for sacroiliac jt anesth..               9              -3             -11
28285...........................  Repair of hammertoe...........               9              18              72
67038...........................  Strip retinal membrane........               9              30             120
29848...........................  Wrist endoscopy/surgery.......               9              -2              -9
64623...........................  Destr paravertebral n ADD-on..               9              -3             -11
45383...........................  Lesion removal colonoscopy....               8              -4             -16
----------------------------------------------------------------------------------------------------------------

    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 would 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 least 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 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 70 identifies a number of ASC procedures receiving the 
highest estimated CY 2008 payment 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 69. In fact, Table 69 shows only one surgical 
specialty group of procedures for which the proposed payments are 
expected to 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 CY 2008 payment rates. 
The estimated increased payments at the full group level are due to the 
moderating effect of the proposed 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 projected aggregate increase in CY 2008 under the 
revised system is driven by a small proposed increase, 1 percent, 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 the proposed payment rate for cystoscopy (CPT code 52000), the 
highest volume ASC genitourinary procedure, is 6 percent less for CY 
2008 than under the existing payment system, overall proposed payment 
to ASCs for the group of genitourinary procedures currently performed 
in ASCs is expected to increase by 12 percent. Although a urology 
specialty ASC may currently perform more cystoscopy procedures than any 
other genitourinary procedure, we believe that under the revised ASC 
payment system, each 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, proposed payment for all of the highest volume 
pain management injection procedures are expected to decrease in CY 
2008, although payment for nervous system procedures overall are 
expected to increase. However, without a transition for CY 2008, we 
estimate that payments also would 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 July 2007 final 
rule for the revised ASC payment system, appear in Table 70 with 
proposed payment decreases under

[[Page 42831]]

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.
    For some procedures the proposed payment amounts in CY 2008 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 30 percent 
compared to estimated CY 2008 payments under the current system. 
Similarly, the proposed 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 amounts.
    As proposed in this rule, payments for most of the highest volume 
colonoscopy and upper gastrointestinal endoscopy procedures will 
decrease under the revised payment system. Table 69 estimates that 
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 negatively 
affected under the revised payment system while procedures for which 
ASC rates have historically been much lower than the comparable OPPS 
rates are positively affected. 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 addition to the procedures currently on the ASC list of covered 
surgical procedures discussed above, 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 rate-setting 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, the July 2007 final 
rule for the revised ASC payment system established 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. We expect that this final methodology will allow 
ASCs to continue to expand their provision of device-intensive services 
and to begin performing new device intensive ASC procedures.
    Table 71 displays a comparison of the Medicare payment rates for 
ASC procedures receiving the highest estimated CY 2008 payment under 
the current ASC payment system, based on the estimates provided in the 
July 2007 ASC final rule for illustrative purposes, and the proposed 
payment rates presented in this CY 2008 OPPS/ASC proposed rule.
    <bullet> Column 1--HCPCS code.
    <bullet> Column 2--Short Descriptor of the HCPCS code.
    <bullet> 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 2006 
ASC utilization multiplied by a factor of 1.176 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 estimated CY 2008 payment amounts are expressed in 
millions of dollars.
    <bullet> Column 4--Final Rule Estimated CY 2008 Payment Rate with 
Transition (75/25 Blend) presents the estimated CY 2008 payment rate 
from the July 2007 final rule for the revised ASC payment system.
    <bullet> Column 5--Proposed Rule Estimated CY 2008 Payment Rate 
presents the proposed CY 2008 payment rate in this proposed rule.
    <bullet> Column 6--Estimated Percent Change from Final Rule to 
Proposed Rule presents the percent change in the payment rate from the 
final rule to this proposed rule.
    Table 71 shows that although the estimated ASC budget neutrality 
percentage has changed from the July 2007 final rule for the revised 
ASC payment system (67 percent) to this CY 2008 OPPS/ASC proposed rule 
(65 percent), payment rates for individual procedures generally change 
very little from the final rule to this proposed rule. Due to the 
proposed OPPS APC recalibration for CY 2008, including the OPPS 
packaging proposal, the CY 2008 OPPS payment rates are typically 
increasing slightly for many surgical procedures compared to the CY 
2007 OPPS payment rates. Because the proposed CY 2008 ASC payment rates 
in this proposed rule are a product of typically higher OPPS payment 
rates and a slightly lower budget neutrality factor (as compared to the 
final rule on the revised ASC payment system), these two forces in many 
cases balance each other, and the resulting ASC payment rates estimated 
in this proposed rule for many procedures change little compared with 
the final rule for the revised ASC payment system. Because we have not 
revised our budget neutrality methodology nor other ASC ratesetting 
policies from the July 2007 final rule, to the extent that there are 
significant observed changes for particular surgical procedures in 
estimated payment rates between the final rule and this proposed rule, 
these reflect more specific changes in the OPPS payment rates stemming 
from the proposed APC recalibration, including the effects of the OPPS 
packaging proposal, under the proposed CY 2008 OPPS.

[[Page 42832]]



  Table 71.--Comparison of Estimated CY 2008 Medicare Payment Rates in the July 2007 Final Rule for the Revised
ASC Payment System and CY 2008 OPPS/ASC Proposed Rule for Procedures With the Highest Estimated CY 2008 Payments
                                            Under the Current System
----------------------------------------------------------------------------------------------------------------
                                                                   July 2007 ASC                     Estimated
                                                   Estimated CY     final rule     Proposed rule  percent change
                                                     2008 ASC      estimated CY    estimated CY   from July 2007
       HCPCS code            Short Descriptor      payments  (in   2008 payment    2008 payment   ASC final rule
                                                     millions)     rate  (75/25    rate  (75/25     to proposed
                                                                      blend)          blend)           rule
----------------------------------------------------------------------------------------------------------------
66984...................  Cataract surg w/iol, 1            $981         $981.09         $980.43               0
                           stage.
43239...................  Upper GI endoscopy,                143          422.96          424.27               0
                           biopsy.
45378...................  Diagnostic colonoscopy             133          427.76           428.0               2
45380...................  Colonoscopy and biopsy             110          427.76          428.02               0
66821...................  After cataract laser                87          288.45          288.60               0
                           surgery.
45385...................  Lesion removal                      87          427.76          428.02               0
                           colonoscopy.
62311...................  Inject spine l/s (cd).              70          317.40          323.62               2
64483...................  Inj foramen epidural l/             42          317.40          323.62               2
                           s.
66982...................  Cataract surgery,                   37          981.09          980.43               0
                           complex.
45384...................  Lesion remove                       36          427.76          428.02               0
                           colonoscopy.
15823...................  Revision of upper                   35          687.02          754.42              10
                           eyelid.
G0121...................  Colon ca scrn not hi                34          417.98          417.44               0
                           rsk ind.
G0105...................  Colorectal scrn; hi                 27          417.98          417.44               0
                           risk ind.
64476...................  Inj paravertebral l/s               24          310.64          292.80              -6
                           ADD-on.
64475...................  Inj paravertebral l/s.              24          317.40          323.62               2
43235...................  Uppr gi endoscopy,                  23          338.21          339.52               0
                           diagnosis.
52000...................  Cystoscopy............              21          318.83          312.97              -2
67904...................  Repair eyelid defect..              16          654.63          671.51               3
64721...................  Carpal tunnel surgery.              15          524.35          526.05               0
29881...................  Knee arthroscopy/                   15          776.94          777.27               0
                           surgery.
43248...................  Uppr gi endoscopy/                  14          422.96          424.27               0
                           guide wire.
62310...................  Inject spine c/t......              12          317.40          323.62               2
64484...................  Inj foramen epidural                11          317.40          323.62               2
                           ADD-on.
29880...................  Knee arthroscopy/                   11          776.94          777.27               0
                           surgery.
G0260...................  Inj for sacroiliac jt                9          310.64          323.62               4
                           anesth.
28285...................  Repair of hammertoe...               9          599.75          601.67               0
67038...................  Strip retinal membrane               9          935.83          932.21               0
29848...................  Wrist endoscopy/                     9        1,308.69        1,309.02               0
                           surgery.
64623...................  Destr paravertebral n                9          317.40          323.62               2
                           ADD-on.
45383...................  Lesion removal                       8          427.76          428.02               0
                           colonoscopy.
----------------------------------------------------------------------------------------------------------------

b. Payment to Physicians for Performing Excluded ASC Procedures in an 
ASC
    As discussed in section XVI.G. of this proposed rule, we are 
proposing to pay physicians at the facility rate for furnishing 
procedures in ASCs that are excluded from the ASC list of covered 
procedures. This policy reduces site of service (facility versus 
nonfacility) differentials that currently exist and aligns physician 
payment policies for services furnished in ASCs and hospital outpatient 
departments.
    We believe that the effect of the proposed change will be small. 
Currently, physicians are paid for procedures performed in ASCs that 
are not on the list of ASC covered surgical procedures based on the 
nonfacility PE RVUs, unless a nonfacility rate does not exist in which 
case they are paid based on the facility rate. For CY 2008, we excluded 
procedures from the ASC list of covered surgical procedures because 
they could pose a significant risk to beneficiary safety or would be 
expected to require an overnight stay and, as such, these procedures 
are generally more complex than procedures furnished in physicians' 
offices. Consequently, most surgical procedures that will be excluded 
from the list of ASC covered surgical procedures in CY 2008 do not have 
nonfacility PE RVUs. Specifically, only 25 of approximately 280 
excluded ASC procedures for CY 2008 have nonfacility PE RVUs. As a 
result, even under our current policy, physicians performing an 
excluded ASC procedure in an ASC would be paid for most excluded 
procedures based on the facility PE RVUs. Thus, our proposed policy to 
pay physicians for excluded ASC procedures performed in ASCs based on 
the facility PE RVUs would only impact Medicare payment rates for the 
small proportion of excluded procedures that have nonfacility PE RVUs.
4. Estimated Effects of This Proposed Rule on Beneficiaries
a. Payment to ASCs
    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

[[Page 42833]]

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 approximately 790 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.
b. Payment to ASCs for Excluded Procedures Performed in an ASC
    In addition, the proposed revision to Sec.  414.22(b)(5)(i) (A) and 
(B) would impose beneficiary liability for facility costs associated 
with surgical procedures that are not Medicare covered surgical 
procedures in ASCs. In the July 2007 final rule for the revised ASC 
payment system, CMS determined that the only surgical procedures that 
will be excluded from ASC payment in CY 2008 are those that could pose 
a significant safety risk to beneficiaries when furnished in an ASC or 
are expected to require an overnight stay when furnished in ASCs and, 
therefore, Medicare provides no payment to ASCs for these procedures. 
The proposed revision to Sec.  414.22(b)(5)(i)(A) and (B) would also 
provide for no payment to physicians for the facility resources 
required to furnish these services, leaving the beneficiary liable for 
the facility payment if a surgical procedure excluded by Medicare from 
ASC payment is, in fact, performed in the ASC setting. In reality, 
however, we do not expect that the proposed change would result in a 
meaningful increase in beneficiary liability because we do not expect 
that these excluded services, which we have determined could pose a 
significant risk to beneficiary safety or would be expected to require 
an overnight stay, will be furnished to Medicare beneficiaries in ASCs. 
We expect further that physicians and ASCs would advise beneficiaries 
of all of the possible consequences (including denial of Medicare 
payment with concomitant beneficiary liability and significant surgical 
risk) if surgical procedures excluded from ASC payment were provided in 
ASCs.
5. Conclusion
    The changes to the ASC payment system for CY 2008 will affect each 
of the approximately 4,600 ASCs currently approved for participation in 
the Medicare program. The effect on an individual ASC will depend on 
the ASC's mix of patients, the proportion of 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 $240 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 
XVI.L. of this proposed rule). Furthermore, we estimate that the 
revised ASC payment system will result in Medicare savings of $200 
million over 5 years due to migration of new ASC services from HOPDs 
and physicians' offices to ASCs over time. We anticipate that this 
proposed 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 72 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 for CY 2008 
will be about $240 million higher than they otherwise would be in the 
absence of the revised ASC payment system. This $240 million in 
additional payments to ASCs will be fully offset by savings from 
reduced Medicare 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 proposed 
rule. All expenditures are classified as transfers.

      Table 72.--Accounting Statement: Classification of Estimated
 Expenditures from CY 2007 to CY 2008 as a Result of the CY 2008 Revised
                           ASC Payment System
------------------------------------------------------------------------
                Category                            Transfers
------------------------------------------------------------------------
Annualized 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.
------------------------------------------------------------------------

D. Effects of the Proposed Requirements for Reporting of Quality Data 
for Hospital Outpatient Settings

    In section XVII. of this proposed rule, we discuss our proposed 
measures and requirements for reporting of quality data to CMS for 
services furnished in hospital outpatient settings under the HOP QDRP. 
We also note that, for the CY 2009 payment update, hospitals must pass 
our validation requirement of a minimum of 80 percent reliability, 
based upon our chart-audit validation process, for January 2008. These 
data are due to the OPPS Clinical Warehouse by May 31, 2008. CMS and 
its contractors will provide assistance to all hospitals that wish to 
submit data. As noted in section XVIII of this proposed rule, we are 
also providing additional validation criteria to ensure that the 
quality data being sent to CMS are accurate. The requirement of 5 
charts

[[Page 42834]]

per hospital will result in the submission of approximately 21,500 
charts for services furnished in January 2008 to the agency. We 
reimburse hospitals for the cost of sending charts to the Clinical Data 
Abstraction Center (CDAC) at the rate of 12 cents per page for copying 
and approximately $4.00 per chart for postage. Our experience shows 
that the average inpatient chart received at the CDAC is approximately 
150 pages, and we estimate outpatient charts will contain a similar 
number of pages. Thus, the agency estimates that it will have 
expenditures of approximately $473,200 to collect the January 2008 
charts. Given that we reimburse for the copying and mailing related to 
this data collection effort, we believe that a requirement for five 
charts per hospital for services furnished in January 2008 represents a 
minimal burden to the participating hospital.

E. Effects of the Proposed Policy on CAH Off-Campus and Co-Location 
Requirements

    In section XVIII.A. of this proposed rule, we discuss our proposed 
changes regarding a CAH's ability to co-locate with another acute care 
hospital or establish an off-campus location that does not comply with 
the location requirements (more than a 35-mile drive, or in the case of 
mountainous terrain or in areas with only secondary roads available, a 
15-mile drive) for CAHs. We are proposing to clarify in this proposed 
rule that if a CAH with a necessary provider designation has a co-
location arrangement with another hospital or CAH that was in effect 
before January 1, 2008, and the type and scope of services offered by 
the facilities co-located with the necessary provider CAH do not 
change, the CAH can continue those arrangements. In addition, if a CAH 
(including one with a necessary provider designation) operates a 
provider-based location or an off-campus distinct part psychiatric or 
rehabilitation unit after January 1, 2008, the CAH must comply with the 
location requirements. We have proposed that CAHs can continue current 
co-location and off-campus arrangements that are in place as of January 
1, 2008. We believe there is no burden associated with this proposed 
clarifying regulation.

F. Effects of Proposed Policy Revisions to the Hospital CoPs

    In section XVIII.B. of this proposed rule, we discuss proposed 
changes to the hospital CoPs relating to timeframes for completion of 
medical history and physical examination and proposed requirements for 
preanesthesia and postanesthesia evaluations of Medicare beneficiaries. 
We believe that these proposed revisions would impose minimal 
additional costs on hospitals. In fact, hospitals may realize some 
minimal cost savings. The cost of implementing these proposed changes 
would largely be limited to the one-time cost related to the revision 
of a hospital's medical staff bylaws and its policies and procedures as 
they relate to the proposed requirements for medical history and 
physical examinations and for preanesthesia and postanesthesia 
evaluations. There also may be some minimal cost associated with 
communicating these changes to affected hospital staff. However, we 
believe that these costs would be offset by the benefits derived from 
the overall intent of these proposed revisions to require that the most 
current information regarding a patient's condition be available to 
hospital staff so that risks to patient safety can be minimized and 
potential adverse outcomes can be avoided. Furthermore, the proposed 
changes would clarify existing hospital CoPs to make them more 
consistent with current practice, while still retaining the flexibility 
and reduction in burden that hospitals are currently provided in 
meeting those CoPs. Therefore, no burden is being assessed on the 
revision of medical staff bylaws and hospital policies and procedures 
or on the communication of these revisions to staff that would be 
required by these proposed revisions as these practices are usual and 
customary business practices.

G. Executive Order 12866

    In accordance with the provisions of Executive Order 12866, this 
proposed rule was reviewed by the OMB.

List of Subjects

42 CFR Part 410

    Health facilities, Health professions, Laboratories, Medicare, 
Rural areas, X rays.

42 CFR Part 411

    Kidney diseases, Medicare, Physician referral, Reporting and 
recordkeeping requirements.

42 CFR Part 414

    Administrative practice and procedure, Health facilities, Health 
professions, Kidney diseases, Medicare, Reporting and recordkeeping 
requirements.

42 CFR Part 416

    Health facilities, Kidney diseases, Medicare, Reporting and 
recordkeeping requirements.

42 CFR Part 419

    Hospitals, Medicare, Reporting and recordkeeping requirements.

42 CFR Part 482

    Grant program-health, Hospitals, Medicaid, Medicare, Reporting and 
recordkeeping requirements.

42 CFR Part 485

    Grant program-health, Health facilities, Medicaid, Medicare, 
Reporting and recordkeeping requirements.
    For reasons stated in the preamble of this proposed rule, the 
Centers for Medicare & Medicaid Services is proposing to amend 42 CFR 
Chapter IV as set forth below:

PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS

    1. The authority citation for Part 410 continues to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).

    2. Section 410.27 is amended by--
    a. Revising paragraph (a)(1)(iii).
    b. Revising paragraph (f).
    The revisions read as follows:


Sec.  410.27  Outpatient hospital services and supplies incident to a 
physician service: Conditions.

    (a) * * *
    (1) * * *
    (iii) In the hospital or at a department of a provider, as defined 
in Sec.  413.65(a)(2) of this subchapter, that has provider-based 
status in relation to a hospital under Sec.  413.65 of this subchapter; 
and
* * * * *
    (f) Services furnished at a department of a provider, as defined in 
Sec.  413.65(a)(2) of this subchapter, that has provider-based status 
in relation to a hospital under Sec.  413.65 of this subchapter, must 
be under the direct supervision of a physician. ``Direct supervision'' 
means the physician must be present and on the premises of the location 
and immediately available to furnish assistance and direction 
throughout the performance of the procedure. It does not mean that the 
physician must be present in the room when the procedure is performed.

PART 411--EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE 
PAYMENT

    3. The authority citation for Part 411 continues to read as 
follows:

    Authority: Secs. 1102, 1860D-1 through 1860D-42, 1871, and 1877 
of the Social

[[Page 42835]]

Security Act (42 U.S.C. 1302, 1395w-101 through 1395w-152, and 
1395nn.

    4. Section 411.351 is amended by revising the definitions of 
``outpatient prescription drugs'' and ``radiology and certain other 
imaging services'' to read as follows:


Sec.  411.351  Definitions.

* * * * *
    Outpatient prescription drugs means all drugs covered by Medicare 
Part B or D, except for those drugs that are ``covered ancillary 
services,'' as defined at Sec.  416.164(b) of this chapter, for which 
separate payment is made to an ambulatory surgical center.
* * * * *
    Radiology and certain other imaging services means those particular 
services so identified on the List of CPT/HCPCS Codes. All services 
identified on the List of CPT/HCPCS Codes are radiology and certain 
other imaging services for purposes of this subpart. Any service not 
specifically identified as radiology and certain other imaging services 
on the List of CPT/HCPCS Codes is not a radiology or certain other 
imaging service for purposes of this subpart. The list of codes 
identifying radiology and certain other imaging services includes the 
professional and technical components of any diagnostic test or 
procedure using x-rays, ultrasound, computerized axial tomography, 
magnetic resonance imaging, nuclear medicine (effective January 1, 
2007), or other imaging services. All codes identified as radiology and 
certain other imaging services are covered under section 1861(s)(3) of 
the Act and Sec.  410.32 and Sec.  410.34 of this chapter, but do not 
include--
    (1) X ray, fluoroscopy, or ultrasound procedures that require the 
insertion of a needle, catheter, tube, or probe through the skin or 
into a body orifice;
    (2) Radiology or certain other imaging services that are integral 
to the performance of a medical procedure that is not identified on the 
list of CPT/HCPCS codes as a radiology or certain other imaging service 
and is performed--
    (i) Immediately prior to or during the medical procedure; or
    (ii) Immediately following the medical procedure when necessary to 
confirm placement of an item placed during the medical procedure.
    (3) Radiology and certain other imaging services that are ``covered 
ancillary services,'' as defined at Sec.  416.164(b), for which 
separate payment is made to an ASC.
* * * * *

PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES

    5. The authority citation for Part 414 continues to read as 
follows:

    Authority: Secs. 1102, 1871, and 1881(b)(1) of the Social 
Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(1)).

    6. Section 414.22 is amended by revising paragraphs (b)(5)(i)(A) 
and (B) to read as follows:


Sec.  414.22  Relative value units (RVUs).

* * * * *
    (b) * * *
    (5) * * *
    (i) * * *
    (A) Facility practice expense RVUs. The lower facility practice 
expense RVUs apply to services furnished to patients in the hospital, 
skilled nursing facility, community mental health center, or in an 
ambulatory surgical center. (The facility practice expense RVUs for a 
particular code may not be greater than the nonfacility RVUs for the 
code.)
    (B) Nonfacility practice expense RVUs. The higher nonfacility 
practice expense RVUs apply to services performed in a physician's 
office, a patient's home, a nursing facility, or a facility or 
institution other than a hospital or skilled nursing facility, 
community mental health center, or ASC.
* * * * *

PART 416--AMBULATORY SURGICAL SERVICES

    7. 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).

    8. Added in a separate final rule published elsewhere in this issue 
of the Federal Register, Sec.  416.179 is amended by--
    a. Revising the section heading.
    b. Revising paragraphs (a)(1) and (a)(2)
    c. Adding new paragraph (a)(3).
    d. Redesignating the text of paragraph (b) as paragraph (b)(1).
    e. Revising newly redesignated paragraph (b)(1).
    f. Adding new paragraph (b)(2).
    The revisions and additions read as follows:


Sec.  416.179  Payment and coinsurance reduction for devices replaced 
without cost or when full or partial credit is received.

    (a) * * *
    (1) The device is replaced without cost to the ASC or the 
beneficiary;
    (2) The ASC receives full credit for the cost of a replaced device; 
or
    (3) The ASC receives partial credit for the cost of a replaced 
device but only where the amount of the device credit is greater than 
or equal to 20 percent of the cost of the new replacement device being 
implanted.
    (b) Amount of reduction to the ASC payment for the covered surgical 
procedure. (1) The amount of the reduction to the ASC payment made 
under paragraphs (a)(1) and (a)(2) 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 the ASC payment amount for a device 
with pass-through status under Sec.  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.
    (2) The amount of the reduction to the ASC payment made under 
paragraph (a)(3) of this section is 50 percent of the payment reduction 
that would be calculated under paragraph (b)(1) of this section.
* * * * *

PART 419--PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT 
DEPARTMENT SERVICES

    9. The authority citation for Part 419 continues to read as 
follows:

    Authority: Secs. 1102, 1833(t), and 1871 of the Social Security 
Act (42 U.S.C. 1302, 1395l(t), and 1395hh).

    10. Section 419.43 is amended by revising paragraph (g)(4) to read 
as follows:


Sec.  419.43  Adjustments to national program payment and beneficiary 
copayment amounts.

* * * * *
    (g) * * *
    (4) Excluded services and groups. Drugs and biologicals that are 
paid under a separate APC and devices paid under Sec.  419.66 are 
excluded from qualification for the payment adjustment in paragraph 
(g)(2) of this section.
* * * * *
    11. Section 419.44 is amended by--
    a. Revising the section heading.
    b. Revising paragraph (b).
    The revisions and addition read as follows:


Sec.  419.44  Payment reductions for procedures.

* * * * *
    (b) Interrupted procedures. When a procedure is terminated prior to

[[Page 42836]]

completion due to extenuating circumstances or circumstances that 
threaten the well-being of the patient, the Medicare program payment 
amount and the beneficiary copayment amount are based on--
    (1) The full program and beneficiary copayment 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 the full program and the beneficiary copayment amounts 
if the procedure for which anesthesia is planned is discontinued after 
the patient is prepared and taken to the room where the procedure is to 
be performed but before anesthesia is induced; or
    (3) One-half of the full program and beneficiary copayment amounts 
if a procedure for which anesthesia is not planned is discontinued 
after the patient is prepared and taken to the room where the procedure 
is to be performed.
    12. Section 419.45 is amended by--
    a. Revising the section heading.
    b. Revising paragraph (a)(1).
    c. Revising paragraph (a)(2).
    d. Adding new paragraph (a)(3).
    e. Revising paragraph (b).
    The revisions and additions read as follows:


Sec.  419.45  Payment and copayment reduction for devices replaced 
without cost or when full or partial credit is received.

    (a) * * *
    (1) The device is replaced without cost to the provider or the 
beneficiary;
    (2) The provider receives full credit for the cost of a replaced 
device; or
    (3) The provider receives partial credit for the cost of a replaced 
device but only where the amount of the device credit is greater than 
or equal to 20 percent of the cost of the new replacement device being 
implanted.
    (b) Amount of reduction to the APC payment.
    (1) The amount of the reduction to the APC payment made under 
paragraphs (a)(1) and (a)(2) of this section is calculated in the same 
manner as the offset amount that would be applied if the device 
implanted during a procedure assigned to the APC had transitional pass-
through status under Sec.  419.66.
    (2) The amount of the reduction to the APC payment made under 
paragraph (a)(3) of this section is 50 percent of the offset amount 
that would be applied if the device implanted during a procedure 
assigned to the APC had transitional pass-through status under Sec.  
419.66.
* * * * *


Sec.  419.70  [Amended]

    13. Section 419.70 is amended by--
    a. In paragraph (d)(1)(i), removing the cross-reference ``Sec.  
412.63(b)'' and adding the cross-reference ``Sec.  412.64(b)'' in its 
place.
    b. In paragraph (d)(2)(i), removing the cross-reference ``Sec.  
412.63(b)'' and adding the cross-reference ``Sec.  412.64(b)'' in its 
place.
    c. In paragraph (d)(4)(ii), removing the cross-reference ``Sec.  
412.63(b)'' and adding the phrase ``Sec.  412.63(b) or Sec.  412.64(b), 
as applicable,'' in its place.

PART 482--CONDITIONS OF PARTICIPATION FOR HOSPITALS

    14. The authority citation for Part 482 continues to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).

    15. Section 482.22 is amended by revising paragraph (c)(5) to read 
as follows:


Sec.  482.22  Condition of participation: Medical staff.

* * * * *
    (c) * * *
    (5) Include a requirement that--
    (i) A medical history and physical examination be completed and 
documented for each patient no more than 30 days before or 24 hours 
after admission or registration, but prior to surgery or a procedure 
requiring anesthesia services. The medical history and physical 
examination must be completed and documented by a physician (as defined 
in section 1861(r) of the Act), an oromaxillofacial surgeon, or other 
qualified licensed individual in accordance with State law and hospital 
policy.
    (ii) An updated examination of the patient, including any changes 
in the patient's condition, be completed and documented within 24 hours 
after admission or registration, but prior to surgery or a procedure 
requiring anesthesia services, when the medical history and physical 
examination are completed within 30 days before admission or 
registration. The updated examination of the patient, including any 
changes in the patient's condition, must be completed and documented by 
a physician (as defined in section 1861(r) of the Act), an 
oromaxillofacial surgeon, or other qualified licensed individual in 
accordance with State law and hospital policy.
* * * * *


Sec.  482.23  [Amended]

    16. In Sec.  482.23(b)(1), the cross-reference ``Sec.  
405.1910(c)'' is removed and the cross-reference ``Sec.  488.54(c)'' is 
added in its place.
    17. Section 482.24 is amended by revising paragraph (c)(2)(i) to 
read as follows:


Sec.  482.24  Condition of participation: Medical record services.

* * * * *
    (c) * * *
    (2) * * *
    (i) Evidence of--
    (A) A medical history and physical examination completed and 
documented no more than 30 days before or 24 hours after admission or 
registration, but prior to surgery or a procedure requiring anesthesia 
services. The medical history and physical examination must be placed 
in the patient's medical record within 24 hours after admission or 
registration, but prior to surgery or a procedure requiring anesthesia 
services.
    (B) An updated examination of the patient, including any changes in 
the patient's condition, when the medical history and physical 
examination are completed within 30 days before admission or 
registration. Documentation of the updated examination must be placed 
in the patient's medical record within 24 hours after admission or 
registration, but prior to surgery or a procedure requiring anesthesia 
services.
* * * * *
    18. Section 482.51 is amended by revising paragraph (b)(1) to read 
as follows:


Sec.  482.51  Condition of participation: Surgical services.

* * * * *
    (b) * * *
    (1) Prior to surgery or a procedure requiring anesthesia services 
and except in the case of emergencies:
    (i) A medical history and physical examination must be completed 
and documented no more than 30 days before or 24 hours after admission 
or registration.
    (ii) An updated examination of the patient, including any changes 
in the patient's condition, must be completed and documented within 24 
hours after admission or registration when the medical history and 
physical examination are completed within 30 days before admission or 
registration.
* * * * *
    19. Section 482.52 is amended by--
    a. Revising paragraph (b)(1).
    b. Revising paragraph (b)(3).
    c. Removing paragraph (b)(4).
    The revisions read as follows:

[[Page 42837]]

Sec.  482.52  Condition of participation: Anesthesia services.

* * * * *
    (b) * * *
    (1) A preanesthesia evaluation completed and documented by an 
individual qualified to administer anesthesia, as specified in 
paragraph (a) of this section, performed within 48 hours prior to 
surgery or a procedure requiring anesthesia services.
* * * * *
    (3) A postanesthesia evaluation completed and documented by an 
individual qualified to administer anesthesia, as specified in 
paragraph (a) of this section, after surgery or a procedure requiring 
anesthesia services, but before discharge or transfer from the 
postanesthesia recovery area.
* * * * *

PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS

    20, The authority citation for Part 485 continues to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).
    21. Section 485.610 is amended by adding new paragraph (e) to read 
as follows:


Sec.  485.610  Condition of participation: Status and location.

* * * * *
    (e) Standard: Off-campus and co-location requirements for CAHs. A 
CAH may continue to meet the location requirement of paragraph (c) of 
this section based only if the CAH meets the following:
    (1) If a CAH with a necessary provider designation is co-located 
(that is, it shares a campus, as defined in Sec.  413.65(a)(2) of this 
chapter, with another hospital or CAH), the necessary provider CAH can 
continue to meet the location requirement of paragraph (c) of this 
section only if the co-location arrangement was in effect before 
January 1, 2008, and the type and scope of services offered by the 
facility co-located with the necessary provider CAH do not change. A 
change of ownership of any of the facilities with a co-location 
arrangement that was in effect before January 1, 2008 will not be 
considered to be a new co-location arrangement.
    (2) If a CAH or a necessary provider CAH operates a provider-based 
location, including a department or remote location, as defined in 
Sec.  413.65(a)(2) of this chapter, or an off-campus distinct part 
psychiatric or rehabilitation unit, as defined in Sec.  485.647, that 
was created or acquired by the CAH after January 1, 2008, the CAH can 
continue to meet the location requirement of paragraph (c) of this 
section only if the provider-based location or off-campus distinct part 
unit is located more than a 35-mile drive (or, in the case of 
mountainous terrain or in areas with only secondary roads available, a 
15-mile drive) from a hospital or another CAH.
    (3) If either a CAH or a CAH that has been designated as a 
necessary provider by the State does not meet the requirements in 
paragraph (e)(1) of this section, by co locating with another hospital 
or CAH after January 1, 2008, or creates or acquires a provider-based 
location or off-campus distinct part unit after January 1, 2008, that 
does not meet the requirements in paragraph (e)(2) of this section, the 
CAH's provider agreement will be subject to termination in accordance 
with the provisions of Sec.  489.53(a)(3), unless the CAH terminates 
the off-campus arrangement or the co-location arrangement, or both.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare 
Supplementary Medical Insurance Program)

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program)

    Dated: July 5, 2007.
Leslie V. Norwalk,
Acting Administrator, Centers for Medicare & Medicaid Services.
    Approved: July 10, 2007.
Michael O. Leavitt,
Secretary.

                                   Addendum A.--Proposed OPPS APCs for CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                                          National     Minimum
       APC               Group Title               SI           Relative     Payment     unadjusted   unadjusted
                                                                 weight        rate      copayment    copayment
----------------------------------------------------------------------------------------------------------------
0001.............  Level I                  S...............       0.5204       $33.15        $7.00        $6.63
                    Photochemotherapy.
0002.............  Level I Fine Needle      T...............       1.1915       $75.89  ...........       $15.18
                    Biopsy/Aspiration.
0003.............  Bone Marrow Biopsy/      T...............       3.2390      $206.30  ...........       $41.26
                    Aspiration.
0004.............  Level I Needle Biopsy/   T...............       4.5062      $287.01  ...........       $57.40
                    Aspiration Except Bone
                    Marrow.
0005.............  Level II Needle Biopsy/  T...............       7.3012      $465.04  ...........       $93.01
                    Aspiration Except Bone
                    Marrow.
0006.............  Level I Incision &       T...............       1.4630       $93.18  ...........       $18.64
                    Drainage.
0007.............  Level II Incision &      T...............      12.5792      $801.21  ...........      $160.24
                    Drainage.
0008.............  Level III Incision and   T...............      19.0457    $1,213.08  ...........      $242.62
                    Drainage.
0012.............  Level I Debridement &    T...............       0.2682       $17.08  ...........        $3.42
                    Destruction.
0013.............  Level II Debridement &   T...............       0.8046       $51.25  ...........       $10.25
                    Destruction.
0015.............  Level III Debridement &  T...............       1.5119       $96.30  ...........       $19.26
                    Destruction.
0016.............  Level IV Debridement &   T...............       2.7493      $175.11  ...........       $35.02
                    Destruction.
0017.............  Level VI Debridement &   T...............      20.0977    $1,280.08  ...........      $256.02
                    Destruction.
0019.............  Level I Excision/Biopsy  T...............       4.4463      $283.20       $71.80       $56.64
0020.............  Level II Excision/       T...............       8.7155      $555.12  ...........      $111.02
                    Biopsy.
0021.............  Level III Excision/      T...............      16.5832    $1,056.23      $219.40      $211.25
                    Biopsy.
0022.............  Level IV Excision/       T...............      21.4534    $1,366.43      $354.40      $273.29
                    Biopsy.
0023.............  Exploration Penetrating  T...............       9.5721      $609.68  ...........      $121.94
                    Wound.
0028.............  Level I Breast Surgery.  T...............      20.9980    $1,337.43      $303.70      $267.49
0029.............  Level II Breast Surgery  T...............      32.4940    $2,069.64      $581.50      $413.93
0030.............  Level III Breast         T...............      40.4634    $2,577.24      $747.00      $515.45
                    Surgery.
0031.............  Smoking Cessation        X...............       0.1660       $10.57  ...........        $2.11
                    Services.
0033.............  Partial Hospitalization  P...............       2.8241      $179.88  ...........       $35.98
0034.............  Mental Health Services   P...............       2.8241      $179.88  ...........       $35.98
                    Composite.
0035.............  Arterial/Venous          T...............       0.2091       $13.32  ...........        $2.66
                    Puncture.
0037.............  Level IV Needle Biopsy/  T...............      13.9599      $889.15      $228.70      $177.83
                    Aspiration Except Bone
                    Marrow.
0039.............  Level I Implantation of  S...............     197.4688   $12,577.38  ...........    $2,515.48
                    Neurostimulator.
0040.............  Percutaneous             S...............      63.7536    $4,060.66  ...........      $812.13
                    Implantation of
                    Neurostimulator
                    Electrodes, Excluding
                    Cranial Nerve.
0041.............  Level I Arthroscopy....  T...............      29.4467    $1,875.55  ...........      $375.11
0042.............  Level II Arthroscopy...  T...............      47.7765    $3,043.03      $804.70      $608.61
0043.............  Closed Treatment         T...............       1.8742      $119.37  ...........       $23.87
                    Fracture Finger/Toe/
                    Trunk.
0045.............  Bone/Joint Manipulation  T...............      15.0176      $956.52      $268.40      $191.30
                    Under Anesthesia.

[[Page 42838]]

 
0047.............  Arthroplasty without     T...............      35.9249    $2,288.16      $537.00      $457.63
                    Prosthesis.
0048.............  Level I Arthroplasty     T...............      51.0431    $3,251.09  ...........      $650.22
                    with Prosthesis.
0049.............  Level I Musculoskeletal  T...............      21.5761    $1,374.25  ...........      $274.85
                    Procedures Except Hand
                    and Foot.
0050.............  Level II                 T...............      29.3263    $1,867.88  ...........      $373.58
                    Musculoskeletal
                    Procedures Except Hand
                    and Foot.
0051.............  Level III                T...............      43.5953    $2,776.72  ...........      $555.34
                    Musculoskeletal
                    Procedures Except Hand
                    and Foot.
0052.............  Level IV                 T...............      78.6518    $5,009.57  ...........    $1,001.91
                    Musculoskeletal
                    Procedures Except Hand
                    and Foot.
0053.............  Level I Hand             T...............      16.8220    $1,071.44      $253.40      $214.29
                    Musculoskeletal
                    Procedures.
0054.............  Level II Hand            T...............      26.7322    $1,702.65  ...........      $340.53
                    Musculoskeletal
                    Procedures.
0055.............  Level I Foot             T...............      21.1762    $1,348.78      $355.30      $269.76
                    Musculoskeletal
                    Procedures.
0056.............  Level II Foot            T...............      44.4710    $2,832.49  ...........      $566.50
                    Musculoskeletal
                    Procedures.
0057.............  Bunion Procedures......  T...............      29.8356    $1,900.32      $475.90      $380.06
0058.............  Level I Strapping and    S...............       1.1272       $71.79  ...........       $14.36
                    Cast Application.
0060.............  Manipulation Therapy...  S...............       0.4877       $31.06  ...........        $6.21
0061.............  Laminectomy or Incision  S...............      81.3252    $5,179.85  ...........    $1,035.97
                    for Implantation of
                    Neurostimulator
                    Electrodes, Excluding
                    Cranial Nerve.
0062.............  Level I Treatment        T...............      26.3092    $1,675.71      $372.80      $335.14
                    Fracture/Dislocation.
0063.............  Level II Treatment       T...............      40.3466    $2,569.80      $548.30      $513.96
                    Fracture/Dislocation.
0064.............  Level III Treatment      T...............      60.0595    $3,825.37      $835.70      $765.07
                    Fracture/Dislocation.
0065.............  Level I Stereotactic     S...............      17.1992    $1,095.47  ...........      $219.09
                    Radiosurgery, MRgFUS,
                    and MEG.
0066.............  Level II Stereotactic    S...............      47.3767    $3,017.56  ...........      $603.51
                    Radiosurgery, MRgFUS,
                    and MEG.
0067.............  Level III Stereotactic   S...............      61.5205    $3,918.43  ...........      $783.69
                    Radiosurgery, MRgFUS,
                    and MEG.
0069.............  Thoracoscopy...........  T...............      33.1688    $2,112.62      $591.60      $422.52
0070.............  Thoracentesis/Lavage     T...............       5.3095      $338.18  ...........       $67.64
                    Procedures.
0071.............  Level I Endoscopy Upper  T...............       0.8256       $52.58       $11.20       $10.52
                    Airway.
0072.............  Level II Endoscopy       T...............       1.5730      $100.19       $21.20       $20.04
                    Upper Airway.
0073.............  Level III Endoscopy      T...............       4.2060      $267.89       $69.10       $53.58
                    Upper Airway.
0074.............  Level IV Endoscopy       T...............      17.4546    $1,111.74      $292.20      $222.35
                    Upper Airway.
0075.............  Level V Endoscopy Upper  T...............      23.2819    $1,482.89      $445.90      $296.58
                    Airway.
0076.............  Level I Endoscopy Lower  T...............      10.1732      $647.96      $189.80      $129.59
                    Airway.
0077.............  Level I Pulmonary        S...............       0.3904       $24.87        $7.70        $4.97
                    Treatment.
0078.............  Level II Pulmonary       S...............       1.3636       $86.85  ...........       $17.37
                    Treatment.
0079.............  Ventilation Initiation   S...............       2.6745      $170.35  ...........       $34.07
                    and Management.
0080.............  Diagnostic Cardiac       T...............      39.8631    $2,539.00      $838.90      $507.80
                    Catheterization.
0082.............  Coronary or Non-         T...............      88.7717    $5,654.14  ...........    $1,130.83
                    Coronary Atherectomy.
0083.............  Coronary or Non-         T...............      46.0685    $2,934.24  ...........      $586.85
                    Coronary Angioplasty
                    and Percutaneous
                    Valvuloplasty.
0084.............  Level I                  S...............      10.2918      $655.52  ...........      $131.10
                    Electrophysiologic
                    Procedures.
0085.............  Level II                 T...............      48.6296    $3,097.37  ...........      $619.47
                    Electrophysiologic
                    Procedures.
0086.............  Level III                T...............      90.7639    $5,781.03  ...........    $1,156.21
                    Electrophysiologic
                    Procedures.
0088.............  Thrombectomy...........  T...............      39.8001    $2,534.99      $655.20      $507.00
0089.............  Insertion/Replacement    T...............     122.5662    $7,806.61    $1,682.20    $1,561.32
                    of Permanent Pacemaker
                    and Electrodes.
0090.............  Insertion/Replacement    T...............      99.8268    $6,358.27    $1,612.80    $1,271.65
                    of Pacemaker Pulse
                    Generator.
0091.............  Level II Vascular        T...............      43.6609    $2,780.89  ...........      $556.18
                    Ligation.
0092.............  Level I Vascular         T...............      26.4396    $1,684.02  ...........      $336.80
                    Ligation.
0093.............  Vascular Reconstruction/ T...............      30.8639    $1,965.81  ...........      $393.16
                    Fistula Repair without
                    Device.
0094.............  Level I Resuscitation    S...............       2.5547      $162.72       $46.20       $32.54
                    and Cardioversion.
0095.............  Cardiac Rehabilitation.  S...............       0.5868       $37.38       $13.80        $7.48
0096.............  Non-Invasive Vascular    S...............       1.5254       $97.16       $37.60       $19.43
                    Studies.
0097.............  Prolonged Physiologic    X...............       1.0396       $66.22       $23.70       $13.24
                    and Ambulatory
                    Monitoring.
0099.............  Electrocardiograms.....  S...............       0.3912       $24.92  ...........        $4.98
0100.............  Cardiac Stress Tests...  X...............       2.8631      $182.36       $41.40       $36.47
0101.............  Tilt Table Evaluation..  S...............       4.4249      $281.84      $100.20       $56.37
0103.............  Miscellaneous Vascular   T...............      15.2572      $971.78  ...........      $194.36
                    Procedures.
0104.............  Transcatheter Placement  T...............      89.0212    $5,670.03  ...........    $1,134.01
                    of Intracoronary
                    Stents.
0105.............  Repair/Revision/Removal  T...............      24.7274    $1,574.96      $370.40      $314.99
                    of Pacemakers, AICDs,
                    or Vascular Devices.
0106.............  Insertion/Replacement    T...............      75.0068    $4,777.41  ...........      $955.48
                    of Pacemaker Leads and/
                    or Electrodes.
0107.............  Insertion of             T...............     353.1242   $22,491.54  ...........    $4,498.31
                    Cardioverter-
                    Defibrillator.
0108.............  Insertion/Replacement/   T...............     403.0232   $25,669.76  ...........    $5,133.95
                    Repair of Cardioverter-
                    Defibrillator Leads.
0109.............  Removal/Repair of        T...............       6.1077      $389.02  ...........       $77.80
                    Implanted Devices.
0110.............  Transfusion............  S...............       3.4924      $222.44  ...........       $44.49
0111.............  Blood Product Exchange.  S...............      12.1982      $776.94      $198.40      $155.39
0112.............  Apheresis and Stem Cell  S...............      31.9648    $2,035.93      $433.20      $407.19
                    Procedures.
0113.............  Excision Lymphatic       T...............      23.5105    $1,497.45  ...........      $299.49
                    System.
0114.............  Thyroid/Lymphadenectomy  T...............      45.1729    $2,877.20  ...........      $575.44
                    Procedures.
0115.............  Cannula/Access Device    T...............      30.5379    $1,945.05  ...........      $389.01
                    Procedures.
0121.............  Level I Tube changes     T...............       3.2914      $209.64       $43.80       $41.93
                    and Repositioning.
0125.............  Refilling of Infusion    T...............       2.3262      $148.16  ...........       $29.63
                    Pump.
0126.............  Level I Urinary and      T...............       1.0850       $69.11       $16.40       $13.82
                    Anal Procedures.
0127.............  Level IV Stereotactic    S...............     123.4696    $7,864.15  ...........    $1,572.83
                    Radiosurgery, MRgFUS,
                    and MEG.
0130.............  Level I Laparoscopy....  T...............      34.8153    $2,217.49      $659.50      $443.50
0131.............  Level II Laparoscopy...  T...............      46.1201    $2,937.53    $1,001.80      $587.51
0132.............  Level III Laparoscopy..  T...............      71.0022    $4,522.34    $1,239.20      $904.47
0133.............  Level I Skin Repair....  T...............       1.3340       $84.97       $26.76       $16.99
0134.............  Level II Skin Repair...  T...............       2.1114      $134.48       $42.36       $26.90
0135.............  Level III Skin Repair..  T...............       4.6816      $298.19  ...........       $59.64
0136.............  Level IV Skin Repair...  T...............      15.4399      $983.41  ...........      $196.68
0137.............  Level V Skin Repair....  T...............      20.9338    $1,333.34  ...........      $266.67
0140.............  Esophageal Dilation      T...............       6.0867      $387.68       $91.40       $77.54
                    without Endoscopy.
0141.............  Level I Upper GI         T...............       8.6730      $552.41      $143.30      $110.48
                    Procedures.
0142.............  Small Intestine          T...............       9.6264      $613.13      $152.70      $122.63
                    Endoscopy.
0143.............  Lower GI Endoscopy.....  T...............       9.0360      $575.53      $186.00      $115.11

[[Page 42839]]

 
0146.............  Level I Sigmoidoscopy    T...............       5.1441      $327.64  ...........       $65.53
                    and Anoscopy.
0147.............  Level II Sigmoidoscopy   T...............       8.8611      $564.39  ...........      $112.88
                    and Anoscopy.
0148.............  Level I Anal/Rectal      T...............       4.5189      $287.82  ...........       $57.56
                    Procedures.
0149.............  Level III Anal/Rectal    T...............      23.2282    $1,479.47  ...........      $295.89
                    Procedures.
0150.............  Level IV Anal/Rectal     T...............      30.5544    $1,946.10      $437.10      $389.22
                    Procedures.
0151.............  Endoscopic Retrograde    T...............      21.2820    $1,355.51  ...........      $271.10
                    Cholangio-
                    Pancreatography (ERCP).
0152.............  Level I Percutaneous     T...............      28.7304    $1,829.93  ...........      $365.99
                    Abdominal and Biliary
                    Procedures.
0153.............  Peritoneal and           T...............      25.4636    $1,621.85      $397.90      $324.37
                    Abdominal Procedures.
0154.............  Hernia/Hydrocele         T...............      31.1722    $1,985.45      $464.80      $397.09
                    Procedures.
0155.............  Level II Anal/Rectal     T...............      11.6524      $742.18  ...........      $148.44
                    Procedures.
0156.............  Level III Urinary and    T...............       3.0601      $194.91  ...........       $38.98
                    Anal Procedures.
0157.............  Colorectal Cancer        S...............       2.2613      $144.03  ...........       $28.81
                    Screening: Barium
                    Enema.
0158.............  Colorectal Cancer        T...............       8.0134      $510.40  ...........      $127.60
                    Screening: Colonoscopy.
0159.............  Colorectal Cancer        S...............       4.7799      $304.45  ...........       $76.11
                    Screening: Flexible
                    Sigmoidoscopy.
0160.............  Level I                  T...............       6.1077      $389.02  ...........       $77.80
                    Cystourethroscopy and
                    other Genitourinary
                    Procedures.
0161.............  Level II                 T...............      18.1376    $1,155.24      $243.72      $231.05
                    Cystourethroscopy and
                    other Genitourinary
                    Procedures.
0162.............  Level III                T...............      25.2775    $1,610.00  ...........      $322.00
                    Cystourethroscopy and
                    other Genitourinary
                    Procedures.
0163.............  Level IV                 T...............      36.9175    $2,351.39  ...........      $470.28
                    Cystourethroscopy and
                    other Genitourinary
                    Procedures.
0164.............  Level II Urinary and     T...............       2.1659      $137.95  ...........       $27.59
                    Anal Procedures.
0165.............  Level IV Urinary and     T...............      19.6126    $1,249.19  ...........      $249.84
                    Anal Procedures.
0166.............  Level I Urethral         T...............      19.6570    $1,252.01  ...........      $250.40
                    Procedures.
0168.............  Level II Urethral        T...............      30.1994    $1,923.49      $388.10      $384.70
                    Procedures.
0169.............  Lithotripsy............  T...............      43.0352    $2,741.04    $1,009.40      $548.21
0170.............  Dialysis...............  S...............       6.7915      $432.57  ...........       $86.51
0181.............  Level II Male Genital    T...............      35.1574    $2,239.28      $621.80      $447.86
                    Procedures.
0183.............  Level I Male Genital     T...............      22.7802    $1,450.94  ...........      $290.19
                    Procedures.
0184.............  Prostate Biopsy........  T...............      11.3168      $720.80  ...........      $144.16
0188.............  Level II Female          T...............       1.4138       $90.05  ...........       $18.01
                    Reproductive Proc.
0189.............  Level III Female         T...............       3.0466      $194.05  ...........       $38.81
                    Reproductive Proc.
0190.............  Level I Hysteroscopy...  T...............      22.1171    $1,408.70      $424.20      $281.74
0191.............  Level I Female           T...............       0.1414        $9.01        $2.50        $1.80
                    Reproductive Proc.
0192.............  Level IV Female          T...............       7.4497      $474.49  ...........       $94.90
                    Reproductive Proc.
0193.............  Level V Female           T...............      19.2052    $1,223.24  ...........      $244.65
                    Reproductive Proc.
0195.............  Level VI Female          T...............      32.9713    $2,100.04      $483.80      $420.01
                    Reproductive
                    Procedures.
0202.............  Level VII Female         T...............      43.2255    $2,753.16      $981.50      $550.63
                    Reproductive
                    Procedures.
0203.............  Level IV Nerve           T...............      15.5687      $991.62      $240.30      $198.32
                    Injections.
0204.............  Level I Nerve            T...............       2.3254      $148.11       $40.10       $29.62
                    Injections.
0206.............  Level II Nerve           T...............       4.1589      $264.89       $56.83       $52.98
                    Injections.
0207.............  Level III Nerve          T...............       7.1370      $454.58  ...........       $90.92
                    Injections.
0208.............  Laminotomies and         T...............      47.6714    $3,036.33  ...........      $607.27
                    Laminectomies.
0209.............  Level II Extended EEG    S...............      11.5647      $736.59      $268.70      $147.32
                    and Sleep Studies.
0212.............  Nervous System           T...............       8.6797      $552.84  ...........      $110.57
                    Injections.
0213.............  Level I Extended EEG     S...............       2.3476      $149.53       $53.50       $29.91
                    and Sleep Studies.
0215.............  Level I Nerve and        S...............       0.5746       $36.60  ...........        $7.32
                    Muscle Tests.
0216.............  Level III Nerve and      S...............       2.7680      $176.30  ...........       $35.26
                    Muscle Tests.
0218.............  Level II Nerve and       S...............       1.1861       $75.55  ...........       $15.11
                    Muscle Tests.
0220.............  Level I Nerve            T...............      18.5069    $1,178.76  ...........      $235.75
                    Procedures.
0221.............  Level II Nerve           T...............      32.0518    $2,041.48      $463.60      $408.30
                    Procedures.
0222.............  Implantation of          T...............     193.3327   $12,313.94  ...........    $2,462.79
                    Neurological Device.
0224.............  Implantation of          T...............      37.1117    $2,363.76  ...........      $472.75
                    Catheter/Reservoir/
                    Shunt.
0225.............  Implantation of          S...............     221.4181   $14,102.78  ...........    $2,820.56
                    Neurostimulator
                    Electrodes, Cranial
                    Nerve.
0227.............  Implantation of Drug     T...............     178.7228   $11,383.39  ...........    $2,276.68
                    Infusion Device.
0229.............  Transcatherter           T...............      89.7027    $5,713.43  ...........    $1,142.69
                    Placement of
                    Intravascular Shunts.
0230.............  Level I Eye Tests &      S...............       0.7379       $47.00  ...........        $9.40
                    Treatments.
0231.............  Level III Eye Tests &    S...............       2.3117      $147.24  ...........       $29.45
                    Treatments.
0232.............  Level I Anterior         T...............       5.1145      $325.76       $81.59       $65.15
                    Segment Eye Procedures.
0233.............  Level II Anterior        T...............      16.5252    $1,052.54      $266.30      $210.51
                    Segment Eye Procedures.
0234.............  Level III Anterior       T...............      24.0821    $1,533.86      $511.30      $306.77
                    Segment Eye Procedures.
0235.............  Level I Posterior        T...............       4.0100      $255.41       $58.90       $51.08
                    Segment Eye Procedures.
0236.............  Level II Posterior       T...............      18.8779    $1,202.39  ...........      $240.48
                    Segment Eye Procedures.
0237.............  Level III Posterior      T...............      29.0019    $1,847.22  ...........      $369.44
                    Segment Eye Procedures.
0238.............  Level I Repair and       T...............       2.8636      $182.39  ...........       $36.48
                    Plastic Eye Procedures.
0239.............  Level II Repair and      T...............       7.1099      $452.85  ...........       $90.57
                    Plastic Eye Procedures.
0240.............  Level III Repair and     T...............      19.2280    $1,224.69      $309.50      $244.94
                    Plastic Eye Procedures.
0241.............  Level IV Repair and      T...............      24.8916    $1,585.42      $384.40      $317.08
                    Plastic Eye Procedures.
0242.............  Level V Repair and       T...............      37.3504    $2,378.96      $597.30      $475.79
                    Plastic Eye Procedures.
0243.............  Strabismus/Muscle        T...............      24.3920    $1,553.60      $430.30      $310.72
                    Procedures.
0244.............  Corneal Transplant.....  T...............      38.2919    $2,438.93      $803.20      $487.79
0245.............  Level I Cataract         T...............      14.9022      $949.17      $217.00      $189.83
                    Procedures without IOL
                    Insert.
0246.............  Cataract Procedures      T...............      24.2197    $1,542.63      $495.90      $308.53
                    with IOL Insert.
0247.............  Laser Eye Procedures...  T...............       5.2389      $333.68      $104.30       $66.74
0249.............  Level II Cataract        T...............      29.7487    $1,894.78      $524.60      $378.96
                    Procedures without IOL
                    Insert.
0250.............  Nasal Cauterization/     T...............       1.1708       $74.57       $25.30       $14.91
                    Packing.
0251.............  Level I ENT Procedures.  T...............       2.5765      $164.11  ...........       $32.82
0252.............  Level II ENT Procedures  T...............       7.6539      $487.50      $109.10       $97.50
0253.............  Level III ENT            T...............      16.6341    $1,059.48      $282.20      $211.90
                    Procedures.
0254.............  Level IV ENT Procedures  T...............      24.3535    $1,551.15      $321.30      $310.23
0256.............  Level V ENT Procedures.  T...............      40.5598    $2,583.38  ...........      $516.68
0258.............  Tonsil and Adenoid       T...............      22.9075    $1,459.05      $437.20      $291.81
                    Procedures.
0259.............  Level VI ENT Procedures  T...............     404.3379   $25,753.49    $8,698.40    $5,150.70

[[Page 42840]]

 
0260.............  Level I Plain Film       X...............       0.7259       $46.23  ...........        $9.25
                    Except Teeth.
0261.............  Level II Plain Film      X...............       1.2024       $76.58  ...........       $15.32
                    Except Teeth Including
                    Bone Density
                    Measurement.
0262.............  Plain Film of Teeth....  X...............       0.5739       $36.55  ...........        $7.31
0263.............  Miscellaneous Radiology  X...............       1.4802       $94.28       $21.44       $18.86
                    Procedures.
0265.............  Level I Diagnostic and   S...............       0.9925       $63.22       $23.60       $12.64
                    Screening Ultrasound.
0266.............  Level II Diagnostic and  S...............       1.5657       $99.72       $37.80       $19.94
                    Screening Ultrasound.
0267.............  Level III Diagnostic     S...............       2.4859      $158.33       $60.50       $31.67
                    and Screening
                    Ultrasound.
0269.............  Level II Echocardiogram  S...............       6.5908      $419.79  ...........       $83.96
                    Except Transesophageal.
0270.............  Transesophageal          S...............       8.4200      $536.30      $141.30      $107.26
                    Echocardiogram.
0272.............  Fluoroscopy............  X...............       1.3270       $84.52       $31.60       $16.90
0274.............  Myelography............  S...............       3.9008      $248.45       $62.80       $49.69
0275.............  Arthrography...........  S...............       2.2785      $145.12       $44.13       $29.02
0276.............  Level I Digestive        S...............       1.4387       $91.64       $34.90       $18.33
                    Radiology.
0277.............  Level II Digestive       S...............       2.2875      $145.70       $54.50       $29.14
                    Radiology.
0278.............  Diagnostic Urography...  S...............       2.6114      $166.33       $59.40       $33.27
0279.............  Level II Angiography     S...............       5.9365      $378.11       $97.07       $75.62
                    and Venography.
0280.............  Level III Angiography    S...............      11.3221      $721.14      $199.34      $144.23
                    and Venography.
0282.............  Miscellaneous Computed   S...............       1.6768      $106.80       $37.80       $21.36
                    Axial Tomography.
0283.............  Level I Computed         S...............       4.5485      $289.71      $100.30       $57.94
                    Tomography with
                    Contrast.
0284.............  Magnetic Resonance       S...............       6.7963      $432.88      $148.40       $86.58
                    Imaging and Magnetic
                    Resonance Angiography
                    with Contrast.
0288.............  Bone Density:Axial       S...............       1.1920       $75.92       $28.90       $15.18
                    Skeleton.
0293.............  Level V Anterior         T...............      83.0605    $5,290.37    $1,128.20    $1,058.07
                    Segment Eye Procedures.
0299.............  Hyperthermia and         S...............       6.0275      $383.91  ...........       $76.78
                    Radiation Treatment
                    Procedures.
0300.............  Level I Radiation        S...............       1.5000       $95.54  ...........       $19.11
                    Therapy.
0301.............  Level II Radiation       S...............       2.2933      $146.07  ...........       $29.21
                    Therapy.
0303.............  Treatment Device         X...............       3.0657      $195.26       $66.90       $39.05
                    Construction.
0304.............  Level I Therapeutic      X...............       1.6409      $104.51       $38.60       $20.90
                    Radiation Treatment
                    Preparation.
0305.............  Level II Therapeutic     X...............       4.1775      $266.08       $91.30       $53.22
                    Radiation Treatment
                    Preparation.
0307.............  Myocardial Positron      S...............      42.5674    $2,711.25  ...........      $542.25
                    Emission Tomography
                    (PET) imaging.
0308.............  Non-Myocardial Positron  S...............      17.3837    $1,107.22  ...........      $221.44
                    Emission Tomography
                    (PET) imaging.
0310.............  Level III Therapeutic    X...............      14.0797      $896.78      $325.20      $179.36
                    Radiation Treatment
                    Preparation.
0312.............  Radioelement             S...............       8.3915      $534.48  ...........      $106.90
                    Applications.
0313.............  Brachytherapy..........  S...............      11.6098      $739.46  ...........      $147.89
0315.............  Level II Implantation    T...............     262.8116   $16,739.26  ...........    $3,347.85
                    of Neurostimulator.
0316.............  Level II Computed        S...............      11.7923      $751.09      $300.26      $150.22
                    Tomography with
                    Contrast.
0320.............  Electroconvulsive        S...............       5.9448      $378.64       $80.00       $75.73
                    Therapy.
0322.............  Brief Individual         S...............       1.2454       $79.32  ...........       $15.86
                    Psychotherapy.
0323.............  Extended Individual      S...............       1.6720      $106.49  ...........       $21.30
                    Psychotherapy.
0324.............  Family Psychotherapy...  S...............       2.2233      $141.61  ...........       $28.32
0325.............  Group Psychotherapy....  S...............       1.0119       $64.45       $14.04       $12.89
0330.............  Dental Procedures......  S...............       9.2780      $590.94  ...........      $118.19
0332.............  Computed Tomography      S...............       3.1487      $200.55       $75.20       $40.11
                    without Contrast.
0333.............  Computed Tomography      S...............       5.3374      $339.96      $119.00       $67.99
                    without Contrast
                    followed by Contrast).
0335.............  Magnetic Resonance       S...............       5.0067      $318.89      $111.90       $63.78
                    Imaging, Miscellaneous.
0336.............  Magnetic Resonance       S...............       5.7101      $363.69      $139.50       $72.74
                    Imaging and Magnetic
                    Resonance Angiography
                    without Contrast.
0337.............  Magnetic Resonance       S...............       8.6689      $552.15      $199.50      $110.43
                    Imaging and Magnetic
                    Resonance Angiography
                    without Contrast
                    followed by Contrast.
0340.............  Minor Ancillary          X...............       0.6416       $40.87  ...........        $8.17
                    Procedures.
0341.............  Skin Tests.............  X...............       0.0879        $5.60        $2.20        $1.12
0342.............  Level I Pathology......  X...............       0.0928        $5.91        $2.00        $1.18
0343.............  Level III Pathology....  X...............       0.5372       $34.22       $10.80        $6.84
0344.............  Level IV Pathology.....  X...............       0.8586       $54.69       $15.60       $10.94
0345.............  Level I Transfusion      X...............       0.2211       $14.08  ...........        $2.82
                    Laboratory Procedures.
0346.............  Level II Transfusion     X...............       0.3464       $22.06  ...........        $4.41
                    Laboratory Procedures.
0347.............  Level III Transfusion    X...............       0.8166       $52.01       $11.20       $10.40
                    Laboratory Procedures.
0350.............  Administration of flu    S...............       0.4037       $25.71  ...........        $0.00
                    and PPV vaccine.
0360.............  Level I Alimentary       X...............       1.6383      $104.35       $33.80       $20.87
                    Tests.
0361.............  Level II Alimentary      X...............       4.0867      $260.29       $83.20       $52.06
                    Tests.
0363.............  Level I                  X...............       0.8542       $54.41       $17.40       $10.88
                    Otorhinolaryngologic
                    Function Tests.
0364.............  Level I Audiometry.....  X...............       0.4448       $28.33        $6.98        $5.67
0365.............  Level II Audiometry....  X...............       1.2810       $81.59       $18.50       $16.32
0366.............  Level III Audiometry...  X...............       1.8646      $118.76       $26.10       $23.75
0367.............  Level I Pulmonary Test.  X...............       0.5955       $37.93       $14.38        $7.59
0368.............  Level II Pulmonary       X...............       0.9541       $60.77       $22.70       $12.15
                    Tests.
0369.............  Level III Pulmonary      X...............       2.7874      $177.54       $44.10       $35.51
                    Tests.
0370.............  Allergy Tests..........  X...............       1.1024       $70.22  ...........       $14.04
0373.............  Level I                  X...............       1.8183      $115.81  ...........       $23.16
                    Neuropsychological
                    Testing.
0375.............  Ancillary Outpatient     S...............      73.4077    $4,675.56  ...........      $935.11
                    Services When Patient
                    Expires.
0377.............  Level II Cardiac         S...............      12.0147      $765.25      $158.80      $153.05
                    Imaging.
0378.............  Level II Pulmonary       S...............       5.1617      $328.76      $125.30       $65.75
                    Imaging.
0379.............  Injection adenosine 6    K...............  ...........       $22.65  ...........        $4.53
                    MG.
0381.............  Single Allergy Tests...  X...............       0.3014       $19.20  ...........        $3.84
0382.............  Level II                 X...............       2.6763      $170.46  ...........       $34.09
                    Neuropsychological
                    Testing.
0383.............  Cardiac Computed         S...............       4.9887      $317.75      $124.17       $63.55
                    Tomographic Imaging.
0384.............  GI Procedures with       T...............      25.2289    $1,606.90  ...........      $321.38
                    Stents.
0385.............  Level I Prosthetic       S...............      85.3372    $5,435.38  ...........    $1,087.08
                    Urological Procedures.
0386.............  Level II Prosthetic      S...............     143.8001    $9,159.06  ...........    $1,831.81
                    Urological Procedures.
0387.............  Level II Hysteroscopy..  T...............      34.8162    $2,217.55      $655.50      $443.51

[[Page 42841]]

 
0388.............  Discography............  S...............       9.0300      $575.15      $169.68      $115.03
0389.............  Level I Non-imaging      S...............       1.5806      $100.67       $33.80       $20.13
                    Nuclear Medicine.
0390.............  Level I Endocrine        S...............       2.8272      $180.07       $57.60       $36.01
                    Imaging.
0391.............  Level II Endocrine       S...............       3.6540      $232.73       $66.10       $46.55
                    Imaging.
0392.............  Level II Non-imaging     S...............       3.2810      $208.98       $49.30       $41.80
                    Nuclear Medicine.
0393.............  Red Cell/Plasma Studies  S...............       5.5260      $351.97       $82.00       $70.39
0394.............  Hepatobiliary Imaging..  S...............       4.5297      $288.51      $102.60       $57.70
0395.............  GI Tract Imaging.......  S...............       3.8546      $245.51       $89.70       $49.10
0396.............  Bone Imaging...........  S...............       3.9566      $252.01       $95.00       $50.40
0397.............  Vascular Imaging.......  S...............       3.0424      $193.78       $49.50       $38.76
0398.............  Level I Cardiac Imaging  S...............       5.4404      $346.52      $100.00       $69.30
0400.............  Hematopoietic Imaging..  S...............       4.1916      $266.98       $93.20       $53.40
0401.............  Level I Pulmonary        S...............       3.2976      $210.03       $78.10       $42.01
                    Imaging.
0402.............  Level II Nervous System  S...............       8.8414      $563.14      $114.10      $112.63
                    Imaging.
0403.............  Level I Nervous System   S...............       3.3325      $212.26       $82.39       $42.45
                    Imaging.
0404.............  Renal and Genitourinary  S...............       5.0935      $324.42       $84.10       $64.88
                    Studies.
0406.............  Level I Tumor/Infection  S...............       4.4988      $286.54       $98.10       $57.31
                    Imaging.
0407.............  Level I Radionuclide     S...............       3.4563      $220.14       $78.10       $44.03
                    Therapy.
0408.............  Level III Tumor/         S...............      16.0595    $1,022.88  ...........      $204.58
                    Infection Imaging.
0409.............  Red Blood Cell Tests...  X...............       0.1246        $7.94        $2.20        $1.59
0412.............  IMRT Treatment Delivery  S...............       5.7275      $364.80  ...........       $72.96
0413.............  Level II Radionuclide    S...............       5.4891      $349.62  ...........       $69.92
                    Therapy.
0414.............  Level II Tumor/          S...............       7.4985      $477.60      $190.92       $95.52
                    Infection Imaging.
0415.............  Level II Endoscopy       T...............      24.2882    $1,546.99      $459.90      $309.40
                    Lower Airway.
0417.............  Computerized             S...............       2.3401      $149.05  ...........       $29.81
                    Reconstruction.
0418.............  Insertion of Left        T...............     250.5383   $15,957.54  ...........    $3,191.51
                    Ventricular Pacing
                    Elect..
0422.............  Level II Upper GI        T...............      24.6480    $1,569.91      $445.06      $313.98
                    Procedures.
0423.............  Level II Percutaneous    T...............      44.1192    $2,810.08  ...........      $562.02
                    Abdominal and Biliary
                    Procedures.
0425.............  Level II Arthroplasty    T...............     113.6713    $7,240.07  ...........    $1,448.01
                    with Prosthesis.
0426.............  Level II Strapping and   S...............       2.2383      $142.56  ...........       $28.51
                    Cast Application.
0427.............  Level II Tube Changes    T...............      14.8912      $948.47  ...........      $189.69
                    and Repositioning.
0428.............  Level III Sigmoidoscopy  T...............      21.8923    $1,394.39  ...........      $278.88
                    and Anoscopy.
0429.............  Level V                  T...............      45.9021    $2,923.64  ...........      $584.73
                    Cystourethroscopy and
                    other Genitourinary
                    Procedures.
0430.............  Drug Preadministration-  S...............       0.6123       $39.00  ...........        $7.80
                    Related Services.
0432.............  Health and Behavior      S...............       0.3020       $19.24  ...........        $3.85
                    Services.
0433.............  Level II Pathology.....  X...............       0.2482       $15.81        $5.90        $3.16
0434.............  Cardiac Defect Repair..  T...............     141.9601    $9,041.86  ...........    $1,808.37
0436.............  Level I Drug             S...............       0.2201       $14.02  ...........        $2.80
                    Administration.
0437.............  Level II Drug            S...............       0.4037       $25.71  ...........        $5.14
                    Administration.
0438.............  Level III Drug           S...............       0.8310       $52.93  ...........       $10.59
                    Administration.
0439.............  Level IV Drug            S...............       1.7152      $109.25  ...........       $21.85
                    Administration.
0440.............  Level V Drug             S...............       1.8310      $116.62  ...........       $23.32
                    Administration.
0441.............  Level VI Drug            S...............       2.4378      $155.27  ...........       $31.05
                    Administration.
0442.............  Dosimetric Drug          S...............      30.2249    $1,925.11  ...........      $385.02
                    Administration.
0604.............  Level 1 Hospital Clinic  V...............       0.8381       $53.38  ...........       $10.68
                    Visits.
0605.............  Level 2 Hospital Clinic  V...............       1.0016       $63.79  ...........       $12.76
                    Visits.
0606.............  Level 3 Hospital Clinic  V...............       1.3665       $87.04  ...........       $17.41
                    Visits.
0607.............  Level 4 Hospital Clinic  V...............       1.7181      $109.43  ...........       $21.89
                    Visits.
0608.............  Level 5 Hospital Clinic  V...............       2.2077      $140.62  ...........       $28.12
                    Visits.
0609.............  Level 1 Emergency        V...............       0.8271       $52.68       $12.70       $10.54
                    Visits.
0613.............  Level 2 Emergency        V...............       1.3789       $87.83       $21.00       $17.57
                    Visits.
0614.............  Level 3 Emergency        V...............       2.1716      $138.32       $34.50       $27.66
                    Visits.
0615.............  Level 4 Emergency        V...............       3.5191      $224.14       $48.40       $44.83
                    Visits.
0616.............  Level 5 Emergency        V...............       5.4765      $348.81       $75.10       $69.76
                    Visits.
0617.............  Critical Care..........  S...............       6.8478      $436.16      $111.50       $87.23
0618.............  Trauma Response with     S...............       5.6539      $360.11      $144.04       $72.02
                    Critical Care.
0621.............  Level I Vascular Access  T...............      11.0043      $700.90  ...........      $140.18
                    Procedures.
0622.............  Level II Vascular        T...............      24.5273    $1,562.22  ...........      $312.44
                    Access Procedures.
0623.............  Level III Vascular       T...............      29.3210    $1,867.54  ...........      $373.51
                    Access Procedures.
0624.............  Phlebotomy and Minor     X...............       0.5763       $36.71       $12.60        $7.34
                    Vascular Access Device
                    Procedures.
0625.............  Level IV Vascular        T...............      87.3200    $5,561.67  ...........    $1,112.33
                    Access Procedures.
0648.............  Level IV Breast Surgery  T...............      52.9438    $3,372.15  ...........      $674.43
0651.............  Complex Interstitial     S...............      15.4158      $981.88  ...........      $196.38
                    Radiation Source
                    Application.
0652.............  Insertion of             T...............      31.7598    $2,022.88  ...........      $404.58
                    Intraperitoneal and
                    Pleural Catheters.
0653.............  Vascular Reconstruction/ T...............      41.0875    $2,616.99  ...........      $523.40
                    Fistula Repair with
                    Device.
0654.............  Insertion/Replacement    T...............     106.9053    $6,809.12  ...........    $1,361.82
                    of a permanent dual
                    chamber pacemaker.
0655.............  Insertion/Replacement/   T...............     144.2764    $9,189.40  ...........    $1,837.88
                    Conversion of a
                    permanent dual chamber
                    pacemaker.
0656.............  Transcatheter Placement  T...............     118.8818    $7,571.94  ...........    $1,514.39
                    of Intracoronary Drug-
                    Eluting Stents.
0659.............  Hyperbaric Oxygen......  S...............       1.5679       $99.86  ...........       $19.97
0660.............  Level II                 X...............       1.4408       $91.77       $28.00       $18.35
                    Otorhinolaryngologic
                    Function Tests.
0661.............  Level V Pathology......  X...............       2.8336      $180.48       $62.00       $36.10
0662.............  CT Angiography.........  S...............       5.2818      $336.41      $118.80       $67.28
0663.............  Level I Electronic       S...............       1.6671      $106.18  ...........       $21.24
                    Analysis of
                    Neurostimulator Pulse
                    Generators.
0664.............  Level I Proton Beam      S...............      13.2746      $845.50  ...........      $169.10
                    Radiation Therapy.
0665.............  Bone                     S...............       0.5225       $33.28       $13.31        $6.66
                    Density:AppendicularSk
                    eleton.
0667.............  Level II Proton Beam     S...............      15.8841    $1,011.71  ...........      $202.34
                    Radiation Therapy.
0668.............  Level I Angiography and  S...............       3.3354      $212.44       $48.81       $42.49
                    Venography.
0672.............  Level IV Posterior       T...............      38.1121    $2,427.47  ...........      $485.49
                    Segment Eye Procedures.
0673.............  Level IV Anterior        T...............      40.8481    $2,601.74      $649.50      $520.35
                    Segment Eye Procedures.

[[Page 42842]]

 
0674.............  Prostate Cryoablation..  T...............     123.7218    $7,880.21  ...........    $1,576.04
0676.............  Thrombolysis and         T...............       2.5179      $160.37  ...........       $32.07
                    Thrombectomy.
0678.............  External                 T...............       1.7081      $108.79  ...........       $21.76
                    Counterpulsation.
0679.............  Level II Resuscitation   S...............       5.5905      $356.08       $95.30       $71.22
                    and Cardioversion.
0680.............  Insertion of Patient     S...............      71.6463    $4,563.37  ...........      $912.67
                    Activated Event
                    Recorders.
0681.............  Knee Arthroplasty......  T...............     191.2387   $12,180.57  ...........    $2,436.11
0682.............  Level V Debridement &    T...............       7.1126      $453.02      $158.60       $90.60
                    Destruction.
0683.............  Level II                 S...............       2.9292      $186.57  ...........       $37.31
                    Photochemotherapy.
0685.............  Level III Needle Biopsy/ T...............       9.5741      $609.80  ...........      $121.96
                    Aspiration Except Bone
                    Marrow.
0687.............  Revision/Removal of      T...............      24.1752    $1,539.79      $438.40      $307.96
                    Neurostimulator
                    Electrodes.
0688.............  Revision/Removal of      T...............      35.7248    $2,275.42      $874.50      $455.08
                    Neurostimulator Pulse
                    Generator Receiver.
0689.............  Electronic Analysis of   S...............       0.5936       $37.81  ...........        $7.56
                    Cardioverter-
                    defibrillators.
0690.............  Electronic Analysis of   S...............       0.3590       $22.87        $8.60        $4.57
                    Pacemakers and other
                    Cardiac Devices.
0691.............  Electronic Analysis of   S...............       2.5849      $164.64       $56.08       $32.93
                    Programmable Shunts/
                    Pumps.
0692.............  Level II Electronic      S...............       1.9206      $122.33       $30.10       $24.47
                    Analysis of
                    Neurostimulator Pulse
                    Generators.
0694.............  Mohs Surgery...........  T...............       3.9713      $252.94       $91.60       $50.59
0697.............  Level I Echocardiogram   S...............       4.8072      $306.18  ...........       $61.24
                    Except Transesophageal.
0698.............  Level II Eye Tests &     S...............       1.1576       $73.73  ...........       $14.75
                    Treatments.
0699.............  Level IV Eye Tests &     T...............      14.2784      $909.43  ...........      $181.89
                    Treatments.
0701.............  Sr89 strontium.........  K...............  ...........      $610.07  ...........      $122.01
0702.............  Sm 153 lexidronm.......  K...............  ...........    $1,446.05  ...........      $289.21
0726.............  Dexrazoxane HCl          K...............  ...........      $172.43  ...........       $34.49
                    injection.
0728.............  Filgrastim 300 mcg       K...............  ...........      $187.68  ...........       $37.54
                    injection.
0730.............  Pamidronate disodium/30  K...............  ...........       $30.49  ...........        $6.10
                    MG.
0731.............  Sargramostim injection.  K...............  ...........       $25.08  ...........        $5.02
0732.............  Mesna injection........  K...............  ...........        $8.89  ...........        $1.78
0735.............  Ampho b cholesteryl      K...............  ...........       $11.89  ...........        $2.38
                    sulfate.
0736.............  Amphotericin b liposome  K...............  ...........       $17.07  ...........        $3.41
                    inj.
0738.............  Rasburicase............  K...............  ...........      $131.28  ...........       $26.26
0747.............  Chlorothiazide sodium    K...............  ...........      $122.67  ...........       $24.53
                    inj.
0748.............  Bleomycin sulfate        K...............  ...........       $35.52  ...........        $7.10
                    injection.
0750.............  Dolasetron mesylate....  K...............  ...........        $6.05  ...........        $1.21
0751.............  Mechlorethamine hcl inj  K...............  ...........      $140.27  ...........       $28.05
0752.............  Dactinomycin             K...............  ...........      $488.78  ...........       $97.76
                    actinomycin d.
0759.............  Naltrexone, depot form.  K...............  ...........        $1.88  ...........        $0.38
0760.............  Anadulafungin injection  G...............  ...........        $1.91  ...........        $0.38
0763.............  Dolasetron mesylate      K...............  ...........       $47.07  ...........        $9.41
                    oral.
0764.............  Granisetron HCl          K...............  ...........        $7.43  ...........        $1.49
                    injection.
0765.............  Granisetron HCl 1 mg     K...............  ...........       $44.44  ...........        $8.89
                    oral.
0767.............  Enfuvirtide injection..  K...............  ...........       $22.69  ...........        $4.54
0768.............  Ondansetron hcl          K...............  ...........        $3.37  ...........        $0.67
                    injection.
0769.............  Ondansetron HCl 8mg      K...............  ...........       $36.21  ...........        $7.24
                    oral.
0800.............  Leuprolide acetate/3.75  K...............  ...........      $429.83  ...........       $85.97
                    MG.
0802.............  Etoposide oral 50 MG...  K...............  ...........       $29.32  ...........        $5.86
0804.............  Immune globulin          K...............  ...........       $12.60  ...........        $2.52
                    subcutaneous.
0805.............  Mecasermin injection...  K...............  ...........       $11.81  ...........        $2.36
0806.............  Hyaluronidase            G...............  ...........        $0.40  ...........        $0.08
                    recombinant.
0807.............  Aldesleukin/single use   K...............  ...........      $755.78  ...........      $151.16
                    vial.
0808.............  Nabilone oral..........  K...............  ...........       $16.80  ...........        $3.36
0809.............  Bcg live intravesical    K...............  ...........      $109.63  ...........       $21.93
                    vac.
0810.............  Goserelin acetate        K...............  ...........      $196.81  ...........       $39.36
                    implant.
0811.............  Carboplatin injection..  K...............  ...........        $8.38  ...........        $1.68
0812.............  Carmus bischl nitro inj  K...............  ...........      $138.52  ...........       $27.70
0814.............  Asparaginase injection.  K...............  ...........       $54.20  ...........       $10.84
0820.............  Daunorubicin...........  K...............  ...........       $20.28  ...........        $4.06
0821.............  Daunorubicin citrate     K...............  ...........       $55.40  ...........       $11.08
                    liposom.
0823.............  Docetaxel..............  K...............  ...........      $303.92  ...........       $60.78
0825.............  Nelarabine injection...  K...............  ...........       $82.54  ...........       $16.51
0827.............  Floxuridine injection..  K...............  ...........       $50.82  ...........       $10.16
0828.............  Gemcitabine HCl........  K...............  ...........      $123.98  ...........       $24.80
0830.............  Irinotecan injection...  K...............  ...........      $124.81  ...........       $24.96
0831.............  Ifosfomide injection...  K...............  ...........       $46.15  ...........        $9.23
0832.............  Idarubicin hcl           K...............  ...........      $301.74  ...........       $60.35
                    injection.
0834.............  Interferon alfa-2a inj.  K...............  ...........       $37.53  ...........        $7.51
0835.............  Inj cosyntropin per      K...............  ...........       $63.25  ...........       $12.65
                    0.25 MG.
0836.............  Interferon alfa-2b inj.  K...............  ...........       $13.75  ...........        $2.75
0837.............  Non-human, non-metab     K...............  ...........       $35.76  ...........        $7.15
                    tissue.
0838.............  Interferon gamma 1-b     K...............  ...........      $287.13  ...........       $57.43
                    inj.
0840.............  Inj melphalan hydrochl   K...............  ...........    $1,272.00  ...........      $254.40
                    50 MG.
0842.............  Fludarabine phosphate    K...............  ...........      $234.21  ...........       $46.84
                    inj.
0843.............  Pegaspargase/singl dose  K...............  ...........    $1,667.61  ...........      $333.52
                    vial.
0844.............  Pentostatin injection..  K...............  ...........    $1,916.66  ...........      $383.33
0849.............  Rituximab cancer         K...............  ...........      $491.54  ...........       $98.31
                    treatment.
0850.............  Streptozocin injection.  K...............  ...........      $152.28  ...........       $30.46
0851.............  Thiotepa injection.....  K...............  ...........       $40.32  ...........        $8.06
0852.............  Topotecan..............  K...............  ...........      $822.90  ...........      $164.58
0855.............  Vinorelbine tartrate/10  K...............  ...........       $19.88  ...........        $3.98
                    mg.
0856.............  Porfimer sodium........  K...............  ...........    $2,539.13  ...........      $507.83
0858.............  Inj cladribine per 1 MG  K...............  ...........       $35.78  ...........        $7.16
0861.............  Leuprolide acetate       K...............  ...........        $8.79  ...........        $1.76
                    injeciton.

[[Page 42843]]

 
0862.............  Mitomycin 5 MG inj.....  K...............  ...........       $15.98  ...........        $3.20
0863.............  Paclitaxel injection...  K...............  ...........       $12.47  ...........        $2.49
0864.............  Mitoxantrone hydrochl/5  K...............  ...........      $166.64  ...........       $33.33
                    MG.
0865.............  Interferon alfa-n3 inj.  K...............  ...........        $9.03  ...........        $1.81
0868.............  Oral aprepitant........  K...............  ...........        $5.02  ...........        $1.00
0873.............  Hyalgan/supartz inj per  K...............  ...........      $103.86  ...........       $20.77
                    dose.
0874.............  Synvisc inj per dose...  K...............  ...........      $184.89  ...........       $36.98
0875.............  Euflexxa inj per dose..  K...............  ...........      $115.19  ...........       $23.04
0877.............  Orthovisc inj per dose.  K...............  ...........      $196.47  ...........       $39.29
0878.............  Gallium nitrate          K...............  ...........        $1.47  ...........        $0.29
                    injection.
0879.............  Bethanechol chloride     K...............       0.5128       $32.66  ...........        $6.53
                    inject.
0880.............  Pentastarch 10%          K...............       0.3707       $23.61  ...........        $4.72
                    solution.
0881.............  Urokinase 5000 IU        K...............  ...........        $9.07  ...........        $1.81
                    injection.
0882.............  Melphalan oral 2 MG....  K...............       0.0681        $4.34  ...........        $0.87
0883.............  Fondaparinux sodium....  K...............  ...........        $5.82  ...........        $1.16
0884.............  Rho d immune globulin    K...............  ...........       $80.71  ...........       $16.14
                    inj.
0887.............  Azathioprine parenteral  K...............  ...........       $47.99  ...........        $9.60
0888.............  Cyclosporine oral 100    K...............  ...........        $3.57  ...........        $0.71
                    mg.
0890.............  Lymphocyte immune        K...............  ...........      $314.19  ...........       $62.84
                    globulin.
0891.............  Tacrolimus oral per 1    K...............  ...........        $3.63  ...........        $0.73
                    MG.
0898.............  Gamma globulin 2 CC inj  K...............  ...........       $22.63  ...........        $4.53
0899.............  Gamma globulin 3 CC inj  K...............  ...........       $33.93  ...........        $6.79
0900.............  Alglucerase injection..  K...............  ...........       $38.85  ...........        $7.77
0901.............  Alpha 1 proteinase       K...............  ...........        $3.24  ...........        $0.65
                    inhibitor.
0902.............  Botulinum toxin a per    K...............  ...........        $5.05  ...........        $1.01
                    unit.
0903.............  Cytomegalovirus imm IV/  K...............  ...........      $859.86  ...........      $171.97
                    vial.
0904.............  Gamma globulin 4 CC inj  K...............  ...........       $45.25  ...........        $9.05
0906.............  RSV-ivig...............  K...............  ...........       $16.02  ...........        $3.20
0910.............  Interferon beta-1b/.25   K...............  ...........       $84.12  ...........       $16.82
                    MG.
0911.............  Inj streptokinase/       K...............       1.1851       $75.48  ...........       $15.10
                    250000 IU.
0912.............  Interferon alfacon-1...  K...............  ...........        $4.60  ...........        $0.92
0913.............  Ganciclovir long act     K...............  ...........    $4,707.42  ...........      $941.48
                    implant.
0916.............  Injection imiglucerase/  K...............  ...........        $3.89  ...........        $0.78
                    unit.
0917.............  Adenosine injection....  K...............  ...........       $68.50  ...........       $13.70
0919.............  Gamma globulin 5 CC inj  K...............  ...........       $56.56  ...........       $11.31
0920.............  Gamma globulin 6 CC inj  K...............  ...........       $67.91  ...........       $13.58
0921.............  Gamma globulin 7 CC inj  K...............  ...........       $79.14  ...........       $15.83
0922.............  Gamma globulin 8 CC inj  K...............  ...........       $90.50  ...........       $18.10
0923.............  Gamma globulin 9 CC inj  K...............  ...........      $101.88  ...........       $20.38
0924.............  Gamma globulin 10 CC     K...............  ...........      $113.13  ...........       $22.63
                    inj.
0925.............  Factor viii............  K...............  ...........        $0.70  ...........        $0.14
0927.............  Factor viii recombinant  K...............  ...........        $1.07  ...........        $0.21
0928.............  Factor ix complex......  K...............  ...........        $0.75  ...........        $0.15
0929.............  Anti-inhibitor.........  K...............  ...........        $1.35  ...........        $0.27
0930.............  Antithrombin iii         K...............  ...........        $1.62  ...........        $0.32
                    injection.
0931.............  Factor IX non-           K...............  ...........        $0.89  ...........        $0.18
                    recombinant.
0932.............  Factor IX recombinant..  K...............  ...........        $0.99  ...........        $0.20
0933.............  Gamma globulin > 10 CC   K...............  ...........      $113.13  ...........       $22.63
                    inj.
0934.............  Capecitabine, oral, 500  K...............  ...........       $13.12  ...........        $2.62
                    mg.
0935.............  Clonidine hydrochloride  K...............  ...........       $62.86  ...........       $12.57
0941.............  Mitomycin 20 MG inj....  K...............  ...........       $63.93  ...........       $12.79
0942.............  Mitomycin 40 MG inj....  K...............  ...........      $127.85  ...........       $25.57
0949.............  Frozen plasma, pooled,   K...............       1.1981       $76.31  ...........       $15.26
                    sd.
0950.............  Whole blood for          K...............       4.4374      $282.63  ...........       $56.53
                    transfusion.
0952.............  Cryoprecipitate each     K...............       0.6843       $43.59  ...........        $8.72
                    unit.
0954.............  RBC leukocytes reduced.  K...............       2.9590      $188.47  ...........       $37.69
0955.............  Plasma, frz between 8-   K...............       1.2456       $79.34  ...........       $15.87
                    24hour.
0956.............  Plasma protein           K...............       1.4392       $91.67  ...........       $18.33
                    fract,5%,50ml.
0957.............  Platelets, each unit...  K...............       1.0834       $69.00  ...........       $13.80
0958.............  Plaelet rich plasma      K...............       5.3744      $342.31  ...........       $68.46
                    unit.
0959.............  Red blood cells unit...  K...............       2.0343      $129.57  ...........       $25.91
0960.............  Washed red blood cells   K...............       4.2092      $268.10  ...........       $53.62
                    unit.
0961.............  Albumin (human),5%,      K...............       0.3757       $23.93  ...........        $4.79
                    50ml.
0963.............  Albumin (human), 5%,     K...............       1.1351       $72.30  ...........       $14.46
                    250 ml.
0964.............  Albumin (human), 25%,    K...............       0.4448       $28.33  ...........        $5.67
                    20 ml.
0965.............  Albumin (human), 25%,    K...............       1.1679       $74.39  ...........       $14.88
                    50ml.
0966.............  Plasmaprotein            K...............       3.9009      $248.46  ...........       $49.69
                    fract,5%,250ml.
0967.............  Blood split unit.......  K...............       2.1237      $135.26  ...........       $27.05
0968.............  Platelets leukoreduced   K...............       2.0280      $129.17  ...........       $25.83
                    irrad.
0969.............  RBC leukoreduced         K...............       3.8191      $243.25  ...........       $48.65
                    irradiated.
1009.............  Cryoprecipitatereducedp  K...............       1.3131       $83.64  ...........       $16.73
                    lasma.
1010.............  Blood, l/r, cmv-neg....  K...............       2.3865      $152.00  ...........       $30.40
1011.............  Platelets, hla-m, l/r,   K...............       9.6766      $616.33  ...........      $123.27
                    unit.
1013.............  Platelets leukocytes     K...............       1.7207      $109.60  ...........       $21.92
                    reduced.
1016.............  Blood, l/r, froz/degly/  K...............       3.3520      $213.50  ...........       $42.70
                    wash.
1017.............  Plt, aph/pher, l/r, cmv- K...............       7.7915      $496.26  ...........       $99.25
                    neg.
1018.............  Blood, l/r, irradiated.  K...............       2.4372      $155.23  ...........       $31.05
1019.............  Plate pheres leukoredu   K...............      10.0408      $639.53  ...........      $127.91
                    irrad.
1020.............  Plt, pher, l/r cmv-neg,  K...............      10.7802      $686.62  ...........      $137.32
                    irr.
1021.............  RBC, frz/deg/wsh, l/r,   K...............       6.4694      $412.06  ...........       $82.41
                    irrad.

[[Page 42844]]

 
1022.............  RBC, l/r, cmv-neg,       K...............       4.6286      $294.81  ...........       $58.96
                    irrad.
1032.............  Aud osseo dev, int/ext   H...............  ...........  ...........  ...........            .
                    comp.
1052.............  Injection, voriconazole  K...............  ...........        $4.94  ...........        $0.99
1064.............  I131 iodide cap, rx....  K...............  ...........       $16.22  ...........        $3.24
1083.............  Adalimumab injection...  K...............  ...........      $316.02  ...........       $63.20
1084.............  Denileukin diftitox,     K...............  ...........    $1,393.32  ...........      $278.66
                    300 mcg.
1086.............  Temozolomide...........  K...............  ...........        $7.34  ...........        $1.47
1150.............  I131 iodide sol, rx....  K...............  ...........       $11.74  ...........        $2.35
1166.............  Cytarabine liposome....  K...............  ...........      $391.31  ...........       $78.26
1167.............  Inj, epirubicin hcl, 2   K...............  ...........       $21.01  ...........        $4.20
                    mg.
1178.............  Busulfan injection.....  K...............  ...........        $8.80  ...........        $1.76
1203.............  Verteporfin injection..  K...............  ...........        $8.84  ...........        $1.77
1207.............  Octreotide injection,    K...............  ...........       $95.86  ...........       $19.17
                    depot.
1280.............  Corticotropin injection  K...............  ...........      $126.52  ...........       $25.30
1436.............  Etidronate disodium inj  K...............  ...........       $70.73  ...........       $14.15
1491.............  New Technology--Level    S...............  ...........        $5.00  ...........        $1.00
                    IA ($0-$10).
1492.............  New Technology--Level    S...............  ...........       $15.00  ...........        $3.00
                    IB ($10-$20).
1493.............  New Technology--Level    S...............  ...........       $25.00  ...........        $5.00
                    IC ($20-$30).
1494.............  New Technology--Level    S...............  ...........       $35.00  ...........        $7.00
                    ID ($30-$40).
1495.............  New Technology--Level    S...............  ...........       $45.00  ...........        $9.00
                    IE ($40-$50).
1496.............  New Technology--Level    T...............  ...........        $5.00  ...........        $1.00
                    IA ($0-$10).
1497.............  New Technology--Level    T...............  ...........       $15.00  ...........        $3.00
                    IB ($10-$20).
1498.............  New Technology--Level    T...............  ...........       $25.00  ...........        $5.00
                    IC ($20-$30).
1499.............  New Technology--Level    T...............  ...........       $35.00  ...........        $7.00
                    ID ($30-$40).
1500.............  New Technology--Level    T...............  ...........       $45.00  ...........        $9.00
                    IE ($40-$50).
1502.............  New Technology--Level    S...............  ...........       $75.00  ...........       $15.00
                    II ($50-$100).
1503.............  New Technology--Level    S...............  ...........      $150.00  ...........       $30.00
                    III ($100-$200).
1504.............  New Technology--Level    S...............  ...........      $250.00  ...........       $50.00
                    IV ($200-$300).
1505.............  New Technology--Level V  S...............  ...........      $350.00  ...........       $70.00
                    ($300-$400).
1506.............  New Technology--Level    S...............  ...........      $450.00  ...........       $90.00
                    VI ($400-$500).
1507.............  New Technology--Level    S...............  ...........      $550.00  ...........      $110.00
                    VII ($500-$600).
1508.............  New Technology--Level    S...............  ...........      $650.00  ...........      $130.00
                    VIII ($600-$700).
1509.............  New Technology--Level    S...............  ...........      $750.00  ...........      $150.00
                    IX ($700-$800).
1510.............  New Technology--Level X  S...............  ...........      $850.00  ...........      $170.00
                    ($800-$900).
1511.............  New Technology--Level    S...............  ...........      $950.00  ...........      $190.00
                    XI ($900-$1000).
1512.............  New Technology--Level    S...............  ...........    $1,050.00  ...........      $210.00
                    XII ($1000-$1100).
1513.............  New Technology--Level    S...............  ...........    $1,150.00  ...........      $230.00
                    XIII ($1100-$1200).
1514.............  New Technology--Level    S...............  ...........    $1,250.00  ...........      $250.00
                    XIV ($1200- $1300).
1515.............  New Technology--Level    S...............  ...........    $1,350.00  ...........      $270.00
                    XV ($1300-$1400).
1516.............  New Technology--Level    S...............  ...........    $1,450.00  ...........      $290.00
                    XVI ($1400-$1500).
1517.............  New Technology--Level    S...............  ...........    $1,550.00  ...........      $310.00
                    XVII ($1500-$1600).
1518.............  New Technology--Level    S...............  ...........    $1,650.00  ...........      $330.00
                    XVIII ($1600-$1700).
1519.............  New Technology--Level    S...............  ...........    $1,750.00  ...........      $350.00
                    IXX ($1700-$1800).
1520.............  New Technology--Level    S...............  ...........    $1,850.00  ...........      $370.00
                    XX ($1800-$1900).
1521.............  New Technology--Level    S...............  ...........    $1,950.00  ...........      $390.00
                    XXI ($1900-$2000).
1522.............  New Technology--Level    S...............  ...........    $2,250.00  ...........      $450.00
                    XXII ($2000-$2500).
1523.............  New Technology--Level    S...............  ...........    $2,750.00  ...........      $550.00
                    XXIII ($2500-$3000).
1524.............  New Technology--Level    S...............  ...........    $3,250.00  ...........      $650.00
                    XXIV ($3000-$3500).
1525.............  New Technology--Level    S...............  ...........    $3,750.00  ...........      $750.00
                    XXV ($3500-$4000).
1526.............  New Technology--Level    S...............  ...........    $4,250.00  ...........      $850.00
                    XXVI ($4000-$4500).
1527.............  New Technology--Level    S...............  ...........    $4,750.00  ...........      $950.00
                    XXVII ($4500-$5000).
1528.............  New Technology--Level    S...............  ...........    $5,250.00  ...........    $1,050.00
                    XXVIII ($5000-$5500).
1529.............  New Technology--Level    S...............  ...........    $5,750.00  ...........    $1,150.00
                    XXIX ($5500-$6000).
1530.............  New Technology--Level    S...............  ...........    $6,250.00  ...........    $1,250.00
                    XXX ($6000-$6500).
1531.............  New Technology--Level    S...............  ...........    $6,750.00  ...........    $1,350.00
                    XXXI ($6500-$7000).
1532.............  New Technology--Level    S...............  ...........    $7,250.00  ...........    $1,450.00
                    XXXII ($7000-$7500).
1533.............  New Technology--Level    S...............  ...........    $7,750.00  ...........    $1,550.00
                    XXXIII ($7500-$8000).
1534.............  New Technology--Level    S...............  ...........    $8,250.00  ...........    $1,650.00
                    XXXIV ($8000-$8500).
1535.............  New Technology--Level    S...............  ...........    $8,750.00  ...........    $1,750.00
                    XXXV ($8500-$9000).
1536.............  New Technology--Level    S...............  ...........    $9,250.00  ...........    $1,850.00
                    XXXVI ($9000-$9500).
1537.............  New Technology--Level    S...............  ...........    $9,750.00  ...........    $1,950.00
                    XXXVII ($9500-$10000).
1539.............  New Technology--Level    T...............  ...........       $75.00  ...........       $15.00
                    II ($50-$100).
1540.............  New Technology--Level    T...............  ...........      $150.00  ...........       $30.00
                    III ($100-$200).
1541.............  New Technology--Level    T...............  ...........      $250.00  ...........       $50.00
                    IV ($200-$300).
1542.............  New Technology--Level V  T...............  ...........      $350.00  ...........       $70.00
                    ($300-$400).
1543.............  New Technology--Level    T...............  ...........      $450.00  ...........       $90.00
                    VI ($400-$500).
1544.............  New Technology--Level    T...............  ...........      $550.00  ...........      $110.00
                    VII ($500-$600).
1545.............  New Technology--Level    T...............  ...........      $650.00  ...........      $130.00
                    VIII ($600-$700).
1546.............  New Technology--Level    T...............  ...........      $750.00  ...........      $150.00
                    IX ($700-$800).
1547.............  New Technology--Level X  T...............  ...........      $850.00  ...........      $170.00
                    ($800-$900).
1548.............  New Technology--Level    T...............  ...........      $950.00  ...........      $190.00
                    XI ($900-$1000).
1549.............  New Technology--Level    T...............  ...........    $1,050.00  ...........      $210.00
                    XII ($1000-$1100).
1550.............  New Technology--Level    T...............  ...........    $1,150.00  ...........      $230.00
                    XIII ($1100-$1200).
1551.............  New Technology--Level    T...............  ...........    $1,250.00  ...........      $250.00
                    XIV ($1200-$1300).
1552.............  New Technology--Level    T...............  ...........    $1,350.00  ...........      $270.00
                    XV ($1300-$1400).
1553.............  New Technology--Level    T...............  ...........    $1,450.00  ...........      $290.00
                    XVI ($1400-$1500).
1554.............  New Technology--Level    T...............  ...........    $1,550.00  ...........      $310.00
                    XVII ($1500-$1600).
1555.............  New Technology--Level    T...............  ...........    $1,650.00  ...........      $330.00
                    XVIII ($1600-$1700).
1556.............  New Technology--Level    T...............  ...........    $1,750.00  ...........      $350.00
                    XIX ($1700-$1800).
1557.............  New Technology--Level    T...............  ...........    $1,850.00  ...........      $370.00
                    XX ($1800-$1900).

[[Page 42845]]

 
1558.............  New Technology--Level    T...............  ...........    $1,950.00  ...........      $390.00
                    XXI ($1900-$2000).
1559.............  New Technology--Level    T...............  ...........    $2,250.00  ...........      $450.00
                    XXII ($2000-$2500).
1560.............  New Technology--Level    T...............  ...........    $2,750.00  ...........      $550.00
                    XXIII ($2500-$3000).
1561.............  New Technology--Level    T...............  ...........    $3,250.00  ...........      $650.00
                    XXIV ($3000-$3500).
1562.............  New Technology--Level    T...............  ...........    $3,750.00  ...........      $750.00
                    XXV ($3500-$4000).
1563.............  New Technology--Level    T...............  ...........    $4,250.00  ...........      $850.00
                    XXVI ($4000-$4500).
1564.............  New Technology--Level    T...............  ...........    $4,750.00  ...........      $950.00
                    XXVII ($4500-$5000).
1565.............  New Technology--Level    T...............  ...........    $5,250.00  ...........    $1,050.00
                    XXVIII ($5000-$5500).
1566.............  New Technology--Level    T...............  ...........    $5,750.00  ...........    $1,150.00
                    XXIX ($5500-$6000).
1567.............  New Technology--Level    T...............  ...........    $6,250.00  ...........    $1,250.00
                    XXX ($6000-$6500).
1568.............  New Technology--Level    T...............  ...........    $6,750.00  ...........    $1,350.00
                    XXXI ($6500-$7000).
1569.............  New Technology--Level    T...............  ...........    $7,250.00  ...........    $1,450.00
                    XXXII ($7000-$7500).
1570.............  New Technology--Level    T...............  ...........    $7,750.00  ...........    $1,550.00
                    XXXIII ($7500-$8000).
1571.............  New Technology--Level    T...............  ...........    $8,250.00  ...........    $1,650.00
                    XXXIV ($8000-$8500).
1572.............  New Technology--Level    T...............  ...........    $8,750.00  ...........    $1,750.00
                    XXXV ($8500-$9000).
1573.............  New Technology--Level    T...............  ...........    $9,250.00  ...........    $1,850.00
                    XXXVI ($9000-$9500).
1574.............  New Technology--Level    T...............  ...........    $9,750.00  ...........    $1,950.00
                    XXXVII ($9500-$10000).
1605.............  Abciximab injection....  K...............  ...........      $409.26  ...........       $81.85
1606.............  Injection anistreplase   K...............      42.2935    $2,693.80  ...........      $538.76
                    30 u.
1607.............  Eptifibatide injection.  K...............  ...........       $15.90  ...........        $3.18
1608.............  Etanercept injection...  K...............  ...........      $160.03  ...........       $32.01
1609.............  Rho(D) immune globulin   K...............  ...........       $15.76  ...........        $3.15
                    h, sd.
1612.............  Daclizumab, parenteral.  K...............  ...........      $297.03  ...........       $59.41
1613.............  Trastuzumab............  K...............  ...........       $57.33  ...........       $11.47
1629.............  Nonmetabolic act d/e     K...............  ...........       $18.13  ...........        $3.63
                    tissue.
1630.............  Hep b ig, im...........  K...............  ...........      $132.42  ...........       $26.48
1631.............  Baclofen intrathecal     K...............  ...........       $70.92  ...........       $14.18
                    trial.
1632.............  Metabolic active D/E     K...............  ...........       $28.51  ...........        $5.70
                    tissue.
1633.............  Alefacept..............  K...............  ...........       $25.82  ...........        $5.16
1643.............  Y90 ibritumomab, rx....  K...............  ...........   $12,030.02  ...........    $2,406.00
1645.............  I131 tositumomab, rx...  K...............  ...........    $8,283.41  ...........    $1,656.68
1670.............  Tetanus immune globulin  K...............  ...........       $96.35  ...........       $19.27
                    inj.
1675.............  P32 Na phosphate.......  K...............  ...........      $118.02  ...........       $23.60
1676.............  P32 chromic phosphate..  K...............  ...........      $122.17  ...........       $24.43
1682.............  Aprotonin, 10,000 kiu..  K...............  ...........        $2.50  ...........        $0.50
1683.............  Basiliximab............  K...............  ...........    $1,347.14  ...........      $269.43
1684.............  Corticorelin ovine       K...............  ...........        $4.26  ...........        $0.85
                    triflutal.
1685.............  Darbepoetin alfa, non-   K...............  ...........        $3.11  ...........        $0.62
                    esrd.
1686.............  Epoetin alfa, non-esrd.  K...............  ...........        $9.36  ...........        $1.87
1687.............  Digoxin immune fab       K...............  ...........      $511.48  ...........      $102.30
                    (ovine).
1688.............  Ethanolamine oleate 100  K...............  ...........       $78.26  ...........       $15.65
                    mg.
1689.............  Fomepizole, 15 mg......  K...............  ...........       $12.28  ...........        $2.46
1690.............  Hemin, 1 mg............  K...............  ...........        $6.74  ...........        $1.35
1691.............  Iron dextran 165         K...............  ...........       $11.61  ...........        $2.32
                    injection.
1692.............  Iron dextran 267         K...............  ...........       $10.32  ...........        $2.06
                    injection.
1693.............  Lepirudin..............  K...............  ...........      $153.42  ...........       $30.68
1694.............  Ziconotide injection...  K...............  ...........        $6.46  ...........        $1.29
1695.............  Nesiritide injection...  K...............  ...........       $31.36  ...........        $6.27
1696.............  Palifermin injection...  K...............  ...........       $11.32  ...........        $2.26
1697.............  Pegaptanib sodium        K...............  ...........    $1,054.70  ...........      $210.94
                    injection.
1700.............  Inj secretin synthetic   K...............  ...........       $20.12  ...........        $4.02
                    human.
1701.............  Treprostinil injection.  K...............  ...........       $55.36  ...........       $11.07
1703.............  Ovine, 1000 USP units..  K...............  ...........      $133.77  ...........       $26.75
1704.............  Inj Vonwillebrand        K...............  ...........        $0.88  ...........        $0.18
                    factor IU.
1705.............  Factor viia............  K...............  ...........        $1.11  ...........        $0.22
1709.............  Azacitidine injection..  K...............  ...........        $4.26  ...........        $0.85
1710.............  Clofarabine injection..  K...............  ...........      $115.64  ...........       $23.13
1711.............  Histrelin implant......  K...............  ...........    $1,446.98  ...........      $289.40
1712.............  Paclitaxel protein       K...............  ...........        $7.03  ...........        $1.41
                    bound.
1716.............  Brachytx source, Gold    K...............       0.5016       $31.95  ...........        $6.39
                    198.
1717.............  Brachytx source, HDR Ir- K...............       2.7225      $173.40  ...........       $34.68
                    192.
1719.............  Brachytx sour,Non-HDR    K...............       0.9012       $57.40  ...........       $11.48
                    Ir-192.
1738.............  Oxaliplatin............  K...............  ...........        $8.89  ...........        $1.78
1739.............  Pegademase bovine, 25    K...............  ...........      $176.16  ...........       $35.23
                    iu.
1740.............  Diazoxide injection....  K...............  ...........      $113.24  ...........       $22.65
1741.............  Urofollitropin, 75 iu..  K...............  ...........       $50.22  ...........       $10.04
1821.............  Interspinous implant...  H...............  ...........  ...........  ...........            .
2210.............  Methyldopate hcl         K...............  ...........       $10.01  ...........        $2.00
                    injection.
2616.............  Brachytx source,         K...............     187.5212   $11,943.79  ...........    $2,388.76
                    Yttrium-90.
2632.............  Iodine I-125 sodium      K...............       0.4494       $28.62  ...........        $5.72
                    iodide.
2634.............  Brachytx source, HA, I-  K...............       0.4699       $29.93  ...........        $5.99
                    125.
2635.............  Brachytx source, HA, P-  K...............       0.7389       $47.06  ...........        $9.41
                    103.
2636.............  Brachytx linear source,  K...............       0.5824       $37.09  ...........        $7.42
                    P-103.
2731.............  Immune globulin, powder  K...............  ...........       $25.48  ...........        $5.10
2732.............  Immune globulin, liquid  K...............  ...........       $30.28  ...........        $6.06
2770.............  Quinupristin/            K...............  ...........      $116.70  ...........       $23.34
                    dalfopristin.
2940.............  Somatrem injection.....  K...............       1.0916       $69.53  ...........       $13.91
3030.............  Sumatriptan succinate/6  K...............  ...........       $58.82  ...........       $11.76
                    MG.
3041.............  Bivalirudin............  K...............  ...........        $1.72  ...........        $0.34
3043.............  Gamma globulin 1 CC inj  K...............  ...........       $11.31  ...........        $2.26

[[Page 42846]]

 
3050.............  Sermorelin acetate       K...............  ...........        $1.74  ...........        $0.35
                    injection.
7000.............  Amifostine.............  K...............  ...........      $476.10  ...........       $95.22
7005.............  Gonadorelin hydroch/100  K...............  ...........      $178.59  ...........       $35.72
                    mcg.
7011.............  Oprelvekin injection...  K...............  ...........      $244.98  ...........       $49.00
7015.............  Oral busulfan..........  K...............  ...........        $2.12  ...........        $0.42
7028.............  Fosphenytoin, 50 mg....  K...............  ...........        $5.50  ...........        $1.10
7034.............  Somatropin injection...  K...............  ...........       $46.75  ...........        $9.35
7035.............  Teniposide, 50 mg......  K...............  ...........      $261.93  ...........       $52.39
7036.............  Urokinase 250,000 IU     K...............  ...........      $453.41  ...........       $90.68
                    inj.
7038.............  Monoclonal antibodies..  K...............  ...........      $886.70  ...........      $177.34
7041.............  Tirofiban HCl..........  K...............  ...........        $7.66  ...........        $1.53
7042.............  Capecitabine, oral, 150  K...............  ...........        $3.94  ...........        $0.79
                    mg.
7043.............  Infliximab injection...  K...............  ...........       $53.25  ...........       $10.65
7045.............  Inj trimetrexate         K...............  ...........      $143.89  ...........       $28.78
                    glucoronate.
7046.............  Doxorubicin hcl          K...............  ...........      $385.81  ...........       $77.16
                    liposome inj.
7048.............  Alteplase recombinant..  K...............  ...........       $32.48  ...........        $6.50
7049.............  Filgrastim 480 mcg       K...............  ...........      $297.75  ...........       $59.55
                    injection.
7051.............  Leuprolide acetate       K...............  ...........    $1,696.96  ...........      $339.39
                    implant.
7308.............  Aminolevulinic acid hcl  K...............  ...........      $104.43  ...........       $20.89
                    top.
8000.............  Cardiac                  T...............     135.5822    $8,635.64  ...........    $1,727.13
                    Electrophysiologic
                    Evaluation and
                    Ablation Composite.
8001.............  LDR Prostate             T...............      49.7153    $3,166.52  ...........      $633.30
                    Brachytherapy
                    Composite.
9001.............  Linezolid injection....  K...............  ...........       $24.93  ...........        $4.99
9002.............  Tenecteplase injection.  K...............  ...........    $2,024.13  ...........      $404.83
9003.............  Palivizumab, per 50 mg.  K...............  ...........      $677.97  ...........      $135.59
9004.............  Gemtuzumab ozogamicin..  K...............  ...........    $2,334.75  ...........      $466.95
9005.............  Reteplase injection....  K...............  ...........      $891.03  ...........      $178.21
9006.............  Tacrolimus injection...  K...............  ...........      $139.11  ...........       $27.82
9012.............  Arsenic trioxide.......  K...............  ...........       $33.84  ...........        $6.77
9015.............  Mycophenolate mofetil    K...............  ...........        $2.60  ...........        $0.52
                    oral.
9018.............  Botulinum toxin type B.  K...............  ...........        $8.30  ...........        $1.66
9019.............  Caspofungin acetate....  K...............  ...........       $30.07  ...........        $6.01
9020.............  Sirolimus, oral........  K...............  ...........        $7.15  ...........        $1.43
9022.............  IM inj interferon beta   K...............  ...........      $113.49  ...........       $22.70
                    1-a.
9023.............  Rho d immune globulin    K...............  ...........       $26.41  ...........        $5.28
                    50 mcg.
9024.............  Amphotericin b lipid     K...............  ...........       $10.28  ...........        $2.06
                    complex.
9032.............  Baclofen 10 MG           K...............  ...........      $195.18  ...........       $39.04
                    injection.
9033.............  Cidofovir injection....  K...............  ...........      $754.62  ...........      $150.92
9038.............  Inj estrogen conjugate   K...............  ...........       $60.32  ...........       $12.06
                    25 MG.
9042.............  Glucagon hydrochloride/  K...............  ...........       $65.64  ...........       $13.13
                    1 MG.
9044.............  Ibutilide fumarate       K...............  ...........      $264.40  ...........       $52.88
                    injection.
9046.............  Iron sucrose injection.  K...............  ...........        $0.37  ...........        $0.08
9047.............  Itraconazole injection.  K...............  ...........       $38.05  ...........        $7.61
9051.............  Urea injection.........  K...............  ...........       $73.46  ...........       $14.69
9054.............  Metabolically active     K...............  ...........       $31.36  ...........        $6.27
                    tissue.
9104.............  Antithymocyte globuln    K...............  ...........      $324.66  ...........       $64.93
                    rabbit.
9108.............  Thyrotropin injection..  K...............  ...........      $758.16  ...........      $151.63
9110.............  Alemtuzumab injection..  K...............  ...........      $536.10  ...........      $107.22
9115.............  Zoledronic acid........  K...............  ...........      $204.09  ...........       $40.82
9119.............  Injection,               K...............  ...........    $2,142.92  ...........      $428.58
                    pegfilgrastim 6mg.
9120.............  Injection, Fulvestrant.  K...............  ...........       $79.80  ...........       $15.96
9121.............  Injection, argatroban..  K...............  ...........       $17.87  ...........        $3.57
9122.............  Triptorelin pamoate....  K...............  ...........      $153.97  ...........       $30.79
9124.............  Daptomycin injection...  K...............  ...........        $0.33  ...........        $0.07
9125.............  Risperidone, long        K...............  ...........        $4.80  ...........        $0.96
                    acting.
9126.............  Natalizumab injection..  K...............  ...........        $7.45  ...........        $1.49
9133.............  Rabies ig, im/sc.......  K...............  ...........       $64.82  ...........       $12.96
9134.............  Rabies ig, heat treated  K...............  ...........       $69.40  ...........       $13.88
9135.............  Varicella-zoster ig, im  K...............  ...........      $121.58  ...........       $24.32
9137.............  Bcg vaccine, percut....  K...............  ...........      $112.56  ...........       $22.51
9139.............  Rabies vaccine, im.....  K...............  ...........      $145.53  ...........       $29.11
9140.............  Rabies vaccine, id.....  K...............       1.9483      $124.09  ...........       $24.82
9141.............  Measles-rubella          K...............       0.9593       $61.10  ...........       $12.22
                    vaccine, sc.
9143.............  Meningococcal vaccine,   K...............  ...........       $88.59  ...........       $17.72
                    sc.
9144.............  Encephalitis vaccine,    K...............  ...........       $98.17  ...........       $19.63
                    sc.
9145.............  Meningococcal vaccine,   K...............       1.1309       $72.03  ...........       $14.41
                    im.
9156.............  Nonmetabolic active      K...............  ...........       $88.37  ...........       $17.67
                    tissue.
9167.............  Valrubicin, 200 mg.....  K...............       3.4445      $219.39  ...........       $43.88
9207.............  Bortezomib injection...  K...............  ...........       $32.37  ...........        $6.47
9208.............  Agalsidase beta          K...............  ...........      $126.00  ...........       $25.20
                    injection.
9209.............  Laronidase injection...  K...............  ...........       $23.64  ...........        $4.73
9210.............  Palonosetron HCl.......  K...............  ...........       $15.85  ...........        $3.17
9213.............  Pemetrexed injection...  K...............  ...........       $43.38  ...........        $8.68
9214.............  Bevacizumab injection..  K...............  ...........       $56.98  ...........       $11.40
9215.............  Cetuximab injection....  K...............  ...........       $49.34  ...........        $9.87
9216.............  Abarelix injection.....  K...............  ...........       $67.97  ...........       $13.59
9217.............  Leuprolide acetate       K...............  ...........      $227.34  ...........       $45.47
                    suspnsion.
9219.............  Mycophenolic acid......  K...............  ...........        $2.25  ...........        $0.45
9222.............  Injectable human tissue  K...............  ...........      $728.44  ...........      $145.69
9224.............  Galsulfase injection...  K...............  ...........      $297.09  ...........       $59.42
9225.............  Fluocinolone acetonide   K...............  ...........   $19,162.50  ...........    $3,832.50
                    implt.

[[Page 42847]]

 
9227.............  Micafungin sodium        G...............  ...........        $1.71  ...........        $0.34
                    injection.
9228.............  Tigecycline injection..  G...............  ...........        $0.91  ...........        $0.18
9229.............  Ibandronate sodium       G...............  ...........      $138.71  ...........       $27.74
                    injection.
9230.............  Abatacept injection....  G...............  ...........       $18.69  ...........        $3.74
9231.............  Decitabine injection...  G...............       0.4157       $26.48  ...........        $5.30
9232.............  Injection, idursulfase.  G...............  ...........      $455.03  ...........       $91.01
9233.............  Injection, ranibizumab.  G...............  ...........    $2,030.92  ...........      $406.18
9234.............  Inj, alglucosidase alfa  K...............  ...........      $126.00  ...........       $25.20
9235.............  Injection, panitumumab.  G...............  ...........       $84.80  ...........       $16.96
9300.............  Omalizumab injection...  K...............  ...........       $16.79  ...........        $3.36
9350.............  Porous collagen tube     G...............  ...........      $485.91  ...........       $97.18
                    per cm.
9351.............  Acellular derm tissue    G...............  ...........       $41.59  ...........        $8.32
                    percm2.
9500.............  Platelets, irradiated..  K...............       2.0742      $132.11  ...........       $26.42
9501.............  Platelet pheres          K...............       7.9954      $509.25  ...........      $101.85
                    leukoreduced.
9502.............  Platelet pheresis        K...............       7.0075      $446.33  ...........       $89.27
                    irradiated.
9503.............  Fr frz plasma donor      K...............       1.1632       $74.09  ...........       $14.82
                    retested.
9504.............  RBC deglycerolized.....  K...............       5.7938      $369.02  ...........       $73.80
9505.............  RBC irradiated.........  K...............       3.3259      $211.84  ...........       $42.37
9506.............  Granulocytes, pheresis   K...............      15.5519      $990.55  ...........      $198.11
                    unit.
9507.............  Platelets, pheresis....  K...............       7.0406      $448.44  ...........       $89.69
9508.............  Plasma 1 donor frz w/in  K...............       1.0902       $69.44  ...........       $13.89
                    8 hr.
----------------------------------------------------------------------------------------------------------------


[[Page 42848]]


            Addendum AA.--Proposed ASC Covered Surgical Procedures for CY 2008 (Including Surgical Procedures for Which Payment Is Packaged)
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                     Proposed                Proposed CY
                                                 Subject to                                           CY 2007 ASC     fully     Proposed CY   2008 first
    HCPCS Code         Short Descriptor           multiple      Comment indicator  Payment indicator    payment    implemented   2008 fully   transition
                                                 procedure                                                rate       payment    implemented      year
                                                discounting                                                           weight      payment      payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
0016T............  Thermotx choroid vasc     Y................  .................  R2...............  ...........       4.0100      $166.01      $166.01
                    lesion.
0017T............  Photocoagulat macular     Y................  .................  R2...............  ...........       4.0100      $166.01      $166.01
                    drusen.
0027T............  Endoscopic epidural       Y................  .................  G2...............  ...........      18.5069      $766.19      $766.19
                    lysis.
0031T............  Speculoscopy............  N................  .................  N1...............  ...........  ...........  ...........  ...........
0032T............  Speculoscopy w/direct     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    sample.
0046T............  Cath lavage, mammary      Y................  .................  R2...............  ...........      16.5832      $686.54      $686.54
                    duct(s).
0047T............  Cath lavage, mammary      Y................  .................  R2...............  ...........      16.5832      $686.54      $686.54
                    duct(s).
0062T............  Rep intradisc annulus; 1  Y................  .................  G2...............  ...........      29.3263    $1,214.11    $1,214.11
                    lev.
0063T............  Rep intradisc annulus;    Y................  .................  G2...............  ...........      29.3263    $1,214.11    $1,214.11
                    >1 lev.
0084T............  Temp prostate urethral    Y................  .................  G2...............  ...........       2.1659       $89.67       $89.67
                    stent.
0099T*...........  Implant corneal ring....  Y................  .................  R2...............  ...........      16.5252      $684.14      $684.14
0100T............  Prosth retina             Y................  .................  G2...............  ...........      38.1121    $1,577.84    $1,577.84
                    receive&gen.
0101T............  Extracorp shockwv tx,hi   Y................  .................  G2...............  ...........      29.3263    $1,214.11    $1,214.11
                    enrg.
0102T............  Extracorp shockwv         Y................  .................  G2...............  ...........      29.3263    $1,214.11    $1,214.11
                    tx,anesth.
0123T............  Scleral fistulization...  Y................  .................  G2...............  ...........      24.0821      $997.00      $997.00
0124T*...........  Conjunctival drug         Y................  .................  R2...............  ...........       5.1145      $211.74      $211.74
                    placement.
0133T............  Esophageal implant        Y................  .................  G2...............  ...........      24.6480    $1,020.43    $1,020.43
                    injexn.
0176T............  Aqu canal dilat w/o       Y................  .................  A2...............    $1,339.00      40.8481    $1,691.11    $1,427.03
                    retent.
0177T............  Aqu canal dilat w retent  Y................  .................  A2...............    $1,339.00      40.8481    $1,691.11    $1,427.03
10021............  Fna w/o image...........  Y................  .................  P2...............  ...........       1.1915       $49.33       $49.33
10022............  Fna w/image.............  Y................  .................  G2...............  ...........       4.5062      $186.56      $186.56
10040............  Acne surgery............  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
10060............  Drainage of skin abscess  Y................  .................  P3...............  ...........       1.1130       $46.08       $46.08
10061............  Drainage of skin abscess  Y................  .................  P2...............  ...........       1.4630       $60.57       $60.57
10080............  Drainage of pilonidal     Y................  .................  P2...............  ...........       1.4630       $60.57       $60.57
                    cyst.
10081............  Drainage of pilonidal     Y................  .................  P3...............  ...........       3.1002      $128.35      $128.35
                    cyst.
10120............  Remove foreign body.....  Y................  .................  P2...............  ...........       1.4630       $60.57       $60.57
10121............  Remove foreign body.....  Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
10140............  Drainage of hematoma/     Y................  .................  P3...............  ...........       1.6490       $68.27       $68.27
                    fluid.
10160............  Puncture drainage of      Y................  CH...............  P3...............  ...........       1.4099       $58.37       $58.37
                    lesion.
10180............  Complex drainage, wound.  Y................  .................  A2...............      $446.00      19.0457      $788.49      $531.62
11000............  Debride infected skin...  Y................  .................  P3...............  ...........       0.5360       $22.19       $22.19
11001............  Debride infected skin     Y................  .................  P3...............  ...........       0.1896        $7.85        $7.85
                    add-on.
11010............  Debride skin, fx........  Y................  .................  A2...............      $251.52       4.4463      $184.08      $234.66
11011............  Debride skin/muscle, fx.  Y................  .................  A2...............      $251.52       4.4463      $184.08      $234.66
11012............  Debride skin/muscle/      Y................  .................  A2...............      $251.52       4.4463      $184.08      $234.66
                    bone, fx.
11040............  Debride skin, partial...  Y................  .................  P3...............  ...........       0.4865       $20.14       $20.14
11041............  Debride skin, full......  Y................  .................  P3...............  ...........       0.5688       $23.55       $23.55
11042............  Debride skin/tissue.....  Y................  .................  A2...............      $164.42       2.7493      $113.82      $151.77
11043............  Debride tissue/muscle...  Y................  .................  A2...............      $164.42       2.7493      $113.82      $151.77
11044............  Debride tissue/muscle/    Y................  .................  A2...............      $423.10       7.1126      $294.46      $390.94
                    bone.
11055............  Trim skin lesion........  Y................  .................  P3...............  ...........       0.5606       $23.21       $23.21
11056............  Trim skin lesions, 2 to   Y................  .................  P3...............  ...........       0.6184       $25.60       $25.60
                    4.
11057............  Trim skin lesions, over   Y................  .................  P3...............  ...........       0.7092       $29.36       $29.36
                    4.
11100............  Biopsy, skin lesion.....  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
11101............  Biopsy, skin add-on.....  Y................  .................  P3...............  ...........       0.3051       $12.63       $12.63
11200............  Removal of skin tags....  Y................  CH...............  P2...............  ...........       0.8046       $33.31       $33.31
11201............  Remove skin tags add-on.  Y................  .................  P3...............  ...........       0.1319        $5.46        $5.46
11300............  Shave skin lesion.......  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
11301............  Shave skin lesion.......  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
11302............  Shave skin lesion.......  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
11303............  Shave skin lesion.......  Y................  .................  P3...............  ...........       1.4841       $61.44       $61.44
11305............  Shave skin lesion.......  Y................  .................  P3...............  ...........       0.7833       $32.43       $32.43
11306............  Shave skin lesion.......  Y................  CH...............  P2...............  ...........       0.8046       $33.31       $33.31
11307............  Shave skin lesion.......  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
11308............  Shave skin lesion.......  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
11310............  Shave skin lesion.......  Y................  CH...............  P2...............  ...........       0.8046       $33.31       $33.31
11311............  Shave skin lesion.......  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
11312............  Shave skin lesion.......  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
11313............  Shave skin lesion.......  Y................  CH...............  P2...............  ...........       0.8046       $33.31       $33.31
11400............  Exc tr-ext b9+marg 0.5 <  Y................  .................  P3...............  ...........       1.5913       $65.88       $65.88
                    cm.
11401............  Exc tr-ext b9+marg 0.6-1  Y................  .................  P3...............  ...........       1.7396       $72.02       $72.02
                    cm.
11402............  Exc tr-ext b9+marg 1.1-2  Y................  .................  P3...............  ...........       1.8964       $78.51       $78.51
                    cm.
11403............  Exc tr-ext b9+marg 2.1-3  Y................  .................  P3...............  ...........       2.0365       $84.31       $84.31
                    cm.
11404............  Exc tr-ext b9+marg 3.1-4  Y................  .................  A2...............      $333.00      16.5832      $686.54      $421.39
                    cm.
11406............  Exc tr-ext b9+marg > 4.0  Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    cm.
11420............  Exc h-f-nk-sp b9+marg     Y................  .................  P3...............  ...........       1.4758       $61.10       $61.10
                    0.5 <.
11421............  Exc h-f-nk-sp b9+marg     Y................  .................  P3...............  ...........       1.7563       $72.71       $72.71
                    0.6-1.
11422............  Exc h-f-nk-sp b9+marg     Y................  .................  P3...............  ...........       1.9210       $79.53       $79.53
                    1.1-2.
11423............  Exc h-f-nk-sp b9+marg     Y................  .................  P3...............  ...........       2.1601       $89.43       $89.43
                    2.1-3.
11424............  Exc h-f-nk-sp b9+marg     Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    3.1-4.
11426............  Exc h-f-nk-sp b9+marg >   Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    4 cm.
11440............  Exc face-mm b9+marg 0.5   Y................  .................  P3...............  ...........       1.7314       $71.68       $71.68
                    < cm.
11441............  Exc face-mm b9+marg 0.6-  Y................  .................  P3...............  ...........       1.9459       $80.56       $80.56
                    1 cm.
11442............  Exc face-mm b9+marg 1.1-  Y................  .................  P3...............  ...........       2.1273       $88.07       $88.07
                    2 cm.
11443............  Exc face-mm b9+marg 2.1-  Y................  .................  P3...............  ...........       2.3829       $98.65       $98.65
                    3 cm.

[[Page 42849]]

 
11444............  Exc face-mm b9+marg 3.1-  Y................  .................  A2...............      $333.00       8.7155      $360.82      $339.96
                    4 cm.
11446............  Exc face-mm b9+marg > 4   Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    cm.
11450............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    lesion.
11451............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    lesion.
11462............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    lesion.
11463............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    lesion.
11470............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    lesion.
11471............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    lesion.
11600............  Exc tr-ext mlg+marg 0.5   Y................  .................  P3...............  ...........       2.2097       $91.48       $91.48
                    < cm.
11601............  Exc tr-ext mlg+marg 0.6-  Y................  .................  P3...............  ...........       2.5312      $104.79      $104.79
                    1 cm.
11602............  Exc tr-ext mlg+marg 1.1-  Y................  .................  P3...............  ...........       2.7457      $113.67      $113.67
                    2 cm.
11603............  Exc tr-ext mlg+marg 2.1-  Y................  .................  P3...............  ...........       2.9353      $121.52      $121.52
                    3 cm.
11604............  Exc tr-ext mlg+marg 3.1-  Y................  .................  A2...............      $418.49       8.7155      $360.82      $404.07
                    4 cm.
11606............  Exc tr-ext mlg+marg > 4   Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    cm.
11620............  Exc h-f-nk-sp mlg+marg    Y................  .................  P3...............  ...........       2.2428       $92.85       $92.85
                    0.5 <.
11621............  Exc h-f-nk-sp mlg+marg    Y................  .................  P3...............  ...........       2.5560      $105.82      $105.82
                    0.6-1.
11622............  Exc h-f-nk-sp mlg+marg    Y................  .................  P3...............  ...........       2.8280      $117.08      $117.08
                    1.1-2.
11623............  Exc h-f-nk-sp mlg+marg    Y................  .................  P3...............  ...........       3.0671      $126.98      $126.98
                    2.1-3.
11624............  Exc h-f-nk-sp mlg+marg    Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    3.1-4.
11626............  Exc h-f-nk-sp mlg+mar >   Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    4 cm.
11640............  Exc face-mm malig+marg    Y................  .................  P3...............  ...........       2.3498       $97.28       $97.28
                    0.5 <.
11641............  Exc face-mm malig+marg    Y................  .................  P3...............  ...........       2.7457      $113.67      $113.67
                    0.6-1.
11642............  Exc face-mm malig+marg    Y................  .................  P3...............  ...........       3.0671      $126.98      $126.98
                    1.1-2.
11643............  Exc face-mm malig+marg    Y................  .................  P3...............  ...........       3.3312      $137.91      $137.91
                    2.1-3.
11644............  Exc face-mm malig+marg    Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    3.1-4.
11646............  Exc face-mm mlg+marg > 4  Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    cm.
11719............  Trim nail(s)............  Y................  .................  P3...............  ...........       0.2556       $10.58       $10.58
11720............  Debride nail, 1-5.......  Y................  .................  P3...............  ...........       0.3297       $13.65       $13.65
11721............  Debride nail, 6 or more.  Y................  .................  P3...............  ...........       0.4041       $16.73       $16.73
11730............  Removal of nail plate...  Y................  CH...............  P2...............  ...........       0.8046       $33.31       $33.31
11732............  Remove nail plate, add-   Y................  .................  P3...............  ...........       0.4041       $16.73       $16.73
                    on.
11740............  Drain blood from under    Y................  CH...............  P2...............  ...........       0.2682       $11.10       $11.10
                    nail.
11750............  Removal of nail bed.....  Y................  .................  P3...............  ...........       2.0942       $86.70       $86.70
11752............  Remove nail bed/finger    Y................  .................  P3...............  ...........       2.8940      $119.81      $119.81
                    tip.
11755............  Biopsy, nail unit.......  Y................  .................  P3...............  ...........       1.4758       $61.10       $61.10
11760............  Repair of nail bed......  Y................  .................  G2...............  ...........       2.1114       $87.41       $87.41
11762............  Reconstruction of nail    Y................  CH...............  P3...............  ...........       2.6961      $111.62      $111.62
                    bed.
11765............  Excision of nail fold,    Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
                    toe.
11770............  Removal of pilonidal      Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    lesion.
11771............  Removal of pilonidal      Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    lesion.
11772............  Removal of pilonidal      Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    lesion.
11900............  Injection into skin       Y................  .................  P3...............  ...........       0.6514       $26.97       $26.97
                    lesions.
11901............  Added skin lesions        Y................  .................  P3...............  ...........       0.6925       $28.67       $28.67
                    injection.
11920............  Correct skin color        Y................  .................  P2...............  ...........       2.1114       $87.41       $87.41
                    defects.
11921............  Correct skin color        Y................  .................  P2...............  ...........       2.1114       $87.41       $87.41
                    defects.
11922............  Correct skin color        Y................  .................  P3...............  ...........       0.8493       $35.16       $35.16
                    defects.
11950............  Therapy for contour       Y................  .................  P3...............  ...........       0.8329       $34.48       $34.48
                    defects.
11951............  Therapy for contour       Y................  .................  P3...............  ...........       1.0225       $42.33       $42.33
                    defects.
11952............  Therapy for contour       Y................  CH...............  P2...............  ...........       1.3340       $55.23       $55.23
                    defects.
11954............  Therapy for contour       Y................  .................  P2...............  ...........       1.3340       $55.23       $55.23
                    defects.
11960............  Insert tissue             Y................  .................  A2...............      $446.00      20.9338      $866.66      $551.17
                    expander(s).
11970............  Replace tissue expander.  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
11971............  Remove tissue             Y................  .................  A2...............      $333.00      21.4534      $888.17      $471.79
                    expander(s).
11976............  Removal of contraceptive  Y................  .................  P3...............  ...........       1.4181       $58.71       $58.71
                    cap.
11980............  Implant hormone           N................  .................  P2...............  ...........       0.6416       $26.56       $26.56
                    pellet(s).
11981............  Insert drug implant       N................  .................  P2...............  ...........       0.6416       $26.56       $26.56
                    device.
11982............  Remove drug implant       N................  .................  P2...............  ...........       0.6416       $26.56       $26.56
                    device.
11983............  Remove/insert drug        N................  .................  P2...............  ...........       0.6416       $26.56       $26.56
                    implant.
12001............  Repair superficial        Y................  .................  P2...............  ...........       1.3340       $55.23       $55.23
                    wound(s).
12002............  Repair superficial        Y................  .................  P2...............  ...........       1.3340       $55.23       $55.23
                    wound(s).
12004............  Repair superficial        Y................  .................  P2...............  ...........       1.3340       $55.23       $55.23
                    wound(s).
12005............  Repair superficial        Y................  .................  A2...............       $91.24       1.3340       $55.23       $82.24
                    wound(s).
12006............  Repair superficial        Y................  .................  A2...............       $91.24       1.3340       $55.23       $82.24
                    wound(s).
12007............  Repair superficial        Y................  .................  A2...............       $91.24       1.3340       $55.23       $82.24
                    wound(s).
12011............  Repair superficial        Y................  .................  P2...............  ...........       1.3340       $55.23       $55.23
                    wound(s).
12013............  Repair superficial        Y................  .................  P2...............  ...........       1.3340       $55.23       $55.23
                    wound(s).
12014............  Repair superficial        Y................  .................  P2...............  ...........       1.3340       $55.23       $55.23
                    wound(s).
12015............  Repair superficial        Y................  .................  G2...............  ...........       1.3340       $55.23       $55.23
                    wound(s).
12016............  Repair superficial        Y................  .................  A2...............       $91.24       1.3340       $55.23       $82.24
                    wound(s).
12017............  Repair superficial        Y................  .................  A2...............       $91.24       1.3340       $55.23       $82.24
                    wound(s).
12018............  Repair superficial        Y................  .................  A2...............       $91.24       1.3340       $55.23       $82.24
                    wound(s).
12020............  Closure of split wound..  Y................  .................  A2...............       $91.24       4.6816      $193.82      $116.89
12021............  Closure of split wound..  Y................  .................  A2...............       $91.24       4.6816      $193.82      $116.89
12031............  Layer closure of          Y................  .................  P2...............  ...........       2.1114       $87.41       $87.41
                    wound(s).
12032............  Layer closure of          Y................  .................  P2...............  ...........       2.1114       $87.41       $87.41
                    wound(s).
12034............  Layer closure of          Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    wound(s).

[[Page 42850]]

 
12035............  Layer closure of          Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    wound(s).
12036............  Layer closure of          Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    wound(s).
12037............  Layer closure of          Y................  .................  A2...............      $323.28       2.1114       $87.41      $264.31
                    wound(s).
12041............  Layer closure of          Y................  .................  P2...............  ...........       2.1114       $87.41       $87.41
                    wound(s).
12042............  Layer closure of          Y................  .................  P2...............  ...........       2.1114       $87.41       $87.41
                    wound(s).
12044............  Layer closure of          Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    wound(s).
12045............  Layer closure of          Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    wound(s).
12046............  Layer closure of          Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    wound(s).
12047............  Layer closure of          Y................  .................  A2...............      $323.28       2.1114       $87.41      $264.31
                    wound(s).
12051............  Layer closure of          Y................  .................  P2...............  ...........       2.1114       $87.41       $87.41
                    wound(s).
12052............  Layer closure of          Y................  .................  P2...............  ...........       2.1114       $87.41       $87.41
                    wound(s).
12053............  Layer closure of          Y................  .................  P2...............  ...........       2.1114       $87.41       $87.41
                    wound(s).
12054............  Layer closure of          Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    wound(s).
12055............  Layer closure of          Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    wound(s).
12056............  Layer closure of          Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    wound(s).
12057............  Layer closure of          Y................  .................  A2...............      $323.28       2.1114       $87.41      $264.31
                    wound(s).
13100............  Repair of wound or        Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    lesion.
13101............  Repair of wound or        Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    lesion.
13102............  Repair wound/lesion add-  Y................  .................  A2...............       $91.24       4.6816      $193.82      $116.89
                    on.
13120............  Repair of wound or        Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    lesion.
13121............  Repair of wound or        Y................  .................  A2...............       $91.24       4.6816      $193.82      $116.89
                    lesion.
13122............  Repair wound/lesion add-  Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    on.
13131............  Repair of wound or        Y................  .................  A2...............       $91.24       4.6816      $193.82      $116.89
                    lesion.
13132............  Repair of wound or        Y................  .................  A2...............       $91.24       4.6816      $193.82      $116.89
                    lesion.
13133............  Repair wound/lesion add-  Y................  .................  A2...............       $91.24       4.6816      $193.82      $116.89
                    on.
13150............  Repair of wound or        Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    lesion.
13151............  Repair of wound or        Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    lesion.
13152............  Repair of wound or        Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    lesion.
13153............  Repair wound/lesion add-  Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    on.
13160............  Late closure of wound...  Y................  .................  A2...............      $446.00      20.9338      $866.66      $551.17
14000............  Skin tissue               Y................  .................  A2...............      $446.00      15.4399      $639.21      $494.30
                    rearrangement.
14001............  Skin tissue               Y................  .................  A2...............      $510.00      15.4399      $639.21      $542.30
                    rearrangement.
14020............  Skin tissue               Y................  .................  A2...............      $510.00      15.4399      $639.21      $542.30
                    rearrangement.
14021............  Skin tissue               Y................  .................  A2...............      $510.00      15.4399      $639.21      $542.30
                    rearrangement.
14040............  Skin tissue               Y................  .................  A2...............      $446.00      15.4399      $639.21      $494.30
                    rearrangement.
14041............  Skin tissue               Y................  .................  A2...............      $510.00      15.4399      $639.21      $542.30
                    rearrangement.
14060............  Skin tissue               Y................  .................  A2...............      $510.00      15.4399      $639.21      $542.30
                    rearrangement.
14061............  Skin tissue               Y................  .................  A2...............      $510.00      15.4399      $639.21      $542.30
                    rearrangement.
14300............  Skin tissue               Y................  .................  A2...............      $630.00      20.9338      $866.66      $689.17
                    rearrangement.
14350............  Skin tissue               Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    rearrangement.
15002............  Wnd prep, ch/inf, trk/    Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    arm/lg.
15003............  Wnd prep, ch/inf addl     Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    100 cm.
15004............  Wnd prep ch/inf, f/n/hf/  Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    g.
15005............  Wnd prep, f/n/hf/g, addl  Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    cm.
15040............  Harvest cultured skin     Y................  .................  A2...............       $91.24       2.1114       $87.41       $90.28
                    graft.
15050............  Skin pinch graft........  Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
15100............  Skin splt grft, trnk/arm/ Y................  .................  A2...............      $446.00      20.9338      $866.66      $551.17
                    leg.
15101............  Skin splt grft t/a/l,     Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    add-on.
15110............  Epidrm autogrft trnk/arm/ Y................  .................  A2...............      $446.00       4.6816      $193.82      $382.96
                    leg.
15111............  Epidrm autogrft t/a/l     Y................  .................  A2...............      $333.00       4.6816      $193.82      $298.21
                    add-on.
15115............  Epidrm a-grft face/nck/   Y................  .................  A2...............      $446.00       4.6816      $193.82      $382.96
                    hf/g.
15116............  Epidrm a-grft f/n/hf/g    Y................  .................  A2...............      $333.00       4.6816      $193.82      $298.21
                    addl.
15120............  Skn splt a-grft fac/nck/  Y................  .................  A2...............      $446.00      20.9338      $866.66      $551.17
                    hf/g.
15121............  Skn splt a-grft f/n/hf/g  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    add.
15130............  Derm autograft, trnk/arm/ Y................  .................  A2...............      $446.00      15.4399      $639.21      $494.30
                    leg.
15131............  Derm autograft t/a/l add- Y................  .................  A2...............      $333.00      15.4399      $639.21      $409.55
                    on.
15135............  Derm autograft face/nck/  Y................  .................  A2...............      $446.00      15.4399      $639.21      $494.30
                    hf/g.
15136............  Derm autograft, f/n/hf/g  Y................  .................  A2...............      $333.00      15.4399      $639.21      $409.55
                    add.
15150............  Cult epiderm grft t/arm/  Y................  .................  A2...............      $446.00       4.6816      $193.82      $382.96
                    leg.
15151............  Cult epiderm grft t/a/l   Y................  .................  A2...............      $333.00       4.6816      $193.82      $298.21
                    addl.
15152............  Cult epiderm graft t/a/l  Y................  .................  A2...............      $333.00       4.6816      $193.82      $298.21
                    +%.
15155............  Cult epiderm graft, f/n/  Y................  .................  A2...............      $446.00       4.6816      $193.82      $382.96
                    hf/g.
15156............  Cult epidrm grft f/n/hfg  Y................  .................  A2...............      $333.00       4.6816      $193.82      $298.21
                    add.
15157............  Cult epiderm grft f/n/    Y................  .................  A2...............      $333.00       4.6816      $193.82      $298.21
                    hfg +%.
15200............  Skin full graft, trunk..  Y................  .................  A2...............      $510.00      15.4399      $639.21      $542.30
15201............  Skin full graft trunk     Y................  .................  A2...............      $323.28      15.4399      $639.21      $402.26
                    add-on.
15220............  Skin full graft sclp/arm/ Y................  .................  A2...............      $446.00      15.4399      $639.21      $494.30
                    leg.
15221............  Skin full graft add-on..  Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
15240............  Skin full grft face/      Y................  .................  A2...............      $510.00      15.4399      $639.21      $542.30
                    genit/hf.
15241............  Skin full graft add-on..  Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
15260............  Skin full graft een &     Y................  .................  A2...............      $446.00      15.4399      $639.21      $494.30
                    lips.
15261............  Skin full graft add-on..  Y................  .................  A2...............      $323.28      15.4399      $639.21      $402.26
15300............  Apply skinallogrft, t/    Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    arm/lg.
15301............  Apply sknallogrft t/a/l   Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    addl.
15320............  Apply skin allogrft f/n/  Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    hf/g.
15321............  Aply sknallogrft f/n/hfg  Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    add.

[[Page 42851]]

 
15330............  Aply acell alogrft t/arm/ Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    leg.
15331............  Aply acell grft t/a/l     Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    add-on.
15335............  Apply acell graft, f/n/   Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    hf/g.
15336............  Aply acell grft f/n/hf/g  Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    add.
15340............  Apply cult skin           Y................  .................  G2...............  ...........       2.1114       $87.41       $87.41
                    substitute.
15341............  Apply cult skin sub add-  Y................  .................  G2...............  ...........       2.1114       $87.41       $87.41
                    on.
15360............  Apply cult derm sub, t/a/ Y................  .................  G2...............  ...........       2.1114       $87.41       $87.41
                    l.
15361............  Aply cult derm sub t/a/l  Y................  .................  G2...............  ...........       2.1114       $87.41       $87.41
                    add.
15365............  Apply cult derm sub f/n/  Y................  .................  G2...............  ...........       2.1114       $87.41       $87.41
                    hf/g.
15366............  Apply cult derm f/hf/g    Y................  .................  G2...............  ...........       2.1114       $87.41       $87.41
                    add.
15400............  Apply skin xenograft, t/  Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    a/l.
15401............  Apply skn xenogrft t/a/l  Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    add.
15420............  Apply skin xgraft, f/n/   Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    hf/g.
15421............  Apply skn xgrft f/n/hf/g  Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    add.
15430............  Apply acellular           Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    xenograft.
15431............  Apply acellular xgraft    Y................  .................  A2...............      $323.28       4.6816      $193.82      $290.92
                    add.
15570............  Form skin pedicle flap..  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15572............  Form skin pedicle flap..  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15574............  Form skin pedicle flap..  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15576............  Form skin pedicle flap..  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15600............  Skin graft..............  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15610............  Skin graft..............  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15620............  Skin graft..............  Y................  .................  A2...............      $630.00      20.9338      $866.66      $689.17
15630............  Skin graft..............  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15650............  Transfer skin pedicle     Y................  .................  A2...............      $717.00      20.9338      $866.66      $754.42
                    flap.
15731............  Forehead flap w/vasc      Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    pedicle.
15732............  Muscle-skin graft, head/  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    neck.
15734............  Muscle-skin graft, trunk  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15736............  Muscle-skin graft, arm..  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15738............  Muscle-skin graft, leg..  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15740............  Island pedicle flap       Y................  .................  A2...............      $446.00      15.4399      $639.21      $494.30
                    graft.
15750............  Neurovascular pedicle     Y................  .................  A2...............      $446.00      20.9338      $866.66      $551.17
                    graft.
15760............  Composite skin graft....  Y................  .................  A2...............      $446.00      20.9338      $866.66      $551.17
15770............  Derma-fat-fascia graft..  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15775............  Hair transplant punch     Y................  .................  A2...............      $323.28       1.3340       $55.23      $256.27
                    grafts.
15776............  Hair transplant punch     Y................  .................  A2...............      $323.28       1.3340       $55.23      $256.27
                    grafts.
15780............  Abrasion treatment of     Y................  .................  P3...............  ...........       9.5232      $394.26      $394.26
                    skin.
15781............  Abrasion treatment of     Y................  .................  P2...............  ...........       4.4463      $184.08      $184.08
                    skin.
15782............  Abrasion treatment of     Y................  .................  P2...............  ...........       4.4463      $184.08      $184.08
                    skin.
15783............  Abrasion treatment of     Y................  .................  P2...............  ...........       2.7493      $113.82      $113.82
                    skin.
15786............  Abrasion, lesion, single  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
15787............  Abrasion, lesions, add-   Y................  .................  P3...............  ...........       0.7915       $32.77       $32.77
                    on.
15788............  Chemical peel, face,      Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
                    epiderm.
15789............  Chemical peel, face,      Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
                    dermal.
15792............  Chemical peel, nonfacial  Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
15793............  Chemical peel, nonfacial  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
15819............  Plastic surgery, neck...  Y................  .................  G2...............  ...........       2.1114       $87.41       $87.41
15820............  Revision of lower eyelid  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15821............  Revision of lower eyelid  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15822............  Revision of upper eyelid  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15823............  Revision of upper eyelid  Y................  .................  A2...............      $717.00      20.9338      $866.66      $754.42
15824............  Removal of forehead       Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    wrinkles.
15825............  Removal of neck wrinkles  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15826............  Removal of brow wrinkles  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15828............  Removal of face wrinkles  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15829............  Removal of skin wrinkles  Y................  .................  A2...............      $717.00      20.9338      $866.66      $754.42
15830............  Exc skin abd............  Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
15832............  Excise excessive skin     Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    tissue.
15833............  Excise excessive skin     Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    tissue.
15834............  Excise excessive skin     Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    tissue.
15835............  Excise excessive skin     Y................  .................  A2...............      $323.28      21.4534      $888.17      $464.50
                    tissue.
15836............  Excise excessive skin     Y................  .................  A2...............      $510.00      16.5832      $686.54      $554.14
                    tissue.
15837............  Excise excessive skin     Y................  .................  G2...............  ...........      16.5832      $686.54      $686.54
                    tissue.
15838............  Excise excessive skin     Y................  .................  G2...............  ...........      16.5832      $686.54      $686.54
                    tissue.
15839............  Excise excessive skin     Y................  .................  A2...............      $510.00      16.5832      $686.54      $554.14
                    tissue.
15840............  Graft for face nerve      Y................  .................  A2...............      $630.00      20.9338      $866.66      $689.17
                    palsy.
15841............  Graft for face nerve      Y................  .................  A2...............      $630.00      20.9338      $866.66      $689.17
                    palsy.
15842............  Flap for face nerve       Y................  .................  G2...............  ...........      20.9338      $866.66      $866.66
                    palsy.
15845............  Skin and muscle repair,   Y................  .................  A2...............      $630.00      20.9338      $866.66      $689.17
                    face.
15847............  Exc skin abd add-on.....  Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
15850............  Removal of sutures......  Y................  .................  G2...............  ...........       2.7493      $113.82      $113.82
15851............  Removal of sutures......  Y................  .................  P3...............  ...........       1.2367       $51.20       $51.20
15852............  Dressing change not for   N................  .................  G2...............  ...........       0.6416       $26.56       $26.56
                    burn.
15860............  Test for blood flow in    N................  .................  G2...............  ...........       0.6416       $26.56       $26.56
                    graft.
15876............  Suction assisted          Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    lipectomy.
15877............  Suction assisted          Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    lipectomy.

[[Page 42852]]

 
15878............  Suction assisted          Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    lipectomy.
15879............  Suction assisted          Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    lipectomy.
15920............  Removal of tail bone      Y................  .................  A2...............      $251.52       4.4463      $184.08      $234.66
                    ulcer.
15922............  Removal of tail bone      Y................  .................  A2...............      $630.00      20.9338      $866.66      $689.17
                    ulcer.
15931............  Remove sacrum pressure    Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    sore.
15933............  Remove sacrum pressure    Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    sore.
15934............  Remove sacrum pressure    Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    sore.
15935............  Remove sacrum pressure    Y................  .................  A2...............      $630.00      20.9338      $866.66      $689.17
                    sore.
15936............  Remove sacrum pressure    Y................  .................  A2...............      $630.00      15.4399      $639.21      $632.30
                    sore.
15937............  Remove sacrum pressure    Y................  .................  A2...............      $630.00      20.9338      $866.66      $689.17
                    sore.
15940............  Remove hip pressure sore  Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
15941............  Remove hip pressure sore  Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
15944............  Remove hip pressure sore  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
15945............  Remove hip pressure sore  Y................  .................  A2...............      $630.00      20.9338      $866.66      $689.17
15946............  Remove hip pressure sore  Y................  .................  A2...............      $630.00      20.9338      $866.66      $689.17
15950............  Remove thigh pressure     Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    sore.
15951............  Remove thigh pressure     Y................  .................  A2...............      $630.00      21.4534      $888.17      $694.54
                    sore.
15952............  Remove thigh pressure     Y................  .................  A2...............      $510.00      15.4399      $639.21      $542.30
                    sore.
15953............  Remove thigh pressure     Y................  .................  A2...............      $630.00      15.4399      $639.21      $632.30
                    sore.
15956............  Remove thigh pressure     Y................  .................  A2...............      $510.00      15.4399      $639.21      $542.30
                    sore.
15958............  Remove thigh pressure     Y................  .................  A2...............      $630.00      15.4399      $639.21      $632.30
                    sore.
16000............  Initial treatment of      Y................  .................  P3...............  ...........       0.6514       $26.97       $26.97
                    burn(s).
16020............  Dress/debrid p-thick      Y................  .................  P3...............  ...........       0.9894       $40.96       $40.96
                    burn, s.
16025............  Dress/debrid p-thick      Y................  .................  A2...............       $67.11       2.7493      $113.82       $78.79
                    burn, m.
16030............  Dress/debrid p-thick      Y................  .................  A2...............       $99.83       2.7493      $113.82      $103.33
                    burn, l.
16035............  Incision of burn scab,    Y................  .................  G2...............  ...........       2.7493      $113.82      $113.82
                    initi.
17000............  Destruct premalg lesion.  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
17003............  Destruct premalg les, 2-  Y................  .................  P3...............  ...........       0.0906        $3.75        $3.75
                    14.
17004............  Destroy premlg lesions    Y................  .................  P3...............  ...........       1.9541       $80.90       $80.90
                    15+.
17106............  Destruction of skin       Y................  .................  P2...............  ...........       2.7493      $113.82      $113.82
                    lesions.
17107............  Destruction of skin       Y................  .................  P2...............  ...........       2.7493      $113.82      $113.82
                    lesions.
17108............  Destruction of skin       Y................  .................  P2...............  ...........       2.7493      $113.82      $113.82
                    lesions.
17110............  Destruct b9 lesion, 1-14  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
17111............  Destruct lesion, 15 or    Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
                    more.
17250............  Chemical cautery, tissue  Y................  .................  P3...............  ...........       1.0471       $43.35       $43.35
17260............  Destruction of skin       Y................  .................  P3...............  ...........       1.1130       $46.08       $46.08
                    lesions.
17261............  Destruction of skin       Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
                    lesions.
17262............  Destruction of skin       Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
                    lesions.
17263............  Destruction of skin       Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
                    lesions.
17264............  Destruction of skin       Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
                    lesions.
17266............  Destruction of skin       Y................  .................  P3...............  ...........       2.4819      $102.75      $102.75
                    lesions.
17270............  Destruction of skin       Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
                    lesions.
17271............  Destruction of skin       Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
                    lesions.
17272............  Destruction of skin       Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
                    lesions.
17273............  Destruction of skin       Y................  CH...............  P3...............  ...........       2.2345       $92.51       $92.51
                    lesions.
17274............  Destruction of skin       Y................  .................  P3...............  ...........       2.5560      $105.82      $105.82
                    lesions.
17276............  Destruction of skin       Y................  .................  P2...............  ...........       2.7493      $113.82      $113.82
                    lesions.
17280............  Destruction of skin       Y................  CH...............  P2...............  ...........       1.5119       $62.59       $62.59
                    lesions.
17281............  Destruction of skin       Y................  CH...............  P3...............  ...........       1.9210       $79.53       $79.53
                    lesions.
17282............  Destruction of skin       Y................  CH...............  P3...............  ...........       2.1932       $90.80       $90.80
                    lesions.
17283............  Destruction of skin       Y................  CH...............  P3...............  ...........       2.5229      $104.45      $104.45
                    lesions.
17284............  Destruction of skin       Y................  .................  P2...............  ...........       2.7493      $113.82      $113.82
                    lesions.
17286............  Destruction of skin       Y................  .................  P2...............  ...........       2.7493      $113.82      $113.82
                    lesions.
17311............  Mohs, 1 stage, h/n/hf/g.  Y................  .................  P2...............  ...........       3.9713      $164.41      $164.41
17312............  Mohs addl stage.........  Y................  .................  P2...............  ...........       3.9713      $164.41      $164.41
17313............  Mohs, 1 stage, t/a/l....  Y................  .................  P2...............  ...........       3.9713      $164.41      $164.41
17314............  Mohs, addl stage, t/a/l.  Y................  .................  P2...............  ...........       3.9713      $164.41      $164.41
17315............  Mohs surg, addl block...  Y................  .................  P3...............  ...........       0.9483       $39.26       $39.26
17340............  Cryotherapy of skin.....  Y................  .................  P3...............  ...........       0.2969       $12.29       $12.29
17360............  Skin peel therapy.......  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
17380............  Hair removal by           Y................  .................  R2...............  ...........       0.8046       $33.31       $33.31
                    electrolysis.
19000............  Drainage of breast        Y................  .................  P3...............  ...........       1.5831       $65.54       $65.54
                    lesion.
19001............  Drain breast lesion add-  Y................  .................  P3...............  ...........       0.2060        $8.53        $8.53
                    on.
19020............  Incision of breast        Y................  .................  A2...............      $446.00      19.0457      $788.49      $531.62
                    lesion.
19030............  Injection for breast x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
19100............  Bx breast percut w/o      Y................  .................  A2...............      $240.00       4.5062      $186.56      $226.64
                    image.
19101............  Biopsy of breast, open..  Y................  .................  A2...............      $446.00      20.9980      $869.32      $551.83
19102............  Bx breast percut w/image  Y................  .................  A2...............      $240.00       7.3012      $302.27      $255.57
19103............  Bx breast percut w/       Y................  .................  A2...............      $395.77      13.9599      $577.94      $441.31
                    device.
19105............  Cryosurg ablate fa, each  Y................  .................  G2...............  ...........      32.4940    $1,345.25    $1,345.25
19110............  Nipple exploration......  Y................  .................  A2...............      $446.00      20.9980      $869.32      $551.83
19112............  Excise breast duct        Y................  .................  A2...............      $510.00      20.9980      $869.32      $599.83
                    fistula.
19120............  Removal of breast lesion  Y................  .................  A2...............      $510.00      20.9980      $869.32      $599.83
19125............  Excision, breast lesion.  Y................  .................  A2...............      $510.00      20.9980      $869.32      $599.83
19126............  Excision, addl breast     Y................  .................  A2...............      $510.00      20.9980      $869.32      $599.83
                    lesion.
19290............  Place needle wire,        N................  .................  N1...............      $333.00  ...........  ...........  ...........
                    breast.

[[Page 42853]]

 
19291............  Place needle wire,        N................  .................  N1...............      $333.00  ...........  ...........  ...........
                    breast.
19295............  Place breast clip,        N................  CH...............  N1...............      $106.76  ...........  ...........  ...........
                    percut.
19296............  Place po breast cath for  Y................  .................  A2...............    $1,339.00      52.9438    $2,191.87    $1,552.22
                    rad.
19297............  Place breast cath for     Y................  .................  A2...............    $1,339.00      52.9438    $2,191.87    $1,552.22
                    rad.
19298............  Place breast rad tube/    Y................  CH...............  A2...............    $1,339.00      52.9438    $2,191.87    $1,552.22
                    caths.
19300............  Removal of breast tissue  Y................  .................  A2...............      $630.00      20.9980      $869.32      $689.83
19301............  Partical mastectomy.....  Y................  .................  A2...............      $510.00      20.9980      $869.32      $599.83
19302............  P-mastectomy w/ln         Y................  .................  A2...............      $995.00      40.4634    $1,675.18    $1,165.05
                    removal.
19303............  Mast, simple, complete..  Y................  .................  A2...............      $630.00      32.4940    $1,345.25      $808.81
19304............  Mast, subq..............  Y................  .................  A2...............      $630.00      32.4940    $1,345.25      $808.81
19316............  Suspension of breast....  Y................  .................  A2...............      $630.00      32.4940    $1,345.25      $808.81
19318............  Reduction of large        Y................  .................  A2...............      $630.00      40.4634    $1,675.18      $891.30
                    breast.
19324............  Enlarge breast..........  Y................  .................  A2...............      $630.00      40.4634    $1,675.18      $891.30
19325............  Enlarge breast with       Y................  .................  A2...............    $1,339.00      52.9438    $2,191.87    $1,552.22
                    implant.
19328............  Removal of breast         Y................  .................  A2...............      $333.00      32.4940    $1,345.25      $586.06
                    implant.
19330............  Removal of implant        Y................  .................  A2...............      $333.00      32.4940    $1,345.25      $586.06
                    material.
19340............  Immediate breast          Y................  .................  A2...............      $446.00      40.4634    $1,675.18      $753.30
                    prosthesis.
19342............  Delayed breast            Y................  .................  A2...............      $510.00      52.9438    $2,191.87      $930.47
                    prosthesis.
19350............  Breast reconstruction...  Y................  .................  A2...............      $630.00      20.9980      $869.32      $689.83
19355............  Correct inverted          Y................  .................  A2...............      $630.00      32.4940    $1,345.25      $808.81
                    nipple(s).
19357............  Breast reconstruction...  Y................  .................  A2...............      $717.00      52.9438    $2,191.87    $1,085.72
19366............  Breast reconstruction...  Y................  .................  A2...............      $717.00      32.4940    $1,345.25      $874.06
19370............  Surgery of breast         Y................  .................  A2...............      $630.00      32.4940    $1,345.25      $808.81
                    capsule.
19371............  Removal of breast         Y................  .................  A2...............      $630.00      32.4940    $1,345.25      $808.81
                    capsule.
19380............  Revise breast             Y................  .................  A2...............      $717.00      40.4634    $1,675.18      $956.55
                    reconstruction.
19396............  Design custom breast      Y................  .................  G2...............  ...........      32.4940    $1,345.25    $1,345.25
                    implant.
20000............  Incision of abscess.....  Y................  .................  P2...............  ...........       1.4630       $60.57       $60.57
20005............  Incision of deep abscess  Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
20103............  Explore wound, extremity  Y................  .................  G2...............  ...........       9.5721      $396.28      $396.28
20150............  Excise epiphyseal bar...  Y................  .................  G2...............  ...........      43.5953    $1,804.85    $1,804.85
20200............  Muscle biopsy...........  Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
20205............  Deep muscle biopsy......  Y................  .................  A2...............      $510.00      16.5832      $686.54      $554.14
20206............  Needle biopsy, muscle...  Y................  .................  A2...............      $240.00       7.3012      $302.27      $255.57
20220............  Bone biopsy, trocar/      Y................  .................  A2...............      $251.52       8.7155      $360.82      $278.85
                    needle.
20225............  Bone biopsy, trocar/      Y................  .................  A2...............      $418.49       8.7155      $360.82      $404.07
                    needle.
20240............  Bone biopsy, excisional.  Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
20245............  Bone biopsy, excisional.  Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
20250............  Open bone biopsy........  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
20251............  Open bone biopsy........  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
20500............  Injection of sinus tract  Y................  .................  P3...............  ...........       1.4676       $60.76       $60.76
20501............  Inject sinus tract for x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
20520............  Removal of foreign body.  Y................  .................  P3...............  ...........       2.2674       $93.87       $93.87
20525............  Removal of foreign body.  Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
20526............  Ther injection, carp      Y................  .................  P3...............  ...........       0.7338       $30.38       $30.38
                    tunnel.
20550............  Inj tendon sheath/        Y................  .................  P3...............  ...........       0.5524       $22.87       $22.87
                    ligament.
20551............  Inj tendon origin/        Y................  .................  P3...............  ...........       0.5442       $22.53       $22.53
                    insertion.
20552............  Inj trigger point, 1/2    Y................  .................  P3...............  ...........       0.5360       $22.19       $22.19
                    muscl.
20553............  Inject trigger points, =/ Y................  .................  P3...............  ...........       0.6019       $24.92       $24.92
                    > 3.
20600............  Drain/inject, joint/      Y................  .................  P3...............  ...........       0.5442       $22.53       $22.53
                    bursa.
20605............  Drain/inject, joint/      Y................  .................  P3...............  ...........       0.6184       $25.60       $25.60
                    bursa.
20610............  Drain/inject, joint/      Y................  .................  P3...............  ...........       0.8329       $34.48       $34.48
                    bursa.
20612............  Aspirate/inj ganglion     Y................  .................  P3...............  ...........       0.5771       $23.89       $23.89
                    cyst.
20615............  Treatment of bone cyst..  Y................  CH...............  P3...............  ...........       2.5560      $105.82      $105.82
20650............  Insert and remove bone    Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    pin.
20662............  Application of pelvis     Y................  .................  R2...............  ...........      21.5761      $893.25      $893.25
                    brace.
20663............  Application of thigh      Y................  .................  R2...............  ...........      21.5761      $893.25      $893.25
                    brace.
20665............  Removal of fixation       N................  .................  G2...............  ...........       0.6416       $26.56       $26.56
                    device.
20670............  Removal of support        Y................  .................  A2...............      $333.00      16.5832      $686.54      $421.39
                    implant.
20680............  Removal of support        Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    implant.
20690............  Apply bone fixation       Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    device.
20692............  Apply bone fixation       Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    device.
20693............  Adjust bone fixation      Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    device.
20694............  Remove bone fixation      Y................  .................  A2...............      $333.00      21.5761      $893.25      $473.06
                    device.
20822............  Replantation digit,       Y................  .................  G2...............  ...........      26.7322    $1,106.71    $1,106.71
                    complete.
20900............  Removal of bone for       Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    graft.
20902............  Removal of bone for       Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    graft.
20910............  Remove cartilage for      Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    graft.
20912............  Remove cartilage for      Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
                    graft.
20920............  Removal of fascia for     Y................  .................  A2...............      $630.00      15.4399      $639.21      $632.30
                    graft.
20922............  Removal of fascia for     Y................  .................  A2...............      $510.00      15.4399      $639.21      $542.30
                    graft.
20924............  Removal of tendon for     Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    graft.
20926............  Removal of tissue for     Y................  .................  A2...............      $630.00       4.6816      $193.82      $520.96
                    graft.
20950............  Fluid pressure, muscle..  Y................  .................  G2...............  ...........       1.4630       $60.57       $60.57
20972............  Bone/skin graft,          Y................  .................  G2...............  ...........      44.4710    $1,841.10    $1,841.10
                    metatarsal.
20973............  Bone/skin graft, great    Y................  .................  R2...............  ...........      44.4710    $1,841.10    $1,841.10
                    toe.
20975............  Electrical bone           N................  CH...............  N1...............       $37.51  ...........  ...........  ...........
                    stimulation.

[[Page 42854]]

 
20979............  Us bone stimulation.....  N................  .................  P3...............  ...........       0.5771       $23.89       $23.89
20982............  Ablate, bone tumor(s)     Y................  .................  G2...............  ...........      43.5953    $1,804.85    $1,804.85
                    perq.
21010............  Incision of jaw joint...  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
21015............  Resection of facial       Y................  .................  A2...............      $510.00      16.6341      $688.65      $554.66
                    tumor.
21025............  Excision of bone, lower   Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
                    jaw.
21026............  Excision of facial        Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
                    bone(s).
21029............  Contour of face bone      Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
                    lesion.
21030............  Excise max/zygoma b9      Y................  .................  P3...............  ...........       5.5737      $230.75      $230.75
                    tumor.
21031............  Remove exostosis,         Y................  .................  P3...............  ...........       4.5761      $189.45      $189.45
                    mandible.
21032............  Remove exostosis,         Y................  .................  P3...............  ...........       4.6915      $194.23      $194.23
                    maxilla.
21034............  Excise max/zygoma mlg     Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
                    tumor.
21040............  Excise mandible lesion..  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
21044............  Removal of jaw bone       Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
                    lesion.
21046............  Remove mandible cyst      Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
                    complex.
21047............  Excise lwr jaw cyst w/    Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
                    repair.
21048............  Remove maxilla cyst       Y................  .................  R2...............  ...........      40.5598    $1,679.18    $1,679.18
                    complex.
21050............  Removal of jaw joint....  Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
21060............  Remove jaw joint          Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
                    cartilage.
21070............  Remove coronoid process.  Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
21076............  Prepare face/oral         Y................  .................  P3...............  ...........       8.3442      $345.45      $345.45
                    prosthesis.
21077............  Prepare face/oral         Y................  .................  P3...............  ...........      20.4563      $846.89      $846.89
                    prosthesis.
21079............  Prepare face/oral         Y................  .................  P3...............  ...........      14.5198      $601.12      $601.12
                    prosthesis.
21080............  Prepare face/oral         Y................  .................  P3...............  ...........      16.6471      $689.19      $689.19
                    prosthesis.
21081............  Prepare face/oral         Y................  .................  P3...............  ...........      15.2783      $632.52      $632.52
                    prosthesis.
21082............  Prepare face/oral         Y................  .................  P3...............  ...........      14.0993      $583.71      $583.71
                    prosthesis.
21083............  Prepare face/oral         Y................  .................  P3...............  ...........      13.7860      $570.74      $570.74
                    prosthesis.
21084............  Prepare face/oral         Y................  .................  P3...............  ...........      16.0370      $663.93      $663.93
                    prosthesis.
21085............  Prepare face/oral         Y................  .................  P3...............  ...........       6.2333      $258.06      $258.06
                    prosthesis.
21086............  Prepare face/oral         Y................  .................  P3...............  ...........      15.0391      $622.62      $622.62
                    prosthesis.
21087............  Prepare face/oral         Y................  .................  P3...............  ...........      14.9237      $617.84      $617.84
                    prosthesis.
21088............  Prepare face/oral         Y................  .................  R2...............  ...........      40.5598    $1,679.18    $1,679.18
                    prosthesis.
21100............  Maxillofacial fixation..  Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
21110............  Interdental fixation....  Y................  .................  P2...............  ...........       7.6539      $316.87      $316.87
21116............  Injection, jaw joint x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
21120............  Reconstruction of chin..  Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
21121............  Reconstruction of chin..  Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
21122............  Reconstruction of chin..  Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
21123............  Reconstruction of chin..  Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
21125............  Augmentation, lower jaw   Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
                    bone.
21127............  Augmentation, lower jaw   Y................  .................  A2...............    $1,339.00      40.5598    $1,679.18    $1,424.05
                    bone.
21137............  Reduction of forehead...  Y................  .................  G2...............  ...........      24.3535    $1,008.23    $1,008.23
21138............  Reduction of forehead...  Y................  .................  G2...............  ...........      40.5598    $1,679.18    $1,679.18
21139............  Reduction of forehead...  Y................  .................  G2...............  ...........      40.5598    $1,679.18    $1,679.18
21150............  Reconstruct midface,      Y................  .................  G2...............  ...........      40.5598    $1,679.18    $1,679.18
                    lefort.
21181............  Contour cranial bone      Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
                    lesion.
21198............  Reconstr lwr jaw segment  Y................  .................  G2...............  ...........      40.5598    $1,679.18    $1,679.18
21199............  Reconstr lwr jaw w/       Y................  .................  G2...............  ...........      40.5598    $1,679.18    $1,679.18
                    advance.
21206............  Reconstruct upper jaw     Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
                    bone.
21208............  Augmentation of facial    Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    bones.
21209............  Reduction of facial       Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
                    bones.
21210............  Face bone graft.........  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
21215............  Lower jaw bone graft....  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
21230............  Rib cartilage graft.....  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
21235............  Ear cartilage graft.....  Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
21240............  Reconstruction of jaw     Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
                    joint.
21242............  Reconstruction of jaw     Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
                    joint.
21243............  Reconstruction of jaw     Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
                    joint.
21244............  Reconstruction of lower   Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    jaw.
21245............  Reconstruction of jaw...  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
21246............  Reconstruction of jaw...  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
21248............  Reconstruction of jaw...  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
21249............  Reconstruction of jaw...  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
21260............  Revise eye sockets......  Y................  .................  G2...............  ...........      40.5598    $1,679.18    $1,679.18
21267............  Revise eye sockets......  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
21270............  Augmentation, cheek bone  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
21275............  Revision, orbitofacial    Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    bones.
21280............  Revision of eyelid......  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
21282............  Revision of eyelid......  Y................  .................  A2...............      $717.00      16.6341      $688.65      $709.91
21295............  Revision of jaw muscle/   Y................  .................  A2...............      $333.00       7.6539      $316.87      $328.97
                    bone.
21296............  Revision of jaw muscle/   Y................  .................  A2...............      $333.00      24.3535    $1,008.23      $501.81
                    bone.
21310............  Treatment of nose         Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
                    fracture.
21315............  Treatment of nose         Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
                    fracture.
21320............  Treatment of nose         Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
                    fracture.
21325............  Treatment of nose         Y................  .................  A2...............      $630.00      24.3535    $1,008.23      $724.56
                    fracture.
21330............  Treatment of nose         Y................  .................  A2...............      $717.00      24.3535    $1,008.23      $789.81
                    fracture.
21335............  Treatment of nose         Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
                    fracture.

[[Page 42855]]

 
21336............  Treat nasal septal        Y................  .................  A2...............      $630.00      40.3466    $1,670.35      $890.09
                    fracture.
21337............  Treat nasal septal        Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
                    fracture.
21338............  Treat nasoethmoid         Y................  .................  A2...............      $630.00      24.3535    $1,008.23      $724.56
                    fracture.
21339............  Treat nasoethmoid         Y................  .................  A2...............      $717.00      24.3535    $1,008.23      $789.81
                    fracture.
21340............  Treatment of nose         Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
                    fracture.
21345............  Treat nose/jaw fracture.  Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
21355............  Treat cheek bone          Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
                    fracture.
21356............  Treat cheek bone          Y................  .................  A2...............      $510.00      24.3535    $1,008.23      $634.56
                    fracture.
21390............  Treat eye socket          Y................  .................  G2...............  ...........      40.5598    $1,679.18    $1,679.18
                    fracture.
21400............  Treat eye socket          Y................  .................  A2...............      $446.00       7.6539      $316.87      $413.72
                    fracture.
21401............  Treat eye socket          Y................  .................  A2...............      $510.00      16.6341      $688.65      $554.66
                    fracture.
21406............  Treat eye socket          Y................  .................  G2...............  ...........      40.5598    $1,679.18    $1,679.18
                    fracture.
21407............  Treat eye socket          Y................  .................  G2...............  ...........      40.5598    $1,679.18    $1,679.18
                    fracture.
21421............  Treat mouth roof          Y................  .................  A2...............      $630.00      24.3535    $1,008.23      $724.56
                    fracture.
21440............  Treat dental ridge        Y................  .................  P3...............  ...........       7.0990      $293.90      $293.90
                    fracture.
21445............  Treat dental ridge        Y................  .................  A2...............      $630.00      24.3535    $1,008.23      $724.56
                    fracture.
21450............  Treat lower jaw fracture  Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
21451............  Treat lower jaw fracture  Y................  .................  A2...............      $464.15       7.6539      $316.87      $427.33
21452............  Treat lower jaw fracture  Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
21453............  Treat lower jaw fracture  Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
21454............  Treat lower jaw fracture  Y................  .................  A2...............      $717.00      24.3535    $1,008.23      $789.81
21461............  Treat lower jaw fracture  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
21462............  Treat lower jaw fracture  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
21465............  Treat lower jaw fracture  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
21480............  Reset dislocated jaw....  Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
21485............  Reset dislocated jaw....  Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
21490............  Repair dislocated jaw...  Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
21495............  Treat hyoid bone          Y................  .................  G2...............  ...........      16.6341      $688.65      $688.65
                    fracture.
21497............  Interdental wiring......  Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
21501............  Drain neck/chest lesion.  Y................  .................  A2...............      $446.00      19.0457      $788.49      $531.62
21502............  Drain chest lesion......  Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
21550............  Biopsy of neck/chest....  Y................  .................  G2...............  ...........       8.7155      $360.82      $360.82
21555............  Remove lesion, neck/      Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    chest.
21556............  Remove lesion, neck/      Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    chest.
21557............  Remove tumor, neck/chest  Y................  .................  G2...............  ...........      21.4534      $888.17      $888.17
21600............  Partial removal of rib..  Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
21610............  Partial removal of rib..  Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
21685............  Hyoid myotomy &           Y................  .................  G2...............  ...........       7.6539      $316.87      $316.87
                    suspension.
21700............  Revision of neck muscle.  Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
21720............  Revision of neck muscle.  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
21725............  Revision of neck muscle.  Y................  .................  A2...............       $88.46       1.4630       $60.57       $81.49
21800............  Treatment of rib          Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
21805............  Treatment of rib          Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
                    fracture.
21820............  Treat sternum fracture..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
21920............  Biopsy soft tissue of     Y................  .................  P3...............  ...........       3.1744      $131.42      $131.42
                    back.
21925............  Biopsy soft tissue of     Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    back.
21930............  Remove lesion, back or    Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    flank.
21935............  Remove tumor, back......  Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
22102............  Remove part, lumbar       Y................  .................  G2...............  ...........      47.6714    $1,973.60    $1,973.60
                    vertebra.
22103............  Remove extra spine        Y................  .................  G2...............  ...........      47.6714    $1,973.60    $1,973.60
                    segment.
22305............  Treat spine process       Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
22310............  Treat spine fracture....  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
22315............  Treat spine fracture....  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
22505............  Manipulation of spine...  Y................  .................  A2...............      $446.00      15.0176      $621.73      $489.93
22520............  Percut vertebroplasty     Y................  .................  A2...............    $1,339.00      29.3263    $1,214.11    $1,307.78
                    thor.
22521............  Percut vertebroplasty     Y................  .................  A2...............    $1,339.00      29.3263    $1,214.11    $1,307.78
                    lumb.
22522............  Percut vertebroplasty     Y................  .................  A2...............    $1,339.00      29.3263    $1,214.11    $1,307.78
                    add'l.
22523............  Percut kyphoplasty, thor  Y................  .................  G2...............  ...........      78.6518    $3,256.18    $3,256.18
22524............  Percut kyphoplasty,       Y................  .................  G2...............  ...........      78.6518    $3,256.18    $3,256.18
                    lumbar.
22525............  Percut kyphoplasty, add-  Y................  .................  G2...............  ...........      78.6518    $3,256.18    $3,256.18
                    on.
22900............  Remove abdominal wall     Y................  .................  A2...............      $630.00      21.4534      $888.17      $694.54
                    lesion.
23000............  Removal of calcium        Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    deposits.
23020............  Release shoulder joint..  Y................  .................  A2...............      $446.00      43.5953    $1,804.85      $785.71
23030............  Drain shoulder lesion...  Y................  .................  A2...............      $333.00      19.0457      $788.49      $446.87
23031............  Drain shoulder bursa....  Y................  .................  A2...............      $510.00      19.0457      $788.49      $579.62
23035............  Drain shoulder bone       Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    lesion.
23040............  Exploratory shoulder      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    surgery.
23044............  Exploratory shoulder      Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    surgery.
23065............  Biopsy shoulder tissues.  Y................  .................  P3...............  ...........       2.2428       $92.85       $92.85
23066............  Biopsy shoulder tissues.  Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
23075............  Removal of shoulder       Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    lesion.
23076............  Removal of shoulder       Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    lesion.
23077............  Remove tumor of shoulder  Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
23100............  Biopsy of shoulder joint  Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
23101............  Shoulder joint surgery..  Y................  .................  A2...............      $995.00      29.3263    $1,214.11    $1,049.78
23105............  Remove shoulder joint     Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    lining.

[[Page 42856]]

 
23106............  Incision of collarbone    Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    joint.
23107............  Explore treat shoulder    Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    joint.
23120............  Partial removal, collar   Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
                    bone.
23125............  Removal of collar bone..  Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
23130............  Remove shoulder bone,     Y................  .................  A2...............      $717.00      43.5953    $1,804.85      $988.96
                    part.
23140............  Removal of bone lesion..  Y................  .................  A2...............      $630.00      21.5761      $893.25      $695.81
23145............  Removal of bone lesion..  Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
23146............  Removal of bone lesion..  Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
23150............  Removal of humerus        Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    lesion.
23155............  Removal of humerus        Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
                    lesion.
23156............  Removal of humerus        Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
                    lesion.
23170............  Remove collar bone        Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    lesion.
23172............  Remove shoulder blade     Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    lesion.
23174............  Remove humerus lesion...  Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
23180............  Remove collar bone        Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    lesion.
23182............  Remove shoulder blade     Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    lesion.
23184............  Remove humerus lesion...  Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
23190............  Partial removal of        Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    scapula.
23195............  Removal of head of        Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
                    humerus.
23330............  Remove shoulder foreign   Y................  .................  A2...............      $333.00       8.7155      $360.82      $339.96
                    body.
23331............  Remove shoulder foreign   Y................  .................  A2...............      $333.00      21.4534      $888.17      $471.79
                    body.
23350............  Injection for shoulder x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
23395............  Muscle transfer,shoulder/ Y................  .................  A2...............      $717.00      43.5953    $1,804.85      $988.96
                    arm.
23397............  Muscle transfers........  Y................  .................  A2...............      $995.00      78.6518    $3,256.18    $1,560.30
23400............  Fixation of shoulder      Y................  .................  A2...............      $995.00      29.3263    $1,214.11    $1,049.78
                    blade.
23405............  Incision of tendon &      Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    muscle.
23406............  Incise tendon(s) &        Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    muscle(s).
23410............  Repair rotator cuff,      Y................  .................  A2...............      $717.00      43.5953    $1,804.85      $988.96
                    acute.
23412............  Repair rotator cuff,      Y................  .................  A2...............      $995.00      43.5953    $1,804.85    $1,197.46
                    chronic.
23415............  Release of shoulder       Y................  .................  A2...............      $717.00      43.5953    $1,804.85      $988.96
                    ligament.
23420............  Repair of shoulder......  Y................  .................  A2...............      $995.00      43.5953    $1,804.85    $1,197.46
23430............  Repair biceps tendon....  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
23440............  Remove/transplant tendon  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
23450............  Repair shoulder capsule.  Y................  .................  A2...............      $717.00      78.6518    $3,256.18    $1,351.80
23455............  Repair shoulder capsule.  Y................  .................  A2...............      $995.00      78.6518    $3,256.18    $1,560.30
23460............  Repair shoulder capsule.  Y................  .................  A2...............      $717.00      78.6518    $3,256.18    $1,351.80
23462............  Repair shoulder capsule.  Y................  .................  A2...............      $995.00      43.5953    $1,804.85    $1,197.46
23465............  Repair shoulder capsule.  Y................  .................  A2...............      $717.00      78.6518    $3,256.18    $1,351.80
23466............  Repair shoulder capsule.  Y................  .................  A2...............      $995.00      43.5953    $1,804.85    $1,197.46
23480............  Revision of collar bone.  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
23485............  Revision of collar bone.  Y................  .................  A2...............      $995.00      78.6518    $3,256.18    $1,560.30
23490............  Reinforce clavicle......  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
23491............  Reinforce shoulder bones  Y................  .................  A2...............      $510.00      78.6518    $3,256.18    $1,196.55
23500............  Treat clavicle fracture.  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
23505............  Treat clavicle fracture.  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
23515............  Treat clavicle fracture.  Y................  .................  A2...............      $510.00      60.0595    $2,486.46    $1,004.12
23520............  Treat clavicle            Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    dislocation.
23525............  Treat clavicle            Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    dislocation.
23530............  Treat clavicle            Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    dislocation.
23532............  Treat clavicle            Y................  .................  A2...............      $630.00      26.3092    $1,089.20      $744.80
                    dislocation.
23540............  Treat clavicle            Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    dislocation.
23545............  Treat clavicle            Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    dislocation.
23550............  Treat clavicle            Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    dislocation.
23552............  Treat clavicle            Y................  .................  A2...............      $630.00      40.3466    $1,670.35      $890.09
                    dislocation.
23570............  Treat shoulder blade fx.  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
23575............  Treat shoulder blade fx.  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
23585............  Treat scapula fracture..  Y................  .................  A2...............      $510.00      60.0595    $2,486.46    $1,004.12
23600............  Treat humerus fracture..  Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
23605............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
23615............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      60.0595    $2,486.46    $1,094.12
23616............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      60.0595    $2,486.46    $1,094.12
23620............  Treat humerus fracture..  Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
23625............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
23630............  Treat humerus fracture..  Y................  .................  A2...............      $717.00      60.0595    $2,486.46    $1,159.37
23650............  Treat shoulder            Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    dislocation.
23655............  Treat shoulder            Y................  .................  A2...............      $333.00      15.0176      $621.73      $405.18
                    dislocation.
23660............  Treat shoulder            Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    dislocation.
23665............  Treat dislocation/        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
23670............  Treat dislocation/        Y................  .................  A2...............      $510.00      60.0595    $2,486.46    $1,004.12
                    fracture.
23675............  Treat dislocation/        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
23680............  Treat dislocation/        Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    fracture.
23700............  Fixation of shoulder....  Y................  .................  A2...............      $333.00      15.0176      $621.73      $405.18
23800............  Fusion of shoulder joint  Y................  .................  A2...............      $630.00      78.6518    $3,256.18    $1,286.55
23802............  Fusion of shoulder joint  Y................  .................  A2...............      $995.00      43.5953    $1,804.85    $1,197.46
23921............  Amputation follow-up      Y................  .................  A2...............      $323.28      15.4399      $639.21      $402.26
                    surgery.
23930............  Drainage of arm lesion..  Y................  .................  A2...............      $333.00      19.0457      $788.49      $446.87

[[Page 42857]]

 
23931............  Drainage of arm bursa...  Y................  .................  A2...............      $446.00      19.0457      $788.49      $531.62
23935............  Drain arm/elbow bone      Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
                    lesion.
24000............  Exploratory elbow         Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    surgery.
24006............  Release elbow joint.....  Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
24065............  Biopsy arm/elbow soft     Y................  .................  P3...............  ...........       3.0343      $125.62      $125.62
                    tissue.
24066............  Biopsy arm/elbow soft     Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    tissue.
24075............  Remove arm/elbow lesion.  Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
24076............  Remove arm/elbow lesion.  Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
24077............  Remove tumor of arm/      Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    elbow.
24100............  Biopsy elbow joint        Y................  .................  A2...............      $333.00      21.5761      $893.25      $473.06
                    lining.
24101............  Explore/treat elbow       Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    joint.
24102............  Remove elbow joint        Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    lining.
24105............  Removal of elbow bursa..  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
24110............  Remove humerus lesion...  Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
24115............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
24116............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
24120............  Remove elbow lesion.....  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
24125............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
24126............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
24130............  Removal of head of        Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    radius.
24134............  Removal of arm bone       Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    lesion.
24136............  Remove radius bone        Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    lesion.
24138............  Remove elbow bone lesion  Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
24140............  Partial removal of arm    Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    bone.
24145............  Partial removal of        Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    radius.
24147............  Partial removal of elbow  Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
24149............  Radical resection of      Y................  .................  G2...............  ...........      29.3263    $1,214.11    $1,214.11
                    elbow.
24152............  Extensive radius surgery  Y................  .................  G2...............  ...........      43.5953    $1,804.85    $1,804.85
24153............  Extensive radius surgery  Y................  .................  G2...............  ...........      78.6518    $3,256.18    $3,256.18
24155............  Removal of elbow joint..  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
24160............  Remove elbow joint        Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    implant.
24164............  Remove radius head        Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    implant.
24200............  Removal of arm foreign    Y................  .................  P3...............  ...........       2.5312      $104.79      $104.79
                    body.
24201............  Removal of arm foreign    Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    body.
24220............  Injection for elbow x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
24300............  Manipulate elbow w/       Y................  .................  G2...............  ...........      15.0176      $621.73      $621.73
                    anesth.
24301............  Muscle/tendon transfer..  Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
24305............  Arm tendon lengthening..  Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
24310............  Revision of arm tendon..  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
24320............  Repair of arm tendon....  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
24330............  Revision of arm muscles.  Y................  .................  A2...............      $510.00      78.6518    $3,256.18    $1,196.55
24331............  Revision of arm muscles.  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
24332............  Tenolysis, triceps......  Y................  .................  G2...............  ...........      21.5761      $893.25      $893.25
24340............  Repair of biceps tendon.  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
24341............  Repair arm tendon/muscle  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
24342............  Repair of ruptured        Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    tendon.
24343............  Repr elbow lat ligmnt w/  Y................  .................  G2...............  ...........      29.3263    $1,214.11    $1,214.11
                    tiss.
24344............  Reconstruct elbow lat     Y................  .................  G2...............  ...........      78.6518    $3,256.18    $3,256.18
                    ligmnt.
24345............  Repr elbw med ligmnt w/   Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    tissu.
24346............  Reconstruct elbow med     Y................  .................  G2...............  ...........      43.5953    $1,804.85    $1,804.85
                    ligmnt.
24350............  Repair of tennis elbow..  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
24351............  Repair of tennis elbow..  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
24352............  Repair of tennis elbow..  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
24354............  Repair of tennis elbow..  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
24356............  Revision of tennis elbow  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
24360............  Reconstruct elbow joint.  Y................  .................  A2...............      $717.00      35.9249    $1,487.29      $909.57
24361............  Reconstruct elbow joint.  Y................  .................  A2...............      $717.00     113.6713    $4,705.99    $1,714.25
24362............  Reconstruct elbow joint.  Y................  .................  A2...............      $717.00      51.0431    $2,113.18    $1,066.05
24363............  Replace elbow joint.....  Y................  .................  A2...............      $995.00     113.6713    $4,705.99    $1,922.75
24365............  Reconstruct head of       Y................  .................  A2...............      $717.00      35.9249    $1,487.29      $909.57
                    radius.
24366............  Reconstruct head of       Y................  .................  A2...............      $717.00     113.6713    $4,705.99    $1,714.25
                    radius.
24400............  Revision of humerus.....  Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
24410............  Revision of humerus.....  Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
24420............  Revision of humerus.....  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
24430............  Repair of humerus.......  Y................  .................  A2...............      $510.00      78.6518    $3,256.18    $1,196.55
24435............  Repair humerus with       Y................  .................  A2...............      $630.00      78.6518    $3,256.18    $1,286.55
                    graft.
24470............  Revision of elbow joint.  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
24495............  Decompression of forearm  Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
24498............  Reinforce humerus.......  Y................  .................  A2...............      $510.00      78.6518    $3,256.18    $1,196.55
24500............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24505............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24515............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      60.0595    $2,486.46    $1,094.12
24516............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      60.0595    $2,486.46    $1,094.12
24530............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24535............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24538............  Treat humerus fracture..  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80

[[Page 42858]]

 
24545............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      60.0595    $2,486.46    $1,094.12
24546............  Treat humerus fracture..  Y................  .................  A2...............      $717.00      60.0595    $2,486.46    $1,159.37
24560............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24565............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24566............  Treat humerus fracture..  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
24575............  Treat humerus fracture..  Y................  .................  A2...............      $510.00      60.0595    $2,486.46    $1,004.12
24576............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24577............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24579............  Treat humerus fracture..  Y................  .................  A2...............      $510.00      60.0595    $2,486.46    $1,004.12
24582............  Treat humerus fracture..  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
24586............  Treat elbow fracture....  Y................  .................  A2...............      $630.00      60.0595    $2,486.46    $1,094.12
24587............  Treat elbow fracture....  Y................  .................  A2...............      $717.00      60.0595    $2,486.46    $1,159.37
24600............  Treat elbow dislocation.  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24605............  Treat elbow dislocation.  Y................  .................  A2...............      $446.00      15.0176      $621.73      $489.93
24615............  Treat elbow dislocation.  Y................  .................  A2...............      $510.00      60.0595    $2,486.46    $1,004.12
24620............  Treat elbow fracture....  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24635............  Treat elbow fracture....  Y................  .................  A2...............      $510.00      60.0595    $2,486.46    $1,004.12
24640............  Treat elbow dislocation.  Y................  CH...............  P3...............  ...........       1.3771       $57.01       $57.01
24650............  Treat radius fracture...  Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
24655............  Treat radius fracture...  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24665............  Treat radius fracture...  Y................  .................  A2...............      $630.00      40.3466    $1,670.35      $890.09
24666............  Treat radius fracture...  Y................  .................  A2...............      $630.00      60.0595    $2,486.46    $1,094.12
24670............  Treat ulnar fracture....  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24675............  Treat ulnar fracture....  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
24685............  Treat ulnar fracture....  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
24800............  Fusion of elbow joint...  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
24802............  Fusion/graft of elbow     Y................  .................  A2...............      $717.00      43.5953    $1,804.85      $988.96
                    joint.
24925............  Amputation follow-up      Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    surgery.
25000............  Incision of tendon        Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    sheath.
25001............  Incise flexor carpi       Y................  .................  G2...............  ...........      21.5761      $893.25      $893.25
                    radialis.
25020............  Decompress forearm 1      Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    space.
25023............  Decompress forearm 1      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    space.
25024............  Decompress forearm 2      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    spaces.
25025............  Decompress forearm 2      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    spaces.
25028............  Drainage of forearm       Y................  .................  A2...............      $333.00      21.5761      $893.25      $473.06
                    lesion.
25031............  Drainage of forearm       Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
                    bursa.
25035............  Treat forearm bone        Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
                    lesion.
25040............  Explore/treat wrist       Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
                    joint.
25065............  Biopsy forearm soft       Y................  .................  P3...............  ...........       3.1085      $128.69      $128.69
                    tissues.
25066............  Biopsy forearm soft       Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    tissues.
25075............  Removal forearm lesion    Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    subcu.
25076............  Removal forearm lesion    Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    deep.
25077............  Remove tumor, forearm/    Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    wrist.
25085............  Incision of wrist         Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    capsule.
25100............  Biopsy of wrist joint...  Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
25101............  Explore/treat wrist       Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    joint.
25105............  Remove wrist joint        Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    lining.
25107............  Remove wrist joint        Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    cartilage.
25109............  Excise tendon forearm/    Y................  .................  G2...............  ...........      21.5761      $893.25      $893.25
                    wrist.
25110............  Remove wrist tendon       Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    lesion.
25111............  Remove wrist tendon       Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    lesion.
25112............  Reremove wrist tendon     Y................  .................  A2...............      $630.00      16.8220      $696.43      $646.61
                    lesion.
25115............  Remove wrist/forearm      Y................  .................  A2...............      $630.00      21.5761      $893.25      $695.81
                    lesion.
25116............  Remove wrist/forearm      Y................  .................  A2...............      $630.00      21.5761      $893.25      $695.81
                    lesion.
25118............  Excise wrist tendon       Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    sheath.
25119............  Partial removal of ulna.  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
25120............  Removal of forearm        Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    lesion.
25125............  Remove/graft forearm      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    lesion.
25126............  Remove/graft forearm      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    lesion.
25130............  Removal of wrist lesion.  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
25135............  Remove & graft wrist      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    lesion.
25136............  Remove & graft wrist      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    lesion.
25145............  Remove forearm bone       Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    lesion.
25150............  Partial removal of ulna.  Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
25151............  Partial removal of        Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    radius.
25210............  Removal of wrist bone...  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
25215............  Removal of wrist bones..  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
25230............  Partial removal of        Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    radius.
25240............  Partial removal of ulna.  Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
25246............  Injection for wrist x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
25248............  Remove forearm foreign    Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
                    body.
25250............  Removal of wrist          Y................  .................  A2...............      $333.00      29.3263    $1,214.11      $553.28
                    prosthesis.
25251............  Removal of wrist          Y................  .................  A2...............      $333.00      29.3263    $1,214.11      $553.28
                    prosthesis.
25259............  Manipulate wrist w/       Y................  .................  G2...............  ...........       1.8742       $77.59       $77.59
                    anesthes.
25260............  Repair forearm tendon/    Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    muscle.
25263............  Repair forearm tendon/    Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    muscle.

[[Page 42859]]

 
25265............  Repair forearm tendon/    Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    muscle.
25270............  Repair forearm tendon/    Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    muscle.
25272............  Repair forearm tendon/    Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    muscle.
25274............  Repair forearm tendon/    Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    muscle.
25275............  Repair forearm tendon     Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    sheath.
25280............  Revise wrist/forearm      Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    tendon.
25290............  Incise wrist/forearm      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    tendon.
25295............  Release wrist/forearm     Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    tendon.
25300............  Fusion of tendons at      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    wrist.
25301............  Fusion of tendons at      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    wrist.
25310............  Transplant forearm        Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    tendon.
25312............  Transplant forearm        Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
                    tendon.
25315............  Revise palsy hand         Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    tendon(s).
25316............  Revise palsy hand         Y................  .................  A2...............      $510.00      78.6518    $3,256.18    $1,196.55
                    tendon(s).
25320............  Repair/revise wrist       Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    joint.
25332............  Revise wrist joint......  Y................  .................  A2...............      $717.00      35.9249    $1,487.29      $909.57
25335............  Realignment of hand.....  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
25337............  Reconstruct ulna/         Y................  .................  A2...............      $717.00      43.5953    $1,804.85      $988.96
                    radioulnar.
25350............  Revision of radius......  Y................  .................  A2...............      $510.00      78.6518    $3,256.18    $1,196.55
25355............  Revision of radius......  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
25360............  Revision of ulna........  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
25365............  Revise radius & ulna....  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
25370............  Revise radius or ulna...  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
25375............  Revise radius & ulna....  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
25390............  Shorten radius or ulna..  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
25391............  Lengthen radius or ulna.  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
25392............  Shorten radius & ulna...  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
25393............  Lengthen radius & ulna..  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
25394............  Repair carpal bone,       Y................  .................  G2...............  ...........      16.8220      $696.43      $696.43
                    shorten.
25400............  Repair radius or ulna...  Y................  .................  A2...............      $510.00      78.6518    $3,256.18    $1,196.55
25405............  Repair/graft radius or    Y................  .................  A2...............      $630.00      78.6518    $3,256.18    $1,286.55
                    ulna.
25415............  Repair radius & ulna....  Y................  .................  A2...............      $510.00      78.6518    $3,256.18    $1,196.55
25420............  Repair/graft radius &     Y................  .................  A2...............      $630.00      78.6518    $3,256.18    $1,286.55
                    ulna.
25425............  Repair/graft radius or    Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    ulna.
25426............  Repair/graft radius &     Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
                    ulna.
25430............  Vasc graft into carpal    Y................  .................  G2...............  ...........      26.7322    $1,106.71    $1,106.71
                    bone.
25431............  Repair nonunion carpal    Y................  .................  G2...............  ...........      26.7322    $1,106.71    $1,106.71
                    bone.
25440............  Repair/graft wrist bone.  Y................  .................  A2...............      $630.00      78.6518    $3,256.18    $1,286.55
25441............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00     113.6713    $4,705.99    $1,714.25
25442............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00     113.6713    $4,705.99    $1,714.25
25443............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00      51.0431    $2,113.18    $1,066.05
25444............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00      51.0431    $2,113.18    $1,066.05
25445............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00      51.0431    $2,113.18    $1,066.05
25446............  Wrist replacement.......  Y................  .................  A2...............      $995.00     113.6713    $4,705.99    $1,922.75
25447............  Repair wrist joint(s)...  Y................  .................  A2...............      $717.00      35.9249    $1,487.29      $909.57
25449............  Remove wrist joint        Y................  .................  A2...............      $717.00      35.9249    $1,487.29      $909.57
                    implant.
25450............  Revision of wrist joint.  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
25455............  Revision of wrist joint.  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
25490............  Reinforce radius........  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
25491............  Reinforce ulna..........  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
25492............  Reinforce radius and      Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    ulna.
25500............  Treat fracture of radius  Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
25505............  Treat fracture of radius  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
25515............  Treat fracture of radius  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
25520............  Treat fracture of radius  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
25525............  Treat fracture of radius  Y................  .................  A2...............      $630.00      40.3466    $1,670.35      $890.09
25526............  Treat fracture of radius  Y................  .................  A2...............      $717.00      40.3466    $1,670.35      $955.34
25530............  Treat fracture of ulna..  Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
25535............  Treat fracture of ulna..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
25545............  Treat fracture of ulna..  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
25560............  Treat fracture radius &   Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    ulna.
25565............  Treat fracture radius &   Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    ulna.
25574............  Treat fracture radius &   Y................  .................  A2...............      $510.00      60.0595    $2,486.46    $1,004.12
                    ulna.
25575............  Treat fracture radius/    Y................  .................  A2...............      $510.00      60.0595    $2,486.46    $1,004.12
                    ulna.
25600............  Treat fracture radius/    Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    ulna.
25605............  Treat fracture radius/    Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    ulna.
25606............  Treat fx distal radial..  Y................  .................  A2...............      $510.00      26.3092    $1,089.20      $654.80
25607............  Treat fx rad extra-       Y................  .................  A2...............      $717.00      60.0595    $2,486.46    $1,159.37
                    articul.
25608............  Treat fx rad intra-       Y................  .................  A2...............      $717.00      60.0595    $2,486.46    $1,159.37
                    articul.
25609............  Treat fx radial 3+ frag.  Y................  .................  A2...............      $717.00      60.0595    $2,486.46    $1,159.37
25622............  Treat wrist bone          Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    fracture.
25624............  Treat wrist bone          Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
25628............  Treat wrist bone          Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    fracture.
25630............  Treat wrist bone          Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    fracture.
25635............  Treat wrist bone          Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
25645............  Treat wrist bone          Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    fracture.

[[Page 42860]]

 
25650............  Treat wrist bone          Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    fracture.
25651............  Pin ulnar styloid         Y................  .................  G2...............  ...........      26.3092    $1,089.20    $1,089.20
                    fracture.
25652............  Treat fracture ulnar      Y................  .................  G2...............  ...........      40.3466    $1,670.35    $1,670.35
                    styloid.
25660............  Treat wrist dislocation.  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
25670............  Treat wrist dislocation.  Y................  .................  A2...............      $510.00      26.3092    $1,089.20      $654.80
25671............  Pin radioulnar            Y................  .................  A2...............      $333.00      26.3092    $1,089.20      $522.05
                    dislocation.
25675............  Treat wrist dislocation.  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
25676............  Treat wrist dislocation.  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
25680............  Treat wrist fracture....  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
25685............  Treat wrist fracture....  Y................  .................  A2...............      $510.00      26.3092    $1,089.20      $654.80
25690............  Treat wrist dislocation.  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
25695............  Treat wrist dislocation.  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
25800............  Fusion of wrist joint...  Y................  .................  A2...............      $630.00      78.6518    $3,256.18    $1,286.55
25805............  Fusion/graft of wrist     Y................  .................  A2...............      $717.00      43.5953    $1,804.85      $988.96
                    joint.
25810............  Fusion/graft of wrist     Y................  .................  A2...............      $717.00      78.6518    $3,256.18    $1,351.80
                    joint.
25820............  Fusion of hand bones....  Y................  .................  A2...............      $630.00      16.8220      $696.43      $646.61
25825............  Fuse hand bones with      Y................  .................  A2...............      $717.00      78.6518    $3,256.18    $1,351.80
                    graft.
25830............  Fusion, radioulnar jnt/   Y................  .................  A2...............      $717.00      78.6518    $3,256.18    $1,351.80
                    ulna.
25907............  Amputation follow-up      Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    surgery.
25922............  Amputate hand at wrist..  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
25929............  Amputation follow-up      Y................  .................  A2...............      $510.00      15.4399      $639.21      $542.30
                    surgery.
25931............  Amputation follow-up      Y................  CH...............  G2...............  ...........      21.5761      $893.25      $893.25
                    surgery.
26010............  Drainage of finger        Y................  .................  P2...............  ...........       1.4630       $60.57       $60.57
                    abscess.
26011............  Drainage of finger        Y................  .................  A2...............      $333.00      12.5792      $520.78      $379.95
                    abscess.
26020............  Drain hand tendon sheath  Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
26025............  Drainage of palm bursa..  Y................  .................  A2...............      $333.00      16.8220      $696.43      $423.86
26030............  Drainage of palm          Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
                    bursa(s).
26034............  Treat hand bone lesion..  Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
26035............  Decompress fingers/hand.  Y................  .................  G2...............  ...........      16.8220      $696.43      $696.43
26040............  Release palm contracture  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26045............  Release palm contracture  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26055............  Incise finger tendon      Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
                    sheath.
26060............  Incision of finger        Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
                    tendon.
26070............  Explore/treat hand joint  Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
26075............  Explore/treat finger      Y................  .................  A2...............      $630.00      16.8220      $696.43      $646.61
                    joint.
26080............  Explore/treat finger      Y................  .................  A2...............      $630.00      16.8220      $696.43      $646.61
                    joint.
26100............  Biopsy hand joint lining  Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
26105............  Biopsy finger joint       Y................  .................  A2...............      $333.00      16.8220      $696.43      $423.86
                    lining.
26110............  Biopsy finger joint       Y................  .................  A2...............      $333.00      16.8220      $696.43      $423.86
                    lining.
26115............  Removal hand lesion       Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    subcut.
26116............  Removal hand lesion,      Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    deep.
26117............  Remove tumor, hand/       Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
                    finger.
26121............  Release palm contracture  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26123............  Release palm contracture  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26125............  Release palm contracture  Y................  .................  A2...............      $630.00      16.8220      $696.43      $646.61
26130............  Remove wrist joint        Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    lining.
26135............  Revise finger joint,      Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
                    each.
26140............  Revise finger joint,      Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
                    each.
26145............  Tendon excision, palm/    Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    finger.
26160............  Remove tendon sheath      Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    lesion.
26170............  Removal of palm tendon,   Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    each.
26180............  Removal of finger tendon  Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
26185............  Remove finger bone......  Y................  .................  A2...............      $630.00      16.8220      $696.43      $646.61
26200............  Remove hand bone lesion.  Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
26205............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26210............  Removal of finger lesion  Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
26215............  Remove/graft finger       Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    lesion.
26230............  Partial removal of hand   Y................  .................  A2...............      $992.95      16.8220      $696.43      $918.82
                    bone.
26235............  Partial removal, finger   Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    bone.
26236............  Partial removal, finger   Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    bone.
26250............  Extensive hand surgery..  Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
26255............  Extensive hand surgery..  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26260............  Extensive finger surgery  Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
26261............  Extensive finger surgery  Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
26262............  Partial removal of        Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
                    finger.
26320............  Removal of implant from   Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    hand.
26340............  Manipulate finger w/      Y................  .................  G2...............  ...........       1.8742       $77.59       $77.59
                    anesth.
26350............  Repair finger/hand        Y................  .................  A2...............      $333.00      26.7322    $1,106.71      $526.43
                    tendon.
26352............  Repair/graft hand tendon  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26356............  Repair finger/hand        Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
                    tendon.
26357............  Repair finger/hand        Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
                    tendon.
26358............  Repair/graft hand tendon  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26370............  Repair finger/hand        Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
                    tendon.
26372............  Repair/graft hand tendon  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26373............  Repair finger/hand        Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    tendon.
26390............  Revise hand/finger        Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
                    tendon.

[[Page 42861]]

 
26392............  Repair/graft hand tendon  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26410............  Repair hand tendon......  Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
26412............  Repair/graft hand tendon  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26415............  Excision, hand/finger     Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
                    tendon.
26416............  Graft hand or finger      Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    tendon.
26418............  Repair finger tendon....  Y................  .................  A2...............      $630.00      16.8220      $696.43      $646.61
26420............  Repair/graft finger       Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
                    tendon.
26426............  Repair finger/hand        Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    tendon.
26428............  Repair/graft finger       Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    tendon.
26432............  Repair finger tendon....  Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
26433............  Repair finger tendon....  Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
26434............  Repair/graft finger       Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    tendon.
26437............  Realignment of tendons..  Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
26440............  Release palm/finger       Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    tendon.
26442............  Release palm & finger     Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    tendon.
26445............  Release hand/finger       Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    tendon.
26449............  Release forearm/hand      Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    tendon.
26450............  Incision of palm tendon.  Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
26455............  Incision of finger        Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    tendon.
26460............  Incise hand/finger        Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    tendon.
26471............  Fusion of finger tendons  Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
26474............  Fusion of finger tendons  Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
26476............  Tendon lengthening......  Y................  .................  A2...............      $333.00      16.8220      $696.43      $423.86
26477............  Tendon shortening.......  Y................  .................  A2...............      $333.00      16.8220      $696.43      $423.86
26478............  Lengthening of hand       Y................  .................  A2...............      $333.00      16.8220      $696.43      $423.86
                    tendon.
26479............  Shortening of hand        Y................  .................  A2...............      $333.00      16.8220      $696.43      $423.86
                    tendon.
26480............  Transplant hand tendon..  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26483............  Transplant/graft hand     Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    tendon.
26485............  Transplant palm tendon..  Y................  .................  A2...............      $446.00      26.7322    $1,106.71      $611.18
26489............  Transplant/graft palm     Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    tendon.
26490............  Revise thumb tendon.....  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26492............  Tendon transfer with      Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    graft.
26494............  Hand tendon/muscle        Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    transfer.
26496............  Revise thumb tendon.....  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26497............  Finger tendon transfer..  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26498............  Finger tendon transfer..  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26499............  Revision of finger......  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26500............  Hand tendon               Y................  .................  A2...............      $630.00      16.8220      $696.43      $646.61
                    reconstruction.
26502............  Hand tendon               Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
                    reconstruction.
26508............  Release thumb             Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    contracture.
26510............  Thumb tendon transfer...  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26516............  Fusion of knuckle joint.  Y................  .................  A2...............      $333.00      26.7322    $1,106.71      $526.43
26517............  Fusion of knuckle joints  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26518............  Fusion of knuckle joints  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26520............  Release knuckle           Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    contracture.
26525............  Release finger            Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    contracture.
26530............  Revise knuckle joint....  Y................  .................  A2...............      $510.00      35.9249    $1,487.29      $754.32
26531............  Revise knuckle with       Y................  .................  A2...............      $995.00      51.0431    $2,113.18    $1,274.55
                    implant.
26535............  Revise finger joint.....  Y................  .................  A2...............      $717.00      35.9249    $1,487.29      $909.57
26536............  Revise/implant finger     Y................  .................  A2...............      $717.00      51.0431    $2,113.18    $1,066.05
                    joint.
26540............  Repair hand joint.......  Y................  .................  A2...............      $630.00      16.8220      $696.43      $646.61
26541............  Repair hand joint with    Y................  .................  A2...............      $995.00      26.7322    $1,106.71    $1,022.93
                    graft.
26542............  Repair hand joint with    Y................  .................  A2...............      $630.00      16.8220      $696.43      $646.61
                    graft.
26545............  Reconstruct finger joint  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26546............  Repair nonunion hand....  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26548............  Reconstruct finger joint  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26550............  Construct thumb           Y................  .................  A2...............      $446.00      26.7322    $1,106.71      $611.18
                    replacement.
26555............  Positional change of      Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    finger.
26560............  Repair of web finger....  Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
26561............  Repair of web finger....  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26562............  Repair of web finger....  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26565............  Correct metacarpal flaw.  Y................  .................  A2...............      $717.00      26.7322    $1,106.71      $814.43
26567............  Correct finger deformity  Y................  .................  A2...............      $717.00      26.7322    $1,106.71      $814.43
26568............  Lengthen metacarpal/      Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    finger.
26580............  Repair hand deformity...  Y................  .................  A2...............      $717.00      16.8220      $696.43      $711.86
26587............  Reconstruct extra finger  Y................  .................  A2...............      $717.00      16.8220      $696.43      $711.86
26590............  Repair finger deformity.  Y................  .................  A2...............      $717.00      16.8220      $696.43      $711.86
26591............  Repair muscles of hand..  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26593............  Release muscles of hand.  Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
26596............  Excision constricting     Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
                    tissue.
26600............  Treat metacarpal          Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    fracture.
26605............  Treat metacarpal          Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
26607............  Treat metacarpal          Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
26608............  Treat metacarpal          Y................  .................  A2...............      $630.00      26.3092    $1,089.20      $744.80
                    fracture.
26615............  Treat metacarpal          Y................  .................  A2...............      $630.00      40.3466    $1,670.35      $890.09
                    fracture.
26641............  Treat thumb dislocation.  Y................  CH...............  P2...............  ...........       1.8742       $77.59       $77.59

[[Page 42862]]

 
26645............  Treat thumb fracture....  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
26650............  Treat thumb fracture....  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
26665............  Treat thumb fracture....  Y................  .................  A2...............      $630.00      40.3466    $1,670.35      $890.09
26670............  Treat hand dislocation..  Y................  CH...............  P2...............  ...........       1.8742       $77.59       $77.59
26675............  Treat hand dislocation..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
26676............  Pin hand dislocation....  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
26685............  Treat hand dislocation..  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
26686............  Treat hand dislocation..  Y................  .................  A2...............      $510.00      60.0595    $2,486.46    $1,004.12
26700............  Treat knuckle             Y................  CH...............  P2...............  ...........       1.8742       $77.59       $77.59
                    dislocation.
26705............  Treat knuckle             Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    dislocation.
26706............  Pin knuckle dislocation.  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
26715............  Treat knuckle             Y................  .................  A2...............      $630.00      40.3466    $1,670.35      $890.09
                    dislocation.
26720............  Treat finger fracture,    Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    each.
26725............  Treat finger fracture,    Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    each.
26727............  Treat finger fracture,    Y................  .................  A2...............      $995.00      26.3092    $1,089.20    $1,018.55
                    each.
26735............  Treat finger fracture,    Y................  .................  A2...............      $630.00      40.3466    $1,670.35      $890.09
                    each.
26740............  Treat finger fracture,    Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    each.
26742............  Treat finger fracture,    Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    each.
26746............  Treat finger fracture,    Y................  .................  A2...............      $717.00      40.3466    $1,670.35      $955.34
                    each.
26750............  Treat finger fracture,    Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    each.
26755............  Treat finger fracture,    Y................  .................  G2...............  ...........       1.8742       $77.59       $77.59
                    each.
26756............  Pin finger fracture,      Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
                    each.
26765............  Treat finger fracture,    Y................  .................  A2...............      $630.00      40.3466    $1,670.35      $890.09
                    each.
26770............  Treat finger dislocation  Y................  .................  G2...............  ...........       1.8742       $77.59       $77.59
26775............  Treat finger dislocation  Y................  CH...............  P3...............  ...........       4.0319      $166.92      $166.92
26776............  Pin finger dislocation..  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
26785............  Treat finger dislocation  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
26820............  Thumb fusion with graft.  Y................  .................  A2...............      $717.00      26.7322    $1,106.71      $814.43
26841............  Fusion of thumb.........  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26842............  Thumb fusion with graft.  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26843............  Fusion of hand joint....  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26844............  Fusion/graft of hand      Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
                    joint.
26850............  Fusion of knuckle.......  Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
26852............  Fusion of knuckle with    Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
                    graft.
26860............  Fusion of finger joint..  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26861............  Fusion of finger jnt,     Y................  .................  A2...............      $446.00      26.7322    $1,106.71      $611.18
                    add-on.
26862............  Fusion/graft of finger    Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
                    joint.
26863............  Fuse/graft added joint..  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26910............  Amputate metacarpal bone  Y................  .................  A2...............      $510.00      26.7322    $1,106.71      $659.18
26951............  Amputation of finger/     Y................  .................  A2...............      $446.00      16.8220      $696.43      $508.61
                    thumb.
26952............  Amputation of finger/     Y................  .................  A2...............      $630.00      16.8220      $696.43      $646.61
                    thumb.
26990............  Drainage of pelvis        Y................  .................  A2...............      $333.00      21.5761      $893.25      $473.06
                    lesion.
26991............  Drainage of pelvis bursa  Y................  .................  A2...............      $333.00      21.5761      $893.25      $473.06
27000............  Incision of hip tendon..  Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
27001............  Incision of hip tendon..  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
27003............  Incision of hip tendon..  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
27033............  Exploration of hip joint  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
27035............  Denervation of hip joint  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
27040............  Biopsy of soft tissues..  Y................  .................  A2...............      $333.00       8.7155      $360.82      $339.96
27041............  Biopsy of soft tissues..  Y................  .................  A2...............      $418.49       8.7155      $360.82      $404.07
27047............  Remove hip/pelvis lesion  Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
27048............  Remove hip/pelvis lesion  Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
27049............  Remove tumor, hip/pelvis  Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
27050............  Biopsy of sacroiliac      Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    joint.
27052............  Biopsy of hip joint.....  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
27060............  Removal of ischial bursa  Y................  .................  A2...............      $717.00      21.5761      $893.25      $761.06
27062............  Remove femur lesion/      Y................  .................  A2...............      $717.00      21.5761      $893.25      $761.06
                    bursa.
27065............  Removal of hip bone       Y................  .................  A2...............      $717.00      21.5761      $893.25      $761.06
                    lesion.
27066............  Removal of hip bone       Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
                    lesion.
27067............  Remove/graft hip bone     Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
                    lesion.
27080............  Removal of tail bone....  Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
27086............  Remove hip foreign body.  Y................  .................  A2...............      $333.00       8.7155      $360.82      $339.96
27087............  Remove hip foreign body.  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
27093............  Injection for hip x-ray.  N................  .................  N1...............  ...........  ...........  ...........  ...........
27095............  Injection for hip x-ray.  N................  .................  N1...............  ...........  ...........  ...........  ...........
27097............  Revision of hip tendon..  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
27098............  Transfer tendon to        Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    pelvis.
27100............  Transfer of abdominal     Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
                    muscle.
27105............  Transfer of spinal        Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
                    muscle.
27110............  Transfer of iliopsoas     Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
                    muscle.
27111............  Transfer of iliopsoas     Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
                    muscle.
27193............  Treat pelvic ring         Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27194............  Treat pelvic ring         Y................  .................  A2...............      $446.00      15.0176      $621.73      $489.93
                    fracture.
27200............  Treat tail bone fracture  Y................  .................  P3...............  ...........       1.7727       $73.39       $73.39
27202............  Treat tail bone fracture  Y................  .................  A2...............      $446.00      40.3466    $1,670.35      $752.09
27220............  Treat hip socket          Y................  .................  G2...............  ...........       1.8742       $77.59       $77.59
                    fracture.

[[Page 42863]]

 
27230............  Treat thigh fracture....  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27238............  Treat thigh fracture....  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27246............  Treat thigh fracture....  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27250............  Treat hip dislocation...  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27252............  Treat hip dislocation...  Y................  .................  A2...............      $446.00      15.0176      $621.73      $489.93
27256............  Treat hip dislocation...  Y................  .................  G2...............  ...........       1.8742       $77.59       $77.59
27257............  Treat hip dislocation...  Y................  .................  A2...............      $510.00      15.0176      $621.73      $537.93
27265............  Treat hip dislocation...  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27266............  Treat hip dislocation...  Y................  .................  A2...............      $446.00      15.0176      $621.73      $489.93
27275............  Manipulation of hip       Y................  .................  A2...............      $446.00      15.0176      $621.73      $489.93
                    joint.
27301............  Drain thigh/knee lesion.  Y................  .................  A2...............      $510.00      19.0457      $788.49      $579.62
27305............  Incise thigh tendon &     Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
                    fascia.
27306............  Incision of thigh tendon  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
27307............  Incision of thigh         Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    tendons.
27310............  Exploration of knee       Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    joint.
27323............  Biopsy, thigh soft        Y................  .................  A2...............      $333.00       8.7155      $360.82      $339.96
                    tissues.
27324............  Biopsy, thigh soft        Y................  .................  A2...............      $333.00      21.4534      $888.17      $471.79
                    tissues.
27325............  Neurectomy, hamstring...  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
27326............  Neurectomy, popliteal...  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
27327............  Removal of thigh lesion.  Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
27328............  Removal of thigh lesion.  Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
27329............  Remove tumor, thigh/knee  Y................  .................  A2...............      $630.00      21.4534      $888.17      $694.54
27330............  Biopsy, knee joint        Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    lining.
27331............  Explore/treat knee joint  Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
27332............  Removal of knee           Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    cartilage.
27333............  Removal of knee           Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    cartilage.
27334............  Remove knee joint lining  Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
27335............  Remove knee joint lining  Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
27340............  Removal of kneecap bursa  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
27345............  Removal of knee cyst....  Y................  .................  A2...............      $630.00      21.5761      $893.25      $695.81
27347............  Remove knee cyst........  Y................  .................  A2...............      $630.00      21.5761      $893.25      $695.81
27350............  Removal of kneecap......  Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
27355............  Remove femur lesion.....  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
27356............  Remove femur lesion/      Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    graft.
27357............  Remove femur lesion/      Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
                    graft.
27358............  Remove femur lesion/      Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
                    fixation.
27360............  Partial removal, leg      Y................  .................  A2...............      $717.00      29.3263    $1,214.11      $841.28
                    bone(s).
27370............  Injection for knee x-ray  N................  .................  N1...............  ...........  ...........  ...........  ...........
27372............  Removal of foreign body.  Y................  .................  A2...............      $995.00      21.4534      $888.17      $968.29
27380............  Repair of kneecap tendon  Y................  .................  A2...............      $333.00      21.5761      $893.25      $473.06
27381............  Repair/graft kneecap      Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    tendon.
27385............  Repair of thigh muscle..  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
27386............  Repair/graft of thigh     Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    muscle.
27390............  Incision of thigh tendon  Y................  .................  A2...............      $333.00      21.5761      $893.25      $473.06
27391............  Incision of thigh         Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
                    tendons.
27392............  Incision of thigh         Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    tendons.
27393............  Lengthening of thigh      Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    tendon.
27394............  Lengthening of thigh      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    tendons.
27395............  Lengthening of thigh      Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    tendons.
27396............  Transplant of thigh       Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    tendon.
27397............  Transplants of thigh      Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    tendons.
27400............  Revise thigh muscles/     Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    tendons.
27403............  Repair of knee cartilage  Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
27405............  Repair of knee ligament.  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
27407............  Repair of knee ligament.  Y................  .................  A2...............      $630.00      78.6518    $3,256.18    $1,286.55
27409............  Repair of knee ligaments  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
27418............  Repair degenerated        Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    kneecap.
27420............  Revision of unstable      Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    kneecap.
27422............  Revision of unstable      Y................  .................  A2...............      $995.00      43.5953    $1,804.85    $1,197.46
                    kneecap.
27424............  Revision/removal of       Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    kneecap.
27425............  Lat retinacular release   Y................  .................  A2...............      $995.00      29.3263    $1,214.11    $1,049.78
                    open.
27427............  Reconstruction, knee....  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
27428............  Reconstruction, knee....  Y................  .................  A2...............      $630.00      78.6518    $3,256.18    $1,286.55
27429............  Reconstruction, knee....  Y................  .................  A2...............      $630.00      78.6518    $3,256.18    $1,286.55
27430............  Revision of thigh         Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
                    muscles.
27435............  Incision of knee joint..  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
27437............  Revise kneecap..........  Y................  .................  A2...............      $630.00      35.9249    $1,487.29      $844.32
27438............  Revise kneecap with       Y................  .................  A2...............      $717.00      51.0431    $2,113.18    $1,066.05
                    implant.
27440............  Revision of knee joint..  Y................  .................  G2...............  ...........      35.9249    $1,487.29    $1,487.29
27441............  Revision of knee joint..  Y................  .................  A2...............      $717.00      35.9249    $1,487.29      $909.57
27442............  Revision of knee joint..  Y................  .................  A2...............      $717.00      35.9249    $1,487.29      $909.57
27443............  Revision of knee joint..  Y................  .................  A2...............      $717.00      35.9249    $1,487.29      $909.57
27446............  Revision of knee joint..  Y................  .................  G2...............  ...........     191.2387    $7,917.28    $7,917.28
27496............  Decompression of thigh/   Y................  .................  A2...............      $717.00      21.5761      $893.25      $761.06
                    knee.
27497............  Decompression of thigh/   Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    knee.
27498............  Decompression of thigh/   Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    knee.

[[Page 42864]]

 
27499............  Decompression of thigh/   Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    knee.
27500............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27501............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27502............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27503............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27508............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27509............  Treatment of thigh        Y................  .................  A2...............      $510.00      26.3092    $1,089.20      $654.80
                    fracture.
27510............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27516............  Treat thigh fx growth     Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    plate.
27517............  Treat thigh fx growth     Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    plate.
27520............  Treat kneecap fracture..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27530............  Treat knee fracture.....  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27532............  Treat knee fracture.....  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27538............  Treat knee fracture(s)..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27550............  Treat knee dislocation..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27552............  Treat knee dislocation..  Y................  .................  A2...............      $333.00      15.0176      $621.73      $405.18
27560............  Treat kneecap             Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    dislocation.
27562............  Treat kneecap             Y................  .................  A2...............      $333.00      15.0176      $621.73      $405.18
                    dislocation.
27566............  Treat kneecap             Y................  .................  A2...............      $446.00      40.3466    $1,670.35      $752.09
                    dislocation.
27570............  Fixation of knee joint..  Y................  .................  A2...............      $333.00      15.0176      $621.73      $405.18
27594............  Amputation follow-up      Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    surgery.
27600............  Decompression of lower    Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    leg.
27601............  Decompression of lower    Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    leg.
27602............  Decompression of lower    Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    leg.
27603............  Drain lower leg lesion..  Y................  .................  A2...............      $446.00      19.0457      $788.49      $531.62
27604............  Drain lower leg bursa...  Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
27605............  Incision of achilles      Y................  .................  A2...............      $333.00      21.1762      $876.69      $468.92
                    tendon.
27606............  Incision of achilles      Y................  .................  A2...............      $333.00      21.5761      $893.25      $473.06
                    tendon.
27607............  Treat lower leg bone      Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
                    lesion.
27610............  Explore/treat ankle       Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    joint.
27612............  Exploration of ankle      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    joint.
27613............  Biopsy lower leg soft     Y................  .................  P3...............  ...........       2.9271      $121.18      $121.18
                    tissue.
27614............  Biopsy lower leg soft     Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
                    tissue.
27615............  Remove tumor, lower leg.  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
27618............  Remove lower leg lesion.  Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
27619............  Remove lower leg lesion.  Y................  .................  A2...............      $510.00      21.4534      $888.17      $604.54
27620............  Explore/treat ankle       Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    joint.
27625............  Remove ankle joint        Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    lining.
27626............  Remove ankle joint        Y................  .................  A2...............      $630.00      29.3263    $1,214.11      $776.03
                    lining.
27630............  Removal of tendon lesion  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
27635............  Remove lower leg bone     Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    lesion.
27637............  Remove/graft leg bone     Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    lesion.
27638............  Remove/graft leg bone     Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    lesion.
27640............  Partial removal of tibia  Y................  .................  A2...............      $446.00      43.5953    $1,804.85      $785.71
27641............  Partial removal of        Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    fibula.
27647............  Extensive ankle/heel      Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    surgery.
27648............  Injection for ankle x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
27650............  Repair achilles tendon..  Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
27652............  Repair/graft achilles     Y................  .................  A2...............      $510.00      78.6518    $3,256.18    $1,196.55
                    tendon.
27654............  Repair of achilles        Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    tendon.
27656............  Repair leg fascia defect  Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
27658............  Repair of leg tendon,     Y................  .................  A2...............      $333.00      21.5761      $893.25      $473.06
                    each.
27659............  Repair of leg tendon,     Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
                    each.
27664............  Repair of leg tendon,     Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
                    each.
27665............  Repair of leg tendon,     Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    each.
27675............  Repair lower leg tendons  Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
27676............  Repair lower leg tendons  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
27680............  Release of lower leg      Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    tendon.
27681............  Release of lower leg      Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    tendons.
27685............  Revision of lower leg     Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    tendon.
27686............  Revise lower leg tendons  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
27687............  Revision of calf tendon.  Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
27690............  Revise lower leg tendon.  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
27691............  Revise lower leg tendon.  Y................  .................  A2...............      $630.00      43.5953    $1,804.85      $923.71
27692............  Revise additional leg     Y................  .................  A2...............      $510.00      43.5953    $1,804.85      $833.71
                    tendon.
27695............  Repair of ankle ligament  Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
27696............  Repair of ankle           Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    ligaments.
27698............  Repair of ankle ligament  Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
27700............  Revision of ankle joint.  Y................  .................  A2...............      $717.00      35.9249    $1,487.29      $909.57
27704............  Removal of ankle implant  Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
27705............  Incision of tibia.......  Y................  .................  A2...............      $446.00      43.5953    $1,804.85      $785.71
27707............  Incision of fibula......  Y................  .................  A2...............      $446.00      21.5761      $893.25      $557.81
27709............  Incision of tibia &       Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    fibula.
27730............  Repair of tibia           Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    epiphysis.
27732............  Repair of fibula          Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    epiphysis.
27734............  Repair lower leg          Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
                    epiphyses.

[[Page 42865]]

 
27740............  Repair of leg epiphyses.  Y................  .................  A2...............      $446.00      29.3263    $1,214.11      $638.03
27742............  Repair of leg epiphyses.  Y................  .................  A2...............      $446.00      43.5953    $1,804.85      $785.71
27745............  Reinforce tibia.........  Y................  .................  A2...............      $510.00      78.6518    $3,256.18    $1,196.55
27750............  Treatment of tibia        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27752............  Treatment of tibia        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27756............  Treatment of tibia        Y................  .................  A2...............      $510.00      26.3092    $1,089.20      $654.80
                    fracture.
27758............  Treatment of tibia        Y................  .................  A2...............      $630.00      40.3466    $1,670.35      $890.09
                    fracture.
27759............  Treatment of tibia        Y................  .................  A2...............      $630.00      60.0595    $2,486.46    $1,094.12
                    fracture.
27760............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27762............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27766............  Treatment of ankle        Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    fracture.
27780............  Treatment of fibula       Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27781............  Treatment of fibula       Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27784............  Treatment of fibula       Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    fracture.
27786............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27788............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27792............  Treatment of ankle        Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    fracture.
27808............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27810............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27814............  Treatment of ankle        Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    fracture.
27816............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27818............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
27822............  Treatment of ankle        Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    fracture.
27823............  Treatment of ankle        Y................  .................  A2...............      $510.00      60.0595    $2,486.46    $1,004.12
                    fracture.
27824............  Treat lower leg fracture  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27825............  Treat lower leg fracture  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27826............  Treat lower leg fracture  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
27827............  Treat lower leg fracture  Y................  .................  A2...............      $510.00      60.0595    $2,486.46    $1,004.12
27828............  Treat lower leg fracture  Y................  .................  A2...............      $630.00      60.0595    $2,486.46    $1,094.12
27829............  Treat lower leg joint...  Y................  .................  A2...............      $446.00      40.3466    $1,670.35      $752.09
27830............  Treat lower leg           Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    dislocation.
27831............  Treat lower leg           Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    dislocation.
27832............  Treat lower leg           Y................  .................  A2...............      $446.00      40.3466    $1,670.35      $752.09
                    dislocation.
27840............  Treat ankle dislocation.  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
27842............  Treat ankle dislocation.  Y................  .................  A2...............      $333.00      15.0176      $621.73      $405.18
27846............  Treat ankle dislocation.  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
27848............  Treat ankle dislocation.  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
27860............  Fixation of ankle joint.  Y................  .................  A2...............      $333.00      15.0176      $621.73      $405.18
27870............  Fusion of ankle joint,    Y................  .................  A2...............      $630.00      78.6518    $3,256.18    $1,286.55
                    open.
27871............  Fusion of tibiofibular    Y................  .................  A2...............      $630.00      78.6518    $3,256.18    $1,286.55
                    joint.
27884............  Amputation follow-up      Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    surgery.
27889............  Amputation of foot at     Y................  .................  A2...............      $510.00      29.3263    $1,214.11      $686.03
                    ankle.
27892............  Decompression of leg....  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
27893............  Decompression of leg....  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
27894............  Decompression of leg....  Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
28001............  Drainage of bursa of      Y................  .................  P3...............  ...........       2.8529      $118.11      $118.11
                    foot.
28002............  Treatment of foot         Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    infection.
28003............  Treatment of foot         Y................  .................  A2...............      $510.00      21.5761      $893.25      $605.81
                    infection.
28005............  Treat foot bone lesion..  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28008............  Incision of foot fascia.  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28010............  Incision of toe tendon..  Y................  .................  P3...............  ...........       2.1437       $88.75       $88.75
28011............  Incision of toe tendons.  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28020............  Exploration of foot       Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
                    joint.
28022............  Exploration of foot       Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
                    joint.
28024............  Exploration of toe joint  Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
28035............  Decompression of tibia    Y................  .................  A2...............      $630.00      18.5069      $766.19      $664.05
                    nerve.
28043............  Excision of foot lesion.  Y................  .................  A2...............      $446.00      21.4534      $888.17      $556.54
28045............  Excision of foot lesion.  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28046............  Resection of tumor, foot  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28050............  Biopsy of foot joint      Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
                    lining.
28052............  Biopsy of foot joint      Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
                    lining.
28054............  Biopsy of toe joint       Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
                    lining.
28055............  Neurectomy, foot........  Y................  .................  A2...............      $630.00      18.5069      $766.19      $664.05
28060............  Partial removal, foot     Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
                    fascia.
28062............  Removal of foot fascia..  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28070............  Removal of foot joint     Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
                    lining.
28072............  Removal of foot joint     Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
                    lining.
28080............  Removal of foot lesion..  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28086............  Excise foot tendon        Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
                    sheath.
28088............  Excise foot tendon        Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
                    sheath.
28090............  Removal of foot lesion..  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28092............  Removal of toe lesions..  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28100............  Removal of ankle/heel     Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
                    lesion.
28102............  Remove/graft foot lesion  Y................  .................  A2...............      $510.00      44.4710    $1,841.10      $842.78
28103............  Remove/graft foot lesion  Y................  .................  A2...............      $510.00      44.4710    $1,841.10      $842.78
28104............  Removal of foot lesion..  Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67

[[Page 42866]]

 
28106............  Remove/graft foot lesion  Y................  .................  A2...............      $510.00      44.4710    $1,841.10      $842.78
28107............  Remove/graft foot lesion  Y................  .................  A2...............      $510.00      44.4710    $1,841.10      $842.78
28108............  Removal of toe lesions..  Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
28110............  Part removal of           Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
                    metatarsal.
28111............  Part removal of           Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
                    metatarsal.
28112............  Part removal of           Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
                    metatarsal.
28113............  Part removal of           Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
                    metatarsal.
28114............  Removal of metatarsal     Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
                    heads.
28116............  Revision of foot........  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28118............  Removal of heel bone....  Y................  .................  A2...............      $630.00      21.1762      $876.69      $691.67
28119............  Removal of heel spur....  Y................  .................  A2...............      $630.00      21.1762      $876.69      $691.67
28120............  Part removal of ankle/    Y................  .................  A2...............      $995.00      21.1762      $876.69      $965.42
                    heel.
28122............  Partial removal of foot   Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
                    bone.
28124............  Partial removal of toe..  Y................  .................  P3...............  ...........       4.8152      $199.35      $199.35
28126............  Partial removal of toe..  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28130............  Removal of ankle bone...  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28140............  Removal of metatarsal...  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28150............  Removal of toe..........  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28153............  Partial removal of toe..  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28160............  Partial removal of toe..  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28171............  Extensive foot surgery..  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28173............  Extensive foot surgery..  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28175............  Extensive foot surgery..  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28190............  Removal of foot foreign   Y................  .................  P3...............  ...........       3.0261      $125.28      $125.28
                    body.
28192............  Removal of foot foreign   Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    body.
28193............  Removal of foot foreign   Y................  .................  A2...............      $418.49       8.7155      $360.82      $404.07
                    body.
28200............  Repair of foot tendon...  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28202............  Repair/graft of foot      Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
                    tendon.
28208............  Repair of foot tendon...  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28210............  Repair/graft of foot      Y................  .................  A2...............      $510.00      44.4710    $1,841.10      $842.78
                    tendon.
28220............  Release of foot tendon..  Y................  .................  P3...............  ...........       4.5266      $187.40      $187.40
28222............  Release of foot tendons.  Y................  .................  A2...............      $333.00      21.1762      $876.69      $468.92
28225............  Release of foot tendon..  Y................  .................  A2...............      $333.00      21.1762      $876.69      $468.92
28226............  Release of foot tendons.  Y................  .................  A2...............      $333.00      21.1762      $876.69      $468.92
28230............  Incision of foot          Y................  .................  P3...............  ...........       4.4771      $185.35      $185.35
                    tendon(s).
28232............  Incision of toe tendon..  Y................  .................  P3...............  ...........       4.2710      $176.82      $176.82
28234............  Incision of foot tendon.  Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
28238............  Revision of foot tendon.  Y................  .................  A2...............      $510.00      44.4710    $1,841.10      $842.78
28240............  Release of big toe......  Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
28250............  Revision of foot fascia.  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28260............  Release of midfoot joint  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28261............  Revision of foot tendon.  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28262............  Revision of foot and      Y................  .................  A2...............      $630.00      21.1762      $876.69      $691.67
                    ankle.
28264............  Release of midfoot joint  Y................  .................  A2...............      $333.00      44.4710    $1,841.10      $710.03
28270............  Release of foot           Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
                    contracture.
28272............  Release of toe joint,     Y................  .................  P3...............  ...........       4.0896      $169.31      $169.31
                    each.
28280............  Fusion of toes..........  Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
28285............  Repair of hammertoe.....  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28286............  Repair of hammertoe.....  Y................  .................  A2...............      $630.00      21.1762      $876.69      $691.67
28288............  Partial removal of foot   Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
                    bone.
28289............  Repair hallux rigidus...  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28290............  Correction of bunion....  Y................  .................  A2...............      $446.00      29.8356    $1,235.19      $643.30
28292............  Correction of bunion....  Y................  .................  A2...............      $446.00      29.8356    $1,235.19      $643.30
28293............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.8356    $1,235.19      $691.30
28294............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.8356    $1,235.19      $691.30
28296............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.8356    $1,235.19      $691.30
28297............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.8356    $1,235.19      $691.30
28298............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.8356    $1,235.19      $691.30
28299............  Correction of bunion....  Y................  .................  A2...............      $717.00      29.8356    $1,235.19      $846.55
28300............  Incision of heel bone...  Y................  .................  A2...............      $446.00      44.4710    $1,841.10      $794.78
28302............  Incision of ankle bone..  Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
28304............  Incision of midfoot       Y................  .................  A2...............      $446.00      44.4710    $1,841.10      $794.78
                    bones.
28305............  Incise/graft midfoot      Y................  .................  A2...............      $510.00      44.4710    $1,841.10      $842.78
                    bones.
28306............  Incision of metatarsal..  Y................  .................  A2...............      $630.00      21.1762      $876.69      $691.67
28307............  Incision of metatarsal..  Y................  .................  A2...............      $630.00      21.1762      $876.69      $691.67
28308............  Incision of metatarsal..  Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
28309............  Incision of metatarsals.  Y................  .................  A2...............      $630.00      44.4710    $1,841.10      $932.78
28310............  Revision of big toe.....  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28312............  Revision of toe.........  Y................  .................  A2...............      $510.00      21.1762      $876.69      $601.67
28313............  Repair deformity of toe.  Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
28315............  Removal of sesamoid bone  Y................  .................  A2...............      $630.00      21.1762      $876.69      $691.67
28320............  Repair of foot bones....  Y................  .................  A2...............      $630.00      44.4710    $1,841.10      $932.78
28322............  Repair of metatarsals...  Y................  .................  A2...............      $630.00      44.4710    $1,841.10      $932.78
28340............  Resect enlarged toe       Y................  .................  A2...............      $630.00      21.1762      $876.69      $691.67
                    tissue.
28341............  Resect enlarged toe.....  Y................  .................  A2...............      $630.00      21.1762      $876.69      $691.67
28344............  Repair extra toe(s).....  Y................  .................  A2...............      $630.00      21.1762      $876.69      $691.67

[[Page 42867]]

 
28345............  Repair webbed toe(s)....  Y................  .................  A2...............      $630.00      21.1762      $876.69      $691.67
28400............  Treatment of heel         Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
28405............  Treatment of heel         Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
28406............  Treatment of heel         Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
                    fracture.
28415............  Treat heel fracture.....  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
28420............  Treat/graft heel          Y................  .................  A2...............      $630.00      40.3466    $1,670.35      $890.09
                    fracture.
28430............  Treatment of ankle        Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    fracture.
28435............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
                    fracture.
28436............  Treatment of ankle        Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
                    fracture.
28445............  Treat ankle fracture....  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
28450............  Treat midfoot fracture,   Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    each.
28455............  Treat midfoot fracture,   Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    each.
28456............  Treat midfoot fracture..  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
28465............  Treat midfoot fracture,   Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    each.
28470............  Treat metatarsal          Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    fracture.
28475............  Treat metatarsal          Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
                    fracture.
28476............  Treat metatarsal          Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
                    fracture.
28485............  Treat metatarsal          Y................  .................  A2...............      $630.00      40.3466    $1,670.35      $890.09
                    fracture.
28490............  Treat big toe fracture..  Y................  .................  P3...............  ...........       1.6821       $69.64       $69.64
28495............  Treat big toe fracture..  Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
28496............  Treat big toe fracture..  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
28505............  Treat big toe fracture..  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
28510............  Treatment of toe          Y................  .................  P3...............  ...........       1.3193       $54.62       $54.62
                    fracture.
28515............  Treatment of toe          Y................  .................  P3...............  ...........       1.6821       $69.64       $69.64
                    fracture.
28525............  Treat toe fracture......  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
28530............  Treat sesamoid bone       Y................  .................  P3...............  ...........       1.2534       $51.89       $51.89
                    fracture.
28531............  Treat sesamoid bone       Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    fracture.
28540............  Treat foot dislocation..  Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
28545............  Treat foot dislocation..  Y................  .................  A2...............      $333.00      26.3092    $1,089.20      $522.05
28546............  Treat foot dislocation..  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
28555............  Repair foot dislocation.  Y................  .................  A2...............      $446.00      40.3466    $1,670.35      $752.09
28570............  Treat foot dislocation..  Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
28575............  Treat foot dislocation..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
28576............  Treat foot dislocation..  Y................  .................  A2...............      $510.00      26.3092    $1,089.20      $654.80
28585............  Repair foot dislocation.  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
28600............  Treat foot dislocation..  Y................  .................  P2...............  ...........       1.8742       $77.59       $77.59
28605............  Treat foot dislocation..  Y................  .................  A2...............      $103.62       1.8742       $77.59       $97.11
28606............  Treat foot dislocation..  Y................  .................  A2...............      $446.00      26.3092    $1,089.20      $606.80
28615............  Repair foot dislocation.  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
28630............  Treat toe dislocation...  Y................  CH...............  P3...............  ...........       1.4181       $58.71       $58.71
28635............  Treat toe dislocation...  Y................  .................  A2...............      $333.00      15.0176      $621.73      $405.18
28636............  Treat toe dislocation...  Y................  .................  A2...............      $510.00      26.3092    $1,089.20      $654.80
28645............  Repair toe dislocation..  Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
28660............  Treat toe dislocation...  Y................  CH...............  P3...............  ...........       1.0471       $43.35       $43.35
28665............  Treat toe dislocation...  Y................  .................  A2...............      $333.00      15.0176      $621.73      $405.18
28666............  Treat toe dislocation...  Y................  .................  A2...............      $510.00      26.3092    $1,089.20      $654.80
28675............  Repair of toe             Y................  .................  A2...............      $510.00      40.3466    $1,670.35      $800.09
                    dislocation.
28705............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.4710    $1,841.10      $932.78
28715............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      78.6518    $3,256.18    $1,286.55
28725............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.4710    $1,841.10      $932.78
28730............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.4710    $1,841.10      $932.78
28735............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.4710    $1,841.10      $932.78
28737............  Revision of foot bones..  Y................  .................  A2...............      $717.00      44.4710    $1,841.10      $998.03
28740............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.4710    $1,841.10      $932.78
28750............  Fusion of big toe joint.  Y................  .................  A2...............      $630.00      44.4710    $1,841.10      $932.78
28755............  Fusion of big toe joint.  Y................  .................  A2...............      $630.00      21.1762      $876.69      $691.67
28760............  Fusion of big toe joint.  Y................  .................  A2...............      $630.00      44.4710    $1,841.10      $932.78
28810............  Amputation toe &          Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
                    metatarsal.
28820............  Amputation of toe.......  Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
28825............  Partial amputation of     Y................  .................  A2...............      $446.00      21.1762      $876.69      $553.67
                    toe.
28890............  High energy eswt,         Y................  CH...............  P3...............  ...........       4.2297      $175.11      $175.11
                    plantar f.
29000............  Application of body cast  N................  .................  G2...............  ...........       1.1272       $46.67       $46.67
29010............  Application of body cast  N................  .................  P2...............  ...........       2.2383       $92.67       $92.67
29015............  Application of body cast  N................  .................  P2...............  ...........       2.2383       $92.67       $92.67
29020............  Application of body cast  N................  .................  G2...............  ...........       1.1272       $46.67       $46.67
29025............  Application of body cast  N................  .................  P2...............  ...........       1.1272       $46.67       $46.67
29035............  Application of body cast  N................  CH...............  P2...............  ...........       2.2383       $92.67       $92.67
29040............  Application of body cast  N................  .................  G2...............  ...........       1.1272       $46.67       $46.67
29044............  Application of body cast  N................  .................  P2...............  ...........       2.2383       $92.67       $92.67
29046............  Application of body cast  N................  .................  G2...............  ...........       2.2383       $92.67       $92.67
29049............  Application of figure     N................  .................  P3...............  ...........       0.9976       $41.30       $41.30
                    eight.
29055............  Application of shoulder   N................  .................  P2...............  ...........       2.2383       $92.67       $92.67
                    cast.
29058............  Application of shoulder   N................  .................  P2...............  ...........       1.1272       $46.67       $46.67
                    cast.
29065............  Application of long arm   N................  .................  P3...............  ...........       1.0720       $44.38       $44.38
                    cast.
29075............  Application of forearm    N................  .................  P3...............  ...........       1.0225       $42.33       $42.33
                    cast.
29085............  Apply hand/wrist cast...  N................  .................  P3...............  ...........       1.0471       $43.35       $43.35

[[Page 42868]]

 
29086............  Apply finger cast.......  N................  .................  P3...............  ...........       0.8329       $34.48       $34.48
29105............  Apply long arm splint...  N................  .................  P3...............  ...........       0.9565       $39.60       $39.60
29125............  Apply forearm splint....  N................  .................  P3...............  ...........       0.8162       $33.79       $33.79
29126............  Apply forearm splint....  N................  .................  P3...............  ...........       0.9152       $37.89       $37.89
29130............  Application of finger     N................  .................  P3...............  ...........       0.3710       $15.36       $15.36
                    splint.
29131............  Application of finger     N................  .................  P3...............  ...........       0.5524       $22.87       $22.87
                    splint.
29200............  Strapping of chest......  N................  .................  P3...............  ...........       0.5442       $22.53       $22.53
29220............  Strapping of low back...  N................  .................  P3...............  ...........       0.5524       $22.87       $22.87
29240............  Strapping of shoulder...  N................  .................  P3...............  ...........       0.6348       $26.28       $26.28
29260............  Strapping of elbow or     N................  .................  P3...............  ...........       0.5771       $23.89       $23.89
                    wrist.
29280............  Strapping of hand or      N................  .................  P3...............  ...........       0.6019       $24.92       $24.92
                    finger.
29305............  Application of hip cast.  N................  CH...............  P2...............  ...........       2.2383       $92.67       $92.67
29325............  Application of hip casts  N................  CH...............  P2...............  ...........       2.2383       $92.67       $92.67
29345............  Application of long leg   N................  .................  P3...............  ...........       1.4099       $58.37       $58.37
                    cast.
29355............  Application of long leg   N................  .................  P3...............  ...........       1.3686       $56.66       $56.66
                    cast.
29358............  Apply long leg cast       N................  .................  P3...............  ...........       1.6821       $69.64       $69.64
                    brace.
29365............  Application of long leg   N................  .................  P3...............  ...........       1.3357       $55.30       $55.30
                    cast.
29405............  Apply short leg cast....  N................  .................  P3...............  ...........       0.9976       $41.30       $41.30
29425............  Apply short leg cast....  N................  .................  P3...............  ...........       1.0058       $41.64       $41.64
29435............  Apply short leg cast....  N................  .................  P3...............  ...........       1.2698       $52.57       $52.57
29440............  Addition of walker to     N................  .................  P3...............  ...........       0.5442       $22.53       $22.53
                    cast.
29445............  Apply rigid leg cast....  N................  .................  P3...............  ...........       1.3935       $57.69       $57.69
29450............  Application of leg cast.  N................  .................  P2...............  ...........       1.1272       $46.67       $46.67
29505............  Application, long leg     N................  CH...............  P3...............  ...........       0.9234       $38.23       $38.23
                    splint.
29515............  Application lower leg     N................  CH...............  P3...............  ...........       0.7502       $31.06       $31.06
                    splint.
29520............  Strapping of hip........  N................  .................  P3...............  ...........       0.6266       $25.94       $25.94
29530............  Strapping of knee.......  N................  .................  P3...............  ...........       0.5937       $24.58       $24.58
29540............  Strapping of ankle and/   N................  .................  P3...............  ...........       0.3957       $16.38       $16.38
                    or ft.
29550............  Strapping of toes.......  N................  .................  P3...............  ...........       0.4041       $16.73       $16.73
29580............  Application of paste      N................  .................  P3...............  ...........       0.5606       $23.21       $23.21
                    boot.
29590............  Application of foot       N................  .................  P3...............  ...........       0.4534       $18.77       $18.77
                    splint.
29700............  Removal/revision of cast  N................  .................  P3...............  ...........       0.7585       $31.40       $31.40
29705............  Removal/revision of cast  N................  .................  P3...............  ...........       0.6514       $26.97       $26.97
29710............  Removal/revision of cast  N................  .................  P3...............  ...........       1.1872       $49.15       $49.15
29715............  Removal/revision of cast  N................  .................  P3...............  ...........       0.9729       $40.28       $40.28
29720............  Repair of body cast.....  N................  .................  P3...............  ...........       0.9565       $39.60       $39.60
29730............  Windowing of cast.......  N................  .................  P3...............  ...........       0.6432       $26.63       $26.63
29740............  Wedging of cast.........  N................  .................  P3...............  ...........       0.9070       $37.55       $37.55
29750............  Wedging of clubfoot cast  N................  .................  P3...............  ...........       0.8575       $35.50       $35.50
29800............  Jaw arthroscopy/surgery.  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29804............  Jaw arthroscopy/surgery.  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29805............  Shoulder arthroscopy, dx  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29806............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      47.7765    $1,977.95      $876.99
                    surgery.
29807............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      47.7765    $1,977.95      $876.99
                    surgery.
29819............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29820............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29821............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29822............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29823............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29824............  Shoulder arthroscopy/     Y................  .................  A2...............      $717.00      29.4467    $1,219.09      $842.52
                    surgery.
29825............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29826............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      47.7765    $1,977.95      $876.99
                    surgery.
29827............  Arthroscop rotator cuff   Y................  .................  A2...............      $717.00      47.7765    $1,977.95    $1,032.24
                    repr.
29830............  Elbow arthroscopy.......  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29834............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29835............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29836............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29837............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29838............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29840............  Wrist arthroscopy.......  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29843............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29844............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29845............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29846............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29847............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29848............  Wrist endoscopy/surgery.  Y................  .................  A2...............    $1,339.00      29.4467    $1,219.09    $1,309.02
29850............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      29.4467    $1,219.09      $777.27
29851............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      47.7765    $1,977.95      $966.99
29855............  Tibial arthroscopy/       Y................  .................  A2...............      $630.00      47.7765    $1,977.95      $966.99
                    surgery.
29856............  Tibial arthroscopy/       Y................  .................  A2...............      $630.00      29.4467    $1,219.09      $777.27
                    surgery.
29860............  Hip arthroscopy, dx.....  Y................  .................  A2...............      $630.00      29.4467    $1,219.09      $777.27
29861............  Hip arthroscopy/surgery.  Y................  .................  A2...............      $630.00      29.4467    $1,219.09      $777.27
29862............  Hip arthroscopy/surgery.  Y................  .................  A2...............    $1,339.00      47.7765    $1,977.95    $1,498.74
29863............  Hip arthroscopy/surgery.  Y................  .................  A2...............      $630.00      47.7765    $1,977.95      $966.99
29870............  Knee arthroscopy, dx....  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29871............  Knee arthroscopy/         Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    drainage.

[[Page 42869]]

 
29873............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29874............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29875............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      29.4467    $1,219.09      $777.27
29876............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      29.4467    $1,219.09      $777.27
29877............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      29.4467    $1,219.09      $777.27
29879............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29880............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      29.4467    $1,219.09      $777.27
29881............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      29.4467    $1,219.09      $777.27
29882............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29883............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29884............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29885............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      47.7765    $1,977.95      $876.99
29886............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29887............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
29888............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      47.7765    $1,977.95      $876.99
29889............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      47.7765    $1,977.95      $876.99
29891............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29892............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29893............  Scope, plantar            Y................  .................  A2...............    $1,255.56      21.1762      $876.69    $1,160.84
                    fasciotomy.
29894............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29895............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29897............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29898............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      29.4467    $1,219.09      $687.27
                    surgery.
29899............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      47.7765    $1,977.95      $876.99
                    surgery.
29900............  Mcp joint arthroscopy,    Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    dx.
29901............  Mcp joint arthroscopy,    Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    surg.
29902............  Mcp joint arthroscopy,    Y................  .................  A2...............      $510.00      16.8220      $696.43      $556.61
                    surg.
30000............  Drainage of nose lesion.  Y................  .................  P2...............  ...........       2.5765      $106.67      $106.67
30020............  Drainage of nose lesion.  Y................  .................  P2...............  ...........       2.5765      $106.67      $106.67
30100............  Intranasal biopsy.......  Y................  .................  P3...............  ...........       1.8469       $76.46       $76.46
30110............  Removal of nose polyp(s)  Y................  .................  P3...............  ...........       2.9024      $120.16      $120.16
30115............  Removal of nose polyp(s)  Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
30117............  Removal of intranasal     Y................  .................  A2...............      $510.00      16.6341      $688.65      $554.66
                    lesion.
30118............  Removal of intranasal     Y................  .................  A2...............      $510.00      24.3535    $1,008.23      $634.56
                    lesion.
30120............  Revision of nose........  Y................  .................  A2...............      $333.00      16.6341      $688.65      $421.91
30124............  Removal of nose lesion..  Y................  .................  R2...............  ...........       7.6539      $316.87      $316.87
30125............  Removal of nose lesion..  Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
30130............  Excise inferior           Y................  .................  A2...............      $510.00      16.6341      $688.65      $554.66
                    turbinate.
30140............  Resect inferior           Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
                    turbinate.
30150............  Partial removal of nose.  Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
30160............  Removal of nose.........  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
30200............  Injection treatment of    Y................  .................  P3...............  ...........       1.4841       $61.44       $61.44
                    nose.
30210............  Nasal sinus therapy.....  Y................  .................  P3...............  ...........       1.8717       $77.49       $77.49
30220............  Insert nasal septal       Y................  .................  A2...............      $464.15       7.6539      $316.87      $427.33
                    button.
30300............  Remove nasal foreign      N................  .................  P2...............  ...........       0.6416       $26.56       $26.56
                    body.
30310............  Remove nasal foreign      Y................  .................  A2...............      $333.00      16.6341      $688.65      $421.91
                    body.
30320............  Remove nasal foreign      Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
                    body.
30400............  Reconstruction of nose..  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
30410............  Reconstruction of nose..  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
30420............  Reconstruction of nose..  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
30430............  Revision of nose........  Y................  .................  A2...............      $510.00      24.3535    $1,008.23      $634.56
30435............  Revision of nose........  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
30450............  Revision of nose........  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
30460............  Revision of nose........  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
30462............  Revision of nose........  Y................  .................  A2...............    $1,339.00      40.5598    $1,679.18    $1,424.05
30465............  Repair nasal stenosis...  Y................  .................  A2...............    $1,339.00      40.5598    $1,679.18    $1,424.05
30520............  Repair of nasal septum..  Y................  .................  A2...............      $630.00      24.3535    $1,008.23      $724.56
30540............  Repair nasal defect.....  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
30545............  Repair nasal defect.....  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
30560............  Release of nasal          Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
                    adhesions.
30580............  Repair upper jaw fistula  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
30600............  Repair mouth/nose         Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
                    fistula.
30620............  Intranasal                Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    reconstruction.
30630............  Repair nasal septum       Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
                    defect.
30801............  Ablate inf turbinate,     Y................  .................  A2...............      $333.00       7.6539      $316.87      $328.97
                    superf.
30802............  Cauterization, inner      Y................  .................  A2...............      $333.00       7.6539      $316.87      $328.97
                    nose.
30901............  Control of nosebleed....  Y................  .................  P3...............  ...........       1.0720       $44.38       $44.38
30903............  Control of nosebleed....  Y................  .................  A2...............       $72.48       1.1708       $48.47       $66.48
30905............  Control of nosebleed....  Y................  .................  A2...............       $72.48       1.1708       $48.47       $66.48
30906............  Repeat control of         Y................  .................  A2...............       $72.48       1.1708       $48.47       $66.48
                    nosebleed.
30915............  Ligation, nasal sinus     Y................  .................  A2...............      $446.00      26.4396    $1,094.60      $608.15
                    artery.
30920............  Ligation, upper jaw       Y................  .................  A2...............      $510.00      26.4396    $1,094.60      $656.15
                    artery.
30930............  Ther fx, nasal inf        Y................  .................  A2...............      $630.00      16.6341      $688.65      $644.66
                    turbinate.
31000............  Irrigation, maxillary     Y................  .................  P3...............  ...........       2.4570      $101.72      $101.72
                    sinus.
31002............  Irrigation, sphenoid      Y................  .................  R2...............  ...........       7.6539      $316.87      $316.87
                    sinus.
31020............  Exploration, maxillary    Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
                    sinus.

[[Page 42870]]

 
31030............  Exploration, maxillary    Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
                    sinus.
31032............  Explore sinus, remove     Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
                    polyps.
31040............  Exploration behind upper  Y................  .................  R2...............  ...........      24.3535    $1,008.23    $1,008.23
                    jaw.
31050............  Exploration, sphenoid     Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
                    sinus.
31051............  Sphenoid sinus surgery..  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
31070............  Exploration of frontal    Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
                    sinus.
31075............  Exploration of frontal    Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
                    sinus.
31080............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
31081............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
31084............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
31085............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
31086............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
31087............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
31090............  Exploration of sinuses..  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
31200............  Removal of ethmoid sinus  Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
31201............  Removal of ethmoid sinus  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
31205............  Removal of ethmoid sinus  Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
31231............  Nasal endoscopy, dx.....  Y................  .................  P2...............  ...........       1.5730       $65.12       $65.12
31233............  Nasal/sinus endoscopy,    Y................  .................  A2...............       $86.39       1.5730       $65.12       $81.07
                    dx.
31235............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $333.00      17.4546      $722.62      $430.41
                    dx.
31237............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $446.00      17.4546      $722.62      $515.16
                    surg.
31238............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $333.00      17.4546      $722.62      $430.41
                    surg.
31239............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $630.00      23.2819      $963.87      $713.47
                    surg.
31240............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $446.00      17.4546      $722.62      $515.16
                    surg.
31254............  Revision of ethmoid       Y................  .................  A2...............      $510.00      23.2819      $963.87      $623.47
                    sinus.
31255............  Removal of ethmoid sinus  Y................  .................  A2...............      $717.00      23.2819      $963.87      $778.72
31256............  Exploration maxillary     Y................  .................  A2...............      $510.00      23.2819      $963.87      $623.47
                    sinus.
31267............  Endoscopy, maxillary      Y................  .................  A2...............      $510.00      23.2819      $963.87      $623.47
                    sinus.
31276............  Sinus endoscopy,          Y................  .................  A2...............      $510.00      23.2819      $963.87      $623.47
                    surgical.
31287............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $510.00      23.2819      $963.87      $623.47
                    surg.
31288............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $510.00      23.2819      $963.87      $623.47
                    surg.
31300............  Removal of larynx lesion  Y................  .................  A2...............      $717.00      24.3535    $1,008.23      $789.81
31320............  Diagnostic incision,      Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
                    larynx.
31400............  Revision of larynx......  Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
31420............  Removal of epiglottis...  Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
31500............  Insert emergency airway.  N................  .................  G2...............  ...........       2.5547      $105.76      $105.76
31502............  Change of windpipe        N................  CH...............  G2...............  ...........       1.3636       $56.45       $56.45
                    airway.
31505............  Diagnostic laryngoscopy.  Y................  .................  P2...............  ...........       0.8256       $34.18       $34.18
31510............  Laryngoscopy with biopsy  Y................  .................  A2...............      $446.00      17.4546      $722.62      $515.16
31511............  Remove foreign body,      Y................  .................  A2...............       $86.39       1.5730       $65.12       $81.07
                    larynx.
31512............  Removal of larynx lesion  Y................  .................  A2...............      $446.00      17.4546      $722.62      $515.16
31513............  Injection into vocal      Y................  .................  A2...............       $86.39       1.5730       $65.12       $81.07
                    cord.
31515............  Laryngoscopy for          Y................  .................  A2...............      $333.00      17.4546      $722.62      $430.41
                    aspiration.
31520............  Dx laryngoscopy, newborn  Y................  .................  G2...............  ...........       1.5730       $65.12       $65.12
31525............  Dx laryngoscopy excl nb.  Y................  .................  A2...............      $333.00      17.4546      $722.62      $430.41
31526............  Dx laryngoscopy w/oper    Y................  .................  A2...............      $446.00      23.2819      $963.87      $575.47
                    scope.
31527............  Laryngoscopy for          Y................  .................  A2...............      $333.00      23.2819      $963.87      $490.72
                    treatment.
31528............  Laryngoscopy and          Y................  .................  A2...............      $446.00      17.4546      $722.62      $515.16
                    dilation.
31529............  Laryngoscopy and          Y................  .................  A2...............      $446.00      17.4546      $722.62      $515.16
                    dilation.
31530............  Laryngoscopy w/fb         Y................  .................  A2...............      $446.00      23.2819      $963.87      $575.47
                    removal.
31531............  Laryngoscopy w/fb & op    Y................  .................  A2...............      $510.00      23.2819      $963.87      $623.47
                    scope.
31535............  Laryngoscopy w/biopsy...  Y................  .................  A2...............      $446.00      23.2819      $963.87      $575.47
31536............  Laryngoscopy w/bx & op    Y................  .................  A2...............      $510.00      23.2819      $963.87      $623.47
                    scope.
31540............  Laryngoscopy w/exc of     Y................  .................  A2...............      $510.00      23.2819      $963.87      $623.47
                    tumor.
31541............  Larynscop w/tumr exc +    Y................  .................  A2...............      $630.00      23.2819      $963.87      $713.47
                    scope.
31545............  Remove vc lesion w/scope  Y................  .................  A2...............      $630.00      23.2819      $963.87      $713.47
31546............  Remove vc lesion scope/   Y................  .................  A2...............      $630.00      23.2819      $963.87      $713.47
                    graft.
31560............  Laryngoscop w/            Y................  .................  A2...............      $717.00      23.2819      $963.87      $778.72
                    arytenoidectom.
31561............  Larynscop, remve cart +   Y................  .................  A2...............      $717.00      23.2819      $963.87      $778.72
                    scop.
31570............  Laryngoscope w/vc inj...  Y................  .................  A2...............      $446.00      17.4546      $722.62      $515.16
31571............  Laryngoscop w/vc inj +    Y................  .................  A2...............      $446.00      23.2819      $963.87      $575.47
                    scope.
31575............  Diagnostic laryngoscopy.  Y................  .................  P3...............  ...........       1.4676       $60.76       $60.76
31576............  Laryngoscopy with biopsy  Y................  .................  A2...............      $446.00      23.2819      $963.87      $575.47
31577............  Remove foreign body,      Y................  .................  A2...............      $236.42       4.2060      $174.13      $220.85
                    larynx.
31578............  Removal of larynx lesion  Y................  .................  A2...............      $446.00      23.2819      $963.87      $575.47
31579............  Diagnostic laryngoscopy.  Y................  .................  P3...............  ...........       2.7126      $112.30      $112.30
31580............  Revision of larynx......  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
31582............  Revision of larynx......  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
31588............  Revision of larynx......  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
31590............  Reinnervate larynx......  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
31595............  Larynx nerve surgery....  Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
31603............  Incision of windpipe....  Y................  .................  A2...............      $333.00       7.6539      $316.87      $328.97
31605............  Incision of windpipe....  Y................  .................  G2...............  ...........       7.6539      $316.87      $316.87
31611............  Surgery/speech            Y................  .................  A2...............      $510.00      24.3535    $1,008.23      $634.56
                    prosthesis.
31612............  Puncture/clear windpipe.  Y................  .................  A2...............      $333.00      24.3535    $1,008.23      $501.81
31613............  Repair windpipe opening.  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56

[[Page 42871]]

 
31614............  Repair windpipe opening.  Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
31615............  Visualization of          Y................  .................  A2...............      $333.00      10.1732      $421.17      $355.04
                    windpipe.
31620............  Endobronchial us add-on.  N................  CH...............  N1...............      $333.00  ...........  ...........  ...........
31622............  Dx bronchoscope/wash....  Y................  .................  A2...............      $333.00      10.1732      $421.17      $355.04
31623............  Dx bronchoscope/brush...  Y................  .................  A2...............      $446.00      10.1732      $421.17      $439.79
31624............  Dx bronchoscope/lavage..  Y................  .................  A2...............      $446.00      10.1732      $421.17      $439.79
31625............  Bronchoscopy w/biopsy(s)  Y................  .................  A2...............      $446.00      10.1732      $421.17      $439.79
31628............  Bronchoscopy/lung bx,     Y................  .................  A2...............      $446.00      10.1732      $421.17      $439.79
                    each.
31629............  Bronchoscopy/needle bx,   Y................  .................  A2...............      $446.00      10.1732      $421.17      $439.79
                    each.
31630............  Bronchoscopy dilate/fx    Y................  .................  A2...............      $446.00      24.2882    $1,005.53      $585.88
                    repr.
31631............  Bronchoscopy, dilate w/   Y................  .................  A2...............      $446.00      24.2882    $1,005.53      $585.88
                    stent.
31632............  Bronchoscopy/lung bx,     Y................  .................  G2...............  ...........      10.1732      $421.17      $421.17
                    add'l.
31633............  Bronchoscopy/needle bx    Y................  .................  G2...............  ...........      10.1732      $421.17      $421.17
                    add'l.
31635............  Bronchoscopy w/fb         Y................  .................  A2...............      $446.00      10.1732      $421.17      $439.79
                    removal.
31636............  Bronchoscopy, bronch      Y................  .................  A2...............      $446.00      24.2882    $1,005.53      $585.88
                    stents.
31637............  Bronchoscopy, stent add-  Y................  .................  A2...............      $333.00      10.1732      $421.17      $355.04
                    on.
31638............  Bronchoscopy, revise      Y................  .................  A2...............      $446.00      24.2882    $1,005.53      $585.88
                    stent.
31640............  Bronchoscopy w/tumor      Y................  .................  A2...............      $446.00      24.2882    $1,005.53      $585.88
                    excise.
31641............  Bronchoscopy, treat       Y................  .................  A2...............      $446.00      24.2882    $1,005.53      $585.88
                    blockage.
31643............  Diag bronchoscope/        Y................  .................  A2...............      $446.00      10.1732      $421.17      $439.79
                    catheter.
31645............  Bronchoscopy, clear       Y................  .................  A2...............      $333.00      10.1732      $421.17      $355.04
                    airways.
31646............  Bronchoscopy, reclear     Y................  .................  A2...............      $333.00      10.1732      $421.17      $355.04
                    airway.
31656............  Bronchoscopy, inj for x-  Y................  .................  A2...............      $333.00      10.1732      $421.17      $355.04
                    ray.
31715............  Injection for bronchus x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
31717............  Bronchial brush biopsy..  Y................  .................  A2...............      $236.42       4.2060      $174.13      $220.85
31720............  Clearance of airways....  N................  CH...............  A2...............       $47.32       0.3904       $16.16       $39.53
31730............  Intro, windpipe wire/     Y................  .................  A2...............      $236.42       4.2060      $174.13      $220.85
                    tube.
31750............  Repair of windpipe......  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
31755............  Repair of windpipe......  Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
31820............  Closure of windpipe       Y................  .................  A2...............      $333.00      16.6341      $688.65      $421.91
                    lesion.
31825............  Repair of windpipe        Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
                    defect.
31830............  Revise windpipe scar....  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
32000............  Drainage of chest.......  Y................  .................  A2...............      $222.78       5.3095      $219.81      $222.04
32002............  Treatment of collapsed    Y................  .................  G2...............  ...........       5.3095      $219.81      $219.81
                    lung.
32019............  Insert pleural catheter.  Y................  .................  G2...............  ...........      31.7598    $1,314.86    $1,314.86
32400............  Needle biopsy chest       Y................  .................  A2...............      $333.00       9.5741      $396.37      $348.84
                    lining.
32405............  Biopsy, lung or           Y................  .................  A2...............      $333.00       9.5741      $396.37      $348.84
                    mediastinum.
32420............  Puncture/clear lung.....  Y................  .................  A2...............      $222.78       5.3095      $219.81      $222.04
32960............  Therapeutic pneumothorax  Y................  .................  G2...............  ...........       5.3095      $219.81      $219.81
33010............  Drainage of heart sac...  Y................  .................  A2...............      $222.78       5.3095      $219.81      $222.04
33011............  Repeat drainage of heart  Y................  .................  A2...............      $222.78       5.3095      $219.81      $222.04
                    sac.
33206............  Insertion of heart        Y................  .................  J8...............  ...........     171.4188    $7,096.74    $7,096.74
                    pacemaker.
33207............  Insertion of heart        Y................  .................  J8...............  ...........     171.4188    $7,096.74    $7,096.74
                    pacemaker.
33208............  Insertion of heart        Y................  .................  J8...............  ...........     202.2251    $8,372.12    $8,372.12
                    pacemaker.
33210............  Insertion of heart        Y................  CH...............  J8...............  ...........      98.1097    $4,061.74    $4,061.74
                    electrode.
33211............  Insertion of heart        Y................  CH...............  J8...............  ...........      98.1097    $4,061.74    $4,061.74
                    electrode.
33212............  Insertion of pulse        Y................  .................  H8...............      $510.00     140.4331    $5,813.93    $5,438.26
                    generator.
33213............  Insertion of pulse        Y................  .................  H8...............      $510.00     150.5751    $6,233.81    $5,815.00
                    generator.
33214............  Upgrade of pacemaker      Y................  .................  J8...............  ...........     202.2251    $8,372.12    $8,372.12
                    system.
33215............  Reposition pacing-defib   Y................  .................  G2...............  ...........      24.7274    $1,023.71    $1,023.71
                    lead.
33216............  Insert lead pace-defib,   Y................  CH...............  J8...............  ...........      98.1097    $4,061.74    $4,061.74
                    one.
33217............  Insert lead pace-defib,   Y................  CH...............  J8...............  ...........      98.1097    $4,061.74    $4,061.74
                    dual.
33218............  Repair lead pace-defib,   Y................  .................  G2...............  ...........      24.7274    $1,023.71    $1,023.71
                    one.
33220............  Repair lead pace-defib,   Y................  .................  G2...............  ...........      24.7274    $1,023.71    $1,023.71
                    dual.
33222............  Revise pocket, pacemaker  Y................  .................  A2...............      $446.00      15.4399      $639.21      $494.30
33223............  Revise pocket, pacing-    Y................  .................  A2...............      $446.00      15.4399      $639.21      $494.30
                    defib.
33224............  Insert pacing lead &      Y................  .................  J8...............  ...........     360.3278   $14,917.57   $14,917.57
                    connect.
33225............  Lventric pacing lead add- Y................  .................  J8...............  ...........     360.3278   $14,917.57   $14,917.57
                    on.
33226............  Reposition l ventric      Y................  .................  G2...............  ...........      24.7274    $1,023.71    $1,023.71
                    lead.
33233............  Removal of pacemaker      Y................  .................  A2...............      $446.00      24.7274    $1,023.71      $590.43
                    system.
33234............  Removal of pacemaker      Y................  .................  G2...............  ...........      24.7274    $1,023.71    $1,023.71
                    system.
33235............  Removal pacemaker         Y................  .................  G2...............  ...........      24.7274    $1,023.71    $1,023.71
                    electrode.
33240............  Insert pulse generator..  Y................  CH...............  J8...............  ...........     523.1751   $21,659.45   $21,659.45
33241............  Remove pulse generator..  Y................  .................  G2...............  ...........      24.7274    $1,023.71    $1,023.71
33249............  Eltrd/insert pace-defib.  Y................  CH...............  J8...............  ...........     596.7345   $24,704.81   $24,704.81
33282............  Implant pat-active ht     N................  .................  J8...............  ...........      99.4780    $4,118.39    $4,118.39
                    record.
33284............  Remove pat-active ht      Y................  .................  G2...............  ...........       6.1077      $252.86      $252.86
                    record.
33508............  Endoscopic vein harvest.  N................  .................  N1...............  ...........  ...........  ...........  ...........
35188............  Repair blood vessel       Y................  .................  A2...............      $630.00      39.8001    $1,647.72      $884.43
                    lesion.
35207............  Repair blood vessel       Y................  .................  A2...............      $630.00      39.8001    $1,647.72      $884.43
                    lesion.
35473............  Repair arterial blockage  Y................  .................  G2...............  ...........      46.0685    $1,907.24    $1,907.24
35474............  Repair arterial blockage  Y................  .................  G2...............  ...........      46.0685    $1,907.24    $1,907.24
35476............  Repair venous blockage..  Y................  .................  G2...............  ...........      46.0685    $1,907.24    $1,907.24
35492............  Atherectomy,              Y................  .................  G2...............  ...........      88.7717    $3,675.15    $3,675.15
                    percutaneous.
35572............  Harvest femoropopliteal   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
35761............  Exploration of artery/    Y................  .................  G2...............  ...........      30.5379    $1,264.27    $1,264.27
                    vein.

[[Page 42872]]

 
35875............  Removal of clot in graft  Y................  .................  A2...............    $1,339.00      39.8001    $1,647.72    $1,416.18
35876............  Removal of clot in graft  Y................  .................  A2...............    $1,339.00      39.8001    $1,647.72    $1,416.18
36000............  Place needle in vein....  N................  .................  N1...............  ...........  ...........  ...........  ...........
36002............  Pseudoaneurysm injection  N................  .................  G2...............  ...........       2.4859      $102.92      $102.92
                    trt.
36005............  Injection ext venography  N................  .................  N1...............  ...........  ...........  ...........  ...........
36010............  Place catheter in vein..  N................  .................  N1...............  ...........  ...........  ...........  ...........
36011............  Place catheter in vein..  N................  .................  N1...............  ...........  ...........  ...........  ...........
36012............  Place catheter in vein..  N................  .................  N1...............  ...........  ...........  ...........  ...........
36013............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36014............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36015............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36100............  Establish access to       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36120............  Establish access to       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36140............  Establish access to       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36145............  Artery to vein shunt....  N................  .................  N1...............  ...........  ...........  ...........  ...........
36160............  Establish access to       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    aorta.
36200............  Place catheter in aorta.  N................  .................  N1...............  ...........  ...........  ...........  ...........
36215............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36216............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36217............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36218............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36245............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36246............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36247............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36248............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36260............  Insertion of infusion     Y................  .................  A2...............      $510.00      29.3210    $1,213.89      $685.97
                    pump.
36261............  Revision of infusion      Y................  .................  A2...............      $446.00      29.3210    $1,213.89      $637.97
                    pump.
36262............  Removal of infusion pump  Y................  .................  A2...............      $333.00      24.5273    $1,015.43      $503.61
36400............  Bl draw < 3 yrs fem/      N................  .................  N1...............  ...........  ...........  ...........  ...........
                    jugular.
36405............  Bl draw < 3 yrs scalp     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36406............  Bl draw < 3 yrs other     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36410............  Non-routine bl draw > 3   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    yrs.
36416............  Capillary blood draw....  N................  .................  N1...............  ...........  ...........  ...........  ...........
36420............  Vein access cutdown < 1   Y................  .................  G2...............  ...........       0.2091        $8.66        $8.66
                    yr.
36425............  Vein access cutdown > 1   Y................  .................  R2...............  ...........       0.2091        $8.66        $8.66
                    yr.
36430............  Blood transfusion         N................  .................  P3...............  ...........       0.7998       $33.11       $33.11
                    service.
36440............  Bl push transfuse, 2 yr   N................  .................  R2...............  ...........       3.4924      $144.59      $144.59
                    or <.
36450............  Bl exchange/transfuse,    N................  .................  R2...............  ...........       3.4924      $144.59      $144.59
                    nb.
36468............  Injection(s), spider      Y................  .................  R2...............  ...........       0.8046       $33.31       $33.31
                    veins.
36469............  Injection(s), spider      Y................  CH...............  R2...............  ...........       0.8046       $33.31       $33.31
                    veins.
36470............  Injection therapy of      Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
                    vein.
36471............  Injection therapy of      Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
                    veins.
36475............  Endovenous rf, 1st vein.  Y................  .................  A2...............    $1,339.00      43.6609    $1,807.56    $1,456.14
36476............  Endovenous rf, vein add-  Y................  .................  A2...............    $1,339.00      26.4396    $1,094.60    $1,277.90
                    on.
36478............  Endovenous laser, 1st     Y................  .................  A2...............    $1,339.00      26.4396    $1,094.60    $1,277.90
                    vein.
36479............  Endovenous laser vein     Y................  .................  A2...............    $1,339.00      26.4396    $1,094.60    $1,277.90
                    addon.
36481............  Insertion of catheter,    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36500............  Insertion of catheter,    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36510............  Insertion of catheter,    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36511............  Apheresis wbc...........  N................  .................  G2...............  ...........      12.1982      $505.01      $505.01
36512............  Apheresis rbc...........  N................  .................  G2...............  ...........      12.1982      $505.01      $505.01
36513............  Apheresis platelets.....  N................  .................  G2...............  ...........      12.1982      $505.01      $505.01
36514............  Apheresis plasma........  N................  .................  G2...............  ...........      12.1982      $505.01      $505.01
36515............  Apheresis, adsorp/        N................  .................  G2...............  ...........      31.9648    $1,323.34    $1,323.34
                    reinfuse.
36516............  Apheresis, selective....  N................  .................  G2...............  ...........      31.9648    $1,323.34    $1,323.34
36522............  Photopheresis...........  N................  .................  G2...............  ...........      31.9648    $1,323.34    $1,323.34
36540............  Collect blood venous      N................  .................  N1...............  ...........  ...........  ...........  ...........
                    device.
36550............  Declot vascular device..  Y................  .................  P3...............  ...........       0.2886       $11.95       $11.95
36555............  Insert non-tunnel cv      Y................  .................  A2...............      $333.00      11.0043      $455.58      $363.65
                    cath.
36556............  Insert non-tunnel cv      Y................  .................  A2...............      $333.00      11.0043      $455.58      $363.65
                    cath.
36557............  Insert tunneled cv cath.  Y................  .................  A2...............      $446.00      24.5273    $1,015.43      $588.36
36558............  Insert tunneled cv cath.  Y................  .................  A2...............      $446.00      24.5273    $1,015.43      $588.36
36560............  Insert tunneled cv cath.  Y................  .................  A2...............      $510.00      29.3210    $1,213.89      $685.97
36561............  Insert tunneled cv cath.  Y................  .................  A2...............      $510.00      29.3210    $1,213.89      $685.97
36563............  Insert tunneled cv cath.  Y................  .................  A2...............      $510.00      29.3210    $1,213.89      $685.97
36565............  Insert tunneled cv cath.  Y................  .................  A2...............      $510.00      29.3210    $1,213.89      $685.97
36566............  Insert tunneled cv cath.  Y................  .................  H8...............      $510.00     116.7686    $4,834.22    $4,203.51
36568............  Insert picc cath........  Y................  .................  A2...............      $333.00      11.0043      $455.58      $363.65
36569............  Insert picc cath........  Y................  .................  A2...............      $333.00      11.0043      $455.58      $363.65
36570............  Insert picvad cath......  Y................  .................  A2...............      $510.00      24.5273    $1,015.43      $636.36
36571............  Insert picvad cath......  Y................  .................  A2...............      $510.00      24.5273    $1,015.43      $636.36
36575............  Repair tunneled cv cath.  Y................  .................  A2...............      $446.00       6.1077      $252.86      $397.72
36576............  Repair tunneled cv cath.  Y................  .................  A2...............      $446.00      11.0043      $455.58      $448.40
36578............  Replace tunneled cv cath  Y................  .................  A2...............      $446.00      24.5273    $1,015.43      $588.36
36580............  Replace cvad cath.......  Y................  .................  A2...............      $333.00      11.0043      $455.58      $363.65
36581............  Replace tunneled cv cath  Y................  .................  A2...............      $446.00      24.5273    $1,015.43      $588.36

[[Page 42873]]

 
36582............  Replace tunneled cv cath  Y................  .................  A2...............      $510.00      29.3210    $1,213.89      $685.97
36583............  Replace tunneled cv cath  Y................  .................  A2...............      $510.00      29.3210    $1,213.89      $685.97
36584............  Replace picc cath.......  Y................  .................  A2...............      $333.00      11.0043      $455.58      $363.65
36585............  Replace picvad cath.....  Y................  .................  A2...............      $510.00      24.5273    $1,015.43      $636.36
36589............  Removal tunneled cv cath  Y................  .................  A2...............      $333.00       6.1077      $252.86      $312.97
36590............  Removal tunneled cv cath  Y................  .................  A2...............      $333.00      11.0043      $455.58      $363.65
36595............  Mech remov tunneled cv    Y................  .................  G2...............  ...........      24.5273    $1,015.43    $1,015.43
                    cath.
36596............  Mech remov tunneled cv    Y................  .................  G2...............  ...........      11.0043      $455.58      $455.58
                    cath.
36597............  Reposition venous         Y................  .................  G2...............  ...........      11.0043      $455.58      $455.58
                    catheter.
36598............  Inj w/fluor, eval cv      Y................  CH...............  P3...............  ...........       1.9872       $82.27       $82.27
                    device.
36600............  Withdrawal of arterial    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    blood.
36620............  Insertion catheter,       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36625............  Insertion catheter,       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36640............  Insertion catheter,       Y................  .................  A2...............      $333.00      29.3210    $1,213.89      $553.22
                    artery.
36680............  Insert needle, bone       Y................  .................  G2...............  ...........       1.1915       $49.33       $49.33
                    cavity.
36800............  Insertion of cannula....  Y................  .................  A2...............      $510.00      30.5379    $1,264.27      $698.57
36810............  Insertion of cannula....  Y................  .................  A2...............      $510.00      30.5379    $1,264.27      $698.57
36815............  Insertion of cannula....  Y................  .................  A2...............      $510.00      30.5379    $1,264.27      $698.57
36818............  Av fuse, uppr arm,        Y................  .................  A2...............      $510.00      39.8001    $1,647.72      $794.43
                    cephalic.
36819............  Av fuse, uppr arm,        Y................  .................  A2...............      $510.00      39.8001    $1,647.72      $794.43
                    basilic.
36820............  Av fusion/forearm vein..  Y................  .................  A2...............      $510.00      39.8001    $1,647.72      $794.43
36821............  Av fusion direct any      Y................  .................  A2...............      $510.00      39.8001    $1,647.72      $794.43
                    site.
36825............  Artery-vein autograft...  Y................  .................  A2...............      $630.00      39.8001    $1,647.72      $884.43
36830............  Artery-vein nonautograft  Y................  .................  A2...............      $630.00      39.8001    $1,647.72      $884.43
36831............  Open thrombect av         Y................  .................  A2...............    $1,339.00      39.8001    $1,647.72    $1,416.18
                    fistula.
36832............  Av fistula revision,      Y................  .................  A2...............      $630.00      39.8001    $1,647.72      $884.43
                    open.
36833............  Av fistula revision.....  Y................  .................  A2...............      $630.00      39.8001    $1,647.72      $884.43
36834............  Repair A-V aneurysm.....  Y................  .................  A2...............      $510.00      39.8001    $1,647.72      $794.43
36835............  Artery to vein shunt....  Y................  .................  A2...............      $630.00      30.5379    $1,264.27      $788.57
36860............  External cannula          Y................  .................  A2...............      $127.40       2.5179      $104.24      $121.61
                    declotting.
36861............  Cannula declotting......  Y................  .................  A2...............      $510.00      30.5379    $1,264.27      $698.57
36870............  Percut thrombect av       Y................  .................  A2...............    $1,339.00      41.0875    $1,701.02    $1,429.51
                    fistula.
37184............  Prim art mech             Y................  .................  G2...............  ...........      39.8001    $1,647.72    $1,647.72
                    thrombectomy.
37185............  Prim art m-thrombect add- Y................  .................  G2...............  ...........      39.8001    $1,647.72    $1,647.72
                    on.
37186............  Sec art m-thrombect add-  Y................  .................  G2...............  ...........      39.8001    $1,647.72    $1,647.72
                    on.
37187............  Venous mech thrombectomy  Y................  .................  G2...............  ...........      39.8001    $1,647.72    $1,647.72
37188............  Venous m-thrombectomy     Y................  .................  G2...............  ...........      39.8001    $1,647.72    $1,647.72
                    add-on.
37200............  Transcatheter biopsy....  Y................  .................  G2...............  ...........      29.3210    $1,213.89    $1,213.89
37203............  Transcatheter retrieval.  Y................  .................  G2...............  ...........      29.3210    $1,213.89    $1,213.89
37250............  Iv us first vessel add-   N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    on.
37251............  Iv us each add vessel     N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    add-on.
37500............  Endoscopy ligate perf     Y................  .................  A2...............      $510.00      43.6609    $1,807.56      $834.39
                    veins.
37607............  Ligation of a-v fistula.  Y................  .................  A2...............      $510.00      26.4396    $1,094.60      $656.15
37609............  Temporal artery           Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    procedure.
37650............  Revision of major vein..  Y................  .................  A2...............      $446.00      26.4396    $1,094.60      $608.15
37700............  Revise leg vein.........  Y................  .................  A2...............      $446.00      26.4396    $1,094.60      $608.15
37718............  Ligate/strip short leg    Y................  .................  A2...............      $510.00      26.4396    $1,094.60      $656.15
                    vein.
37722............  Ligate/strip long leg     Y................  .................  A2...............      $510.00      43.6609    $1,807.56      $834.39
                    vein.
37735............  Removal of leg veins/     Y................  .................  A2...............      $510.00      43.6609    $1,807.56      $834.39
                    lesion.
37760............  Ligation, leg veins,      Y................  .................  A2...............      $510.00      26.4396    $1,094.60      $656.15
                    open.
37765............  Phleb veins--extrem--to   Y................  .................  R2...............  ...........      26.4396    $1,094.60    $1,094.60
                    20.
37766............  Phleb veins--extrem 20+.  Y................  .................  R2...............  ...........      26.4396    $1,094.60    $1,094.60
37780............  Revision of leg vein....  Y................  .................  A2...............      $510.00      26.4396    $1,094.60      $656.15
37785............  Ligate/divide/excise      Y................  .................  A2...............      $510.00      26.4396    $1,094.60      $656.15
                    vein.
37790............  Penile venous occlusion.  Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
38200............  Injection for spleen x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
38204............  Bl donor search           N................  .................  N1...............  ...........  ...........  ...........  ...........
                    management.
38205............  Harvest allogenic stem    N................  .................  G2...............  ...........      12.1982      $505.01      $505.01
                    cells.
38206............  Harvest auto stem cells.  N................  .................  G2...............  ...........      12.1982      $505.01      $505.01
38220............  Bone marrow aspiration..  Y................  CH...............  P3...............  ...........       2.6302      $108.89      $108.89
38221............  Bone marrow biopsy......  Y................  CH...............  P3...............  ...........       2.7621      $114.35      $114.35
38230............  Bone marrow collection..  N................  .................  G2...............  ...........      31.9648    $1,323.34    $1,323.34
38241............  Bone marrow/stem          N................  .................  G2...............  ...........      31.9648    $1,323.34    $1,323.34
                    transplant.
38242............  Lymphocyte infuse         N................  .................  R2...............  ...........      12.1982      $505.01      $505.01
                    transplant.
38300............  Drainage, lymph node      Y................  .................  A2...............      $333.00      12.5792      $520.78      $379.95
                    lesion.
38305............  Drainage, lymph node      Y................  .................  A2...............      $446.00      19.0457      $788.49      $531.62
                    lesion.
38308............  Incision of lymph         Y................  .................  A2...............      $446.00      23.5105      $973.33      $577.83
                    channels.
38500............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      23.5105      $973.33      $577.83
                    nodes.
38505............  Needle biopsy, lymph      Y................  .................  A2...............      $240.00       7.3012      $302.27      $255.57
                    nodes.
38510............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      23.5105      $973.33      $577.83
                    nodes.
38520............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      23.5105      $973.33      $577.83
                    nodes.
38525............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      23.5105      $973.33      $577.83
                    nodes.
38530............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      23.5105      $973.33      $577.83
                    nodes.
38542............  Explore deep node(s),     Y................  .................  A2...............      $446.00      45.1729    $1,870.16      $802.04
                    neck.
38550............  Removal, neck/armpit      Y................  .................  A2...............      $510.00      23.5105      $973.33      $625.83
                    lesion.
38555............  Removal, neck/armpit      Y................  .................  A2...............      $630.00      23.5105      $973.33      $715.83
                    lesion.

[[Page 42874]]

 
38570............  Laparoscopy, lymph node   Y................  .................  A2...............    $1,339.00      46.1201    $1,909.37    $1,481.59
                    biop.
38571............  Laparoscopy,              Y................  .................  A2...............    $1,339.00      71.0022    $2,939.49    $1,739.12
                    lymphadenectomy.
38572............  Laparoscopy,              Y................  .................  A2...............    $1,339.00      46.1201    $1,909.37    $1,481.59
                    lymphadenectomy.
38700............  Removal of lymph nodes,   Y................  .................  G2...............  ...........      23.5105      $973.33      $973.33
                    neck.
38740............  Remove armpit lymph       Y................  .................  A2...............      $446.00      45.1729    $1,870.16      $802.04
                    nodes.
38745............  Remove armpit lymph       Y................  .................  A2...............      $630.00      45.1729    $1,870.16      $940.04
                    nodes.
38760............  Remove groin lymph nodes  Y................  .................  A2...............      $446.00      23.5105      $973.33      $577.83
38790............  Inject for lymphatic x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
38792............  Identify sentinel node..  N................  .................  N1...............  ...........  ...........  ...........  ...........
38794............  Access thoracic lymph     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    duct.
40490............  Biopsy of lip...........  Y................  .................  P3...............  ...........       1.5336       $63.49       $63.49
40500............  Partial excision of lip.  Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
40510............  Partial excision of lip.  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
40520............  Partial excision of lip.  Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
40525............  Reconstruct lip with      Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
                    flap.
40527............  Reconstruct lip with      Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
                    flap.
40530............  Partial removal of lip..  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
40650............  Repair lip..............  Y................  .................  A2...............      $464.15       7.6539      $316.87      $427.33
40652............  Repair lip..............  Y................  .................  A2...............      $464.15       7.6539      $316.87      $427.33
40654............  Repair lip..............  Y................  .................  A2...............      $464.15       7.6539      $316.87      $427.33
40700............  Repair cleft lip/nasal..  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
40701............  Repair cleft lip/nasal..  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
40702............  Repair cleft lip/nasal..  Y................  .................  R2...............  ...........      40.5598    $1,679.18    $1,679.18
40720............  Repair cleft lip/nasal..  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
40761............  Repair cleft lip/nasal..  Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
40800............  Drainage of mouth lesion  Y................  .................  P2...............  ...........       1.4630       $60.57       $60.57
40801............  Drainage of mouth lesion  Y................  .................  A2...............      $446.00       7.6539      $316.87      $413.72
40804............  Removal, foreign body,    N................  .................  P2...............  ...........       0.6416       $26.56       $26.56
                    mouth.
40805............  Removal, foreign body,    Y................  .................  P3...............  ...........       3.9495      $163.51      $163.51
                    mouth.
40806............  Incision of lip fold....  Y................  .................  P3...............  ...........       1.7481       $72.37       $72.37
40808............  Biopsy of mouth lesion..  Y................  .................  P3...............  ...........       2.5643      $106.16      $106.16
40810............  Excision of mouth lesion  Y................  .................  P3...............  ...........       2.6879      $111.28      $111.28
40812............  Excise/repair mouth       Y................  .................  P3...............  ...........       3.4053      $140.98      $140.98
                    lesion.
40814............  Excise/repair mouth       Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
                    lesion.
40816............  Excision of mouth lesion  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
40818............  Excise oral mucosa for    Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
                    graft.
40819............  Excise lip or cheek fold  Y................  .................  A2...............      $333.00       7.6539      $316.87      $328.97
40820............  Treatment of mouth        Y................  .................  P3...............  ...........       3.7763      $156.34      $156.34
                    lesion.
40830............  Repair mouth laceration.  Y................  .................  G2...............  ...........       2.5765      $106.67      $106.67
40831............  Repair mouth laceration.  Y................  .................  A2...............      $333.00       7.6539      $316.87      $328.97
40840............  Reconstruction of mouth.  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
40842............  Reconstruction of mouth.  Y................  .................  A2...............      $510.00      24.3535    $1,008.23      $634.56
40843............  Reconstruction of mouth.  Y................  .................  A2...............      $510.00      24.3535    $1,008.23      $634.56
40844............  Reconstruction of mouth.  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
40845............  Reconstruction of mouth.  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
41000............  Drainage of mouth lesion  Y................  .................  P3...............  ...........       1.9954       $82.61       $82.61
41005............  Drainage of mouth lesion  Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
41006............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00      24.3535    $1,008.23      $501.81
41007............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00      16.6341      $688.65      $421.91
41008............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00      16.6341      $688.65      $421.91
41009............  Drainage of mouth lesion  Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
41010............  Incision of tongue fold.  Y................  .................  A2...............      $333.00       7.6539      $316.87      $328.97
41015............  Drainage of mouth lesion  Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
41016............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00       7.6539      $316.87      $328.97
41017............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00       7.6539      $316.87      $328.97
41018............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00       7.6539      $316.87      $328.97
41100............  Biopsy of tongue........  Y................  .................  P3...............  ...........       2.0860       $86.36       $86.36
41105............  Biopsy of tongue........  Y................  .................  P3...............  ...........       2.0365       $84.31       $84.31
41108............  Biopsy of floor of mouth  Y................  .................  P3...............  ...........       1.8717       $77.49       $77.49
41110............  Excision of tongue        Y................  .................  P3...............  ...........       2.7043      $111.96      $111.96
                    lesion.
41112............  Excision of tongue        Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
                    lesion.
41113............  Excision of tongue        Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
                    lesion.
41114............  Excision of tongue        Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
                    lesion.
41115............  Excision of tongue fold.  Y................  .................  P3...............  ...........       3.0920      $128.01      $128.01
41116............  Excision of mouth lesion  Y................  .................  A2...............      $333.00      16.6341      $688.65      $421.91
41120............  Partial removal of        Y................  .................  A2...............      $717.00      24.3535    $1,008.23      $789.81
                    tongue.
41250............  Repair tongue laceration  Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
41251............  Repair tongue laceration  Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
41252............  Repair tongue laceration  Y................  .................  A2...............      $446.00       7.6539      $316.87      $413.72
41500............  Fixation of tongue......  Y................  .................  A2...............      $333.00      24.3535    $1,008.23      $501.81
41510............  Tongue to lip surgery...  Y................  .................  A2...............      $333.00      16.6341      $688.65      $421.91
41520............  Reconstruction, tongue    Y................  .................  A2...............      $446.00       7.6539      $316.87      $413.72
                    fold.
41800............  Drainage of gum lesion..  Y................  .................  A2...............       $88.46       1.4630       $60.57       $81.49
41805............  Removal foreign body,     Y................  .................  P3...............  ...........       3.0176      $124.93      $124.93
                    gum.
41806............  Removal foreign body,     Y................  .................  P3...............  ...........       3.8836      $160.78      $160.78
                    jawbone.
41820............  Excision, gum, each       Y................  .................  R2...............  ...........       7.6539      $316.87      $316.87
                    quadrant.

[[Page 42875]]

 
41821............  Excision of gum flap....  Y................  .................  G2...............  ...........       7.6539      $316.87      $316.87
41822............  Excision of gum lesion..  Y................  .................  P3...............  ...........       3.5618      $147.46      $147.46
41823............  Excision of gum lesion..  Y................  .................  P3...............  ...........       4.9471      $204.81      $204.81
41825............  Excision of gum lesion..  Y................  .................  P3...............  ...........       2.7703      $114.69      $114.69
41826............  Excision of gum lesion..  Y................  .................  P3...............  ...........       3.1002      $128.35      $128.35
41827............  Excision of gum lesion..  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
41828............  Excision of gum lesion..  Y................  .................  P3...............  ...........       3.2568      $134.83      $134.83
41830............  Removal of gum tissue...  Y................  .................  P3...............  ...........       4.5184      $187.06      $187.06
41850............  Treatment of gum lesion.  Y................  .................  R2...............  ...........      16.6341      $688.65      $688.65
41870............  Gum graft...............  Y................  .................  G2...............  ...........      24.3535    $1,008.23    $1,008.23
41872............  Repair gum..............  Y................  .................  P3...............  ...........       4.5348      $187.74      $187.74
41874............  Repair tooth socket.....  Y................  .................  P3...............  ...........       4.3452      $179.89      $179.89
42000............  Drainage mouth roof       Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
                    lesion.
42100............  Biopsy roof of mouth....  Y................  .................  P3...............  ...........       1.7809       $73.73       $73.73
42104............  Excision lesion, mouth    Y................  .................  P3...............  ...........       2.4983      $103.43      $103.43
                    roof.
42106............  Excision lesion, mouth    Y................  .................  P3...............  ...........       3.1580      $130.74      $130.74
                    roof.
42107............  Excision lesion, mouth    Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
                    roof.
42120............  Remove palate/lesion....  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
42140............  Excision of uvula.......  Y................  .................  A2...............      $446.00       7.6539      $316.87      $413.72
42145............  Repair palate, pharynx/   Y................  .................  A2...............      $717.00      24.3535    $1,008.23      $789.81
                    uvula.
42160............  Treatment mouth roof      Y................  .................  P3...............  ...........       3.2899      $136.20      $136.20
                    lesion.
42180............  Repair palate...........  Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
42182............  Repair palate...........  Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
42200............  Reconstruct cleft palate  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
42205............  Reconstruct cleft palate  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
42210............  Reconstruct cleft palate  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
42215............  Reconstruct cleft palate  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
42220............  Reconstruct cleft palate  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
42226............  Lengthening of palate...  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
42235............  Repair palate...........  Y................  .................  A2...............      $717.00      16.6341      $688.65      $709.91
42260............  Repair nose to lip        Y................  .................  A2...............      $630.00      24.3535    $1,008.23      $724.56
                    fistula.
42280............  Preparation, palate mold  Y................  .................  P3...............  ...........       1.7314       $71.68       $71.68
42281............  Insertion, palate         Y................  .................  G2...............  ...........      16.6341      $688.65      $688.65
                    prosthesis.
42300............  Drainage of salivary      Y................  .................  A2...............      $333.00      16.6341      $688.65      $421.91
                    gland.
42305............  Drainage of salivary      Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
                    gland.
42310............  Drainage of salivary      Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
                    gland.
42320............  Drainage of salivary      Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
                    gland.
42330............  Removal of salivary       Y................  .................  P3...............  ...........       2.6715      $110.60      $110.60
                    stone.
42335............  Removal of salivary       Y................  .................  P3...............  ...........       4.3534      $180.23      $180.23
                    stone.
42340............  Removal of salivary       Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
                    stone.
42400............  Biopsy of salivary gland  Y................  .................  P3...............  ...........       1.4841       $61.44       $61.44
42405............  Biopsy of salivary gland  Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
42408............  Excision of salivary      Y................  .................  A2...............      $510.00      16.6341      $688.65      $554.66
                    cyst.
42409............  Drainage of salivary      Y................  .................  A2...............      $510.00      16.6341      $688.65      $554.66
                    cyst.
42410............  Excise parotid gland/     Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
                    lesion.
42415............  Excise parotid gland/     Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    lesion.
42420............  Excise parotid gland/     Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    lesion.
42425............  Excise parotid gland/     Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    lesion.
42440............  Excise submaxillary       Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
                    gland.
42450............  Excise sublingual gland.  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
42500............  Repair salivary duct....  Y................  .................  A2...............      $510.00      24.3535    $1,008.23      $634.56
42505............  Repair salivary duct....  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
42507............  Parotid duct diversion..  Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
42508............  Parotid duct diversion..  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
42509............  Parotid duct diversion..  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
42510............  Parotid duct diversion..  Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
42550............  Injection for salivary x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
42600............  Closure of salivary       Y................  .................  A2...............      $333.00      16.6341      $688.65      $421.91
                    fistula.
42650............  Dilation of salivary      Y................  .................  P3...............  ...........       0.9729       $40.28       $40.28
                    duct.
42660............  Dilation of salivary      Y................  .................  P3...............  ...........       1.1543       $47.79       $47.79
                    duct.
42665............  Ligation of salivary      Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
                    duct.
42700............  Drainage of tonsil        Y................  .................  A2...............      $150.72       2.5765      $106.67      $139.71
                    abscess.
42720............  Drainage of throat        Y................  .................  A2...............      $333.00      16.6341      $688.65      $421.91
                    abscess.
42725............  Drainage of throat        Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
                    abscess.
42800............  Biopsy of throat........  Y................  .................  P3...............  ...........       1.8882       $78.17       $78.17
42802............  Biopsy of throat........  Y................  .................  A2...............      $333.00      16.6341      $688.65      $421.91
42804............  Biopsy of upper nose/     Y................  .................  A2...............      $333.00      16.6341      $688.65      $421.91
                    throat.
42806............  Biopsy of upper nose/     Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
                    throat.
42808............  Excise pharynx lesion...  Y................  .................  A2...............      $446.00      16.6341      $688.65      $506.66
42809............  Remove pharynx foreign    N................  .................  G2...............  ...........       0.6416       $26.56       $26.56
                    body.
42810............  Excision of neck cyst...  Y................  .................  A2...............      $510.00      24.3535    $1,008.23      $634.56
42815............  Excision of neck cyst...  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
42820............  Remove tonsils and        Y................  .................  A2...............      $510.00      22.9075      $948.37      $619.59
                    adenoids.
42821............  Remove tonsils and        Y................  .................  A2...............      $717.00      22.9075      $948.37      $774.84
                    adenoids.
42825............  Removal of tonsils......  Y................  .................  A2...............      $630.00      22.9075      $948.37      $709.59
42826............  Removal of tonsils......  Y................  .................  A2...............      $630.00      22.9075      $948.37      $709.59

[[Page 42876]]

 
42830............  Removal of adenoids.....  Y................  .................  A2...............      $630.00      22.9075      $948.37      $709.59
42831............  Removal of adenoids.....  Y................  .................  A2...............      $630.00      22.9075      $948.37      $709.59
42835............  Removal of adenoids.....  Y................  .................  A2...............      $630.00      22.9075      $948.37      $709.59
42836............  Removal of adenoids.....  Y................  .................  A2...............      $630.00      22.9075      $948.37      $709.59
42860............  Excision of tonsil tags.  Y................  .................  A2...............      $510.00      22.9075      $948.37      $619.59
42870............  Excision of lingual       Y................  .................  A2...............      $510.00      22.9075      $948.37      $619.59
                    tonsil.
42890............  Partial removal of        Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    pharynx.
42892............  Revision of pharyngeal    Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    walls.
42900............  Repair throat wound.....  Y................  .................  A2...............      $333.00       7.6539      $316.87      $328.97
42950............  Reconstruction of throat  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
42955............  Surgical opening of       Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
                    throat.
42960............  Control throat bleeding.  Y................  .................  A2...............       $72.48       1.1708       $48.47       $66.48
42962............  Control throat bleeding.  Y................  .................  A2...............      $446.00      40.5598    $1,679.18      $754.30
42970............  Control nose/throat       Y................  .................  R2...............  ...........       1.1708       $48.47       $48.47
                    bleeding.
42972............  Control nose/throat       Y................  .................  A2...............      $510.00      16.6341      $688.65      $554.66
                    bleeding.
43030............  Throat muscle surgery...  Y................  .................  G2...............  ...........      16.6341      $688.65      $688.65
43200............  Esophagus endoscopy.....  Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
43201............  Esoph scope w/submucous   Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
                    inj.
43202............  Esophagus endoscopy,      Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
                    biopsy.
43204............  Esoph scope w/sclerosis   Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
                    inj.
43205............  Esophagus endoscopy/      Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
                    ligation.
43215............  Esophagus endoscopy.....  Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
43216............  Esophagus endoscopy/      Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
                    lesion.
43217............  Esophagus endoscopy.....  Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
43219............  Esophagus endoscopy.....  Y................  .................  A2...............      $333.00      25.2289    $1,044.48      $510.87
43220............  Esoph endoscopy,          Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
                    dilation.
43226............  Esoph endoscopy,          Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
                    dilation.
43227............  Esoph endoscopy, repair.  Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
43228............  Esoph endoscopy,          Y................  .................  A2...............      $446.00      24.6480    $1,020.43      $589.61
                    ablation.
43231............  Esoph endoscopy w/us      Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    exam.
43232............  Esoph endoscopy w/us fn   Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    bx.
43234............  Upper GI endoscopy, exam  Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
43235............  Uppr gi endoscopy,        Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
                    diagnosis.
43236............  Uppr gi scope w/submuc    Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    inj.
43237............  Endoscopic us exam,       Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    esoph.
43238............  Uppr gi endoscopy w/us    Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    fn bx.
43239............  Upper GI endoscopy,       Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    biopsy.
43240............  Esoph endoscope w/drain   Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    cyst.
43241............  Upper GI endoscopy with   Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    tube.
43242............  Uppr gi endoscopy w/us    Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    fn bx.
43243............  Upper gi endoscopy &      Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    inject.
43244............  Upper GI endoscopy/       Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    ligation.
43245............  Uppr gi scope dilate      Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    strictr.
43246............  Place gastrostomy tube..  Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
43247............  Operative upper GI        Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    endoscopy.
43248............  Uppr gi endoscopy/guide   Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    wire.
43249............  Esoph endoscopy,          Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    dilation.
43250............  Upper GI endoscopy/tumor  Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
43251............  Operative upper GI        Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    endoscopy.
43255............  Operative upper GI        Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
                    endoscopy.
43256............  Uppr gi endoscopy w/      Y................  .................  A2...............      $510.00      25.2289    $1,044.48      $643.62
                    stent.
43257............  Uppr gi scope w/thrml     Y................  .................  A2...............      $510.00      24.6480    $1,020.43      $637.61
                    txmnt.
43258............  Operative upper GI        Y................  .................  A2...............      $510.00       8.6730      $359.06      $472.27
                    endoscopy.
43259............  Endoscopic ultrasound     Y................  .................  A2...............      $510.00       8.6730      $359.06      $472.27
                    exam.
43260............  Endo                      Y................  .................  A2...............      $446.00      21.2820      $881.07      $554.77
                    cholangiopancreatograph.
43261............  Endo                      Y................  .................  A2...............      $446.00      21.2820      $881.07      $554.77
                    cholangiopancreatograph.
43262............  Endo                      Y................  .................  A2...............      $446.00      21.2820      $881.07      $554.77
                    cholangiopancreatograph.
43263............  Endo                      Y................  .................  A2...............      $446.00      21.2820      $881.07      $554.77
                    cholangiopancreatograph.
43264............  Endo                      Y................  .................  A2...............      $446.00      21.2820      $881.07      $554.77
                    cholangiopancreatograph.
43265............  Endo                      Y................  .................  A2...............      $446.00      21.2820      $881.07      $554.77
                    cholangiopancreatograph.
43267............  Endo                      Y................  .................  A2...............      $446.00      21.2820      $881.07      $554.77
                    cholangiopancreatograph.
43268............  Endo                      Y................  .................  A2...............      $446.00      25.2289    $1,044.48      $595.62
                    cholangiopancreatograph.
43269............  Endo                      Y................  .................  A2...............      $446.00      25.2289    $1,044.48      $595.62
                    cholangiopancreatograph.
43271............  Endo                      Y................  .................  A2...............      $446.00      21.2820      $881.07      $554.77
                    cholangiopancreatograph.
43272............  Endo                      Y................  .................  A2...............      $446.00      21.2820      $881.07      $554.77
                    cholangiopancreatograph.
43450............  Dilate esophagus........  Y................  .................  A2...............      $333.00       6.0867      $251.99      $312.75
43453............  Dilate esophagus........  Y................  .................  A2...............      $333.00       6.0867      $251.99      $312.75
43456............  Dilate esophagus........  Y................  .................  A2...............      $335.41       6.0867      $251.99      $314.56
43458............  Dilate esophagus........  Y................  .................  A2...............      $335.41       8.6730      $359.06      $341.32
43600............  Biopsy of stomach.......  Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
43653............  Laparoscopy, gastrostomy  Y................  .................  A2...............    $1,339.00      46.1201    $1,909.37    $1,481.59
43750............  Place gastrostomy tube..  Y................  .................  A2...............      $446.00       8.6730      $359.06      $424.27
43760............  Change gastrostomy tube.  Y................  .................  A2...............      $144.98       3.2914      $136.26      $142.80
43761............  Reposition gastrostomy    Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
                    tube.
43870............  Repair stomach opening..  Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
43886............  Revise gastric port,      Y................  .................  G2...............  ...........      20.9338      $866.66      $866.66
                    open.

[[Page 42877]]

 
43887............  Remove gastric port,      Y................  .................  G2...............  ...........       4.6816      $193.82      $193.82
                    open.
43888............  Change gastric port,      Y................  .................  G2...............  ...........      20.9338      $866.66      $866.66
                    open.
44100............  Biopsy of bowel.........  Y................  .................  A2...............      $333.00       8.6730      $359.06      $339.52
44312............  Revision of ileostomy...  Y................  .................  A2...............      $333.00      20.9338      $866.66      $466.42
44340............  Revision of colostomy...  Y................  .................  A2...............      $510.00      20.9338      $866.66      $599.17
44360............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.6264      $398.53      $434.13
44361............  Small bowel endoscopy/    Y................  .................  A2...............      $446.00       9.6264      $398.53      $434.13
                    biopsy.
44363............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.6264      $398.53      $434.13
44364............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.6264      $398.53      $434.13
44365............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.6264      $398.53      $434.13
44366............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.6264      $398.53      $434.13
44369............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.6264      $398.53      $434.13
44370............  Small bowel endoscopy/    Y................  .................  A2...............    $1,339.00      25.2289    $1,044.48    $1,265.37
                    stent.
44372............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.6264      $398.53      $434.13
44373............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.6264      $398.53      $434.13
44376............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.6264      $398.53      $434.13
44377............  Small bowel endoscopy/    Y................  .................  A2...............      $446.00       9.6264      $398.53      $434.13
                    biopsy.
44378............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.6264      $398.53      $434.13
44379............  Sbowel endoscope w/stent  Y................  .................  A2...............    $1,339.00      25.2289    $1,044.48    $1,265.37
44380............  Small bowel endoscopy...  Y................  .................  A2...............      $333.00       9.6264      $398.53      $349.38
44382............  Small bowel endoscopy...  Y................  .................  A2...............      $333.00       9.6264      $398.53      $349.38
44383............  Ileoscopy w/stent.......  Y................  .................  A2...............    $1,339.00      25.2289    $1,044.48    $1,265.37
44385............  Endoscopy of bowel pouch  Y................  .................  A2...............      $333.00       9.0360      $374.09      $343.27
44386............  Endoscopy, bowel pouch/   Y................  .................  A2...............      $333.00       9.0360      $374.09      $343.27
                    biop.
44388............  Colonoscopy.............  Y................  .................  A2...............      $333.00       9.0360      $374.09      $343.27
44389............  Colonoscopy with biopsy.  Y................  .................  A2...............      $333.00       9.0360      $374.09      $343.27
44390............  Colonoscopy for foreign   Y................  .................  A2...............      $333.00       9.0360      $374.09      $343.27
                    body.
44391............  Colonoscopy for bleeding  Y................  .................  A2...............      $333.00       9.0360      $374.09      $343.27
44392............  Colonoscopy &             Y................  .................  A2...............      $333.00       9.0360      $374.09      $343.27
                    polypectomy.
44393............  Colonoscopy, lesion       Y................  .................  A2...............      $333.00       9.0360      $374.09      $343.27
                    removal.
44394............  Colonoscopy w/snare.....  Y................  .................  A2...............      $333.00       9.0360      $374.09      $343.27
44397............  Colonoscopy w/stent.....  Y................  .................  A2...............      $333.00      25.2289    $1,044.48      $510.87
44701............  Intraop colon lavage add- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    on.
45000............  Drainage of pelvic        Y................  .................  A2...............      $312.07      11.6524      $482.41      $354.66
                    abscess.
45005............  Drainage of rectal        Y................  .................  A2...............      $446.00      11.6524      $482.41      $455.10
                    abscess.
45020............  Drainage of rectal        Y................  .................  A2...............      $446.00      11.6524      $482.41      $455.10
                    abscess.
45100............  Biopsy of rectum........  Y................  .................  A2...............      $333.00      23.2282      $961.65      $490.16
45108............  Removal of anorectal      Y................  .................  A2...............      $446.00      23.2282      $961.65      $574.91
                    lesion.
45150............  Excision of rectal        Y................  .................  A2...............      $446.00      23.2282      $961.65      $574.91
                    stricture.
45160............  Excision of rectal        Y................  .................  A2...............      $446.00      23.2282      $961.65      $574.91
                    lesion.
45170............  Excision of rectal        Y................  .................  A2...............      $446.00      23.2282      $961.65      $574.91
                    lesion.
45190............  Destruction, rectal       Y................  .................  A2...............    $1,339.00      23.2282      $961.65    $1,244.66
                    tumor.
45300............  Proctosigmoidoscopy dx..  Y................  .................  P3...............  ...........       1.4345       $59.39       $59.39
45303............  Proctosigmoidoscopy       Y................  .................  P2...............  ...........       8.8611      $366.85      $366.85
                    dilate.
45305............  Proctosigmoidoscopy w/bx  Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
45307............  Proctosigmoidoscopy fb..  Y................  .................  A2...............      $333.00      21.8923      $906.34      $476.34
45308............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
                    removal.
45309............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
                    removal.
45315............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
                    removal.
45317............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
                    bleed.
45320............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00      21.8923      $906.34      $476.34
                    ablate.
45321............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00      21.8923      $906.34      $476.34
                    volvul.
45327............  Proctosigmoidoscopy w/    Y................  .................  A2...............      $333.00      25.2289    $1,044.48      $510.87
                    stent.
45330............  Diagnostic sigmoidoscopy  Y................  .................  P3...............  ...........       1.9705       $81.58       $81.58
45331............  Sigmoidoscopy and biopsy  Y................  .................  A2...............      $299.24       5.1441      $212.97      $277.67
45332............  Sigmoidoscopy w/fb        Y................  .................  A2...............      $299.24       5.1441      $212.97      $277.67
                    removal.
45333............  Sigmoidoscopy &           Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
                    polypectomy.
45334............  Sigmoidoscopy for         Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
                    bleeding.
45335............  Sigmoidoscopy w/submuc    Y................  .................  A2...............      $299.24       5.1441      $212.97      $277.67
                    inj.
45337............  Sigmoidoscopy &           Y................  .................  A2...............      $299.24       5.1441      $212.97      $277.67
                    decompress.
45338............  Sigmoidoscopy w/tumr      Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
                    remove.
45339............  Sigmoidoscopy w/ablate    Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
                    tumr.
45340............  Sig w/balloon dilation..  Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
45341............  Sigmoidoscopy w/          Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
                    ultrasound.
45342............  Sigmoidoscopy w/us guide  Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
                    bx.
45345............  Sigmoidoscopy w/stent...  Y................  .................  A2...............      $333.00      25.2289    $1,044.48      $510.87
45355............  Surgical colonoscopy....  Y................  .................  A2...............      $333.00       9.0360      $374.09      $343.27
45378............  Diagnostic colonoscopy..  Y................  .................  A2...............      $446.00       9.0360      $374.09      $428.02
45379............  Colonoscopy w/fb removal  Y................  .................  A2...............      $446.00       9.0360      $374.09      $428.02
45380............  Colonoscopy and biopsy..  Y................  .................  A2...............      $446.00       9.0360      $374.09      $428.02
45381............  Colonoscopy, submucous    Y................  .................  A2...............      $446.00       9.0360      $374.09      $428.02
                    inj.
45382............  Colonoscopy/control       Y................  .................  A2...............      $446.00       9.0360      $374.09      $428.02
                    bleeding.
45383............  Lesion removal            Y................  .................  A2...............      $446.00       9.0360      $374.09      $428.02
                    colonoscopy.
45384............  Lesion remove             Y................  .................  A2...............      $446.00       9.0360      $374.09      $428.02
                    colonoscopy.
45385............  Lesion removal            Y................  .................  A2...............      $446.00       9.0360      $374.09      $428.02
                    colonoscopy.
45386............  Colonoscopy dilate        Y................  .................  A2...............      $446.00       9.0360      $374.09      $428.02
                    stricture.

[[Page 42878]]

 
45387............  Colonoscopy w/stent.....  Y................  .................  A2...............      $333.00      25.2289    $1,044.48      $510.87
45391............  Colonoscopy w/endoscope   Y................  .................  A2...............      $446.00       9.0360      $374.09      $428.02
                    us.
45392............  Colonoscopy w/endoscopic  Y................  .................  A2...............      $446.00       9.0360      $374.09      $428.02
                    fnb.
45500............  Repair of rectum........  Y................  .................  A2...............      $446.00      23.2282      $961.65      $574.91
45505............  Repair of rectum........  Y................  .................  A2...............      $446.00      30.5544    $1,264.95      $650.74
45520............  Treatment of rectal       Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
                    prolapse.
45560............  Repair of rectocele.....  Y................  .................  A2...............      $446.00      30.5544    $1,264.95      $650.74
45900............  Reduction of rectal       Y................  .................  A2...............      $312.07       4.5189      $187.08      $280.82
                    prolapse.
45905............  Dilation of anal          Y................  .................  A2...............      $333.00      23.2282      $961.65      $490.16
                    sphincter.
45910............  Dilation of rectal        Y................  .................  A2...............      $333.00      23.2282      $961.65      $490.16
                    narrowing.
45915............  Remove rectal             Y................  .................  A2...............      $312.07      11.6524      $482.41      $354.66
                    obstruction.
45990............  Surg dx exam, anorectal.  Y................  .................  A2...............      $312.07      23.2282      $961.65      $474.47
46020............  Placement of seton......  Y................  .................  A2...............      $510.00      23.2282      $961.65      $622.91
46030............  Removal of rectal marker  Y................  .................  A2...............      $312.07       4.5189      $187.08      $280.82
46040............  Incision of rectal        Y................  .................  A2...............      $510.00      23.2282      $961.65      $622.91
                    abscess.
46045............  Incision of rectal        Y................  .................  A2...............      $446.00      23.2282      $961.65      $574.91
                    abscess.
46050............  Incision of anal abscess  Y................  .................  A2...............      $312.07      11.6524      $482.41      $354.66
46060............  Incision of rectal        Y................  .................  A2...............      $446.00      23.2282      $961.65      $574.91
                    abscess.
46070............  Incision of anal septum.  Y................  .................  G2...............  ...........      11.6524      $482.41      $482.41
46080............  Incision of anal          Y................  .................  A2...............      $510.00      23.2282      $961.65      $622.91
                    sphincter.
46083............  Incise external           Y................  .................  P3...............  ...........       2.0036       $82.95       $82.95
                    hemorrhoid.
46200............  Removal of anal fissure.  Y................  .................  A2...............      $446.00      23.2282      $961.65      $574.91
46210............  Removal of anal crypt...  Y................  .................  A2...............      $446.00      23.2282      $961.65      $574.91
46211............  Removal of anal crypts..  Y................  .................  A2...............      $446.00      23.2282      $961.65      $574.91
46220............  Removal of anal tag.....  Y................  .................  A2...............      $333.00      23.2282      $961.65      $490.16
46221............  Ligation of               Y................  .................  P3...............  ...........       2.6138      $108.21      $108.21
                    hemorrhoid(s).
46230............  Removal of anal tags....  Y................  .................  A2...............      $333.00      23.2282      $961.65      $490.16
46250............  Hemorrhoidectomy........  Y................  .................  A2...............      $510.00      23.2282      $961.65      $622.91
46255............  Hemorrhoidectomy........  Y................  .................  A2...............      $510.00      23.2282      $961.65      $622.91
46257............  Remove hemorrhoids &      Y................  .................  A2...............      $510.00      23.2282      $961.65      $622.91
                    fissure.
46258............  Remove hemorrhoids &      Y................  .................  A2...............      $510.00      23.2282      $961.65      $622.91
                    fistula.
46260............  Hemorrhoidectomy........  Y................  .................  A2...............      $510.00      23.2282      $961.65      $622.91
46261............  Remove hemorrhoids &      Y................  .................  A2...............      $630.00      23.2282      $961.65      $712.91
                    fissure.
46262............  Remove hemorrhoids &      Y................  .................  A2...............      $630.00      23.2282      $961.65      $712.91
                    fistula.
46270............  Removal of anal fistula.  Y................  .................  A2...............      $510.00      23.2282      $961.65      $622.91
46275............  Removal of anal fistula.  Y................  .................  A2...............      $510.00      23.2282      $961.65      $622.91
46280............  Removal of anal fistula.  Y................  .................  A2...............      $630.00      23.2282      $961.65      $712.91
46285............  Removal of anal fistula.  Y................  .................  A2...............      $333.00      23.2282      $961.65      $490.16
46288............  Repair anal fistula.....  Y................  .................  A2...............      $630.00      23.2282      $961.65      $712.91
46320............  Removal of hemorrhoid     Y................  .................  P3...............  ...........       1.8635       $77.15       $77.15
                    clot.
46500............  Injection into            Y................  .................  P3...............  ...........       2.3498       $97.28       $97.28
                    hemorrhoid(s).
46505............  Chemodenervation anal     Y................  CH...............  P3...............  ...........       2.5973      $107.53      $107.53
                    musc.
46600............  Diagnostic anoscopy.....  N................  .................  P2...............  ...........       0.6416       $26.56       $26.56
46604............  Anoscopy and dilation...  Y................  .................  P2...............  ...........       8.8611      $366.85      $366.85
46606............  Anoscopy and biopsy.....  Y................  .................  P3...............  ...........       3.1498      $130.40      $130.40
46608............  Anoscopy, remove for      Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
                    body.
46610............  Anoscopy, remove lesion.  Y................  .................  A2...............      $333.00      21.8923      $906.34      $476.34
46611............  Anoscopy................  Y................  .................  A2...............      $333.00       8.8611      $366.85      $341.46
46612............  Anoscopy, remove lesions  Y................  .................  A2...............      $333.00      21.8923      $906.34      $476.34
46614............  Anoscopy, control         Y................  .................  P3...............  ...........       1.8386       $76.12       $76.12
                    bleeding.
46615............  Anoscopy................  Y................  .................  A2...............      $446.00      21.8923      $906.34      $561.09
46700............  Repair of anal stricture  Y................  .................  A2...............      $510.00      23.2282      $961.65      $622.91
46706............  Repr of anal fistula w/   Y................  .................  A2...............      $333.00      30.5544    $1,264.95      $565.99
                    glue.
46750............  Repair of anal sphincter  Y................  .................  A2...............      $510.00      30.5544    $1,264.95      $698.74
46753............  Reconstruction of anus..  Y................  .................  A2...............      $510.00      23.2282      $961.65      $622.91
46754............  Removal of suture from    Y................  .................  A2...............      $446.00      23.2282      $961.65      $574.91
                    anus.
46760............  Repair of anal sphincter  Y................  .................  A2...............      $446.00      30.5544    $1,264.95      $650.74
46761............  Repair of anal sphincter  Y................  .................  A2...............      $510.00      30.5544    $1,264.95      $698.74
46762............  Implant artificial        Y................  .................  A2...............      $995.00      30.5544    $1,264.95    $1,062.49
                    sphincter.
46900............  Destruction, anal         Y................  .................  P3...............  ...........       2.5560      $105.82      $105.82
                    lesion(s).
46910............  Destruction, anal         Y................  .................  P3...............  ...........       2.7870      $115.38      $115.38
                    lesion(s).
46916............  Cryosurgery, anal         Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
                    lesion(s).
46917............  Laser surgery, anal       Y................  .................  A2...............      $333.00      20.0977      $832.04      $457.76
                    lesions.
46922............  Excision of anal          Y................  .................  A2...............      $333.00      20.0977      $832.04      $457.76
                    lesion(s).
46924............  Destruction, anal         Y................  .................  A2...............      $333.00      20.0977      $832.04      $457.76
                    lesion(s).
46934............  Destruction of            Y................  .................  P3...............  ...........       4.3534      $180.23      $180.23
                    hemorrhoids.
46935............  Destruction of            Y................  .................  P3...............  ...........       2.9930      $123.91      $123.91
                    hemorrhoids.
46936............  Destruction of            Y................  .................  P3...............  ...........       4.5597      $188.77      $188.77
                    hemorrhoids.
46937............  Cryotherapy of rectal     Y................  .................  A2...............      $446.00      23.2282      $961.65      $574.91
                    lesion.
46938............  Cryotherapy of rectal     Y................  .................  A2...............      $446.00      30.5544    $1,264.95      $650.74
                    lesion.
46940............  Treatment of anal         Y................  .................  P3...............  ...........       1.9872       $82.27       $82.27
                    fissure.
46942............  Treatment of anal         Y................  .................  P3...............  ...........       1.9046       $78.85       $78.85
                    fissure.
46945............  Ligation of hemorrhoids.  Y................  .................  P3...............  ...........       3.3145      $137.22      $137.22
46946............  Ligation of hemorrhoids.  Y................  .................  A2...............      $333.00      11.6524      $482.41      $370.35
46947............  Hemorrhoidopexy by        Y................  .................  A2...............      $995.00      30.5544    $1,264.95    $1,062.49
                    stapling.
47000............  Needle biopsy of liver..  Y................  .................  A2...............      $333.00       9.5741      $396.37      $348.84

[[Page 42879]]

 
47001............  Needle biopsy, liver add- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    on.
47382............  Percut ablate liver rf..  Y................  .................  G2...............  ...........      44.1192    $1,826.53    $1,826.53
47500............  Injection for liver x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    rays.
47505............  Injection for liver x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    rays.
47510............  Insert catheter, bile     Y................  .................  A2...............      $446.00      28.7304    $1,189.44      $631.86
                    duct.
47511............  Insert bile duct drain..  Y................  .................  A2...............    $1,245.85      28.7304    $1,189.44    $1,231.75
47525............  Change bile duct          Y................  .................  A2...............      $333.00      14.8912      $616.50      $403.88
                    catheter.
47530............  Revise/reinsert bile      Y................  .................  A2...............      $333.00      14.8912      $616.50      $403.88
                    tube.
47552............  Biliary endoscopy thru    Y................  .................  A2...............      $446.00      28.7304    $1,189.44      $631.86
                    skin.
47553............  Biliary endoscopy thru    Y................  .................  A2...............      $510.00      28.7304    $1,189.44      $679.86
                    skin.
47554............  Biliary endoscopy thru    Y................  .................  A2...............      $510.00      28.7304    $1,189.44      $679.86
                    skin.
47555............  Biliary endoscopy thru    Y................  .................  A2...............      $510.00      28.7304    $1,189.44      $679.86
                    skin.
47556............  Biliary endoscopy thru    Y................  .................  A2...............    $1,245.85      28.7304    $1,189.44    $1,231.75
                    skin.
47560............  Laparoscopy w/cholangio.  Y................  .................  A2...............      $510.00      34.8153    $1,441.35      $742.84
47561............  Laparo w/cholangio/       Y................  .................  A2...............      $510.00      34.8153    $1,441.35      $742.84
                    biopsy.
47562............  Laparoscopic              Y................  .................  G2...............  ...........      46.1201    $1,909.37    $1,909.37
                    cholecystectomy.
47563............  Laparo cholecystectomy/   Y................  .................  G2...............  ...........      46.1201    $1,909.37    $1,909.37
                    graph.
47564............  Laparo cholecystectomy/   Y................  .................  G2...............  ...........      46.1201    $1,909.37    $1,909.37
                    explr.
47630............  Remove bile duct stone..  Y................  .................  A2...............      $510.00      28.7304    $1,189.44      $679.86
48102............  Needle biopsy, pancreas.  Y................  .................  A2...............      $333.00       9.5741      $396.37      $348.84
49080............  Puncture, peritoneal      Y................  .................  A2...............      $222.78       5.3095      $219.81      $222.04
                    cavity.
49081............  Removal of abdominal      Y................  .................  A2...............      $222.78       5.3095      $219.81      $222.04
                    fluid.
49180............  Biopsy, abdominal mass..  Y................  .................  A2...............      $333.00       9.5741      $396.37      $348.84
49250............  Excision of umbilicus...  Y................  .................  A2...............      $630.00      25.4636    $1,054.19      $736.05
49320............  Diag laparo separate      Y................  .................  A2...............      $510.00      34.8153    $1,441.35      $742.84
                    proc.
49321............  Laparoscopy, biopsy.....  Y................  .................  A2...............      $630.00      34.8153    $1,441.35      $832.84
49322............  Laparoscopy, aspiration.  Y................  .................  A2...............      $630.00      34.8153    $1,441.35      $832.84
49400............  Air injection into        N................  .................  N1...............  ...........  ...........  ...........  ...........
                    abdomen.
49402............  Remove foreign body,      Y................  .................  A2...............      $446.00      25.4636    $1,054.19      $598.05
                    adbomen.
49419............  Insrt abdom cath for      Y................  .................  A2...............      $333.00      30.5379    $1,264.27      $565.82
                    chemotx.
49420............  Insert abdom drain, temp  Y................  .................  A2...............      $333.00      31.7598    $1,314.86      $578.47
49421............  Insert abdom drain, perm  Y................  .................  A2...............      $333.00      31.7598    $1,314.86      $578.47
49422............  Remove perm cannula/      Y................  .................  A2...............      $333.00      24.7274    $1,023.71      $505.68
                    catheter.
49423............  Exchange drainage         Y................  .................  G2...............  ...........      14.8912      $616.50      $616.50
                    catheter.
49424............  Assess cyst, contrast     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    inject.
49426............  Revise abdomen-venous     Y................  .................  A2...............      $446.00      25.4636    $1,054.19      $598.05
                    shunt.
49427............  Injection, abdominal      N................  .................  N1...............  ...........  ...........  ...........  ...........
                    shunt.
49429............  Removal of shunt........  Y................  .................  G2...............  ...........      24.7274    $1,023.71    $1,023.71
49495............  Rpr ing hernia baby,      Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
                    reduc.
49496............  Rpr ing hernia baby,      Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
                    blocked.
49500............  Rpr ing hernia, init,     Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
                    reduce.
49501............  Rpr ing hernia, init      Y................  .................  A2...............    $1,339.00      31.1722    $1,290.53    $1,326.88
                    blocked.
49505............  Prp i/hern init reduc >5  Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
                    yr.
49507............  Prp i/hern init block >5  Y................  .................  A2...............    $1,339.00      31.1722    $1,290.53    $1,326.88
                    yr.
49520............  Rerepair ing hernia,      Y................  .................  A2...............      $995.00      31.1722    $1,290.53    $1,068.88
                    reduce.
49521............  Rerepair ing hernia,      Y................  .................  A2...............    $1,339.00      31.1722    $1,290.53    $1,326.88
                    blocked.
49525............  Repair ing hernia,        Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
                    sliding.
49540............  Repair lumbar hernia....  Y................  .................  A2...............      $446.00      31.1722    $1,290.53      $657.13
49550............  Rpr rem hernia, init,     Y................  .................  A2...............      $717.00      31.1722    $1,290.53      $860.38
                    reduce.
49553............  Rpr fem hernia, init      Y................  .................  A2...............    $1,339.00      31.1722    $1,290.53    $1,326.88
                    blocked.
49555............  Rerepair fem hernia,      Y................  .................  A2...............      $717.00      31.1722    $1,290.53      $860.38
                    reduce.
49557............  Rerepair fem hernia,      Y................  .................  A2...............    $1,339.00      31.1722    $1,290.53    $1,326.88
                    blocked.
49560............  Rpr ventral hern init,    Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
                    reduc.
49561............  Rpr ventral hern init,    Y................  .................  A2...............    $1,339.00      31.1722    $1,290.53    $1,326.88
                    block.
49565............  Rerepair ventrl hern,     Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
                    reduce.
49566............  Rerepair ventrl hern,     Y................  .................  A2...............    $1,339.00      31.1722    $1,290.53    $1,326.88
                    block.
49568............  Hernia repair w/mesh....  Y................  .................  A2...............      $995.00      31.1722    $1,290.53    $1,068.88
49570............  Rpr epigastric hern,      Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
                    reduce.
49572............  Rpr epigastric hern,      Y................  .................  A2...............    $1,339.00      31.1722    $1,290.53    $1,326.88
                    blocked.
49580............  Rpr umbil hern, reduc <   Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
                    5 yr.
49582............  Rpr umbil hern, block <   Y................  .................  A2...............    $1,339.00      31.1722    $1,290.53    $1,326.88
                    5 yr.
49585............  Rpr umbil hern, reduc >   Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
                    5 yr.
49587............  Rpr umbil hern, block >   Y................  .................  A2...............    $1,339.00      31.1722    $1,290.53    $1,326.88
                    5 yr.
49590............  Repair spigelian hernia.  Y................  .................  A2...............      $510.00      31.1722    $1,290.53      $705.13
49600............  Repair umbilical lesion.  Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
49650............  Laparo hernia repair      Y................  .................  A2...............      $630.00      46.1201    $1,909.37      $949.84
                    initial.
49651............  Laparo hernia repair      Y................  .................  A2...............      $995.00      46.1201    $1,909.37    $1,223.59
                    recur.
50200............  Biopsy of kidney........  Y................  .................  A2...............      $333.00       9.5741      $396.37      $348.84
50382............  Change ureter stent,      Y................  .................  G2...............  ...........      25.2775    $1,046.49    $1,046.49
                    percut.
50384............  Remove ureter stent,      Y................  .................  G2...............  ...........      18.1376      $750.90      $750.90
                    percut.
50387............  Change ext/int ureter     Y................  .................  G2...............  ...........      14.8912      $616.50      $616.50
                    stent.
50389............  Remove renal tube w/      Y................  .................  G2...............  ...........       6.1077      $252.86      $252.86
                    fluoro.
50390............  Drainage of kidney        Y................  .................  A2...............      $333.00       9.5741      $396.37      $348.84
                    lesion.
50391............  Instll rx agnt into rnal  Y................  .................  P2...............  ...........       1.0850       $44.92       $44.92
                    tub.
50392............  Insert kidney drain.....  Y................  .................  A2...............      $333.00      18.1376      $750.90      $437.48
50393............  Insert ureteral tube....  Y................  .................  A2...............      $333.00      25.2775    $1,046.49      $511.37

[[Page 42880]]

 
50394............  Injection for kidney x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
50395............  Create passage to kidney  Y................  .................  A2...............      $333.00      18.1376      $750.90      $437.48
50396............  Measure kidney pressure.  Y................  .................  A2...............      $131.50       2.1659       $89.67      $121.04
50398............  Change kidney tube......  Y................  .................  A2...............      $333.00      14.8912      $616.50      $403.88
50551............  Kidney endoscopy........  Y................  .................  A2...............      $333.00       6.1077      $252.86      $312.97
50553............  Kidney endoscopy........  Y................  .................  A2...............      $333.00      25.2775    $1,046.49      $511.37
50555............  Kidney endoscopy &        Y................  .................  A2...............      $333.00       6.1077      $252.86      $312.97
                    biopsy.
50557............  Kidney endoscopy &        Y................  .................  A2...............      $333.00      25.2775    $1,046.49      $511.37
                    treatment.
50561............  Kidney endoscopy &        Y................  .................  A2...............      $333.00      25.2775    $1,046.49      $511.37
                    treatment.
50562............  Renal scope w/tumor       Y................  .................  G2...............  ...........       6.1077      $252.86      $252.86
                    resect.
50570............  Kidney endoscopy........  Y................  .................  G2...............  ...........       6.1077      $252.86      $252.86
50572............  Kidney endoscopy........  Y................  .................  G2...............  ...........       6.1077      $252.86      $252.86
50574............  Kidney endoscopy &        Y................  .................  G2...............  ...........       6.1077      $252.86      $252.86
                    biopsy.
50575............  Kidney endoscopy........  Y................  .................  G2...............  ...........      36.9175    $1,528.38    $1,528.38
50576............  Kidney endoscopy &        Y................  .................  G2...............  ...........      18.1376      $750.90      $750.90
                    treatment.
50580............  Kidney endoscopy &        Y................  CH...............  G2...............  ...........      18.1376      $750.90      $750.90
                    treatment.
50590............  Fragmenting of kidney     Y................  .................  G2...............  ...........      43.0352    $1,781.66    $1,781.66
                    stone.
50592............  Perc rf ablate renal      Y................  .................  G2...............  ...........      44.1192    $1,826.53    $1,826.53
                    tumor.
50684............  Injection for ureter x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
50686............  Measure ureter pressure.  Y................  .................  P2...............  ...........       1.0850       $44.92       $44.92
50688............  Change of ureter tube/    Y................  .................  A2...............      $333.00      14.8912      $616.50      $403.88
                    stent.
50690............  Injection for ureter x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
50947............  Laparo new ureter/        Y................  .................  A2...............    $1,339.00      46.1201    $1,909.37    $1,481.59
                    bladder.
50948............  Laparo new ureter/        Y................  .................  A2...............    $1,339.00      46.1201    $1,909.37    $1,481.59
                    bladder.
50951............  Endoscopy of ureter.....  Y................  .................  A2...............      $333.00       6.1077      $252.86      $312.97
50953............  Endoscopy of ureter.....  Y................  .................  A2...............      $333.00       6.1077      $252.86      $312.97
50955............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      25.2775    $1,046.49      $511.37
                    biopsy.
50957............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      25.2775    $1,046.49      $511.37
                    treatment.
50961............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      25.2775    $1,046.49      $511.37
                    treatment.
50970............  Ureter endoscopy........  Y................  .................  A2...............      $333.00       6.1077      $252.86      $312.97
50972............  Ureter endoscopy &        Y................  .................  A2...............      $333.00       6.1077      $252.86      $312.97
                    catheter.
50974............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      18.1376      $750.90      $437.48
                    biopsy.
50976............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      18.1376      $750.90      $437.48
                    treatment.
50980............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      25.2775    $1,046.49      $511.37
                    treatment.
51000............  Drainage of bladder.....  Y................  .................  P3...............  ...........       1.1790       $48.81       $48.81
51005............  Drainage of bladder.....  Y................  .................  P2...............  ...........       1.0850       $44.92       $44.92
51010............  Drainage of bladder.....  Y................  .................  A2...............      $333.00      19.6126      $811.96      $452.74
51020............  Incise & treat bladder..  Y................  .................  A2...............      $630.00      25.2775    $1,046.49      $734.12
51030............  Incise & treat bladder..  Y................  .................  A2...............      $630.00      25.2775    $1,046.49      $734.12
51040............  Incise & drain bladder..  Y................  .................  A2...............      $630.00      25.2775    $1,046.49      $734.12
51045............  Incise bladder/drain      Y................  .................  A2...............      $399.24       6.1077      $252.86      $362.65
                    ureter.
51050............  Removal of bladder stone  Y................  .................  A2...............      $630.00      25.2775    $1,046.49      $734.12
51065............  Remove ureter calculus..  Y................  .................  A2...............      $630.00      25.2775    $1,046.49      $734.12
51080............  Drainage of bladder       Y................  .................  A2...............      $333.00      19.0457      $788.49      $446.87
                    abscess.
51500............  Removal of bladder cyst.  Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
51520............  Removal of bladder        Y................  .................  A2...............      $630.00      25.2775    $1,046.49      $734.12
                    lesion.
51600............  Injection for bladder x-  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
51605............  Preparation for bladder   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    xray.
51610............  Injection for bladder x-  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
51700............  Irrigation of bladder...  Y................  .................  P3...............  ...........       1.2780       $52.91       $52.91
51701............  Insert bladder catheter.  N................  .................  P2...............  ...........       0.6416       $26.56       $26.56
51702............  Insert temp bladder cath  N................  .................  P2...............  ...........       0.6416       $26.56       $26.56
51703............  Insert bladder cath,      Y................  .................  P2...............  ...........       1.0850       $44.92       $44.92
                    complex.
51705............  Change of bladder tube..  Y................  .................  P3...............  ...........       1.7727       $73.39       $73.39
51710............  Change of bladder tube..  Y................  .................  A2...............      $333.00      14.8912      $616.50      $403.88
51715............  Endoscopic injection/     Y................  .................  A2...............      $510.00      30.1994    $1,250.26      $695.07
                    implant.
51720............  Treatment of bladder      Y................  .................  P3...............  ...........       1.3935       $57.69       $57.69
                    lesion.
51725............  Simple cystometrogram...  Y................  .................  P2...............  ...........       3.0601      $126.69      $126.69
51726............  Complex cystometrogram..  Y................  .................  A2...............      $209.48       3.0601      $126.69      $188.78
51736............  Urine flow measurement..  Y................  .................  P3...............  ...........       0.4452       $18.43       $18.43
51741............  Electro-uroflowmetry,     Y................  .................  P3...............  ...........       0.5111       $21.16       $21.16
                    first.
51772............  Urethra pressure profile  Y................  .................  A2...............      $131.50       2.1659       $89.67      $121.04
51784............  Anal/urinary muscle       Y................  .................  P2...............  ...........       1.0850       $44.92       $44.92
                    study.
51785............  Anal/urinary muscle       Y................  .................  A2...............       $66.92       1.0850       $44.92       $61.42
                    study.
51792............  Urinary reflex study....  Y................  .................  P2...............  ...........       1.0850       $44.92       $44.92
51795............  Urine voiding pressure    Y................  .................  P2...............  ...........       2.1659       $89.67       $89.67
                    study.
51797............  Intraabdominal pressure   Y................  .................  P2...............  ...........       2.1659       $89.67       $89.67
                    test.
51798............  Us urine capacity         N................  .................  P3...............  ...........       0.3792       $15.70       $15.70
                    measure.
51880............  Repair of bladder         Y................  .................  A2...............      $333.00      25.2775    $1,046.49      $511.37
                    opening.
51992............  Laparo sling operation..  Y................  .................  A2...............      $717.00      46.1201    $1,909.37    $1,015.09
52000............  Cystoscopy..............  Y................  .................  A2...............      $333.00       6.1077      $252.86      $312.97
52001............  Cystoscopy, removal of    Y................  .................  A2...............      $399.24      18.1376      $750.90      $487.16
                    clots.
52005............  Cystoscopy & ureter       Y................  .................  A2...............      $446.00      18.1376      $750.90      $522.23
                    catheter.
52007............  Cystoscopy and biopsy...  Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
52010............  Cystoscopy & duct         Y................  .................  A2...............      $399.24       6.1077      $252.86      $362.65
                    catheter.
52204............  Cystoscopy w/biopsy(s)..  Y................  .................  A2...............      $446.00      18.1376      $750.90      $522.23

[[Page 42881]]

 
52214............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
52224............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
52234............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
52235............  Cystoscopy and treatment  Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
52240............  Cystoscopy and treatment  Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
52250............  Cystoscopy and            Y................  .................  A2...............      $630.00      25.2775    $1,046.49      $734.12
                    radiotracer.
52260............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      18.1376      $750.90      $522.23
52265............  Cystoscopy and treatment  Y................  .................  P2...............  ...........       6.1077      $252.86      $252.86
52270............  Cystoscopy & revise       Y................  .................  A2...............      $446.00      18.1376      $750.90      $522.23
                    urethra.
52275............  Cystoscopy & revise       Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
                    urethra.
52276............  Cystoscopy and treatment  Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
52277............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
52281............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      18.1376      $750.90      $522.23
52282............  Cystoscopy, implant       Y................  .................  A2...............    $1,339.00      36.9175    $1,528.38    $1,386.35
                    stent.
52283............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
52285............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      18.1376      $750.90      $522.23
52290............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      18.1376      $750.90      $522.23
52300............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
52301............  Cystoscopy and treatment  Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
52305............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
52310............  Cystoscopy and treatment  Y................  .................  A2...............      $399.24      18.1376      $750.90      $487.16
52315............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
52317............  Remove bladder stone....  Y................  .................  A2...............      $333.00      25.2775    $1,046.49      $511.37
52318............  Remove bladder stone....  Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
52320............  Cystoscopy and treatment  Y................  .................  A2...............      $717.00      25.2775    $1,046.49      $799.37
52325............  Cystoscopy, stone         Y................  .................  A2...............      $630.00      25.2775    $1,046.49      $734.12
                    removal.
52327............  Cystoscopy, inject        Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
                    material.
52330............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
52332............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
52334............  Create passage to kidney  Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
52341............  Cysto w/ureter stricture  Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
                    tx.
52342............  Cysto w/up stricture tx.  Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
52343............  Cysto w/renal stricture   Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
                    tx.
52344............  Cysto/uretero, stricture  Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
                    tx.
52345............  Cysto/uretero w/up        Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
                    stricture.
52346............  Cystouretero w/renal      Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
                    strict.
52351............  Cystouretero & or         Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
                    pyeloscope.
52352............  Cystouretero w/stone      Y................  .................  A2...............      $630.00      25.2775    $1,046.49      $734.12
                    remove.
52353............  Cystouretero w/           Y................  .................  A2...............      $630.00      36.9175    $1,528.38      $854.60
                    lithotripsy.
52354............  Cystouretero w/biopsy...  Y................  .................  A2...............      $630.00      25.2775    $1,046.49      $734.12
52355............  Cystouretero w/excise     Y................  .................  A2...............      $630.00      25.2775    $1,046.49      $734.12
                    tumor.
52400............  Cystouretero w/congen     Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
                    repr.
52402............  Cystourethro cut ejacul   Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
                    duct.
52450............  Incision of prostate....  Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
52500............  Revision of bladder neck  Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
52510............  Dilation prostatic        Y................  .................  A2...............      $510.00      25.2775    $1,046.49      $644.12
                    urethra.
52601............  Prostatectomy (TURP)....  Y................  .................  A2...............      $630.00      36.9175    $1,528.38      $854.60
52606............  Control postop bleeding.  Y................  .................  A2...............      $333.00      25.2775    $1,046.49      $511.37
52612............  Prostatectomy, first      Y................  .................  A2...............      $446.00      36.9175    $1,528.38      $716.60
                    stage.
52614............  Prostatectomy, second     Y................  .................  A2...............      $333.00      36.9175    $1,528.38      $631.85
                    stage.
52620............  Remove residual prostate  Y................  .................  A2...............      $333.00      36.9175    $1,528.38      $631.85
52630............  Remove prostate regrowth  Y................  .................  A2...............      $446.00      36.9175    $1,528.38      $716.60
52640............  Relieve bladder           Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
                    contracture.
52647............  Laser surgery of          Y................  .................  A2...............    $1,339.00      45.9021    $1,900.35    $1,479.34
                    prostate.
52648............  Laser surgery of          Y................  .................  A2...............    $1,339.00      45.9021    $1,900.35    $1,479.34
                    prostate.
52700............  Drainage of prostate      Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
                    abscess.
53000............  Incision of urethra.....  Y................  .................  A2...............      $333.00      19.6570      $813.80      $453.20
53010............  Incision of urethra.....  Y................  .................  A2...............      $333.00      19.6570      $813.80      $453.20
53020............  Incision of urethra.....  Y................  .................  A2...............      $333.00      19.6570      $813.80      $453.20
53025............  Incision of urethra.....  Y................  .................  R2...............  ...........      19.6570      $813.80      $813.80
53040............  Drainage of urethra       Y................  .................  A2...............      $446.00      19.6570      $813.80      $537.95
                    abscess.
53060............  Drainage of urethra       Y................  .................  P3...............  ...........       1.7068       $70.66       $70.66
                    abscess.
53080............  Drainage of urinary       Y................  .................  A2...............      $510.00      19.6570      $813.80      $585.95
                    leakage.
53085............  Drainage of urinary       Y................  .................  G2...............  ...........      19.6570      $813.80      $813.80
                    leakage.
53200............  Biopsy of urethra.......  Y................  .................  A2...............      $333.00      19.6570      $813.80      $453.20
53210............  Removal of urethra......  Y................  .................  A2...............      $717.00      30.1994    $1,250.26      $850.32
53215............  Removal of urethra......  Y................  .................  A2...............      $717.00      19.6570      $813.80      $741.20
53220............  Treatment of urethra      Y................  .................  A2...............      $446.00      30.1994    $1,250.26      $647.07
                    lesion.
53230............  Removal of urethra        Y................  .................  A2...............      $446.00      30.1994    $1,250.26      $647.07
                    lesion.
53235............  Removal of urethra        Y................  .................  A2...............      $510.00      19.6570      $813.80      $585.95
                    lesion.
53240............  Surgery for urethra       Y................  .................  A2...............      $446.00      30.1994    $1,250.26      $647.07
                    pouch.
53250............  Removal of urethra gland  Y................  .................  A2...............      $446.00      19.6570      $813.80      $537.95
53260............  Treatment of urethra      Y................  .................  A2...............      $446.00      19.6570      $813.80      $537.95
                    lesion.
53265............  Treatment of urethra      Y................  .................  A2...............      $446.00      19.6570      $813.80      $537.95
                    lesion.
53270............  Removal of urethra gland  Y................  .................  A2...............      $446.00      19.6570      $813.80      $537.95
53275............  Repair of urethra defect  Y................  .................  A2...............      $446.00      19.6570      $813.80      $537.95

[[Page 42882]]

 
53400............  Revise urethra, stage 1.  Y................  .................  A2...............      $510.00      30.1994    $1,250.26      $695.07
53405............  Revise urethra, stage 2.  Y................  .................  A2...............      $446.00      30.1994    $1,250.26      $647.07
53410............  Reconstruction of         Y................  .................  A2...............      $446.00      30.1994    $1,250.26      $647.07
                    urethra.
53420............  Reconstruct urethra,      Y................  .................  A2...............      $510.00      30.1994    $1,250.26      $695.07
                    stage 1.
53425............  Reconstruct urethra,      Y................  .................  A2...............      $446.00      30.1994    $1,250.26      $647.07
                    stage 2.
53430............  Reconstruction of         Y................  .................  A2...............      $446.00      30.1994    $1,250.26      $647.07
                    urethra.
53431............  Reconstruct urethra/      Y................  .................  A2...............      $446.00      30.1994    $1,250.26      $647.07
                    bladder.
53440............  Male sling procedure....  N................  CH...............  H8...............      $446.00     109.0807    $4,515.94    $3,569.83
53442............  Remove/revise male sling  Y................  .................  A2...............      $333.00      30.1994    $1,250.26      $562.32
53444............  Insert tandem cuff......  N................  CH...............  H8...............      $446.00     109.0807    $4,515.94    $3,569.83
53445............  Insert uro/ves nck        N................  .................  H8...............      $333.00     191.7932    $7,940.24    $6,492.40
                    sphincter.
53446............  Remove uro sphincter....  Y................  .................  A2...............      $333.00      30.1994    $1,250.26      $562.32
53447............  Remove/replace ur         N................  .................  H8...............      $333.00     191.7932    $7,940.24    $6,492.40
                    sphincter.
53449............  Repair uro sphincter....  Y................  .................  A2...............      $333.00      30.1994    $1,250.26      $562.32
53450............  Revision of urethra.....  Y................  .................  A2...............      $333.00      30.1994    $1,250.26      $562.32
53460............  Revision of urethra.....  Y................  .................  A2...............      $333.00      19.6570      $813.80      $453.20
53502............  Repair of urethra injury  Y................  .................  A2...............      $446.00      19.6570      $813.80      $537.95
53505............  Repair of urethra injury  Y................  .................  A2...............      $446.00      30.1994    $1,250.26      $647.07
53510............  Repair of urethra injury  Y................  .................  A2...............      $446.00      19.6570      $813.80      $537.95
53515............  Repair of urethra injury  Y................  .................  A2...............      $446.00      30.1994    $1,250.26      $647.07
53520............  Repair of urethra defect  Y................  .................  A2...............      $446.00      30.1994    $1,250.26      $647.07
53600............  Dilate urethra stricture  Y................  .................  P3...............  ...........       0.9483       $39.26       $39.26
53601............  Dilate urethra stricture  Y................  CH...............  P2...............  ...........       1.0850       $44.92       $44.92
53605............  Dilate urethra stricture  Y................  .................  A2...............      $446.00      18.1376      $750.90      $522.23
53620............  Dilate urethra stricture  Y................  .................  P3...............  ...........       1.5254       $63.15       $63.15
53621............  Dilate urethra stricture  Y................  .................  P3...............  ...........       1.5995       $66.22       $66.22
53660............  Dilation of urethra.....  Y................  .................  P3...............  ...........       1.0802       $44.72       $44.72
53661............  Dilation of urethra.....  Y................  .................  P3...............  ...........       1.0720       $44.38       $44.38
53665............  Dilation of urethra.....  Y................  .................  A2...............      $333.00      19.6570      $813.80      $453.20
53850............  Prostatic microwave       Y................  .................  P2...............  ...........      36.9175    $1,528.38    $1,528.38
                    thermotx.
53852............  Prostatic rf thermotx...  Y................  .................  P2...............  ...........      36.9175    $1,528.38    $1,528.38
53853............  Prostatic water           Y................  .................  P2...............  ...........      25.2775    $1,046.49    $1,046.49
                    thermother.
54000............  Slitting of prepuce.....  Y................  .................  A2...............      $446.00      19.6570      $813.80      $537.95
54001............  Slitting of prepuce.....  Y................  .................  A2...............      $446.00      19.6570      $813.80      $537.95
54015............  Drain penis lesion......  Y................  .................  A2...............      $630.00      19.0457      $788.49      $669.62
54050............  Destruction, penis        Y................  .................  P2...............  ...........       1.5119       $62.59       $62.59
                    lesion(s).
54055............  Destruction, penis        Y................  .................  P3...............  ...........       1.4676       $60.76       $60.76
                    lesion(s).
54056............  Cryosurgery, penis        Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
                    lesion(s).
54057............  Laser surg, penis         Y................  .................  A2...............      $333.00      20.0977      $832.04      $457.76
                    lesion(s).
54060............  Excision of penis         Y................  .................  A2...............      $333.00      20.0977      $832.04      $457.76
                    lesion(s).
54065............  Destruction, penis        Y................  .................  A2...............      $333.00      20.0977      $832.04      $457.76
                    lesion(s).
54100............  Biopsy of penis.........  Y................  .................  A2...............      $333.00      16.5832      $686.54      $421.39
54105............  Biopsy of penis.........  Y................  .................  A2...............      $333.00      21.4534      $888.17      $471.79
54110............  Treatment of penis        Y................  .................  A2...............      $446.00      35.1574    $1,455.52      $698.38
                    lesion.
54111............  Treat penis lesion,       Y................  .................  A2...............      $446.00      35.1574    $1,455.52      $698.38
                    graft.
54112............  Treat penis lesion,       Y................  .................  A2...............      $446.00      35.1574    $1,455.52      $698.38
                    graft.
54115............  Treatment of penis        Y................  .................  A2...............      $333.00      19.0457      $788.49      $446.87
                    lesion.
54120............  Partial removal of penis  Y................  .................  A2...............      $446.00      35.1574    $1,455.52      $698.38
54150............  Circumcision w/regionl    Y................  .................  A2...............      $333.00      22.7802      $943.10      $485.53
                    block.
54160............  Circumcision, neonate...  Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
54161............  Circum 28 days or older.  Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
54162............  Lysis penil circumic      Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
                    lesion.
54163............  Repair of circumcision..  Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
54164............  Frenulotomy of penis....  Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
54200............  Treatment of penis        Y................  .................  P3...............  ...........       1.5667       $64.86       $64.86
                    lesion.
54205............  Treatment of penis        Y................  .................  A2...............      $630.00      35.1574    $1,455.52      $836.38
                    lesion.
54220............  Treatment of penis        Y................  .................  A2...............      $131.50       2.1659       $89.67      $121.04
                    lesion.
54230............  Prepare penis study.....  N................  .................  N1...............  ...........  ...........  ...........  ...........
54231............  Dynamic cavernosometry..  Y................  .................  P3...............  ...........       1.3686       $56.66       $56.66
54235............  Penile injection........  Y................  .................  P3...............  ...........       0.9729       $40.28       $40.28
54240............  Penis study.............  Y................  .................  P3...............  ...........       0.6679       $27.65       $27.65
54250............  Penis study.............  Y................  .................  P3...............  ...........       0.2309        $9.56        $9.56
54300............  Revision of penis.......  Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
54304............  Revision of penis.......  Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
54308............  Reconstruction of         Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    urethra.
54312............  Reconstruction of         Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    urethra.
54316............  Reconstruction of         Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    urethra.
54318............  Reconstruction of         Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    urethra.
54322............  Reconstruction of         Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    urethra.
54324............  Reconstruction of         Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    urethra.
54326............  Reconstruction of         Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    urethra.
54328............  Revise penis/urethra....  Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
54340............  Secondary urethral        Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    surgery.
54344............  Secondary urethral        Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    surgery.
54348............  Secondary urethral        Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    surgery.
54352............  Reconstruct urethra/      Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    penis.

[[Page 42883]]

 
54360............  Penis plastic surgery...  Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
54380............  Repair penis............  Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
54385............  Repair penis............  Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
54400............  Insert semi-rigid         N................  CH...............  H8...............      $510.00     109.0807    $4,515.94    $3,617.83
                    prosthesis.
54401............  Insert self-contd         N................  .................  H8...............      $510.00     191.7932    $7,940.24    $6,625.15
                    prosthesis.
54405............  Insert multi-comp penis   N................  .................  H8...............      $510.00     191.7932    $7,940.24    $6,625.15
                    pros.
54406............  Remove muti-comp penis    Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    pros.
54408............  Repair multi-comp penis   Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    pros.
54410............  Remove/replace penis      N................  .................  H8...............      $510.00     191.7932    $7,940.24    $6,625.15
                    prosth.
54415............  Remove self-contd penis   Y................  .................  A2...............      $510.00      35.1574    $1,455.52      $746.38
                    pros.
54416............  Remv/repl penis contain   N................  .................  H8...............      $510.00     191.7932    $7,940.24    $6,625.15
                    pros.
54420............  Revision of penis.......  Y................  .................  A2...............      $630.00      35.1574    $1,455.52      $836.38
54435............  Revision of penis.......  Y................  .................  A2...............      $630.00      35.1574    $1,455.52      $836.38
54440............  Repair of penis.........  Y................  .................  A2...............      $630.00      35.1574    $1,455.52      $836.38
54450............  Preputial stretching....  Y................  .................  A2...............      $209.48       3.0601      $126.69      $188.78
54500............  Biopsy of testis........  Y................  .................  A2...............      $333.00      13.9599      $577.94      $394.24
54505............  Biopsy of testis........  Y................  .................  A2...............      $333.00      22.7802      $943.10      $485.53
54512............  Excise lesion testis....  Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
54520............  Removal of testis.......  Y................  .................  A2...............      $510.00      22.7802      $943.10      $618.28
54522............  Orchiectomy, partial....  Y................  .................  A2...............      $510.00      22.7802      $943.10      $618.28
54530............  Removal of testis.......  Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
54550............  Exploration for testis..  Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
54560............  Exploration for testis..  Y................  .................  G2...............  ...........      22.7802      $943.10      $943.10
54600............  Reduce testis torsion...  Y................  .................  A2...............      $630.00      22.7802      $943.10      $708.28
54620............  Suspension of testis....  Y................  .................  A2...............      $510.00      22.7802      $943.10      $618.28
54640............  Suspension of testis....  Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
54660............  Revision of testis......  Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
54670............  Repair testis injury....  Y................  .................  A2...............      $510.00      22.7802      $943.10      $618.28
54680............  Relocation of testis(es)  Y................  .................  A2...............      $510.00      22.7802      $943.10      $618.28
54690............  Laparoscopy, orchiectomy  Y................  .................  A2...............    $1,339.00      46.1201    $1,909.37    $1,481.59
54692............  Laparoscopy, orchiopexy.  Y................  .................  G2...............  ...........      71.0022    $2,939.49    $2,939.49
54700............  Drainage of scrotum.....  Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
54800............  Biopsy of epididymis....  Y................  .................  A2...............      $127.16       4.5062      $186.56      $142.01
54830............  Remove epididymis lesion  Y................  .................  A2...............      $510.00      22.7802      $943.10      $618.28
54840............  Remove epididymis lesion  Y................  .................  A2...............      $630.00      22.7802      $943.10      $708.28
54860............  Removal of epididymis...  Y................  .................  A2...............      $510.00      22.7802      $943.10      $618.28
54861............  Removal of epididymis...  Y................  .................  A2...............      $630.00      22.7802      $943.10      $708.28
54865............  Explore epididymis......  Y................  .................  A2...............      $333.00      22.7802      $943.10      $485.53
54900............  Fusion of spermatic       Y................  .................  A2...............      $630.00      22.7802      $943.10      $708.28
                    ducts.
54901............  Fusion of spermatic       Y................  .................  A2...............      $630.00      22.7802      $943.10      $708.28
                    ducts.
55000............  Drainage of hydrocele...  Y................  .................  P3...............  ...........       1.6159       $66.90       $66.90
55040............  Removal of hydrocele....  Y................  .................  A2...............      $510.00      31.1722    $1,290.53      $705.13
55041............  Removal of hydroceles...  Y................  .................  A2...............      $717.00      31.1722    $1,290.53      $860.38
55060............  Repair of hydrocele.....  Y................  .................  A2...............      $630.00      22.7802      $943.10      $708.28
55100............  Drainage of scrotum       Y................  .................  A2...............      $333.00      12.5792      $520.78      $379.95
                    abscess.
55110............  Explore scrotum.........  Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
55120............  Removal of scrotum        Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
                    lesion.
55150............  Removal of scrotum......  Y................  .................  A2...............      $333.00      22.7802      $943.10      $485.53
55175............  Revision of scrotum.....  Y................  .................  A2...............      $333.00      22.7802      $943.10      $485.53
55180............  Revision of scrotum.....  Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
55200............  Incision of sperm duct..  Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
55250............  Removal of sperm duct(s)  Y................  .................  A2...............      $446.00      22.7802      $943.10      $570.28
55300............  Prepare, sperm duct x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
55400............  Repair of sperm duct....  Y................  .................  A2...............      $333.00      22.7802      $943.10      $485.53
55450............  Ligation of sperm duct..  Y................  .................  P3...............  ...........       5.2027      $215.39      $215.39
55500............  Removal of hydrocele....  Y................  .................  A2...............      $510.00      22.7802      $943.10      $618.28
55520............  Removal of sperm cord     Y................  .................  A2...............      $630.00      22.7802      $943.10      $708.28
                    lesion.
55530............  Revise spermatic cord     Y................  .................  A2...............      $630.00      22.7802      $943.10      $708.28
                    veins.
55535............  Revise spermatic cord     Y................  .................  A2...............      $630.00      31.1722    $1,290.53      $795.13
                    veins.
55540............  Revise hernia & sperm     Y................  .................  A2...............      $717.00      31.1722    $1,290.53      $860.38
                    veins.
55550............  Laparo ligate spermatic   Y................  .................  A2...............    $1,339.00      46.1201    $1,909.37    $1,481.59
                    vein.
55600............  Incise sperm duct pouch.  Y................  .................  R2...............  ...........      22.7802      $943.10      $943.10
55680............  Remove sperm pouch        Y................  .................  A2...............      $333.00      22.7802      $943.10      $485.53
                    lesion.
55700............  Biopsy of prostate......  Y................  .................  A2...............      $345.83      11.3168      $468.52      $376.50
55705............  Biopsy of prostate......  Y................  .................  A2...............      $345.83      11.3168      $468.52      $376.50
55720............  Drainage of prostate      Y................  .................  A2...............      $333.00      25.2775    $1,046.49      $511.37
                    abscess.
55725............  Drainage of prostate      Y................  .................  A2...............      $446.00      25.2775    $1,046.49      $596.12
                    abscess.
55860............  Surgical exposure,        Y................  .................  G2...............  ...........      19.6126      $811.96      $811.96
                    prostate.
55870............  Electroejaculation......  Y................  .................  P3...............  ...........       1.6572       $68.61       $68.61
55873............  Cryoablate prostate.....  Y................  CH...............  H8...............    $1,339.00     163.2548    $6,758.75    $6,201.03
55875............  Transperi needle place,   N................  CH...............  A2...............    $1,339.00      36.9175    $1,528.38    $1,386.35
                    pros.
55876*...........  Place rt device/marker,   Y................  .................  P3...............  ...........       1.6903       $69.98       $69.98
                    pros.
56405............  I & D of vulva/perineum.  Y................  .................  P3...............  ...........       1.0307       $42.67       $42.67
56420............  Drainage of gland         Y................  .................  P2...............  ...........       1.4138       $58.53       $58.53
                    abscess.
56440............  Surgery for vulva lesion  Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
56441............  Lysis of labial           Y................  .................  A2...............      $333.00      19.2052      $795.10      $448.53
                    lesion(s).

[[Page 42884]]

 
56442............  Hymenotomy..............  Y................  .................  A2...............      $333.00      19.2052      $795.10      $448.53
56501............  Destroy, vulva lesions,   Y................  .................  P3...............  ...........       1.4017       $58.03       $58.03
                    sim.
56515............  Destroy vulva lesion/s    Y................  .................  A2...............      $510.00      20.0977      $832.04      $590.51
                    compl.
56605............  Biopsy of vulva/perineum  Y................  .................  P3...............  ...........       0.8162       $33.79       $33.79
56606............  Biopsy of vulva/perineum  Y................  .................  P3...............  ...........       0.3546       $14.68       $14.68
56620............  Partial removal of vulva  Y................  .................  A2...............      $717.00      19.2052      $795.10      $736.53
56625............  Complete removal of       Y................  .................  A2...............      $995.00      19.2052      $795.10      $945.03
                    vulva.
56700............  Partial removal of hymen  Y................  .................  A2...............      $333.00      19.2052      $795.10      $448.53
56740............  Remove vagina gland       Y................  .................  A2...............      $510.00      19.2052      $795.10      $581.28
                    lesion.
56800............  Repair of vagina........  Y................  .................  A2...............      $510.00      19.2052      $795.10      $581.28
56805............  Repair clitoris.........  Y................  .................  G2...............  ...........      19.2052      $795.10      $795.10
56810............  Repair of perineum......  Y................  .................  A2...............      $717.00      19.2052      $795.10      $736.53
56820............  Exam of vulva w/scope...  Y................  .................  P3...............  ...........       1.0307       $42.67       $42.67
56821............  Exam/biopsy of vulva w/   Y................  .................  P3...............  ...........       1.3522       $55.98       $55.98
                    scope.
57000............  Exploration of vagina...  Y................  .................  A2...............      $333.00      19.2052      $795.10      $448.53
57010............  Drainage of pelvic        Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
                    abscess.
57020............  Drainage of pelvic fluid  Y................  .................  A2...............      $409.33       7.4497      $308.42      $384.10
57022............  I & d vaginal hematoma,   Y................  .................  G2...............  ...........      12.5792      $520.78      $520.78
                    pp.
57023............  I & d vag hematoma, non-  Y................  .................  A2...............      $333.00      19.0457      $788.49      $446.87
                    ob.
57061............  Destroy vag lesions,      Y................  .................  P3...............  ...........       1.3027       $53.93       $53.93
                    simple.
57065............  Destroy vag lesions,      Y................  .................  A2...............      $333.00      19.2052      $795.10      $448.53
                    complex.
57100............  Biopsy of vagina........  Y................  .................  P3...............  ...........       0.8329       $34.48       $34.48
57105............  Biopsy of vagina........  Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
57130............  Remove vagina lesion....  Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
57135............  Remove vagina lesion....  Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
57150............  Treat vagina infection..  Y................  .................  P3...............  ...........       0.6925       $28.67       $28.67
57155............  Insert uteri tandems/     Y................  .................  A2...............      $409.33       7.4497      $308.42      $384.10
                    ovoids.
57160............  Insert pessary/other      Y................  .................  P3...............  ...........       0.8493       $35.16       $35.16
                    device.
57170............  Fitting of diaphragm/cap  Y................  .................  P2...............  ...........       0.1414        $5.85        $5.85
57180............  Treat vaginal bleeding..  Y................  .................  A2...............      $178.05       1.4138       $58.53      $148.17
57200............  Repair of vagina........  Y................  .................  A2...............      $333.00      19.2052      $795.10      $448.53
57210............  Repair vagina/perineum..  Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
57220............  Revision of urethra.....  Y................  .................  A2...............      $510.00      43.2255    $1,789.54      $829.89
57230............  Repair of urethral        Y................  .................  A2...............      $510.00      32.9713    $1,365.01      $723.75
                    lesion.
57240............  Repair bladder & vagina.  Y................  .................  A2...............      $717.00      32.9713    $1,365.01      $879.00
57250............  Repair rectum & vagina..  Y................  .................  A2...............      $717.00      32.9713    $1,365.01      $879.00
57260............  Repair of vagina........  Y................  .................  A2...............      $717.00      32.9713    $1,365.01      $879.00
57265............  Extensive repair of       Y................  .................  A2...............      $995.00      43.2255    $1,789.54    $1,193.64
                    vagina.
57267............  Insert mesh/pelvic flr    Y................  .................  A2...............      $995.00      32.9713    $1,365.01    $1,087.50
                    addon.
57268............  Repair of bowel bulge...  Y................  .................  A2...............      $510.00      32.9713    $1,365.01      $723.75
57287............  Revise/remove sling       Y................  .................  G2...............  ...........      32.9713    $1,365.01    $1,365.01
                    repair.
57288............  Repair bladder defect...  Y................  .................  A2...............      $717.00      43.2255    $1,789.54      $985.14
57289............  Repair bladder & vagina.  Y................  .................  A2...............      $717.00      32.9713    $1,365.01      $879.00
57291............  Construction of vagina..  Y................  .................  A2...............      $717.00      32.9713    $1,365.01      $879.00
57300............  Repair rectum-vagina      Y................  .................  A2...............      $510.00      32.9713    $1,365.01      $723.75
                    fistula.
57320............  Repair bladder-vagina     Y................  .................  G2...............  ...........      32.9713    $1,365.01    $1,365.01
                    lesion.
57400............  Dilation of vagina......  Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
57410............  Pelvic examination......  Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
57415............  Remove vaginal foreign    Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
                    body.
57420............  Exam of vagina w/scope..  Y................  .................  P3...............  ...........       1.0635       $44.03       $44.03
57421............  Exam/biopsy of vag w/     Y................  .................  P3...............  ...........       1.4181       $58.71       $58.71
                    scope.
57452............  Exam of cervix w/scope..  Y................  .................  P3...............  ...........       1.0143       $41.99       $41.99
57454............  Bx/curett of cervix w/    Y................  .................  P3...............  ...........       1.2534       $51.89       $51.89
                    scope.
57455............  Biopsy of cervix w/scope  Y................  .................  P3...............  ...........       1.3275       $54.96       $54.96
57456............  Endocerv curettage w/     Y................  .................  P3...............  ...........       1.2780       $52.91       $52.91
                    scope.
57460............  Bx of cervix w/scope,     Y................  .................  P3...............  ...........       4.1638      $172.38      $172.38
                    leep.
57461............  Conz of cervix w/scope,   Y................  .................  P3...............  ...........       4.3865      $181.60      $181.60
                    leep.
57500............  Biopsy of cervix........  Y................  .................  P3...............  ...........       1.8717       $77.49       $77.49
57505............  Endocervical curettage..  Y................  .................  P3...............  ...........       1.1461       $47.45       $47.45
57510............  Cauterization of cervix.  Y................  .................  P3...............  ...........       1.1872       $49.15       $49.15
57511............  Cryocautery of cervix...  Y................  CH...............  P3...............  ...........       1.4099       $58.37       $58.37
57513............  Laser surgery of cervix.  Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
57520............  Conization of cervix....  Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
57522............  Conization of cervix....  Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
57530............  Removal of cervix.......  Y................  .................  A2...............      $510.00      32.9713    $1,365.01      $723.75
57550............  Removal of residual       Y................  .................  A2...............      $510.00      32.9713    $1,365.01      $723.75
                    cervix.
57556............  Remove cervix, repair     Y................  .................  A2...............      $717.00      43.2255    $1,789.54      $985.14
                    bowel.
57558............  D&c of cervical stump...  Y................  .................  A2...............      $510.00      19.2052      $795.10      $581.28
57700............  Revision of cervix......  Y................  .................  A2...............      $333.00      19.2052      $795.10      $448.53
57720............  Revision of cervix......  Y................  .................  A2...............      $510.00      19.2052      $795.10      $581.28
57800............  Dilation of cervical      Y................  .................  P3...............  ...........       0.6101       $25.26       $25.26
                    canal.
58100............  Biopsy of uterus lining.  Y................  .................  P3...............  ...........       1.0143       $41.99       $41.99
58110............  Bx done w/colposcopy add- N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    on.
58120............  Dilation and curettage..  Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
58145............  Myomectomy vag method...  Y................  .................  A2...............      $717.00      32.9713    $1,365.01      $879.00
58301............  Remove intrauterine       Y................  .................  P3...............  ...........       0.9729       $40.28       $40.28
                    device.

[[Page 42885]]

 
58321............  Artificial insemination.  Y................  .................  P3...............  ...........       0.8575       $35.50       $35.50
58322............  Artificial insemination.  Y................  .................  P3...............  ...........       0.9234       $38.23       $38.23
58323............  Sperm washing...........  Y................  .................  P3...............  ...........       0.2886       $11.95       $11.95
58340............  Catheter for              N................  .................  N1...............  ...........  ...........  ...........  ...........
                    hysterography.
58345............  Reopen fallopian tube...  Y................  .................  R2...............  ...........      19.2052      $795.10      $795.10
58346............  Insert heyman uteri       Y................  .................  A2...............      $446.00      19.2052      $795.10      $533.28
                    capsule.
58350............  Reopen fallopian tube...  Y................  .................  A2...............      $510.00      32.9713    $1,365.01      $723.75
58353............  Endometr ablate, thermal  Y................  .................  A2...............      $995.00      32.9713    $1,365.01    $1,087.50
58356............  Endometrial cryoablation  Y................  .................  P3...............  ...........      43.0481    $1,782.19    $1,782.19
58545............  Laparoscopic myomectomy.  Y................  .................  A2...............    $1,339.00      34.8153    $1,441.35    $1,364.59
58546............  Laparo-myomectomy,        Y................  .................  A2...............    $1,339.00      46.1201    $1,909.37    $1,481.59
                    complex.
58550............  Laparo-asst vag           Y................  .................  A2...............    $1,339.00      71.0022    $2,939.49    $1,739.12
                    hysterectomy.
58552............  Laparo-vag hyst incl t/o  Y................  .................  G2...............  ...........      46.1201    $1,909.37    $1,909.37
58555............  Hysteroscopy, dx, sep     Y................  .................  A2...............      $333.00      22.1171      $915.65      $478.66
                    proc.
58558............  Hysteroscopy, biopsy....  Y................  .................  A2...............      $510.00      22.1171      $915.65      $611.41
58559............  Hysteroscopy, lysis.....  Y................  .................  A2...............      $446.00      22.1171      $915.65      $563.41
58560............  Hysteroscopy, resect      Y................  .................  A2...............      $510.00      34.8162    $1,441.39      $742.85
                    septum.
58561............  Hysteroscopy, remove      Y................  .................  A2...............      $510.00      34.8162    $1,441.39      $742.85
                    myoma.
58562............  Hysteroscopy, remove fb.  Y................  .................  A2...............      $510.00      22.1171      $915.65      $611.41
58563............  Hysteroscopy, ablation..  Y................  .................  A2...............    $1,339.00      34.8162    $1,441.39    $1,364.60
58565............  Hysteroscopy,             Y................  .................  A2...............    $1,339.00      43.2255    $1,789.54    $1,451.64
                    sterilization.
58600............  Division of fallopian     Y................  .................  G2...............  ...........      32.9713    $1,365.01    $1,365.01
                    tube.
58615............  Occlude fallopian         Y................  .................  G2...............  ...........      19.2052      $795.10      $795.10
                    tube(s).
58660............  Laparoscopy, lysis......  Y................  .................  A2...............      $717.00      46.1201    $1,909.37    $1,015.09
58661............  Laparoscopy, remove       Y................  .................  A2...............      $717.00      46.1201    $1,909.37    $1,015.09
                    adnexa.
58662............  Laparoscopy, excise       Y................  .................  A2...............      $717.00      46.1201    $1,909.37    $1,015.09
                    lesions.
58670............  Laparoscopy, tubal        Y................  .................  A2...............      $510.00      46.1201    $1,909.37      $859.84
                    cautery.
58671............  Laparoscopy, tubal block  Y................  .................  A2...............      $510.00      46.1201    $1,909.37      $859.84
58672............  Laparoscopy,              Y................  .................  A2...............      $717.00      46.1201    $1,909.37    $1,015.09
                    fimbrioplasty.
58673............  Laparoscopy,              Y................  .................  A2...............      $717.00      46.1201    $1,909.37    $1,015.09
                    salpingostomy.
58800............  Drainage of ovarian       Y................  .................  A2...............      $510.00      19.2052      $795.10      $581.28
                    cyst(s).
58805............  Drainage of ovarian       Y................  CH...............  G2...............  ...........      32.9713    $1,365.01    $1,365.01
                    cyst(s).
58820............  Drain ovary abscess,      Y................  .................  A2...............      $510.00      32.9713    $1,365.01      $723.75
                    open.
58900............  Biopsy of ovary(s)......  Y................  .................  A2...............      $510.00      19.2052      $795.10      $581.28
58970............  Retrieval of oocyte.....  Y................  .................  A2...............      $245.92       3.0466      $126.13      $215.97
58974............  Transfer of embryo......  Y................  .................  A2...............      $245.92       3.0466      $126.13      $215.97
58976............  Transfer of embryo......  Y................  .................  A2...............      $245.92       3.0466      $126.13      $215.97
59000............  Amniocentesis,            Y................  CH...............  P3...............  ...........       1.5667       $64.86       $64.86
                    diagnostic.
59001............  Amniocentesis,            Y................  .................  R2...............  ...........       7.4497      $308.42      $308.42
                    therapeutic.
59012............  Fetal cord                Y................  .................  G2...............  ...........       3.0466      $126.13      $126.13
                    puncture,prenatal.
59015............  Chorion biopsy..........  Y................  .................  P3...............  ...........       1.2285       $50.86       $50.86
59020............  Fetal contract stress     Y................  .................  P3...............  ...........       0.5771       $23.89       $23.89
                    test.
59025............  Fetal non-stress test...  Y................  .................  P3...............  ...........       0.2886       $11.95       $11.95
59070............  Transabdom amnioinfus w/  Y................  .................  G2...............  ...........       3.0466      $126.13      $126.13
                    us.
59072............  Umbilical cord occlud w/  Y................  .................  G2...............  ...........       3.0466      $126.13      $126.13
                    us.
59076............  Fetal shunt placement, w/ Y................  .................  G2...............  ...........       3.0466      $126.13      $126.13
                    us.
59100............  Remove uterus lesion....  Y................  .................  R2...............  ...........      32.9713    $1,365.01    $1,365.01
59150............  Treat ectopic pregnancy.  Y................  .................  G2...............  ...........      46.1201    $1,909.37    $1,909.37
59151............  Treat ectopic pregnancy.  Y................  .................  G2...............  ...........      46.1201    $1,909.37    $1,909.37
59160............  D& c after delivery.....  Y................  .................  A2...............      $510.00      19.2052      $795.10      $581.28
59200............  Insert cervical dilator.  Y................  .................  P3...............  ...........       0.8821       $36.52       $36.52
59300............  Episiotomy or vaginal     Y................  .................  P3...............  ...........       1.7973       $74.41       $74.41
                    repair.
59320............  Revision of cervix......  Y................  .................  A2...............      $333.00      19.2052      $795.10      $448.53
59412............  Antepartum manipulation.  Y................  .................  G2...............  ...........      19.2052      $795.10      $795.10
59414............  Deliver placenta........  Y................  .................  G2...............  ...........      19.2052      $795.10      $795.10
59812............  Treatment of miscarriage  Y................  .................  A2...............      $717.00      19.2052      $795.10      $736.53
59820............  Care of miscarriage.....  Y................  .................  A2...............      $717.00      19.2052      $795.10      $736.53
59821............  Treatment of miscarriage  Y................  .................  A2...............      $717.00      19.2052      $795.10      $736.53
59840............  Abortion................  Y................  .................  A2...............      $717.00      19.2052      $795.10      $736.53
59841............  Abortion................  Y................  .................  A2...............      $717.00      19.2052      $795.10      $736.53
59866............  Abortion (mpr)..........  Y................  .................  G2...............  ...........       3.0466      $126.13      $126.13
59870............  Evacuate mole of uterus.  Y................  .................  A2...............      $717.00      19.2052      $795.10      $736.53
59871............  Remove cerclage suture..  Y................  .................  A2...............      $717.00      19.2052      $795.10      $736.53
60000............  Drain thyroid/tongue      Y................  .................  A2...............      $333.00       7.6539      $316.87      $328.97
                    cyst.
60001............  Aspirate/inject thyriod   Y................  .................  P3...............  ...........       1.3686       $56.66       $56.66
                    cyst.
60100............  Biopsy of thyroid.......  Y................  .................  P3...............  ...........       1.1048       $45.74       $45.74
60200............  Remove thyroid lesion...  Y................  .................  A2...............      $446.00      45.1729    $1,870.16      $802.04
60280............  Remove thyroid duct       Y................  .................  A2...............      $630.00      45.1729    $1,870.16      $940.04
                    lesion.
60281............  Remove thyroid duct       Y................  .................  A2...............      $630.00      45.1729    $1,870.16      $940.04
                    lesion.
61000............  Remove cranial cavity     Y................  .................  R2...............  ...........       8.6797      $359.34      $359.34
                    fluid.
61001............  Remove cranial cavity     Y................  .................  R2...............  ...........       8.6797      $359.34      $359.34
                    fluid.
61020............  Remove brain cavity       Y................  .................  A2...............      $183.83       8.6797      $359.34      $227.71
                    fluid.
61026............  Injection into brain      Y................  .................  A2...............      $183.83       8.6797      $359.34      $227.71
                    canal.
61050............  Remove brain canal fluid  Y................  .................  A2...............      $183.83       8.6797      $359.34      $227.71
61055............  Injection into brain      Y................  .................  A2...............      $183.83       8.6797      $359.34      $227.71
                    canal.
61070............  Brain canal shunt         Y................  .................  A2...............      $183.83       3.2914      $136.26      $171.94
                    procedure.

[[Page 42886]]

 
61215............  Insert brain-fluid        Y................  .................  A2...............      $510.00      37.1117    $1,536.42      $766.61
                    device.
61330............  Decompress eye socket...  Y................  .................  G2...............  ...........      40.5598    $1,679.18    $1,679.18
61334............  Explore orbit/remove      Y................  .................  G2...............  ...........      40.5598    $1,679.18    $1,679.18
                    object.
61790............  Treat trigeminal nerve..  Y................  .................  A2...............      $510.00      18.5069      $766.19      $574.05
61791............  Treat trigeminal tract..  Y................  .................  A2...............      $351.92      15.5687      $644.54      $425.08
61795............  Brain surgery using       N................  CH...............  N1...............      $302.04  ...........  ...........  ...........
                    computer.
61880............  Revise/remove             Y................  .................  G2...............  ...........      24.1752    $1,000.85    $1,000.85
                    neuroelectrode.
61885............  Insrt/redo neurostim 1    N................  .................  H8...............      $446.00     284.8210   $11,791.59   $11,031.64
                    array.
61886............  Implant neurostim arrays  Y................  .................  H8...............      $510.00     384.8428   $15,932.49   $15,191.32
61888............  Revise/remove             Y................  .................  A2...............      $333.00      35.7248    $1,479.01      $619.50
                    neuroreceiver.
62194............  Replace/irrigate          Y................  .................  A2...............      $333.00       8.6797      $359.34      $339.59
                    catheter.
62225............  Replace/irrigate          Y................  .................  A2...............      $333.00      14.8912      $616.50      $403.88
                    catheter.
62230............  Replace/revise brain      Y................  .................  A2...............      $446.00      37.1117    $1,536.42      $718.61
                    shunt.
62252............  Csf shunt reprogram.....  N................  .................  P3...............  ...........       1.0720       $44.38       $44.38
62263............  Epidural lysis mult       Y................  .................  A2...............      $333.00      15.5687      $644.54      $410.89
                    sessions.
62264............  Epidural lysis on single  Y................  .................  A2...............      $333.00      15.5687      $644.54      $410.89
                    day.
62268............  Drain spinal cord cyst..  Y................  .................  A2...............      $183.83       8.6797      $359.34      $227.71
62269............  Needle biopsy, spinal     Y................  .................  A2...............      $333.00       9.5741      $396.37      $348.84
                    cord.
62270............  Spinal fluid tap,         Y................  .................  A2...............      $139.00       4.1589      $172.18      $147.30
                    diagnostic.
62272............  Drain cerebro spinal      Y................  .................  A2...............      $139.00       4.1589      $172.18      $147.30
                    fluid.
62273............  Inject epidural patch...  Y................  .................  A2...............      $333.00       4.1589      $172.18      $292.80
62280............  Treat spinal cord lesion  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
62281............  Treat spinal cord lesion  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
62282............  Treat spinal canal        Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
                    lesion.
62284............  Injection for myelogram.  N................  .................  N1...............  ...........  ...........  ...........  ...........
62287............  Percutaneous diskectomy.  Y................  .................  A2...............    $1,339.00      32.0518    $1,326.94    $1,335.99
62290............  Inject for spine disk x-  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
62291............  Inject for spine disk x-  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
62292............  Injection into disk       Y................  CH...............  R2...............  ...........       8.6797      $359.34      $359.34
                    lesion.
62294............  Injection into spinal     Y................  .................  A2...............      $183.83       8.6797      $359.34      $227.71
                    artery.
62310............  Inject spine c/t........  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
62311............  Inject spine l/s (cd)...  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
62318............  Inject spine w/cath, c/t  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
62319............  Inject spine w/cath l/s   Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
                    (cd).
62350............  Implant spinal canal      Y................  .................  A2...............      $446.00      37.1117    $1,536.42      $718.61
                    cath.
62355............  Remove spinal canal       Y................  .................  A2...............      $446.00      15.5687      $644.54      $495.64
                    catheter.
62360............  Insert spine infusion     Y................  .................  A2...............      $446.00      37.1117    $1,536.42      $718.61
                    device.
62361............  Implant spine infusion    Y................  .................  H8...............      $446.00     255.4150   $10,574.18    $9,781.61
                    pump.
62362............  Implant spine infusion    Y................  .................  H8...............      $446.00     255.4150   $10,574.18    $9,781.61
                    pump.
62365............  Remove spine infusion     Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
                    device.
62367............  Analyze spine infusion    N................  .................  P3...............  ...........       0.4205       $17.41       $17.41
                    pump.
62368............  Analyze spine infusion    N................  .................  P3...............  ...........       0.5278       $21.85       $21.85
                    pump.
63600............  Remove spinal cord        Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
                    lesion.
63610............  Stimulation of spinal     Y................  .................  A2...............      $333.00      18.5069      $766.19      $441.30
                    cord.
63615............  Remove lesion of spinal   Y................  .................  R2...............  ...........      18.5069      $766.19      $766.19
                    cord.
63650............  Implant neuroelectrodes.  N................  .................  H8...............      $446.00      82.9543    $3,434.31    $2,896.42
63655............  Implant neuroelectrodes.  N................  .................  J8...............  ...........     107.3027    $4,442.33    $4,442.33
63660............  Revise/remove             Y................  .................  A2...............      $333.00      24.1752    $1,000.85      $499.96
                    neuroelectrode.
63685............  Insrt/redo spine n        Y................  .................  H8...............      $446.00     280.0420   $11,593.74   $10,925.15
                    generator.
63688............  Revise/remove             Y................  .................  A2...............      $333.00      35.7248    $1,479.01      $619.50
                    neuroreceiver.
63744............  Revision of spinal shunt  Y................  .................  A2...............      $510.00      37.1117    $1,536.42      $766.61
63746............  Removal of spinal shunt.  Y................  .................  A2...............      $446.00       6.1077      $252.86      $397.72
64400............  Nblock inj, trigeminal..  Y................  .................  P3...............  ...........       1.3604       $56.32       $56.32
64402............  Nblock inj, facial......  Y................  .................  P3...............  ...........       1.2449       $51.54       $51.54
64405............  Nblock inj, occipital...  Y................  .................  P3...............  ...........       1.0802       $44.72       $44.72
64408............  Nblock inj, vagus.......  Y................  .................  P3...............  ...........       1.2449       $51.54       $51.54
64410............  Nblock inj, phrenic.....  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
64412............  Nblock inj, spinal        Y................  .................  P3...............  ...........       1.9541       $80.90       $80.90
                    accessor.
64413............  Nblock inj, cervical      Y................  .................  P3...............  ...........       1.2944       $53.59       $53.59
                    plexus.
64415............  Nblock inj, brachial      Y................  .................  A2...............      $139.00       4.1589      $172.18      $147.30
                    plexus.
64416............  Nblock cont infuse, b     Y................  .................  G2...............  ...........       7.1370      $295.47      $295.47
                    plex.
64417............  Nblock inj, axillary....  Y................  .................  A2...............      $139.00       4.1589      $172.18      $147.30
64418............  Nblock inj,               Y................  .................  P3...............  ...........       1.8551       $76.80       $76.80
                    suprascapular.
64420............  Nblock inj, intercost,    Y................  .................  A2...............      $139.00       4.1589      $172.18      $147.30
                    sng.
64421............  Nblock inj, intercost,    Y................  .................  A2...............      $333.00       4.1589      $172.18      $292.80
                    mlt.
64425............  Nblock inj, ilio-ing/     Y................  .................  P3...............  ...........       1.2203       $50.52       $50.52
                    hypogi.
64430............  Nblock inj, pudendal....  Y................  .................  A2...............      $139.00       7.1370      $295.47      $178.12
64435............  Nblock inj, paracervical  Y................  .................  P3...............  ...........       1.8551       $76.80       $76.80
64445............  Nblock inj, sciatic, sng  Y................  .................  P3...............  ...........       1.7727       $73.39       $73.39
64446............  Nblk inj, sciatic, cont   Y................  .................  G2...............  ...........      15.5687      $644.54      $644.54
                    inf.
64447............  Nblock inj fem, single..  Y................  CH...............  R2...............  ...........       4.1589      $172.18      $172.18
64450............  Nblock, other peripheral  Y................  .................  P3...............  ...........       1.0307       $42.67       $42.67
64470............  Inj paravertebral c/t...  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
64472............  Inj paravertebral c/t     Y................  .................  A2...............      $333.00       4.1589      $172.18      $292.80
                    add-on.
64475............  Inj paravertebral l/s...  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
64476............  Inj paravertebral l/s     Y................  .................  A2...............      $333.00       4.1589      $172.18      $292.80
                    add-on.

[[Page 42887]]

 
64479............  Inj foramen epidural c/t  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
64480............  Inj foramen epidural add- Y................  .................  A2...............      $333.00       4.1589      $172.18      $292.80
                    on.
64483............  Inj foramen epidural l/s  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
64484............  Inj foramen epidural add- Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
                    on.
64505............  Nblock, spenopalatine     Y................  .................  P3...............  ...........       0.9729       $40.28       $40.28
                    gangl.
64508............  Nblock, carotid sinus s/  Y................  .................  P3...............  ...........       2.1768       $90.12       $90.12
                    p.
64510............  Nblock, stellate          Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
                    ganglion.
64517............  Nblock inj, hypogas plxs  Y................  .................  A2...............      $139.00       7.1370      $295.47      $178.12
64520............  Nblock, lumbar/thoracic.  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
64530............  Nblock inj, celiac pelus  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
64553............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     317.8027   $13,157.03   $12,089.52
64555............  Implant neuroelectrodes.  N................  .................  J8...............  ...........      82.9543    $3,434.31    $3,434.31
64560............  Implant neuroelectrodes.  N................  .................  J8...............  ...........      82.9543    $3,434.31    $3,434.31
64561............  Implant neuroelectrodes.  N................  .................  H8...............      $510.00      82.9543    $3,434.31    $2,944.42
64565............  Implant neuroelectrodes.  N................  .................  J8...............  ...........      82.9543    $3,434.31    $3,434.31
64573............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     317.8027   $13,157.03   $12,089.52
64575............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     107.3027    $4,442.33    $3,664.85
64577............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     107.3027    $4,442.33    $3,664.85
64580............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     107.3027    $4,442.33    $3,664.85
64581............  Implant neuroelectrodes.  N................  .................  H8...............      $510.00     107.3027    $4,442.33    $3,797.60
64585............  Revise/remove             Y................  .................  A2...............      $333.00      24.1752    $1,000.85      $499.96
                    neuroelectrode.
64590............  Insrt/redo pn/gastr       Y................  .................  H8...............      $446.00     280.0420   $11,593.74   $10,925.15
                    stimul.
64595............  Revise/rmv pn/gastr       Y................  .................  A2...............      $333.00      35.7248    $1,479.01      $619.50
                    stimul.
64600............  Injection treatment of    Y................  .................  A2...............      $333.00      15.5687      $644.54      $410.89
                    nerve.
64605............  Injection treatment of    Y................  .................  A2...............      $333.00      15.5687      $644.54      $410.89
                    nerve.
64610............  Injection treatment of    Y................  .................  A2...............      $333.00      15.5687      $644.54      $410.89
                    nerve.
64612............  Destroy nerve, face       Y................  .................  P3...............  ...........       1.6821       $69.64       $69.64
                    muscle.
64613............  Destroy nerve, neck       Y................  .................  P3...............  ...........       1.7727       $73.39       $73.39
                    muscle.
64614............  Destroy nerve, extrem     Y................  .................  P3...............  ...........       1.9954       $82.61       $82.61
                    musc.
64620............  Injection treatment of    Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
                    nerve.
64622............  Destr paravertebrl nerve  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
                    l/s.
64623............  Destr paravertebral n     Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
                    add-on.
64626............  Destr paravertebrl nerve  Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
                    c/t.
64627............  Destr paravertebral n     Y................  .................  A2...............      $333.00       2.3254       $96.27      $273.82
                    add-on.
64630............  Injection treatment of    Y................  .................  A2...............      $351.92       7.1370      $295.47      $337.81
                    nerve.
64640............  Injection treatment of    Y................  .................  P3...............  ...........       2.7126      $112.30      $112.30
                    nerve.
64650............  Chemodenerv eccrine       Y................  CH...............  P3...............  ...........       0.6597       $27.31       $27.31
                    glands.
64653............  Chemodenerv eccrine       Y................  CH...............  P3...............  ...........       0.7007       $29.01       $29.01
                    glands.
64680............  Injection treatment of    Y................  .................  A2...............      $390.95       7.1370      $295.47      $367.08
                    nerve.
64681............  Injection treatment of    Y................  .................  A2...............      $446.00      15.5687      $644.54      $495.64
                    nerve.
64702............  Revise finger/toe nerve.  Y................  .................  A2...............      $333.00      18.5069      $766.19      $441.30
64704............  Revise hand/foot nerve..  Y................  .................  A2...............      $333.00      18.5069      $766.19      $441.30
64708............  Revise arm/leg nerve....  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64712............  Revision of sciatic       Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
                    nerve.
64713............  Revision of arm nerve(s)  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64714............  Revise low back nerve(s)  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64716............  Revision of cranial       Y................  .................  A2...............      $510.00      18.5069      $766.19      $574.05
                    nerve.
64718............  Revise ulnar nerve at     Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
                    elbow.
64719............  Revise ulnar nerve at     Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
                    wrist.
64721............  Carpal tunnel surgery...  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64722............  Relieve pressure on       Y................  .................  A2...............      $333.00      18.5069      $766.19      $441.30
                    nerve(s).
64726............  Release foot/toe nerve..  Y................  .................  A2...............      $333.00      18.5069      $766.19      $441.30
64727............  Internal nerve revision.  Y................  .................  A2...............      $333.00      18.5069      $766.19      $441.30
64732............  Incision of brow nerve..  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64734............  Incision of cheek nerve.  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64736............  Incision of chin nerve..  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64738............  Incision of jaw nerve...  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64740............  Incision of tongue nerve  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64742............  Incision of facial nerve  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64744............  Incise nerve, back of     Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
                    head.
64746............  Incise diaphragm nerve..  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64761............  Incision of pelvis nerve  Y................  .................  G2...............  ...........      18.5069      $766.19      $766.19
64763............  Incise hip/thigh nerve..  Y................  .................  G2...............  ...........      18.5069      $766.19      $766.19
64766............  Incise hip/thigh nerve..  Y................  .................  G2...............  ...........      32.0518    $1,326.94    $1,326.94
64771............  Sever cranial nerve.....  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64772............  Incision of spinal nerve  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64774............  Remove skin nerve lesion  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64776............  Remove digit nerve        Y................  .................  A2...............      $510.00      18.5069      $766.19      $574.05
                    lesion.
64778............  Digit nerve surgery add-  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
                    on.
64782............  Remove limb nerve lesion  Y................  .................  A2...............      $510.00      18.5069      $766.19      $574.05
64783............  Limb nerve surgery add-   Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
                    on.
64784............  Remove nerve lesion.....  Y................  .................  A2...............      $510.00      18.5069      $766.19      $574.05
64786............  Remove sciatic nerve      Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
                    lesion.
64787............  Implant nerve end.......  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64788............  Remove skin nerve lesion  Y................  .................  A2...............      $510.00      18.5069      $766.19      $574.05
64790............  Removal of nerve lesion.  Y................  .................  A2...............      $510.00      18.5069      $766.19      $574.05

[[Page 42888]]

 
64792............  Removal of nerve lesion.  Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
64795............  Biopsy of nerve.........  Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
64802............  Remove sympathetic        Y................  .................  A2...............      $446.00      18.5069      $766.19      $526.05
                    nerves.
64820............  Remove sympathetic        Y................  .................  G2...............  ...........      18.5069      $766.19      $766.19
                    nerves.
64821............  Remove sympathetic        Y................  .................  A2...............      $630.00      26.7322    $1,106.71      $749.18
                    nerves.
64822............  Remove sympathetic        Y................  .................  G2...............  ...........      26.7322    $1,106.71    $1,106.71
                    nerves.
64823............  Remove sympathetic        Y................  .................  G2...............  ...........      26.7322    $1,106.71    $1,106.71
                    nerves.
64831............  Repair of digit nerve...  Y................  .................  A2...............      $630.00      32.0518    $1,326.94      $804.24
64832............  Repair nerve add-on.....  Y................  .................  A2...............      $333.00      32.0518    $1,326.94      $581.49
64834............  Repair of hand or foot    Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
                    nerve.
64835............  Repair of hand or foot    Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
                    nerve.
64836............  Repair of hand or foot    Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
                    nerve.
64837............  Repair nerve add-on.....  Y................  .................  A2...............      $333.00      32.0518    $1,326.94      $581.49
64840............  Repair of leg nerve.....  Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
64856............  Repair/transpose nerve..  Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
64857............  Repair arm/leg nerve....  Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
64858............  Repair sciatic nerve....  Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
64859............  Nerve surgery...........  Y................  .................  A2...............      $333.00      32.0518    $1,326.94      $581.49
64861............  Repair of arm nerves....  Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
64862............  Repair of low back        Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
                    nerves.
64864............  Repair of facial nerve..  Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
64865............  Repair of facial nerve..  Y................  .................  A2...............      $630.00      32.0518    $1,326.94      $804.24
64870............  Fusion of facial/other    Y................  .................  A2...............      $630.00      32.0518    $1,326.94      $804.24
                    nerve.
64872............  Subsequent repair of      Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
                    nerve.
64874............  Repair & revise nerve     Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
                    add-on.
64876............  Repair nerve/shorten      Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
                    bone.
64885............  Nerve graft, head or      Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
                    neck.
64886............  Nerve graft, head or      Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
                    neck.
64890............  Nerve graft, hand or      Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
                    foot.
64891............  Nerve graft, hand or      Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
                    foot.
64892............  Nerve graft, arm or leg.  Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
64893............  Nerve graft, arm or leg.  Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
64895............  Nerve graft, hand or      Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
                    foot.
64896............  Nerve graft, hand or      Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
                    foot.
64897............  Nerve graft, arm or leg.  Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
64898............  Nerve graft, arm or leg.  Y................  .................  A2...............      $510.00      32.0518    $1,326.94      $714.24
64901............  Nerve graft add-on......  Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
64902............  Nerve graft add-on......  Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
64905............  Nerve pedicle transfer..  Y................  .................  A2...............      $446.00      32.0518    $1,326.94      $666.24
64907............  Nerve pedicle transfer..  Y................  .................  A2...............      $333.00      32.0518    $1,326.94      $581.49
65091............  Revise eye..............  Y................  .................  A2...............      $510.00      37.3504    $1,546.31      $769.08
65093............  Revise eye with implant.  Y................  .................  A2...............      $510.00      37.3504    $1,546.31      $769.08
65101............  Removal of eye..........  Y................  .................  A2...............      $510.00      37.3504    $1,546.31      $769.08
65103............  Remove eye/insert         Y................  .................  A2...............      $510.00      37.3504    $1,546.31      $769.08
                    implant.
65105............  Remove eye/attach         Y................  .................  A2...............      $630.00      37.3504    $1,546.31      $859.08
                    implant.
65110............  Removal of eye..........  Y................  .................  A2...............      $717.00      37.3504    $1,546.31      $924.33
65112............  Remove eye/revise socket  Y................  .................  A2...............      $995.00      37.3504    $1,546.31    $1,132.83
65114............  Remove eye/revise socket  Y................  .................  A2...............      $995.00      37.3504    $1,546.31    $1,132.83
65125............  Revise ocular implant...  Y................  .................  G2...............  ...........      19.2280      $796.04      $796.04
65130............  Insert ocular implant...  Y................  .................  A2...............      $510.00      24.8916    $1,030.51      $640.13
65135............  Insert ocular implant...  Y................  .................  A2...............      $446.00      24.8916    $1,030.51      $592.13
65140............  Attach ocular implant...  Y................  .................  A2...............      $510.00      37.3504    $1,546.31      $769.08
65150............  Revise ocular implant...  Y................  .................  A2...............      $446.00      24.8916    $1,030.51      $592.13
65155............  Reinsert ocular implant.  Y................  .................  A2...............      $510.00      37.3504    $1,546.31      $769.08
65175............  Removal of ocular         Y................  .................  A2...............      $333.00      19.2280      $796.04      $448.76
                    implant.
65205............  Remove foreign body from  N................  .................  P3...............  ...........       0.5029       $20.82       $20.82
                    eye.
65210............  Remove foreign body from  N................  .................  P3...............  ...........       0.6266       $25.94       $25.94
                    eye.
65220............  Remove foreign body from  N................  .................  G2...............  ...........       1.1576       $47.92       $47.92
                    eye.
65222............  Remove foreign body from  N................  .................  P3...............  ...........       0.6925       $28.67       $28.67
                    eye.
65235............  Remove foreign body from  Y................  .................  A2...............      $446.00      16.5252      $684.14      $505.54
                    eye.
65260............  Remove foreign body from  Y................  .................  A2...............      $510.00      18.8779      $781.55      $577.89
                    eye.
65265............  Remove foreign body from  Y................  .................  A2...............      $630.00      29.0019    $1,200.68      $772.67
                    eye.
65270............  Repair of eye wound.....  Y................  .................  A2...............      $446.00      19.2280      $796.04      $533.51
65272............  Repair of eye wound.....  Y................  .................  A2...............      $446.00      24.0821      $997.00      $583.75
65275............  Repair of eye wound.....  Y................  .................  A2...............      $630.00      24.0821      $997.00      $721.75
65280............  Repair of eye wound.....  Y................  .................  A2...............      $630.00      18.8779      $781.55      $667.89
65285............  Repair of eye wound.....  Y................  .................  A2...............      $630.00      38.1121    $1,577.84      $866.96
65286............  Repair of eye wound.....  Y................  .................  P2...............  ...........       5.1145      $211.74      $211.74
65290............  Repair of eye socket      Y................  .................  A2...............      $510.00      24.3920    $1,009.83      $634.96
                    wound.
65400............  Removal of eye lesion...  Y................  .................  A2...............      $333.00      16.5252      $684.14      $420.79
65410............  Biopsy of cornea........  Y................  .................  A2...............      $446.00      16.5252      $684.14      $505.54
65420............  Removal of eye lesion...  Y................  .................  A2...............      $446.00      16.5252      $684.14      $505.54
65426............  Removal of eye lesion...  Y................  .................  A2...............      $717.00      24.0821      $997.00      $787.00
65430............  Corneal smear...........  N................  .................  P3...............  ...........       0.9894       $40.96       $40.96
65435............  Curette/treat cornea....  Y................  .................  P3...............  ...........       0.7669       $31.75       $31.75
65436............  Curette/treat cornea....  Y................  .................  G2...............  ...........      16.5252      $684.14      $684.14

[[Page 42889]]

 
65450............  Treatment of corneal      N................  .................  G2...............  ...........       2.3117       $95.70       $95.70
                    lesion.
65600............  Revision of cornea......  Y................  .................  P3...............  ...........       3.9164      $162.14      $162.14
65710............  Corneal transplant......  Y................  .................  A2...............      $995.00      38.2919    $1,585.28    $1,142.57
65730............  Corneal transplant......  Y................  .................  A2...............      $995.00      38.2919    $1,585.28    $1,142.57
65750............  Corneal transplant......  Y................  .................  A2...............      $995.00      38.2919    $1,585.28    $1,142.57
65755............  Corneal transplant......  Y................  .................  A2...............      $995.00      38.2919    $1,585.28    $1,142.57
65770............  Revise cornea with        Y................  .................  A2...............      $995.00      83.0605    $3,438.70    $1,605.93
                    implant.
65772............  Correction of             Y................  .................  A2...............      $630.00      16.5252      $684.14      $643.54
                    astigmatism.
65775............  Correction of             Y................  .................  A2...............      $630.00      16.5252      $684.14      $643.54
                    astigmatism.
65780............  Ocular reconst,           Y................  .................  A2...............      $717.00      38.2919    $1,585.28      $934.07
                    transplant.
65781............  Ocular reconst,           Y................  .................  A2...............      $717.00      38.2919    $1,585.28      $934.07
                    transplant.
65782............  Ocular reconst,           Y................  .................  A2...............      $717.00      38.2919    $1,585.28      $934.07
                    transplant.
65800............  Drainage of eye.........  Y................  .................  A2...............      $333.00      16.5252      $684.14      $420.79
65805............  Drainage of eye.........  Y................  .................  A2...............      $333.00      16.5252      $684.14      $420.79
65810............  Drainage of eye.........  Y................  .................  A2...............      $510.00      24.0821      $997.00      $631.75
65815............  Drainage of eye.........  Y................  .................  A2...............      $446.00      24.0821      $997.00      $583.75
65820............  Relieve inner eye         Y................  .................  A2...............      $333.00       5.1145      $211.74      $302.69
                    pressure.
65850............  Incision of eye.........  Y................  .................  A2...............      $630.00      24.0821      $997.00      $721.75
65855............  Laser surgery of eye....  Y................  .................  P3...............  ...........       3.2403      $134.15      $134.15
65860............  Incise inner eye          Y................  .................  P3...............  ...........       3.0343      $125.62      $125.62
                    adhesions.
65865............  Incise inner eye          Y................  .................  A2...............      $333.00      16.5252      $684.14      $420.79
                    adhesions.
65870............  Incise inner eye          Y................  .................  A2...............      $630.00      24.0821      $997.00      $721.75
                    adhesions.
65875............  Incise inner eye          Y................  .................  A2...............      $630.00      24.0821      $997.00      $721.75
                    adhesions.
65880............  Incise inner eye          Y................  .................  A2...............      $630.00      16.5252      $684.14      $643.54
                    adhesions.
65900............  Remove eye lesion.......  Y................  .................  A2...............      $717.00      16.5252      $684.14      $708.79
65920............  Remove implant of eye...  Y................  .................  A2...............      $995.00      24.0821      $997.00      $995.50
65930............  Remove blood clot from    Y................  .................  A2...............      $717.00      24.0821      $997.00      $787.00
                    eye.
66020............  Injection treatment of    Y................  .................  A2...............      $333.00      16.5252      $684.14      $420.79
                    eye.
66030............  Injection treatment of    Y................  .................  A2...............      $333.00       5.1145      $211.74      $302.69
                    eye.
66130............  Remove eye lesion.......  Y................  .................  A2...............      $995.00      24.0821      $997.00      $995.50
66150............  Glaucoma surgery........  Y................  .................  A2...............      $630.00      24.0821      $997.00      $721.75
66155............  Glaucoma surgery........  Y................  .................  A2...............      $630.00      24.0821      $997.00      $721.75
66160............  Glaucoma surgery........  Y................  .................  A2...............      $446.00      24.0821      $997.00      $583.75
66165............  Glaucoma surgery........  Y................  .................  A2...............      $630.00      24.0821      $997.00      $721.75
66170............  Glaucoma surgery........  Y................  .................  A2...............      $630.00      24.0821      $997.00      $721.75
66172............  Incision of eye.........  Y................  .................  A2...............      $630.00      24.0821      $997.00      $721.75
66180............  Implant eye shunt.......  Y................  .................  A2...............      $717.00      40.8481    $1,691.11      $960.53
66185............  Revise eye shunt........  Y................  .................  A2...............      $446.00      40.8481    $1,691.11      $757.28
66220............  Repair eye lesion.......  Y................  .................  A2...............      $510.00      38.1121    $1,577.84      $776.96
66225............  Repair/graft eye lesion.  Y................  .................  A2...............      $630.00      40.8481    $1,691.11      $895.28
66250............  Follow-up surgery of eye  Y................  .................  A2...............      $446.00      16.5252      $684.14      $505.54
66500............  Incision of iris........  Y................  .................  A2...............      $333.00       5.1145      $211.74      $302.69
66505............  Incision of iris........  Y................  .................  A2...............      $333.00       5.1145      $211.74      $302.69
66600............  Remove iris and lesion..  Y................  .................  A2...............      $510.00      24.0821      $997.00      $631.75
66605............  Removal of iris.........  Y................  .................  A2...............      $510.00      24.0821      $997.00      $631.75
66625............  Removal of iris.........  Y................  .................  A2...............      $372.94       5.1145      $211.74      $332.64
66630............  Removal of iris.........  Y................  .................  A2...............      $510.00      24.0821      $997.00      $631.75
66635............  Removal of iris.........  Y................  .................  A2...............      $510.00      24.0821      $997.00      $631.75
66680............  Repair iris & ciliary     Y................  .................  A2...............      $510.00      24.0821      $997.00      $631.75
                    body.
66682............  Repair iris & ciliary     Y................  .................  A2...............      $446.00      24.0821      $997.00      $583.75
                    body.
66700............  Destruction, ciliary      Y................  .................  A2...............      $446.00      16.5252      $684.14      $505.54
                    body.
66710............  Ciliary transsleral       Y................  .................  A2...............      $446.00      16.5252      $684.14      $505.54
                    therapy.
66711............  Ciliary endoscopic        Y................  .................  A2...............      $446.00      16.5252      $684.14      $505.54
                    ablation.
66720............  Destruction, ciliary      Y................  .................  A2...............      $446.00      16.5252      $684.14      $505.54
                    body.
66740............  Destruction, ciliary      Y................  .................  A2...............      $446.00      24.0821      $997.00      $583.75
                    body.
66761............  Revision of iris........  Y................  .................  P3...............  ...........       4.4029      $182.28      $182.28
66762............  Revision of iris........  Y................  .................  P3...............  ...........       4.4606      $184.67      $184.67
66770............  Removal of inner eye      Y................  .................  P3...............  ...........       4.8234      $199.69      $199.69
                    lesion.
66820............  Incision, secondary       Y................  .................  G2...............  ...........       5.1145      $211.74      $211.74
                    cataract.
66821............  After cataract laser      Y................  .................  A2...............      $312.50       5.2389      $216.89      $288.60
                    surgery.
66825............  Reposition intraocular    Y................  .................  A2...............      $630.00      24.0821      $997.00      $721.75
                    lens.
66830............  Removal of lens lesion..  Y................  .................  A2...............      $372.94       5.1145      $211.74      $332.64
66840............  Removal of lens material  Y................  .................  A2...............      $630.00      14.9022      $616.95      $626.74
66850............  Removal of lens material  Y................  .................  A2...............      $995.00      29.7487    $1,231.60    $1,054.15
66852............  Removal of lens material  Y................  .................  A2...............      $630.00      29.7487    $1,231.60      $780.40
66920............  Extraction of lens......  Y................  .................  A2...............      $630.00      29.7487    $1,231.60      $780.40
66930............  Extraction of lens......  Y................  .................  A2...............      $717.00      29.7487    $1,231.60      $845.65
66940............  Extraction of lens......  Y................  .................  A2...............      $717.00      14.9022      $616.95      $691.99
66982............  Cataract surgery,         Y................  .................  A2...............      $973.00      24.2197    $1,002.70      $980.43
                    complex.
66983............  Cataract surg w/iol, 1    Y................  .................  A2...............      $973.00      24.2197    $1,002.70      $980.43
                    stage.
66984............  Cataract surg w/iol, 1    Y................  .................  A2...............      $973.00      24.2197    $1,002.70      $980.43
                    stage.
66985............  Insert lens prosthesis..  Y................  .................  A2...............      $826.00      24.2197    $1,002.70      $870.18
66986............  Exchange lens prosthesis  Y................  .................  A2...............      $826.00      24.2197    $1,002.70      $870.18
66990............  Ophthalmic endoscope add- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    on.
67005............  Partial removal of eye    Y................  .................  A2...............      $630.00      29.0019    $1,200.68      $772.67
                    fluid.
67010............  Partial removal of eye    Y................  .................  A2...............      $630.00      29.0019    $1,200.68      $772.67
                    fluid.

[[Page 42890]]

 
67015............  Release of eye fluid....  Y................  .................  A2...............      $333.00      29.0019    $1,200.68      $549.92
67025............  Replace eye fluid.......  Y................  .................  A2...............      $333.00      29.0019    $1,200.68      $549.92
67027............  Implant eye drug system.  Y................  .................  A2...............      $630.00      38.1121    $1,577.84      $866.96
67028............  Injection eye drug......  N................  .................  P3...............  ...........       2.0200       $83.63       $83.63
67030............  Incise inner eye strands  Y................  .................  A2...............      $333.00      18.8779      $781.55      $445.14
67031............  Laser surgery, eye        Y................  .................  A2...............      $312.50       5.2389      $216.89      $288.60
                    strands.
67036............  Removal of inner eye      Y................  .................  A2...............      $630.00      38.1121    $1,577.84      $866.96
                    fluid.
67038............  Strip retinal membrane..  Y................  .................  A2...............      $717.00      38.1121    $1,577.84      $932.21
67039............  Laser treatment of        Y................  .................  A2...............      $995.00      38.1121    $1,577.84    $1,140.71
                    retina.
67040............  Laser treatment of        Y................  .................  A2...............      $995.00      38.1121    $1,577.84    $1,140.71
                    retina.
67101............  Repair detached retina..  Y................  .................  P3...............  ...........       7.3135      $302.78      $302.78
67105............  Repair detached retina..  Y................  .................  P2...............  ...........       5.2389      $216.89      $216.89
67107............  Repair detached retina..  Y................  .................  A2...............      $717.00      38.1121    $1,577.84      $932.21
67108............  Repair detached retina..  Y................  .................  A2...............      $995.00      38.1121    $1,577.84    $1,140.71
67110............  Repair detached retina..  Y................  .................  P3...............  ...........       7.9565      $329.40      $329.40
67112............  Rerepair detached retina  Y................  .................  A2...............      $995.00      38.1121    $1,577.84    $1,140.71
67115............  Release encircling        Y................  .................  A2...............      $446.00      18.8779      $781.55      $529.89
                    material.
67120............  Remove eye implant        Y................  .................  A2...............      $446.00      18.8779      $781.55      $529.89
                    material.
67121............  Remove eye implant        Y................  .................  A2...............      $446.00      29.0019    $1,200.68      $634.67
                    material.
67141............  Treatment of retina.....  Y................  .................  A2...............      $241.77       4.0100      $166.01      $222.83
67145............  Treatment of retina.....  Y................  .................  P3...............  ...........       4.6007      $190.47      $190.47
67208............  Treatment of retinal      Y................  .................  P3...............  ...........       4.8976      $202.76      $202.76
                    lesion.
67210............  Treatment of retinal      Y................  .................  P3...............  ...........       5.2027      $215.39      $215.39
                    lesion.
67218............  Treatment of retinal      Y................  .................  A2...............      $717.00      18.8779      $781.55      $733.14
                    lesion.
67220............  Treatment of choroid      Y................  .................  P2...............  ...........       4.0100      $166.01      $166.01
                    lesion.
67221............  Ocular photodynamic ther  Y................  .................  P3...............  ...........       3.0094      $124.59      $124.59
67225............  Eye photodynamic ther     Y................  .................  P3...............  ...........       0.1978        $8.19        $8.19
                    add-on.
67227............  Treatment of retinal      Y................  .................  A2...............      $333.00      29.0019    $1,200.68      $549.92
                    lesion.
67228............  Treatment of retinal      Y................  .................  P2...............  ...........       5.2389      $216.89      $216.89
                    lesion.
67250............  Reinforce eye wall......  Y................  .................  A2...............      $510.00      19.2280      $796.04      $581.51
67255............  Reinforce/graft eye wall  Y................  .................  A2...............      $510.00      29.0019    $1,200.68      $682.67
67311............  Revise eye muscle.......  Y................  .................  A2...............      $510.00      24.3920    $1,009.83      $634.96
67312............  Revise two eye muscles..  Y................  .................  A2...............      $630.00      24.3920    $1,009.83      $724.96
67314............  Revise eye muscle.......  Y................  .................  A2...............      $630.00      24.3920    $1,009.83      $724.96
67316............  Revise two eye muscles..  Y................  .................  A2...............      $630.00      24.3920    $1,009.83      $724.96
67318............  Revise eye muscle(s)....  Y................  .................  A2...............      $630.00      24.3920    $1,009.83      $724.96
67320............  Revise eye muscle(s) add- Y................  .................  A2...............      $630.00      24.3920    $1,009.83      $724.96
                    on.
67331............  Eye surgery follow-up     Y................  .................  A2...............      $630.00      24.3920    $1,009.83      $724.96
                    add-on.
67332............  Rerevise eye muscles add- Y................  .................  A2...............      $630.00      24.3920    $1,009.83      $724.96
                    on.
67334............  Revise eye muscle w/      Y................  .................  A2...............      $630.00      24.3920    $1,009.83      $724.96
                    suture.
67335............  Eye suture during         Y................  .................  A2...............      $630.00      24.3920    $1,009.83      $724.96
                    surgery.
67340............  Revise eye muscle add-on  Y................  .................  A2...............      $630.00      24.3920    $1,009.83      $724.96
67343............  Release eye tissue......  Y................  .................  A2...............      $995.00      24.3920    $1,009.83      $998.71
67345............  Destroy nerve of eye      Y................  .................  P3...............  ...........       1.9787       $81.92       $81.92
                    muscle.
67346............  Biopsy, eye muscle......  Y................  .................  A2...............      $333.00      14.2784      $591.13      $397.53
67400............  Explore/biopsy eye        Y................  .................  A2...............      $510.00      24.8916    $1,030.51      $640.13
                    socket.
67405............  Explore/drain eye socket  Y................  .................  A2...............      $630.00      24.8916    $1,030.51      $730.13
67412............  Explore/treat eye socket  Y................  .................  A2...............      $717.00      24.8916    $1,030.51      $795.38
67413............  Explore/treat eye socket  Y................  .................  A2...............      $717.00      24.8916    $1,030.51      $795.38
67414............  Explr/decompress eye      Y................  .................  G2...............  ...........      37.3504    $1,546.31    $1,546.31
                    socket.
67415............  Aspiration, orbital       Y................  .................  A2...............      $333.00      19.2280      $796.04      $448.76
                    contents.
67420............  Explore/treat eye socket  Y................  .................  A2...............      $717.00      37.3504    $1,546.31      $924.33
67430............  Explore/treat eye socket  Y................  .................  A2...............      $717.00      37.3504    $1,546.31      $924.33
67440............  Explore/drain eye socket  Y................  .................  A2...............      $717.00      37.3504    $1,546.31      $924.33
67445............  Explr/decompress eye      Y................  .................  A2...............      $717.00      37.3504    $1,546.31      $924.33
                    socket.
67450............  Explore/biopsy eye        Y................  .................  A2...............      $717.00      37.3504    $1,546.31      $924.33
                    socket.
67500............  Inject/treat eye socket.  N................  .................  G2...............  ...........       2.3117       $95.70       $95.70
67505............  Inject/treat eye socket.  Y................  .................  G2...............  ...........       2.8636      $118.55      $118.55
67515............  Inject/treat eye socket.  Y................  .................  P3...............  ...........       0.5688       $23.55       $23.55
67550............  Insert eye socket         Y................  .................  A2...............      $630.00      37.3504    $1,546.31      $859.08
                    implant.
67560............  Revise eye socket         Y................  .................  A2...............      $446.00      24.8916    $1,030.51      $592.13
                    implant.
67570............  Decompress optic nerve..  Y................  .................  A2...............      $630.00      37.3504    $1,546.31      $859.08
67700............  Drainage of eyelid        Y................  .................  P2...............  ...........       2.8636      $118.55      $118.55
                    abscess.
67710............  Incision of eyelid......  Y................  .................  P3...............  ...........       3.7432      $154.97      $154.97
67715............  Incision of eyelid fold.  Y................  .................  A2...............      $333.00      19.2280      $796.04      $448.76
67800............  Remove eyelid lesion....  Y................  .................  P3...............  ...........       1.2534       $51.89       $51.89
67801............  Remove eyelid lesions...  Y................  .................  P3...............  ...........       1.5089       $62.47       $62.47
67805............  Remove eyelid lesions...  Y................  .................  P3...............  ...........       1.9541       $80.90       $80.90
67808............  Remove eyelid lesion(s).  Y................  .................  A2...............      $446.00      19.2280      $796.04      $533.51
67810............  Biopsy of eyelid........  Y................  .................  P2...............  ...........       2.8636      $118.55      $118.55
67820............  Revise eyelashes........  N................  .................  P3...............  ...........       0.4370       $18.09       $18.09
67825............  Revise eyelashes........  Y................  .................  P3...............  ...........       1.2944       $53.59       $53.59
67830............  Revise eyelashes........  Y................  .................  A2...............      $446.00       7.1099      $294.35      $408.09
67835............  Revise eyelashes........  Y................  .................  A2...............      $446.00      19.2280      $796.04      $533.51
67840............  Remove eyelid lesion....  Y................  .................  P3...............  ...........       3.8751      $160.43      $160.43
67850............  Treat eyelid lesion.....  Y................  .................  P3...............  ...........       2.7457      $113.67      $113.67

[[Page 42891]]

 
67875............  Closure of eyelid by      Y................  .................  G2...............  ...........       7.1099      $294.35      $294.35
                    suture.
67880............  Revision of eyelid......  Y................  .................  A2...............      $510.00      16.5252      $684.14      $553.54
67882............  Revision of eyelid......  Y................  .................  A2...............      $510.00      19.2280      $796.04      $581.51
67900............  Repair brow defect......  Y................  .................  A2...............      $630.00      19.2280      $796.04      $671.51
67901............  Repair eyelid defect....  Y................  .................  A2...............      $717.00      19.2280      $796.04      $736.76
67902............  Repair eyelid defect....  Y................  .................  A2...............      $717.00      19.2280      $796.04      $736.76
67903............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      19.2280      $796.04      $671.51
67904............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      19.2280      $796.04      $671.51
67906............  Repair eyelid defect....  Y................  .................  A2...............      $717.00      19.2280      $796.04      $736.76
67908............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      19.2280      $796.04      $671.51
67909............  Revise eyelid defect....  Y................  .................  A2...............      $630.00      19.2280      $796.04      $671.51
67911............  Revise eyelid defect....  Y................  .................  A2...............      $510.00      19.2280      $796.04      $581.51
67912............  Correction eyelid w/      Y................  .................  A2...............      $510.00      19.2280      $796.04      $581.51
                    implant.
67914............  Repair eyelid defect....  Y................  .................  A2...............      $510.00      19.2280      $796.04      $581.51
67915............  Repair eyelid defect....  Y................  .................  P3...............  ...........       4.2792      $177.16      $177.16
67916............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      19.2280      $796.04      $671.51
67917............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      19.2280      $796.04      $671.51
67921............  Repair eyelid defect....  Y................  .................  A2...............      $510.00      19.2280      $796.04      $581.51
67922............  Repair eyelid defect....  Y................  .................  P3...............  ...........       4.1969      $173.75      $173.75
67923............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      19.2280      $796.04      $671.51
67924............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      19.2280      $796.04      $671.51
67930............  Repair eyelid wound.....  Y................  .................  P3...............  ...........       4.1720      $172.72      $172.72
67935............  Repair eyelid wound.....  Y................  .................  A2...............      $446.00      19.2280      $796.04      $533.51
67938............  Remove eyelid foreign     N................  .................  P2...............  ...........       1.1576       $47.92       $47.92
                    body.
67950............  Revision of eyelid......  Y................  .................  A2...............      $446.00      19.2280      $796.04      $533.51
67961............  Revision of eyelid......  Y................  .................  A2...............      $510.00      19.2280      $796.04      $581.51
67966............  Revision of eyelid......  Y................  .................  A2...............      $510.00      19.2280      $796.04      $581.51
67971............  Reconstruction of eyelid  Y................  .................  A2...............      $510.00      24.8916    $1,030.51      $640.13
67973............  Reconstruction of eyelid  Y................  .................  A2...............      $510.00      24.8916    $1,030.51      $640.13
67974............  Reconstruction of eyelid  Y................  .................  A2...............      $510.00      24.8916    $1,030.51      $640.13
67975............  Reconstruction of eyelid  Y................  .................  A2...............      $510.00      19.2280      $796.04      $581.51
68020............  Incise/drain eyelid       Y................  .................  P3...............  ...........       1.0966       $45.40       $45.40
                    lining.
68040............  Treatment of eyelid       N................  .................  P3...............  ...........       0.5442       $22.53       $22.53
                    lesions.
68100............  Biopsy of eyelid lining.  Y................  .................  P3...............  ...........       2.3169       $95.92       $95.92
68110............  Remove eyelid lining      Y................  .................  P3...............  ...........       2.9684      $122.89      $122.89
                    lesion.
68115............  Remove eyelid lining      Y................  .................  A2...............      $446.00      19.2280      $796.04      $533.51
                    lesion.
68130............  Remove eyelid lining      Y................  .................  A2...............      $446.00      16.5252      $684.14      $505.54
                    lesion.
68135............  Remove eyelid lining      Y................  .................  P3...............  ...........       1.4099       $58.37       $58.37
                    lesion.
68200............  Treat eyelid by           N................  .................  P3...............  ...........       0.4123       $17.07       $17.07
                    injection.
68320............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      19.2280      $796.04      $671.51
                    lining.
68325............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      24.8916    $1,030.51      $730.13
                    lining.
68326............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      24.8916    $1,030.51      $730.13
                    lining.
68328............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      24.8916    $1,030.51      $730.13
                    lining.
68330............  Revise eyelid lining....  Y................  .................  A2...............      $630.00      24.0821      $997.00      $721.75
68335............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      24.8916    $1,030.51      $730.13
                    lining.
68340............  Separate eyelid           Y................  .................  A2...............      $630.00      19.2280      $796.04      $671.51
                    adhesions.
68360............  Revise eyelid lining....  Y................  .................  A2...............      $446.00      24.0821      $997.00      $583.75
68362............  Revise eyelid lining....  Y................  .................  A2...............      $446.00      24.0821      $997.00      $583.75
68371............  Harvest eye tissue,       Y................  .................  A2...............      $446.00      16.5252      $684.14      $505.54
                    alograft.
68400............  Incise/drain tear gland.  Y................  .................  P2...............  ...........       2.8636      $118.55      $118.55
68420............  Incise/drain tear sac...  Y................  .................  P3...............  ...........       4.4606      $184.67      $184.67
68440............  Incise tear duct opening  Y................  .................  P3...............  ...........       1.3771       $57.01       $57.01
68500............  Removal of tear gland...  Y................  .................  A2...............      $510.00      24.8916    $1,030.51      $640.13
68505............  Partial removal, tear     Y................  .................  A2...............      $510.00      24.8916    $1,030.51      $640.13
                    gland.
68510............  Biopsy of tear gland....  Y................  .................  A2...............      $333.00      19.2280      $796.04      $448.76
68520............  Removal of tear sac.....  Y................  .................  A2...............      $510.00      24.8916    $1,030.51      $640.13
68525............  Biopsy of tear sac......  Y................  .................  A2...............      $333.00      19.2280      $796.04      $448.76
68530............  Clearance of tear duct..  Y................  .................  P3...............  ...........       5.6973      $235.87      $235.87
68540............  Remove tear gland lesion  Y................  .................  A2...............      $510.00      24.8916    $1,030.51      $640.13
68550............  Remove tear gland lesion  Y................  .................  A2...............      $510.00      24.8916    $1,030.51      $640.13
68700............  Repair tear ducts.......  Y................  .................  A2...............      $446.00      24.8916    $1,030.51      $592.13
68705............  Revise tear duct opening  Y................  .................  P2...............  ...........       2.8636      $118.55      $118.55
68720............  Create tear sac drain...  Y................  .................  A2...............      $630.00      24.8916    $1,030.51      $730.13
68745............  Create tear duct drain..  Y................  .................  A2...............      $630.00      24.8916    $1,030.51      $730.13
68750............  Create tear duct drain..  Y................  .................  A2...............      $630.00      24.8916    $1,030.51      $730.13
68760............  Close tear duct opening.  N................  .................  P2...............  ...........       2.3117       $95.70       $95.70
68761............  Close tear duct opening.  N................  .................  P3...............  ...........       1.6986       $70.32       $70.32
68770............  Close tear system         Y................  .................  A2...............      $630.00      19.2280      $796.04      $671.51
                    fistula.
68801............  Dilate tear duct opening  N................  .................  P2...............  ...........       1.1576       $47.92       $47.92
68810............  Probe nasolacrimal duct.  N................  .................  A2...............      $131.86       2.3117       $95.70      $122.82
68811............  Probe nasolacrimal duct.  Y................  .................  A2...............      $446.00      19.2280      $796.04      $533.51
68815............  Probe nasolacrimal duct.  Y................  .................  A2...............      $446.00      19.2280      $796.04      $533.51
68840............  Explore/irrigate tear     N................  .................  P2...............  ...........       1.1576       $47.92       $47.92
                    ducts.
68850............  Injection for tear sac x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
69000............  Drain external ear        Y................  .................  P2...............  ...........       1.4630       $60.57       $60.57
                    lesion.
69005............  Drain external ear        Y................  .................  P3...............  ...........       2.4075       $99.67       $99.67
                    lesion.

[[Page 42892]]

 
69020............  Drain outer ear canal     Y................  .................  P2...............  ...........       1.4630       $60.57       $60.57
                    lesion.
69100............  Biopsy of external ear..  Y................  .................  P3...............  ...........       1.4676       $60.76       $60.76
69105............  Biopsy of external ear    Y................  .................  P3...............  ...........       2.0283       $83.97       $83.97
                    canal.
69110............  Remove external ear,      Y................  .................  A2...............      $333.00      16.5832      $686.54      $421.39
                    partial.
69120............  Removal of external ear.  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
69140............  Remove ear canal          Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
                    lesion(s).
69145............  Remove ear canal          Y................  .................  A2...............      $446.00      16.5832      $686.54      $506.14
                    lesion(s).
69150............  Extensive ear canal       Y................  .................  A2...............      $464.15       7.6539      $316.87      $427.33
                    surgery.
69200............  Clear outer ear canal...  N................  .................  P2...............  ...........       0.6416       $26.56       $26.56
69205............  Clear outer ear canal...  Y................  .................  A2...............      $333.00      21.4534      $888.17      $471.79
69210............  Remove impacted ear wax.  N................  .................  P3...............  ...........       0.4947       $20.48       $20.48
69220............  Clean out mastoid cavity  Y................  .................  P2...............  ...........       0.8046       $33.31       $33.31
69222............  Clean out mastoid cavity  Y................  .................  P3...............  ...........       3.1826      $131.76      $131.76
69300............  Revise external ear.....  Y................  .................  A2...............      $510.00      24.3535    $1,008.23      $634.56
69310............  Rebuild outer ear canal.  Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
69320............  Rebuild outer ear canal.  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69400............  Inflate middle ear canal  Y................  .................  P3...............  ...........       2.0200       $83.63       $83.63
69401............  Inflate middle ear canal  Y................  .................  P3...............  ...........       1.1295       $46.76       $46.76
69405............  Catheterize middle ear    Y................  .................  P3...............  ...........       2.9188      $120.84      $120.84
                    canal.
69420............  Incision of eardrum.....  Y................  .................  P2...............  ...........       2.5765      $106.67      $106.67
69421............  Incision of eardrum.....  Y................  .................  A2...............      $510.00      16.6341      $688.65      $554.66
69424............  Remove ventilating tube.  Y................  .................  P3...............  ...........       1.8386       $76.12       $76.12
69433............  Create eardrum opening..  Y................  .................  P3...............  ...........       2.6056      $107.87      $107.87
69436............  Create eardrum opening..  Y................  .................  A2...............      $510.00      16.6341      $688.65      $554.66
69440............  Exploration of middle     Y................  .................  A2...............      $510.00      24.3535    $1,008.23      $634.56
                    ear.
69450............  Eardrum revision........  Y................  .................  A2...............      $333.00      40.5598    $1,679.18      $669.55
69501............  Mastoidectomy...........  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69502............  Mastoidectomy...........  Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
69505............  Remove mastoid            Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    structures.
69511............  Extensive mastoid         Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    surgery.
69530............  Extensive mastoid         Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    surgery.
69540............  Remove ear lesion.......  Y................  .................  P3...............  ...........       3.1085      $128.69      $128.69
69550............  Remove ear lesion.......  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
69552............  Remove ear lesion.......  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69601............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69602............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69603............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69604............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69605............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69610............  Repair of eardrum.......  Y................  .................  P3...............  ...........       4.2546      $176.14      $176.14
69620............  Repair of eardrum.......  Y................  .................  A2...............      $446.00      24.3535    $1,008.23      $586.56
69631............  Repair eardrum            Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
                    structures.
69632............  Rebuild eardrum           Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
                    structures.
69633............  Rebuild eardrum           Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
                    structures.
69635............  Repair eardrum            Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    structures.
69636............  Rebuild eardrum           Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    structures.
69637............  Rebuild eardrum           Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    structures.
69641............  Revise middle ear &       Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    mastoid.
69642............  Revise middle ear &       Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    mastoid.
69643............  Revise middle ear &       Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    mastoid.
69644............  Revise middle ear &       Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    mastoid.
69645............  Revise middle ear &       Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    mastoid.
69646............  Revise middle ear &       Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    mastoid.
69650............  Release middle ear bone.  Y................  .................  A2...............      $995.00      24.3535    $1,008.23      $998.31
69660............  Revise middle ear bone..  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
69661............  Revise middle ear bone..  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
69662............  Revise middle ear bone..  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
69666............  Repair middle ear         Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
                    structures.
69667............  Repair middle ear         Y................  .................  A2...............      $630.00      40.5598    $1,679.18      $892.30
                    structures.
69670............  Remove mastoid air cells  Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
69676............  Remove middle ear nerve.  Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
69700............  Close mastoid fistula...  Y................  .................  A2...............      $510.00      40.5598    $1,679.18      $802.30
69711............  Remove/repair hearing     Y................  .................  A2...............      $333.00      40.5598    $1,679.18      $669.55
                    aid.
69714............  Implant temple bone w/    Y................  .................  A2...............    $1,339.00      40.5598    $1,679.18    $1,424.05
                    stimul.
69715............  Temple bne implnt w/      Y................  .................  A2...............    $1,339.00      40.5598    $1,679.18    $1,424.05
                    stimulat.
69717............  Temple bone implant       Y................  .................  A2...............    $1,339.00      40.5598    $1,679.18    $1,424.05
                    revision.
69718............  Revise temple bone        Y................  .................  A2...............    $1,339.00      40.5598    $1,679.18    $1,424.05
                    implant.
69720............  Release facial nerve....  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
69740............  Repair facial nerve.....  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
69745............  Repair facial nerve.....  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
69801............  Incise inner ear........  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
69802............  Incise inner ear........  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69805............  Explore inner ear.......  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69806............  Explore inner ear.......  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69820............  Establish inner ear       Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55
                    window.
69840............  Revise inner ear window.  Y................  .................  A2...............      $717.00      40.5598    $1,679.18      $957.55

[[Page 42893]]

 
69905............  Remove inner ear........  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69910............  Remove inner ear &        Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
                    mastoid.
69915............  Incise inner ear nerve..  Y................  .................  A2...............      $995.00      40.5598    $1,679.18    $1,166.05
69930............  Implant cochlear device.  Y................  .................  H8...............      $995.00     585.1167   $24,223.83   $22,839.55
69990............  Microsurgery add-on.....  N................  .................  N1...............  ...........  ...........  ...........  ...........
C9716............  Radiofrequency energy to  Y................  .................  G2...............  ...........      30.5544    $1,264.95    $1,264.95
                    anu.
C9724............  EPS gast cardia plic....  Y................  .................  G2...............  ...........      24.6480    $1,020.43    $1,020.43
C9725............  Place endorectal app....  N................  .................  G2...............  ...........       8.6353      $357.50      $357.50
C9726............  Rxt breast appl place/    N................  .................  G2...............  ...........      10.2053      $422.50      $422.50
                    remov.
C9727............  Insert palate implants..  N................  .................  G2...............  ...........      13.3454      $552.50      $552.50
G0104............  CA screen;flexi           N................  .................  P3...............  ...........       1.9705       $81.58       $81.58
                    sigmoidscope.
G0105............  Colorectal scrn; hi risk  Y................  .................  A2...............      $446.00       8.0134      $331.75      $417.44
                    ind.
G0121............  Colon ca scrn not hi rsk  Y................  .................  A2...............      $446.00       8.0134      $331.75      $417.44
                    ind.
G0127............  Trim nail(s)............  Y................  .................  P3...............  ...........       0.2556       $10.58       $10.58
G0186............  Dstry eye lesn,fdr vssl   Y................  .................  R2...............  ...........       4.0100      $166.01      $166.01
                    tech.
G0247............  Routine footcare pt w     Y................  .................  P3...............  ...........       0.4865       $20.14       $20.14
                    lops.
G0260............  Inj for sacroiliac jt     Y................  .................  A2...............      $333.00       7.1370      $295.47      $323.62
                    anesth.
G0268............  Removal of impacted wax   N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    md.
G0364............  Bone marrow aspirate      Y................  .................  P3...............  ...........       0.1237        $5.12        $5.12
                    &biopsy.
G0392............  AV fistula or graft       Y................  .................  A2...............    $1,339.00      46.0685    $1,907.24    $1,481.06
                    arterial.
G0393............  AV fistula or graft       Y................  .................  A2...............    $1,339.00      46.0685    $1,907.24    $1,481.06
                    venous.
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 42894]]


                               Addendum B.--Proposed OPPS Payment Status by HCPCS Code and Related Information for CY 2008
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                  National     Minimum
     HCPCS code           Short descriptor               CI                  SI              APC        Relative     Payment     unadjusted   unadjusted
                                                                                                         weight        rate      copayment    copayment
--------------------------------------------------------------------------------------------------------------------------------------------------------
00100..............  Anesth, salivary gland....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00102..............  Anesth, repair of cleft     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      lip.
00103..............  Anesth, blepharoplasty....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00104..............  Anesth, electroshock......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00120..............  Anesth, ear surgery.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00124..............  Anesth, ear exam..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00126..............  Anesth, tympanotomy.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0012F..............  Cap bacterial assess......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
00140..............  Anesth, procedures on eye.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00142..............  Anesth, lens surgery......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00144..............  Anesth, corneal transplant  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00145..............  Anesth, vitreoretinal surg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00147..............  Anesth, iridectomy........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00148..............  Anesth, eye exam..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00160..............  Anesth, nose/sinus surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00162..............  Anesth, nose/sinus surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00164..............  Anesth, biopsy of nose....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0016T..............  Thermotx choroid vasc       ..................  T.................         0235         4.01      $255.41       $58.90       $51.08
                      lesion.
00170..............  Anesth, procedure on mouth  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00172..............  Anesth, cleft palate        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      repair.
00174..............  Anesth, pharyngeal surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00176..............  Anesth, pharyngeal surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0017T..............  Photocoagulat macular       ..................  T.................         0235         4.01      $255.41       $58.90       $51.08
                      drusen.
00190..............  Anesth, face/skull bone     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
00192..............  Anesth, facial bone         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
0019T..............  Extracorp shock wv tx,ms    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      nos.
00210..............  Anesth, open head surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00212..............  Anesth, skull drainage....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00214..............  Anesth, skull drainage....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00215..............  Anesth, skull repair/fract  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00216..............  Anesth, head vessel         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00218..............  Anesth, special head        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00220..............  Anesth, intrcrn nerve.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00222..............  Anesth, head nerve surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0024T..............  Transcath cardiac           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      reduction.
0026T..............  Measure remnant             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lipoproteins.
0027T..............  Endoscopic epidural lysis.  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
0028T..............  Dexa body composition       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      study.
0029T..............  Magnetic tx for             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      incontinence.
00300..............  Anesth, head/neck/ptrunk..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0030T..............  Antiprothrombin antibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
0031T..............  Speculoscopy..............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00320..............  Anesth, neck organ, 1 &     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      over.
00322..............  Anesth, biopsy of thyroid.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00326..............  Anesth, larynx/trach, < 1   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      yr.
0032T..............  Speculoscopy w/direct       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      sample.
00350..............  Anesth, neck vessel         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00352..............  Anesth, neck vessel         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00400..............  Anesth, skin, ext/per/      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      atrunk.
00402..............  Anesth, surgery of breast.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00404..............  Anesth, surgery of breast.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00406..............  Anesth, surgery of breast.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00410..............  Anesth, correct heart       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      rhythm.
0041T..............  Detect ur infect agnt w/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cpas.
0042T..............  Ct perfusion w/contrast,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      cbf.
0043T..............  Co expired gas analysis...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
00450..............  Anesth, surgery of          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      shoulder.
00452..............  Anesth, surgery of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shoulder.
00454..............  Anesth, collar bone biopsy  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0046T..............  Cath lavage, mammary        ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      duct(s).
00470..............  Anesth, removal of rib....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00472..............  Anesth, chest wall repair.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00474..............  Anesth, surgery of rib(s).  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0047T..............  Cath lavage, mammary        ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      duct(s).
0048T..............  Implant ventricular device  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0049T..............  External circulation        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      assist.
00500..............  Anesth, esophageal surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0050T..............  Removal circulation assist  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0051T..............  Implant total heart system  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00520..............  Anesth, chest procedure...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00522..............  Anesth, chest lining        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      biopsy.
00524..............  Anesth, chest drainage....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00528..............  Anesth, chest partition     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      view.
00529..............  Anesth, chest partition     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      view.
0052T..............  Replace component heart     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      syst.
00530..............  Anesth, pacemaker           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      insertion.
00532..............  Anesth, vascular access...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00534..............  Anesth, cardioverter/defib  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00537..............  Anesth, cardiac             ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      electrophys.
00539..............  Anesth, trach-bronch        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      reconst.

[[Page 42895]]

 
0053T..............  Replace component heart     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      syst.
00540..............  Anesth, chest surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00541..............  Anesth, one lung            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ventilation.
00542..............  Anesth, release of lung...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00546..............  Anesth, lung,chest wall     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
00548..............  Anesth, trachea,bronchi     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0054T..............  Bone surgery using          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      computer.
00550..............  Anesth, sternal             ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      debridement.
0055T..............  Bone surgery using          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      computer.
00560..............  Anesth, heart surg w/o      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pump.
00561..............  Anesth, heart surg < age 1  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00562..............  Anesth, heart surg w/pump.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00563..............  Anesth, heart surg w/       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      arrest.
00566..............  Anesth, cabg w/o pump.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0056T..............  Bone surgery using          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      computer.
00580..............  Anesth, heart/lung          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      transplnt.
0058T..............  Cryopreservation, ovary     CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      tiss.
0059T..............  Cryopreservation, oocyte..  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
00600..............  Anesth, spine, cord         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00604..............  Anesth, sitting procedure.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0060T..............  Electrical impedance scan.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
0061T..............  Destruction of tumor,       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      breast.
00620..............  Anesth, spine, cord         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00622..............  Anesth, removal of nerves.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00625..............  Anes spine tranthor w/o     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vent.
00626..............  Anes, spine transthor w/    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vent.
0062T..............  Rep intradisc annulus;1     ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      lev.
00630..............  Anesth, spine, cord         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00632..............  Anesth, removal of nerves.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00634..............  Anesth for                  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      chemonucleolysis.
00635..............  Anesth, lumbar puncture...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0063T..............  Rep intradisc               ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      annulus;>1lev.
00640..............  Anesth, spine manipulation  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0064T..............  Spectroscop eval expired    ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
                      gas.
0065T..............  Ocular photoscreen bilat..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
0066T..............  Ct colonography;screen....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
00670..............  Anesth, spine, cord         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
0067T..............  Ct colonography;dx........  CH................  S.................         0332       3.1487      $200.55       $75.20       $40.11
0068T..............  Interp/rept heart sound...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
0069T..............  Analysis only heart sound.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00700..............  Anesth, abdominal wall      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
00702..............  Anesth, for liver biopsy..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0070T..............  Interp only heart sound...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
0071T..............  U/s leiomyomata ablate      CH................  S.................         0067      61.5205    $3,918.43  ...........      $783.69
                      <200.
0072T..............  U/s leiomyomata ablate      CH................  S.................         0067      61.5205    $3,918.43  ...........      $783.69
                      >200.
00730..............  Anesth, abdominal wall      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0073T..............  Delivery, comp imrt.......  ..................  S.................         0412       5.7275      $364.80  ...........       $72.96
00740..............  Anesth, upper gi visualize  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0074T..............  Online physician e/m......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
00750..............  Anesth, repair of hernia..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00752..............  Anesth, repair of hernia..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00754..............  Anesth, repair of hernia..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00756..............  Anesth, repair of hernia..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0075T..............  Perq stent/chest vert art.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0076T..............  S&i stent/chest vert art..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00770..............  Anesth, blood vessel        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      repair.
0077T..............  Cereb therm perfusion       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      probe.
0078T..............  Endovasc aort repr w/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
00790..............  Anesth, surg upper abdomen  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00792..............  Anesth, hemorr/excise       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      liver.
00794..............  Anesth, pancreas removal..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00796..............  Anesth, for liver           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      transplant.
00797..............  Anesth, surgery for         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      obesity.
0079T..............  Endovasc visc extnsn repr.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00800..............  Anesth, abdominal wall      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
00802..............  Anesth, fat layer removal.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0080T..............  Endovasc aort repr rad s&i  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00810..............  Anesth, low intestine       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      scope.
0081T..............  Endovasc visc extnsn s&i..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00820..............  Anesth, abdominal wall      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
00830..............  Anesth, repair of hernia..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00832..............  Anesth, repair of hernia..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00834..............  Anesth, hernia repair< 1    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      yr.
00836..............  Anesth hernia repair        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      preemie.
00840..............  Anesth, surg lower abdomen  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00842..............  Anesth, amniocentesis.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00844..............  Anesth, pelvis surgery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00846..............  Anesth, hysterectomy......  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42896]]

 
00848..............  Anesth, pelvic organ surg.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0084T..............  Temp prostate urethral      ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
                      stent.
00851..............  Anesth, tubal ligation....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0085T..............  Breath test heart reject..  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
00860..............  Anesth, surgery of abdomen  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00862..............  Anesth, kidney/ureter surg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00864..............  Anesth, removal of bladder  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00865..............  Anesth, removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      prostate.
00866..............  Anesth, removal of adrenal  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00868..............  Anesth, kidney transplant.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0086T..............  L ventricle fill pressure.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00870..............  Anesth, bladder stone surg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00872..............  Anesth kidney stone         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      destruct.
00873..............  Anesth kidney stone         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      destruct.
0087T..............  Sperm eval hyaluronan.....  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
00880..............  Anesth, abdomen vessel      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
00882..............  Anesth, major vein          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ligation.
0088T..............  Rf tongue base vol reduxn.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
0089T..............  Actigraphy testing, 3-day.  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
00902..............  Anesth, anorectal surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00904..............  Anesth, perineal surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00906..............  Anesth, removal of vulva..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00908..............  Anesth, removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      prostate.
0090T..............  Cervical artific disc.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00910..............  Anesth, bladder surgery...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00912..............  Anesth, bladder tumor surg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00914..............  Anesth, removal of          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      prostate.
00916..............  Anesth, bleeding control..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00918..............  Anesth, stone removal.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00920..............  Anesth, genitalia surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00921..............  Anesth, vasectomy.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00922..............  Anesth, sperm duct surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00924..............  Anesth, testis exploration  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00926..............  Anesth, removal of testis.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00928..............  Anesth, removal of testis.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0092T..............  Artific disc addl.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00930..............  Anesth, testis suspension.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00932..............  Anesth, amputation of       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      penis.
00934..............  Anesth, penis, nodes        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      removal.
00936..............  Anesth, penis, nodes        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      removal.
00938..............  Anesth, insert penis        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      device.
0093T..............  Cervical artific            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      diskectomy.
00940..............  Anesth, vaginal procedures  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00942..............  Anesth, surg on vag/        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      urethral.
00944..............  Anesth, vaginal             ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      hysterectomy.
00948..............  Anesth, repair of cervix..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00950..............  Anesth, vaginal endoscopy.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00952..............  Anesth, hysteroscope/graph  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0095T..............  Artific diskectomy addl...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0096T..............  Rev cervical artific disc.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0098T..............  Rev artific disc addl.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0099T..............  Implant corneal ring......  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
0100T..............  Prosth retina receive&gen.  ..................  T.................         0672      38.1121    $2,427.47  ...........      $485.49
0101T..............  Extracorp shockwv tx,hi     ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      enrg.
0102T..............  Extracorp shockwv           ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      tx,anesth.
0103T..............  Holotranscobalamin........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
0104T..............  At rest cardio gas          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rebreathe.
0105T..............  Exerc cardio gas rebreathe  ..................  A.................  ...........  ...........  ...........  ...........  ...........
0106T..............  Touch quant sensory test..  ..................  X.................         0341       0.0879        $5.60        $2.20        $1.12
0107T..............  Vibrate quant sensory test  ..................  X.................         0341       0.0879        $5.60        $2.20        $1.12
0108T..............  Cool quant sensory test...  ..................  X.................         0341       0.0879        $5.60        $2.20        $1.12
0109T..............  Heat quant sensory test...  ..................  X.................         0341       0.0879        $5.60        $2.20        $1.12
0110T..............  Nos quant sensory test....  ..................  X.................         0341       0.0879        $5.60        $2.20        $1.12
01112..............  Anesth, bone aspirate/bx..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0111T..............  Rbc membranes fatty acids.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
01120..............  Anesth, pelvis surgery....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01130..............  Anesth, body cast           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01140..............  Anesth, amputation at       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pelvis.
01150..............  Anesth, pelvic tumor        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
0115T..............  Med tx mngmt 15 min.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
01160..............  Anesth, pelvis procedure..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0116T..............  Med tx mngmt subsqt.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
01170..............  Anesth, pelvis surgery....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01173..............  Anesth, fx repair, pelvis.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0117T..............  Med tx mngmt addl 15 min..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
01180..............  Anesth, pelvis nerve        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      removal.
01190..............  Anesth, pelvis nerve        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      removal.
01200..............  Anesth, hip joint           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.

[[Page 42897]]

 
01202..............  Anesth, arthroscopy of hip  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01210..............  Anesth, hip joint surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01212..............  Anesth, hip                 ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      disarticulation.
01214..............  Anesth, hip arthroplasty..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01215..............  Anesth, revise hip repair.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01220..............  Anesth, procedure on femur  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01230..............  Anesth, surgery of femur..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01232..............  Anesth, amputation of       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      femur.
01234..............  Anesth, radical femur surg  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0123T..............  Scleral fistulization.....  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
0124T..............  Conjunctival drug           ..................  T.................         0232       5.1145      $325.76       $81.59       $65.15
                      placement.
01250..............  Anesth, upper leg surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01260..............  Anesth, upper leg veins     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0126T..............  Chd risk imt study........  CH................  Q.................         0340       0.6416       $40.87  ...........        $8.17
01270..............  Anesth, thigh arteries      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01272..............  Anesth, femoral artery      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01274..............  Anesth, femoral             ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      embolectomy.
0130T..............  Chron care drug             ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      investigatn.
01320..............  Anesth, knee area surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0133T..............  Esophageal implant injexn.  ..................  T.................         0422       24.648    $1,569.91      $445.06      $313.98
01340..............  Anesth, knee area           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
0135T..............  Perq cryoablate renal       ..................  T.................         0423      44.1192    $2,810.08  ...........      $562.02
                      tumor.
01360..............  Anesth, knee area surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0137T..............  Prostate saturation         ..................  T.................         0184      11.3168      $720.80  ...........      $144.16
                      sampling.
01380..............  Anesth, knee joint          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01382..............  Anesth, dx knee             ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      arthroscopy.
01390..............  Anesth, knee area           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01392..............  Anesth, knee area surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01400..............  Anesth, knee joint surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01402..............  Anesth, knee arthroplasty.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01404..............  Anesth, amputation at knee  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0140T..............  Exhaled breath condensate   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ph.
0141T..............  Perq islet transplant.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
01420..............  Anesth, knee joint casting  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0142T..............  Open islet transplant.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
01430..............  Anesth, knee veins surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01432..............  Anesth, knee vessel surg..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0143T..............  Laparoscopic islet          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      transplnt.
01440..............  Anesth, knee arteries surg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01442..............  Anesth, knee artery surg..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01444..............  Anesth, knee artery repair  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0144T..............  CT heart wo dye; qual calc  CH................  S.................         0282       1.6768      $106.80       $37.80       $21.36
0145T..............  CT heart w/wo dye funct...  CH................  S.................         0383       4.9887      $317.75      $124.17       $63.55
01462..............  Anesth, lower leg           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01464..............  Anesth, ankle/ft            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      arthroscopy.
0146T..............  CCTA w/wo dye.............  CH................  S.................         0383       4.9887      $317.75      $124.17       $63.55
01470..............  Anesth, lower leg surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01472..............  Anesth, achilles tendon     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01474..............  Anesth, lower leg surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0147T..............  CCTA w/wo, quan calcium...  CH................  S.................         0383       4.9887      $317.75      $124.17       $63.55
01480..............  Anesth, lower leg bone      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01482..............  Anesth, radical leg         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
01484..............  Anesth, lower leg revision  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01486..............  Anesth, ankle replacement.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0148T..............  CCTA w/wo, strxr..........  CH................  S.................         0383       4.9887      $317.75      $124.17       $63.55
01490..............  Anesth, lower leg casting.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0149T..............  CCTA w/wo, strxr quan calc  CH................  S.................         0383       4.9887      $317.75      $124.17       $63.55
01500..............  Anesth, leg arteries surg.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01502..............  Anesth, lwr leg             ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      embolectomy.
0150T..............  CCTA w/wo, disease strxr..  CH................  S.................         0383       4.9887      $317.75      $124.17       $63.55
0151T..............  CT heart funct add-on.....  ..................  S.................         0282       1.6768      $106.80       $37.80       $21.36
01520..............  Anesth, lower leg vein      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01522..............  Anesth, lower leg vein      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0153T..............  Tcath sensor aneurysm sac.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0154T..............  Study sensor aneurysm sac.  ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
0155T..............  Lap impl gast curve         ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
                      electrd.
0156T..............  Lap remv gast curve         ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
                      electrd.
0157T..............  Open impl gast curve        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      electrd.
0158T..............  Open remv gast curve        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      electrd.
0159T..............  Cad breast mri............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0160T..............  Tcranial magn stim tx plan  ..................  S.................         0216        2.768      $176.30  ...........       $35.26
01610..............  Anesth, surgery of          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      shoulder.
0161T..............  Tcranial magn stim tx       ..................  S.................         0216        2.768      $176.30  ...........       $35.26
                      deliv.
01620..............  Anesth, shoulder procedure  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01622..............  Anes dx shoulder            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      arthroscopy.
0162T..............  Anal program gast           ..................  S.................         0692       1.9206      $122.33       $30.10       $24.47
                      neurostim.
01630..............  Anesth, surgery of          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      shoulder.
01632..............  Anesth, surgery of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shoulder.

[[Page 42898]]

 
01634..............  Anesth, shoulder joint      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      amput.
01636..............  Anesth, forequarter amput.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01638..............  Anesth, shoulder            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
0163T..............  Lumb artif diskectomy addl  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0164T..............  Remove lumb artif disc      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      addl.
01650..............  Anesth, shoulder artery     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01652..............  Anesth, shoulder vessel     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01654..............  Anesth, shoulder vessel     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01656..............  Anesth, arm-leg vessel      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0165T..............  Revise lumb artif disc      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      addl.
0166T..............  Tcath vsd close w/o bypass  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01670..............  Anesth, shoulder vein surg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0167T..............  Tcath vsd close w bypass..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01680..............  Anesth, shoulder casting..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01682..............  Anesth, airplane cast.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0168T..............  Rhinophototx light app      ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
                      bilat.
0169T..............  Place stereo cath brain...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0170T..............  Anorectal fistula plug rpr  ..................  T.................         0150      30.5544    $1,946.10      $437.10      $389.22
01710..............  Anesth, elbow area surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01712..............  Anesth, uppr arm tendon     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01714..............  Anesth, uppr arm tendon     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01716..............  Anesth, biceps tendon       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      repair.
0171T..............  Lumbar spine proces         ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      distract.
0172T..............  Lumbar spine proces addl..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
01730..............  Anesth, uppr arm procedure  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01732..............  Anesth, dx elbow            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      arthroscopy.
0173T..............  Iop monit io pressure.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01740..............  Anesth, upper arm surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01742..............  Anesth, humerus surgery...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01744..............  Anesth, humerus repair....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0174T..............  Cad cxr with interp.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01756..............  Anesth, radical humerus     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01758..............  Anesth, humeral lesion      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0175T..............  Cad cxr remote............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01760..............  Anesth, elbow replacement.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0176T..............  Aqu canal dilat w/o retent  ..................  T.................         0673      40.8481    $2,601.74      $649.50      $520.35
01770..............  Anesth, uppr arm artery     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01772..............  Anesth, uppr arm            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      embolectomy.
0177T..............  Aqu canal dilat w retent..  ..................  T.................         0673      40.8481    $2,601.74      $649.50      $520.35
01780..............  Anesth, upper arm vein      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01782..............  Anesth, uppr arm vein       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      repair.
01810..............  Anesth, lower arm surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01820..............  Anesth, lower arm           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01829..............  Anesth, dx wrist            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      arthroscopy.
01830..............  Anesth, lower arm surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01832..............  Anesth, wrist replacement.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01840..............  Anesth, lwr arm artery      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01842..............  Anesth, lwr arm             ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      embolectomy.
01844..............  Anesth, vascular shunt      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01850..............  Anesth, lower arm vein      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01852..............  Anesth, lwr arm vein        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      repair.
01860..............  Anesth, lower arm casting.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01905..............  Anes, spine inject, x-ray/  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      re.
01916..............  Anesth, dx arteriography..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01920..............  Anesth, catheterize heart.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01922..............  Anesth, cat or MRI scan...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01924..............  Anes, ther interven rad,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      art.
01925..............  Anes, ther interven rad,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      car.
01926..............  Anes, tx interv rad hrt/    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      cran.
01930..............  Anes, ther interven rad,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vei.
01931..............  Anes, ther interven rad,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      tip.
01932..............  Anes, tx interv rad, th     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vein.
01933..............  Anes, tx interv rad, cran   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      v.
01951..............  Anesth, burn, less 4        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      percent.
01952..............  Anesth, burn, 4-9 percent.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01953..............  Anesth, burn, each 9        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      percent.
01958..............  Anesth, antepartum manipul  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01960..............  Anesth, vaginal delivery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01961..............  Anesth, cs delivery.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01962..............  Anesth, emer hysterectomy.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01963..............  Anesth, cs hysterectomy...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01965..............  Anesth, inc/missed ab proc  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01966..............  Anesth, induced ab          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01967..............  Anesth/analg, vag delivery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01968..............  Anes/analg cs deliver add-  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
01969..............  Anesth/analg cs hyst add-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
01990..............  Support for organ donor...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01991..............  Anesth, nerve block/inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 42899]]

 
01992..............  Anesth, n block/inj, prone  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01996..............  Hosp manage cont drug       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      admin.
01999..............  Unlisted anesth procedure.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0500F..............  Initial prenatal care       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      visit.
0501F..............  Prenatal flow sheet.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
0502F..............  Subsequent prenatal care..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
0503F..............  Postpartum care visit.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
0505F..............  Hemodialysis plan doc'd...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
0507F..............  Periton dialysis plan       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
0509F..............  Urine incon plan doc......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1000F..............  Tobacco use assessed......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
10021..............  Fna w/o image.............  ..................  T.................         0002       1.1915       $75.89  ...........       $15.18
10022..............  Fna w/image...............  CH................  T.................         0004       4.5062      $287.01  ...........       $57.40
1002F..............  Assess anginal symptom/     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      level.
1003F..............  Level of activity assess..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
10040..............  Acne surgery..............  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
1004F..............  Clin symp vol ovrld assess  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1005F..............  Asthma symptoms evaluate..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
10060..............  Drainage of skin abscess..  ..................  T.................         0006        1.463       $93.18  ...........       $18.64
10061..............  Drainage of skin abscess..  ..................  T.................         0006        1.463       $93.18  ...........       $18.64
1006F..............  Osteoarthritis assess.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1007F..............  Anti-inflm/anlgsc otc       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      assess.
10080..............  Drainage of pilonidal cyst  ..................  T.................         0006        1.463       $93.18  ...........       $18.64
10081..............  Drainage of pilonidal cyst  ..................  T.................         0007      12.5792      $801.21  ...........      $160.24
1008F..............  Gi/renal risk assess......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
10120..............  Remove foreign body.......  ..................  T.................         0006        1.463       $93.18  ...........       $18.64
10121..............  Remove foreign body.......  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
10140..............  Drainage of hematoma/fluid  ..................  T.................         0007      12.5792      $801.21  ...........      $160.24
1015F..............  Copd symptoms assess......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
10160..............  Puncture drainage of        CH................  T.................         0006        1.463       $93.18  ...........       $18.64
                      lesion.
10180..............  Complex drainage, wound...  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
1018F..............  Assess dyspnea not present  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1019F..............  Assess dyspnea present....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1022F..............  Pneumo imm status assess..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1026F..............  Co-morbid condition assess  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1030F..............  Influenza imm status        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      assess.
1034F..............  Current tobacco smoker....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1035F..............  Smokeless tobacco user....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1036F..............  Tobacco non-user..........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1038F..............  Persistent asthma.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1039F..............  Intermittent asthma.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1040F..............  Dsm-iv info mdd doc'd.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1050F..............  History of mole changes...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1055F..............  Visual funct status assess  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1060F..............  Doc perm/cont/parox atr.    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      fib.
1061F..............  Doc lack perm+cont+parox    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      fib.
1065F..............  Ischm stroke symp <3 hrs b/ ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      4.
1066F..............  Ischm stroke symp ?3 hrs b/ ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      4.
1070F..............  Alarm symp assessed-absent  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1071F..............  Alarm symp assessed-1+      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prsnt.
1080F..............  Decis mkr/advncd plan       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
1090F..............  Pres/absn urine incon       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      assess.
1091F..............  Urine incon characterized.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
11000..............  Debride infected skin.....  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
11001..............  Debride infected skin add-  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
                      on.
11004..............  Debride genitalia &         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      perineum.
11005..............  Debride abdom wall........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
11006..............  Debride genit/per/abdom     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      wall.
11008..............  Remove mesh from abd wall.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
1100F..............  Pt falls assess-doc'd?2+/   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      yr.
11010..............  Debride skin, fx..........  ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
11011..............  Debride skin/muscle, fx...  ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
11012..............  Debride skin/muscle/bone,   ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      fx.
1101F..............  Pt falls assessed-doc'd?1/  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      yr.
11040..............  Debride skin, partial.....  ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
11041..............  Debride skin, full........  ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
11042..............  Debride skin/tissue.......  ..................  T.................         0016       2.7493      $175.11  ...........       $35.02
11043..............  Debride tissue/muscle.....  ..................  T.................         0016       2.7493      $175.11  ...........       $35.02
11044..............  Debride tissue/muscle/bone  ..................  T.................         0682       7.1126      $453.02      $158.60       $90.60
11055..............  Trim skin lesion..........  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
11056..............  Trim skin lesions, 2 to 4.  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
11057..............  Trim skin lesions, over 4.  CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
11100..............  Biopsy, skin lesion.......  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
11101..............  Biopsy, skin add-on.......  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
1110F..............  Pt lft inpt fac w/in 60     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      days.
1111F..............  Dschrg med/current med      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      merge.
11200..............  Removal of skin tags......  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
11201..............  Remove skin tags add-on...  ..................  T.................         0015       1.5119       $96.30  ...........       $19.26

[[Page 42900]]

 
11300..............  Shave skin lesion.........  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
11301..............  Shave skin lesion.........  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
11302..............  Shave skin lesion.........  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
11303..............  Shave skin lesion.........  ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
11305..............  Shave skin lesion.........  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
11306..............  Shave skin lesion.........  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
11307..............  Shave skin lesion.........  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
11308..............  Shave skin lesion.........  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
11310..............  Shave skin lesion.........  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
11311..............  Shave skin lesion.........  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
11312..............  Shave skin lesion.........  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
11313..............  Shave skin lesion.........  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
11400..............  Exc tr-ext b9+marg 0.5 <    ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      cm.
11401..............  Exc tr-ext b9+marg 0.6-1    ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      cm.
11402..............  Exc tr-ext b9+marg 1.1-2    ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      cm.
11403..............  Exc tr-ext b9+marg 2.1-3    ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      cm.
11404..............  Exc tr-ext b9+marg 3.1-4    ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      cm.
11406..............  Exc tr-ext b9+marg > 4.0    ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      cm.
11420..............  Exc h-f-nk-sp b9+marg 0.5   ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      <.
11421..............  Exc h-f-nk-sp b9+marg 0.6-  ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      1.
11422..............  Exc h-f-nk-sp b9+marg 1.1-  ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      2.
11423..............  Exc h-f-nk-sp b9+marg 2.1-  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      3.
11424..............  Exc h-f-nk-sp b9+marg 3.1-  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      4.
11426..............  Exc h-f-nk-sp b9+marg > 4   ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      cm.
11440..............  Exc face-mm b9+marg 0.5 <   ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      cm.
11441..............  Exc face-mm b9+marg 0.6-1   ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      cm.
11442..............  Exc face-mm b9+marg 1.1-2   ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      cm.
11443..............  Exc face-mm b9+marg 2.1-3   ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      cm.
11444..............  Exc face-mm b9+marg 3.1-4   ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      cm.
11446..............  Exc face-mm b9+marg > 4 cm  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
11450..............  Removal, sweat gland        ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      lesion.
11451..............  Removal, sweat gland        ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      lesion.
11462..............  Removal, sweat gland        ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      lesion.
11463..............  Removal, sweat gland        ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      lesion.
11470..............  Removal, sweat gland        ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      lesion.
11471..............  Removal, sweat gland        ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      lesion.
11600..............  Exc tr-ext mlg+marg 0.5 <   ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      cm.
11601..............  Exc tr-ext mlg+marg 0.6-1   ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      cm.
11602..............  Exc tr-ext mlg+marg 1.1-2   ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      cm.
11603..............  Exc tr-ext mlg+marg 2.1-3   ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      cm.
11604..............  Exc tr-ext mlg+marg 3.1-4   ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      cm.
11606..............  Exc tr-ext mlg+marg > 4 cm  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
11620..............  Exc h-f-nk-sp mlg+marg 0.5  ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      <.
11621..............  Exc h-f-nk-sp mlg+marg 0.6- ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      1.
11622..............  Exc h-f-nk-sp mlg+marg 1.1- ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      2.
11623..............  Exc h-f-nk-sp mlg+marg 2.1- CH................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      3.
11624..............  Exc h-f-nk-sp mlg+marg 3.1- ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      4.
11626..............  Exc h-f-nk-sp mlg+mar > 4   ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      cm.
11640..............  Exc face-mm malig+marg 0.5  CH................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      <.
11641..............  Exc face-mm malig+marg 0.6- CH................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      1.
11642..............  Exc face-mm malig+marg 1.1- ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      2.
11643..............  Exc face-mm malig+marg 2.1- ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      3.
11644..............  Exc face-mm malig+marg 3.1- ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      4.
11646..............  Exc face-mm mlg+marg > 4    ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      cm.
11719..............  Trim nail(s)..............  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
11720..............  Debride nail, 1-5.........  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
11721..............  Debride nail, 6 or more...  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
11730..............  Removal of nail plate.....  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
11732..............  Remove nail plate, add-on.  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
11740..............  Drain blood from under      CH................  T.................         0012       0.2682       $17.08  ...........        $3.42
                      nail.
11750..............  Removal of nail bed.......  ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
11752..............  Remove nail bed/finger tip  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
11755..............  Biopsy, nail unit.........  ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
11760..............  Repair of nail bed........  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
11762..............  Reconstruction of nail bed  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
11765..............  Excision of nail fold, toe  ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
11770..............  Removal of pilonidal        ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      lesion.
11771..............  Removal of pilonidal        ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      lesion.
11772..............  Removal of pilonidal        ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      lesion.
11900..............  Injection into skin         CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
                      lesions.
11901..............  Added skin lesions          CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
                      injection.
11920..............  Correct skin color defects  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
11921..............  Correct skin color defects  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
11922..............  Correct skin color defects  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
11950..............  Therapy for contour         CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      defects.
11951..............  Therapy for contour         CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      defects.
11952..............  Therapy for contour         CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      defects.
11954..............  Therapy for contour         CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      defects.

[[Page 42901]]

 
11960..............  Insert tissue expander(s).  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
11970..............  Replace tissue expander...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
11971..............  Remove tissue expander(s).  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
11975..............  Insert contraceptive cap..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
11976..............  Removal of contraceptive    ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      cap.
11977..............  Removal/reinsert contra     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cap.
11980..............  Implant hormone pellet(s).  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
11981..............  Insert drug implant device  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
11982..............  Remove drug implant device  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
11983..............  Remove/insert drug implant  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
12001..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12002..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12004..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12005..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12006..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12007..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12011..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12013..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12014..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12015..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12016..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12017..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12018..............  Repair superficial          CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      wound(s).
12020..............  Closure of split wound....  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
12021..............  Closure of split wound....  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
12031..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12032..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12034..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12035..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12036..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12037..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12041..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12042..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12044..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12045..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12046..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12047..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12051..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12052..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12053..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12054..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12055..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12056..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
12057..............  Layer closure of wound(s).  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
13100..............  Repair of wound or lesion.  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
13101..............  Repair of wound or lesion.  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
13102..............  Repair wound/lesion add-on  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
13120..............  Repair of wound or lesion.  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
13121..............  Repair of wound or lesion.  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
13122..............  Repair wound/lesion add-on  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
13131..............  Repair of wound or lesion.  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
13132..............  Repair of wound or lesion.  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
13133..............  Repair wound/lesion add-on  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
13150..............  Repair of wound or lesion.  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
13151..............  Repair of wound or lesion.  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
13152..............  Repair of wound or lesion.  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
13153..............  Repair wound/lesion add-on  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
13160..............  Late closure of wound.....  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
14000..............  Skin tissue rearrangement.  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
14001..............  Skin tissue rearrangement.  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
14020..............  Skin tissue rearrangement.  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
14021..............  Skin tissue rearrangement.  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
14040..............  Skin tissue rearrangement.  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
14041..............  Skin tissue rearrangement.  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
14060..............  Skin tissue rearrangement.  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
14061..............  Skin tissue rearrangement.  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
14300..............  Skin tissue rearrangement.  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
14350..............  Skin tissue rearrangement.  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15002..............  Wnd prep, ch/inf, trk/arm/  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      lg.
15003..............  Wnd prep, ch/inf addl 100   CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      cm.
15004..............  Wnd prep ch/inf, f/n/hf/g.  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
15005..............  Wnd prep, f/n/hf/g, addl    CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      cm.
15040..............  Harvest cultured skin       CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
                      graft.
15050..............  Skin pinch graft..........  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
15100..............  Skin splt grft, trnk/arm/   CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
                      leg.
15101..............  Skin splt grft t/a/l, add-  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
                      on.
15110..............  Epidrm autogrft trnk/arm/   CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      leg.
15111..............  Epidrm autogrft t/a/l add-  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      on.

[[Page 42902]]

 
15115..............  Epidrm a-grft face/nck/hf/  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      g.
15116..............  Epidrm a-grft f/n/hf/g      CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      addl.
15120..............  Skn splt a-grft fac/nck/hf/ CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
                      g.
15121..............  Skn splt a-grft f/n/hf/g    CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
                      add.
15130..............  Derm autograft, trnk/arm/   CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      leg.
15131..............  Derm autograft t/a/l add-   CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      on.
15135..............  Derm autograft face/nck/hf/ CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      g.
15136..............  Derm autograft, f/n/hf/g    CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      add.
15150..............  Cult epiderm grft t/arm/    CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      leg.
15151..............  Cult epiderm grft t/a/l     CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      addl.
15152..............  Cult epiderm graft t/a/l    CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      +%.
15155..............  Cult epiderm graft, f/n/hf/ CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      g.
15156..............  Cult epidrm grft f/n/hfg    CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      add.
15157..............  Cult epiderm grft f/n/hfg   CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      +%.
15170..............  Acell graft trunk/arms/     CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
                      legs.
15171..............  Acell graft t/arm/leg add-  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
                      on.
15175..............  Acellular graft, f/n/hf/g.  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
15176..............  Acell graft, f/n/hf/g add-  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      on.
15200..............  Skin full graft, trunk....  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
15201..............  Skin full graft trunk add-  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      on.
15220..............  Skin full graft sclp/arm/   CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      leg.
15221..............  Skin full graft add-on....  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
15240..............  Skin full grft face/genit/  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      hf.
15241..............  Skin full graft add-on....  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
15260..............  Skin full graft een & lips  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
15261..............  Skin full graft add-on....  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
15300..............  Apply skinallogrft, t/arm/  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      lg.
15301..............  Apply sknallogrft t/a/l     CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      addl.
15320..............  Apply skin allogrft f/n/hf/ CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      g.
15321..............  Aply sknallogrft f/n/hfg    CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      add.
15330..............  Aply acell alogrft t/arm/   CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      leg.
15331..............  Aply acell grft t/a/l add-  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      on.
15335..............  Apply acell graft, f/n/hf/  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      g.
15336..............  Aply acell grft f/n/hf/g    CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      add.
15340..............  Apply cult skin substitute  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
15341..............  Apply cult skin sub add-on  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
15360..............  Apply cult derm sub, t/a/l  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
15361..............  Aply cult derm sub t/a/l    CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
                      add.
15365..............  Apply cult derm sub f/n/hf/ CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
                      g.
15366..............  Apply cult derm f/hf/g add  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
15400..............  Apply skin xenograft, t/a/  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      l.
15401..............  Apply skn xenogrft t/a/l    CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      add.
15420..............  Apply skin xgraft, f/n/hf/  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      g.
15421..............  Apply skn xgrft f/n/hf/g    CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      add.
15430..............  Apply acellular xenograft.  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
15431..............  Apply acellular xgraft add  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
15570..............  Form skin pedicle flap....  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15572..............  Form skin pedicle flap....  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15574..............  Form skin pedicle flap....  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15576..............  Form skin pedicle flap....  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15600..............  Skin graft................  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15610..............  Skin graft................  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15620..............  Skin graft................  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15630..............  Skin graft................  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15650..............  Transfer skin pedicle flap  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15731..............  Forehead flap w/vasc        CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
                      pedicle.
15732..............  Muscle-skin graft, head/    CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
                      neck.
15734..............  Muscle-skin graft, trunk..  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15736..............  Muscle-skin graft, arm....  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15738..............  Muscle-skin graft, leg....  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15740..............  Island pedicle flap graft.  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
15750..............  Neurovascular pedicle       CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
                      graft.
15756..............  Free myo/skin flap          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
15757..............  Free skin flap, microvasc.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
15758..............  Free fascial flap,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
15760..............  Composite skin graft......  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15770..............  Derma-fat-fascia graft....  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15775..............  Hair transplant punch       CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      grafts.
15776..............  Hair transplant punch       CH................  T.................         0133        1.334       $84.97       $26.76       $16.99
                      grafts.
15780..............  Abrasion treatment of skin  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
15781..............  Abrasion treatment of skin  ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
15782..............  Abrasion treatment of skin  ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
15783..............  Abrasion treatment of skin  ..................  T.................         0016       2.7493      $175.11  ...........       $35.02
15786..............  Abrasion, lesion, single..  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
15787..............  Abrasion, lesions, add-on.  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
15788..............  Chemical peel, face,        CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
                      epiderm.
15789..............  Chemical peel, face,        ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      dermal.
15792..............  Chemical peel, nonfacial..  CH................  T.................         0015       1.5119       $96.30  ...........       $19.26

[[Page 42903]]

 
15793..............  Chemical peel, nonfacial..  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
15819..............  Plastic surgery, neck.....  CH................  T.................         0134       2.1114      $134.48       $42.36       $26.90
15820..............  Revision of lower eyelid..  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15821..............  Revision of lower eyelid..  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15822..............  Revision of upper eyelid..  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15823..............  Revision of upper eyelid..  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15824..............  Removal of forehead         CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
                      wrinkles.
15825..............  Removal of neck wrinkles..  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15826..............  Removal of brow wrinkles..  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15828..............  Removal of face wrinkles..  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15829..............  Removal of skin wrinkles..  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15830..............  Exc skin abd..............  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
15832..............  Excise excessive skin       ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      tissue.
15833..............  Excise excessive skin       ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      tissue.
15834..............  Excise excessive skin       ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      tissue.
15835..............  Excise excessive skin       CH................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      tissue.
15836..............  Excise excessive skin       ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      tissue.
15837..............  Excise excessive skin       ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      tissue.
15838..............  Excise excessive skin       ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      tissue.
15839..............  Excise excessive skin       ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      tissue.
15840..............  Graft for face nerve palsy  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15841..............  Graft for face nerve palsy  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15842..............  Flap for face nerve palsy.  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15845..............  Skin and muscle repair,     CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
                      face.
15847..............  Exc skin abd add-on.......  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
15850..............  Removal of sutures........  ..................  T.................         0016       2.7493      $175.11  ...........       $35.02
15851..............  Removal of sutures........  ..................  T.................         0016       2.7493      $175.11  ...........       $35.02
15852..............  Dressing change not for     ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
                      burn.
15860..............  Test for blood flow in      ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
                      graft.
15876..............  Suction assisted lipectomy  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15877..............  Suction assisted lipectomy  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15878..............  Suction assisted lipectomy  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15879..............  Suction assisted lipectomy  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15920..............  Removal of tail bone ulcer  ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
15922..............  Removal of tail bone ulcer  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15931..............  Remove sacrum pressure      ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      sore.
15933..............  Remove sacrum pressure      ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      sore.
15934..............  Remove sacrum pressure      CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
                      sore.
15935..............  Remove sacrum pressure      CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
                      sore.
15936..............  Remove sacrum pressure      CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      sore.
15937..............  Remove sacrum pressure      CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
                      sore.
15940..............  Remove hip pressure sore..  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
15941..............  Remove hip pressure sore..  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
15944..............  Remove hip pressure sore..  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15945..............  Remove hip pressure sore..  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15946..............  Remove hip pressure sore..  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
15950..............  Remove thigh pressure sore  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
15951..............  Remove thigh pressure sore  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
15952..............  Remove thigh pressure sore  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
15953..............  Remove thigh pressure sore  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
15956..............  Remove thigh pressure sore  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
15958..............  Remove thigh pressure sore  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
15999..............  Removal of pressure sore..  ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
16000..............  Initial treatment of        CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
                      burn(s).
16020..............  Dress/debrid p-thick burn,  CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      s.
16025..............  Dress/debrid p-thick burn,  CH................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      m.
16030..............  Dress/debrid p-thick burn,  CH................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      l.
16035..............  Incision of burn scab,      ..................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      initi.
16036..............  Escharotomy; add'l          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      incision.
17000..............  Destruct premalg lesion...  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
17003..............  Destruct premalg les, 2-14  CH................  T.................         0012       0.2682       $17.08  ...........        $3.42
17004..............  Destroy premlg lesions 15+  CH................  T.................         0016       2.7493      $175.11  ...........       $35.02
17106..............  Destruction of skin         CH................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesions.
17107..............  Destruction of skin         CH................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesions.
17108..............  Destruction of skin         CH................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesions.
17110..............  Destruct b9 lesion, 1-14..  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
17111..............  Destruct lesion, 15 or      CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      more.
17250..............  Chemical cautery, tissue..  CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
17260..............  Destruction of skin         ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      lesions.
17261..............  Destruction of skin         ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      lesions.
17262..............  Destruction of skin         ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      lesions.
17263..............  Destruction of skin         ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      lesions.
17264..............  Destruction of skin         ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      lesions.
17266..............  Destruction of skin         ..................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesions.
17270..............  Destruction of skin         ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      lesions.
17271..............  Destruction of skin         CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      lesions.
17272..............  Destruction of skin         ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      lesions.
17273..............  Destruction of skin         CH................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesions.

[[Page 42904]]

 
17274..............  Destruction of skin         ..................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesions.
17276..............  Destruction of skin         ..................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesions.
17280..............  Destruction of skin         ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      lesions.
17281..............  Destruction of skin         CH................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesions.
17282..............  Destruction of skin         CH................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesions.
17283..............  Destruction of skin         CH................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesions.
17284..............  Destruction of skin         ..................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesions.
17286..............  Destruction of skin         CH................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesions.
17311..............  Mohs, 1 stage, h/n/hf/g...  ..................  T.................         0694       3.9713      $252.94       $91.60       $50.59
17312..............  Mohs addl stage...........  ..................  T.................         0694       3.9713      $252.94       $91.60       $50.59
17313..............  Mohs, 1 stage, t/a/l......  ..................  T.................         0694       3.9713      $252.94       $91.60       $50.59
17314..............  Mohs, addl stage, t/a/l...  ..................  T.................         0694       3.9713      $252.94       $91.60       $50.59
17315..............  Mohs surg, addl block.....  ..................  T.................         0694       3.9713      $252.94       $91.60       $50.59
17340..............  Cryotherapy of skin.......  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
17360..............  Skin peel therapy.........  ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
17380..............  Hair removal by             ..................  T.................         0013       0.8046       $51.25  ...........       $10.25
                      electrolysis.
17999..............  Skin tissue procedure.....  ..................  T.................         0012       0.2682       $17.08  ...........        $3.42
19000..............  Drainage of breast lesion.  ..................  T.................         0004       4.5062      $287.01  ...........       $57.40
19001..............  Drain breast lesion add-on  ..................  T.................         0002       1.1915       $75.89  ...........       $15.18
19020..............  Incision of breast lesion.  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
19030..............  Injection for breast x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
19100..............  Bx breast percut w/o image  CH................  T.................         0004       4.5062      $287.01  ...........       $57.40
19101..............  Biopsy of breast, open....  ..................  T.................         0028       20.998    $1,337.43      $303.70      $267.49
19102..............  Bx breast percut w/image..  ..................  T.................         0005       7.3012      $465.04  ...........       $93.01
19103..............  Bx breast percut w/device.  CH................  T.................         0037      13.9599      $889.15      $228.70      $177.83
19105..............  Cryosurg ablate fa, each..  ..................  T.................         0029       32.494    $2,069.64      $581.50      $413.93
19110..............  Nipple exploration........  ..................  T.................         0028       20.998    $1,337.43      $303.70      $267.49
19112..............  Excise breast duct fistula  ..................  T.................         0028       20.998    $1,337.43      $303.70      $267.49
19120..............  Removal of breast lesion..  ..................  T.................         0028       20.998    $1,337.43      $303.70      $267.49
19125..............  Excision, breast lesion...  ..................  T.................         0028       20.998    $1,337.43      $303.70      $267.49
19126..............  Excision, addl breast       ..................  T.................         0028       20.998    $1,337.43      $303.70      $267.49
                      lesion.
19260..............  Removal of chest wall       ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      lesion.
19271..............  Revision of chest wall....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19272..............  Extensive chest wall        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
19290..............  Place needle wire, breast.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
19291..............  Place needle wire, breast.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
19295..............  Place breast clip, percut.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
19296..............  Place po breast cath for    ..................  T.................         0648      52.9438    $3,372.15  ...........      $674.43
                      rad.
19297..............  Place breast cath for rad.  ..................  T.................         0648      52.9438    $3,372.15  ...........      $674.43
19298..............  Place breast rad tube/      CH................  T.................         0648      52.9438    $3,372.15  ...........      $674.43
                      caths.
19300..............  Removal of breast tissue..  ..................  T.................         0028       20.998    $1,337.43      $303.70      $267.49
19301..............  Partical mastectomy.......  ..................  T.................         0028       20.998    $1,337.43      $303.70      $267.49
19302..............  P-mastectomy w/ln removal.  CH................  T.................         0030      40.4634    $2,577.24      $747.00      $515.45
19303..............  Mast, simple, complete....  ..................  T.................         0029       32.494    $2,069.64      $581.50      $413.93
19304..............  Mast, subq................  ..................  T.................         0029       32.494    $2,069.64      $581.50      $413.93
19305..............  Mast, radical.............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19306..............  Mast, rad, urban type.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19307..............  Mast, mod rad.............  ..................  T.................         0030      40.4634    $2,577.24      $747.00      $515.45
19316..............  Suspension of breast......  ..................  T.................         0029       32.494    $2,069.64      $581.50      $413.93
19318..............  Reduction of large breast.  CH................  T.................         0030      40.4634    $2,577.24      $747.00      $515.45
19324..............  Enlarge breast............  CH................  T.................         0030      40.4634    $2,577.24      $747.00      $515.45
19325..............  Enlarge breast with         ..................  T.................         0648      52.9438    $3,372.15  ...........      $674.43
                      implant.
19328..............  Removal of breast implant.  ..................  T.................         0029       32.494    $2,069.64      $581.50      $413.93
19330..............  Removal of implant          ..................  T.................         0029       32.494    $2,069.64      $581.50      $413.93
                      material.
19340..............  Immediate breast            ..................  T.................         0030      40.4634    $2,577.24      $747.00      $515.45
                      prosthesis.
19342..............  Delayed breast prosthesis.  ..................  T.................         0648      52.9438    $3,372.15  ...........      $674.43
19350..............  Breast reconstruction.....  ..................  T.................         0028       20.998    $1,337.43      $303.70      $267.49
19355..............  Correct inverted nipple(s)  ..................  T.................         0029       32.494    $2,069.64      $581.50      $413.93
19357..............  Breast reconstruction.....  ..................  T.................         0648      52.9438    $3,372.15  ...........      $674.43
19361..............  Breast reconstr w/lat flap  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19364..............  Breast reconstruction.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19366..............  Breast reconstruction.....  ..................  T.................         0029       32.494    $2,069.64      $581.50      $413.93
19367..............  Breast reconstruction.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19368..............  Breast reconstruction.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19369..............  Breast reconstruction.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19370..............  Surgery of breast capsule.  ..................  T.................         0029       32.494    $2,069.64      $581.50      $413.93
19371..............  Removal of breast capsule.  ..................  T.................         0029       32.494    $2,069.64      $581.50      $413.93
19380..............  Revise breast               ..................  T.................         0030      40.4634    $2,577.24      $747.00      $515.45
                      reconstruction.
19396..............  Design custom breast        ..................  T.................         0029       32.494    $2,069.64      $581.50      $413.93
                      implant.
19499..............  Breast surgery procedure..  ..................  T.................         0028       20.998    $1,337.43      $303.70      $267.49
20000..............  Incision of abscess.......  ..................  T.................         0006        1.463       $93.18  ...........       $18.64
20005..............  Incision of deep abscess..  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
2000F..............  Blood pressure measure....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2001F..............  Weight record.............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2002F..............  Clin sign vol ovrld assess  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2004F..............  Initial exam involved       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      joints.
20100..............  Explore wound, neck.......  ..................  T.................         0023       9.5721      $609.68  ...........      $121.94
20101..............  Explore wound, chest......  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67

[[Page 42905]]

 
20102..............  Explore wound, abdomen....  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
20103..............  Explore wound, extremity..  ..................  T.................         0023       9.5721      $609.68  ...........      $121.94
2010F..............  Vital signs recorded......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2014F..............  Mental status assess......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
20150..............  Excise epiphyseal bar.....  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
2018F..............  Hydration status assess...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2019F..............  Dilated macul exam done...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
20200..............  Muscle biopsy.............  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
20205..............  Deep muscle biopsy........  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
20206..............  Needle biopsy, muscle.....  ..................  T.................         0005       7.3012      $465.04  ...........       $93.01
2020F..............  Dilated fundus eval done..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2021F..............  Dilat macul+exam done.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
20220..............  Bone biopsy, trocar/needle  CH................  T.................         0020       8.7155      $555.12  ...........      $111.02
20225..............  Bone biopsy, trocar/needle  ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
2022F..............  Dil retina exam interp rev  ..................  M.................  ...........  ...........  ...........  ...........  ...........
20240..............  Bone biopsy, excisional...  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
20245..............  Bone biopsy, excisional...  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
2024F..............  7 field photo interp doc    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rev.
20250..............  Open bone biopsy..........  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
20251..............  Open bone biopsy..........  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
2026F..............  Eye image valid to dx rev.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2027F..............  Optic nerve head eval done  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2028F..............  Foot exam performed.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2029F..............  Complete phys skin exam     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      done.
2030F..............  H2O stat doc'd, normal....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2031F..............  H2O stat doc'd, dehydrated  ..................  M.................  ...........  ...........  ...........  ...........  ...........
20500..............  Injection of sinus tract..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
20501..............  Inject sinus tract for x-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
20520..............  Removal of foreign body...  ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
20525..............  Removal of foreign body...  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
20526..............  Ther injection, carp        ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
                      tunnel.
20550..............  Inj tendon sheath/ligament  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
20551..............  Inj tendon origin/          ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
                      insertion.
20552..............  Inj trigger point, 1/2      ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
                      muscl.
20553..............  Inject trigger points, =/>  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
                      3.
20600..............  Drain/inject, joint/bursa.  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
20605..............  Drain/inject, joint/bursa.  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
20610..............  Drain/inject, joint/bursa.  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
20612..............  Aspirate/inj ganglion cyst  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
20615..............  Treatment of bone cyst....  ..................  T.................         0004       4.5062      $287.01  ...........       $57.40
20650..............  Insert and remove bone pin  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
20660..............  Apply, rem fixation device  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20661..............  Application of head brace.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20662..............  Application of pelvis       ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      brace.
20663..............  Application of thigh brace  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
20664..............  Halo brace application....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20665..............  Removal of fixation device  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
20670..............  Removal of support implant  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
20680..............  Removal of support implant  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
20690..............  Apply bone fixation device  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
20692..............  Apply bone fixation device  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
20693..............  Adjust bone fixation        ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      device.
20694..............  Remove bone fixation        ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      device.
20802..............  Replantation, arm,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
20805..............  Replant forearm, complete.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20808..............  Replantation hand,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
20816..............  Replantation digit,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
20822..............  Replantation digit,         ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      complete.
20824..............  Replantation thumb,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
20827..............  Replantation thumb,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
20838..............  Replantation foot,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
20900..............  Removal of bone for graft.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
20902..............  Removal of bone for graft.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
20910..............  Remove cartilage for graft  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
20912..............  Remove cartilage for graft  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
20920..............  Removal of fascia for       CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      graft.
20922..............  Removal of fascia for       CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      graft.
20924..............  Removal of tendon for       ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      graft.
20926..............  Removal of tissue for       CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
                      graft.
20930..............  Spinal bone allograft.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20931..............  Spinal bone allograft.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20936..............  Spinal bone autograft.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20937..............  Spinal bone autograft.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20938..............  Spinal bone autograft.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20950..............  Fluid pressure, muscle....  ..................  T.................         0006        1.463       $93.18  ...........       $18.64
20955..............  Fibula bone graft,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
20956..............  Iliac bone graft,           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
20957..............  Mt bone graft, microvasc..  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42906]]

 
20962..............  Other bone graft,           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
20969..............  Bone/skin graft, microvasc  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20970..............  Bone/skin graft, iliac      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      crest.
20972..............  Bone/skin graft,            ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
                      metatarsal.
20973..............  Bone/skin graft, great toe  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
20974..............  Electrical bone             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stimulation.
20975..............  Electrical bone             CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      stimulation.
20979..............  Us bone stimulation.......  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
20982..............  Ablate, bone tumor(s) perq  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
20999..............  Musculoskeletal surgery...  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
21010..............  Incision of jaw joint.....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21015..............  Resection of facial tumor.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
21025..............  Excision of bone, lower     ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      jaw.
21026..............  Excision of facial bone(s)  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21029..............  Contour of face bone        ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      lesion.
21030..............  Excise max/zygoma b9 tumor  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21031..............  Remove exostosis, mandible  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21032..............  Remove exostosis, maxilla.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21034..............  Excise max/zygoma mlg       ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      tumor.
21040..............  Excise mandible lesion....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21044..............  Removal of jaw bone lesion  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21045..............  Extensive jaw surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21046..............  Remove mandible cyst        ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      complex.
21047..............  Excise lwr jaw cyst w/      ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      repair.
21048..............  Remove maxilla cyst         ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      complex.
21049..............  Excis uppr jaw cyst w/      ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      repair.
21050..............  Removal of jaw joint......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21060..............  Remove jaw joint cartilage  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21070..............  Remove coronoid process...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21076..............  Prepare face/oral           ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      prosthesis.
21077..............  Prepare face/oral           ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      prosthesis.
21079..............  Prepare face/oral           ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      prosthesis.
21080..............  Prepare face/oral           ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      prosthesis.
21081..............  Prepare face/oral           ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      prosthesis.
21082..............  Prepare face/oral           ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      prosthesis.
21083..............  Prepare face/oral           ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      prosthesis.
21084..............  Prepare face/oral           ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      prosthesis.
21085..............  Prepare face/oral           ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      prosthesis.
21086..............  Prepare face/oral           ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      prosthesis.
21087..............  Prepare face/oral           ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      prosthesis.
21088..............  Prepare face/oral           ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      prosthesis.
21089..............  Prepare face/oral           ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
                      prosthesis.
21100..............  Maxillofacial fixation....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21110..............  Interdental fixation......  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
21116..............  Injection, jaw joint x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
21120..............  Reconstruction of chin....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21121..............  Reconstruction of chin....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21122..............  Reconstruction of chin....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21123..............  Reconstruction of chin....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21125..............  Augmentation, lower jaw     ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      bone.
21127..............  Augmentation, lower jaw     ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      bone.
21137..............  Reduction of forehead.....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21138..............  Reduction of forehead.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21139..............  Reduction of forehead.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21141..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21142..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21143..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21145..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21146..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21147..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21150..............  Reconstruct midface,        ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      lefort.
21151..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21154..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21155..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21159..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21160..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21172..............  Reconstruct orbit/forehead  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21175..............  Reconstruct orbit/forehead  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21179..............  Reconstruct entire          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      forehead.
21180..............  Reconstruct entire          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      forehead.
21181..............  Contour cranial bone        ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      lesion.
21182..............  Reconstruct cranial bone..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21183..............  Reconstruct cranial bone..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21184..............  Reconstruct cranial bone..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21188..............  Reconstruction of midface.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21193..............  Reconst lwr jaw w/o graft.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21194..............  Reconst lwr jaw w/graft...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21195..............  Reconst lwr jaw w/o         ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      fixation.

[[Page 42907]]

 
21196..............  Reconst lwr jaw w/fixation  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21198..............  Reconstr lwr jaw segment..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21199..............  Reconstr lwr jaw w/advance  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21206..............  Reconstruct upper jaw bone  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21208..............  Augmentation of facial      ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      bones.
21209..............  Reduction of facial bones.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21210..............  Face bone graft...........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21215..............  Lower jaw bone graft......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21230..............  Rib cartilage graft.......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21235..............  Ear cartilage graft.......  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21240..............  Reconstruction of jaw       ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      joint.
21242..............  Reconstruction of jaw       ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      joint.
21243..............  Reconstruction of jaw       ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      joint.
21244..............  Reconstruction of lower     ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      jaw.
21245..............  Reconstruction of jaw.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21246..............  Reconstruction of jaw.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21247..............  Reconstruct lower jaw bone  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21248..............  Reconstruction of jaw.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21249..............  Reconstruction of jaw.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21255..............  Reconstruct lower jaw bone  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21256..............  Reconstruction of orbit...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21260..............  Revise eye sockets........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21261..............  Revise eye sockets........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21263..............  Revise eye sockets........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21267..............  Revise eye sockets........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21268..............  Revise eye sockets........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21270..............  Augmentation, cheek bone..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21275..............  Revision, orbitofacial      ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      bones.
21280..............  Revision of eyelid........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21282..............  Revision of eyelid........  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
21295..............  Revision of jaw muscle/     ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
                      bone.
21296..............  Revision of jaw muscle/     ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      bone.
21299..............  Cranio/maxillofacial        ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
                      surgery.
21310..............  Treatment of nose fracture  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
21315..............  Treatment of nose fracture  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
21320..............  Treatment of nose fracture  CH................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
21325..............  Treatment of nose fracture  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21330..............  Treatment of nose fracture  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21335..............  Treatment of nose fracture  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21336..............  Treat nasal septal          ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      fracture.
21337..............  Treat nasal septal          ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      fracture.
21338..............  Treat nasoethmoid fracture  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21339..............  Treat nasoethmoid fracture  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21340..............  Treatment of nose fracture  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21343..............  Treatment of sinus          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21344..............  Treatment of sinus          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21345..............  Treat nose/jaw fracture...  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21346..............  Treat nose/jaw fracture...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21347..............  Treat nose/jaw fracture...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21348..............  Treat nose/jaw fracture...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21355..............  Treat cheek bone fracture.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21356..............  Treat cheek bone fracture.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21360..............  Treat cheek bone fracture.  CH................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21365..............  Treat cheek bone fracture.  CH................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21366..............  Treat cheek bone fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21385..............  Treat eye socket fracture.  CH................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21386..............  Treat eye socket fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21387..............  Treat eye socket fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21390..............  Treat eye socket fracture.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21395..............  Treat eye socket fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21400..............  Treat eye socket fracture.  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
21401..............  Treat eye socket fracture.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
21406..............  Treat eye socket fracture.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21407..............  Treat eye socket fracture.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21408..............  Treat eye socket fracture.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21421..............  Treat mouth roof fracture.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21422..............  Treat mouth roof fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21423..............  Treat mouth roof fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21431..............  Treat craniofacial          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21432..............  Treat craniofacial          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21433..............  Treat craniofacial          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21435..............  Treat craniofacial          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21436..............  Treat craniofacial          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21440..............  Treat dental ridge          ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      fracture.
21445..............  Treat dental ridge          ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      fracture.
21450..............  Treat lower jaw fracture..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
21451..............  Treat lower jaw fracture..  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
21452..............  Treat lower jaw fracture..  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90

[[Page 42908]]

 
21453..............  Treat lower jaw fracture..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21454..............  Treat lower jaw fracture..  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
21461..............  Treat lower jaw fracture..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21462..............  Treat lower jaw fracture..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21465..............  Treat lower jaw fracture..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21470..............  Treat lower jaw fracture..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21480..............  Reset dislocated jaw......  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
21485..............  Reset dislocated jaw......  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
21490..............  Repair dislocated jaw.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
21495..............  Treat hyoid bone fracture.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
21497..............  Interdental wiring........  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
21499..............  Head surgery procedure....  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
21501..............  Drain neck/chest lesion...  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
21502..............  Drain chest lesion........  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
21510..............  Drainage of bone lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21550..............  Biopsy of neck/chest......  ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
21555..............  Remove lesion, neck/chest.  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
21556..............  Remove lesion, neck/chest.  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
21557..............  Remove tumor, neck/chest..  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
21600..............  Partial removal of rib....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
21610..............  Partial removal of rib....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
21615..............  Removal of rib............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21616..............  Removal of rib and nerves.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21620..............  Partial removal of sternum  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21627..............  Sternal debridement.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21630..............  Extensive sternum surgery.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21632..............  Extensive sternum surgery.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21685..............  Hyoid myotomy & suspension  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
21700..............  Revision of neck muscle...  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
21705..............  Revision of neck muscle/    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      rib.
21720..............  Revision of neck muscle...  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
21725..............  Revision of neck muscle...  ..................  T.................         0006        1.463       $93.18  ...........       $18.64
21740..............  Reconstruction of sternum.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21742..............  Repair stern/nuss w/o       ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      scope.
21743..............  Repair sternum/nuss w/      ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      scope.
21750..............  Repair of sternum           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      separation.
21800..............  Treatment of rib fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
21805..............  Treatment of rib fracture.  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
21810..............  Treatment of rib            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture(s).
21820..............  Treat sternum fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
21825..............  Treat sternum fracture....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21899..............  Neck/chest surgery          ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
                      procedure.
21920..............  Biopsy soft tissue of back  ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
21925..............  Biopsy soft tissue of back  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
21930..............  Remove lesion, back or      ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      flank.
21935..............  Remove tumor, back........  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
22010..............  I&d, p-spine, c/t/cerv-     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      thor.
22015..............  I&d, p-spine, l/s/ls......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22100..............  Remove part of neck         ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
                      vertebra.
22101..............  Remove part, thorax         ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
                      vertebra.
22102..............  Remove part, lumbar         ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
                      vertebra.
22103..............  Remove extra spine segment  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
22110..............  Remove part of neck         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vertebra.
22112..............  Remove part, thorax         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vertebra.
22114..............  Remove part, lumbar         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vertebra.
22116..............  Remove extra spine segment  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22210..............  Revision of neck spine....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22212..............  Revision of thorax spine..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22214..............  Revision of lumbar spine..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22216..............  Revise, extra spine         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      segment.
22220..............  Revision of neck spine....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22222..............  Revision of thorax spine..  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
22224..............  Revision of lumbar spine..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22226..............  Revise, extra spine         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      segment.
22305..............  Treat spine process         ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
22310..............  Treat spine fracture......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
22315..............  Treat spine fracture......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
22318..............  Treat odontoid fx w/o       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      graft.
22319..............  Treat odontoid fx w/graft.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22325..............  Treat spine fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22326..............  Treat neck spine fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22327..............  Treat thorax spine          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
22328..............  Treat each add spine fx...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22505..............  Manipulation of spine.....  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
22520..............  Percut vertebroplasty thor  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
22521..............  Percut vertebroplasty lumb  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
22522..............  Percut vertebroplasty       ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      add'l.
22523..............  Percut kyphoplasty, thor..  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91

[[Page 42909]]

 
22524..............  Percut kyphoplasty, lumbar  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
22525..............  Percut kyphoplasty, add-on  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
22526..............  Idet, single level........  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
22527..............  Idet, 1 or more levels....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
22532..............  Lat thorax spine fusion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22533..............  Lat lumbar spine fusion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22534..............  Lat thor/lumb, add'l seg..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22548..............  Neck spine fusion.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22554..............  Neck spine fusion.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22556..............  Thorax spine fusion.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22558..............  Lumbar spine fusion.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22585..............  Additional spinal fusion..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22590..............  Spine & skull spinal        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fusion.
22595..............  Neck spinal fusion........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22600..............  Neck spine fusion.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22610..............  Thorax spine fusion.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22612..............  Lumbar spine fusion.......  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
22614..............  Spine fusion, extra         ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
                      segment.
22630..............  Lumbar spine fusion.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22632..............  Spine fusion, extra         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      segment.
22800..............  Fusion of spine...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22802..............  Fusion of spine...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22804..............  Fusion of spine...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22808..............  Fusion of spine...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22810..............  Fusion of spine...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22812..............  Fusion of spine...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22818..............  Kyphectomy, 1-2 segments..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22819..............  Kyphectomy, 3 or more.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22830..............  Exploration of spinal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fusion.
22840..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22841..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22842..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22843..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22844..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22845..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22846..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22847..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22848..............  Insert pelv fixation        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22849..............  Reinsert spinal fixation..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22850..............  Remove spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22851..............  Apply spine prosth device.  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
22852..............  Remove spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22855..............  Remove spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22857..............  Lumbar artif diskectomy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22862..............  Revise lumbar artif disc..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22865..............  Remove lumb artif disc....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22899..............  Spine surgery procedure...  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
22900..............  Remove abdominal wall       ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      lesion.
22999..............  Abdomen surgery procedure.  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
23000..............  Removal of calcium          ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      deposits.
23020..............  Release shoulder joint....  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
23030..............  Drain shoulder lesion.....  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
23031..............  Drain shoulder bursa......  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
23035..............  Drain shoulder bone lesion  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
23040..............  Exploratory shoulder        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      surgery.
23044..............  Exploratory shoulder        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      surgery.
23065..............  Biopsy shoulder tissues...  ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
23066..............  Biopsy shoulder tissues...  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
23075..............  Removal of shoulder lesion  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
23076..............  Removal of shoulder lesion  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
23077..............  Remove tumor of shoulder..  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
23100..............  Biopsy of shoulder joint..  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
23101..............  Shoulder joint surgery....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23105..............  Remove shoulder joint       ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      lining.
23106..............  Incision of collarbone      ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      joint.
23107..............  Explore treat shoulder      ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      joint.
23120..............  Partial removal, collar     CH................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      bone.
23125..............  Removal of collar bone....  CH................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23130..............  Remove shoulder bone, part  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
23140..............  Removal of bone lesion....  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
23145..............  Removal of bone lesion....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23146..............  Removal of bone lesion....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23150..............  Removal of humerus lesion.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23155..............  Removal of humerus lesion.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23156..............  Removal of humerus lesion.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23170..............  Remove collar bone lesion.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23172..............  Remove shoulder blade       ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      lesion.
23174..............  Remove humerus lesion.....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58

[[Page 42910]]

 
23180..............  Remove collar bone lesion.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23182..............  Remove shoulder blade       ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      lesion.
23184..............  Remove humerus lesion.....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23190..............  Partial removal of scapula  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23195..............  Removal of head of humerus  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23200..............  Removal of collar bone....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23210..............  Removal of shoulder blade.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23220..............  Partial removal of humerus  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23221..............  Partial removal of humerus  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23222..............  Partial removal of humerus  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23330..............  Remove shoulder foreign     ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      body.
23331..............  Remove shoulder foreign     ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      body.
23332..............  Remove shoulder foreign     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      body.
23350..............  Injection for shoulder x-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
23395..............  Muscle transfer,shoulder/   ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      arm.
23397..............  Muscle transfers..........  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
23400..............  Fixation of shoulder blade  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
23405..............  Incision of tendon &        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      muscle.
23406..............  Incise tendon(s) &          ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      muscle(s).
23410..............  Repair rotator cuff, acute  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
23412..............  Repair rotator cuff,        ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      chronic.
23415..............  Release of shoulder         ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      ligament.
23420..............  Repair of shoulder........  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
23430..............  Repair biceps tendon......  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
23440..............  Remove/transplant tendon..  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
23450..............  Repair shoulder capsule...  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
23455..............  Repair shoulder capsule...  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
23460..............  Repair shoulder capsule...  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
23462..............  Repair shoulder capsule...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
23465..............  Repair shoulder capsule...  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
23466..............  Repair shoulder capsule...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
23470..............  Reconstruct shoulder joint  ..................  T.................         0425     113.6713    $7,240.07  ...........    $1,448.01
23472..............  Reconstruct shoulder joint  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23480..............  Revision of collar bone...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
23485..............  Revision of collar bone...  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
23490..............  Reinforce clavicle........  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
23491..............  Reinforce shoulder bones..  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
23500..............  Treat clavicle fracture...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23505..............  Treat clavicle fracture...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23515..............  Treat clavicle fracture...  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
23520..............  Treat clavicle dislocation  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23525..............  Treat clavicle dislocation  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23530..............  Treat clavicle dislocation  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
23532..............  Treat clavicle dislocation  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
23540..............  Treat clavicle dislocation  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23545..............  Treat clavicle dislocation  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23550..............  Treat clavicle dislocation  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
23552..............  Treat clavicle dislocation  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
23570..............  Treat shoulder blade fx...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23575..............  Treat shoulder blade fx...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23585..............  Treat scapula fracture....  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
23600..............  Treat humerus fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23605..............  Treat humerus fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23615..............  Treat humerus fracture....  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
23616..............  Treat humerus fracture....  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
23620..............  Treat humerus fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23625..............  Treat humerus fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23630..............  Treat humerus fracture....  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
23650..............  Treat shoulder dislocation  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23655..............  Treat shoulder dislocation  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
23660..............  Treat shoulder dislocation  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
23665..............  Treat dislocation/fracture  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23670..............  Treat dislocation/fracture  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
23675..............  Treat dislocation/fracture  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23680..............  Treat dislocation/fracture  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
23700..............  Fixation of shoulder......  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
23800..............  Fusion of shoulder joint..  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
23802..............  Fusion of shoulder joint..  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
23900..............  Amputation of arm & girdle  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23920..............  Amputation at shoulder      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      joint.
23921..............  Amputation follow-up        CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      surgery.
23929..............  Shoulder surgery procedure  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
23930..............  Drainage of arm lesion....  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
23931..............  Drainage of arm bursa.....  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
23935..............  Drain arm/elbow bone        ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      lesion.
24000..............  Exploratory elbow surgery.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24006..............  Release elbow joint.......  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24065..............  Biopsy arm/elbow soft       ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      tissue.

[[Page 42911]]

 
24066..............  Biopsy arm/elbow soft       ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      tissue.
24075..............  Remove arm/elbow lesion...  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
24076..............  Remove arm/elbow lesion...  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
24077..............  Remove tumor of arm/elbow.  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
24100..............  Biopsy elbow joint lining.  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
24101..............  Explore/treat elbow joint.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24102..............  Remove elbow joint lining.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24105..............  Removal of elbow bursa....  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
24110..............  Remove humerus lesion.....  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
24115..............  Remove/graft bone lesion..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24116..............  Remove/graft bone lesion..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24120..............  Remove elbow lesion.......  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
24125..............  Remove/graft bone lesion..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24126..............  Remove/graft bone lesion..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24130..............  Removal of head of radius.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24134..............  Removal of arm bone lesion  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24136..............  Remove radius bone lesion.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24138..............  Remove elbow bone lesion..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24140..............  Partial removal of arm      ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      bone.
24145..............  Partial removal of radius.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24147..............  Partial removal of elbow..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24149..............  Radical resection of elbow  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24150..............  Extensive humerus surgery.  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
24151..............  Extensive humerus surgery.  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
24152..............  Extensive radius surgery..  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
24153..............  Extensive radius surgery..  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
24155..............  Removal of elbow joint....  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
24160..............  Remove elbow joint implant  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24164..............  Remove radius head implant  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24200..............  Removal of arm foreign      ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      body.
24201..............  Removal of arm foreign      ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      body.
24220..............  Injection for elbow x-ray.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
24300..............  Manipulate elbow w/anesth.  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
24301..............  Muscle/tendon transfer....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24305..............  Arm tendon lengthening....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24310..............  Revision of arm tendon....  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
24320..............  Repair of arm tendon......  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
24330..............  Revision of arm muscles...  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
24331..............  Revision of arm muscles...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
24332..............  Tenolysis, triceps........  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
24340..............  Repair of biceps tendon...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
24341..............  Repair arm tendon/muscle..  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
24342..............  Repair of ruptured tendon.  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
24343..............  Repr elbow lat ligmnt w/    ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      tiss.
24344..............  Reconstruct elbow lat       ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
                      ligmnt.
24345..............  Repr elbw med ligmnt w/     ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      tissu.
24346..............  Reconstruct elbow med       ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      ligmnt.
24350..............  Repair of tennis elbow....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24351..............  Repair of tennis elbow....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24352..............  Repair of tennis elbow....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24354..............  Repair of tennis elbow....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24356..............  Revision of tennis elbow..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24360..............  Reconstruct elbow joint...  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
24361..............  Reconstruct elbow joint...  ..................  T.................         0425     113.6713    $7,240.07  ...........    $1,448.01
24362..............  Reconstruct elbow joint...  ..................  T.................         0048      51.0431    $3,251.09  ...........      $650.22
24363..............  Replace elbow joint.......  ..................  T.................         0425     113.6713    $7,240.07  ...........    $1,448.01
24365..............  Reconstruct head of radius  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
24366..............  Reconstruct head of radius  ..................  T.................         0425     113.6713    $7,240.07  ...........    $1,448.01
24400..............  Revision of humerus.......  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24410..............  Revision of humerus.......  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24420..............  Revision of humerus.......  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
24430..............  Repair of humerus.........  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
24435..............  Repair humerus with graft.  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
24470..............  Revision of elbow joint...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
24495..............  Decompression of forearm..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
24498..............  Reinforce humerus.........  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
24500..............  Treat humerus fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24505..............  Treat humerus fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24515..............  Treat humerus fracture....  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
24516..............  Treat humerus fracture....  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
24530..............  Treat humerus fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24535..............  Treat humerus fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24538..............  Treat humerus fracture....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
24545..............  Treat humerus fracture....  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
24546..............  Treat humerus fracture....  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
24560..............  Treat humerus fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24565..............  Treat humerus fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24566..............  Treat humerus fracture....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14

[[Page 42912]]

 
24575..............  Treat humerus fracture....  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
24576..............  Treat humerus fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24577..............  Treat humerus fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24579..............  Treat humerus fracture....  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
24582..............  Treat humerus fracture....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
24586..............  Treat elbow fracture......  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
24587..............  Treat elbow fracture......  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
24600..............  Treat elbow dislocation...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24605..............  Treat elbow dislocation...  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
24615..............  Treat elbow dislocation...  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
24620..............  Treat elbow fracture......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24635..............  Treat elbow fracture......  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
24640..............  Treat elbow dislocation...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24650..............  Treat radius fracture.....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24655..............  Treat radius fracture.....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24665..............  Treat radius fracture.....  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
24666..............  Treat radius fracture.....  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
24670..............  Treat ulnar fracture......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24675..............  Treat ulnar fracture......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
24685..............  Treat ulnar fracture......  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
24800..............  Fusion of elbow joint.....  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
24802..............  Fusion/graft of elbow       ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      joint.
24900..............  Amputation of upper arm...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
24920..............  Amputation of upper arm...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
24925..............  Amputation follow-up        ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      surgery.
24930..............  Amputation follow-up        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
24931..............  Amputate upper arm &        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      implant.
24935..............  Revision of amputation....  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
24940..............  Revision of upper arm.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
24999..............  Upper arm/elbow surgery...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25000..............  Incision of tendon sheath.  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
25001..............  Incise flexor carpi         ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      radialis.
25020..............  Decompress forearm 1 space  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
25023..............  Decompress forearm 1 space  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25024..............  Decompress forearm 2        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      spaces.
25025..............  Decompress forearm 2        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      spaces.
25028..............  Drainage of forearm lesion  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
25031..............  Drainage of forearm bursa.  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
25035..............  Treat forearm bone lesion.  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
25040..............  Explore/treat wrist joint.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25065..............  Biopsy forearm soft         ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      tissues.
25066..............  Biopsy forearm soft         ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      tissues.
25075..............  Removal forearm lesion      ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      subcu.
25076..............  Removal forearm lesion      ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      deep.
25077..............  Remove tumor, forearm/      ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      wrist.
25085..............  Incision of wrist capsule.  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
25100..............  Biopsy of wrist joint.....  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
25101..............  Explore/treat wrist joint.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25105..............  Remove wrist joint lining.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25107..............  Remove wrist joint          ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      cartilage.
25109..............  Excise tendon forearm/      ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      wrist.
25110..............  Remove wrist tendon lesion  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
25111..............  Remove wrist tendon lesion  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
25112..............  Reremove wrist tendon       ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      lesion.
25115..............  Remove wrist/forearm        ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      lesion.
25116..............  Remove wrist/forearm        ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      lesion.
25118..............  Excise wrist tendon sheath  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25119..............  Partial removal of ulna...  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25120..............  Removal of forearm lesion.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25125..............  Remove/graft forearm        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      lesion.
25126..............  Remove/graft forearm        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      lesion.
25130..............  Removal of wrist lesion...  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25135..............  Remove & graft wrist        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      lesion.
25136..............  Remove & graft wrist        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      lesion.
25145..............  Remove forearm bone lesion  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25150..............  Partial removal of ulna...  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25151..............  Partial removal of radius.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25170..............  Extensive forearm surgery.  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25210..............  Removal of wrist bone.....  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
25215..............  Removal of wrist bones....  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
25230..............  Partial removal of radius.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25240..............  Partial removal of ulna...  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25246..............  Injection for wrist x-ray.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
25248..............  Remove forearm foreign      ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      body.
25250..............  Removal of wrist            ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      prosthesis.
25251..............  Removal of wrist            ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      prosthesis.
25259..............  Manipulate wrist w/         ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      anesthes.
25260..............  Repair forearm tendon/      ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      muscle.

[[Page 42913]]

 
25263..............  Repair forearm tendon/      ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      muscle.
25265..............  Repair forearm tendon/      ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      muscle.
25270..............  Repair forearm tendon/      ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      muscle.
25272..............  Repair forearm tendon/      ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      muscle.
25274..............  Repair forearm tendon/      ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      muscle.
25275..............  Repair forearm tendon       ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      sheath.
25280..............  Revise wrist/forearm        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      tendon.
25290..............  Incise wrist/forearm        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      tendon.
25295..............  Release wrist/forearm       ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      tendon.
25300..............  Fusion of tendons at wrist  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25301..............  Fusion of tendons at wrist  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25310..............  Transplant forearm tendon.  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25312..............  Transplant forearm tendon.  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25315..............  Revise palsy hand           ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      tendon(s).
25316..............  Revise palsy hand           ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
                      tendon(s).
25320..............  Repair/revise wrist joint.  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25332..............  Revise wrist joint........  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
25335..............  Realignment of hand.......  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25337..............  Reconstruct ulna/           ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      radioulnar.
25350..............  Revision of radius........  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
25355..............  Revision of radius........  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25360..............  Revision of ulna..........  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25365..............  Revise radius & ulna......  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25370..............  Revise radius or ulna.....  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25375..............  Revise radius & ulna......  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25390..............  Shorten radius or ulna....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25391..............  Lengthen radius or ulna...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25392..............  Shorten radius & ulna.....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
25393..............  Lengthen radius & ulna....  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25394..............  Repair carpal bone,         ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      shorten.
25400..............  Repair radius or ulna.....  CH................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
25405..............  Repair/graft radius or      CH................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
                      ulna.
25415..............  Repair radius & ulna......  CH................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
25420..............  Repair/graft radius & ulna  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
25425..............  Repair/graft radius or      ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      ulna.
25426..............  Repair/graft radius & ulna  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25430..............  Vasc graft into carpal      ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      bone.
25431..............  Repair nonunion carpal      ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      bone.
25440..............  Repair/graft wrist bone...  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
25441..............  Reconstruct wrist joint...  ..................  T.................         0425     113.6713    $7,240.07  ...........    $1,448.01
25442..............  Reconstruct wrist joint...  ..................  T.................         0425     113.6713    $7,240.07  ...........    $1,448.01
25443..............  Reconstruct wrist joint...  ..................  T.................         0048      51.0431    $3,251.09  ...........      $650.22
25444..............  Reconstruct wrist joint...  ..................  T.................         0048      51.0431    $3,251.09  ...........      $650.22
25445..............  Reconstruct wrist joint...  ..................  T.................         0048      51.0431    $3,251.09  ...........      $650.22
25446..............  Wrist replacement.........  ..................  T.................         0425     113.6713    $7,240.07  ...........    $1,448.01
25447..............  Repair wrist joint(s).....  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
25449..............  Remove wrist joint implant  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
25450..............  Revision of wrist joint...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25455..............  Revision of wrist joint...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25490..............  Reinforce radius..........  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25491..............  Reinforce ulna............  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25492..............  Reinforce radius and ulna.  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
25500..............  Treat fracture of radius..  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25505..............  Treat fracture of radius..  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25515..............  Treat fracture of radius..  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
25520..............  Treat fracture of radius..  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25525..............  Treat fracture of radius..  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
25526..............  Treat fracture of radius..  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
25530..............  Treat fracture of ulna....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25535..............  Treat fracture of ulna....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25545..............  Treat fracture of ulna....  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
25560..............  Treat fracture radius &     ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      ulna.
25565..............  Treat fracture radius &     ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      ulna.
25574..............  Treat fracture radius &     ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
                      ulna.
25575..............  Treat fracture radius/ulna  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
25600..............  Treat fracture radius/ulna  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25605..............  Treat fracture radius/ulna  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25606..............  Treat fx distal radial....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
25607..............  Treat fx rad extra-articul  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
25608..............  Treat fx rad intra-articul  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
25609..............  Treat fx radial 3+ frag...  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
25622..............  Treat wrist bone fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25624..............  Treat wrist bone fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25628..............  Treat wrist bone fracture.  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
25630..............  Treat wrist bone fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25635..............  Treat wrist bone fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25645..............  Treat wrist bone fracture.  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
25650..............  Treat wrist bone fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87

[[Page 42914]]

 
25651..............  Pin ulnar styloid fracture  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
25652..............  Treat fracture ulnar        ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      styloid.
25660..............  Treat wrist dislocation...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25670..............  Treat wrist dislocation...  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
25671..............  Pin radioulnar dislocation  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
25675..............  Treat wrist dislocation...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25676..............  Treat wrist dislocation...  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
25680..............  Treat wrist fracture......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25685..............  Treat wrist fracture......  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
25690..............  Treat wrist dislocation...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
25695..............  Treat wrist dislocation...  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
25800..............  Fusion of wrist joint.....  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
25805..............  Fusion/graft of wrist       ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      joint.
25810..............  Fusion/graft of wrist       ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
                      joint.
25820..............  Fusion of hand bones......  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
25825..............  Fuse hand bones with graft  CH................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
25830..............  Fusion, radioulnar jnt/     ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
                      ulna.
25900..............  Amputation of forearm.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
25905..............  Amputation of forearm.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
25907..............  Amputation follow-up        ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      surgery.
25909..............  Amputation follow-up        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
25915..............  Amputation of forearm.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
25920..............  Amputate hand at wrist....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
25922..............  Amputate hand at wrist....  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
25924..............  Amputation follow-up        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
25927..............  Amputation of hand........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
25929..............  Amputation follow-up        CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      surgery.
25931..............  Amputation follow-up        CH................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      surgery.
25999..............  Forearm or wrist surgery..  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26010..............  Drainage of finger abscess  ..................  T.................         0006        1.463       $93.18  ...........       $18.64
26011..............  Drainage of finger abscess  ..................  T.................         0007      12.5792      $801.21  ...........      $160.24
26020..............  Drain hand tendon sheath..  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26025..............  Drainage of palm bursa....  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26030..............  Drainage of palm bursa(s).  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26034..............  Treat hand bone lesion....  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26035..............  Decompress fingers/hand...  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26037..............  Decompress fingers/hand...  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26040..............  Release palm contracture..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26045..............  Release palm contracture..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26055..............  Incise finger tendon        ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      sheath.
26060..............  Incision of finger tendon.  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26070..............  Explore/treat hand joint..  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26075..............  Explore/treat finger joint  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26080..............  Explore/treat finger joint  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26100..............  Biopsy hand joint lining..  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26105..............  Biopsy finger joint lining  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26110..............  Biopsy finger joint lining  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26115..............  Removal hand lesion subcut  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
26116..............  Removal hand lesion, deep.  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
26117..............  Remove tumor, hand/finger.  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
26121..............  Release palm contracture..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26123..............  Release palm contracture..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26125..............  Release palm contracture..  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26130..............  Remove wrist joint lining.  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26135..............  Revise finger joint, each.  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26140..............  Revise finger joint, each.  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26145..............  Tendon excision, palm/      ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      finger.
26160..............  Remove tendon sheath        ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      lesion.
26170..............  Removal of palm tendon,     ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      each.
26180..............  Removal of finger tendon..  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26185..............  Remove finger bone........  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26200..............  Remove hand bone lesion...  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26205..............  Remove/graft bone lesion..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26210..............  Removal of finger lesion..  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26215..............  Remove/graft finger lesion  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26230..............  Partial removal of hand     ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      bone.
26235..............  Partial removal, finger     ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      bone.
26236..............  Partial removal, finger     ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      bone.
26250..............  Extensive hand surgery....  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26255..............  Extensive hand surgery....  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26260..............  Extensive finger surgery..  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26261..............  Extensive finger surgery..  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26262..............  Partial removal of finger.  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26320..............  Removal of implant from     ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      hand.
26340..............  Manipulate finger w/anesth  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26350..............  Repair finger/hand tendon.  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26352..............  Repair/graft hand tendon..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26356..............  Repair finger/hand tendon.  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53

[[Page 42915]]

 
26357..............  Repair finger/hand tendon.  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26358..............  Repair/graft hand tendon..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26370..............  Repair finger/hand tendon.  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26372..............  Repair/graft hand tendon..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26373..............  Repair finger/hand tendon.  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26390..............  Revise hand/finger tendon.  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26392..............  Repair/graft hand tendon..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26410..............  Repair hand tendon........  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26412..............  Repair/graft hand tendon..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26415..............  Excision, hand/finger       ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      tendon.
26416..............  Graft hand or finger        ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      tendon.
26418..............  Repair finger tendon......  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26420..............  Repair/graft finger tendon  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26426..............  Repair finger/hand tendon.  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26428..............  Repair/graft finger tendon  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26432..............  Repair finger tendon......  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26433..............  Repair finger tendon......  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26434..............  Repair/graft finger tendon  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26437..............  Realignment of tendons....  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26440..............  Release palm/finger tendon  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26442..............  Release palm & finger       ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      tendon.
26445..............  Release hand/finger tendon  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26449..............  Release forearm/hand        ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      tendon.
26450..............  Incision of palm tendon...  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26455..............  Incision of finger tendon.  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26460..............  Incise hand/finger tendon.  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26471..............  Fusion of finger tendons..  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26474..............  Fusion of finger tendons..  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26476..............  Tendon lengthening........  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26477..............  Tendon shortening.........  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26478..............  Lengthening of hand tendon  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26479..............  Shortening of hand tendon.  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26480..............  Transplant hand tendon....  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26483..............  Transplant/graft hand       ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      tendon.
26485..............  Transplant palm tendon....  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26489..............  Transplant/graft palm       ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      tendon.
26490..............  Revise thumb tendon.......  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26492..............  Tendon transfer with graft  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26494..............  Hand tendon/muscle          ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      transfer.
26496..............  Revise thumb tendon.......  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26497..............  Finger tendon transfer....  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26498..............  Finger tendon transfer....  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26499..............  Revision of finger........  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26500..............  Hand tendon reconstruction  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26502..............  Hand tendon reconstruction  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26508..............  Release thumb contracture.  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26510..............  Thumb tendon transfer.....  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26516..............  Fusion of knuckle joint...  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26517..............  Fusion of knuckle joints..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26518..............  Fusion of knuckle joints..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26520..............  Release knuckle             ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      contracture.
26525..............  Release finger contracture  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26530..............  Revise knuckle joint......  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
26531..............  Revise knuckle with         ..................  T.................         0048      51.0431    $3,251.09  ...........      $650.22
                      implant.
26535..............  Revise finger joint.......  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
26536..............  Revise/implant finger       ..................  T.................         0048      51.0431    $3,251.09  ...........      $650.22
                      joint.
26540..............  Repair hand joint.........  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26541..............  Repair hand joint with      ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      graft.
26542..............  Repair hand joint with      ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      graft.
26545..............  Reconstruct finger joint..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26546..............  Repair nonunion hand......  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26548..............  Reconstruct finger joint..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26550..............  Construct thumb             ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      replacement.
26551..............  Great toe-hand transfer...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
26553..............  Single transfer, toe-hand.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
26554..............  Double transfer, toe-hand.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
26555..............  Positional change of        ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      finger.
26556..............  Toe joint transfer........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
26560..............  Repair of web finger......  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26561..............  Repair of web finger......  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26562..............  Repair of web finger......  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26565..............  Correct metacarpal flaw...  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26567..............  Correct finger deformity..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26568..............  Lengthen metacarpal/finger  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26580..............  Repair hand deformity.....  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26587..............  Reconstruct extra finger..  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26590..............  Repair finger deformity...  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26591..............  Repair muscles of hand....  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53

[[Page 42916]]

 
26593..............  Release muscles of hand...  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26596..............  Excision constricting       ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      tissue.
26600..............  Treat metacarpal fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26605..............  Treat metacarpal fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26607..............  Treat metacarpal fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26608..............  Treat metacarpal fracture.  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
26615..............  Treat metacarpal fracture.  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
26641..............  Treat thumb dislocation...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26645..............  Treat thumb fracture......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26650..............  Treat thumb fracture......  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
26665..............  Treat thumb fracture......  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
26670..............  Treat hand dislocation....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26675..............  Treat hand dislocation....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26676..............  Pin hand dislocation......  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
26685..............  Treat hand dislocation....  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
26686..............  Treat hand dislocation....  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
26700..............  Treat knuckle dislocation.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26705..............  Treat knuckle dislocation.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26706..............  Pin knuckle dislocation...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26715..............  Treat knuckle dislocation.  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
26720..............  Treat finger fracture,      ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      each.
26725..............  Treat finger fracture,      ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      each.
26727..............  Treat finger fracture,      ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
                      each.
26735..............  Treat finger fracture,      ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      each.
26740..............  Treat finger fracture,      ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      each.
26742..............  Treat finger fracture,      ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      each.
26746..............  Treat finger fracture,      ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      each.
26750..............  Treat finger fracture,      ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      each.
26755..............  Treat finger fracture,      ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      each.
26756..............  Pin finger fracture, each.  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
26765..............  Treat finger fracture,      ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      each.
26770..............  Treat finger dislocation..  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26775..............  Treat finger dislocation..  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
26776..............  Pin finger dislocation....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
26785..............  Treat finger dislocation..  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
26820..............  Thumb fusion with graft...  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26841..............  Fusion of thumb...........  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26842..............  Thumb fusion with graft...  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26843..............  Fusion of hand joint......  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26844..............  Fusion/graft of hand joint  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26850..............  Fusion of knuckle.........  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26852..............  Fusion of knuckle with      ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      graft.
26860..............  Fusion of finger joint....  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26861..............  Fusion of finger jnt, add-  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      on.
26862..............  Fusion/graft of finger      ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
                      joint.
26863..............  Fuse/graft added joint....  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26910..............  Amputate metacarpal bone..  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
26951..............  Amputation of finger/thumb  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26952..............  Amputation of finger/thumb  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
26989..............  Hand/finger surgery.......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
26990..............  Drainage of pelvis lesion.  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
26991..............  Drainage of pelvis bursa..  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
26992..............  Drainage of bone lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27000..............  Incision of hip tendon....  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27001..............  Incision of hip tendon....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27003..............  Incision of hip tendon....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27005..............  Incision of hip tendon....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27006..............  Incision of hip tendons...  CH................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27025..............  Incision of hip/thigh       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fascia.
27030..............  Drainage of hip joint.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27033..............  Exploration of hip joint..  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27035..............  Denervation of hip joint..  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27036..............  Excision of hip joint/      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      muscle.
27040..............  Biopsy of soft tissues....  ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
27041..............  Biopsy of soft tissues....  ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
27047..............  Remove hip/pelvis lesion..  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
27048..............  Remove hip/pelvis lesion..  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
27049..............  Remove tumor, hip/pelvis..  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
27050..............  Biopsy of sacroiliac joint  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27052..............  Biopsy of hip joint.......  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27054..............  Removal of hip joint        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lining.
27060..............  Removal of ischial bursa..  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27062..............  Remove femur lesion/bursa.  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27065..............  Removal of hip bone lesion  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27066..............  Removal of hip bone lesion  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27067..............  Remove/graft hip bone       ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      lesion.
27070..............  Partial removal of hip      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bone.
27071..............  Partial removal of hip      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bone.

[[Page 42917]]

 
27075..............  Extensive hip surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27076..............  Extensive hip surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27077..............  Extensive hip surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27078..............  Extensive hip surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27079..............  Extensive hip surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27080..............  Removal of tail bone......  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27086..............  Remove hip foreign body...  ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
27087..............  Remove hip foreign body...  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27090..............  Removal of hip prosthesis.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27091..............  Removal of hip prosthesis.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27093..............  Injection for hip x-ray...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
27095..............  Injection for hip x-ray...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
27096..............  Inject sacroiliac joint...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
27097..............  Revision of hip tendon....  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27098..............  Transfer tendon to pelvis.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27100..............  Transfer of abdominal       ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      muscle.
27105..............  Transfer of spinal muscle.  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27110..............  Transfer of iliopsoas       ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      muscle.
27111..............  Transfer of iliopsoas       ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      muscle.
27120..............  Reconstruction of hip       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      socket.
27122..............  Reconstruction of hip       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      socket.
27125..............  Partial hip replacement...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27130..............  Total hip arthroplasty....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27132..............  Total hip arthroplasty....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27134..............  Revise hip joint            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
27137..............  Revise hip joint            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
27138..............  Revise hip joint            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
27140..............  Transplant femur ridge....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27146..............  Incision of hip bone......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27147..............  Revision of hip bone......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27151..............  Incision of hip bones.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27156..............  Revision of hip bones.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27158..............  Revision of pelvis........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27161..............  Incision of neck of femur.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27165..............  Incision/fixation of femur  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27170..............  Repair/graft femur head/    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      neck.
27175..............  Treat slipped epiphysis...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27176..............  Treat slipped epiphysis...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27177..............  Treat slipped epiphysis...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27178..............  Treat slipped epiphysis...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27179..............  Revise head/neck of femur.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27181..............  Treat slipped epiphysis...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27185..............  Revision of femur           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      epiphysis.
27187..............  Reinforce hip bones.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27193..............  Treat pelvic ring fracture  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27194..............  Treat pelvic ring fracture  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
27200..............  Treat tail bone fracture..  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27202..............  Treat tail bone fracture..  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
27215..............  Treat pelvic fracture(s)..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27216..............  Treat pelvic ring fracture  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27217..............  Treat pelvic ring fracture  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27218..............  Treat pelvic ring fracture  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27220..............  Treat hip socket fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27222..............  Treat hip socket fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27226..............  Treat hip wall fracture...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27227..............  Treat hip fracture(s).....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27228..............  Treat hip fracture(s).....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27230..............  Treat thigh fracture......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27232..............  Treat thigh fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27235..............  Treat thigh fracture......  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27236..............  Treat thigh fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27238..............  Treat thigh fracture......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27240..............  Treat thigh fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27244..............  Treat thigh fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27245..............  Treat thigh fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27246..............  Treat thigh fracture......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27248..............  Treat thigh fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27250..............  Treat hip dislocation.....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27252..............  Treat hip dislocation.....  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
27253..............  Treat hip dislocation.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27254..............  Treat hip dislocation.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27256..............  Treat hip dislocation.....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27257..............  Treat hip dislocation.....  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
27258..............  Treat hip dislocation.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27259..............  Treat hip dislocation.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27265..............  Treat hip dislocation.....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27266..............  Treat hip dislocation.....  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
27275..............  Manipulation of hip joint.  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30

[[Page 42918]]

 
27280..............  Fusion of sacroiliac joint  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27282..............  Fusion of pubic bones.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27284..............  Fusion of hip joint.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27286..............  Fusion of hip joint.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27290..............  Amputation of leg at hip..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27295..............  Amputation of leg at hip..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27299..............  Pelvis/hip joint surgery..  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27301..............  Drain thigh/knee lesion...  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
27303..............  Drainage of bone lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27305..............  Incise thigh tendon &       ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      fascia.
27306..............  Incision of thigh tendon..  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27307..............  Incision of thigh tendons.  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27310..............  Exploration of knee joint.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27323..............  Biopsy, thigh soft tissues  ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
27324..............  Biopsy, thigh soft tissues  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
27325..............  Neurectomy, hamstring.....  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
27326..............  Neurectomy, popliteal.....  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
27327..............  Removal of thigh lesion...  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
27328..............  Removal of thigh lesion...  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
27329..............  Remove tumor, thigh/knee..  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
27330..............  Biopsy, knee joint lining.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27331..............  Explore/treat knee joint..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27332..............  Removal of knee cartilage.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27333..............  Removal of knee cartilage.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27334..............  Remove knee joint lining..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27335..............  Remove knee joint lining..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27340..............  Removal of kneecap bursa..  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27345..............  Removal of knee cyst......  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27347..............  Remove knee cyst..........  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27350..............  Removal of kneecap........  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27355..............  Remove femur lesion.......  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27356..............  Remove femur lesion/graft.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27357..............  Remove femur lesion/graft.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27358..............  Remove femur lesion/        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      fixation.
27360..............  Partial removal, leg        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      bone(s).
27365..............  Extensive leg surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27370..............  Injection for knee x-ray..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
27372..............  Removal of foreign body...  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
27380..............  Repair of kneecap tendon..  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27381..............  Repair/graft kneecap        ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      tendon.
27385..............  Repair of thigh muscle....  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27386..............  Repair/graft of thigh       ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      muscle.
27390..............  Incision of thigh tendon..  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27391..............  Incision of thigh tendons.  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27392..............  Incision of thigh tendons.  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27393..............  Lengthening of thigh        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      tendon.
27394..............  Lengthening of thigh        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      tendons.
27395..............  Lengthening of thigh        ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      tendons.
27396..............  Transplant of thigh tendon  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27397..............  Transplants of thigh        ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      tendons.
27400..............  Revise thigh muscles/       ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      tendons.
27403..............  Repair of knee cartilage..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27405..............  Repair of knee ligament...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27407..............  Repair of knee ligament...  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
27409..............  Repair of knee ligaments..  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27412..............  Autochondrocyte implant     ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
                      knee.
27415..............  Osteochondral knee          ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
                      allograft.
27418..............  Repair degenerated kneecap  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27420..............  Revision of unstable        ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      kneecap.
27422..............  Revision of unstable        ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      kneecap.
27424..............  Revision/removal of         ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      kneecap.
27425..............  Lat retinacular release     ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      open.
27427..............  Reconstruction, knee......  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27428..............  Reconstruction, knee......  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
27429..............  Reconstruction, knee......  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
27430..............  Revision of thigh muscles.  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27435..............  Incision of knee joint....  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27437..............  Revise kneecap............  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
27438..............  Revise kneecap with         ..................  T.................         0048      51.0431    $3,251.09  ...........      $650.22
                      implant.
27440..............  Revision of knee joint....  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
27441..............  Revision of knee joint....  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
27442..............  Revision of knee joint....  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
27443..............  Revision of knee joint....  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
27445..............  Revision of knee joint....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27446..............  Revision of knee joint....  ..................  T.................         0681     191.2387   $12,180.57  ...........    $2,436.11
27447..............  Total knee arthroplasty...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27448..............  Incision of thigh.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27450..............  Incision of thigh.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42919]]

 
27454..............  Realignment of thigh bone.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27455..............  Realignment of knee.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27457..............  Realignment of knee.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27465..............  Shortening of thigh bone..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27466..............  Lengthening of thigh bone.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27468..............  Shorten/lengthen thighs...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27470..............  Repair of thigh...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27472..............  Repair/graft of thigh.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27475..............  Surgery to stop leg growth  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27477..............  Surgery to stop leg growth  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27479..............  Surgery to stop leg growth  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27485..............  Surgery to stop leg growth  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27486..............  Revise/replace knee joint.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27487..............  Revise/replace knee joint.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27488..............  Removal of knee prosthesis  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27495..............  Reinforce thigh...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27496..............  Decompression of thigh/     ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      knee.
27497..............  Decompression of thigh/     ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      knee.
27498..............  Decompression of thigh/     ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      knee.
27499..............  Decompression of thigh/     ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      knee.
27500..............  Treatment of thigh          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27501..............  Treatment of thigh          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27502..............  Treatment of thigh          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27503..............  Treatment of thigh          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27506..............  Treatment of thigh          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
27507..............  Treatment of thigh          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
27508..............  Treatment of thigh          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27509..............  Treatment of thigh          ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
                      fracture.
27510..............  Treatment of thigh          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27511..............  Treatment of thigh          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
27513..............  Treatment of thigh          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
27514..............  Treatment of thigh          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
27516..............  Treat thigh fx growth       ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      plate.
27517..............  Treat thigh fx growth       ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      plate.
27519..............  Treat thigh fx growth       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      plate.
27520..............  Treat kneecap fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27524..............  Treat kneecap fracture....  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
27530..............  Treat knee fracture.......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27532..............  Treat knee fracture.......  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27535..............  Treat knee fracture.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27536..............  Treat knee fracture.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27538..............  Treat knee fracture(s)....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27540..............  Treat knee fracture.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27550..............  Treat knee dislocation....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27552..............  Treat knee dislocation....  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
27556..............  Treat knee dislocation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27557..............  Treat knee dislocation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27558..............  Treat knee dislocation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27560..............  Treat kneecap dislocation.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27562..............  Treat kneecap dislocation.  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
27566..............  Treat kneecap dislocation.  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
27570..............  Fixation of knee joint....  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
27580..............  Fusion of knee............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27590..............  Amputate leg at thigh.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27591..............  Amputate leg at thigh.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27592..............  Amputate leg at thigh.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27594..............  Amputation follow-up        ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      surgery.
27596..............  Amputation follow-up        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
27598..............  Amputate lower leg at knee  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27599..............  Leg surgery procedure.....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27600..............  Decompression of lower leg  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27601..............  Decompression of lower leg  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27602..............  Decompression of lower leg  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27603..............  Drain lower leg lesion....  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
27604..............  Drain lower leg bursa.....  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27605..............  Incision of achilles        ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      tendon.
27606..............  Incision of achilles        ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      tendon.
27607..............  Treat lower leg bone        ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      lesion.
27610..............  Explore/treat ankle joint.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27612..............  Exploration of ankle joint  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27613..............  Biopsy lower leg soft       ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      tissue.
27614..............  Biopsy lower leg soft       ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
                      tissue.
27615..............  Remove tumor, lower leg...  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27618..............  Remove lower leg lesion...  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
27619..............  Remove lower leg lesion...  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
27620..............  Explore/treat ankle joint.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27625..............  Remove ankle joint lining.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27626..............  Remove ankle joint lining.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58

[[Page 42920]]

 
27630..............  Removal of tendon lesion..  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27635..............  Remove lower leg bone       ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      lesion.
27637..............  Remove/graft leg bone       ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      lesion.
27638..............  Remove/graft leg bone       ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      lesion.
27640..............  Partial removal of tibia..  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27641..............  Partial removal of fibula.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27645..............  Extensive lower leg         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
27646..............  Extensive lower leg         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
27647..............  Extensive ankle/heel        ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      surgery.
27648..............  Injection for ankle x-ray.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
27650..............  Repair achilles tendon....  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27652..............  Repair/graft achilles       ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
                      tendon.
27654..............  Repair of achilles tendon.  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27656..............  Repair leg fascia defect..  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27658..............  Repair of leg tendon, each  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27659..............  Repair of leg tendon, each  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27664..............  Repair of leg tendon, each  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27665..............  Repair of leg tendon, each  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27675..............  Repair lower leg tendons..  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27676..............  Repair lower leg tendons..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27680..............  Release of lower leg        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      tendon.
27681..............  Release of lower leg        ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      tendons.
27685..............  Revision of lower leg       ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      tendon.
27686..............  Revise lower leg tendons..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27687..............  Revision of calf tendon...  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27690..............  Revise lower leg tendon...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27691..............  Revise lower leg tendon...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27692..............  Revise additional leg       ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
                      tendon.
27695..............  Repair of ankle ligament..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27696..............  Repair of ankle ligaments.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27698..............  Repair of ankle ligament..  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27700..............  Revision of ankle joint...  ..................  T.................         0047      35.9249    $2,288.16      $537.00      $457.63
27702..............  Reconstruct ankle joint...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27703..............  Reconstruction, ankle       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      joint.
27704..............  Removal of ankle implant..  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27705..............  Incision of tibia.........  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27707..............  Incision of fibula........  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27709..............  Incision of tibia & fibula  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27712..............  Realignment of lower leg..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27715..............  Revision of lower leg.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27720..............  Repair of tibia...........  CH................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
27722..............  Repair/graft of tibia.....  CH................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
27724..............  Repair/graft of tibia.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27725..............  Repair of lower leg.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27727..............  Repair of lower leg.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27730..............  Repair of tibia epiphysis.  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27732..............  Repair of fibula epiphysis  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27734..............  Repair lower leg epiphyses  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27740..............  Repair of leg epiphyses...  ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
27742..............  Repair of leg epiphyses...  ..................  T.................         0051      43.5953    $2,776.72  ...........      $555.34
27745..............  Reinforce tibia...........  ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
27750..............  Treatment of tibia          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27752..............  Treatment of tibia          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27756..............  Treatment of tibia          ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
                      fracture.
27758..............  Treatment of tibia          ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      fracture.
27759..............  Treatment of tibia          ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
                      fracture.
27760..............  Treatment of ankle          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27762..............  Treatment of ankle          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27766..............  Treatment of ankle          ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      fracture.
27780..............  Treatment of fibula         ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27781..............  Treatment of fibula         ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27784..............  Treatment of fibula         ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      fracture.
27786..............  Treatment of ankle          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27788..............  Treatment of ankle          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27792..............  Treatment of ankle          ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      fracture.
27808..............  Treatment of ankle          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27810..............  Treatment of ankle          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27814..............  Treatment of ankle          ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      fracture.
27816..............  Treatment of ankle          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27818..............  Treatment of ankle          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
27822..............  Treatment of ankle          ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      fracture.
27823..............  Treatment of ankle          ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
                      fracture.
27824..............  Treat lower leg fracture..  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27825..............  Treat lower leg fracture..  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27826..............  Treat lower leg fracture..  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
27827..............  Treat lower leg fracture..  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
27828..............  Treat lower leg fracture..  ..................  T.................         0064      60.0595    $3,825.37      $835.70      $765.07
27829..............  Treat lower leg joint.....  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96

[[Page 42921]]

 
27830..............  Treat lower leg             ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      dislocation.
27831..............  Treat lower leg             ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      dislocation.
27832..............  Treat lower leg             ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      dislocation.
27840..............  Treat ankle dislocation...  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
27842..............  Treat ankle dislocation...  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
27846..............  Treat ankle dislocation...  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
27848..............  Treat ankle dislocation...  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
27860..............  Fixation of ankle joint...  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
27870..............  Fusion of ankle joint,      ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
                      open.
27871..............  Fusion of tibiofibular      ..................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
                      joint.
27880..............  Amputation of lower leg...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27881..............  Amputation of lower leg...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27882..............  Amputation of lower leg...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27884..............  Amputation follow-up        ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      surgery.
27886..............  Amputation follow-up        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
27888..............  Amputation of foot at       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ankle.
27889..............  Amputation of foot at       ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      ankle.
27892..............  Decompression of leg......  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27893..............  Decompression of leg......  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27894..............  Decompression of leg......  ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
27899..............  Leg/ankle surgery           ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      procedure.
28001..............  Drainage of bursa of foot.  ..................  T.................         0007      12.5792      $801.21  ...........      $160.24
28002..............  Treatment of foot           ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      infection.
28003..............  Treatment of foot           ..................  T.................         0049      21.5761    $1,374.25  ...........      $274.85
                      infection.
28005..............  Treat foot bone lesion....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28008..............  Incision of foot fascia...  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28010..............  Incision of toe tendon....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28011..............  Incision of toe tendons...  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28020..............  Exploration of foot joint.  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28022..............  Exploration of foot joint.  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28024..............  Exploration of toe joint..  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28035..............  Decompression of tibia      ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
                      nerve.
28043..............  Excision of foot lesion...  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
28045..............  Excision of foot lesion...  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28046..............  Resection of tumor, foot..  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28050..............  Biopsy of foot joint        ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      lining.
28052..............  Biopsy of foot joint        ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      lining.
28054..............  Biopsy of toe joint lining  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28055..............  Neurectomy, foot..........  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
28060..............  Partial removal, foot       ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      fascia.
28062..............  Removal of foot fascia....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28070..............  Removal of foot joint       ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      lining.
28072..............  Removal of foot joint       ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      lining.
28080..............  Removal of foot lesion....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28086..............  Excise foot tendon sheath.  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28088..............  Excise foot tendon sheath.  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28090..............  Removal of foot lesion....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28092..............  Removal of toe lesions....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28100..............  Removal of ankle/heel       ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      lesion.
28102..............  Remove/graft foot lesion..  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28103..............  Remove/graft foot lesion..  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28104..............  Removal of foot lesion....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28106..............  Remove/graft foot lesion..  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28107..............  Remove/graft foot lesion..  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28108..............  Removal of toe lesions....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28110..............  Part removal of metatarsal  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28111..............  Part removal of metatarsal  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28112..............  Part removal of metatarsal  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28113..............  Part removal of metatarsal  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28114..............  Removal of metatarsal       ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      heads.
28116..............  Revision of foot..........  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28118..............  Removal of heel bone......  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28119..............  Removal of heel spur......  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28120..............  Part removal of ankle/heel  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28122..............  Partial removal of foot     ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      bone.
28124..............  Partial removal of toe....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28126..............  Partial removal of toe....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28130..............  Removal of ankle bone.....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28140..............  Removal of metatarsal.....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28150..............  Removal of toe............  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28153..............  Partial removal of toe....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28160..............  Partial removal of toe....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28171..............  Extensive foot surgery....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28173..............  Extensive foot surgery....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28175..............  Extensive foot surgery....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28190..............  Removal of foot foreign     ..................  T.................         0019       4.4463      $283.20       $71.80       $56.64
                      body.
28192..............  Removal of foot foreign     ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      body.
28193..............  Removal of foot foreign     ..................  T.................         0020       8.7155      $555.12  ...........      $111.02
                      body.

[[Page 42922]]

 
28200..............  Repair of foot tendon.....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28202..............  Repair/graft of foot        ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      tendon.
28208..............  Repair of foot tendon.....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28210..............  Repair/graft of foot        ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
                      tendon.
28220..............  Release of foot tendon....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28222..............  Release of foot tendons...  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28225..............  Release of foot tendon....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28226..............  Release of foot tendons...  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28230..............  Incision of foot tendon(s)  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28232..............  Incision of toe tendon....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28234..............  Incision of foot tendon...  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28238..............  Revision of foot tendon...  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28240..............  Release of big toe........  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28250..............  Revision of foot fascia...  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28260..............  Release of midfoot joint..  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28261..............  Revision of foot tendon...  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28262..............  Revision of foot and ankle  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28264..............  Release of midfoot joint..  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28270..............  Release of foot             ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      contracture.
28272..............  Release of toe joint, each  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28280..............  Fusion of toes............  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28285..............  Repair of hammertoe.......  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28286..............  Repair of hammertoe.......  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28288..............  Partial removal of foot     ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      bone.
28289..............  Repair hallux rigidus.....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28290..............  Correction of bunion......  ..................  T.................         0057      29.8356    $1,900.32      $475.90      $380.06
28292..............  Correction of bunion......  ..................  T.................         0057      29.8356    $1,900.32      $475.90      $380.06
28293..............  Correction of bunion......  ..................  T.................         0057      29.8356    $1,900.32      $475.90      $380.06
28294..............  Correction of bunion......  ..................  T.................         0057      29.8356    $1,900.32      $475.90      $380.06
28296..............  Correction of bunion......  ..................  T.................         0057      29.8356    $1,900.32      $475.90      $380.06
28297..............  Correction of bunion......  ..................  T.................         0057      29.8356    $1,900.32      $475.90      $380.06
28298..............  Correction of bunion......  ..................  T.................         0057      29.8356    $1,900.32      $475.90      $380.06
28299..............  Correction of bunion......  ..................  T.................         0057      29.8356    $1,900.32      $475.90      $380.06
28300..............  Incision of heel bone.....  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28302..............  Incision of ankle bone....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28304..............  Incision of midfoot bones.  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28305..............  Incise/graft midfoot bones  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28306..............  Incision of metatarsal....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28307..............  Incision of metatarsal....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28308..............  Incision of metatarsal....  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28309..............  Incision of metatarsals...  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28310..............  Revision of big toe.......  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28312..............  Revision of toe...........  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28313..............  Repair deformity of toe...  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28315..............  Removal of sesamoid bone..  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28320..............  Repair of foot bones......  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28322..............  Repair of metatarsals.....  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28340..............  Resect enlarged toe tissue  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28341..............  Resect enlarged toe.......  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28344..............  Repair extra toe(s).......  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28345..............  Repair webbed toe(s)......  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28360..............  Reconstruct cleft foot....  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28400..............  Treatment of heel fracture  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28405..............  Treatment of heel fracture  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28406..............  Treatment of heel fracture  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
28415..............  Treat heel fracture.......  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
28420..............  Treat/graft heel fracture.  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
28430..............  Treatment of ankle          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
28435..............  Treatment of ankle          ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
28436..............  Treatment of ankle          ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
                      fracture.
28445..............  Treat ankle fracture......  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
28450..............  Treat midfoot fracture,     ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      each.
28455..............  Treat midfoot fracture,     ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      each.
28456..............  Treat midfoot fracture....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
28465..............  Treat midfoot fracture,     ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      each.
28470..............  Treat metatarsal fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28475..............  Treat metatarsal fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28476..............  Treat metatarsal fracture.  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
28485..............  Treat metatarsal fracture.  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
28490..............  Treat big toe fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28495..............  Treat big toe fracture....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28496..............  Treat big toe fracture....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
28505..............  Treat big toe fracture....  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
28510..............  Treatment of toe fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28515..............  Treatment of toe fracture.  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28525..............  Treat toe fracture........  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
28530..............  Treat sesamoid bone         ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      fracture.
28531..............  Treat sesamoid bone         ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
                      fracture.

[[Page 42923]]

 
28540..............  Treat foot dislocation....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28545..............  Treat foot dislocation....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
28546..............  Treat foot dislocation....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
28555..............  Repair foot dislocation...  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
28570..............  Treat foot dislocation....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28575..............  Treat foot dislocation....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28576..............  Treat foot dislocation....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
28585..............  Repair foot dislocation...  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
28600..............  Treat foot dislocation....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28605..............  Treat foot dislocation....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28606..............  Treat foot dislocation....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
28615..............  Repair foot dislocation...  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
28630..............  Treat toe dislocation.....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28635..............  Treat toe dislocation.....  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
28636..............  Treat toe dislocation.....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
28645..............  Repair toe dislocation....  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
28660..............  Treat toe dislocation.....  ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
28665..............  Treat toe dislocation.....  ..................  T.................         0045      15.0176      $956.52      $268.40      $191.30
28666..............  Treat toe dislocation.....  ..................  T.................         0062      26.3092    $1,675.71      $372.80      $335.14
28675..............  Repair of toe dislocation.  ..................  T.................         0063      40.3466    $2,569.80      $548.30      $513.96
28705..............  Fusion of foot bones......  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28715..............  Fusion of foot bones......  CH................  T.................         0052      78.6518    $5,009.57  ...........    $1,001.91
28725..............  Fusion of foot bones......  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28730..............  Fusion of foot bones......  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28735..............  Fusion of foot bones......  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28737..............  Revision of foot bones....  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28740..............  Fusion of foot bones......  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28750..............  Fusion of big toe joint...  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28755..............  Fusion of big toe joint...  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28760..............  Fusion of big toe joint...  ..................  T.................         0056       44.471    $2,832.49  ...........      $566.50
28800..............  Amputation of midfoot.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
28805..............  Amputation thru metatarsal  ..................  C.................  ...........  ...........  ...........  ...........  ...........
28810..............  Amputation toe &            ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
                      metatarsal.
28820..............  Amputation of toe.........  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28825..............  Partial amputation of toe.  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
28890..............  High energy eswt, plantar   ..................  T.................         0050      29.3263    $1,867.88  ...........      $373.58
                      f.
28899..............  Foot/toes surgery           ..................  T.................         0043       1.8742      $119.37  ...........       $23.87
                      procedure.
29000..............  Application of body cast..  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29010..............  Application of body cast..  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29015..............  Application of body cast..  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29020..............  Application of body cast..  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29025..............  Application of body cast..  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29035..............  Application of body cast..  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29040..............  Application of body cast..  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29044..............  Application of body cast..  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29046..............  Application of body cast..  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29049..............  Application of figure       ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
                      eight.
29055..............  Application of shoulder     ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
                      cast.
29058..............  Application of shoulder     ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
                      cast.
29065..............  Application of long arm     ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
                      cast.
29075..............  Application of forearm      ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
                      cast.
29085..............  Apply hand/wrist cast.....  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29086..............  Apply finger cast.........  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29105..............  Apply long arm splint.....  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29125..............  Apply forearm splint......  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29126..............  Apply forearm splint......  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29130..............  Application of finger       ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
                      splint.
29131..............  Application of finger       ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
                      splint.
29200..............  Strapping of chest........  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29220..............  Strapping of low back.....  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29240..............  Strapping of shoulder.....  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29260..............  Strapping of elbow or       ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
                      wrist.
29280..............  Strapping of hand or        ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
                      finger.
29305..............  Application of hip cast...  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29325..............  Application of hip casts..  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29345..............  Application of long leg     ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
                      cast.
29355..............  Application of long leg     ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
                      cast.
29358..............  Apply long leg cast brace.  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29365..............  Application of long leg     ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
                      cast.
29405..............  Apply short leg cast......  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29425..............  Apply short leg cast......  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29435..............  Apply short leg cast......  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29440..............  Addition of walker to cast  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29445..............  Apply rigid leg cast......  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29450..............  Application of leg cast...  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29505..............  Application, long leg       ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
                      splint.
29515..............  Application lower leg       ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
                      splint.
29520..............  Strapping of hip..........  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36

[[Page 42924]]

 
29530..............  Strapping of knee.........  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29540..............  Strapping of ankle and/or   ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
                      ft.
29550..............  Strapping of toes.........  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29580..............  Application of paste boot.  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29590..............  Application of foot splint  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29700..............  Removal/revision of cast..  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29705..............  Removal/revision of cast..  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29710..............  Removal/revision of cast..  ..................  S.................         0426       2.2383      $142.56  ...........       $28.51
29715..............  Removal/revision of cast..  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29720..............  Repair of body cast.......  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29730..............  Windowing of cast.........  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29740..............  Wedging of cast...........  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29750..............  Wedging of clubfoot cast..  ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
29799..............  Casting/strapping           ..................  S.................         0058       1.1272       $71.79  ...........       $14.36
                      procedure.
29800..............  Jaw arthroscopy/surgery...  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29804..............  Jaw arthroscopy/surgery...  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29805..............  Shoulder arthroscopy, dx..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29806..............  Shoulder arthroscopy/       ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
                      surgery.
29807..............  Shoulder arthroscopy/       ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
                      surgery.
29819..............  Shoulder arthroscopy/       ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
                      surgery.
29820..............  Shoulder arthroscopy/       ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
                      surgery.
29821..............  Shoulder arthroscopy/       ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
                      surgery.
29822..............  Shoulder arthroscopy/       ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
                      surgery.
29823..............  Shoulder arthroscopy/       ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
                      surgery.
29824..............  Shoulder arthroscopy/       ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
                      surgery.
29825..............  Shoulder arthroscopy/       ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
                      surgery.
29826..............  Shoulder arthroscopy/       ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
                      surgery.
29827..............  Arthroscop rotator cuff     ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
                      repr.
29830..............  Elbow arthroscopy.........  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29834..............  Elbow arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29835..............  Elbow arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29836..............  Elbow arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29837..............  Elbow arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29838..............  Elbow arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29840..............  Wrist arthroscopy.........  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29843..............  Wrist arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29844..............  Wrist arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29845..............  Wrist arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29846..............  Wrist arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29847..............  Wrist arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29848..............  Wrist endoscopy/surgery...  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29850..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29851..............  Knee arthroscopy/surgery..  ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
29855..............  Tibial arthroscopy/surgery  ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
29856..............  Tibial arthroscopy/surgery  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29860..............  Hip arthroscopy, dx.......  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29861..............  Hip arthroscopy/surgery...  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29862..............  Hip arthroscopy/surgery...  ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
29863..............  Hip arthroscopy/surgery...  ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
29866..............  Autgrft implnt, knee w/     ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
                      scope.
29867..............  Allgrft implnt, knee w/     ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
                      scope.
29868..............  Meniscal trnspl, knee w/    ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
                      scpe.
29870..............  Knee arthroscopy, dx......  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29871..............  Knee arthroscopy/drainage.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29873..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29874..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29875..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29876..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29877..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29879..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29880..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29881..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29882..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29883..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29884..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29885..............  Knee arthroscopy/surgery..  ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
29886..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29887..............  Knee arthroscopy/surgery..  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29888..............  Knee arthroscopy/surgery..  ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
29889..............  Knee arthroscopy/surgery..  ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61
29891..............  Ankle arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29892..............  Ankle arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29893..............  Scope, plantar fasciotomy.  ..................  T.................         0055      21.1762    $1,348.78      $355.30      $269.76
29894..............  Ankle arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29895..............  Ankle arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29897..............  Ankle arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29898..............  Ankle arthroscopy/surgery.  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
29899..............  Ankle arthroscopy/surgery.  ..................  T.................         0042      47.7765    $3,043.03      $804.70      $608.61

[[Page 42925]]

 
29900..............  Mcp joint arthroscopy, dx.  ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
29901..............  Mcp joint arthroscopy,      ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      surg.
29902..............  Mcp joint arthroscopy,      ..................  T.................         0053       16.822    $1,071.44      $253.40      $214.29
                      surg.
29999..............  Arthroscopy of joint......  ..................  T.................         0041      29.4467    $1,875.55  ...........      $375.11
30000..............  Drainage of nose lesion...  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
30020..............  Drainage of nose lesion...  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
3006F..............  Cxr doc rev...............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30100..............  Intranasal biopsy.........  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
30110..............  Removal of nose polyp(s)..  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
30115..............  Removal of nose polyp(s)..  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
30117..............  Removal of intranasal       ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      lesion.
30118..............  Removal of intranasal       ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      lesion.
3011F..............  Lipid panel doc rev.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30120..............  Revision of nose..........  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
30124..............  Removal of nose lesion....  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
30125..............  Removal of nose lesion....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
30130..............  Excise inferior turbinate.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
30140..............  Resect inferior turbinate.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
3014F..............  Screen mammo doc rev......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30150..............  Partial removal of nose...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
30160..............  Removal of nose...........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
3017F..............  Colorectal ca screen doc    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rev.
30200..............  Injection treatment of      ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
                      nose.
3020F..............  Lvf assess................  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30210..............  Nasal sinus therapy.......  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
3021F..............  Lvef mod/sever deprs syst.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30220..............  Insert nasal septal button  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
3022F..............  Lvef =40% systolic........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3023F..............  Spirom doc rev............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3025F..............  Spirom fev/fvc<70% w copd.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3027F..............  Spirom fev/fvc=70%/ w/o     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      copd.
3028F..............  O2 saturation doc rev.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30300..............  Remove nasal foreign body.  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
30310..............  Remove nasal foreign body.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
30320..............  Remove nasal foreign body.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
3035F..............  O2 saturation =88% /pa0     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      =55.
3037F..............  O2 saturation> 88% /pao>55  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30400..............  Reconstruction of nose....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
3040F..............  Fev<40% predicted value...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30410..............  Reconstruction of nose....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
30420..............  Reconstruction of nose....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
3042F..............  Fev=40% predicted value...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30430..............  Revision of nose..........  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
30435..............  Revision of nose..........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
3044F..............  HG a1c level < 7.0%.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30450..............  Revision of nose..........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
3045F..............  HG a1c level 7.0-9.0%.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30460..............  Revision of nose..........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
30462..............  Revision of nose..........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
30465..............  Repair nasal stenosis.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
3046F..............  Hemoglobin a1c level >      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      9.0%.
3048F..............  LDL-C <100 mg/dL..........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3049F..............  LDL-C 100-129 mg/dL.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3050F..............  LDL-C = 130 mg/dL.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30520..............  Repair of nasal septum....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
30540..............  Repair nasal defect.......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
30545..............  Repair nasal defect.......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
30560..............  Release of nasal adhesions  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
30580..............  Repair upper jaw fistula..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
30600..............  Repair mouth/nose fistula.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
3060F..............  Pos microalbuminuria rev..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3061F..............  Neg microalbuminuria rev..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30620..............  Intranasal reconstruction.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
3062F..............  Pos macroalbuminuria rev..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30630..............  Repair nasal septum defect  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
3066F..............  Nephropathy doc tx........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3072F..............  Low risk for retinopathy..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3073F..............  Pre-surg eye measures       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
3074F..............  Syst bp < 130 mm hg.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3075F..............  Syst bp [gE]130-139 mm hg.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3077F..............  Syst bp = 140 mm hg.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3078F..............  Diast bp < 80 mm hg.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3079F..............  Diast bp 80-89 mm hg......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30801..............  Ablate inf turbinate,       ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
                      superf.
30802..............  Cauterization, inner nose.  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
3080F..............  Diast bp = 90 mm hg.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3082F..............  Kt/v <1.2.................  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3083F..............  Kt/v [gE] 1.2 and <1.7....  ..................  M.................  ...........  ...........  ...........  ...........  ...........

[[Page 42926]]

 
3084F..............  Kt/v[gE]1.7...............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3085F..............  Suicide risk assessed.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3088F..............  MDD, mild.................  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3089F..............  MDD, moderate.............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30901..............  Control of nosebleed......  ..................  T.................         0250       1.1708       $74.57       $25.30       $14.91
30903..............  Control of nosebleed......  ..................  T.................         0250       1.1708       $74.57       $25.30       $14.91
30905..............  Control of nosebleed......  ..................  T.................         0250       1.1708       $74.57       $25.30       $14.91
30906..............  Repeat control of           ..................  T.................         0250       1.1708       $74.57       $25.30       $14.91
                      nosebleed.
3090F..............  MDD, severe; w/o psych....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30915..............  Ligation, nasal sinus       ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
                      artery.
3091F..............  MDD, severe; w/ psych.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30920..............  Ligation, upper jaw artery  ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
3092F..............  MDD, in remission.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30930..............  Ther fx, nasal inf          ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      turbinate.
3093F..............  Doc new diag 1st/addl. mdd  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3095F..............  Central dexa results doc'd  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3096F..............  Central dexa ordered......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30999..............  Nasal surgery procedure...  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
31000..............  Irrigation, maxillary       ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
                      sinus.
31002..............  Irrigation, sphenoid sinus  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
3100F..............  Carot blk doc'd w/ carot    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ref.
3101F..............  Intl carot blk 30-99%       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      range.
31020..............  Exploration, maxillary      ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      sinus.
3102F..............  Int carot blk < 30%.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
31030..............  Exploration, maxillary      ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      sinus.
31032..............  Explore sinus, remove       ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      polyps.
31040..............  Exploration behind upper    ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      jaw.
31050..............  Exploration, sphenoid       ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      sinus.
31051..............  Sphenoid sinus surgery....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31070..............  Exploration of frontal      ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      sinus.
31075..............  Exploration of frontal      ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      sinus.
31080..............  Removal of frontal sinus..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31081..............  Removal of frontal sinus..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31084..............  Removal of frontal sinus..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31085..............  Removal of frontal sinus..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31086..............  Removal of frontal sinus..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31087..............  Removal of frontal sinus..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31090..............  Exploration of sinuses....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
3110F..............  Pres/absn hmrhg/lesion      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
3111F..............  Ct/mri brain done w/in      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      24hrs.
3112F..............  Ct/mri brain done > 24 hrs  ..................  M.................  ...........  ...........  ...........  ...........  ...........
31200..............  Removal of ethmoid sinus..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31201..............  Removal of ethmoid sinus..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31205..............  Removal of ethmoid sinus..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
3120F..............  12-lead ecg performed.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
31225..............  Removal of upper jaw......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31230..............  Removal of upper jaw......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31231..............  Nasal endoscopy, dx.......  ..................  T.................         0072        1.573      $100.19       $21.20       $20.04
31233..............  Nasal/sinus endoscopy, dx.  ..................  T.................         0072        1.573      $100.19       $21.20       $20.04
31235..............  Nasal/sinus endoscopy, dx.  ..................  T.................         0074      17.4546    $1,111.74      $292.20      $222.35
31237..............  Nasal/sinus endoscopy,      ..................  T.................         0074      17.4546    $1,111.74      $292.20      $222.35
                      surg.
31238..............  Nasal/sinus endoscopy,      ..................  T.................         0074      17.4546    $1,111.74      $292.20      $222.35
                      surg.
31239..............  Nasal/sinus endoscopy,      ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      surg.
31240..............  Nasal/sinus endoscopy,      ..................  T.................         0074      17.4546    $1,111.74      $292.20      $222.35
                      surg.
31254..............  Revision of ethmoid sinus.  ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
31255..............  Removal of ethmoid sinus..  ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
31256..............  Exploration maxillary       ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      sinus.
31267..............  Endoscopy, maxillary sinus  ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
31276..............  Sinus endoscopy, surgical.  ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
31287..............  Nasal/sinus endoscopy,      ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      surg.
31288..............  Nasal/sinus endoscopy,      ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      surg.
31290..............  Nasal/sinus endoscopy,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
31291..............  Nasal/sinus endoscopy,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
31292..............  Nasal/sinus endoscopy,      ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      surg.
31293..............  Nasal/sinus endoscopy,      ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      surg.
31294..............  Nasal/sinus endoscopy,      ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      surg.
31299..............  Sinus surgery procedure...  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
31300..............  Removal of larynx lesion..  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
3130F..............  Upper gi endoscopy          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      performed.
31320..............  Diagnostic incision,        ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      larynx.
3132F..............  Doc ref. upper gi           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      endoscopy.
31360..............  Removal of larynx.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31365..............  Removal of larynx.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31367..............  Partial removal of larynx.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31368..............  Partial removal of larynx.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31370..............  Partial removal of larynx.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31375..............  Partial removal of larynx.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31380..............  Partial removal of larynx.  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42927]]

 
31382..............  Partial removal of larynx.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31390..............  Removal of larynx &         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pharynx.
31395..............  Reconstruct larynx &        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pharynx.
31400..............  Revision of larynx........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
3140F..............  Forceps esoph biopsy done.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3141F..............  Upper gi endo shows         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      barrtt's.
31420..............  Removal of epiglottis.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
3142F..............  Upper gi endo not barrtt's  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3143F..............  Doc order barium swallow    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      tst.
31500..............  Insert emergency airway...  ..................  S.................         0094       2.5547      $162.72       $46.20       $32.54
31502..............  Change of windpipe airway.  CH................  S.................         0078       1.3636       $86.85  ...........       $17.37
31505..............  Diagnostic laryngoscopy...  ..................  T.................         0071       0.8256       $52.58       $11.20       $10.52
31510..............  Laryngoscopy with biopsy..  ..................  T.................         0074      17.4546    $1,111.74      $292.20      $222.35
31511..............  Remove foreign body,        ..................  T.................         0072        1.573      $100.19       $21.20       $20.04
                      larynx.
31512..............  Removal of larynx lesion..  ..................  T.................         0074      17.4546    $1,111.74      $292.20      $222.35
31513..............  Injection into vocal cord.  ..................  T.................         0072        1.573      $100.19       $21.20       $20.04
31515..............  Laryngoscopy for            ..................  T.................         0074      17.4546    $1,111.74      $292.20      $222.35
                      aspiration.
31520..............  Dx laryngoscopy, newborn..  ..................  T.................         0072        1.573      $100.19       $21.20       $20.04
31525..............  Dx laryngoscopy excl nb...  ..................  T.................         0074      17.4546    $1,111.74      $292.20      $222.35
31526..............  Dx laryngoscopy w/oper      ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      scope.
31527..............  Laryngoscopy for treatment  ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
31528..............  Laryngoscopy and dilation.  ..................  T.................         0074      17.4546    $1,111.74      $292.20      $222.35
31529..............  Laryngoscopy and dilation.  ..................  T.................         0074      17.4546    $1,111.74      $292.20      $222.35
31530..............  Laryngoscopy w/fb removal.  ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
31531..............  Laryngoscopy w/fb & op      ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      scope.
31535..............  Laryngoscopy w/biopsy.....  ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
31536..............  Laryngoscopy w/bx & op      ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      scope.
31540..............  Laryngoscopy w/exc of       ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      tumor.
31541..............  Larynscop w/tumr exc +      ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      scope.
31545..............  Remove vc lesion w/scope..  ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
31546..............  Remove vc lesion scope/     ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      graft.
31560..............  Laryngoscop w/              ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      arytenoidectom.
31561..............  Larynscop, remve cart +     ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      scop.
31570..............  Laryngoscope w/vc inj.....  ..................  T.................         0074      17.4546    $1,111.74      $292.20      $222.35
31571..............  Laryngoscop w/vc inj +      ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
                      scope.
31575..............  Diagnostic laryngoscopy...  ..................  T.................         0072        1.573      $100.19       $21.20       $20.04
31576..............  Laryngoscopy with biopsy..  ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
31577..............  Remove foreign body,        ..................  T.................         0073        4.206      $267.89       $69.10       $53.58
                      larynx.
31578..............  Removal of larynx lesion..  ..................  T.................         0075      23.2819    $1,482.89      $445.90      $296.58
31579..............  Diagnostic laryngoscopy...  ..................  T.................         0073        4.206      $267.89       $69.10       $53.58
31580..............  Revision of larynx........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31582..............  Revision of larynx........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31584..............  Treat larynx fracture.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31587..............  Revision of larynx........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31588..............  Revision of larynx........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31590..............  Reinnervate larynx........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31595..............  Larynx nerve surgery......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31599..............  Larynx surgery procedure..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
31600..............  Incision of windpipe......  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
31601..............  Incision of windpipe......  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
31603..............  Incision of windpipe......  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
31605..............  Incision of windpipe......  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
31610..............  Incision of windpipe......  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
31611..............  Surgery/speech prosthesis.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
31612..............  Puncture/clear windpipe...  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
31613..............  Repair windpipe opening...  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
31614..............  Repair windpipe opening...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31615..............  Visualization of windpipe.  ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
31620..............  Endobronchial us add-on...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
31622..............  Dx bronchoscope/wash......  ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
31623..............  Dx bronchoscope/brush.....  ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
31624..............  Dx bronchoscope/lavage....  ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
31625..............  Bronchoscopy w/biopsy(s)..  ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
31628..............  Bronchoscopy/lung bx, each  ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
31629..............  Bronchoscopy/needle bx,     ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
                      each.
31630..............  Bronchoscopy dilate/fx      ..................  T.................         0415      24.2882    $1,546.99      $459.90      $309.40
                      repr.
31631..............  Bronchoscopy, dilate w/     ..................  T.................         0415      24.2882    $1,546.99      $459.90      $309.40
                      stent.
31632..............  Bronchoscopy/lung bx,       ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
                      add'l.
31633..............  Bronchoscopy/needle bx      ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
                      add'l.
31635..............  Bronchoscopy w/fb removal.  ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
31636..............  Bronchoscopy, bronch        ..................  T.................         0415      24.2882    $1,546.99      $459.90      $309.40
                      stents.
31637..............  Bronchoscopy, stent add-on  ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
31638..............  Bronchoscopy, revise stent  ..................  T.................         0415      24.2882    $1,546.99      $459.90      $309.40
31640..............  Bronchoscopy w/tumor        ..................  T.................         0415      24.2882    $1,546.99      $459.90      $309.40
                      excise.
31641..............  Bronchoscopy, treat         ..................  T.................         0415      24.2882    $1,546.99      $459.90      $309.40
                      blockage.
31643..............  Diag bronchoscope/catheter  ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
31645..............  Bronchoscopy, clear         ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
                      airways.
31646..............  Bronchoscopy, reclear       ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
                      airway.

[[Page 42928]]

 
31656..............  Bronchoscopy, inj for x-    ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
                      ray.
31715..............  Injection for bronchus x-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
31717..............  Bronchial brush biopsy....  ..................  T.................         0073        4.206      $267.89       $69.10       $53.58
31720..............  Clearance of airways......  CH................  S.................         0077       0.3904       $24.87        $7.70        $4.97
31725..............  Clearance of airways......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31730..............  Intro, windpipe wire/tube.  ..................  T.................         0073        4.206      $267.89       $69.10       $53.58
31750..............  Repair of windpipe........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31755..............  Repair of windpipe........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
31760..............  Repair of windpipe........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31766..............  Reconstruction of windpipe  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31770..............  Repair/graft of bronchus..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31775..............  Reconstruct bronchus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31780..............  Reconstruct windpipe......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31781..............  Reconstruct windpipe......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31785..............  Remove windpipe lesion....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
31786..............  Remove windpipe lesion....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31800..............  Repair of windpipe injury.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31805..............  Repair of windpipe injury.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31820..............  Closure of windpipe lesion  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
31825..............  Repair of windpipe defect.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
31830..............  Revise windpipe scar......  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
31899..............  Airways surgical procedure  ..................  T.................         0076      10.1732      $647.96      $189.80      $129.59
32000..............  Drainage of chest.........  ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
32002..............  Treatment of collapsed      ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
                      lung.
32005..............  Treat lung lining           ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
                      chemically.
32019..............  Insert pleural catheter...  ..................  T.................         0652      31.7598    $2,022.88  ...........      $404.58
32020..............  Insertion of chest tube...  ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
32035..............  Exploration of chest......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32036..............  Exploration of chest......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32095..............  Biopsy through chest wall.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32100..............  Exploration/biopsy of       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      chest.
32110..............  Explore/repair chest......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32120..............  Re-exploration of chest...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32124..............  Explore chest free          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      adhesions.
32140..............  Removal of lung lesion(s).  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32141..............  Remove/treat lung lesions.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32150..............  Removal of lung lesion(s).  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32151..............  Remove lung foreign body..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32160..............  Open chest heart massage..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32200..............  Drain, open, lung lesion..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32201..............  Drain, percut, lung lesion  ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
32215..............  Treat chest lining........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32220..............  Release of lung...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32225..............  Partial release of lung...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32310..............  Removal of chest lining...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32320..............  Free/remove chest lining..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32400..............  Needle biopsy chest lining  ..................  T.................         0685       9.5741      $609.80  ...........      $121.96
32402..............  Open biopsy chest lining..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32405..............  Biopsy, lung or             ..................  T.................         0685       9.5741      $609.80  ...........      $121.96
                      mediastinum.
32420..............  Puncture/clear lung.......  ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
32440..............  Removal of lung...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32442..............  Sleeve pneumonectomy......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32445..............  Removal of lung...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32480..............  Partial removal of lung...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32482..............  Bilobectomy...............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32484..............  Segmentectomy.............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32486..............  Sleeve lobectomy..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32488..............  Completion pneumonectomy..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32491..............  Lung volume reduction.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32500..............  Partial removal of lung...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32501..............  Repair bronchus add-on....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32503..............  Resect apical lung tumor..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32504..............  Resect apical lung tum/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      chest.
32540..............  Removal of lung lesion....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32601..............  Thoracoscopy, diagnostic..  ..................  T.................         0069      33.1688    $2,112.62      $591.60      $422.52
32602..............  Thoracoscopy, diagnostic..  ..................  T.................         0069      33.1688    $2,112.62      $591.60      $422.52
32603..............  Thoracoscopy, diagnostic..  ..................  T.................         0069      33.1688    $2,112.62      $591.60      $422.52
32604..............  Thoracoscopy, diagnostic..  ..................  T.................         0069      33.1688    $2,112.62      $591.60      $422.52
32605..............  Thoracoscopy, diagnostic..  ..................  T.................         0069      33.1688    $2,112.62      $591.60      $422.52
32606..............  Thoracoscopy, diagnostic..  ..................  T.................         0069      33.1688    $2,112.62      $591.60      $422.52
32650..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32651..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32652..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32653..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32654..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32655..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32656..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32657..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42929]]

 
32658..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32659..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32660..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32661..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32662..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32663..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32664..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32665..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32800..............  Repair lung hernia........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32810..............  Close chest after drainage  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32815..............  Close bronchial fistula...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32820..............  Reconstruct injured chest.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32850..............  Donor pneumonectomy.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32851..............  Lung transplant, single...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32852..............  Lung transplant with        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bypass.
32853..............  Lung transplant, double...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32854..............  Lung transplant with        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bypass.
32855..............  Prepare donor lung, single  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32856..............  Prepare donor lung, double  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32900..............  Removal of rib(s).........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32905..............  Revise & repair chest wall  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32906..............  Revise & repair chest wall  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32940..............  Revision of lung..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32960..............  Therapeutic pneumothorax..  ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
32997..............  Total lung lavage.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32998..............  Perq rf ablate tx, pul      ..................  T.................         0423      44.1192    $2,810.08  ...........      $562.02
                      tumor.
32999..............  Chest surgery procedure...  ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
33010..............  Drainage of heart sac.....  ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
33011..............  Repeat drainage of heart    ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
                      sac.
33015..............  Incision of heart sac.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33020..............  Incision of heart sac.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33025..............  Incision of heart sac.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33030..............  Partial removal of heart    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      sac.
33031..............  Partial removal of heart    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      sac.
33050..............  Removal of heart sac        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
33120..............  Removal of heart lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33130..............  Removal of heart lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33140..............  Heart revascularize (tmr).  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33141..............  Heart tmr w/other           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
33202..............  Insert epicard eltrd, open  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33203..............  Insert epicard eltrd, endo  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33206..............  Insertion of heart          ..................  T.................         0089     122.5662    $7,806.61    $1,682.20    $1,561.32
                      pacemaker.
33207..............  Insertion of heart          ..................  T.................         0089     122.5662    $7,806.61    $1,682.20    $1,561.32
                      pacemaker.
33208..............  Insertion of heart          ..................  T.................         0655     144.2764    $9,189.40  ...........    $1,837.88
                      pacemaker.
33210..............  Insertion of heart          ..................  T.................         0106      75.0068    $4,777.41  ...........      $955.48
                      electrode.
33211..............  Insertion of heart          ..................  T.................         0106      75.0068    $4,777.41  ...........      $955.48
                      electrode.
33212..............  Insertion of pulse          ..................  T.................         0090      99.8268    $6,358.27    $1,612.80    $1,271.65
                      generator.
33213..............  Insertion of pulse          ..................  T.................         0654     106.9053    $6,809.12  ...........    $1,361.82
                      generator.
33214..............  Upgrade of pacemaker        ..................  T.................         0655     144.2764    $9,189.40  ...........    $1,837.88
                      system.
33215..............  Reposition pacing-defib     ..................  T.................         0105      24.7274    $1,574.96      $370.40      $314.99
                      lead.
33216..............  Insert lead pace-defib,     ..................  T.................         0106      75.0068    $4,777.41  ...........      $955.48
                      one.
33217..............  Insert lead pace-defib,     ..................  T.................         0106      75.0068    $4,777.41  ...........      $955.48
                      dual.
33218..............  Repair lead pace-defib,     ..................  T.................         0105      24.7274    $1,574.96      $370.40      $314.99
                      one.
33220..............  Repair lead pace-defib,     ..................  T.................         0105      24.7274    $1,574.96      $370.40      $314.99
                      dual.
33222..............  Revise pocket, pacemaker..  CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
33223..............  Revise pocket, pacing-      CH................  T.................         0136      15.4399      $983.41  ...........      $196.68
                      defib.
33224..............  Insert pacing lead &        ..................  T.................         0418     250.5383   $15,957.54  ...........    $3,191.51
                      connect.
33225..............  L ventric pacing lead add-  ..................  T.................         0418     250.5383   $15,957.54  ...........    $3,191.51
                      on.
33226..............  Reposition l ventric lead.  ..................  T.................         0105      24.7274    $1,574.96      $370.40      $314.99
33233..............  Removal of pacemaker        ..................  T.................         0105      24.7274    $1,574.96      $370.40      $314.99
                      system.
33234..............  Removal of pacemaker        ..................  T.................         0105      24.7274    $1,574.96      $370.40      $314.99
                      system.
33235..............  Removal pacemaker           ..................  T.................         0105      24.7274    $1,574.96      $370.40      $314.99
                      electrode.
33236..............  Remove electrode/           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      thoracotomy.
33237..............  Remove electrode/           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      thoracotomy.
33238..............  Remove electrode/           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      thoracotomy.
33240..............  Insert pulse generator....  CH................  T.................         0107     353.1242   $22,491.54  ...........    $4,498.31
33241..............  Remove pulse generator....  ..................  T.................         0105      24.7274    $1,574.96      $370.40      $314.99
33243..............  Remove eltrd/thoracotomy..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33244..............  Remove eltrd, transven....  ..................  T.................         0105      24.7274    $1,574.96      $370.40      $314.99
33249..............  Eltrd/insert pace-defib...  CH................  T.................         0108     403.0232   $25,669.76  ...........    $5,133.95
33250..............  Ablate heart dysrhythm      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      focus.
33251..............  Ablate heart dysrhythm      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      focus.
33254..............  Ablate atria, lmtd........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33255..............  Ablate atria w/o bypass,    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ext.
33256..............  Ablate atria w/bypass,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      exten.
33261..............  Ablate heart dysrhythm      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      focus.
33265..............  Ablate atria w/bypass,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      endo.
33266..............  Ablate atria w/o bypass     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      endo.

[[Page 42930]]

 
33282..............  Implant pat-active ht       ..................  S.................         0680      71.6463    $4,563.37  ...........      $912.67
                      record.
33284..............  Remove pat-active ht        ..................  T.................         0109       6.1077      $389.02  ...........       $77.80
                      record.
33300..............  Repair of heart wound.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33305..............  Repair of heart wound.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33310..............  Exploratory heart surgery.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33315..............  Exploratory heart surgery.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33320..............  Repair major blood          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vessel(s).
33321..............  Repair major vessel.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33322..............  Repair major blood          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vessel(s).
33330..............  Insert major vessel graft.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33332..............  Insert major vessel graft.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33335..............  Insert major vessel graft.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33400..............  Repair of aortic valve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33401..............  Valvuloplasty, open.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33403..............  Valvuloplasty, w/cp bypass  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33404..............  Prepare heart-aorta         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      conduit.
33405..............  Replacement of aortic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33406..............  Replacement of aortic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33410..............  Replacement of aortic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33411..............  Replacement of aortic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33412..............  Replacement of aortic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33413..............  Replacement of aortic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33414..............  Repair of aortic valve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33415..............  Revision, subvalvular       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tissue.
33416..............  Revise ventricle muscle...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33417..............  Repair of aortic valve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33420..............  Revision of mitral valve..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33422..............  Revision of mitral valve..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33425..............  Repair of mitral valve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33426..............  Repair of mitral valve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33427..............  Repair of mitral valve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33430..............  Replacement of mitral       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33460..............  Revision of tricuspid       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33463..............  Valvuloplasty, tricuspid..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33464..............  Valvuloplasty, tricuspid..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33465..............  Replace tricuspid valve...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33468..............  Revision of tricuspid       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33470..............  Revision of pulmonary       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33471..............  Valvotomy, pulmonary valve  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33472..............  Revision of pulmonary       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33474..............  Revision of pulmonary       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33475..............  Replacement, pulmonary      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33476..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33478..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33496..............  Repair, prosth valve clot.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33500..............  Repair heart vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
33501..............  Repair heart vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
33502..............  Coronary artery correction  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33503..............  Coronary artery graft.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33504..............  Coronary artery graft.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33505..............  Repair artery w/tunnel....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33506..............  Repair artery,              ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      translocation.
33507..............  Repair art, intramural....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33508..............  Endoscopic vein harvest...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
33510..............  CABG, vein, single........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33511..............  CABG, vein, two...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33512..............  CABG, vein, three.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33513..............  CABG, vein, four..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33514..............  CABG, vein, five..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33516..............  Cabg, vein, six or more...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33517..............  CABG, artery-vein, single.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33518..............  CABG, artery-vein, two....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33519..............  CABG, artery-vein, three..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33521..............  CABG, artery-vein, four...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33522..............  CABG, artery-vein, five...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33523..............  Cabg, art-vein, six or      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      more.
33530..............  Coronary artery, bypass/    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      reop.
33533..............  CABG, arterial, single....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33534..............  CABG, arterial, two.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33535..............  CABG, arterial, three.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33536..............  Cabg, arterial, four or     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      more.
33542..............  Removal of heart lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33545..............  Repair of heart damage....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33548..............  Restore/remodel, ventricle  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33572..............  Open coronary               ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      endarterectomy.
33600..............  Closure of valve..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33602..............  Closure of valve..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33606..............  Anastomosis/artery-aorta..  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42931]]

 
33608..............  Repair anomaly w/conduit..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33610..............  Repair by enlargement.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33611..............  Repair double ventricle...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33612..............  Repair double ventricle...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33615..............  Repair, modified fontan...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33617..............  Repair single ventricle...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33619..............  Repair single ventricle...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33641..............  Repair heart septum defect  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33645..............  Revision of heart veins...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33647..............  Repair heart septum         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defects.
33660..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33665..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33670..............  Repair of heart chambers..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33675..............  Close mult vsd............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33676..............  Close mult vsd w/resection  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33677..............  Cl mult vsd w/rem pul band  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33681..............  Repair heart septum defect  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33684..............  Repair heart septum defect  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33688..............  Repair heart septum defect  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33690..............  Reinforce pulmonary artery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33692..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33694..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33697..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33702..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33710..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33720..............  Repair of heart defect....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33722..............  Repair of heart defect....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33724..............  Repair venous anomaly.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33726..............  Repair pul venous stenosis  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33730..............  Repair heart-vein           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect(s).
33732..............  Repair heart-vein defect..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33735..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33736..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33737..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33750..............  Major vessel shunt........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33755..............  Major vessel shunt........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33762..............  Major vessel shunt........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33764..............  Major vessel shunt & graft  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33766..............  Major vessel shunt........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33767..............  Major vessel shunt........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33768..............  Cavopulmonary shunting....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33770..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33771..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33774..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33775..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33776..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33777..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33778..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33779..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33780..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33781..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33786..............  Repair arterial trunk.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33788..............  Revision of pulmonary       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
33800..............  Aortic suspension.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33802..............  Repair vessel defect......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33803..............  Repair vessel defect......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33813..............  Repair septal defect......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33814..............  Repair septal defect......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33820..............  Revise major vessel.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33822..............  Revise major vessel.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33824..............  Revise major vessel.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33840..............  Remove aorta constriction.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33845..............  Remove aorta constriction.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33851..............  Remove aorta constriction.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33852..............  Repair septal defect......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33853..............  Repair septal defect......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33860..............  Ascending aortic graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33861..............  Ascending aortic graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33863..............  Ascending aortic graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33870..............  Transverse aortic arch      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      graft.
33875..............  Thoracic aortic graft.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33877..............  Thoracoabdominal graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33880..............  Endovasc taa repr incl      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      subcl.
33881..............  Endovasc taa repr w/o       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      subcl.
33883..............  Insert endovasc prosth,     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      taa.
33884..............  Endovasc prosth, taa, add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
33886..............  Endovasc prosth, delayed..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33889..............  Artery transpose/endovas    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      taa.

[[Page 42932]]

 
33891..............  Car-car bp grft/endovas     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      taa.
33910..............  Remove lung artery emboli.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33915..............  Remove lung artery emboli.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33916..............  Surgery of great vessel...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33917..............  Repair pulmonary artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33920..............  Repair pulmonary atresia..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33922..............  Transect pulmonary artery.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33924..............  Remove pulmonary shunt....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33925..............  Rpr pul art unifocal w/o    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cpb.
33926..............  Repr pul art, unifocal w/   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cpb.
33930..............  Removal of donor heart/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lung.
33933..............  Prepare donor heart/lung..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33935..............  Transplantation, heart/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lung.
33940..............  Removal of donor heart....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33944..............  Prepare donor heart.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33945..............  Transplantation of heart..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33960..............  External circulation        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      assist.
33961..............  External circulation        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      assist.
33967..............  Insert ia percut device...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33968..............  Remove aortic assist        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
33970..............  Aortic circulation assist.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33971..............  Aortic circulation assist.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33973..............  Insert balloon device.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33974..............  Remove intra-aortic         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      balloon.
33975..............  Implant ventricular device  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33976..............  Implant ventricular device  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33977..............  Remove ventricular device.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33978..............  Remove ventricular device.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33979..............  Insert intracorporeal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
33980..............  Remove intracorporeal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
33999..............  Cardiac surgery procedure.  ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
34001..............  Removal of artery clot....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34051..............  Removal of artery clot....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34101..............  Removal of artery clot....  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
34111..............  Removal of arm artery clot  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
34151..............  Removal of artery clot....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34201..............  Removal of artery clot....  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
34203..............  Removal of leg artery clot  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
34401..............  Removal of vein clot......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34421..............  Removal of vein clot......  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
34451..............  Removal of vein clot......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34471..............  Removal of vein clot......  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
34490..............  Removal of vein clot......  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
34501..............  Repair valve, femoral vein  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
34502..............  Reconstruct vena cava.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34510..............  Transposition of vein       ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
                      valve.
34520..............  Cross-over vein graft.....  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
34530..............  Leg vein fusion...........  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
34800..............  Endovas aaa repr w/sm tube  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34802..............  Endovas aaa repr w/2-p      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      part.
34803..............  Endovas aaa repr w/3-p      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      part.
34804..............  Endovas aaa repr w/1-p      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      part.
34805..............  Endovas aaa repr w/long     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tube.
34808..............  Endovas iliac a device      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      addon.
34812..............  Xpose for endoprosth,       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      femorl.
34813..............  Femoral endovas graft add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
34820..............  Xpose for endoprosth,       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      iliac.
34825..............  Endovasc extend prosth,     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      init.
34826..............  Endovasc exten prosth,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      add'l.
34830..............  Open aortic tube prosth     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      repr.
34831..............  Open aortoiliac prosth      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      repr.
34832..............  Open aortofemor prosth      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      repr.
34833..............  Xpose for endoprosth,       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      iliac.
34834..............  Xpose, endoprosth,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      brachial.
34900..............  Endovasc iliac repr w/      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      graft.
35001..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35002..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      neck.
35005..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35011..............  Repair defect of artery...  ..................  T.................         0653      41.0875    $2,616.99  ...........      $523.40
35013..............  Repair artery rupture, arm  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35021..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35022..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      chest.
35045..............  Repair defect of arm        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
35081..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35082..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      aorta.
35091..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35092..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      aorta.
35102..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42933]]

 
35103..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      groin.
35111..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35112..............  Repair artery               ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      rupture,spleen.
35121..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35122..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      belly.
35131..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35132..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      groin.
35141..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35142..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      thigh.
35151..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35152..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      knee.
35180..............  Repair blood vessel lesion  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
35182..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35184..............  Repair blood vessel lesion  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
35188..............  Repair blood vessel lesion  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
35189..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35190..............  Repair blood vessel lesion  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
35201..............  Repair blood vessel lesion  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
35206..............  Repair blood vessel lesion  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
35207..............  Repair blood vessel lesion  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
35211..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35216..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35221..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35226..............  Repair blood vessel lesion  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
35231..............  Repair blood vessel lesion  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
35236..............  Repair blood vessel lesion  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
35241..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35246..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35251..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35256..............  Repair blood vessel lesion  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
35261..............  Repair blood vessel lesion  ..................  T.................         0653      41.0875    $2,616.99  ...........      $523.40
35266..............  Repair blood vessel lesion  ..................  T.................         0653      41.0875    $2,616.99  ...........      $523.40
35271..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35276..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35281..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35286..............  Repair blood vessel lesion  ..................  T.................         0653      41.0875    $2,616.99  ...........      $523.40
35301..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35302..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35303..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35304..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35305..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35306..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35311..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35321..............  Rechanneling of artery....  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
35331..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35341..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35351..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35355..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35361..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35363..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35371..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35372..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35390..............  Reoperation, carotid add-   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
35400..............  Angioscopy................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35450..............  Repair arterial blockage..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35452..............  Repair arterial blockage..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35454..............  Repair arterial blockage..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35456..............  Repair arterial blockage..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35458..............  Repair arterial blockage..  CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
35459..............  Repair arterial blockage..  CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
35460..............  Repair venous blockage....  CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
35470..............  Repair arterial blockage..  CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
35471..............  Repair arterial blockage..  CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
35472..............  Repair arterial blockage..  CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
35473..............  Repair arterial blockage..  CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
35474..............  Repair arterial blockage..  CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
35475..............  Repair arterial blockage..  CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
35476..............  Repair venous blockage....  CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
35480..............  Atherectomy, open.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35481..............  Atherectomy, open.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35482..............  Atherectomy, open.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35483..............  Atherectomy, open.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35484..............  Atherectomy, open.........  CH................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83
35485..............  Atherectomy, open.........  CH................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83
35490..............  Atherectomy, percutaneous.  CH................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83
35491..............  Atherectomy, percutaneous.  CH................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83
35492..............  Atherectomy, percutaneous.  CH................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83
35493..............  Atherectomy, percutaneous.  CH................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83

[[Page 42934]]

 
35494..............  Atherectomy, percutaneous.  CH................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83
35495..............  Atherectomy, percutaneous.  CH................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83
35500..............  Harvest vein for bypass...  CH................  T.................         0103      15.2572      $971.78  ...........      $194.36
35501..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35506..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35508..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35509..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35510..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35511..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35512..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35515..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35516..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35518..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35521..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35522..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35525..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35526..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35531..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35533..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35536..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35537..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35538..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35539..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35540..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35548..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35549..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35551..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35556..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35558..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35560..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35563..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35565..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35566..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35571..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35572..............  Harvest femoropopliteal     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vein.
35583..............  Vein bypass graft.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35585..............  Vein bypass graft.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35587..............  Vein bypass graft.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35600..............  Harvest artery for cabg...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35601..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35606..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35612..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35616..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35621..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35623..............  Bypass graft, not vein....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35626..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35631..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35636..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35637..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35638..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35642..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35645..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35646..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35647..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35650..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35651..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35654..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35656..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35661..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35663..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35665..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35666..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35671..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35681..............  Composite bypass graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35682..............  Composite bypass graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35683..............  Composite bypass graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35685..............  Bypass graft patency/patch  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
35686..............  Bypass graft/av fist        ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
                      patency.
35691..............  Arterial transposition....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35693..............  Arterial transposition....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35694..............  Arterial transposition....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35695..............  Arterial transposition....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35697..............  Reimplant artery each.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35700..............  Reoperation, bypass graft.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35701..............  Exploration, carotid        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
35721..............  Exploration, femoral        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
35741..............  Exploration popliteal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
35761..............  Exploration of artery/vein  ..................  T.................         0115      30.5379    $1,945.05  ...........      $389.01

[[Page 42935]]

 
35800..............  Explore neck vessels......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35820..............  Explore chest vessels.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35840..............  Explore abdominal vessels.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35860..............  Explore limb vessels......  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
35870..............  Repair vessel graft defect  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35875..............  Removal of clot in graft..  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
35876..............  Removal of clot in graft..  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
35879..............  Revise graft w/vein.......  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
35881..............  Revise graft w/vein.......  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
35883..............  Revise graft w/nonauto      ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
                      graft.
35884..............  Revise graft w/vein.......  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
35901..............  Excision, graft, neck.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35903..............  Excision, graft, extremity  ..................  T.................         0115      30.5379    $1,945.05  ...........      $389.01
35905..............  Excision, graft, thorax...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35907..............  Excision, graft, abdomen..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
36000..............  Place needle in vein......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36002..............  Pseudoaneurysm injection    ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
                      trt.
36005..............  Injection ext venography..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36010..............  Place catheter in vein....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36011..............  Place catheter in vein....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36012..............  Place catheter in vein....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36013..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36014..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36015..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36100..............  Establish access to artery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36120..............  Establish access to artery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36140..............  Establish access to artery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36145..............  Artery to vein shunt......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36160..............  Establish access to aorta.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36200..............  Place catheter in aorta...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36215..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36216..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36217..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36218..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36245..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36246..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36247..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36248..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36260..............  Insertion of infusion pump  ..................  T.................         0623      29.3210    $1,867.54  ...........      $373.51
36261..............  Revision of infusion pump.  ..................  T.................         0623      29.3210    $1,867.54  ...........      $373.51
36262..............  Removal of infusion pump..  ..................  T.................         0622      24.5273    $1,562.22  ...........      $312.44
36299..............  Vessel injection procedure  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36400..............  Bl draw < 3 yrs fem/        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      jugular.
36405..............  Bl draw < 3 yrs scalp vein  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36406..............  Bl draw < 3 yrs other vein  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36410..............  Non-routine bl draw > 3     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      yrs.
36415..............  Routine venipuncture......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
36416..............  Capillary blood draw......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36420..............  Vein access cutdown < 1 yr  ..................  T.................         0035       0.2091       $13.32  ...........        $2.66
36425..............  Vein access cutdown > 1 yr  ..................  T.................         0035       0.2091       $13.32  ...........        $2.66
36430..............  Blood transfusion service.  ..................  S.................         0110       3.4924      $222.44  ...........       $44.49
36440..............  Bl push transfuse, 2 yr or  ..................  S.................         0110       3.4924      $222.44  ...........       $44.49
                      <.
36450..............  Bl exchange/transfuse, nb.  ..................  S.................         0110       3.4924      $222.44  ...........       $44.49
36455..............  Bl exchange/transfuse non-  ..................  S.................         0110       3.4924      $222.44  ...........       $44.49
                      nb.
36460..............  Transfusion service, fetal  ..................  S.................         0110       3.4924      $222.44  ...........       $44.49
36468..............  Injection(s), spider veins  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
36469..............  Injection(s), spider veins  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
36470..............  Injection therapy of vein.  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
36471..............  Injection therapy of veins  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
36475..............  Endovenous rf, 1st vein...  ..................  T.................         0091      43.6609    $2,780.89  ...........      $556.18
36476..............  Endovenous rf, vein add-on  CH................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
36478..............  Endovenous laser, 1st vein  ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
36479..............  Endovenous laser vein       ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
                      addon.
36481..............  Insertion of catheter,      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vein.
36500..............  Insertion of catheter,      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vein.
36510..............  Insertion of catheter,      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vein.
36511..............  Apheresis wbc.............  ..................  S.................         0111      12.1982      $776.94      $198.40      $155.39
36512..............  Apheresis rbc.............  ..................  S.................         0111      12.1982      $776.94      $198.40      $155.39
36513..............  Apheresis platelets.......  ..................  S.................         0111      12.1982      $776.94      $198.40      $155.39
36514..............  Apheresis plasma..........  ..................  S.................         0111      12.1982      $776.94      $198.40      $155.39
36515..............  Apheresis, adsorp/reinfuse  ..................  S.................         0112      31.9648    $2,035.93      $433.20      $407.19
36516..............  Apheresis, selective......  ..................  S.................         0112      31.9648    $2,035.93      $433.20      $407.19
36522..............  Photopheresis.............  ..................  S.................         0112      31.9648    $2,035.93      $433.20      $407.19
36540..............  Collect blood venous        ..................  Q.................         0624       0.5763       $36.71       $12.60        $7.34
                      device.
36550..............  Declot vascular device....  ..................  T.................         0676       2.5179      $160.37  ...........       $32.07
36555..............  Insert non-tunnel cv cath.  ..................  T.................         0621      11.0043      $700.90  ...........      $140.18
36556..............  Insert non-tunnel cv cath.  ..................  T.................         0621      11.0043      $700.90  ...........      $140.18
36557..............  Insert tunneled cv cath...  ..................  T.................         0622      24.5273    $1,562.22  ...........      $312.44

[[Page 42936]]

 
36558..............  Insert tunneled cv cath...  ..................  T.................         0622      24.5273    $1,562.22  ...........      $312.44
36560..............  Insert tunneled cv cath...  ..................  T.................         0623      29.3210    $1,867.54  ...........      $373.51
36561..............  Insert tunneled cv cath...  ..................  T.................         0623      29.3210    $1,867.54  ...........      $373.51
36563..............  Insert tunneled cv cath...  ..................  T.................         0623      29.3210    $1,867.54  ...........      $373.51
36565..............  Insert tunneled cv cath...  ..................  T.................         0623      29.3210    $1,867.54  ...........      $373.51
36566..............  Insert tunneled cv cath...  ..................  T.................         0625        87.32    $5,561.67  ...........    $1,112.33
36568..............  Insert picc cath..........  ..................  T.................         0621      11.0043      $700.90  ...........      $140.18
36569..............  Insert picc cath..........  ..................  T.................         0621      11.0043      $700.90  ...........      $140.18
36570..............  Insert picvad cath........  ..................  T.................         0622      24.5273    $1,562.22  ...........      $312.44
36571..............  Insert picvad cath........  ..................  T.................         0622      24.5273    $1,562.22  ...........      $312.44
36575..............  Repair tunneled cv cath...  CH................  T.................         0109       6.1077      $389.02  ...........       $77.80
36576..............  Repair tunneled cv cath...  ..................  T.................         0621      11.0043      $700.90  ...........      $140.18
36578..............  Replace tunneled cv cath..  ..................  T.................         0622      24.5273    $1,562.22  ...........      $312.44
36580..............  Replace cvad cath.........  ..................  T.................         0621      11.0043      $700.90  ...........      $140.18
36581..............  Replace tunneled cv cath..  ..................  T.................         0622      24.5273    $1,562.22  ...........      $312.44
36582..............  Replace tunneled cv cath..  ..................  T.................         0623      29.3210    $1,867.54  ...........      $373.51
36583..............  Replace tunneled cv cath..  ..................  T.................         0623      29.3210    $1,867.54  ...........      $373.51
36584..............  Replace picc cath.........  ..................  T.................         0621      11.0043      $700.90  ...........      $140.18
36585..............  Replace picvad cath.......  ..................  T.................         0622      24.5273    $1,562.22  ...........      $312.44
36589..............  Removal tunneled cv cath..  CH................  T.................         0109       6.1077      $389.02  ...........       $77.80
36590..............  Removal tunneled cv cath..  ..................  T.................         0621      11.0043      $700.90  ...........      $140.18
36595..............  Mech remov tunneled cv      ..................  T.................         0622      24.5273    $1,562.22  ...........      $312.44
                      cath.
36596..............  Mech remov tunneled cv      ..................  T.................         0621      11.0043      $700.90  ...........      $140.18
                      cath.
36597..............  Reposition venous catheter  ..................  T.................         0621      11.0043      $700.90  ...........      $140.18
36598..............  Inj w/fluor, eval cv        CH................  T.................         0676       2.5179      $160.37  ...........       $32.07
                      device.
36600..............  Withdrawal of arterial      ..................  Q.................         0035       0.2091       $13.32  ...........        $2.66
                      blood.
36620..............  Insertion catheter, artery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36625..............  Insertion catheter, artery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36640..............  Insertion catheter, artery  ..................  T.................         0623      29.3210    $1,867.54  ...........      $373.51
36660..............  Insertion catheter, artery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
36680..............  Insert needle, bone cavity  ..................  T.................         0002       1.1915       $75.89  ...........       $15.18
36800..............  Insertion of cannula......  ..................  T.................         0115      30.5379    $1,945.05  ...........      $389.01
36810..............  Insertion of cannula......  ..................  T.................         0115      30.5379    $1,945.05  ...........      $389.01
36815..............  Insertion of cannula......  ..................  T.................         0115      30.5379    $1,945.05  ...........      $389.01
36818..............  Av fuse, uppr arm,          ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
                      cephalic.
36819..............  Av fuse, uppr arm, basilic  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
36820..............  Av fusion/forearm vein....  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
36821..............  Av fusion direct any site.  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
36822..............  Insertion of cannula(s)...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
36823..............  Insertion of cannula(s)...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
36825..............  Artery-vein autograft.....  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
36830..............  Artery-vein nonautograft..  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
36831..............  Open thrombect av fistula.  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
36832..............  Av fistula revision, open.  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
36833..............  Av fistula revision.......  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
36834..............  Repair A-V aneurysm.......  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
36835..............  Artery to vein shunt......  ..................  T.................         0115      30.5379    $1,945.05  ...........      $389.01
36838..............  Dist revas ligation, hemo.  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
36860..............  External cannula            ..................  T.................         0676       2.5179      $160.37  ...........       $32.07
                      declotting.
36861..............  Cannula declotting........  ..................  T.................         0115      30.5379    $1,945.05  ...........      $389.01
36870..............  Percut thrombect av         ..................  T.................         0653      41.0875    $2,616.99  ...........      $523.40
                      fistula.
37140..............  Revision of circulation...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37145..............  Revision of circulation...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37160..............  Revision of circulation...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37180..............  Revision of circulation...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37181..............  Splice spleen/kidney veins  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37182..............  Insert hepatic shunt        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      (tips).
37183..............  Remove hepatic shunt        ..................  T.................         0229      89.7027    $5,713.43  ...........    $1,142.69
                      (tips).
37184..............  Prim art mech thrombectomy  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
37185..............  Prim art m-thrombect add-   ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
                      on.
37186..............  Sec art m-thrombect add-on  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
37187..............  Venous mech thrombectomy..  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
37188..............  Venous m-thrombectomy add-  ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
                      on.
37195..............  Thrombolytic therapy,       ..................  T.................         0676       2.5179      $160.37  ...........       $32.07
                      stroke.
37200..............  Transcatheter biopsy......  CH................  T.................         0623      29.3210    $1,867.54  ...........      $373.51
37201..............  Transcatheter therapy       CH................  T.................         0103      15.2572      $971.78  ...........      $194.36
                      infuse.
37202..............  Transcatheter therapy       CH................  T.................         0103      15.2572      $971.78  ...........      $194.36
                      infuse.
37203..............  Transcatheter retrieval...  CH................  T.................         0623      29.3210    $1,867.54  ...........      $373.51
37204..............  Transcatheter occlusion...  CH................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83
37205..............  Transcath iv stent, percut  ..................  T.................         0229      89.7027    $5,713.43  ...........    $1,142.69
37206..............  Transcath iv stent/perc     ..................  T.................         0229      89.7027    $5,713.43  ...........    $1,142.69
                      addl.
37207..............  Transcath iv stent, open..  ..................  T.................         0229      89.7027    $5,713.43  ...........    $1,142.69
37208..............  Transcath iv stent/open     ..................  T.................         0229      89.7027    $5,713.43  ...........    $1,142.69
                      addl.
37209..............  Change iv cath at thromb    CH................  T.................         0623      29.3210    $1,867.54  ...........      $373.51
                      tx.
37210..............  Embolization uterine        ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
                      fibroid.
37215..............  Transcath stent, cca w/eps  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37216..............  Transcath stent, cca w/o    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      eps.
37250..............  Iv us first vessel add-on.  CH................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 42937]]

 
37251..............  Iv us each add vessel add-  CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
37500..............  Endoscopy ligate perf       ..................  T.................         0091      43.6609    $2,780.89  ...........      $556.18
                      veins.
37501..............  Vascular endoscopy          ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
                      procedure.
37565..............  Ligation of neck vein.....  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
37600..............  Ligation of neck artery...  ..................  T.................         0093      30.8639    $1,965.81  ...........      $393.16
37605..............  Ligation of neck artery...  ..................  T.................         0091      43.6609    $2,780.89  ...........      $556.18
37606..............  Ligation of neck artery...  ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
37607..............  Ligation of a-v fistula...  ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
37609..............  Temporal artery procedure.  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
37615..............  Ligation of neck artery...  ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
37616..............  Ligation of chest artery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37617..............  Ligation of abdomen artery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37618..............  Ligation of extremity       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
37620..............  Revision of major vein....  ..................  T.................         0091      43.6609    $2,780.89  ...........      $556.18
37650..............  Revision of major vein....  ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
37660..............  Revision of major vein....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37700..............  Revise leg vein...........  CH................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
37718..............  Ligate/strip short leg      CH................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
                      vein.
37722..............  Ligate/strip long leg vein  ..................  T.................         0091      43.6609    $2,780.89  ...........      $556.18
37735..............  Removal of leg veins/       ..................  T.................         0091      43.6609    $2,780.89  ...........      $556.18
                      lesion.
37760..............  Ligation, leg veins, open.  ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
37765..............  Phleb veins - extrem - to   ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
                      20.
37766..............  Phleb veins - extrem 20+..  ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
37780..............  Revision of leg vein......  ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
37785..............  Ligate/divide/excise vein.  ..................  T.................         0092      26.4396    $1,684.02  ...........      $336.80
37788..............  Revascularization, penis..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37790..............  Penile venous occlusion...  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
37799..............  Vascular surgery procedure  ..................  T.................         0103      15.2572      $971.78  ...........      $194.36
38100..............  Removal of spleen, total..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38101..............  Removal of spleen, partial  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38102..............  Removal of spleen, total..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38115..............  Repair of ruptured spleen.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38120..............  Laparoscopy, splenectomy..  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
38129..............  Laparoscope proc, spleen..  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
38200..............  Injection for spleen x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
38204..............  Bl donor search management  ..................  N.................  ...........  ...........  ...........  ...........  ...........
38205..............  Harvest allogenic stem      ..................  S.................         0111      12.1982      $776.94      $198.40      $155.39
                      cells.
38206..............  Harvest auto stem cells...  ..................  S.................         0111      12.1982      $776.94      $198.40      $155.39
38207..............  Cryopreserve stem cells...  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
38208..............  Thaw preserved stem cells.  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
38209..............  Wash harvest stem cells...  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
38210..............  T-cell depletion of         CH................  S.................         0110       3.4924      $222.44  ...........       $44.49
                      harvest.
38211..............  Tumor cell deplete of       CH................  S.................         0110       3.4924      $222.44  ...........       $44.49
                      harvst.
38212..............  Rbc depletion of harvest..  CH................  S.................         0110       3.4924      $222.44  ...........       $44.49
38213..............  Platelet deplete of         CH................  S.................         0110       3.4924      $222.44  ...........       $44.49
                      harvest.
38214..............  Volume deplete of harvest.  CH................  S.................         0110       3.4924      $222.44  ...........       $44.49
38215..............  Harvest stem cell           CH................  S.................         0110       3.4924      $222.44  ...........       $44.49
                      concentrte.
38220..............  Bone marrow aspiration....  ..................  T.................         0003        3.239      $206.30  ...........       $41.26
38221..............  Bone marrow biopsy........  ..................  T.................         0003        3.239      $206.30  ...........       $41.26
38230..............  Bone marrow collection....  CH................  S.................         0112      31.9648    $2,035.93      $433.20      $407.19
38240..............  Bone marrow/stem            CH................  S.................         0112      31.9648    $2,035.93      $433.20      $407.19
                      transplant.
38241..............  Bone marrow/stem            CH................  S.................         0112      31.9648    $2,035.93      $433.20      $407.19
                      transplant.
38242..............  Lymphocyte infuse           ..................  S.................         0111      12.1982      $776.94      $198.40      $155.39
                      transplant.
38300..............  Drainage, lymph node        ..................  T.................         0007      12.5792      $801.21  ...........      $160.24
                      lesion.
38305..............  Drainage, lymph node        ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
                      lesion.
38308..............  Incision of lymph channels  ..................  T.................         0113      23.5105    $1,497.45  ...........      $299.49
38380..............  Thoracic duct procedure...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38381..............  Thoracic duct procedure...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38382..............  Thoracic duct procedure...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38500..............  Biopsy/removal, lymph       ..................  T.................         0113      23.5105    $1,497.45  ...........      $299.49
                      nodes.
38505..............  Needle biopsy, lymph nodes  ..................  T.................         0005       7.3012      $465.04  ...........       $93.01
38510..............  Biopsy/removal, lymph       ..................  T.................         0113      23.5105    $1,497.45  ...........      $299.49
                      nodes.
38520..............  Biopsy/removal, lymph       ..................  T.................         0113      23.5105    $1,497.45  ...........      $299.49
                      nodes.
38525..............  Biopsy/removal, lymph       ..................  T.................         0113      23.5105    $1,497.45  ...........      $299.49
                      nodes.
38530..............  Biopsy/removal, lymph       ..................  T.................         0113      23.5105    $1,497.45  ...........      $299.49
                      nodes.
38542..............  Explore deep node(s), neck  ..................  T.................         0114      45.1729    $2,877.20  ...........      $575.44
38550..............  Removal, neck/armpit        ..................  T.................         0113      23.5105    $1,497.45  ...........      $299.49
                      lesion.
38555..............  Removal, neck/armpit        ..................  T.................         0113      23.5105    $1,497.45  ...........      $299.49
                      lesion.
38562..............  Removal, pelvic lymph       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nodes.
38564..............  Removal, abdomen lymph      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nodes.
38570..............  Laparoscopy, lymph node     ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
                      biop.
38571..............  Laparoscopy,                ..................  T.................         0132      71.0022    $4,522.34    $1,239.20      $904.47
                      lymphadenectomy.
38572..............  Laparoscopy,                ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
                      lymphadenectomy.
38589..............  Laparoscope proc,           ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
                      lymphatic.
38700..............  Removal of lymph nodes,     ..................  T.................         0113      23.5105    $1,497.45  ...........      $299.49
                      neck.
38720..............  Removal of lymph nodes,     ..................  T.................         0113      23.5105    $1,497.45  ...........      $299.49
                      neck.
38724..............  Removal of lymph nodes,     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      neck.
38740..............  Remove armpit lymph nodes.  ..................  T.................         0114      45.1729    $2,877.20  ...........      $575.44

[[Page 42938]]

 
38745..............  Remove armpit lymph nodes.  ..................  T.................         0114      45.1729    $2,877.20  ...........      $575.44
38746..............  Remove thoracic lymph       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nodes.
38747..............  Remove abdominal lymph      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nodes.
38760..............  Remove groin lymph nodes..  ..................  T.................         0113      23.5105    $1,497.45  ...........      $299.49
38765..............  Remove groin lymph nodes..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38770..............  Remove pelvis lymph nodes.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38780..............  Remove abdomen lymph nodes  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38790..............  Inject for lymphatic x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
38792..............  Identify sentinel node....  ..................  Q.................         0389       1.5806      $100.67       $33.80       $20.13
38794..............  Access thoracic lymph duct  ..................  N.................  ...........  ...........  ...........  ...........  ...........
38999..............  Blood/lymph system          ..................  S.................         0110       3.4924      $222.44  ...........       $44.49
                      procedure.
39000..............  Exploration of chest......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39010..............  Exploration of chest......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39200..............  Removal chest lesion......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39220..............  Removal chest lesion......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39400..............  Visualization of chest....  ..................  T.................         0069      33.1688    $2,112.62      $591.60      $422.52
39499..............  Chest procedure...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39501..............  Repair diaphragm            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      laceration.
39502..............  Repair paraesophageal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      hernia.
39503..............  Repair of diaphragm hernia  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39520..............  Repair of diaphragm hernia  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39530..............  Repair of diaphragm hernia  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39531..............  Repair of diaphragm hernia  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39540..............  Repair of diaphragm hernia  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39541..............  Repair of diaphragm hernia  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39545..............  Revision of diaphragm.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39560..............  Resect diaphragm, simple..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39561..............  Resect diaphragm, complex.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39599..............  Diaphragm surgery           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
4000F..............  Tobacco use txmnt           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      counseling.
4001F..............  Tobacco use txmnt,          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      pharmacol.
4002F..............  Statin therapy, rx........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4003F..............  Pt ed write/oral, pts w/    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      hf.
4005F..............  Pharm thx for op rx'd.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4006F..............  Beta-blocker therapy rx...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4007F..............  Antiox vit/min supp rx'd..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4009F..............  Ace/arb inhibitor therapy   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rx.
4011F..............  Oral antiplatelet therapy   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rx.
4012F..............  Warfarin therapy rx.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4014F..............  Written discharge instr     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prvd.
4015F..............  Persist asthma medicine     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ctrl.
4016F..............  Anti-inflm/anlgsc agent rx  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4017F..............  Gi prophylaxis for nsaid    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rx.
4018F..............  Therapy exercise joint rx.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4019F..............  Doc recpt counsl vit d/     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      calc+.
4025F..............  Inhaled broncholidator rx.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4030F..............  Oxygen therapy rx.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4033F..............  Pulmonary rehab rec.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4035F..............  Influenza imm rec.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4037F..............  Influenza imm order/admin.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4040F..............  pneumoc imm order/admin...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4041F..............  Doc order cefazolin/        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      cefurox.
4042F..............  Doc antibio not given.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4043F..............  Doc order given stop        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antibio.
4044F..............  Doc order given vte         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prophylx.
4045F..............  Empiric antibiotic rx.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4046F..............  Doc antibio given b/4 surg  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4047F..............  Doc antibio given b/4 surg  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4048F..............  Doc antibio given b/4 surg  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40490..............  Biopsy of lip.............  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
4049F..............  Doc order given stop        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antibio.
40500..............  Partial excision of lip...  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
4050F..............  Ht care plan doc..........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40510..............  Partial excision of lip...  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
4051F..............  Referred for an av fistula  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40520..............  Partial excision of lip...  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
40525..............  Reconstruct lip with flap.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
40527..............  Reconstruct lip with flap.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
4052F..............  Hemodialysis via av         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
40530..............  Partial removal of lip....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
4053F..............  Hemodialysis via av graft.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4054F..............  Hemodialysis via catheter.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4055F..............  Pt. rcvng periton dialysis  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4056F..............  Approp. oral rehyd.         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recomm'd.
4058F..............  Ped gastro ed given,        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      caregvr.
4060F..............  Psych svcs provided.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4062F..............  Pt referral psych doc'd...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4064F..............  Antidepressant rx.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........

[[Page 42939]]

 
40650..............  Repair lip................  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
40652..............  Repair lip................  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
40654..............  Repair lip................  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
4065F..............  Antipsychotic rx..........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4066F..............  Ect provided..............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4067F..............  Pt referral for ect doc'd.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40700..............  Repair cleft lip/nasal....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
40701..............  Repair cleft lip/nasal....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
40702..............  Repair cleft lip/nasal....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
4070F..............  Dvt prophylx recv'd day 2.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40720..............  Repair cleft lip/nasal....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
4073F..............  Oral antiplat thx rx        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      dischrg.
4075F..............  Anticoag thx rx at dischrg  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40761..............  Repair cleft lip/nasal....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
4077F..............  Doc t-pa admin considered.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40799..............  Lip surgery procedure.....  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
4079F..............  Doc rehab svcs considered.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40800..............  Drainage of mouth lesion..  ..................  T.................         0006        1.463       $93.18  ...........       $18.64
40801..............  Drainage of mouth lesion..  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
40804..............  Removal, foreign body,      ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
                      mouth.
40805..............  Removal, foreign body,      ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
                      mouth.
40806..............  Incision of lip fold......  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
40808..............  Biopsy of mouth lesion....  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
40810..............  Excision of mouth lesion..  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
40812..............  Excise/repair mouth lesion  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
40814..............  Excise/repair mouth lesion  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
40816..............  Excision of mouth lesion..  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
40818..............  Excise oral mucosa for      ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
                      graft.
40819..............  Excise lip or cheek fold..  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
40820..............  Treatment of mouth lesion.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
40830..............  Repair mouth laceration...  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
40831..............  Repair mouth laceration...  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
40840..............  Reconstruction of mouth...  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
40842..............  Reconstruction of mouth...  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
40843..............  Reconstruction of mouth...  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
40844..............  Reconstruction of mouth...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
40845..............  Reconstruction of mouth...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
4084F..............  Aspirin recv'd w/in 24 hrs  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40899..............  Mouth surgery procedure...  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
41000..............  Drainage of mouth lesion..  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41005..............  Drainage of mouth lesion..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
41006..............  Drainage of mouth lesion..  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
41007..............  Drainage of mouth lesion..  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41008..............  Drainage of mouth lesion..  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41009..............  Drainage of mouth lesion..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
41010..............  Incision of tongue fold...  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
41015..............  Drainage of mouth lesion..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
41016..............  Drainage of mouth lesion..  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
41017..............  Drainage of mouth lesion..  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
41018..............  Drainage of mouth lesion..  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
41100..............  Biopsy of tongue..........  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
41105..............  Biopsy of tongue..........  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41108..............  Biopsy of floor of mouth..  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
41110..............  Excision of tongue lesion.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41112..............  Excision of tongue lesion.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41113..............  Excision of tongue lesion.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41114..............  Excision of tongue lesion.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
41115..............  Excision of tongue fold...  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
41116..............  Excision of mouth lesion..  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41120..............  Partial removal of tongue.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
41130..............  Partial removal of tongue.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
41135..............  Tongue and neck surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
41140..............  Removal of tongue.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
41145..............  Tongue removal, neck        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
41150..............  Tongue, mouth, jaw surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
41153..............  Tongue, mouth, neck         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
41155..............  Tongue, jaw, & neck         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
41250..............  Repair tongue laceration..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
41251..............  Repair tongue laceration..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
41252..............  Repair tongue laceration..  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
41500..............  Fixation of tongue........  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
41510..............  Tongue to lip surgery.....  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41520..............  Reconstruction, tongue      ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
                      fold.
41599..............  Tongue and mouth surgery..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
41800..............  Drainage of gum lesion....  ..................  T.................         0006        1.463       $93.18  ...........       $18.64
41805..............  Removal foreign body, gum.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
41806..............  Removal foreign             ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      body,jawbone.
41820..............  Excision, gum, each         ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
                      quadrant.

[[Page 42940]]

 
41821..............  Excision of gum flap......  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
41822..............  Excision of gum lesion....  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41823..............  Excision of gum lesion....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
41825..............  Excision of gum lesion....  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41826..............  Excision of gum lesion....  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41827..............  Excision of gum lesion....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
41828..............  Excision of gum lesion....  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41830..............  Removal of gum tissue.....  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41850..............  Treatment of gum lesion...  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41870..............  Gum graft.................  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
41872..............  Repair gum................  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
41874..............  Repair tooth socket.......  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
41899..............  Dental surgery procedure..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
42000..............  Drainage mouth roof lesion  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
42100..............  Biopsy roof of mouth......  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
42104..............  Excision lesion, mouth      ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      roof.
42106..............  Excision lesion, mouth      ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      roof.
42107..............  Excision lesion, mouth      ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      roof.
42120..............  Remove palate/lesion......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42140..............  Excision of uvula.........  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
42145..............  Repair palate, pharynx/     ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      uvula.
42160..............  Treatment mouth roof        ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      lesion.
42180..............  Repair palate.............  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
42182..............  Repair palate.............  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42200..............  Reconstruct cleft palate..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42205..............  Reconstruct cleft palate..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42210..............  Reconstruct cleft palate..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42215..............  Reconstruct cleft palate..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42220..............  Reconstruct cleft palate..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42225..............  Reconstruct cleft palate..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42226..............  Lengthening of palate.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42227..............  Lengthening of palate.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42235..............  Repair palate.............  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
42260..............  Repair nose to lip fistula  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
42280..............  Preparation, palate mold..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
42281..............  Insertion, palate           ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      prosthesis.
42299..............  Palate/uvula surgery......  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
42300..............  Drainage of salivary gland  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
42305..............  Drainage of salivary gland  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
42310..............  Drainage of salivary gland  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
42320..............  Drainage of salivary gland  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
42330..............  Removal of salivary stone.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
42335..............  Removal of salivary stone.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
42340..............  Removal of salivary stone.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
42400..............  Biopsy of salivary gland..  ..................  T.................         0005       7.3012      $465.04  ...........       $93.01
42405..............  Biopsy of salivary gland..  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
42408..............  Excision of salivary cyst.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
42409..............  Drainage of salivary cyst.  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
42410..............  Excise parotid gland/       ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      lesion.
42415..............  Excise parotid gland/       ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      lesion.
42420..............  Excise parotid gland/       ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      lesion.
42425..............  Excise parotid gland/       ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      lesion.
42426..............  Excise parotid gland/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
42440..............  Excise submaxillary gland.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42450..............  Excise sublingual gland...  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
42500..............  Repair salivary duct......  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
42505..............  Repair salivary duct......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42507..............  Parotid duct diversion....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42508..............  Parotid duct diversion....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42509..............  Parotid duct diversion....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42510..............  Parotid duct diversion....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42550..............  Injection for salivary x-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
42600..............  Closure of salivary         ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      fistula.
42650..............  Dilation of salivary duct.  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
42660..............  Dilation of salivary duct.  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
42665..............  Ligation of salivary duct.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
42699..............  Salivary surgery procedure  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
42700..............  Drainage of tonsil abscess  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
42720..............  Drainage of throat abscess  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
42725..............  Drainage of throat abscess  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42800..............  Biopsy of throat..........  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
42802..............  Biopsy of throat..........  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
42804..............  Biopsy of upper nose/       ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      throat.
42806..............  Biopsy of upper nose/       ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      throat.
42808..............  Excise pharynx lesion.....  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
42809..............  Remove pharynx foreign      ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
                      body.
42810..............  Excision of neck cyst.....  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
42815..............  Excision of neck cyst.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68

[[Page 42941]]

 
42820..............  Remove tonsils and          ..................  T.................         0258      22.9075    $1,459.05      $437.20      $291.81
                      adenoids.
42821..............  Remove tonsils and          ..................  T.................         0258      22.9075    $1,459.05      $437.20      $291.81
                      adenoids.
42825..............  Removal of tonsils........  ..................  T.................         0258      22.9075    $1,459.05      $437.20      $291.81
42826..............  Removal of tonsils........  ..................  T.................         0258      22.9075    $1,459.05      $437.20      $291.81
42830..............  Removal of adenoids.......  ..................  T.................         0258      22.9075    $1,459.05      $437.20      $291.81
42831..............  Removal of adenoids.......  ..................  T.................         0258      22.9075    $1,459.05      $437.20      $291.81
42835..............  Removal of adenoids.......  ..................  T.................         0258      22.9075    $1,459.05      $437.20      $291.81
42836..............  Removal of adenoids.......  ..................  T.................         0258      22.9075    $1,459.05      $437.20      $291.81
42842..............  Extensive surgery of        ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
                      throat.
42844..............  Extensive surgery of        ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      throat.
42845..............  Extensive surgery of        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      throat.
42860..............  Excision of tonsil tags...  ..................  T.................         0258      22.9075    $1,459.05      $437.20      $291.81
42870..............  Excision of lingual tonsil  ..................  T.................         0258      22.9075    $1,459.05      $437.20      $291.81
42890..............  Partial removal of pharynx  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42892..............  Revision of pharyngeal      ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      walls.
42894..............  Revision of pharyngeal      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      walls.
42900..............  Repair throat wound.......  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
42950..............  Reconstruction of throat..  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
42953..............  Repair throat, esophagus..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
42955..............  Surgical opening of throat  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
42960..............  Control throat bleeding...  ..................  T.................         0250       1.1708       $74.57       $25.30       $14.91
42961..............  Control throat bleeding...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
42962..............  Control throat bleeding...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
42970..............  Control nose/throat         ..................  T.................         0250       1.1708       $74.57       $25.30       $14.91
                      bleeding.
42971..............  Control nose/throat         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bleeding.
42972..............  Control nose/throat         ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      bleeding.
42999..............  Throat surgery procedure..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
43020..............  Incision of esophagus.....  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
43030..............  Throat muscle surgery.....  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
43045..............  Incision of esophagus.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43100..............  Excision of esophagus       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
43101..............  Excision of esophagus       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
43107..............  Removal of esophagus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43108..............  Removal of esophagus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43112..............  Removal of esophagus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43113..............  Removal of esophagus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43116..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43117..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43118..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43121..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43122..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43123..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43124..............  Removal of esophagus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43130..............  Removal of esophagus pouch  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
43135..............  Removal of esophagus pouch  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43200..............  Esophagus endoscopy.......  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43201..............  Esoph scope w/submucous     ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      inj.
43202..............  Esophagus endoscopy,        ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      biopsy.
43204..............  Esoph scope w/sclerosis     ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      inj.
43205..............  Esophagus endoscopy/        ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      ligation.
43215..............  Esophagus endoscopy.......  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43216..............  Esophagus endoscopy/lesion  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43217..............  Esophagus endoscopy.......  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43219..............  Esophagus endoscopy.......  ..................  T.................         0384      25.2289    $1,606.90  ...........      $321.38
43220..............  Esoph endoscopy, dilation.  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43226..............  Esoph endoscopy, dilation.  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43227..............  Esoph endoscopy, repair...  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43228..............  Esoph endoscopy, ablation.  ..................  T.................         0422       24.648    $1,569.91      $445.06      $313.98
43231..............  Esoph endoscopy w/us exam.  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43232..............  Esoph endoscopy w/us fn bx  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43234..............  Upper GI endoscopy, exam..  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43235..............  Uppr gi endoscopy,          ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      diagnosis.
43236..............  Uppr gi scope w/submuc inj  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43237..............  Endoscopic us exam, esoph.  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43238..............  Uppr gi endoscopy w/us fn   ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      bx.
43239..............  Upper GI endoscopy, biopsy  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43240..............  Esoph endoscope w/drain     ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      cyst.
43241..............  Upper GI endoscopy with     ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      tube.
43242..............  Uppr gi endoscopy w/us fn   ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      bx.
43243..............  Upper gi endoscopy &        ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      inject.
43244..............  Upper GI endoscopy/         ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      ligation.
43245..............  Uppr gi scope dilate        ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      strictr.
43246..............  Place gastrostomy tube....  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43247..............  Operative upper GI          ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      endoscopy.
43248..............  Uppr gi endoscopy/guide     ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      wire.
43249..............  Esoph endoscopy, dilation.  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43250..............  Upper GI endoscopy/tumor..  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43251..............  Operative upper GI          ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      endoscopy.

[[Page 42942]]

 
43255..............  Operative upper GI          ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      endoscopy.
43256..............  Uppr gi endoscopy w/stent.  ..................  T.................         0384      25.2289    $1,606.90  ...........      $321.38
43257..............  Uppr gi scope w/thrml       ..................  T.................         0422       24.648    $1,569.91      $445.06      $313.98
                      txmnt.
43258..............  Operative upper GI          ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      endoscopy.
43259..............  Endoscopic ultrasound exam  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43260..............  Endo                        ..................  T.................         0151       21.282    $1,355.51  ...........      $271.10
                      cholangiopancreatograph.
43261..............  Endo                        ..................  T.................         0151       21.282    $1,355.51  ...........      $271.10
                      cholangiopancreatograph.
43262..............  Endo                        ..................  T.................         0151       21.282    $1,355.51  ...........      $271.10
                      cholangiopancreatograph.
43263..............  Endo                        ..................  T.................         0151       21.282    $1,355.51  ...........      $271.10
                      cholangiopancreatograph.
43264..............  Endo                        ..................  T.................         0151       21.282    $1,355.51  ...........      $271.10
                      cholangiopancreatograph.
43265..............  Endo                        ..................  T.................         0151       21.282    $1,355.51  ...........      $271.10
                      cholangiopancreatograph.
43267..............  Endo                        ..................  T.................         0151       21.282    $1,355.51  ...........      $271.10
                      cholangiopancreatograph.
43268..............  Endo                        ..................  T.................         0384      25.2289    $1,606.90  ...........      $321.38
                      cholangiopancreatograph.
43269..............  Endo                        ..................  T.................         0384      25.2289    $1,606.90  ...........      $321.38
                      cholangiopancreatograph.
43271..............  Endo                        ..................  T.................         0151       21.282    $1,355.51  ...........      $271.10
                      cholangiopancreatograph.
43272..............  Endo                        ..................  T.................         0151       21.282    $1,355.51  ...........      $271.10
                      cholangiopancreatograph.
43280..............  Laparoscopy, fundoplasty..  ..................  T.................         0132      71.0022    $4,522.34    $1,239.20      $904.47
43289..............  Laparoscope proc, esoph...  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
43300..............  Repair of esophagus.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43305..............  Repair esophagus and        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
43310..............  Repair of esophagus.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43312..............  Repair esophagus and        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
43313..............  Esophagoplasty congenital.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43314..............  Tracheo-esophagoplasty      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cong.
43320..............  Fuse esophagus & stomach..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43324..............  Revise esophagus & stomach  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43325..............  Revise esophagus & stomach  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43326..............  Revise esophagus & stomach  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43330..............  Repair of esophagus.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43331..............  Repair of esophagus.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43340..............  Fuse esophagus & intestine  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43341..............  Fuse esophagus & intestine  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43350..............  Surgical opening,           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43351..............  Surgical opening,           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43352..............  Surgical opening,           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43360..............  Gastrointestinal repair...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43361..............  Gastrointestinal repair...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43400..............  Ligate esophagus veins....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43401..............  Esophagus surgery for       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      veins.
43405..............  Ligate/staple esophagus...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43410..............  Repair esophagus wound....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43415..............  Repair esophagus wound....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43420..............  Repair esophagus opening..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43425..............  Repair esophagus opening..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43450..............  Dilate esophagus..........  ..................  T.................         0140       6.0867      $387.68       $91.40       $77.54
43453..............  Dilate esophagus..........  ..................  T.................         0140       6.0867      $387.68       $91.40       $77.54
43456..............  Dilate esophagus..........  ..................  T.................         0140       6.0867      $387.68       $91.40       $77.54
43458..............  Dilate esophagus..........  CH................  T.................         0141        8.673      $552.41      $143.30      $110.48
43460..............  Pressure treatment          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43496..............  Free jejunum flap,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
43499..............  Esophagus surgery           ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      procedure.
43500..............  Surgical opening of         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      stomach.
43501..............  Surgical repair of stomach  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43502..............  Surgical repair of stomach  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43510..............  Surgical opening of         ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      stomach.
43520..............  Incision of pyloric muscle  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43600..............  Biopsy of stomach.........  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43605..............  Biopsy of stomach.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43610..............  Excision of stomach lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43611..............  Excision of stomach lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43620..............  Removal of stomach........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43621..............  Removal of stomach........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43622..............  Removal of stomach........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43631..............  Removal of stomach,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      partial.
43632..............  Removal of stomach,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      partial.
43633..............  Removal of stomach,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      partial.
43634..............  Removal of stomach,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      partial.
43635..............  Removal of stomach,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      partial.
43640..............  Vagotomy & pylorus repair.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43641..............  Vagotomy & pylorus repair.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43644..............  Lap gastric bypass/roux-en- ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      y.
43645..............  Lap gastr bypass incl smll  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      i.
43647..............  Lap impl electrode, antrum  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
43648..............  Lap revise/remv eltrd       ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
                      antrum.
43651..............  Laparoscopy, vagus nerve..  ..................  T.................         0132      71.0022    $4,522.34    $1,239.20      $904.47
43652..............  Laparoscopy, vagus nerve..  ..................  T.................         0132      71.0022    $4,522.34    $1,239.20      $904.47
43653..............  Laparoscopy, gastrostomy..  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
43659..............  Laparoscope proc, stom....  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50

[[Page 42943]]

 
43750..............  Place gastrostomy tube....  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43752..............  Nasal/orogastric w/stent..  ..................  X.................         0272        1.327       $84.52       $31.60       $16.90
43760..............  Change gastrostomy tube...  ..................  T.................         0121       3.2914      $209.64       $43.80       $41.93
43761..............  Reposition gastrostomy      CH................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      tube.
43770..............  Lap, place gastr adjust     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      band.
43771..............  Lap, revise adjust gast     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      band.
43772..............  Lap, remove adjust gast     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      band.
43773..............  Lap, change adjust gast     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      band.
43774..............  Lap remov adj gast band/    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      port.
43800..............  Reconstruction of pylorus.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43810..............  Fusion of stomach and       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
43820..............  Fusion of stomach and       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
43825..............  Fusion of stomach and       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
43830..............  Place gastrostomy tube....  ..................  T.................         0422       24.648    $1,569.91      $445.06      $313.98
43831..............  Place gastrostomy tube....  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43832..............  Place gastrostomy tube....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43840..............  Repair of stomach lesion..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43842..............  V-band gastroplasty.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
43843..............  Gastroplasty w/o v-band...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43845..............  Gastroplasty duodenal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      switch.
43846..............  Gastric bypass for obesity  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43847..............  Gastric bypass incl small   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      i.
43848..............  Revision gastroplasty.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43850..............  Revise stomach-bowel        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fusion.
43855..............  Revise stomach-bowel        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fusion.
43860..............  Revise stomach-bowel        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fusion.
43865..............  Revise stomach-bowel        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fusion.
43870..............  Repair stomach opening....  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
43880..............  Repair stomach-bowel        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
43881..............  Impl/redo electrd, antrum.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43882..............  Revise/remove electrd       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      antrum.
43886..............  Revise gastric port, open.  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
43887..............  Remove gastric port, open.  CH................  T.................         0135       4.6816      $298.19  ...........       $59.64
43888..............  Change gastric port, open.  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
43999..............  Stomach surgery procedure.  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
44005..............  Freeing of bowel adhesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44010..............  Incision of small bowel...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44015..............  Insert needle cath bowel..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44020..............  Explore small intestine...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44021..............  Decompress small bowel....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44025..............  Incision of large bowel...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44050..............  Reduce bowel obstruction..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44055..............  Correct malrotation of      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
44100..............  Biopsy of bowel...........  ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
44110..............  Excise intestine lesion(s)  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44111..............  Excision of bowel           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion(s).
44120..............  Removal of small intestine  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44121..............  Removal of small intestine  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44125..............  Removal of small intestine  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44126..............  Enterectomy w/o taper,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cong.
44127..............  Enterectomy w/taper, cong.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44128..............  Enterectomy cong, add-on..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44130..............  Bowel to bowel fusion.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44132..............  Enterectomy, cadaver donor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44133..............  Enterectomy, live donor...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44135..............  Intestine transplnt,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cadaver.
44136..............  Intestine transplant, live  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44137..............  Remove intestinal           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      allograft.
44139..............  Mobilization of colon.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44140..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44141..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44143..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44144..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44145..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44146..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44147..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44150..............  Removal of colon..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44151..............  Removal of colon/ileostomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44155..............  Removal of colon/ileostomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44156..............  Removal of colon/ileostomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44157..............  Colectomy w/ileoanal anast  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44158..............  Colectomy w/neo-rectum      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pouch.
44160..............  Removal of colon..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44180..............  Lap, enterolysis..........  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
44186..............  Lap, jejunostomy..........  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
44187..............  Lap, ileo/jejuno-stomy....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44188..............  Lap, colostomy............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44202..............  Lap, enterectomy..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42944]]

 
44203..............  Lap resect s/intestine,     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      addl.
44204..............  Laparo partial colectomy..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44205..............  Lap colectomy part w/ileum  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44206..............  Lap part colectomy w/stoma  ..................  T.................         0132      71.0022    $4,522.34    $1,239.20      $904.47
44207..............  L colectomy/                ..................  T.................         0132      71.0022    $4,522.34    $1,239.20      $904.47
                      coloproctostomy.
44208..............  L colectomy/                ..................  T.................         0132      71.0022    $4,522.34    $1,239.20      $904.47
                      coloproctostomy.
44210..............  Laparo total                ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      proctocolectomy.
44211..............  Lap colectomy w/            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      proctectomy.
44212..............  Laparo total                ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      proctocolectomy.
44213..............  Lap, mobil splenic fl add-  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
                      on.
44227..............  Lap, close enterostomy....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44238..............  Laparoscope proc,           ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
                      intestine.
44300..............  Open bowel to skin........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44310..............  Ileostomy/jejunostomy.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44312..............  Revision of ileostomy.....  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
44314..............  Revision of ileostomy.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44316..............  Devise bowel pouch........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44320..............  Colostomy.................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44322..............  Colostomy with biopsies...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44340..............  Revision of colostomy.....  CH................  T.................         0137      20.9338    $1,333.34  ...........      $266.67
44345..............  Revision of colostomy.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44346..............  Revision of colostomy.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44360..............  Small bowel endoscopy.....  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
44361..............  Small bowel endoscopy/      ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
                      biopsy.
44363..............  Small bowel endoscopy.....  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
44364..............  Small bowel endoscopy.....  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
44365..............  Small bowel endoscopy.....  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
44366..............  Small bowel endoscopy.....  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
44369..............  Small bowel endoscopy.....  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
44370..............  Small bowel endoscopy/      ..................  T.................         0384      25.2289    $1,606.90  ...........      $321.38
                      stent.
44372..............  Small bowel endoscopy.....  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
44373..............  Small bowel endoscopy.....  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
44376..............  Small bowel endoscopy.....  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
44377..............  Small bowel endoscopy/      ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
                      biopsy.
44378..............  Small bowel endoscopy.....  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
44379..............  S bowel endoscope w/stent.  ..................  T.................         0384      25.2289    $1,606.90  ...........      $321.38
44380..............  Small bowel endoscopy.....  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
44382..............  Small bowel endoscopy.....  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
44383..............  Ileoscopy w/stent.........  ..................  T.................         0384      25.2289    $1,606.90  ...........      $321.38
44385..............  Endoscopy of bowel pouch..  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
44386..............  Endoscopy, bowel pouch/     ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
                      biop.
44388..............  Colonoscopy...............  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
44389..............  Colonoscopy with biopsy...  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
44390..............  Colonoscopy for foreign     ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
                      body.
44391..............  Colonoscopy for bleeding..  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
44392..............  Colonoscopy & polypectomy.  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
44393..............  Colonoscopy, lesion         ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
                      removal.
44394..............  Colonoscopy w/snare.......  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
44397..............  Colonoscopy w/stent.......  ..................  T.................         0384      25.2289    $1,606.90  ...........      $321.38
44500..............  Intro, gastrointestinal     ..................  T.................         0121       3.2914      $209.64       $43.80       $41.93
                      tube.
44602..............  Suture, small intestine...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44603..............  Suture, small intestine...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44604..............  Suture, large intestine...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44605..............  Repair of bowel lesion....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44615..............  Intestinal stricturoplasty  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44620..............  Repair bowel opening......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44625..............  Repair bowel opening......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44626..............  Repair bowel opening......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44640..............  Repair bowel-skin fistula.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44650..............  Repair bowel fistula......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44660..............  Repair bowel-bladder        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
44661..............  Repair bowel-bladder        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
44680..............  Surgical revision,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      intestine.
44700..............  Suspend bowel w/prosthesis  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44701..............  Intraop colon lavage add-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
44715..............  Prepare donor intestine...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44720..............  Prep donor intestine/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      venous.
44721..............  Prep donor intestine/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
44799..............  Unlisted procedure          ..................  T.................         0153      25.4636    $1,621.85      $397.90      $324.37
                      intestine.
44800..............  Excision of bowel pouch...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44820..............  Excision of mesentery       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
44850..............  Repair of mesentery.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44899..............  Bowel surgery procedure...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44900..............  Drain app abscess, open...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44901..............  Drain app abscess, percut.  ..................  T.................         0037      13.9599      $889.15      $228.70      $177.83
44950..............  Appendectomy..............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44955..............  Appendectomy add-on.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44960..............  Appendectomy..............  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42945]]

 
44970..............  Laparoscopy, appendectomy.  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
44979..............  Laparoscope proc, app.....  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
45000..............  Drainage of pelvic abscess  CH................  T.................         0155      11.6524      $742.18  ...........      $148.44
45005..............  Drainage of rectal abscess  ..................  T.................         0155      11.6524      $742.18  ...........      $148.44
45020..............  Drainage of rectal abscess  ..................  T.................         0155      11.6524      $742.18  ...........      $148.44
45100..............  Biopsy of rectum..........  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
45108..............  Removal of anorectal        ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
                      lesion.
45110..............  Removal of rectum.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45111..............  Partial removal of rectum.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45112..............  Removal of rectum.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45113..............  Partial proctectomy.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45114..............  Partial removal of rectum.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45116..............  Partial removal of rectum.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45119..............  Remove rectum w/reservoir.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45120..............  Removal of rectum.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45121..............  Removal of rectum and       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      colon.
45123..............  Partial proctectomy.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45126..............  Pelvic exenteration.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45130..............  Excision of rectal          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      prolapse.
45135..............  Excision of rectal          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      prolapse.
45136..............  Excise ileoanal reservior.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45150..............  Excision of rectal          ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
                      stricture.
45160..............  Excision of rectal lesion.  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
45170..............  Excision of rectal lesion.  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
45190..............  Destruction, rectal tumor.  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
45300..............  Proctosigmoidoscopy dx....  ..................  T.................         0146       5.1441      $327.64  ...........       $65.53
45303..............  Proctosigmoidoscopy dilate  ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
45305..............  Proctosigmoidoscopy w/bx..  ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
45307..............  Proctosigmoidoscopy fb....  ..................  T.................         0428      21.8923    $1,394.39  ...........      $278.88
45308..............  Proctosigmoidoscopy         ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
                      removal.
45309..............  Proctosigmoidoscopy         ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
                      removal.
45315..............  Proctosigmoidoscopy         ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
                      removal.
45317..............  Proctosigmoidoscopy bleed.  ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
45320..............  Proctosigmoidoscopy ablate  ..................  T.................         0428      21.8923    $1,394.39  ...........      $278.88
45321..............  Proctosigmoidoscopy volvul  ..................  T.................         0428      21.8923    $1,394.39  ...........      $278.88
45327..............  Proctosigmoidoscopy w/      ..................  T.................         0384      25.2289    $1,606.90  ...........      $321.38
                      stent.
45330..............  Diagnostic sigmoidoscopy..  ..................  T.................         0146       5.1441      $327.64  ...........       $65.53
45331..............  Sigmoidoscopy and biopsy..  ..................  T.................         0146       5.1441      $327.64  ...........       $65.53
45332..............  Sigmoidoscopy w/fb removal  ..................  T.................         0146       5.1441      $327.64  ...........       $65.53
45333..............  Sigmoidoscopy &             ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
                      polypectomy.
45334..............  Sigmoidoscopy for bleeding  ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
45335..............  Sigmoidoscopy w/submuc inj  ..................  T.................         0146       5.1441      $327.64  ...........       $65.53
45337..............  Sigmoidoscopy & decompress  ..................  T.................         0146       5.1441      $327.64  ...........       $65.53
45338..............  Sigmoidoscopy w/tumr        ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
                      remove.
45339..............  Sigmoidoscopy w/ablate      ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
                      tumr.
45340..............  Sig w/balloon dilation....  ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
45341..............  Sigmoidoscopy w/ultrasound  ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
45342..............  Sigmoidoscopy w/us guide    ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
                      bx.
45345..............  Sigmoidoscopy w/stent.....  ..................  T.................         0384      25.2289    $1,606.90  ...........      $321.38
45355..............  Surgical colonoscopy......  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
45378..............  Diagnostic colonoscopy....  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
45379..............  Colonoscopy w/fb removal..  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
45380..............  Colonoscopy and biopsy....  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
45381..............  Colonoscopy, submucous inj  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
45382..............  Colonoscopy/control         ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
                      bleeding.
45383..............  Lesion removal colonoscopy  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
45384..............  Lesion remove colonoscopy.  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
45385..............  Lesion removal colonoscopy  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
45386..............  Colonoscopy dilate          ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
                      stricture.
45387..............  Colonoscopy w/stent.......  ..................  T.................         0384      25.2289    $1,606.90  ...........      $321.38
45391..............  Colonoscopy w/endoscope us  ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
45392..............  Colonoscopy w/endoscopic    ..................  T.................         0143        9.036      $575.53      $186.00      $115.11
                      fnb.
45395..............  Lap, removal of rectum....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45397..............  Lap, remove rectum w/pouch  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45400..............  Laparoscopic proc.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45402..............  Lap proctopexy w/sig        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      resect.
45499..............  Laparoscope proc, rectum..  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
45500..............  Repair of rectum..........  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
45505..............  Repair of rectum..........  ..................  T.................         0150      30.5544    $1,946.10      $437.10      $389.22
45520..............  Treatment of rectal         CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
                      prolapse.
45540..............  Correct rectal prolapse...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45541..............  Correct rectal prolapse...  ..................  T.................         0150      30.5544    $1,946.10      $437.10      $389.22
45550..............  Repair rectum/remove        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      sigmoid.
45560..............  Repair of rectocele.......  ..................  T.................         0150      30.5544    $1,946.10      $437.10      $389.22
45562..............  Exploration/repair of       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      rectum.
45563..............  Exploration/repair of       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      rectum.
45800..............  Repair rect/bladder         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
45805..............  Repair fistula w/colostomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42946]]

 
45820..............  Repair rectourethral        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
45825..............  Repair fistula w/colostomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45900..............  Reduction of rectal         ..................  T.................         0148       4.5189      $287.82  ...........       $57.56
                      prolapse.
45905..............  Dilation of anal sphincter  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
45910..............  Dilation of rectal          ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
                      narrowing.
45915..............  Remove rectal obstruction.  CH................  T.................         0155      11.6524      $742.18  ...........      $148.44
45990..............  Surg dx exam, anorectal...  CH................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
45999..............  Rectum surgery procedure..  ..................  T.................         0148       4.5189      $287.82  ...........       $57.56
46020..............  Placement of seton........  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46030..............  Removal of rectal marker..  ..................  T.................         0148       4.5189      $287.82  ...........       $57.56
46040..............  Incision of rectal abscess  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46045..............  Incision of rectal abscess  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46050..............  Incision of anal abscess..  CH................  T.................         0155      11.6524      $742.18  ...........      $148.44
46060..............  Incision of rectal abscess  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46070..............  Incision of anal septum...  ..................  T.................         0155      11.6524      $742.18  ...........      $148.44
46080..............  Incision of anal sphincter  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46083..............  Incise external hemorrhoid  ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
46200..............  Removal of anal fissure...  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46210..............  Removal of anal crypt.....  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46211..............  Removal of anal crypts....  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46220..............  Removal of anal tag.......  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46221..............  Ligation of hemorrhoid(s).  ..................  T.................         0148       4.5189      $287.82  ...........       $57.56
46230..............  Removal of anal tags......  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46250..............  Hemorrhoidectomy..........  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46255..............  Hemorrhoidectomy..........  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46257..............  Remove hemorrhoids &        ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
                      fissure.
46258..............  Remove hemorrhoids &        ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
                      fistula.
46260..............  Hemorrhoidectomy..........  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46261..............  Remove hemorrhoids &        ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
                      fissure.
46262..............  Remove hemorrhoids &        ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
                      fistula.
46270..............  Removal of anal fistula...  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46275..............  Removal of anal fistula...  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46280..............  Removal of anal fistula...  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46285..............  Removal of anal fistula...  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46288..............  Repair anal fistula.......  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46320..............  Removal of hemorrhoid clot  CH................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46500..............  Injection into              ..................  T.................         0155      11.6524      $742.18  ...........      $148.44
                      hemorrhoid(s).
46505..............  Chemodenervation anal musc  ..................  T.................         0148       4.5189      $287.82  ...........       $57.56
46600..............  Diagnostic anoscopy.......  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
46604..............  Anoscopy and dilation.....  ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
46606..............  Anoscopy and biopsy.......  ..................  T.................         0146       5.1441      $327.64  ...........       $65.53
46608..............  Anoscopy, remove for body.  ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
46610..............  Anoscopy, remove lesion...  ..................  T.................         0428      21.8923    $1,394.39  ...........      $278.88
46611..............  Anoscopy..................  ..................  T.................         0147       8.8611      $564.39  ...........      $112.88
46612..............  Anoscopy, remove lesions..  ..................  T.................         0428      21.8923    $1,394.39  ...........      $278.88
46614..............  Anoscopy, control bleeding  ..................  T.................         0146       5.1441      $327.64  ...........       $65.53
46615..............  Anoscopy..................  ..................  T.................         0428      21.8923    $1,394.39  ...........      $278.88
46700..............  Repair of anal stricture..  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46705..............  Repair of anal stricture..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
46706..............  Repr of anal fistula w/     ..................  T.................         0150      30.5544    $1,946.10      $437.10      $389.22
                      glue.
46710..............  Repr per/vag pouch sngl     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      proc.
46712..............  Repr per/vag pouch dbl      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      proc.
46715..............  Rep perf anoper fistu.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
46716..............  Rep perf anoper/vestib      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistu.
46730..............  Construction of absent      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      anus.
46735..............  Construction of absent      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      anus.
46740..............  Construction of absent      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      anus.
46742..............  Repair of imperforated      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      anus.
46744..............  Repair of cloacal anomaly.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
46746..............  Repair of cloacal anomaly.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
46748..............  Repair of cloacal anomaly.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
46750..............  Repair of anal sphincter..  CH................  T.................         0150      30.5544    $1,946.10      $437.10      $389.22
46751..............  Repair of anal sphincter..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
46753..............  Reconstruction of anus....  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46754..............  Removal of suture from      ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
                      anus.
46760..............  Repair of anal sphincter..  CH................  T.................         0150      30.5544    $1,946.10      $437.10      $389.22
46761..............  Repair of anal sphincter..  CH................  T.................         0150      30.5544    $1,946.10      $437.10      $389.22
46762..............  Implant artificial          CH................  T.................         0150      30.5544    $1,946.10      $437.10      $389.22
                      sphincter.
46900..............  Destruction, anal           ..................  T.................         0016       2.7493      $175.11  ...........       $35.02
                      lesion(s).
46910..............  Destruction, anal           ..................  T.................         0017      20.0977    $1,280.08  ...........      $256.02
                      lesion(s).
46916..............  Cryosurgery, anal           CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      lesion(s).
46917..............  Laser surgery, anal         CH................  T.................         0017      20.0977    $1,280.08  ...........      $256.02
                      lesions.
46922..............  Excision of anal lesion(s)  CH................  T.................         0017      20.0977    $1,280.08  ...........      $256.02
46924..............  Destruction, anal           CH................  T.................         0017      20.0977    $1,280.08  ...........      $256.02
                      lesion(s).
46934..............  Destruction of hemorrhoids  ..................  T.................         0155      11.6524      $742.18  ...........      $148.44
46935..............  Destruction of hemorrhoids  ..................  T.................         0155      11.6524      $742.18  ...........      $148.44
46936..............  Destruction of hemorrhoids  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46937..............  Cryotherapy of rectal       ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
                      lesion.

[[Page 42947]]

 
46938..............  Cryotherapy of rectal       ..................  T.................         0150      30.5544    $1,946.10      $437.10      $389.22
                      lesion.
46940..............  Treatment of anal fissure.  ..................  T.................         0149      23.2282    $1,479.47  ...........      $295.89
46942..............  Treatment of anal fissure.  ..................  T.................         0148       4.5189      $287.82  ...........       $57.56
46945..............  Ligation of hemorrhoids...  ..................  T.................         0155      11.6524      $742.18  ...........      $148.44
46946..............  Ligation of hemorrhoids...  ..................  T.................         0155      11.6524      $742.18  ...........      $148.44
46947..............  Hemorrhoidopexy by          ..................  T.................         0150      30.5544    $1,946.10      $437.10      $389.22
                      stapling.
46999..............  Anus surgery procedure....  ..................  T.................         0148       4.5189      $287.82  ...........       $57.56
47000..............  Needle biopsy of liver....  ..................  T.................         0685       9.5741      $609.80  ...........      $121.96
47001..............  Needle biopsy, liver add-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
47010..............  Open drainage, liver        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
47011..............  Percut drain, liver lesion  ..................  T.................         0037      13.9599      $889.15      $228.70      $177.83
47015..............  Inject/aspirate liver cyst  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47100..............  Wedge biopsy of liver.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47120..............  Partial removal of liver..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47122..............  Extensive removal of liver  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47125..............  Partial removal of liver..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47130..............  Partial removal of liver..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47133..............  Removal of donor liver....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47135..............  Transplantation of liver..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47136..............  Transplantation of liver..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47140..............  Partial removal, donor      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      liver.
47141..............  Partial removal, donor      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      liver.
47142..............  Partial removal, donor      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      liver.
47143..............  Prep donor liver, whole...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47144..............  Prep donor liver, 3-        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      segment.
47145..............  Prep donor liver, lobe      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      split.
47146..............  Prep donor liver/venous...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47147..............  Prep donor liver/arterial.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47300..............  Surgery for liver lesion..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47350..............  Repair liver wound........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47360..............  Repair liver wound........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47361..............  Repair liver wound........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47362..............  Repair liver wound........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47370..............  Laparo ablate liver tumor   ..................  T.................         0132      71.0022    $4,522.34    $1,239.20      $904.47
                      rf.
47371..............  Laparo ablate liver         ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
                      cryosurg.
47379..............  Laparoscope procedure,      ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
                      liver.
47380..............  Open ablate liver tumor rf  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47381..............  Open ablate liver tumor     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cryo.
47382..............  Percut ablate liver rf....  ..................  T.................         0423      44.1192    $2,810.08  ...........      $562.02
47399..............  Liver surgery procedure...  ..................  T.................         0004       4.5062      $287.01  ...........       $57.40
47400..............  Incision of liver duct....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47420..............  Incision of bile duct.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47425..............  Incision of bile duct.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47460..............  Incise bile duct sphincter  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47480..............  Incision of gallbladder...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47490..............  Incision of gallbladder...  ..................  T.................         0152      28.7304    $1,829.93  ...........      $365.99
47500..............  Injection for liver x-rays  ..................  N.................  ...........  ...........  ...........  ...........  ...........
47505..............  Injection for liver x-rays  ..................  N.................  ...........  ...........  ...........  ...........  ...........
47510..............  Insert catheter, bile duct  ..................  T.................         0152      28.7304    $1,829.93  ...........      $365.99
47511..............  Insert bile duct drain....  ..................  T.................         0152      28.7304    $1,829.93  ...........      $365.99
47525..............  Change bile duct catheter.  ..................  T.................         0427      14.8912      $948.47  ...........      $189.69
47530..............  Revise/reinsert bile tube.  ..................  T.................         0427      14.8912      $948.47  ...........      $189.69
47550..............  Bile duct endoscopy add-on  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47552..............  Biliary endoscopy thru      ..................  T.................         0152      28.7304    $1,829.93  ...........      $365.99
                      skin.
47553..............  Biliary endoscopy thru      ..................  T.................         0152      28.7304    $1,829.93  ...........      $365.99
                      skin.
47554..............  Biliary endoscopy thru      ..................  T.................         0152      28.7304    $1,829.93  ...........      $365.99
                      skin.
47555..............  Biliary endoscopy thru      ..................  T.................         0152      28.7304    $1,829.93  ...........      $365.99
                      skin.
47556..............  Biliary endoscopy thru      ..................  T.................         0152      28.7304    $1,829.93  ...........      $365.99
                      skin.
47560..............  Laparoscopy w/cholangio...  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
47561..............  Laparo w/cholangio/biopsy.  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
47562..............  Laparoscopic                ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
                      cholecystectomy.
47563..............  Laparo cholecystectomy/     ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
                      graph.
47564..............  Laparo cholecystectomy/     ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
                      explr.
47570..............  Laparo                      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cholecystoenterostomy.
47579..............  Laparoscope proc, biliary.  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
47600..............  Removal of gallbladder....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47605..............  Removal of gallbladder....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47610..............  Removal of gallbladder....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47612..............  Removal of gallbladder....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47620..............  Removal of gallbladder....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47630..............  Remove bile duct stone....  ..................  T.................         0152      28.7304    $1,829.93  ...........      $365.99
47700..............  Exploration of bile ducts.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47701..............  Bile duct revision........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47711..............  Excision of bile duct       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tumor.
47712..............  Excision of bile duct       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tumor.
47715..............  Excision of bile duct cyst  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47719..............  Fusion of bile duct cyst..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47720..............  Fuse gallbladder & bowel..  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42948]]

 
47721..............  Fuse upper gi structures..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47740..............  Fuse gallbladder & bowel..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47741..............  Fuse gallbladder & bowel..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47760..............  Fuse bile ducts and bowel.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47765..............  Fuse liver ducts & bowel..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47780..............  Fuse bile ducts and bowel.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47785..............  Fuse bile ducts and bowel.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47800..............  Reconstruction of bile      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ducts.
47801..............  Placement, bile duct        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      support.
47802..............  Fuse liver duct &           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      intestine.
47900..............  Suture bile duct injury...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47999..............  Bile tract surgery          ..................  T.................         0152      28.7304    $1,829.93  ...........      $365.99
                      procedure.
48000..............  Drainage of abdomen.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48001..............  Placement of drain,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pancreas.
48020..............  Removal of pancreatic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      stone.
48100..............  Biopsy of pancreas, open..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48102..............  Needle biopsy, pancreas...  ..................  T.................         0685       9.5741      $609.80  ...........      $121.96
48105..............  Resect/debride pancreas...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48120..............  Removal of pancreas lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48140..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pancreas.
48145..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pancreas.
48146..............  Pancreatectomy............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48148..............  Removal of pancreatic duct  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48150..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pancreas.
48152..............  Pancreatectomy............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48153..............  Pancreatectomy............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48154..............  Pancreatectomy............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48155..............  Removal of pancreas.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48160..............  Pancreas removal/           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      transplant.
48400..............  Injection, intraop add-on.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48500..............  Surgery of pancreatic cyst  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48510..............  Drain pancreatic            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pseudocyst.
48511..............  Drain pancreatic            ..................  T.................         0037      13.9599      $889.15      $228.70      $177.83
                      pseudocyst.
48520..............  Fuse pancreas cyst and      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
48540..............  Fuse pancreas cyst and      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
48545..............  Pancreatorrhaphy..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48547..............  Duodenal exclusion........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48548..............  Fuse pancreas and bowel...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48550..............  Donor pancreatectomy......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
48551..............  Prep donor pancreas.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48552..............  Prep donor pancreas/venous  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48554..............  Transpl allograft pancreas  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48556..............  Removal, allograft          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pancreas.
48999..............  Pancreas surgery procedure  ..................  T.................         0004       4.5062      $287.01  ...........       $57.40
49000..............  Exploration of abdomen....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49002..............  Reopening of abdomen......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49010..............  Exploration behind abdomen  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49020..............  Drain abdominal abscess...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49021..............  Drain abdominal abscess...  ..................  T.................         0037      13.9599      $889.15      $228.70      $177.83
49040..............  Drain, open, abdom abscess  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49041..............  Drain, percut, abdom        ..................  T.................         0037      13.9599      $889.15      $228.70      $177.83
                      abscess.
49060..............  Drain, open, retrop         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      abscess.
49061..............  Drain, percut, retroper     ..................  T.................         0037      13.9599      $889.15      $228.70      $177.83
                      absc.
49062..............  Drain to peritoneal cavity  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49080..............  Puncture, peritoneal        ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
                      cavity.
49081..............  Removal of abdominal fluid  ..................  T.................         0070       5.3095      $338.18  ...........       $67.64
49180..............  Biopsy, abdominal mass....  ..................  T.................         0685       9.5741      $609.80  ...........      $121.96
49200..............  Removal of abdominal        ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
                      lesion.
49201..............  Remove abdom lesion,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complex.
49215..............  Excise sacral spine tumor.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49220..............  Multiple surgery, abdomen.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49250..............  Excision of umbilicus.....  ..................  T.................         0153      25.4636    $1,621.85      $397.90      $324.37
49255..............  Removal of omentum........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49320..............  Diag laparo separate proc.  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
49321..............  Laparoscopy, biopsy.......  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
49322..............  Laparoscopy, aspiration...  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
49323..............  Laparo drain lymphocele...  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
49324..............  Lap insertion perm ip cath  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
49325..............  Lap revision perm ip cath.  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
49326..............  Lap w/omentopexy add-on...  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
49329..............  Laparo proc, abdm/per/      ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
                      oment.
49400..............  Air injection into abdomen  ..................  N.................  ...........  ...........  ...........  ...........  ...........
49402..............  Remove foreign body,        ..................  T.................         0153      25.4636    $1,621.85      $397.90      $324.37
                      adbomen.
49419..............  Insrt abdom cath for        ..................  T.................         0115      30.5379    $1,945.05  ...........      $389.01
                      chemotx.
49420..............  Insert abdom drain, temp..  ..................  T.................         0652      31.7598    $2,022.88  ...........      $404.58
49421..............  Insert abdom drain, perm..  ..................  T.................         0652      31.7598    $2,022.88  ...........      $404.58
49422..............  Remove perm cannula/        ..................  T.................         0105      24.7274    $1,574.96      $370.40      $314.99
                      catheter.
49423..............  Exchange drainage catheter  ..................  T.................         0427      14.8912      $948.47  ...........      $189.69

[[Page 42949]]

 
49424..............  Assess cyst, contrast       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inject.
49425..............  Insert abdomen-venous       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      drain.
49426..............  Revise abdomen-venous       ..................  T.................         0153      25.4636    $1,621.85      $397.90      $324.37
                      shunt.
49427..............  Injection, abdominal shunt  ..................  N.................  ...........  ...........  ...........  ...........  ...........
49428..............  Ligation of shunt.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49429..............  Removal of shunt..........  ..................  T.................         0105      24.7274    $1,574.96      $370.40      $314.99
49435..............  Insert subq exten to ip     ..................  T.................         0427      14.8912      $948.47  ...........      $189.69
                      cath.
49436..............  Embedded ip cath exit-site  ..................  T.................         0427      14.8912      $948.47  ...........      $189.69
49491..............  Rpr hern preemie reduc....  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
49492..............  Rpr ing hern premie,        ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      blocked.
49495..............  Rpr ing hernia baby, reduc  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
49496..............  Rpr ing hernia baby,        ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      blocked.
49500..............  Rpr ing hernia, init,       ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      reduce.
49501..............  Rpr ing hernia, init        ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      blocked.
49505..............  Prp i/hern init reduc >5    ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      yr.
49507..............  Prp i/hern init block >5    ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      yr.
49520..............  Rerepair ing hernia,        ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      reduce.
49521..............  Rerepair ing hernia,        ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      blocked.
49525..............  Repair ing hernia, sliding  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
49540..............  Repair lumbar hernia......  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
49550..............  Rpr rem hernia, init,       ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      reduce.
49553..............  Rpr fem hernia, init        ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      blocked.
49555..............  Rerepair fem hernia,        ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      reduce.
49557..............  Rerepair fem hernia,        ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      blocked.
49560..............  Rpr ventral hern init,      ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      reduc.
49561..............  Rpr ventral hern init,      ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      block.
49565..............  Rerepair ventrl hern,       ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      reduce.
49566..............  Rerepair ventrl hern,       ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      block.
49568..............  Hernia repair w/mesh......  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
49570..............  Rpr epigastric hern,        ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      reduce.
49572..............  Rpr epigastric hern,        ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      blocked.
49580..............  Rpr umbil hern, reduc < 5   ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      yr.
49582..............  Rpr umbil hern, block < 5   ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      yr.
49585..............  Rpr umbil hern, reduc > 5   ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      yr.
49587..............  Rpr umbil hern, block > 5   ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      yr.
49590..............  Repair spigelian hernia...  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
49600..............  Repair umbilical lesion...  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
49605..............  Repair umbilical lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49606..............  Repair umbilical lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49610..............  Repair umbilical lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49611..............  Repair umbilical lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49650..............  Laparo hernia repair        ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
                      initial.
49651..............  Laparo hernia repair recur  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
49659..............  Laparo proc, hernia repair  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
49900..............  Repair of abdominal wall..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49904..............  Omental flap, extra-abdom.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49905..............  Omental flap, intra-abdom.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49906..............  Free omental flap,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
49999..............  Abdomen surgery procedure.  ..................  T.................         0153      25.4636    $1,621.85      $397.90      $324.37
50010..............  Exploration of kidney.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50020..............  Renal abscess, open drain.  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
50021..............  Renal abscess, percut       ..................  T.................         0037      13.9599      $889.15      $228.70      $177.83
                      drain.
50040..............  Drainage of kidney........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50045..............  Exploration of kidney.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
5005F..............  Pt counsld on exam for      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      moles.
50060..............  Removal of kidney stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50065..............  Incision of kidney........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50070..............  Incision of kidney........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50075..............  Removal of kidney stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50080..............  Removal of kidney stone...  ..................  T.................         0429      45.9021    $2,923.64  ...........      $584.73
50081..............  Removal of kidney stone...  ..................  T.................         0429      45.9021    $2,923.64  ...........      $584.73
50100..............  Revise kidney blood         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vessels.
5010F..............  Macul+fndngs to dr mng dm.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
50120..............  Exploration of kidney.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50125..............  Explore and drain kidney..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50130..............  Removal of kidney stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50135..............  Exploration of kidney.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
5015F..............  Doc fx & test/txmnt for op  ..................  M.................  ...........  ...........  ...........  ...........  ...........
50200..............  Biopsy of kidney..........  ..................  T.................         0685       9.5741      $609.80  ...........      $121.96
50205..............  Biopsy of kidney..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50220..............  Remove kidney, open.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50225..............  Removal kidney open,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complex.
50230..............  Removal kidney open,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      radical.
50234..............  Removal of kidney & ureter  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50236..............  Removal of kidney & ureter  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50240..............  Partial removal of kidney.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50250..............  Cryoablate renal mass open  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50280..............  Removal of kidney lesion..  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42950]]

 
50290..............  Removal of kidney lesion..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50300..............  Remove cadaver donor        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      kidney.
50320..............  Remove kidney, living       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      donor.
50323..............  Prep cadaver renal          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      allograft.
50325..............  Prep donor renal graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50327..............  Prep renal graft/venous...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50328..............  Prep renal graft/arterial.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50329..............  Prep renal graft/ureteral.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50340..............  Removal of kidney.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50360..............  Transplantation of kidney.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50365..............  Transplantation of kidney.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50370..............  Remove transplanted kidney  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50380..............  Reimplantation of kidney..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50382..............  Change ureter stent,        CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      percut.
50384..............  Remove ureter stent,        ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
                      percut.
50387..............  Change ext/int ureter       CH................  T.................         0427      14.8912      $948.47  ...........      $189.69
                      stent.
50389..............  Remove renal tube w/fluoro  CH................  T.................         0160       6.1077      $389.02  ...........       $77.80
50390..............  Drainage of kidney lesion.  ..................  T.................         0685       9.5741      $609.80  ...........      $121.96
50391..............  Instll rx agnt into rnal    ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
                      tub.
50392..............  Insert kidney drain.......  ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
50393..............  Insert ureteral tube......  CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
50394..............  Injection for kidney x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
50395..............  Create passage to kidney..  ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
50396..............  Measure kidney pressure...  ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
50398..............  Change kidney tube........  CH................  T.................         0427      14.8912      $948.47  ...........      $189.69
50400..............  Revision of kidney/ureter.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50405..............  Revision of kidney/ureter.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50500..............  Repair of kidney wound....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50520..............  Close kidney-skin fistula.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50525..............  Repair renal-abdomen        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
50526..............  Repair renal-abdomen        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
50540..............  Revision of horseshoe       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      kidney.
50541..............  Laparo ablate renal cyst..  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
50542..............  Laparo ablate renal mass..  ..................  T.................         0132      71.0022    $4,522.34    $1,239.20      $904.47
50543..............  Laparo partial nephrectomy  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
50544..............  Laparoscopy, pyeloplasty..  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
50545..............  Laparo radical nephrectomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50546..............  Laparoscopic nephrectomy..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50547..............  Laparo removal donor        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      kidney.
50548..............  Laparo remove w/ureter....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50549..............  Laparoscope proc, renal...  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
50551..............  Kidney endoscopy..........  ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
50553..............  Kidney endoscopy..........  CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
50555..............  Kidney endoscopy & biopsy.  ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
50557..............  Kidney endoscopy &          ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      treatment.
50561..............  Kidney endoscopy &          CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      treatment.
50562..............  Renal scope w/tumor resect  ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
50570..............  Kidney endoscopy..........  ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
50572..............  Kidney endoscopy..........  ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
50574..............  Kidney endoscopy & biopsy.  ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
50575..............  Kidney endoscopy..........  ..................  T.................         0163      36.9175    $2,351.39  ...........      $470.28
50576..............  Kidney endoscopy &          ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
                      treatment.
50580..............  Kidney endoscopy &          CH................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
                      treatment.
50590..............  Fragmenting of kidney       ..................  T.................         0169      43.0352    $2,741.04    $1,009.40      $548.21
                      stone.
50592..............  Perc rf ablate renal tumor  ..................  T.................         0423      44.1192    $2,810.08  ...........      $562.02
50600..............  Exploration of ureter.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50605..............  Insert ureteral support...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50610..............  Removal of ureter stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50620..............  Removal of ureter stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50630..............  Removal of ureter stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50650..............  Removal of ureter.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50660..............  Removal of ureter.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50684..............  Injection for ureter x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
50686..............  Measure ureter pressure...  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
50688..............  Change of ureter tube/      CH................  T.................         0427      14.8912      $948.47  ...........      $189.69
                      stent.
50690..............  Injection for ureter x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
50700..............  Revision of ureter........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50715..............  Release of ureter.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50722..............  Release of ureter.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50725..............  Release/revise ureter.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50727..............  Revise ureter.............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50728..............  Revise ureter.............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50740..............  Fusion of ureter & kidney.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50750..............  Fusion of ureter & kidney.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50760..............  Fusion of ureters.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50770..............  Splicing of ureters.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50780..............  Reimplant ureter in         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bladder.
50782..............  Reimplant ureter in         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bladder.

[[Page 42951]]

 
50783..............  Reimplant ureter in         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bladder.
50785..............  Reimplant ureter in         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bladder.
50800..............  Implant ureter in bowel...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50810..............  Fusion of ureter & bowel..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50815..............  Urine shunt to intestine..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50820..............  Construct bowel bladder...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50825..............  Construct bowel bladder...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50830..............  Revise urine flow.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50840..............  Replace ureter by bowel...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50845..............  Appendico-vesicostomy.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50860..............  Transplant ureter to skin.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50900..............  Repair of ureter..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50920..............  Closure ureter/skin         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
50930..............  Closure ureter/bowel        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
50940..............  Release of ureter.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50945..............  Laparoscopy                 ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
                      ureterolithotomy.
50947..............  Laparo new ureter/bladder.  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
50948..............  Laparo new ureter/bladder.  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
50949..............  Laparoscope proc, ureter..  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
50951..............  Endoscopy of ureter.......  ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
50953..............  Endoscopy of ureter.......  ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
50955..............  Ureter endoscopy & biopsy.  CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
50957..............  Ureter endoscopy &          CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      treatment.
50961..............  Ureter endoscopy &          CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      treatment.
50970..............  Ureter endoscopy..........  ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
50972..............  Ureter endoscopy &          ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
                      catheter.
50974..............  Ureter endoscopy & biopsy.  ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
50976..............  Ureter endoscopy &          ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
                      treatment.
50980..............  Ureter endoscopy &          CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      treatment.
51000..............  Drainage of bladder.......  ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
51005..............  Drainage of bladder.......  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
51010..............  Drainage of bladder.......  ..................  T.................         0165      19.6126    $1,249.19  ...........      $249.84
51020..............  Incise & treat bladder....  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
51030..............  Incise & treat bladder....  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
51040..............  Incise & drain bladder....  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
51045..............  Incise bladder/drain        ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
                      ureter.
51050..............  Removal of bladder stone..  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
51060..............  Removal of ureter stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51065..............  Remove ureter calculus....  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
51080..............  Drainage of bladder         ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
                      abscess.
51500..............  Removal of bladder cyst...  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
51520..............  Removal of bladder lesion.  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
51525..............  Removal of bladder lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51530..............  Removal of bladder lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51535..............  Repair of ureter lesion...  CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
51550..............  Partial removal of bladder  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51555..............  Partial removal of bladder  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51565..............  Revise bladder & ureter(s)  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51570..............  Removal of bladder........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51575..............  Removal of bladder & nodes  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51580..............  Remove bladder/revise       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tract.
51585..............  Removal of bladder & nodes  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51590..............  Remove bladder/revise       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tract.
51595..............  Remove bladder/revise       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tract.
51596..............  Remove bladder/create       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pouch.
51597..............  Removal of pelvic           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      structures.
51600..............  Injection for bladder x-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
51605..............  Preparation for bladder     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      xray.
51610..............  Injection for bladder x-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
51700..............  Irrigation of bladder.....  ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
51701..............  Insert bladder catheter...  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
51702..............  Insert temp bladder cath..  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
51703..............  Insert bladder cath,        ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
                      complex.
51705..............  Change of bladder tube....  CH................  T.................         0164       2.1659      $137.95  ...........       $27.59
51710..............  Change of bladder tube....  CH................  T.................         0427      14.8912      $948.47  ...........      $189.69
51715..............  Endoscopic injection/       ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
                      implant.
51720..............  Treatment of bladder        ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
                      lesion.
51725..............  Simple cystometrogram.....  CH................  T.................         0156       3.0601      $194.91  ...........       $38.98
51726..............  Complex cystometrogram....  ..................  T.................         0156       3.0601      $194.91  ...........       $38.98
51736..............  Urine flow measurement....  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
51741..............  Electro-uroflowmetry,       ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
                      first.
51772..............  Urethra pressure profile..  ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
51784..............  Anal/urinary muscle study.  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
51785..............  Anal/urinary muscle study.  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
51792..............  Urinary reflex study......  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
51795..............  Urine voiding pressure      ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
                      study.
51797..............  Intraabdominal pressure     ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
                      test.
51798..............  Us urine capacity measure.  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17

[[Page 42952]]

 
51800..............  Revision of bladder/        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      urethra.
51820..............  Revision of urinary tract.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51840..............  Attach bladder/urethra....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51841..............  Attach bladder/urethra....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51845..............  Repair bladder neck.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51860..............  Repair of bladder wound...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51865..............  Repair of bladder wound...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51880..............  Repair of bladder opening.  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
51900..............  Repair bladder/vagina       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
51920..............  Close bladder-uterus        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
51925..............  Hysterectomy/bladder        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      repair.
51940..............  Correction of bladder       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
51960..............  Revision of bladder &       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
51980..............  Construct bladder opening.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51990..............  Laparo urethral suspension  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
51992..............  Laparo sling operation....  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
51999..............  Laparoscope proc, bla.....  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
52000..............  Cystoscopy................  ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
52001..............  Cystoscopy, removal of      CH................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
                      clots.
52005..............  Cystoscopy & ureter         ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
                      catheter.
52007..............  Cystoscopy and biopsy.....  CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52010..............  Cystoscopy & duct catheter  ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
52204..............  Cystoscopy w/biopsy(s)....  ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
52214..............  Cystoscopy and treatment..  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52224..............  Cystoscopy and treatment..  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52234..............  Cystoscopy and treatment..  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52235..............  Cystoscopy and treatment..  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52240..............  Cystoscopy and treatment..  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52250..............  Cystoscopy and radiotracer  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52260..............  Cystoscopy and treatment..  ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
52265..............  Cystoscopy and treatment..  ..................  T.................         0160       6.1077      $389.02  ...........       $77.80
52270..............  Cystoscopy & revise         ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
                      urethra.
52275..............  Cystoscopy & revise         CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      urethra.
52276..............  Cystoscopy and treatment..  CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52277..............  Cystoscopy and treatment..  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52281..............  Cystoscopy and treatment..  ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
52282..............  Cystoscopy, implant stent.  ..................  T.................         0163      36.9175    $2,351.39  ...........      $470.28
52283..............  Cystoscopy and treatment..  CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52285..............  Cystoscopy and treatment..  ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
52290..............  Cystoscopy and treatment..  ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
52300..............  Cystoscopy and treatment..  CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52301..............  Cystoscopy and treatment..  CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52305..............  Cystoscopy and treatment..  CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52310..............  Cystoscopy and treatment..  CH................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
52315..............  Cystoscopy and treatment..  CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52317..............  Remove bladder stone......  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52318..............  Remove bladder stone......  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52320..............  Cystoscopy and treatment..  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52325..............  Cystoscopy, stone removal.  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52327..............  Cystoscopy, inject          ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      material.
52330..............  Cystoscopy and treatment..  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52332..............  Cystoscopy and treatment..  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52334..............  Create passage to kidney..  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52341..............  Cysto w/ureter stricture    ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      tx.
52342..............  Cysto w/up stricture tx...  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52343..............  Cysto w/renal stricture tx  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52344..............  Cysto/uretero, stricture    ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      tx.
52345..............  Cysto/uretero w/up          ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      stricture.
52346..............  Cystouretero w/renal        ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      strict.
52351..............  Cystouretero & or           CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      pyeloscope.
52352..............  Cystouretero w/stone        ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      remove.
52353..............  Cystouretero w/lithotripsy  ..................  T.................         0163      36.9175    $2,351.39  ...........      $470.28
52354..............  Cystouretero w/biopsy.....  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52355..............  Cystouretero w/excise       ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      tumor.
52400..............  Cystouretero w/congen repr  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52402..............  Cystourethro cut ejacul     ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      duct.
52450..............  Incision of prostate......  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52500..............  Revision of bladder neck..  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52510..............  Dilation prostatic urethra  CH................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52601..............  Prostatectomy (TURP)......  ..................  T.................         0163      36.9175    $2,351.39  ...........      $470.28
52606..............  Control postop bleeding...  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
52612..............  Prostatectomy, first stage  ..................  T.................         0163      36.9175    $2,351.39  ...........      $470.28
52614..............  Prostatectomy, second       ..................  T.................         0163      36.9175    $2,351.39  ...........      $470.28
                      stage.
52620..............  Remove residual prostate..  ..................  T.................         0163      36.9175    $2,351.39  ...........      $470.28
52630..............  Remove prostate regrowth..  ..................  T.................         0163      36.9175    $2,351.39  ...........      $470.28
52640..............  Relieve bladder             ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      contracture.
52647..............  Laser surgery of prostate.  ..................  T.................         0429      45.9021    $2,923.64  ...........      $584.73
52648..............  Laser surgery of prostate.  ..................  T.................         0429      45.9021    $2,923.64  ...........      $584.73

[[Page 42953]]

 
52700..............  Drainage of prostate        ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      abscess.
53000..............  Incision of urethra.......  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53010..............  Incision of urethra.......  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53020..............  Incision of urethra.......  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53025..............  Incision of urethra.......  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53040..............  Drainage of urethra         ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
                      abscess.
53060..............  Drainage of urethra         ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
                      abscess.
53080..............  Drainage of urinary         ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
                      leakage.
53085..............  Drainage of urinary         ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
                      leakage.
53200..............  Biopsy of urethra.........  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53210..............  Removal of urethra........  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53215..............  Removal of urethra........  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53220..............  Treatment of urethra        ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
                      lesion.
53230..............  Removal of urethra lesion.  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53235..............  Removal of urethra lesion.  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53240..............  Surgery for urethra pouch.  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53250..............  Removal of urethra gland..  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53260..............  Treatment of urethra        ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
                      lesion.
53265..............  Treatment of urethra        ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
                      lesion.
53270..............  Removal of urethra gland..  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53275..............  Repair of urethra defect..  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53400..............  Revise urethra, stage 1...  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53405..............  Revise urethra, stage 2...  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53410..............  Reconstruction of urethra.  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53415..............  Reconstruction of urethra.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
53420..............  Reconstruct urethra, stage  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
                      1.
53425..............  Reconstruct urethra, stage  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
                      2.
53430..............  Reconstruction of urethra.  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53431..............  Reconstruct urethra/        ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
                      bladder.
53440..............  Male sling procedure......  ..................  S.................         0385      85.3372    $5,435.38  ...........    $1,087.08
53442..............  Remove/revise male sling..  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53444..............  Insert tandem cuff........  ..................  S.................         0385      85.3372    $5,435.38  ...........    $1,087.08
53445..............  Insert uro/ves nck          ..................  S.................         0386     143.8001    $9,159.06  ...........    $1,831.81
                      sphincter.
53446..............  Remove uro sphincter......  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53447..............  Remove/replace ur           ..................  S.................         0386     143.8001    $9,159.06  ...........    $1,831.81
                      sphincter.
53448..............  Remov/replc ur sphinctr     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      comp.
53449..............  Repair uro sphincter......  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53450..............  Revision of urethra.......  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53460..............  Revision of urethra.......  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53500..............  Urethrlys, transvag w/      ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
                      scope.
53502..............  Repair of urethra injury..  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53505..............  Repair of urethra injury..  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53510..............  Repair of urethra injury..  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53515..............  Repair of urethra injury..  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53520..............  Repair of urethra defect..  ..................  T.................         0168      30.1994    $1,923.49      $388.10      $384.70
53600..............  Dilate urethra stricture..  ..................  T.................         0156       3.0601      $194.91  ...........       $38.98
53601..............  Dilate urethra stricture..  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
53605..............  Dilate urethra stricture..  ..................  T.................         0161      18.1376    $1,155.24      $243.72      $231.05
53620..............  Dilate urethra stricture..  ..................  T.................         0165      19.6126    $1,249.19  ...........      $249.84
53621..............  Dilate urethra stricture..  ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
53660..............  Dilation of urethra.......  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
53661..............  Dilation of urethra.......  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
53665..............  Dilation of urethra.......  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
53850..............  Prostatic microwave         CH................  T.................         0163      36.9175    $2,351.39  ...........      $470.28
                      thermotx.
53852..............  Prostatic rf thermotx.....  CH................  T.................         0163      36.9175    $2,351.39  ...........      $470.28
53853..............  Prostatic water thermother  ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
53899..............  Urology surgery procedure.  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
54000..............  Slitting of prepuce.......  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
54001..............  Slitting of prepuce.......  ..................  T.................         0166       19.657    $1,252.01  ...........      $250.40
54015..............  Drain penis lesion........  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
54050..............  Destruction, penis          CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      lesion(s).
54055..............  Destruction, penis          ..................  T.................         0017      20.0977    $1,280.08  ...........      $256.02
                      lesion(s).
54056..............  Cryosurgery, penis          CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
                      lesion(s).
54057..............  Laser surg, penis           ..................  T.................         0017      20.0977    $1,280.08  ...........      $256.02
                      lesion(s).
54060..............  Excision of penis           ..................  T.................         0017      20.0977    $1,280.08  ...........      $256.02
                      lesion(s).
54065..............  Destruction, penis          CH................  T.................         0017      20.0977    $1,280.08  ...........      $256.02
                      lesion(s).
54100..............  Biopsy of penis...........  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
54105..............  Biopsy of penis...........  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
54110..............  Treatment of penis lesion.  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54111..............  Treat penis lesion, graft.  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54112..............  Treat penis lesion, graft.  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54115..............  Treatment of penis lesion.  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
54120..............  Partial removal of penis..  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54125..............  Removal of penis..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54130..............  Remove penis & nodes......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54135..............  Remove penis & nodes......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54150..............  Circumcision w/regionl      CH................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
                      block.
54160..............  Circumcision, neonate.....  CH................  T.................         0183      22.7802    $1,450.94  ...........      $290.19

[[Page 42954]]

 
54161..............  Circum 28 days or older...  CH................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54162..............  Lysis penil circumic        CH................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
                      lesion.
54163..............  Repair of circumcision....  CH................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54164..............  Frenulotomy of penis......  CH................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54200..............  Treatment of penis lesion.  ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
54205..............  Treatment of penis lesion.  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54220..............  Treatment of penis lesion.  ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
54230..............  Prepare penis study.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
54231..............  Dynamic cavernosometry....  ..................  T.................         0165      19.6126    $1,249.19  ...........      $249.84
54235..............  Penile injection..........  ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
54240..............  Penis study...............  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
54250..............  Penis study...............  ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
54300..............  Revision of penis.........  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54304..............  Revision of penis.........  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54308..............  Reconstruction of urethra.  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54312..............  Reconstruction of urethra.  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54316..............  Reconstruction of urethra.  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54318..............  Reconstruction of urethra.  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54322..............  Reconstruction of urethra.  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54324..............  Reconstruction of urethra.  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54326..............  Reconstruction of urethra.  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54328..............  Revise penis/urethra......  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54332..............  Revise penis/urethra......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54336..............  Revise penis/urethra......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54340..............  Secondary urethral surgery  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54344..............  Secondary urethral surgery  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54348..............  Secondary urethral surgery  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54352..............  Reconstruct urethra/penis.  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54360..............  Penis plastic surgery.....  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54380..............  Repair penis..............  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54385..............  Repair penis..............  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54390..............  Repair penis and bladder..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54400..............  Insert semi-rigid           ..................  S.................         0385      85.3372    $5,435.38  ...........    $1,087.08
                      prosthesis.
54401..............  Insert self-contd           ..................  S.................         0386     143.8001    $9,159.06  ...........    $1,831.81
                      prosthesis.
54405..............  Insert multi-comp penis     ..................  S.................         0386     143.8001    $9,159.06  ...........    $1,831.81
                      pros.
54406..............  Remove muti-comp penis      ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
                      pros.
54408..............  Repair multi-comp penis     ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
                      pros.
54410..............  Remove/replace penis        ..................  S.................         0386     143.8001    $9,159.06  ...........    $1,831.81
                      prosth.
54411..............  Remov/replc penis pros,     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      comp.
54415..............  Remove self-contd penis     ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
                      pros.
54416..............  Remv/repl penis contain     ..................  S.................         0386     143.8001    $9,159.06  ...........    $1,831.81
                      pros.
54417..............  Remv/replc penis pros,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      compl.
54420..............  Revision of penis.........  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54430..............  Revision of penis.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54435..............  Revision of penis.........  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54440..............  Repair of penis...........  ..................  T.................         0181      35.1574    $2,239.28      $621.80      $447.86
54450..............  Preputial stretching......  ..................  T.................         0156       3.0601      $194.91  ...........       $38.98
54500..............  Biopsy of testis..........  ..................  T.................         0037      13.9599      $889.15      $228.70      $177.83
54505..............  Biopsy of testis..........  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54512..............  Excise lesion testis......  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54520..............  Removal of testis.........  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54522..............  Orchiectomy, partial......  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54530..............  Removal of testis.........  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
54535..............  Extensive testis surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54550..............  Exploration for testis....  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
54560..............  Exploration for testis....  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54600..............  Reduce testis torsion.....  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54620..............  Suspension of testis......  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54640..............  Suspension of testis......  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
54650..............  Orchiopexy (Fowler-         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      Stephens).
54660..............  Revision of testis........  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54670..............  Repair testis injury......  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54680..............  Relocation of testis(es)..  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54690..............  Laparoscopy, orchiectomy..  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
54692..............  Laparoscopy, orchiopexy...  ..................  T.................         0132      71.0022    $4,522.34    $1,239.20      $904.47
54699..............  Laparoscope proc, testis..  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
54700..............  Drainage of scrotum.......  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54800..............  Biopsy of epididymis......  ..................  T.................         0004       4.5062      $287.01  ...........       $57.40
54830..............  Remove epididymis lesion..  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54840..............  Remove epididymis lesion..  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54860..............  Removal of epididymis.....  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54861..............  Removal of epididymis.....  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54865..............  Explore epididymis........  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54900..............  Fusion of spermatic ducts.  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
54901..............  Fusion of spermatic ducts.  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55000..............  Drainage of hydrocele.....  ..................  T.................         0004       4.5062      $287.01  ...........       $57.40
55040..............  Removal of hydrocele......  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
55041..............  Removal of hydroceles.....  ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09

[[Page 42955]]

 
55060..............  Repair of hydrocele.......  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55100..............  Drainage of scrotum         ..................  T.................         0007      12.5792      $801.21  ...........      $160.24
                      abscess.
55110..............  Explore scrotum...........  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55120..............  Removal of scrotum lesion.  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55150..............  Removal of scrotum........  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55175..............  Revision of scrotum.......  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55180..............  Revision of scrotum.......  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55200..............  Incision of sperm duct....  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55250..............  Removal of sperm duct(s)..  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55300..............  Prepare, sperm duct x-ray.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
55400..............  Repair of sperm duct......  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55450..............  Ligation of sperm duct....  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55500..............  Removal of hydrocele......  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55520..............  Removal of sperm cord       ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
                      lesion.
55530..............  Revise spermatic cord       ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
                      veins.
55535..............  Revise spermatic cord       ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      veins.
55540..............  Revise hernia & sperm       ..................  T.................         0154      31.1722    $1,985.45      $464.80      $397.09
                      veins.
55550..............  Laparo ligate spermatic     ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
                      vein.
55559..............  Laparo proc, spermatic      ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
                      cord.
55600..............  Incise sperm duct pouch...  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55605..............  Incise sperm duct pouch...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55650..............  Remove sperm duct pouch...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55680..............  Remove sperm pouch lesion.  ..................  T.................         0183      22.7802    $1,450.94  ...........      $290.19
55700..............  Biopsy of prostate........  ..................  T.................         0184      11.3168      $720.80  ...........      $144.16
55705..............  Biopsy of prostate........  ..................  T.................         0184      11.3168      $720.80  ...........      $144.16
55720..............  Drainage of prostate        ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      abscess.
55725..............  Drainage of prostate        ..................  T.................         0162      25.2775    $1,610.00  ...........      $322.00
                      abscess.
55801..............  Removal of prostate.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55810..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55812..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55815..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55821..............  Removal of prostate.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55831..............  Removal of prostate.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55840..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55842..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55845..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55860..............  Surgical exposure,          ..................  T.................         0165      19.6126    $1,249.19  ...........      $249.84
                      prostate.
55862..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55865..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55866..............  Laparo radical              ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      prostatectomy.
55870..............  Electroejaculation........  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
55873..............  Cryoablate prostate.......  ..................  T.................         0674     123.7218    $7,880.21  ...........    $1,576.04
55875..............  Transperi needle place,     CH................  Q.................         0163      36.9175    $2,351.39  ...........      $470.28
                      pros.
55876..............  Place rt device/marker,     ..................  T.................         0156       3.0601      $194.91  ...........       $38.98
                      pros.
55899..............  Genital surgery procedure.  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
55970..............  Sex transformation, M to F  ..................  E.................  ...........  ...........  ...........  ...........  ...........
55980..............  Sex transformation, F to M  ..................  E.................  ...........  ...........  ...........  ...........  ...........
56405..............  I & D of vulva/perineum...  ..................  T.................         0189       3.0466      $194.05  ...........       $38.81
56420..............  Drainage of gland abscess.  ..................  T.................         0188       1.4138       $90.05  ...........       $18.01
56440..............  Surgery for vulva lesion..  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
56441..............  Lysis of labial lesion(s).  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
56442..............  Hymenotomy................  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
56501..............  Destroy, vulva lesions,     ..................  T.................         0017      20.0977    $1,280.08  ...........      $256.02
                      sim.
56515..............  Destroy vulva lesion/s      CH................  T.................         0017      20.0977    $1,280.08  ...........      $256.02
                      compl.
56605..............  Biopsy of vulva/perineum..  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
56606..............  Biopsy of vulva/perineum..  CH................  T.................         0188       1.4138       $90.05  ...........       $18.01
56620..............  Partial removal of vulva..  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
56625..............  Complete removal of vulva.  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
56630..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56631..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56632..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56633..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56634..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56637..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56640..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56700..............  Partial removal of hymen..  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
56740..............  Remove vagina gland lesion  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
56800..............  Repair of vagina..........  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
56805..............  Repair clitoris...........  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
56810..............  Repair of perineum........  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
56820..............  Exam of vulva w/scope.....  ..................  T.................         0188       1.4138       $90.05  ...........       $18.01
56821..............  Exam/biopsy of vulva w/     CH................  T.................         0188       1.4138       $90.05  ...........       $18.01
                      scope.
57000..............  Exploration of vagina.....  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57010..............  Drainage of pelvic abscess  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57020..............  Drainage of pelvic fluid..  ..................  T.................         0192       7.4497      $474.49  ...........       $94.90
57022..............  I & d vaginal hematoma, pp  ..................  T.................         0007      12.5792      $801.21  ...........      $160.24
57023..............  I & d vag hematoma, non-ob  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
57061..............  Destroy vag lesions,        CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
                      simple.

[[Page 42956]]

 
57065..............  Destroy vag lesions,        CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
                      complex.
57100..............  Biopsy of vagina..........  ..................  T.................         0192       7.4497      $474.49  ...........       $94.90
57105..............  Biopsy of vagina..........  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57106..............  Remove vagina wall,         CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
                      partial.
57107..............  Remove vagina tissue, part  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57109..............  Vaginectomy partial w/      ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
                      nodes.
57110..............  Remove vagina wall,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
57111..............  Remove vagina tissue,       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      compl.
57112..............  Vaginectomy w/nodes, compl  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57120..............  Closure of vagina.........  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57130..............  Remove vagina lesion......  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57135..............  Remove vagina lesion......  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57150..............  Treat vagina infection....  CH................  T.................         0188       1.4138       $90.05  ...........       $18.01
57155..............  Insert uteri tandems/       ..................  T.................         0192       7.4497      $474.49  ...........       $94.90
                      ovoids.
57160..............  Insert pessary/other        ..................  T.................         0188       1.4138       $90.05  ...........       $18.01
                      device.
57170..............  Fitting of diaphragm/cap..  ..................  T.................         0191       0.1414        $9.01        $2.50        $1.80
57180..............  Treat vaginal bleeding....  CH................  T.................         0188       1.4138       $90.05  ...........       $18.01
57200..............  Repair of vagina..........  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57210..............  Repair vagina/perineum....  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57220..............  Revision of urethra.......  ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
57230..............  Repair of urethral lesion.  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57240..............  Repair bladder & vagina...  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57250..............  Repair rectum & vagina....  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57260..............  Repair of vagina..........  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57265..............  Extensive repair of vagina  ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
57267..............  Insert mesh/pelvic flr      ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
                      addon.
57268..............  Repair of bowel bulge.....  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57270..............  Repair of bowel pouch.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57280..............  Suspension of vagina......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57282..............  Colpopexy, extraperitoneal  ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
57283..............  Colpopexy, intraperitoneal  ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
57284..............  Repair paravaginal defect.  ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
57287..............  Revise/remove sling repair  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57288..............  Repair bladder defect.....  ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
57289..............  Repair bladder & vagina...  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57291..............  Construction of vagina....  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57292..............  Construct vagina with       ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
                      graft.
57295..............  Revise vag graft via        CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
                      vagina.
57296..............  Revise vag graft, open abd  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57300..............  Repair rectum-vagina        ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
                      fistula.
57305..............  Repair rectum-vagina        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
57307..............  Fistula repair & colostomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57308..............  Fistula repair,             ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      transperine.
57310..............  Repair urethrovaginal       ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
                      lesion.
57311..............  Repair urethrovaginal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
57320..............  Repair bladder-vagina       ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
                      lesion.
57330..............  Repair bladder-vagina       ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
                      lesion.
57335..............  Repair vagina.............  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57400..............  Dilation of vagina........  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57410..............  Pelvic examination........  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57415..............  Remove vaginal foreign      CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
                      body.
57420..............  Exam of vagina w/scope....  ..................  T.................         0189       3.0466      $194.05  ...........       $38.81
57421..............  Exam/biopsy of vag w/scope  ..................  T.................         0189       3.0466      $194.05  ...........       $38.81
57425..............  Laparoscopy, surg,          ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
                      colpopexy.
57452..............  Exam of cervix w/scope....  ..................  T.................         0188       1.4138       $90.05  ...........       $18.01
57454..............  Bx/curett of cervix w/      ..................  T.................         0189       3.0466      $194.05  ...........       $38.81
                      scope.
57455..............  Biopsy of cervix w/scope..  ..................  T.................         0189       3.0466      $194.05  ...........       $38.81
57456..............  Endocerv curettage w/scope  ..................  T.................         0189       3.0466      $194.05  ...........       $38.81
57460..............  Bx of cervix w/scope, leep  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57461..............  Conz of cervix w/scope,     CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
                      leep.
57500..............  Biopsy of cervix..........  ..................  T.................         0189       3.0466      $194.05  ...........       $38.81
57505..............  Endocervical curettage....  ..................  T.................         0189       3.0466      $194.05  ...........       $38.81
57510..............  Cauterization of cervix...  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57511..............  Cryocautery of cervix.....  ..................  T.................         0188       1.4138       $90.05  ...........       $18.01
57513..............  Laser surgery of cervix...  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57520..............  Conization of cervix......  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57522..............  Conization of cervix......  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57530..............  Removal of cervix.........  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57531..............  Removal of cervix, radical  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57540..............  Removal of residual cervix  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57545..............  Remove cervix/repair        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pelvis.
57550..............  Removal of residual cervix  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
57555..............  Remove cervix/repair        ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
                      vagina.
57556..............  Remove cervix, repair       ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
                      bowel.
57558..............  D&c of cervical stump.....  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57700..............  Revision of cervix........  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57720..............  Revision of cervix........  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
57800..............  Dilation of cervical canal  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65

[[Page 42957]]

 
58100..............  Biopsy of uterus lining...  ..................  T.................         0188       1.4138       $90.05  ...........       $18.01
58110..............  Bx done w/colposcopy add-   CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
58120..............  Dilation and curettage....  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
58140..............  Myomectomy abdom method...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58145..............  Myomectomy vag method.....  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
58146..............  Myomectomy abdom complex..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58150..............  Total hysterectomy........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58152..............  Total hysterectomy........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58180..............  Partial hysterectomy......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58200..............  Extensive hysterectomy....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58210..............  Extensive hysterectomy....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58240..............  Removal of pelvis contents  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58260..............  Vaginal hysterectomy......  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
58262..............  Vag hyst including t/o....  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
58263..............  Vag hyst w/t/o & vag        ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
                      repair.
58267..............  Vag hyst w/urinary repair.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58270..............  Vag hyst w/enterocele       ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
                      repair.
58275..............  Hysterectomy/revise vagina  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58280..............  Hysterectomy/revise vagina  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58285..............  Extensive hysterectomy....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58290..............  Vag hyst complex..........  ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
58291..............  Vag hyst incl t/o, complex  ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
58292..............  Vag hyst t/o & repair,      ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
                      compl.
58293..............  Vag hyst w/uro repair,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      compl.
58294..............  Vag hyst w/enterocele,      ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
                      compl.
58300..............  Insert intrauterine device  ..................  E.................  ...........  ...........  ...........  ...........  ...........
58301..............  Remove intrauterine device  ..................  T.................         0188       1.4138       $90.05  ...........       $18.01
58321..............  Artificial insemination...  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
58322..............  Artificial insemination...  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
58323..............  Sperm washing.............  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
58340..............  Catheter for hysterography  ..................  N.................  ...........  ...........  ...........  ...........  ...........
58345..............  Reopen fallopian tube.....  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
58346..............  Insert heyman uteri         ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
                      capsule.
58350..............  Reopen fallopian tube.....  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
58353..............  Endometr ablate, thermal..  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
58356..............  Endometrial cryoablation..  ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
58400..............  Suspension of uterus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58410..............  Suspension of uterus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58520..............  Repair of ruptured uterus.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58540..............  Revision of uterus........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58541..............  Lsh, uterus 250 g or less.  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
58542..............  Lsh w/t/o ut 250 g or less  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
58543..............  Lsh uterus above 250 g....  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
58544..............  Lsh w/t/o uterus above 250  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
                      g.
58545..............  Laparoscopic myomectomy...  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
58546..............  Laparo-myomectomy, complex  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
58548..............  Lap radical hyst..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58550..............  Laparo-asst vag             ..................  T.................         0132      71.0022    $4,522.34    $1,239.20      $904.47
                      hysterectomy.
58552..............  Laparo-vag hyst incl t/o..  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
58553..............  Laparo-vag hyst, complex..  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
58554..............  Laparo-vag hyst w/t/o,      ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
                      compl.
58555..............  Hysteroscopy, dx, sep proc  ..................  T.................         0190      22.1171    $1,408.70      $424.20      $281.74
58558..............  Hysteroscopy, biopsy......  ..................  T.................         0190      22.1171    $1,408.70      $424.20      $281.74
58559..............  Hysteroscopy, lysis.......  ..................  T.................         0190      22.1171    $1,408.70      $424.20      $281.74
58560..............  Hysteroscopy, resect        ..................  T.................         0387      34.8162    $2,217.55      $655.50      $443.51
                      septum.
58561..............  Hysteroscopy, remove myoma  ..................  T.................         0387      34.8162    $2,217.55      $655.50      $443.51
58562..............  Hysteroscopy, remove fb...  ..................  T.................         0190      22.1171    $1,408.70      $424.20      $281.74
58563..............  Hysteroscopy, ablation....  ..................  T.................         0387      34.8162    $2,217.55      $655.50      $443.51
58565..............  Hysteroscopy,               ..................  T.................         0202      43.2255    $2,753.16      $981.50      $550.63
                      sterilization.
58578..............  Laparo proc, uterus.......  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
58579..............  Hysteroscope procedure....  ..................  T.................         0190      22.1171    $1,408.70      $424.20      $281.74
58600..............  Division of fallopian tube  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
58605..............  Division of fallopian tube  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58611..............  Ligate oviduct(s) add-on..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58615..............  Occlude fallopian tube(s).  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
58660..............  Laparoscopy, lysis........  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
58661..............  Laparoscopy, remove adnexa  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
58662..............  Laparoscopy, excise         ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
                      lesions.
58670..............  Laparoscopy, tubal cautery  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
58671..............  Laparoscopy, tubal block..  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
58672..............  Laparoscopy, fimbrioplasty  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
58673..............  Laparoscopy, salpingostomy  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
58679..............  Laparo proc, oviduct-ovary  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
58700..............  Removal of fallopian tube.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58720..............  Removal of ovary/tube(s)..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58740..............  Revise fallopian tube(s)..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58750..............  Repair oviduct............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58752..............  Revise ovarian tube(s)....  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42958]]

 
58760..............  Remove tubal obstruction..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58770..............  Create new tubal opening..  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
58800..............  Drainage of ovarian         ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
                      cyst(s).
58805..............  Drainage of ovarian         CH................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
                      cyst(s).
58820..............  Drain ovary abscess, open.  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
58822..............  Drain ovary abscess,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      percut.
58823..............  Drain pelvic abscess,       ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
                      percut.
58825..............  Transposition, ovary(s)...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58900..............  Biopsy of ovary(s)........  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
58920..............  Partial removal of          ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
                      ovary(s).
58925..............  Removal of ovarian cyst(s)  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
58940..............  Removal of ovary(s).......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58943..............  Removal of ovary(s).......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58950..............  Resect ovarian malignancy.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58951..............  Resect ovarian malignancy.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58952..............  Resect ovarian malignancy.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58953..............  Tah, rad dissect for        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      debulk.
58954..............  Tah rad debulk/lymph        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      remove.
58956..............  Bso, omentectomy w/tah....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58957..............  Resect recurrent gyn mal..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58958..............  Resect recur gyn mal w/lym  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58960..............  Exploration of abdomen....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58970..............  Retrieval of oocyte.......  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
58974..............  Transfer of embryo........  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
58976..............  Transfer of embryo........  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
58999..............  Genital surgery procedure.  ..................  T.................         0191       0.1414        $9.01        $2.50        $1.80
59000..............  Amniocentesis, diagnostic.  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
59001..............  Amniocentesis, therapeutic  ..................  T.................         0192       7.4497      $474.49  ...........       $94.90
59012..............  Fetal cord                  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
                      puncture,prenatal.
59015..............  Chorion biopsy............  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
59020..............  Fetal contract stress test  CH................  T.................         0188       1.4138       $90.05  ...........       $18.01
59025..............  Fetal non-stress test.....  CH................  T.................         0188       1.4138       $90.05  ...........       $18.01
59030..............  Fetal scalp blood sample..  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
59050..............  Fetal monitor w/report....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
59051..............  Fetal monitor/interpret     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      only.
59070..............  Transabdom amnioinfus w/us  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
59072..............  Umbilical cord occlud w/us  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
59074..............  Fetal fluid drainage w/us.  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
59076..............  Fetal shunt placement, w/   CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
                      us.
59100..............  Remove uterus lesion......  ..................  T.................         0195      32.9713    $2,100.04      $483.80      $420.01
59120..............  Treat ectopic pregnancy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59121..............  Treat ectopic pregnancy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59130..............  Treat ectopic pregnancy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59135..............  Treat ectopic pregnancy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59136..............  Treat ectopic pregnancy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59140..............  Treat ectopic pregnancy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59150..............  Treat ectopic pregnancy...  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
59151..............  Treat ectopic pregnancy...  ..................  T.................         0131      46.1201    $2,937.53    $1,001.80      $587.51
59160..............  D & c after delivery......  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
59200..............  Insert cervical dilator...  ..................  T.................         0189       3.0466      $194.05  ...........       $38.81
59300..............  Episiotomy or vaginal       ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
                      repair.
59320..............  Revision of cervix........  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
59325..............  Revision of cervix........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59350..............  Repair of uterus..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59400..............  Obstetrical care..........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59409..............  Obstetrical care..........  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
59410..............  Obstetrical care..........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59412..............  Antepartum manipulation...  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
59414..............  Deliver placenta..........  ..................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
59425..............  Antepartum care only......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59426..............  Antepartum care only......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59430..............  Care after delivery.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59510..............  Cesarean delivery.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59514..............  Cesarean delivery only....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59515..............  Cesarean delivery.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59525..............  Remove uterus after         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cesarean.
59610..............  Vbac delivery.............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59612..............  Vbac delivery only........  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
59614..............  Vbac care after delivery..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59618..............  Attempted vbac delivery...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59620..............  Attempted vbac delivery     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      only.
59622..............  Attempted vbac after care.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59812..............  Treatment of miscarriage..  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
59820..............  Care of miscarriage.......  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
59821..............  Treatment of miscarriage..  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
59830..............  Treat uterus infection....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59840..............  Abortion..................  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
59841..............  Abortion..................  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65

[[Page 42959]]

 
59850..............  Abortion..................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59851..............  Abortion..................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59852..............  Abortion..................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59855..............  Abortion..................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59856..............  Abortion..................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59857..............  Abortion..................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59866..............  Abortion (mpr)............  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
59870..............  Evacuate mole of uterus...  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
59871..............  Remove cerclage suture....  CH................  T.................         0193      19.2052    $1,223.24  ...........      $244.65
59897..............  Fetal invas px w/us.......  CH................  T.................         0189       3.0466      $194.05  ...........       $38.81
59898..............  Laparo proc, ob care/       ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
                      deliver.
59899..............  Maternity care procedure..  CH................  T.................         0191       0.1414        $9.01        $2.50        $1.80
60000..............  Drain thyroid/tongue cyst.  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
60001..............  Aspirate/inject thyriod     ..................  T.................         0004       4.5062      $287.01  ...........       $57.40
                      cyst.
6005F..............  Care level rationale doc..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
60100..............  Biopsy of thyroid.........  ..................  T.................         0004       4.5062      $287.01  ...........       $57.40
6010F..............  Dysphag test done b/4       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      eating.
6015F..............  Pt recvng/OK for eating/    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      swal.
60200..............  Remove thyroid lesion.....  ..................  T.................         0114      45.1729    $2,877.20  ...........      $575.44
6020F..............  NPO (nothing-mouth)         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ordered.
60210..............  Partial thyroid excision..  ..................  T.................         0114      45.1729    $2,877.20  ...........      $575.44
60212..............  Partial thyroid excision..  ..................  T.................         0114      45.1729    $2,877.20  ...........      $575.44
60220..............  Partial removal of thyroid  ..................  T.................         0114      45.1729    $2,877.20  ...........      $575.44
60225..............  Partial removal of thyroid  ..................  T.................         0114      45.1729    $2,877.20  ...........      $575.44
60240..............  Removal of thyroid........  ..................  T.................         0114      45.1729    $2,877.20  ...........      $575.44
60252..............  Removal of thyroid........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
60254..............  Extensive thyroid surgery.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60260..............  Repeat thyroid surgery....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
60270..............  Removal of thyroid........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60271..............  Removal of thyroid........  CH................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
60280..............  Remove thyroid duct lesion  ..................  T.................         0114      45.1729    $2,877.20  ...........      $575.44
60281..............  Remove thyroid duct lesion  ..................  T.................         0114      45.1729    $2,877.20  ...........      $575.44
60500..............  Explore parathyroid glands  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
60502..............  Re-explore parathyroids...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
60505..............  Explore parathyroid glands  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60512..............  Autotransplant parathyroid  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
60520..............  Removal of thymus gland...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
60521..............  Removal of thymus gland...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60522..............  Removal of thymus gland...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60540..............  Explore adrenal gland.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60545..............  Explore adrenal gland.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60600..............  Remove carotid body lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60605..............  Remove carotid body lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60650..............  Laparoscopy adrenalectomy.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60659..............  Laparo proc, endocrine....  ..................  T.................         0130      34.8153    $2,217.49      $659.50      $443.50
60699..............  Endocrine surgery           ..................  T.................         0114      45.1729    $2,877.20  ...........      $575.44
                      procedure.
61000..............  Remove cranial cavity       ..................  T.................         0212       8.6797      $552.84  ...........      $110.57
                      fluid.
61001..............  Remove cranial cavity       ..................  T.................         0212       8.6797      $552.84  ...........      $110.57
                      fluid.
61020..............  Remove brain cavity fluid.  ..................  T.................         0212       8.6797      $552.84  ...........      $110.57
61026..............  Injection into brain canal  ..................  T.................         0212       8.6797      $552.84  ...........      $110.57
61050..............  Remove brain canal fluid..  ..................  T.................         0212       8.6797      $552.84  ...........      $110.57
61055..............  Injection into brain canal  ..................  T.................         0212       8.6797      $552.84  ...........      $110.57
61070..............  Brain canal shunt           CH................  T.................         0121       3.2914      $209.64       $43.80       $41.93
                      procedure.
61105..............  Twist drill hole..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61107..............  Drill skull for             ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      implantation.
61108..............  Drill skull for drainage..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61120..............  Burr hole for puncture....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61140..............  Pierce skull for biopsy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61150..............  Pierce skull for drainage.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61151..............  Pierce skull for drainage.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61154..............  Pierce skull & remove clot  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61156..............  Pierce skull for drainage.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61210..............  Pierce skull, implant       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
61215..............  Insert brain-fluid device.  ..................  T.................         0224      37.1117    $2,363.76  ...........      $472.75
61250..............  Pierce skull & explore....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61253..............  Pierce skull & explore....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61304..............  Open skull for exploration  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61305..............  Open skull for exploration  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61312..............  Open skull for drainage...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61313..............  Open skull for drainage...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61314..............  Open skull for drainage...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61315..............  Open skull for drainage...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61316..............  Implt cran bone flap to     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      abdo.
61320..............  Open skull for drainage...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61321..............  Open skull for drainage...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61322..............  Decompressive craniotomy..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61323..............  Decompressive lobectomy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61330..............  Decompress eye socket.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68

[[Page 42960]]

 
61332..............  Explore/biopsy eye socket.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61333..............  Explore orbit/remove        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61334..............  Explore orbit/remove        ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      object.
61340..............  Subtemporal decompression.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61343..............  Incise skull (press         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      relief).
61345..............  Relieve cranial pressure..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61440..............  Incise skull for surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61450..............  Incise skull for surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61458..............  Incise skull for brain      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      wound.
61460..............  Incise skull for surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61470..............  Incise skull for surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61480..............  Incise skull for surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61490..............  Incise skull for surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61500..............  Removal of skull lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61501..............  Remove infected skull bone  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61510..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61512..............  Remove brain lining lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61514..............  Removal of brain abscess..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61516..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61517..............  Implt brain chemotx add-on  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61518..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61519..............  Remove brain lining lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61520..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61521..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61522..............  Removal of brain abscess..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61524..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61526..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61530..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61531..............  Implant brain electrodes..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61533..............  Implant brain electrodes..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61534..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61535..............  Remove brain electrodes...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61536..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61537..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61538..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61539..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61540..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61541..............  Incision of brain tissue..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61542..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61543..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61544..............  Remove & treat brain        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61545..............  Excision of brain tumor...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61546..............  Removal of pituitary gland  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61548..............  Removal of pituitary gland  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61550..............  Release of skull seams....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61552..............  Release of skull seams....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61556..............  Incise skull/sutures......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61557..............  Incise skull/sutures......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61558..............  Excision of skull/sutures.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61559..............  Excision of skull/sutures.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61563..............  Excision of skull tumor...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61564..............  Excision of skull tumor...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61566..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61567..............  Incision of brain tissue..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61570..............  Remove foreign body, brain  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61571..............  Incise skull for brain      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      wound.
61575..............  Skull base/brainstem        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61576..............  Skull base/brainstem        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61580..............  Craniofacial approach,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61581..............  Craniofacial approach,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61582..............  Craniofacial approach,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61583..............  Craniofacial approach,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61584..............  Orbitocranial approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61585..............  Orbitocranial approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61586..............  Resect nasopharynx, skull.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61590..............  Infratemporal approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61591..............  Infratemporal approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61592..............  Orbitocranial approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61595..............  Transtemporal approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61596..............  Transcochlear approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61597..............  Transcondylar approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61598..............  Transpetrosal approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61600..............  Resect/excise cranial       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61601..............  Resect/excise cranial       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61605..............  Resect/excise cranial       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61606..............  Resect/excise cranial       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61607..............  Resect/excise cranial       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61608..............  Resect/excise cranial       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.

[[Page 42961]]

 
61609..............  Transect artery, sinus....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61610..............  Transect artery, sinus....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61611..............  Transect artery, sinus....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61612..............  Transect artery, sinus....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61613..............  Remove aneurysm, sinus....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61615..............  Resect/excise lesion,       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61616..............  Resect/excise lesion,       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61618..............  Repair dura...............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61619..............  Repair dura...............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61623..............  Endovasc tempory vessel     CH................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83
                      occl.
61624..............  Transcath occlusion, cns..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61626..............  Transcath occlusion, non-   CH................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83
                      cns.
61630..............  Intracranial angioplasty..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
61635..............  Intracran angioplsty w/     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      stent.
61640..............  Dilate ic vasospasm, init.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
61641..............  Dilate ic vasospasm add-on  ..................  E.................  ...........  ...........  ...........  ...........  ...........
61642..............  Dilate ic vasospasm add-on  ..................  E.................  ...........  ...........  ...........  ...........  ...........
61680..............  Intracranial vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61682..............  Intracranial vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61684..............  Intracranial vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61686..............  Intracranial vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61690..............  Intracranial vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61692..............  Intracranial vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61697..............  Brain aneurysm repr,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complx.
61698..............  Brain aneurysm repr,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complx.
61700..............  Brain aneurysm repr,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      simple.
61702..............  Inner skull vessel surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61703..............  Clamp neck artery.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61705..............  Revise circulation to head  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61708..............  Revise circulation to head  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61710..............  Revise circulation to head  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61711..............  Fusion of skull arteries..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61720..............  Incise skull/brain surgery  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
61735..............  Incise skull/brain surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61750..............  Incise skull/brain biopsy.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61751..............  Brain biopsy w/ct/mr guide  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61760..............  Implant brain electrodes..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61770..............  Incise skull for treatment  CH................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
61790..............  Treat trigeminal nerve....  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
61791..............  Treat trigeminal tract....  CH................  T.................         0203      15.5687      $991.62      $240.30      $198.32
61793..............  Focus radiation beam......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
61795..............  Brain surgery using         CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      computer.
61850..............  Implant neuroelectrodes...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61860..............  Implant neuroelectrodes...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61863..............  Implant neuroelectrode....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61864..............  Implant neuroelectrde,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      addl.
61867..............  Implant neuroelectrode....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61868..............  Implant neuroelectrde,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      add'l.
61870..............  Implant neuroelectrodes...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61875..............  Implant neuroelectrodes...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61880..............  Revise/remove               ..................  T.................         0687      24.1752    $1,539.79      $438.40      $307.96
                      neuroelectrode.
61885..............  Insrt/redo neurostim 1      ..................  S.................         0039     197.4688   $12,577.38  ...........    $2,515.48
                      array.
61886..............  Implant neurostim arrays..  ..................  T.................         0315     262.8116   $16,739.26  ...........    $3,347.85
61888..............  Revise/remove               ..................  T.................         0688      35.7248    $2,275.42      $874.50      $455.08
                      neuroreceiver.
62000..............  Treat skull fracture......  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
62005..............  Treat skull fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62010..............  Treatment of head injury..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62100..............  Repair brain fluid leakage  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62115..............  Reduction of skull defect.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62116..............  Reduction of skull defect.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62117..............  Reduction of skull defect.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62120..............  Repair skull cavity lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62121..............  Incise skull repair.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62140..............  Repair of skull defect....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62141..............  Repair of skull defect....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62142..............  Remove skull plate/flap...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62143..............  Replace skull plate/flap..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62145..............  Repair of skull & brain...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62146..............  Repair of skull with graft  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62147..............  Repair of skull with graft  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62148..............  Retr bone flap to fix       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
62160..............  Neuroendoscopy add-on.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
62161..............  Dissect brain w/scope.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62162..............  Remove colloid cyst w/      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      scope.
62163..............  Neuroendoscopy w/fb         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      removal.
62164..............  Remove brain tumor w/scope  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62165..............  Remove pituit tumor w/      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      scope.
62180..............  Establish brain cavity      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shunt.

[[Page 42962]]

 
62190..............  Establish brain cavity      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shunt.
62192..............  Establish brain cavity      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shunt.
62194..............  Replace/irrigate catheter.  CH................  T.................         0212       8.6797      $552.84  ...........      $110.57
62200..............  Establish brain cavity      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shunt.
62201..............  Brain cavity shunt w/scope  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62220..............  Establish brain cavity      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shunt.
62223..............  Establish brain cavity      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shunt.
62225..............  Replace/irrigate catheter.  ..................  T.................         0427      14.8912      $948.47  ...........      $189.69
62230..............  Replace/revise brain shunt  ..................  T.................         0224      37.1117    $2,363.76  ...........      $472.75
62252..............  Csf shunt reprogram.......  ..................  S.................         0691       2.5849      $164.64       $56.08       $32.93
62256..............  Remove brain cavity shunt.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62258..............  Replace brain cavity shunt  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62263..............  Epidural lysis mult         ..................  T.................         0203      15.5687      $991.62      $240.30      $198.32
                      sessions.
62264..............  Epidural lysis on single    ..................  T.................         0203      15.5687      $991.62      $240.30      $198.32
                      day.
62268..............  Drain spinal cord cyst....  ..................  T.................         0212       8.6797      $552.84  ...........      $110.57
62269..............  Needle biopsy, spinal cord  ..................  T.................         0685       9.5741      $609.80  ...........      $121.96
62270..............  Spinal fluid tap,           CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
                      diagnostic.
62272..............  Drain cerebro spinal fluid  CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
62273..............  Inject epidural patch.....  ..................  T.................         0206       4.1589      $264.89       $56.83       $52.98
62280..............  Treat spinal cord lesion..  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
62281..............  Treat spinal cord lesion..  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
62282..............  Treat spinal canal lesion.  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
62284..............  Injection for myelogram...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
62287..............  Percutaneous diskectomy...  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
62290..............  Inject for spine disk x-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
62291..............  Inject for spine disk x-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
62292..............  Injection into disk lesion  ..................  T.................         0212       8.6797      $552.84  ...........      $110.57
62294..............  Injection into spinal       ..................  T.................         0212       8.6797      $552.84  ...........      $110.57
                      artery.
62310..............  Inject spine c/t..........  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
62311..............  Inject spine l/s (cd).....  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
62318..............  Inject spine w/cath, c/t..  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
62319..............  Inject spine w/cath l/s     ..................  T.................         0207        7.137      $454.58  ...........       $90.92
                      (cd).
62350..............  Implant spinal canal cath.  CH................  T.................         0224      37.1117    $2,363.76  ...........      $472.75
62351..............  Implant spinal canal cath.  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
62355..............  Remove spinal canal         ..................  T.................         0203      15.5687      $991.62      $240.30      $198.32
                      catheter.
62360..............  Insert spine infusion       CH................  T.................         0224      37.1117    $2,363.76  ...........      $472.75
                      device.
62361..............  Implant spine infusion      ..................  T.................         0227     178.7228   $11,383.39  ...........    $2,276.68
                      pump.
62362..............  Implant spine infusion      ..................  T.................         0227     178.7228   $11,383.39  ...........    $2,276.68
                      pump.
62365..............  Remove spine infusion       ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
                      device.
62367..............  Analyze spine infusion      ..................  S.................         0691       2.5849      $164.64       $56.08       $32.93
                      pump.
62368..............  Analyze spine infusion      ..................  S.................         0691       2.5849      $164.64       $56.08       $32.93
                      pump.
63001..............  Removal of spinal lamina..  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63003..............  Removal of spinal lamina..  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63005..............  Removal of spinal lamina..  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63011..............  Removal of spinal lamina..  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63012..............  Removal of spinal lamina..  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63015..............  Removal of spinal lamina..  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63016..............  Removal of spinal lamina..  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63017..............  Removal of spinal lamina..  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63020..............  Neck spine disk surgery...  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63030..............  Low back disk surgery.....  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63035..............  Spinal disk surgery add-on  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63040..............  Laminotomy, single          ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
                      cervical.
63042..............  Laminotomy, single lumbar.  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63043..............  Laminotomy, add'l cervical  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63044..............  Laminotomy, add'l lumbar..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63045..............  Removal of spinal lamina..  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63046..............  Removal of spinal lamina..  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63047..............  Removal of spinal lamina..  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63048..............  Remove spinal lamina add-   ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
                      on.
63050..............  Cervical laminoplasty.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63051..............  C-laminoplasty w/graft/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      plate.
63055..............  Decompress spinal cord....  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63056..............  Decompress spinal cord....  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63057..............  Decompress spine cord add-  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
                      on.
63064..............  Decompress spinal cord....  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63066..............  Decompress spine cord add-  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
                      on.
63075..............  Neck spine disk surgery...  ..................  T.................         0208      47.6714    $3,036.33  ...........      $607.27
63076..............  Neck spine disk surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63077..............  Spine disk surgery, thorax  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63078..............  Spine disk surgery, thorax  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63081..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63082..............  Remove vertebral body add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
63085..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63086..............  Remove vertebral body add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
63087..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63088..............  Remove vertebral body add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
63090..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42963]]

 
63091..............  Remove vertebral body add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
63101..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63102..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63103..............  Remove vertebral body add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
63170..............  Incise spinal cord          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tract(s).
63172..............  Drainage of spinal cyst...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63173..............  Drainage of spinal cyst...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63180..............  Revise spinal cord          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ligaments.
63182..............  Revise spinal cord          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ligaments.
63185..............  Incise spinal column/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nerves.
63190..............  Incise spinal column/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nerves.
63191..............  Incise spinal column/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nerves.
63194..............  Incise spinal column &      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cord.
63195..............  Incise spinal column &      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cord.
63196..............  Incise spinal column &      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cord.
63197..............  Incise spinal column &      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cord.
63198..............  Incise spinal column &      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cord.
63199..............  Incise spinal column &      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cord.
63200..............  Release of spinal cord....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63250..............  Revise spinal cord vessels  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63251..............  Revise spinal cord vessels  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63252..............  Revise spinal cord vessels  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63265..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63266..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63267..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63268..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63270..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63271..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63272..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63273..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63275..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63276..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63277..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63278..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63280..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63281..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63282..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63283..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63285..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63286..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63287..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63290..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63295..............  Repair of laminectomy       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
63300..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63301..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63302..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63303..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63304..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63305..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63306..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63307..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63308..............  Remove vertebral body add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
63600..............  Remove spinal cord lesion.  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
63610..............  Stimulation of spinal cord  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
63615..............  Remove lesion of spinal     ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
                      cord.
63650..............  Implant neuroelectrodes...  ..................  S.................         0040      63.7536    $4,060.66  ...........      $812.13
63655..............  Implant neuroelectrodes...  ..................  S.................         0061      81.3252    $5,179.85  ...........    $1,035.97
63660..............  Revise/remove               ..................  T.................         0687      24.1752    $1,539.79      $438.40      $307.96
                      neuroelectrode.
63685..............  Insrt/redo spine n          ..................  T.................         0222     193.3327   $12,313.94  ...........    $2,462.79
                      generator.
63688..............  Revise/remove               ..................  T.................         0688      35.7248    $2,275.42      $874.50      $455.08
                      neuroreceiver.
63700..............  Repair of spinal            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      herniation.
63702..............  Repair of spinal            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      herniation.
63704..............  Repair of spinal            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      herniation.
63706..............  Repair of spinal            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      herniation.
63707..............  Repair spinal fluid         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      leakage.
63709..............  Repair spinal fluid         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      leakage.
63710..............  Graft repair of spine       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
63740..............  Install spinal shunt......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63741..............  Install spinal shunt......  CH................  T.................         0224      37.1117    $2,363.76  ...........      $472.75
63744..............  Revision of spinal shunt..  CH................  T.................         0224      37.1117    $2,363.76  ...........      $472.75
63746..............  Removal of spinal shunt...  ..................  T.................         0109       6.1077      $389.02  ...........       $77.80
64400..............  N block inj, trigeminal...  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
64402..............  N block inj, facial.......  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
64405..............  N block inj, occipital....  CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
64408..............  N block inj, vagus........  CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
64410..............  N block inj, phrenic......  CH................  T.................         0207        7.137      $454.58  ...........       $90.92
64412..............  N block inj, spinal         CH................  T.................         0207        7.137      $454.58  ...........       $90.92
                      accessor.
64413..............  N block inj, cervical       CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
                      plexus.

[[Page 42964]]

 
64415..............  N block inj, brachial       CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
                      plexus.
64416..............  N block cont infuse, b      CH................  T.................         0207        7.137      $454.58  ...........       $90.92
                      plex.
64417..............  N block inj, axillary.....  CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
64418..............  N block inj, suprascapular  CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
64420..............  N block inj, intercost,     CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
                      sng.
64421..............  N block inj, intercost,     ..................  T.................         0206       4.1589      $264.89       $56.83       $52.98
                      mlt.
64425..............  N block inj, ilio-ing/      CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
                      hypogi.
64430..............  N block inj, pudendal.....  CH................  T.................         0207        7.137      $454.58  ...........       $90.92
64435..............  N block inj, paracervical.  CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
64445..............  N block inj, sciatic, sng.  CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
64446..............  N blk inj, sciatic, cont    CH................  T.................         0203      15.5687      $991.62      $240.30      $198.32
                      inf.
64447..............  N block inj fem, single...  CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
64448..............  N block inj fem, cont inf.  CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
64449..............  N block inj, lumbar plexus  CH................  T.................         0207        7.137      $454.58  ...........       $90.92
64450..............  N block, other peripheral.  CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
64470..............  Inj paravertebral c/t.....  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
64472..............  Inj paravertebral c/t add-  ..................  T.................         0206       4.1589      $264.89       $56.83       $52.98
                      on.
64475..............  Inj paravertebral l/s.....  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
64476..............  Inj paravertebral l/s add-  ..................  T.................         0206       4.1589      $264.89       $56.83       $52.98
                      on.
64479..............  Inj foramen epidural c/t..  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
64480..............  Inj foramen epidural add-   CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
                      on.
64483..............  Inj foramen epidural l/s..  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
64484..............  Inj foramen epidural add-   ..................  T.................         0207        7.137      $454.58  ...........       $90.92
                      on.
64505..............  N block, spenopalatine      ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
                      gangl.
64508..............  N block, carotid sinus s/p  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
64510..............  N block, stellate ganglion  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
64517..............  N block inj, hypogas plxs.  CH................  T.................         0207        7.137      $454.58  ...........       $90.92
64520..............  N block, lumbar/thoracic..  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
64530..............  N block inj, celiac pelus.  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
64550..............  Apply neurostimulator.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
64553..............  Implant neuroelectrodes...  ..................  S.................         0225     221.4181   $14,102.78  ...........    $2,820.56
64555..............  Implant neuroelectrodes...  ..................  S.................         0040      63.7536    $4,060.66  ...........      $812.13
64560..............  Implant neuroelectrodes...  ..................  S.................         0040      63.7536    $4,060.66  ...........      $812.13
64561..............  Implant neuroelectrodes...  ..................  S.................         0040      63.7536    $4,060.66  ...........      $812.13
64565..............  Implant neuroelectrodes...  ..................  S.................         0040      63.7536    $4,060.66  ...........      $812.13
64573..............  Implant neuroelectrodes...  ..................  S.................         0225     221.4181   $14,102.78  ...........    $2,820.56
64575..............  Implant neuroelectrodes...  ..................  S.................         0061      81.3252    $5,179.85  ...........    $1,035.97
64577..............  Implant neuroelectrodes...  ..................  S.................         0061      81.3252    $5,179.85  ...........    $1,035.97
64580..............  Implant neuroelectrodes...  ..................  S.................         0061      81.3252    $5,179.85  ...........    $1,035.97
64581..............  Implant neuroelectrodes...  ..................  S.................         0061      81.3252    $5,179.85  ...........    $1,035.97
64585..............  Revise/remove               ..................  T.................         0687      24.1752    $1,539.79      $438.40      $307.96
                      neuroelectrode.
64590..............  Insrt/redo pn/gastr stimul  ..................  T.................         0222     193.3327   $12,313.94  ...........    $2,462.79
64595..............  Revise/rmv pn/gastr stimul  ..................  T.................         0688      35.7248    $2,275.42      $874.50      $455.08
64600..............  Injection treatment of      ..................  T.................         0203      15.5687      $991.62      $240.30      $198.32
                      nerve.
64605..............  Injection treatment of      ..................  T.................         0203      15.5687      $991.62      $240.30      $198.32
                      nerve.
64610..............  Injection treatment of      ..................  T.................         0203      15.5687      $991.62      $240.30      $198.32
                      nerve.
64612..............  Destroy nerve, face muscle  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
64613..............  Destroy nerve, neck muscle  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
64614..............  Destroy nerve, extrem musc  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
64620..............  Injection treatment of      CH................  T.................         0207        7.137      $454.58  ...........       $90.92
                      nerve.
64622..............  Destr paravertebrl nerve l/ CH................  T.................         0207        7.137      $454.58  ...........       $90.92
                      s.
64623..............  Destr paravertebral n add-  ..................  T.................         0207        7.137      $454.58  ...........       $90.92
                      on.
64626..............  Destr paravertebrl nerve c/ CH................  T.................         0207        7.137      $454.58  ...........       $90.92
                      t.
64627..............  Destr paravertebral n add-  CH................  T.................         0204       2.3254      $148.11       $40.10       $29.62
                      on.
64630..............  Injection treatment of      CH................  T.................         0207        7.137      $454.58  ...........       $90.92
                      nerve.
64640..............  Injection treatment of      CH................  T.................         0207        7.137      $454.58  ...........       $90.92
                      nerve.
64650..............  Chemodenerv eccrine glands  CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
64653..............  Chemodenerv eccrine glands  CH................  T.................         0206       4.1589      $264.89       $56.83       $52.98
64680..............  Injection treatment of      ..................  T.................         0207        7.137      $454.58  ...........       $90.92
                      nerve.
64681..............  Injection treatment of      ..................  T.................         0203      15.5687      $991.62      $240.30      $198.32
                      nerve.
64702..............  Revise finger/toe nerve...  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64704..............  Revise hand/foot nerve....  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64708..............  Revise arm/leg nerve......  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64712..............  Revision of sciatic nerve.  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64713..............  Revision of arm nerve(s)..  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64714..............  Revise low back nerve(s)..  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64716..............  Revision of cranial nerve.  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64718..............  Revise ulnar nerve at       ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
                      elbow.
64719..............  Revise ulnar nerve at       ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
                      wrist.
64721..............  Carpal tunnel surgery.....  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64722..............  Relieve pressure on         ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
                      nerve(s).
64726..............  Release foot/toe nerve....  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64727..............  Internal nerve revision...  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64732..............  Incision of brow nerve....  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64734..............  Incision of cheek nerve...  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64736..............  Incision of chin nerve....  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64738..............  Incision of jaw nerve.....  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64740..............  Incision of tongue nerve..  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75

[[Page 42965]]

 
64742..............  Incision of facial nerve..  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64744..............  Incise nerve, back of head  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64746..............  Incise diaphragm nerve....  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64752..............  Incision of vagus nerve...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
64755..............  Incision of stomach nerves  ..................  C.................  ...........  ...........  ...........  ...........  ...........
64760..............  Incision of vagus nerve...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
64761..............  Incision of pelvis nerve..  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64763..............  Incise hip/thigh nerve....  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64766..............  Incise hip/thigh nerve....  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64771..............  Sever cranial nerve.......  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64772..............  Incision of spinal nerve..  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64774..............  Remove skin nerve lesion..  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64776..............  Remove digit nerve lesion.  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64778..............  Digit nerve surgery add-on  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64782..............  Remove limb nerve lesion..  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64783..............  Limb nerve surgery add-on.  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64784..............  Remove nerve lesion.......  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64786..............  Remove sciatic nerve        ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
                      lesion.
64787..............  Implant nerve end.........  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64788..............  Remove skin nerve lesion..  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64790..............  Removal of nerve lesion...  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64792..............  Removal of nerve lesion...  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64795..............  Biopsy of nerve...........  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64802..............  Remove sympathetic nerves.  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64804..............  Remove sympathetic nerves.  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64809..............  Remove sympathetic nerves.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
64818..............  Remove sympathetic nerves.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
64820..............  Remove sympathetic nerves.  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64821..............  Remove sympathetic nerves.  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
64822..............  Remove sympathetic nerves.  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
64823..............  Remove sympathetic nerves.  ..................  T.................         0054      26.7322    $1,702.65  ...........      $340.53
64831..............  Repair of digit nerve.....  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64832..............  Repair nerve add-on.......  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64834..............  Repair of hand or foot      ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
                      nerve.
64835..............  Repair of hand or foot      ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
                      nerve.
64836..............  Repair of hand or foot      ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
                      nerve.
64837..............  Repair nerve add-on.......  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64840..............  Repair of leg nerve.......  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64856..............  Repair/transpose nerve....  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64857..............  Repair arm/leg nerve......  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64858..............  Repair sciatic nerve......  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64859..............  Nerve surgery.............  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64861..............  Repair of arm nerves......  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64862..............  Repair of low back nerves.  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64864..............  Repair of facial nerve....  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64865..............  Repair of facial nerve....  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64866..............  Fusion of facial/other      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nerve.
64868..............  Fusion of facial/other      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nerve.
64870..............  Fusion of facial/other      ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
                      nerve.
64872..............  Subsequent repair of nerve  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64874..............  Repair & revise nerve add-  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
                      on.
64876..............  Repair nerve/shorten bone.  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64885..............  Nerve graft, head or neck.  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64886..............  Nerve graft, head or neck.  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64890..............  Nerve graft, hand or foot.  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64891..............  Nerve graft, hand or foot.  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64892..............  Nerve graft, arm or leg...  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64893..............  Nerve graft, arm or leg...  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64895..............  Nerve graft, hand or foot.  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64896..............  Nerve graft, hand or foot.  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64897..............  Nerve graft, arm or leg...  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64898..............  Nerve graft, arm or leg...  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64901..............  Nerve graft add-on........  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64902..............  Nerve graft add-on........  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64905..............  Nerve pedicle transfer....  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64907..............  Nerve pedicle transfer....  ..................  T.................         0221      32.0518    $2,041.48      $463.60      $408.30
64910..............  Nerve repair w/allograft..  ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
64911..............  Neurorraphy w/vein          ..................  T.................         0220      18.5069    $1,178.76  ...........      $235.75
                      autograft.
64999..............  Nervous system surgery....  ..................  T.................         0204       2.3254      $148.11       $40.10       $29.62
65091..............  Revise eye................  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
65093..............  Revise eye with implant...  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
65101..............  Removal of eye............  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
65103..............  Remove eye/insert implant.  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
65105..............  Remove eye/attach implant.  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
65110..............  Removal of eye............  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
65112..............  Remove eye/revise socket..  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
65114..............  Remove eye/revise socket..  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
65125..............  Revise ocular implant.....  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94

[[Page 42966]]

 
65130..............  Insert ocular implant.....  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
65135..............  Insert ocular implant.....  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
65140..............  Attach ocular implant.....  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
65150..............  Revise ocular implant.....  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
65155..............  Reinsert ocular implant...  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
65175..............  Removal of ocular implant.  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
65205..............  Remove foreign body from    ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
                      eye.
65210..............  Remove foreign body from    ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
                      eye.
65220..............  Remove foreign body from    ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
                      eye.
65222..............  Remove foreign body from    ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
                      eye.
65235..............  Remove foreign body from    ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
                      eye.
65260..............  Remove foreign body from    ..................  T.................         0236      18.8779    $1,202.39  ...........      $240.48
                      eye.
65265..............  Remove foreign body from    ..................  T.................         0237      29.0019    $1,847.22  ...........      $369.44
                      eye.
65270..............  Repair of eye wound.......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
65272..............  Repair of eye wound.......  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
65273..............  Repair of eye wound.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
65275..............  Repair of eye wound.......  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
65280..............  Repair of eye wound.......  ..................  T.................         0236      18.8779    $1,202.39  ...........      $240.48
65285..............  Repair of eye wound.......  ..................  T.................         0672      38.1121    $2,427.47  ...........      $485.49
65286..............  Repair of eye wound.......  ..................  T.................         0232       5.1145      $325.76       $81.59       $65.15
65290..............  Repair of eye socket wound  ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
65400..............  Removal of eye lesion.....  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
65410..............  Biopsy of cornea..........  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
65420..............  Removal of eye lesion.....  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
65426..............  Removal of eye lesion.....  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
65430..............  Corneal smear.............  ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
65435..............  Curette/treat cornea......  ..................  T.................         0239       7.1099      $452.85  ...........       $90.57
65436..............  Curette/treat cornea......  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
65450..............  Treatment of corneal        ..................  S.................         0231       2.3117      $147.24  ...........       $29.45
                      lesion.
65600..............  Revision of cornea........  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
65710..............  Corneal transplant........  ..................  T.................         0244      38.2919    $2,438.93      $803.20      $487.79
65730..............  Corneal transplant........  ..................  T.................         0244      38.2919    $2,438.93      $803.20      $487.79
65750..............  Corneal transplant........  ..................  T.................         0244      38.2919    $2,438.93      $803.20      $487.79
65755..............  Corneal transplant........  ..................  T.................         0244      38.2919    $2,438.93      $803.20      $487.79
65760..............  Revision of cornea........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
65765..............  Revision of cornea........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
65767..............  Corneal tissue transplant.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
65770..............  Revise cornea with implant  ..................  T.................         0293      83.0605    $5,290.37    $1,128.20    $1,058.07
65771..............  Radial keratotomy.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
65772..............  Correction of astigmatism.  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
65775..............  Correction of astigmatism.  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
65780..............  Ocular reconst, transplant  ..................  T.................         0244      38.2919    $2,438.93      $803.20      $487.79
65781..............  Ocular reconst, transplant  ..................  T.................         0244      38.2919    $2,438.93      $803.20      $487.79
65782..............  Ocular reconst, transplant  ..................  T.................         0244      38.2919    $2,438.93      $803.20      $487.79
65800..............  Drainage of eye...........  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
65805..............  Drainage of eye...........  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
65810..............  Drainage of eye...........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
65815..............  Drainage of eye...........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
65820..............  Relieve inner eye pressure  ..................  T.................         0232       5.1145      $325.76       $81.59       $65.15
65850..............  Incision of eye...........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
65855..............  Laser surgery of eye......  ..................  T.................         0247       5.2389      $333.68      $104.30       $66.74
65860..............  Incise inner eye adhesions  ..................  T.................         0247       5.2389      $333.68      $104.30       $66.74
65865..............  Incise inner eye adhesions  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
65870..............  Incise inner eye adhesions  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
65875..............  Incise inner eye adhesions  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
65880..............  Incise inner eye adhesions  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
65900..............  Remove eye lesion.........  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
65920..............  Remove implant of eye.....  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
65930..............  Remove blood clot from eye  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66020..............  Injection treatment of eye  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
66030..............  Injection treatment of eye  ..................  T.................         0232       5.1145      $325.76       $81.59       $65.15
66130..............  Remove eye lesion.........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66150..............  Glaucoma surgery..........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66155..............  Glaucoma surgery..........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66160..............  Glaucoma surgery..........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66165..............  Glaucoma surgery..........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66170..............  Glaucoma surgery..........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66172..............  Incision of eye...........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66180..............  Implant eye shunt.........  ..................  T.................         0673      40.8481    $2,601.74      $649.50      $520.35
66185..............  Revise eye shunt..........  ..................  T.................         0673      40.8481    $2,601.74      $649.50      $520.35
66220..............  Repair eye lesion.........  ..................  T.................         0672      38.1121    $2,427.47  ...........      $485.49
66225..............  Repair/graft eye lesion...  ..................  T.................         0673      40.8481    $2,601.74      $649.50      $520.35
66250..............  Follow-up surgery of eye..  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
66500..............  Incision of iris..........  ..................  T.................         0232       5.1145      $325.76       $81.59       $65.15
66505..............  Incision of iris..........  ..................  T.................         0232       5.1145      $325.76       $81.59       $65.15
66600..............  Remove iris and lesion....  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66605..............  Removal of iris...........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66625..............  Removal of iris...........  ..................  T.................         0232       5.1145      $325.76       $81.59       $65.15

[[Page 42967]]

 
66630..............  Removal of iris...........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66635..............  Removal of iris...........  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66680..............  Repair iris & ciliary body  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66682..............  Repair iris & ciliary body  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66700..............  Destruction, ciliary body.  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
66710..............  Ciliary transsleral         ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
                      therapy.
66711..............  Ciliary endoscopic          ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
                      ablation.
66720..............  Destruction, ciliary body.  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
66740..............  Destruction, ciliary body.  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
66761..............  Revision of iris..........  ..................  T.................         0247       5.2389      $333.68      $104.30       $66.74
66762..............  Revision of iris..........  ..................  T.................         0247       5.2389      $333.68      $104.30       $66.74
66770..............  Removal of inner eye        ..................  T.................         0247       5.2389      $333.68      $104.30       $66.74
                      lesion.
66820..............  Incision, secondary         ..................  T.................         0232       5.1145      $325.76       $81.59       $65.15
                      cataract.
66821..............  After cataract laser        ..................  T.................         0247       5.2389      $333.68      $104.30       $66.74
                      surgery.
66825..............  Reposition intraocular      ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
                      lens.
66830..............  Removal of lens lesion....  ..................  T.................         0232       5.1145      $325.76       $81.59       $65.15
66840..............  Removal of lens material..  ..................  T.................         0245      14.9022      $949.17      $217.00      $189.83
66850..............  Removal of lens material..  ..................  T.................         0249      29.7487    $1,894.78      $524.60      $378.96
66852..............  Removal of lens material..  ..................  T.................         0249      29.7487    $1,894.78      $524.60      $378.96
66920..............  Extraction of lens........  ..................  T.................         0249      29.7487    $1,894.78      $524.60      $378.96
66930..............  Extraction of lens........  ..................  T.................         0249      29.7487    $1,894.78      $524.60      $378.96
66940..............  Extraction of lens........  ..................  T.................         0245      14.9022      $949.17      $217.00      $189.83
66982..............  Cataract surgery, complex.  ..................  T.................         0246      24.2197    $1,542.63      $495.90      $308.53
66983..............  Cataract surg w/iol, 1      ..................  T.................         0246      24.2197    $1,542.63      $495.90      $308.53
                      stage.
66984..............  Cataract surg w/iol, 1      ..................  T.................         0246      24.2197    $1,542.63      $495.90      $308.53
                      stage.
66985..............  Insert lens prosthesis....  ..................  T.................         0246      24.2197    $1,542.63      $495.90      $308.53
66986..............  Exchange lens prosthesis..  ..................  T.................         0246      24.2197    $1,542.63      $495.90      $308.53
66990..............  Ophthalmic endoscope add-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
66999..............  Eye surgery procedure.....  ..................  T.................         0232       5.1145      $325.76       $81.59       $65.15
67005..............  Partial removal of eye      ..................  T.................         0237      29.0019    $1,847.22  ...........      $369.44
                      fluid.
67010..............  Partial removal of eye      ..................  T.................         0237      29.0019    $1,847.22  ...........      $369.44
                      fluid.
67015..............  Release of eye fluid......  ..................  T.................         0237      29.0019    $1,847.22  ...........      $369.44
67025..............  Replace eye fluid.........  ..................  T.................         0237      29.0019    $1,847.22  ...........      $369.44
67027..............  Implant eye drug system...  ..................  T.................         0672      38.1121    $2,427.47  ...........      $485.49
67028..............  Injection eye drug........  CH................  S.................         0231       2.3117      $147.24  ...........       $29.45
67030..............  Incise inner eye strands..  ..................  T.................         0236      18.8779    $1,202.39  ...........      $240.48
67031..............  Laser surgery, eye strands  ..................  T.................         0247       5.2389      $333.68      $104.30       $66.74
67036..............  Removal of inner eye fluid  ..................  T.................         0672      38.1121    $2,427.47  ...........      $485.49
67038..............  Strip retinal membrane....  ..................  T.................         0672      38.1121    $2,427.47  ...........      $485.49
67039..............  Laser treatment of retina.  ..................  T.................         0672      38.1121    $2,427.47  ...........      $485.49
67040..............  Laser treatment of retina.  ..................  T.................         0672      38.1121    $2,427.47  ...........      $485.49
67101..............  Repair detached retina....  ..................  T.................         0236      18.8779    $1,202.39  ...........      $240.48
67105..............  Repair detached retina....  CH................  T.................         0247       5.2389      $333.68      $104.30       $66.74
67107..............  Repair detached retina....  ..................  T.................         0672      38.1121    $2,427.47  ...........      $485.49
67108..............  Repair detached retina....  ..................  T.................         0672      38.1121    $2,427.47  ...........      $485.49
67110..............  Repair detached retina....  ..................  T.................         0236      18.8779    $1,202.39  ...........      $240.48
67112..............  Rerepair detached retina..  ..................  T.................         0672      38.1121    $2,427.47  ...........      $485.49
67115..............  Release encircling          ..................  T.................         0236      18.8779    $1,202.39  ...........      $240.48
                      material.
67120..............  Remove eye implant          ..................  T.................         0236      18.8779    $1,202.39  ...........      $240.48
                      material.
67121..............  Remove eye implant          ..................  T.................         0237      29.0019    $1,847.22  ...........      $369.44
                      material.
67141..............  Treatment of retina.......  ..................  T.................         0235         4.01      $255.41       $58.90       $51.08
67145..............  Treatment of retina.......  CH................  T.................         0247       5.2389      $333.68      $104.30       $66.74
67208..............  Treatment of retinal        ..................  T.................         0236      18.8779    $1,202.39  ...........      $240.48
                      lesion.
67210..............  Treatment of retinal        CH................  T.................         0247       5.2389      $333.68      $104.30       $66.74
                      lesion.
67218..............  Treatment of retinal        ..................  T.................         0236      18.8779    $1,202.39  ...........      $240.48
                      lesion.
67220..............  Treatment of choroid        ..................  T.................         0235         4.01      $255.41       $58.90       $51.08
                      lesion.
67221..............  Ocular photodynamic ther..  ..................  T.................         0235         4.01      $255.41       $58.90       $51.08
67225..............  Eye photodynamic ther add-  ..................  T.................         0235         4.01      $255.41       $58.90       $51.08
                      on.
67227..............  Treatment of retinal        ..................  T.................         0237      29.0019    $1,847.22  ...........      $369.44
                      lesion.
67228..............  Treatment of retinal        CH................  T.................         0247       5.2389      $333.68      $104.30       $66.74
                      lesion.
67250..............  Reinforce eye wall........  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67255..............  Reinforce/graft eye wall..  ..................  T.................         0237      29.0019    $1,847.22  ...........      $369.44
67299..............  Eye surgery procedure.....  ..................  T.................         0235         4.01      $255.41       $58.90       $51.08
67311..............  Revise eye muscle.........  ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
67312..............  Revise two eye muscles....  ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
67314..............  Revise eye muscle.........  ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
67316..............  Revise two eye muscles....  ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
67318..............  Revise eye muscle(s)......  ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
67320..............  Revise eye muscle(s) add-   ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
                      on.
67331..............  Eye surgery follow-up add-  ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
                      on.
67332..............  Rerevise eye muscles add-   ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
                      on.
67334..............  Revise eye muscle w/suture  ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
67335..............  Eye suture during surgery.  ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
67340..............  Revise eye muscle add-on..  ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
67343..............  Release eye tissue........  ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
67345..............  Destroy nerve of eye        ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
                      muscle.
67346..............  Biopsy, eye muscle........  ..................  T.................         0699      14.2784      $909.43  ...........      $181.89
67399..............  Eye muscle surgery          ..................  T.................         0243       24.392    $1,553.60      $430.30      $310.72
                      procedure.

[[Page 42968]]

 
67400..............  Explore/biopsy eye socket.  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
67405..............  Explore/drain eye socket..  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
67412..............  Explore/treat eye socket..  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
67413..............  Explore/treat eye socket..  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
67414..............  Explr/decompress eye        ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
                      socket.
67415..............  Aspiration, orbital         ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
                      contents.
67420..............  Explore/treat eye socket..  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
67430..............  Explore/treat eye socket..  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
67440..............  Explore/drain eye socket..  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
67445..............  Explr/decompress eye        ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
                      socket.
67450..............  Explore/biopsy eye socket.  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
67500..............  Inject/treat eye socket...  ..................  S.................         0231       2.3117      $147.24  ...........       $29.45
67505..............  Inject/treat eye socket...  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
67515..............  Inject/treat eye socket...  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
67550..............  Insert eye socket implant.  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
67560..............  Revise eye socket implant.  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
67570..............  Decompress optic nerve....  ..................  T.................         0242      37.3504    $2,378.96      $597.30      $475.79
67599..............  Orbit surgery procedure...  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
67700..............  Drainage of eyelid abscess  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
67710..............  Incision of eyelid........  ..................  T.................         0239       7.1099      $452.85  ...........       $90.57
67715..............  Incision of eyelid fold...  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67800..............  Remove eyelid lesion......  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
67801..............  Remove eyelid lesions.....  ..................  T.................         0239       7.1099      $452.85  ...........       $90.57
67805..............  Remove eyelid lesions.....  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
67808..............  Remove eyelid lesion(s)...  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67810..............  Biopsy of eyelid..........  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
67820..............  Revise eyelashes..........  ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
67825..............  Revise eyelashes..........  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
67830..............  Revise eyelashes..........  ..................  T.................         0239       7.1099      $452.85  ...........       $90.57
67835..............  Revise eyelashes..........  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67840..............  Remove eyelid lesion......  ..................  T.................         0239       7.1099      $452.85  ...........       $90.57
67850..............  Treat eyelid lesion.......  ..................  T.................         0239       7.1099      $452.85  ...........       $90.57
67875..............  Closure of eyelid by        ..................  T.................         0239       7.1099      $452.85  ...........       $90.57
                      suture.
67880..............  Revision of eyelid........  ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
67882..............  Revision of eyelid........  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67900..............  Repair brow defect........  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67901..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67902..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67903..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67904..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67906..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67908..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67909..............  Revise eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67911..............  Revise eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67912..............  Correction eyelid w/        ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
                      implant.
67914..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67915..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67916..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67917..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67921..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67922..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67923..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67924..............  Repair eyelid defect......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67930..............  Repair eyelid wound.......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67935..............  Repair eyelid wound.......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67938..............  Remove eyelid foreign body  ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
67950..............  Revision of eyelid........  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67961..............  Revision of eyelid........  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67966..............  Revision of eyelid........  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67971..............  Reconstruction of eyelid..  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
67973..............  Reconstruction of eyelid..  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
67974..............  Reconstruction of eyelid..  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
67975..............  Reconstruction of eyelid..  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
67999..............  Revision of eyelid........  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
68020..............  Incise/drain eyelid lining  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
68040..............  Treatment of eyelid         ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
                      lesions.
68100..............  Biopsy of eyelid lining...  ..................  T.................         0232       5.1145      $325.76       $81.59       $65.15
68110..............  Remove eyelid lining        ..................  T.................         0699      14.2784      $909.43  ...........      $181.89
                      lesion.
68115..............  Remove eyelid lining        ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
                      lesion.
68130..............  Remove eyelid lining        ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
                      lesion.
68135..............  Remove eyelid lining        ..................  T.................         0239       7.1099      $452.85  ...........       $90.57
                      lesion.
68200..............  Treat eyelid by injection.  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
68320..............  Revise/graft eyelid lining  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
68325..............  Revise/graft eyelid lining  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
68326..............  Revise/graft eyelid lining  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
68328..............  Revise/graft eyelid lining  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
68330..............  Revise eyelid lining......  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
68335..............  Revise/graft eyelid lining  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08

[[Page 42969]]

 
68340..............  Separate eyelid adhesions.  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
68360..............  Revise eyelid lining......  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
68362..............  Revise eyelid lining......  ..................  T.................         0234      24.0821    $1,533.86      $511.30      $306.77
68371..............  Harvest eye tissue,         ..................  T.................         0233      16.5252    $1,052.54      $266.30      $210.51
                      alograft.
68399..............  Eyelid lining surgery.....  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
68400..............  Incise/drain tear gland...  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
68420..............  Incise/drain tear sac.....  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
68440..............  Incise tear duct opening..  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
68500..............  Removal of tear gland.....  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
68505..............  Partial removal, tear       ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
                      gland.
68510..............  Biopsy of tear gland......  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
68520..............  Removal of tear sac.......  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
68525..............  Biopsy of tear sac........  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
68530..............  Clearance of tear duct....  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
68540..............  Remove tear gland lesion..  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
68550..............  Remove tear gland lesion..  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
68700..............  Repair tear ducts.........  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
68705..............  Revise tear duct opening..  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
68720..............  Create tear sac drain.....  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
68745..............  Create tear duct drain....  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
68750..............  Create tear duct drain....  ..................  T.................         0241      24.8916    $1,585.42      $384.40      $317.08
68760..............  Close tear duct opening...  ..................  S.................         0231       2.3117      $147.24  ...........       $29.45
68761..............  Close tear duct opening...  ..................  S.................         0231       2.3117      $147.24  ...........       $29.45
68770..............  Close tear system fistula.  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
68801..............  Dilate tear duct opening..  ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
68810..............  Probe nasolacrimal duct...  ..................  S.................         0231       2.3117      $147.24  ...........       $29.45
68811..............  Probe nasolacrimal duct...  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
68815..............  Probe nasolacrimal duct...  ..................  T.................         0240       19.228    $1,224.69      $309.50      $244.94
68840..............  Explore/irrigate tear       ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
                      ducts.
68850..............  Injection for tear sac x-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
68899..............  Tear duct system surgery..  ..................  T.................         0238       2.8636      $182.39  ...........       $36.48
69000..............  Drain external ear lesion.  ..................  T.................         0006        1.463       $93.18  ...........       $18.64
69005..............  Drain external ear lesion.  ..................  T.................         0008      19.0457    $1,213.08  ...........      $242.62
69020..............  Drain outer ear canal       ..................  T.................         0006        1.463       $93.18  ...........       $18.64
                      lesion.
69090..............  Pierce earlobes...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
69100..............  Biopsy of external ear....  CH................  T.................         0251       2.5765      $164.11  ...........       $32.82
69105..............  Biopsy of external ear      ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
                      canal.
69110..............  Remove external ear,        ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
                      partial.
69120..............  Removal of external ear...  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
69140..............  Remove ear canal lesion(s)  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
69145..............  Remove ear canal lesion(s)  ..................  T.................         0021      16.5832    $1,056.23      $219.40      $211.25
69150..............  Extensive ear canal         ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
                      surgery.
69155..............  Extensive ear/neck surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
69200..............  Clear outer ear canal.....  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
69205..............  Clear outer ear canal.....  ..................  T.................         0022      21.4534    $1,366.43      $354.40      $273.29
69210..............  Remove impacted ear wax...  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
69220..............  Clean out mastoid cavity..  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
69222..............  Clean out mastoid cavity..  CH................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
69300..............  Revise external ear.......  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
69310..............  Rebuild outer ear canal...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69320..............  Rebuild outer ear canal...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69399..............  Outer ear surgery           ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
                      procedure.
69400..............  Inflate middle ear canal..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
69401..............  Inflate middle ear canal..  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
69405..............  Catheterize middle ear      ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
                      canal.
69420..............  Incision of eardrum.......  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
69421..............  Incision of eardrum.......  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
69424..............  Remove ventilating tube...  CH................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
69433..............  Create eardrum opening....  ..................  T.................         0252       7.6539      $487.50      $109.10       $97.50
69436..............  Create eardrum opening....  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
69440..............  Exploration of middle ear.  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
69450..............  Eardrum revision..........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69501..............  Mastoidectomy.............  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69502..............  Mastoidectomy.............  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
69505..............  Remove mastoid structures.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69511..............  Extensive mastoid surgery.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69530..............  Extensive mastoid surgery.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69535..............  Remove part of temporal     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bone.
69540..............  Remove ear lesion.........  ..................  T.................         0253      16.6341    $1,059.48      $282.20      $211.90
69550..............  Remove ear lesion.........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69552..............  Remove ear lesion.........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69554..............  Remove ear lesion.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
69601..............  Mastoid surgery revision..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69602..............  Mastoid surgery revision..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69603..............  Mastoid surgery revision..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69604..............  Mastoid surgery revision..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69605..............  Mastoid surgery revision..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69610..............  Repair of eardrum.........  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23

[[Page 42970]]

 
69620..............  Repair of eardrum.........  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
69631..............  Repair eardrum structures.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69632..............  Rebuild eardrum structures  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69633..............  Rebuild eardrum structures  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69635..............  Repair eardrum structures.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69636..............  Rebuild eardrum structures  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69637..............  Rebuild eardrum structures  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69641..............  Revise middle ear &         ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      mastoid.
69642..............  Revise middle ear &         ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      mastoid.
69643..............  Revise middle ear &         ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      mastoid.
69644..............  Revise middle ear &         ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      mastoid.
69645..............  Revise middle ear &         ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      mastoid.
69646..............  Revise middle ear &         ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      mastoid.
69650..............  Release middle ear bone...  ..................  T.................         0254      24.3535    $1,551.15      $321.30      $310.23
69660..............  Revise middle ear bone....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69661..............  Revise middle ear bone....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69662..............  Revise middle ear bone....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69666..............  Repair middle ear           ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      structures.
69667..............  Repair middle ear           ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      structures.
69670..............  Remove mastoid air cells..  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69676..............  Remove middle ear nerve...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69700..............  Close mastoid fistula.....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69710..............  Implant/replace hearing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
69711..............  Remove/repair hearing aid.  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69714..............  Implant temple bone w/      ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      stimul.
69715..............  Temple bne implnt w/        ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      stimulat.
69717..............  Temple bone implant         ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
                      revision.
69718..............  Revise temple bone implant  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69720..............  Release facial nerve......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69725..............  Release facial nerve......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69740..............  Repair facial nerve.......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69745..............  Repair facial nerve.......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69799..............  Middle ear surgery          ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
                      procedure.
69801..............  Incise inner ear..........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69802..............  Incise inner ear..........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69805..............  Explore inner ear.........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69806..............  Explore inner ear.........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69820..............  Establish inner ear window  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69840..............  Revise inner ear window...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69905..............  Remove inner ear..........  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69910..............  Remove inner ear & mastoid  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69915..............  Incise inner ear nerve....  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69930..............  Implant cochlear device...  ..................  T.................         0259     404.3379   $25,753.49    $8,698.40    $5,150.70
69949..............  Inner ear surgery           ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
                      procedure.
69950..............  Incise inner ear nerve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
69955..............  Release facial nerve......  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69960..............  Release inner ear canal...  ..................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69970..............  Remove inner ear lesion...  CH................  T.................         0256      40.5598    $2,583.38  ...........      $516.68
69979..............  Temporal bone surgery.....  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
69990..............  Microsurgery add-on.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
70010..............  Contrast x-ray of brain...  CH................  Q.................         0274       3.9008      $248.45       $62.80       $49.69
70015..............  Contrast x-ray of brain...  CH................  Q.................         0274       3.9008      $248.45       $62.80       $49.69
70030..............  X-ray eye for foreign body  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70100..............  X-ray exam of jaw.........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70110..............  X-ray exam of jaw.........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70120..............  X-ray exam of mastoids....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70130..............  X-ray exam of mastoids....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70134..............  X-ray exam of middle ear..  ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
70140..............  X-ray exam of facial bones  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70150..............  X-ray exam of facial bones  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70160..............  X-ray exam of nasal bones.  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70170..............  X-ray exam of tear duct...  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
70190..............  X-ray exam of eye sockets.  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70200..............  X-ray exam of eye sockets.  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70210..............  X-ray exam of sinuses.....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70220..............  X-ray exam of sinuses.....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70240..............  X-ray exam, pituitary       ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      saddle.
70250..............  X-ray exam of skull.......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70260..............  X-ray exam of skull.......  ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
70300..............  X-ray exam of teeth.......  ..................  X.................         0262       0.5739       $36.55  ...........        $7.31
70310..............  X-ray exam of teeth.......  ..................  X.................         0262       0.5739       $36.55  ...........        $7.31
70320..............  Full mouth x-ray of teeth.  ..................  X.................         0262       0.5739       $36.55  ...........        $7.31
70328..............  X-ray exam of jaw joint...  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70330..............  X-ray exam of jaw joints..  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70332..............  X-ray exam of jaw joint...  CH................  Q.................         0275       2.2785      $145.12       $44.13       $29.02
70336..............  Magnetic image, jaw joint.  ..................  S.................         0335       5.0067      $318.89      $111.90       $63.78
70350..............  X-ray head for orthodontia  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70355..............  Panoramic x-ray of jaws...  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25

[[Page 42971]]

 
70360..............  X-ray exam of neck........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
70370..............  Throat x-ray & fluoroscopy  ..................  X.................         0272        1.327       $84.52       $31.60       $16.90
70371..............  Speech evaluation, complex  ..................  X.................         0272        1.327       $84.52       $31.60       $16.90
70373..............  Contrast x-ray of larynx..  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
70380..............  X-ray exam of salivary      ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      gland.
70390..............  X-ray exam of salivary      CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
                      duct.
70450..............  Ct head/brain w/o dye.....  ..................  S.................         0332       3.1487      $200.55       $75.20       $40.11
70460..............  Ct head/brain w/dye.......  ..................  S.................         0283       4.5485      $289.71      $100.30       $57.94
70470..............  Ct head/brain w/o & w/dye.  ..................  S.................         0333       5.3374      $339.96      $119.00       $67.99
70480..............  Ct orbit/ear/fossa w/o dye  ..................  S.................         0332       3.1487      $200.55       $75.20       $40.11
70481..............  Ct orbit/ear/fossa w/dye..  ..................  S.................         0283       4.5485      $289.71      $100.30       $57.94
70482..............  Ct orbit/ear/fossa w/o&w/   ..................  S.................         0333       5.3374      $339.96      $119.00       $67.99
                      dye.
70486..............  Ct maxillofacial w/o dye..  ..................  S.................         0332       3.1487      $200.55       $75.20       $40.11
70487..............  Ct maxillofacial w/dye....  ..................  S.................         0283       4.5485      $289.71      $100.30       $57.94
70488..............  Ct maxillofacial w/o & w/   ..................  S.................         0333       5.3374      $339.96      $119.00       $67.99
                      dye.
70490..............  Ct soft tissue neck w/o     ..................  S.................         0332       3.1487      $200.55       $75.20       $40.11
                      dye.
70491..............  Ct soft tissue neck w/dye.  ..................  S.................         0283       4.5485      $289.71      $100.30       $57.94
70492..............  Ct sft tsue nck w/o & w/    ..................  S.................         0333       5.3374      $339.96      $119.00       $67.99
                      dye.
70496..............  Ct angiography, head......  ..................  S.................         0662       5.2818      $336.41      $118.80       $67.28
70498..............  Ct angiography, neck......  ..................  S.................         0662       5.2818      $336.41      $118.80       $67.28
70540..............  Mri orbit/face/neck w/o     ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
                      dye.
70542..............  Mri orbit/face/neck w/dye.  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
70543..............  Mri orbt/fac/nck w/o & w/   ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
                      dye.
70544..............  Mr angiography head w/o     ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
                      dye.
70545..............  Mr angiography head w/dye.  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
70546..............  Mr angiograph head w/o&w/   ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
                      dye.
70547..............  Mr angiography neck w/o     ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
                      dye.
70548..............  Mr angiography neck w/dye.  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
70549..............  Mr angiograph neck w/o&w/   ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
                      dye.
70551..............  Mri brain w/o dye.........  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
70552..............  Mri brain w/dye...........  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
70553..............  Mri brain w/o & w/dye.....  ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
70554..............  Fmri brain by tech........  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
70555..............  Fmri brain by phys/psych..  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
70557..............  Mri brain w/o dye.........  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
70558..............  Mri brain w/dye...........  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
70559..............  Mri brain w/o & w/dye.....  ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
71010..............  Chest x-ray...............  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
71015..............  Chest x-ray...............  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
71020..............  Chest x-ray...............  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
71021..............  Chest x-ray...............  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
71022..............  Chest x-ray...............  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
71023..............  Chest x-ray and             ..................  X.................         0272        1.327       $84.52       $31.60       $16.90
                      fluoroscopy.
71030..............  Chest x-ray...............  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
71034..............  Chest x-ray and             ..................  X.................         0272        1.327       $84.52       $31.60       $16.90
                      fluoroscopy.
71035..............  Chest x-ray...............  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
71040..............  Contrast x-ray of bronchi.  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
71060..............  Contrast x-ray of bronchi.  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
71090..............  X-ray & pacemaker           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      insertion.
71100..............  X-ray exam of ribs........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
71101..............  X-ray exam of ribs/chest..  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
71110..............  X-ray exam of ribs........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
71111..............  X-ray exam of ribs/chest..  ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
71120..............  X-ray exam of breastbone..  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
71130..............  X-ray exam of breastbone..  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
71250..............  Ct thorax w/o dye.........  ..................  S.................         0332       3.1487      $200.55       $75.20       $40.11
71260..............  Ct thorax w/dye...........  ..................  S.................         0283       4.5485      $289.71      $100.30       $57.94
71270..............  Ct thorax w/o & w/dye.....  ..................  S.................         0333       5.3374      $339.96      $119.00       $67.99
71275..............  Ct angiography, chest.....  ..................  S.................         0662       5.2818      $336.41      $118.80       $67.28
71550..............  Mri chest w/o dye.........  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
71551..............  Mri chest w/dye...........  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
71552..............  Mri chest w/o & w/dye.....  ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
71555..............  Mri angio chest w or w/o    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dye.
72010..............  X-ray exam of spine.......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
72020..............  X-ray exam of spine.......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
72040..............  X-ray exam of neck spine..  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
72050..............  X-ray exam of neck spine..  ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
72052..............  X-ray exam of neck spine..  ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
72069..............  X-ray exam of trunk spine.  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
72070..............  X-ray exam of thoracic      ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      spine.
72072..............  X-ray exam of thoracic      ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      spine.
72074..............  X-ray exam of thoracic      ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      spine.
72080..............  X-ray exam of trunk spine.  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
72090..............  X-ray exam of trunk spine.  ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
72100..............  X-ray exam of lower spine.  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
72110..............  X-ray exam of lower spine.  ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
72114..............  X-ray exam of lower spine.  ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
72120..............  X-ray exam of lower spine.  ..................  X.................         0261       1.2024       $76.58  ...........       $15.32

[[Page 42972]]

 
72125..............  Ct neck spine w/o dye.....  ..................  S.................         0332       3.1487      $200.55       $75.20       $40.11
72126..............  Ct neck spine w/dye.......  CH................  S.................         0316      11.7923      $751.09      $300.26      $150.22
72127..............  Ct neck spine w/o & w/dye.  ..................  S.................         0333       5.3374      $339.96      $119.00       $67.99
72128..............  Ct chest spine w/o dye....  ..................  S.................         0332       3.1487      $200.55       $75.20       $40.11
72129..............  Ct chest spine w/dye......  ..................  S.................         0283       4.5485      $289.71      $100.30       $57.94
72130..............  Ct chest spine w/o & w/dye  ..................  S.................         0333       5.3374      $339.96      $119.00       $67.99
72131..............  Ct lumbar spine w/o dye...  ..................  S.................         0332       3.1487      $200.55       $75.20       $40.11
72132..............  Ct lumbar spine w/dye.....  CH................  S.................         0316      11.7923      $751.09      $300.26      $150.22
72133..............  Ct lumbar spine w/o & w/    ..................  S.................         0333       5.3374      $339.96      $119.00       $67.99
                      dye.
72141..............  Mri neck spine w/o dye....  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
72142..............  Mri neck spine w/dye......  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
72146..............  Mri chest spine w/o dye...  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
72147..............  Mri chest spine w/dye.....  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
72148..............  Mri lumbar spine w/o dye..  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
72149..............  Mri lumbar spine w/dye....  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
72156..............  Mri neck spine w/o & w/dye  ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
72157..............  Mri chest spine w/o & w/    ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
                      dye.
72158..............  Mri lumbar spine w/o & w/   ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
                      dye.
72159..............  Mr angio spine w/o&w/dye..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
72170..............  X-ray exam of pelvis......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
72190..............  X-ray exam of pelvis......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
72191..............  Ct angiograph pelv w/o&w/   ..................  S.................         0662       5.2818      $336.41      $118.80       $67.28
                      dye.
72192..............  Ct pelvis w/o dye.........  ..................  S.................         0332       3.1487      $200.55       $75.20       $40.11
72193..............  Ct pelvis w/dye...........  ..................  S.................         0283       4.5485      $289.71      $100.30       $57.94
72194..............  Ct pelvis w/o & w/dye.....  ..................  S.................         0333       5.3374      $339.96      $119.00       $67.99
72195..............  Mri pelvis w/o dye........  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
72196..............  Mri pelvis w/dye..........  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
72197..............  Mri pelvis w/o & w/dye....  ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
72198..............  Mr angio pelvis w/o & w/    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dye.
72200..............  X-ray exam sacroiliac       ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      joints.
72202..............  X-ray exam sacroiliac       ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      joints.
72220..............  X-ray exam of tailbone....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
72240..............  Contrast x-ray of neck      CH................  Q.................         0274       3.9008      $248.45       $62.80       $49.69
                      spine.
72255..............  Contrast x-ray, thorax      CH................  Q.................         0274       3.9008      $248.45       $62.80       $49.69
                      spine.
72265..............  Contrast x-ray, lower       CH................  Q.................         0274       3.9008      $248.45       $62.80       $49.69
                      spine.
72270..............  Contrast x-ray, spine.....  CH................  Q.................         0274       3.9008      $248.45       $62.80       $49.69
72275..............  Epidurography.............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
72285..............  X-ray c/t spine disk......  CH................  Q.................         0388         9.03      $575.15      $169.68      $115.03
72291..............  Perq vertebroplasty, fluor  CH................  N.................  ...........  ...........  ...........  ...........  ...........
72292..............  Perq vertebroplasty, ct...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
72295..............  X-ray of lower spine disk.  CH................  Q.................         0388         9.03      $575.15      $169.68      $115.03
73000..............  X-ray exam of collar bone.  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73010..............  X-ray exam of shoulder      ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      blade.
73020..............  X-ray exam of shoulder....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73030..............  X-ray exam of shoulder....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73040..............  Contrast x-ray of shoulder  CH................  Q.................         0275       2.2785      $145.12       $44.13       $29.02
73050..............  X-ray exam of shoulders...  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73060..............  X-ray exam of humerus.....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73070..............  X-ray exam of elbow.......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73080..............  X-ray exam of elbow.......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73085..............  Contrast x-ray of elbow...  CH................  Q.................         0275       2.2785      $145.12       $44.13       $29.02
73090..............  X-ray exam of forearm.....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73092..............  X-ray exam of arm, infant.  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73100..............  X-ray exam of wrist.......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73110..............  X-ray exam of wrist.......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73115..............  Contrast x-ray of wrist...  CH................  Q.................         0275       2.2785      $145.12       $44.13       $29.02
73120..............  X-ray exam of hand........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73130..............  X-ray exam of hand........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73140..............  X-ray exam of finger(s)...  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73200..............  Ct upper extremity w/o dye  ..................  S.................         0332       3.1487      $200.55       $75.20       $40.11
73201..............  Ct upper extremity w/dye..  ..................  S.................         0283       4.5485      $289.71      $100.30       $57.94
73202..............  Ct uppr extremity w/o&w/    ..................  S.................         0333       5.3374      $339.96      $119.00       $67.99
                      dye.
73206..............  Ct angio upr extrm w/o&w/   ..................  S.................         0662       5.2818      $336.41      $118.80       $67.28
                      dye.
73218..............  Mri upper extremity w/o     ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
                      dye.
73219..............  Mri upper extremity w/dye.  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
73220..............  Mri uppr extremity w/o&w/   ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
                      dye.
73221..............  Mri joint upr extrem w/o    ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
                      dye.
73222..............  Mri joint upr extrem w/dye  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
73223..............  Mri joint upr extr w/o&w/   ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
                      dye.
73225..............  Mr angio upr extr w/o&w/    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dye.
73500..............  X-ray exam of hip.........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73510..............  X-ray exam of hip.........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73520..............  X-ray exam of hips........  ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
73525..............  Contrast x-ray of hip.....  CH................  Q.................         0275       2.2785      $145.12       $44.13       $29.02
73530..............  X-ray exam of hip.........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
73540..............  X-ray exam of pelvis &      ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      hips.
73542..............  X-ray exam, sacroiliac      CH................  Q.................         0275       2.2785      $145.12       $44.13       $29.02
                      joint.
73550..............  X-ray exam of thigh.......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25

[[Page 42973]]

 
73560..............  X-ray exam of knee, 1 or 2  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73562..............  X-ray exam of knee, 3.....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73564..............  X-ray exam, knee, 4 or      ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      more.
73565..............  X-ray exam of knees.......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73580..............  Contrast x-ray of knee      CH................  Q.................         0275       2.2785      $145.12       $44.13       $29.02
                      joint.
73590..............  X-ray exam of lower leg...  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73592..............  X-ray exam of leg, infant.  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73600..............  X-ray exam of ankle.......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73610..............  X-ray exam of ankle.......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73615..............  Contrast x-ray of ankle...  CH................  Q.................         0275       2.2785      $145.12       $44.13       $29.02
73620..............  X-ray exam of foot........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73630..............  X-ray exam of foot........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73650..............  X-ray exam of heel........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73660..............  X-ray exam of toe(s)......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
73700..............  Ct lower extremity w/o dye  ..................  S.................         0332       3.1487      $200.55       $75.20       $40.11
73701..............  Ct lower extremity w/dye..  ..................  S.................         0283       4.5485      $289.71      $100.30       $57.94
73702..............  Ct lwr extremity w/o&w/dye  ..................  S.................         0333       5.3374      $339.96      $119.00       $67.99
73706..............  Ct angio lwr extr w/o&w/    ..................  S.................         0662       5.2818      $336.41      $118.80       $67.28
                      dye.
73718..............  Mri lower extremity w/o     ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
                      dye.
73719..............  Mri lower extremity w/dye.  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
73720..............  Mri lwr extremity w/o&w/    ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
                      dye.
73721..............  Mri jnt of lwr extre w/o    ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
                      dye.
73722..............  Mri joint of lwr extr w/    ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
                      dye.
73723..............  Mri joint lwr extr w/o&w/   ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
                      dye.
73725..............  Mr ang lwr ext w or w/o     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dye.
74000..............  X-ray exam of abdomen.....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
74010..............  X-ray exam of abdomen.....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
74020..............  X-ray exam of abdomen.....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
74022..............  X-ray exam series, abdomen  ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
74150..............  Ct abdomen w/o dye........  ..................  S.................         0332       3.1487      $200.55       $75.20       $40.11
74160..............  Ct abdomen w/dye..........  ..................  S.................         0283       4.5485      $289.71      $100.30       $57.94
74170..............  Ct abdomen w/o & w/dye....  ..................  S.................         0333       5.3374      $339.96      $119.00       $67.99
74175..............  Ct angio abdom w/o & w/dye  ..................  S.................         0662       5.2818      $336.41      $118.80       $67.28
74181..............  Mri abdomen w/o dye.......  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
74182..............  Mri abdomen w/dye.........  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
74183..............  Mri abdomen w/o & w/dye...  ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
74185..............  Mri angio, abdom w orw/o    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dye.
74190..............  X-ray exam of peritoneum..  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
74210..............  Contrst x-ray exam of       ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
                      throat.
74220..............  Contrast x-ray, esophagus.  ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
74230..............  Cine/vid x-ray, throat/     ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
                      esoph.
74235..............  Remove esophagus            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      obstruction.
74240..............  X-ray exam, upper gi tract  ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
74241..............  X-ray exam, upper gi tract  ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
74245..............  X-ray exam, upper gi tract  ..................  S.................         0277       2.2875      $145.70       $54.50       $29.14
74246..............  Contrst x-ray uppr gi       ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
                      tract.
74247..............  Contrst x-ray uppr gi       ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
                      tract.
74249..............  Contrst x-ray uppr gi       ..................  S.................         0277       2.2875      $145.70       $54.50       $29.14
                      tract.
74250..............  X-ray exam of small bowel.  ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
74251..............  X-ray exam of small bowel.  ..................  S.................         0277       2.2875      $145.70       $54.50       $29.14
74260..............  X-ray exam of small bowel.  ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
74270..............  Contrast x-ray exam of      ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
                      colon.
74280..............  Contrast x-ray exam of      ..................  S.................         0277       2.2875      $145.70       $54.50       $29.14
                      colon.
74283..............  Contrast x-ray exam of      ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
                      colon.
74290..............  Contrast x-ray,             ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
                      gallbladder.
74291..............  Contrast x-rays,            ..................  S.................         0276       1.4387       $91.64       $34.90       $18.33
                      gallbladder.
74300..............  X-ray bile ducts/pancreas.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74301..............  X-rays at surgery add-on..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74305..............  X-ray bile ducts/pancreas.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74320..............  Contrast x-ray of bile      CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
                      ducts.
74327..............  X-ray bile stone removal..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74328..............  X-ray bile duct endoscopy.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
74329..............  X-ray for pancreas          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      endoscopy.
74330..............  X-ray bile/panc endoscopy.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
74340..............  X-ray guide for GI tube...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74350..............  X-ray guide, stomach tube.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74355..............  X-ray guide, intestinal     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      tube.
74360..............  X-ray guide, GI dilation..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74363..............  X-ray, bile duct dilation.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74400..............  Contrst x-ray, urinary      ..................  S.................         0278       2.6114      $166.33       $59.40       $33.27
                      tract.
74410..............  Contrst x-ray, urinary      ..................  S.................         0278       2.6114      $166.33       $59.40       $33.27
                      tract.
74415..............  Contrst x-ray, urinary      ..................  S.................         0278       2.6114      $166.33       $59.40       $33.27
                      tract.
74420..............  Contrst x-ray, urinary      ..................  S.................         0278       2.6114      $166.33       $59.40       $33.27
                      tract.
74425..............  Contrst x-ray, urinary      CH................  Q.................         0278       2.6114      $166.33       $59.40       $33.27
                      tract.
74430..............  Contrast x-ray, bladder...  CH................  Q.................         0278       2.6114      $166.33       $59.40       $33.27
74440..............  X-ray, male genital tract.  CH................  Q.................         0278       2.6114      $166.33       $59.40       $33.27
74445..............  X-ray exam of penis.......  CH................  Q.................         0278       2.6114      $166.33       $59.40       $33.27
74450..............  X-ray, urethra/bladder....  CH................  Q.................         0278       2.6114      $166.33       $59.40       $33.27

[[Page 42974]]

 
74455..............  X-ray, urethra/bladder....  CH................  Q.................         0278       2.6114      $166.33       $59.40       $33.27
74470..............  X-ray exam of kidney        CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
                      lesion.
74475..............  X-ray control, cath insert  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
74480..............  X-ray control, cath insert  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
74485..............  X-ray guide, GU dilation..  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
74710..............  X-ray measurement of        ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
                      pelvis.
74740..............  X-ray, female genital       CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
                      tract.
74742..............  X-ray, fallopian tube.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74775..............  X-ray exam of perineum....  ..................  S.................         0278       2.6114      $166.33       $59.40       $33.27
75552..............  Heart mri for morph w/o     ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
                      dye.
75553..............  Heart mri for morph w/dye.  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
75554..............  Cardiac MRI/function......  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
75555..............  Cardiac MRI/limited study.  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
75556..............  Cardiac MRI/flow mapping..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
75600..............  Contrast x-ray exam of      CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
                      aorta.
75605..............  Contrast x-ray exam of      CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
                      aorta.
75625..............  Contrast x-ray exam of      CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
                      aorta.
75630..............  X-ray aorta, leg arteries.  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75635..............  Ct angio abdominal          CH................  Q.................         0662       5.2818      $336.41      $118.80       $67.28
                      arteries.
75650..............  Artery x-rays, head & neck  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75658..............  Artery x-rays, arm........  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75660..............  Artery x-rays, head & neck  CH................  Q.................         0668       3.3354      $212.44       $48.81       $42.49
75662..............  Artery x-rays, head & neck  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75665..............  Artery x-rays, head & neck  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75671..............  Artery x-rays, head & neck  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75676..............  Artery x-rays, neck.......  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75680..............  Artery x-rays, neck.......  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75685..............  Artery x-rays, spine......  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75705..............  Artery x-rays, spine......  CH................  Q.................         0668       3.3354      $212.44       $48.81       $42.49
75710..............  Artery x-rays, arm/leg....  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75716..............  Artery x-rays, arms/legs..  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75722..............  Artery x-rays, kidney.....  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75724..............  Artery x-rays, kidneys....  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75726..............  Artery x-rays, abdomen....  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75731..............  Artery x-rays, adrenal      CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
                      gland.
75733..............  Artery x-rays, adrenals...  CH................  Q.................         0668       3.3354      $212.44       $48.81       $42.49
75736..............  Artery x-rays, pelvis.....  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75741..............  Artery x-rays, lung.......  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75743..............  Artery x-rays, lungs......  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75746..............  Artery x-rays, lung.......  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75756..............  Artery x-rays, chest......  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75774..............  Artery x-ray, each vessel.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75790..............  Visualize A-V shunt.......  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75801..............  Lymph vessel x-ray, arm/    CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
                      leg.
75803..............  Lymph vessel x-ray,arms/    CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
                      legs.
75805..............  Lymph vessel x-ray, trunk.  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
75807..............  Lymph vessel x-ray, trunk.  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
75809..............  Nonvascular shunt, x-ray..  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
75810..............  Vein x-ray, spleen/liver..  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75820..............  Vein x-ray, arm/leg.......  CH................  Q.................         0668       3.3354      $212.44       $48.81       $42.49
75822..............  Vein x-ray, arms/legs.....  CH................  Q.................         0668       3.3354      $212.44       $48.81       $42.49
75825..............  Vein x-ray, trunk.........  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75827..............  Vein x-ray, chest.........  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75831..............  Vein x-ray, kidney........  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75833..............  Vein x-ray, kidneys.......  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75840..............  Vein x-ray, adrenal gland.  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75842..............  Vein x-ray, adrenal glands  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75860..............  Vein x-ray, neck..........  CH................  Q.................         0668       3.3354      $212.44       $48.81       $42.49
75870..............  Vein x-ray, skull.........  CH................  Q.................         0668       3.3354      $212.44       $48.81       $42.49
75872..............  Vein x-ray, skull.........  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75880..............  Vein x-ray, eye socket....  CH................  Q.................         0668       3.3354      $212.44       $48.81       $42.49
75885..............  Vein x-ray, liver.........  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75887..............  Vein x-ray, liver.........  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75889..............  Vein x-ray, liver.........  CH................  Q.................         0280      11.3221      $721.14      $199.34      $144.23
75891..............  Vein x-ray, liver.........  CH................  Q.................         0279       5.9365      $378.11       $97.07       $75.62
75893..............  Venous sampling by          ..................  Q.................         0668       3.3354      $212.44       $48.81       $42.49
                      catheter.
75894..............  X-rays, transcath therapy.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75896..............  X-rays, transcath therapy.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75898..............  Follow-up angiography.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75900..............  Intravascular cath          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      exchange.
75901..............  Remove cva device obstruct  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75902..............  Remove cva lumen obstruct.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75940..............  X-ray placement, vein       CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      filter.
75945..............  Intravascular us..........  CH................  Q.................         0267       2.4859      $158.33       $60.50       $31.67
75946..............  Intravascular us add-on...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75952..............  Endovasc repair abdom       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      aorta.
75953..............  Abdom aneurysm endovas rpr  ..................  C.................  ...........  ...........  ...........  ...........  ...........
75954..............  Iliac aneurysm endovas rpr  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 42975]]

 
75956..............  Xray, endovasc thor ao      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      repr.
75957..............  Xray, endovasc thor ao      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      repr.
75958..............  Xray, place prox ext thor   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ao.
75959..............  Xray, place dist ext thor   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ao.
75960..............  Transcath iv stent rs&i...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75961..............  Retrieval, broken catheter  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75962..............  Repair arterial blockage..  CH................  Q.................         0668       3.3354      $212.44       $48.81       $42.49
75964..............  Repair artery blockage,     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      each.
75966..............  Repair arterial blockage..  CH................  Q.................         0668       3.3354      $212.44       $48.81       $42.49
75968..............  Repair artery blockage,     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      each.
75970..............  Vascular biopsy...........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75978..............  Repair venous blockage....  CH................  Q.................         0668       3.3354      $212.44       $48.81       $42.49
75980..............  Contrast xray exam bile     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      duct.
75982..............  Contrast xray exam bile     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      duct.
75984..............  Xray control catheter       CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      change.
75989..............  Abscess drainage under x-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
75992..............  Atherectomy, x-ray exam...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75993..............  Atherectomy, x-ray exam...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75994..............  Atherectomy, x-ray exam...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75995..............  Atherectomy, x-ray exam...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75996..............  Atherectomy, x-ray exam...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76000..............  Fluoroscope examination...  CH................  Q.................         0272        1.327       $84.52       $31.60       $16.90
76001..............  Fluoroscope exam,           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      extensive.
76010..............  X-ray, nose to rectum.....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
76080..............  X-ray exam of fistula.....  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
76098..............  X-ray exam, breast          ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      specimen.
76100..............  X-ray exam of body section  ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
76101..............  Complex body section x-ray  ..................  X.................         0263       1.4802       $94.28       $21.44       $18.86
76102..............  Complex body section x-     CH................  X.................         0263       1.4802       $94.28       $21.44       $18.86
                      rays.
76120..............  Cine/video x-rays.........  ..................  X.................         0272        1.327       $84.52       $31.60       $16.90
76125..............  Cine/video x-rays add-on..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76140..............  X-ray consultation........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
76150..............  X-ray exam, dry process...  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
76350..............  Special x-ray contrast      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      study.
76376..............  3d render w/o postprocess.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76377..............  3d rendering w/postprocess  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76380..............  CAT scan follow-up study..  ..................  S.................         0282       1.6768      $106.80       $37.80       $21.36
76390..............  Mr spectroscopy...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
76496..............  Fluoroscopic procedure....  ..................  X.................         0272        1.327       $84.52       $31.60       $16.90
76497..............  Ct procedure..............  ..................  S.................         0282       1.6768      $106.80       $37.80       $21.36
76498..............  Mri procedure.............  ..................  S.................         0335       5.0067      $318.89      $111.90       $63.78
76499..............  Radiographic procedure....  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
76506..............  Echo exam of head.........  ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
76510..............  Ophth us, b & quant a.....  CH................  T.................         0232       5.1145      $325.76       $81.59       $65.15
76511..............  Ophth us, quant a only....  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76512..............  Ophth us, b w/non-quant a.  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76513..............  Echo exam of eye, water     ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
                      bath.
76514..............  Echo exam of eye,           ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
                      thickness.
76516..............  Echo exam of eye..........  ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
76519..............  Echo exam of eye..........  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76529..............  Echo exam of eye..........  ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
76536..............  Us exam of head and neck..  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76604..............  Us exam, chest............  ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
76645..............  Us exam, breast(s)........  ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
76700..............  Us exam, abdom, complete..  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76705..............  Echo exam of abdomen......  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76770..............  Us exam abdo back wall,     ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
                      comp.
76775..............  Us exam abdo back wall,     ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
                      lim.
76776..............  Us exam k transpl w/        ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
                      doppler.
76800..............  Us exam, spinal canal.....  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76801..............  Ob us < 14 wks, single      ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
                      fetus.
76802..............  Ob us < 14 wks, add'l       ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
                      fetus.
76805..............  Ob us >/= 14 wks, sngl      ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
                      fetus.
76810..............  Ob us >/= 14 wks, addl      ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
                      fetus.
76811..............  Ob us, detailed, sngl       ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
                      fetus.
76812..............  Ob us, detailed, addl       ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
                      fetus.
76813..............  Ob us nuchal meas, 1 gest.  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76814..............  Ob us nuchal meas, add-on.  ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
76815..............  Ob us, limited, fetus(s)..  ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
76816..............  Ob us, follow-up, per       ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
                      fetus.
76817..............  Transvaginal us, obstetric  ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
76818..............  Fetal biophys profile w/    ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
                      nst.
76819..............  Fetal biophys profil w/o    ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
                      nst.
76820..............  Umbilical artery echo.....  ..................  S.................         0096       1.5254       $97.16       $37.60       $19.43
76821..............  Middle cerebral artery      ..................  S.................         0096       1.5254       $97.16       $37.60       $19.43
                      echo.
76825..............  Echo exam of fetal heart..  CH................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76826..............  Echo exam of fetal heart..  CH................  S.................         0265       0.9925       $63.22       $23.60       $12.64
76827..............  Echo exam of fetal heart..  CH................  S.................         0265       0.9925       $63.22       $23.60       $12.64

[[Page 42976]]

 
76828..............  Echo exam of fetal heart..  CH................  S.................         0265       0.9925       $63.22       $23.60       $12.64
76830..............  Transvaginal us, non-ob...  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76831..............  Echo exam, uterus.........  ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
76856..............  Us exam, pelvic, complete.  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76857..............  Us exam, pelvic, limited..  ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
76870..............  Us exam, scrotum..........  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76872..............  Us, transrectal...........  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76873..............  Echograp trans r, pros      ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
                      study.
76880..............  Us exam, extremity........  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
76885..............  Us exam infant hips,        ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
                      dynamic.
76886..............  Us exam infant hips,        ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
                      static.
76930..............  Echo guide, cardiocentesis  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76932..............  Echo guide for heart        CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      biopsy.
76936..............  Echo guide for artery       CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      repair.
76937..............  Us guide, vascular access.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
76940..............  Us guide, tissue ablation.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76941..............  Echo guide for transfusion  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76942..............  Echo guide for biopsy.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76945..............  Echo guide, villus          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      sampling.
76946..............  Echo guide for              CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      amniocentesis.
76948..............  Echo guide, ova aspiration  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76950..............  Echo guidance radiotherapy  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76965..............  Echo guidance radiotherapy  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76970..............  Ultrasound exam follow-up.  ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
76975..............  GI endoscopic ultrasound..  CH................  Q.................         0267       2.4859      $158.33       $60.50       $31.67
76977..............  Us bone density measure...  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
76998..............  Us guide, intraop.........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76999..............  Echo examination procedure  ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
77001..............  Fluoroguide for vein        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      device.
77002..............  Needle localization by      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      xray.
77003..............  Fluoroguide for spine       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inject.
77011..............  Ct scan for localization..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
77012..............  Ct scan for needle biopsy.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
77013..............  Ct guide for tissue         CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      ablation.
77014..............  Ct scan for therapy guide.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
77021..............  Mr guidance for needle      CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      place.
77022..............  Mri for tissue ablation...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
77031..............  Stereotact guide for brst   CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      bx.
77032..............  Guidance for needle,        CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      breast.
77051..............  Computer dx mammogram add-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      on.
77052..............  Comp screen mammogram add-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      on.
77053..............  X-ray of mammary duct.....  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
77054..............  X-ray of mammary ducts....  CH................  Q.................         0263       1.4802       $94.28       $21.44       $18.86
77055..............  Mammogram, one breast.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
77056..............  Mammogram, both breasts...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
77057..............  Mammogram, screening......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
77058..............  Mri, one breast...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77059..............  Mri, both breasts.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77071..............  X-ray stress view.........  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
77072..............  X-rays for bone age.......  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
77073..............  X-rays, bone length         ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      studies.
77074..............  X-rays, bone survey,        ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
                      limited.
77075..............  X-rays, bone survey         ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
                      complete.
77076..............  X-rays, bone survey,        ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
                      infant.
77077..............  Joint survey, single view.  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
77078..............  Ct bone density, axial....  ..................  S.................         0288        1.192       $75.92       $28.90       $15.18
77079..............  Ct bone density,            ..................  S.................         0282       1.6768      $106.80       $37.80       $21.36
                      peripheral.
77080..............  Dxa bone density, axial...  ..................  S.................         0288        1.192       $75.92       $28.90       $15.18
77081..............  Dxa bone density/           ..................  S.................         0665       0.5225       $33.28       $13.31        $6.66
                      peripheral.
77082..............  Dxa bone density, vert fx.  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
77083..............  Radiographic                ..................  X.................         0261       1.2024       $76.58  ...........       $15.32
                      absorptiometry.
77084..............  Magnetic image, bone        ..................  S.................         0335       5.0067      $318.89      $111.90       $63.78
                      marrow.
77261..............  Radiation therapy planning  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77262..............  Radiation therapy planning  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77263..............  Radiation therapy planning  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77280..............  Set radiation therapy       ..................  X.................         0304       1.6409      $104.51       $38.60       $20.90
                      field.
77285..............  Set radiation therapy       ..................  X.................         0305       4.1775      $266.08       $91.30       $53.22
                      field.
77290..............  Set radiation therapy       ..................  X.................         0305       4.1775      $266.08       $91.30       $53.22
                      field.
77295..............  Set radiation therapy       ..................  X.................         0310      14.0797      $896.78      $325.20      $179.36
                      field.
77299..............  Radiation therapy planning  ..................  X.................         0304       1.6409      $104.51       $38.60       $20.90
77300..............  Radiation therapy dose      ..................  X.................         0304       1.6409      $104.51       $38.60       $20.90
                      plan.
77301..............  Radiotherapy dose plan,     ..................  X.................         0310      14.0797      $896.78      $325.20      $179.36
                      imrt.
77305..............  Teletx isodose plan simple  ..................  X.................         0304       1.6409      $104.51       $38.60       $20.90
77310..............  Teletx isodose plan         ..................  X.................         0305       4.1775      $266.08       $91.30       $53.22
                      intermed.
77315..............  Teletx isodose plan         ..................  X.................         0305       4.1775      $266.08       $91.30       $53.22
                      complex.
77321..............  Special teletx port plan..  ..................  X.................         0305       4.1775      $266.08       $91.30       $53.22
77326..............  Brachytx isodose calc simp  ..................  X.................         0304       1.6409      $104.51       $38.60       $20.90
77327..............  Brachytx isodose calc       ..................  X.................         0305       4.1775      $266.08       $91.30       $53.22
                      interm.

[[Page 42977]]

 
77328..............  Brachytx isodose plan       ..................  X.................         0305       4.1775      $266.08       $91.30       $53.22
                      compl.
77331..............  Special radiation           ..................  X.................         0304       1.6409      $104.51       $38.60       $20.90
                      dosimetry.
77332..............  Radiation treatment aid(s)  ..................  X.................         0303       3.0657      $195.26       $66.90       $39.05
77333..............  Radiation treatment aid(s)  ..................  X.................         0303       3.0657      $195.26       $66.90       $39.05
77334..............  Radiation treatment aid(s)  ..................  X.................         0303       3.0657      $195.26       $66.90       $39.05
77336..............  Radiation physics consult.  ..................  X.................         0304       1.6409      $104.51       $38.60       $20.90
77370..............  Radiation physics consult.  ..................  X.................         0304       1.6409      $104.51       $38.60       $20.90
77371..............  Srs, multisource..........  ..................  S.................         0127     123.4696    $7,864.15  ...........    $1,572.83
77372..............  Srs, linear based.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77373..............  Sbrt delivery.............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77399..............  External radiation          ..................  X.................         0304       1.6409      $104.51       $38.60       $20.90
                      dosimetry.
77401..............  Radiation treatment         ..................  S.................         0300          1.5       $95.54  ...........       $19.11
                      delivery.
77402..............  Radiation treatment         ..................  S.................         0300          1.5       $95.54  ...........       $19.11
                      delivery.
77403..............  Radiation treatment         ..................  S.................         0300          1.5       $95.54  ...........       $19.11
                      delivery.
77404..............  Radiation treatment         ..................  S.................         0300          1.5       $95.54  ...........       $19.11
                      delivery.
77406..............  Radiation treatment         ..................  S.................         0300          1.5       $95.54  ...........       $19.11
                      delivery.
77407..............  Radiation treatment         ..................  S.................         0300          1.5       $95.54  ...........       $19.11
                      delivery.
77408..............  Radiation treatment         ..................  S.................         0300          1.5       $95.54  ...........       $19.11
                      delivery.
77409..............  Radiation treatment         ..................  S.................         0300          1.5       $95.54  ...........       $19.11
                      delivery.
77411..............  Radiation treatment         ..................  S.................         0301       2.2933      $146.07  ...........       $29.21
                      delivery.
77412..............  Radiation treatment         ..................  S.................         0301       2.2933      $146.07  ...........       $29.21
                      delivery.
77413..............  Radiation treatment         ..................  S.................         0301       2.2933      $146.07  ...........       $29.21
                      delivery.
77414..............  Radiation treatment         ..................  S.................         0301       2.2933      $146.07  ...........       $29.21
                      delivery.
77416..............  Radiation treatment         ..................  S.................         0301       2.2933      $146.07  ...........       $29.21
                      delivery.
77417..............  Radiology port film(s)....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
77418..............  Radiation tx delivery,      ..................  S.................         0412       5.7275      $364.80  ...........       $72.96
                      imrt.
77421..............  Stereoscopic x-ray          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      guidance.
77422..............  Neutron beam tx, simple...  ..................  S.................         0301       2.2933      $146.07  ...........       $29.21
77423..............  Neutron beam tx, complex..  ..................  S.................         0301       2.2933      $146.07  ...........       $29.21
77427..............  Radiation tx management,    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      x5.
77431..............  Radiation therapy           ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      management.
77432..............  Stereotactic radiation      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      trmt.
77435..............  Sbrt management...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
77470..............  Special radiation           ..................  S.................         0299       6.0275      $383.91  ...........       $76.78
                      treatment.
77499..............  Radiation therapy           ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      management.
77520..............  Proton trmt, simple w/o     ..................  S.................         0664      13.2746      $845.50  ...........      $169.10
                      comp.
77522..............  Proton trmt, simple w/comp  ..................  S.................         0664      13.2746      $845.50  ...........      $169.10
77523..............  Proton trmt, intermediate.  ..................  S.................         0667      15.8841    $1,011.71  ...........      $202.34
77525..............  Proton treatment, complex.  ..................  S.................         0667      15.8841    $1,011.71  ...........      $202.34
77600..............  Hyperthermia treatment....  CH................  S.................         0299       6.0275      $383.91  ...........       $76.78
77605..............  Hyperthermia treatment....  CH................  S.................         0299       6.0275      $383.91  ...........       $76.78
77610..............  Hyperthermia treatment....  CH................  S.................         0299       6.0275      $383.91  ...........       $76.78
77615..............  Hyperthermia treatment....  CH................  S.................         0299       6.0275      $383.91  ...........       $76.78
77620..............  Hyperthermia treatment....  CH................  S.................         0299       6.0275      $383.91  ...........       $76.78
77750..............  Infuse radioactive          ..................  S.................         0301       2.2933      $146.07  ...........       $29.21
                      materials.
77761..............  Apply intrcav radiat        ..................  S.................         0312       8.3915      $534.48  ...........      $106.90
                      simple.
77762..............  Apply intrcav radiat        ..................  S.................         0312       8.3915      $534.48  ...........      $106.90
                      interm.
77763..............  Apply intrcav radiat compl  ..................  S.................         0312       8.3915      $534.48  ...........      $106.90
77776..............  Apply interstit radiat      ..................  S.................         0312       8.3915      $534.48  ...........      $106.90
                      simpl.
77777..............  Apply interstit radiat      ..................  S.................         0312       8.3915      $534.48  ...........      $106.90
                      inter.
77778..............  Apply interstit radiat      CH................  Q.................         0651      15.4158      $981.88  ...........      $196.38
                      compl.
77781..............  High intensity              ..................  S.................         0313      11.6098      $739.46  ...........      $147.89
                      brachytherapy.
77782..............  High intensity              ..................  S.................         0313      11.6098      $739.46  ...........      $147.89
                      brachytherapy.
77783..............  High intensity              ..................  S.................         0313      11.6098      $739.46  ...........      $147.89
                      brachytherapy.
77784..............  High intensity              ..................  S.................         0313      11.6098      $739.46  ...........      $147.89
                      brachytherapy.
77789..............  Apply surface radiation...  ..................  S.................         0300          1.5       $95.54  ...........       $19.11
77790..............  Radiation handling........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
77799..............  Radium/radioisotope         ..................  S.................         0312       8.3915      $534.48  ...........      $106.90
                      therapy.
78000..............  Thyroid, single uptake....  ..................  S.................         0389       1.5806      $100.67       $33.80       $20.13
78001..............  Thyroid, multiple uptakes.  ..................  S.................         0389       1.5806      $100.67       $33.80       $20.13
78003..............  Thyroid suppress/stimul...  ..................  S.................         0392        3.281      $208.98       $49.30       $41.80
78006..............  Thyroid imaging with        ..................  S.................         0390       2.8272      $180.07       $57.60       $36.01
                      uptake.
78007..............  Thyroid image, mult         ..................  S.................         0391        3.654      $232.73       $66.10       $46.55
                      uptakes.
78010..............  Thyroid imaging...........  ..................  S.................         0390       2.8272      $180.07       $57.60       $36.01
78011..............  Thyroid imaging with flow.  ..................  S.................         0390       2.8272      $180.07       $57.60       $36.01
78015..............  Thyroid met imaging.......  ..................  S.................         0406       4.4988      $286.54       $98.10       $57.31
78016..............  Thyroid met imaging/        ..................  S.................         0406       4.4988      $286.54       $98.10       $57.31
                      studies.
78018..............  Thyroid met imaging, body.  ..................  S.................         0406       4.4988      $286.54       $98.10       $57.31
78020..............  Thyroid met uptake........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
78070..............  Parathyroid nuclear         ..................  S.................         0391        3.654      $232.73       $66.10       $46.55
                      imaging.
78075..............  Adrenal nuclear imaging...  ..................  S.................         0391        3.654      $232.73       $66.10       $46.55
78099..............  Endocrine nuclear           ..................  S.................         0390       2.8272      $180.07       $57.60       $36.01
                      procedure.
78102..............  Bone marrow imaging, ltd..  ..................  S.................         0400       4.1916      $266.98       $93.20       $53.40
78103..............  Bone marrow imaging, mult.  ..................  S.................         0400       4.1916      $266.98       $93.20       $53.40
78104..............  Bone marrow imaging, body.  ..................  S.................         0400       4.1916      $266.98       $93.20       $53.40
78110..............  Plasma volume, single.....  ..................  S.................         0393        5.526      $351.97       $82.00       $70.39
78111..............  Plasma volume, multiple...  ..................  S.................         0393        5.526      $351.97       $82.00       $70.39
78120..............  Red cell mass, single.....  ..................  S.................         0393        5.526      $351.97       $82.00       $70.39

[[Page 42978]]

 
78121..............  Red cell mass, multiple...  ..................  S.................         0393        5.526      $351.97       $82.00       $70.39
78122..............  Blood volume..............  ..................  S.................         0393        5.526      $351.97       $82.00       $70.39
78130..............  Red cell survival study...  ..................  S.................         0393        5.526      $351.97       $82.00       $70.39
78135..............  Red cell survival kinetics  ..................  S.................         0393        5.526      $351.97       $82.00       $70.39
78140..............  Red cell sequestration....  ..................  S.................         0393        5.526      $351.97       $82.00       $70.39
78185..............  Spleen imaging............  ..................  S.................         0400       4.1916      $266.98       $93.20       $53.40
78190..............  Platelet survival,          ..................  S.................         0392        3.281      $208.98       $49.30       $41.80
                      kinetics.
78191..............  Platelet survival.........  ..................  S.................         0392        3.281      $208.98       $49.30       $41.80
78195..............  Lymph system imaging......  ..................  S.................         0400       4.1916      $266.98       $93.20       $53.40
78199..............  Blood/lymph nuclear exam..  ..................  S.................         0400       4.1916      $266.98       $93.20       $53.40
78201..............  Liver imaging.............  ..................  S.................         0394       4.5297      $288.51      $102.60       $57.70
78202..............  Liver imaging with flow...  ..................  S.................         0394       4.5297      $288.51      $102.60       $57.70
78205..............  Liver imaging (3D)........  ..................  S.................         0394       4.5297      $288.51      $102.60       $57.70
78206..............  Liver image (3d) with flow  ..................  S.................         0394       4.5297      $288.51      $102.60       $57.70
78215..............  Liver and spleen imaging..  ..................  S.................         0394       4.5297      $288.51      $102.60       $57.70
78216..............  Liver & spleen image/flow.  ..................  S.................         0394       4.5297      $288.51      $102.60       $57.70
78220..............  Liver function study......  ..................  S.................         0394       4.5297      $288.51      $102.60       $57.70
78223..............  Hepatobiliary imaging.....  ..................  S.................         0394       4.5297      $288.51      $102.60       $57.70
78230..............  Salivary gland imaging....  ..................  S.................         0395       3.8546      $245.51       $89.70       $49.10
78231..............  Serial salivary imaging...  ..................  S.................         0395       3.8546      $245.51       $89.70       $49.10
78232..............  Salivary gland function     ..................  S.................         0395       3.8546      $245.51       $89.70       $49.10
                      exam.
78258..............  Esophageal motility study.  ..................  S.................         0395       3.8546      $245.51       $89.70       $49.10
78261..............  Gastric mucosa imaging....  ..................  S.................         0395       3.8546      $245.51       $89.70       $49.10
78262..............  Gastroesophageal reflux     ..................  S.................         0395       3.8546      $245.51       $89.70       $49.10
                      exam.
78264..............  Gastric emptying study....  ..................  S.................         0395       3.8546      $245.51       $89.70       $49.10
78267..............  Breath tst attain/anal c-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      14.
78268..............  Breath test analysis, c-14  ..................  A.................  ...........  ...........  ...........  ...........  ...........
78270..............  Vit B-12 absorption exam..  ..................  S.................         0392        3.281      $208.98       $49.30       $41.80
78271..............  Vit b-12 absrp exam, int    ..................  S.................         0392        3.281      $208.98       $49.30       $41.80
                      fac.
78272..............  Vit B-12 absorp, combined.  ..................  S.................         0392        3.281      $208.98       $49.30       $41.80
78278..............  Acute GI blood loss         ..................  S.................         0395       3.8546      $245.51       $89.70       $49.10
                      imaging.
78282..............  GI protein loss exam......  ..................  S.................         0395       3.8546      $245.51       $89.70       $49.10
78290..............  Meckel'ts divert exam.....  ..................  S.................         0395       3.8546      $245.51       $89.70       $49.10
78291..............  Leveen/shunt patency exam.  ..................  S.................         0395       3.8546      $245.51       $89.70       $49.10
78299..............  GI nuclear procedure......  ..................  S.................         0395       3.8546      $245.51       $89.70       $49.10
78300..............  Bone imaging, limited area  ..................  S.................         0396       3.9566      $252.01       $95.00       $50.40
78305..............  Bone imaging, multiple      ..................  S.................         0396       3.9566      $252.01       $95.00       $50.40
                      areas.
78306..............  Bone imaging, whole body..  ..................  S.................         0396       3.9566      $252.01       $95.00       $50.40
78315..............  Bone imaging, 3 phase.....  ..................  S.................         0396       3.9566      $252.01       $95.00       $50.40
78320..............  Bone imaging (3D).........  ..................  S.................         0396       3.9566      $252.01       $95.00       $50.40
78350..............  Bone mineral, single        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      photon.
78351..............  Bone mineral, dual photon.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
78399..............  Musculoskeletal nuclear     ..................  S.................         0396       3.9566      $252.01       $95.00       $50.40
                      exam.
78414..............  Non-imaging heart function  ..................  S.................         0398       5.4404      $346.52      $100.00       $69.30
78428..............  Cardiac shunt imaging.....  ..................  S.................         0398       5.4404      $346.52      $100.00       $69.30
78445..............  Vascular flow imaging.....  ..................  S.................         0397       3.0424      $193.78       $49.50       $38.76
78456..............  Acute venous thrombus       ..................  S.................         0397       3.0424      $193.78       $49.50       $38.76
                      image.
78457..............  Venous thrombosis imaging.  ..................  S.................         0397       3.0424      $193.78       $49.50       $38.76
78458..............  Ven thrombosis images,      ..................  S.................         0397       3.0424      $193.78       $49.50       $38.76
                      bilat.
78459..............  Heart muscle imaging (PET)  ..................  S.................         0307      42.5674    $2,711.25  ...........      $542.25
78460..............  Heart muscle blood, single  ..................  S.................         0398       5.4404      $346.52      $100.00       $69.30
78461..............  Heart muscle blood,         CH................  S.................         0398       5.4404      $346.52      $100.00       $69.30
                      multiple.
78464..............  Heart image (3d), single..  ..................  S.................         0398       5.4404      $346.52      $100.00       $69.30
78465..............  Heart image (3d), multiple  ..................  S.................         0377      12.0147      $765.25      $158.80      $153.05
78466..............  Heart infarct image.......  ..................  S.................         0398       5.4404      $346.52      $100.00       $69.30
78468..............  Heart infarct image (ef)..  ..................  S.................         0398       5.4404      $346.52      $100.00       $69.30
78469..............  Heart infarct image (3D)..  ..................  S.................         0398       5.4404      $346.52      $100.00       $69.30
78472..............  Gated heart, planar,        ..................  S.................         0398       5.4404      $346.52      $100.00       $69.30
                      single.
78473..............  Gated heart, multiple.....  CH................  S.................         0398       5.4404      $346.52      $100.00       $69.30
78478..............  Heart wall motion add-on..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
78480..............  Heart function add-on.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
78481..............  Heart first pass, single..  ..................  S.................         0398       5.4404      $346.52      $100.00       $69.30
78483..............  Heart first pass, multiple  CH................  S.................         0398       5.4404      $346.52      $100.00       $69.30
78491..............  Heart image (pet), single.  ..................  S.................         0307      42.5674    $2,711.25  ...........      $542.25
78492..............  Heart image (pet),          ..................  S.................         0307      42.5674    $2,711.25  ...........      $542.25
                      multiple.
78494..............  Heart image, spect........  ..................  S.................         0398       5.4404      $346.52      $100.00       $69.30
78496..............  Heart first pass add-on...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
78499..............  Cardiovascular nuclear      ..................  S.................         0398       5.4404      $346.52      $100.00       $69.30
                      exam.
78580..............  Lung perfusion imaging....  ..................  S.................         0401       3.2976      $210.03       $78.10       $42.01
78584..............  Lung V/Q image single       ..................  S.................         0378       5.1617      $328.76      $125.30       $65.75
                      breath.
78585..............  Lung V/Q imaging..........  ..................  S.................         0378       5.1617      $328.76      $125.30       $65.75
78586..............  Aerosol lung image, single  ..................  S.................         0401       3.2976      $210.03       $78.10       $42.01
78587..............  Aerosol lung image,         ..................  S.................         0401       3.2976      $210.03       $78.10       $42.01
                      multiple.
78588..............  Perfusion lung image......  ..................  S.................         0378       5.1617      $328.76      $125.30       $65.75
78591..............  Vent image, 1 breath, 1     ..................  S.................         0401       3.2976      $210.03       $78.10       $42.01
                      proj.
78593..............  Vent image, 1 proj, gas...  ..................  S.................         0401       3.2976      $210.03       $78.10       $42.01
78594..............  Vent image, mult proj, gas  ..................  S.................         0401       3.2976      $210.03       $78.10       $42.01
78596..............  Lung differential function  ..................  S.................         0378       5.1617      $328.76      $125.30       $65.75

[[Page 42979]]

 
78599..............  Respiratory nuclear exam..  ..................  S.................         0401       3.2976      $210.03       $78.10       $42.01
78600..............  Brain imaging, ltd static.  CH................  S.................         0403       3.3325      $212.26       $82.39       $42.45
78601..............  Brain imaging, ltd w/flow.  CH................  S.................         0403       3.3325      $212.26       $82.39       $42.45
78605..............  Brain imaging, complete...  CH................  S.................         0403       3.3325      $212.26       $82.39       $42.45
78606..............  Brain imaging, compl w/     ..................  S.................         0402       8.8414      $563.14      $114.10      $112.63
                      flow.
78607..............  Brain imaging (3D)........  ..................  S.................         0402       8.8414      $563.14      $114.10      $112.63
78608..............  Brain imaging (PET).......  ..................  S.................         0308      17.3837    $1,107.22  ...........      $221.44
78609..............  Brain imaging (PET).......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
78610..............  Brain flow imaging only...  ..................  S.................         0402       8.8414      $563.14      $114.10      $112.63
78615..............  Cerebral vascular flow      ..................  S.................         0402       8.8414      $563.14      $114.10      $112.63
                      image.
78630..............  Cerebrospinal fluid scan..  CH................  S.................         0402       8.8414      $563.14      $114.10      $112.63
78635..............  CSF ventriculography......  CH................  S.................         0402       8.8414      $563.14      $114.10      $112.63
78645..............  CSF shunt evaluation......  ..................  S.................         0403       3.3325      $212.26       $82.39       $42.45
78647..............  Cerebrospinal fluid scan..  CH................  S.................         0402       8.8414      $563.14      $114.10      $112.63
78650..............  CSF leakage imaging.......  CH................  S.................         0402       8.8414      $563.14      $114.10      $112.63
78660..............  Nuclear exam of tear flow.  ..................  S.................         0403       3.3325      $212.26       $82.39       $42.45
78699..............  Nervous system nuclear      CH................  S.................         0403       3.3325      $212.26       $82.39       $42.45
                      exam.
78700..............  Kidney imaging, morphol...  ..................  S.................         0404       5.0935      $324.42       $84.10       $64.88
78701..............  Kidney imaging with flow..  ..................  S.................         0404       5.0935      $324.42       $84.10       $64.88
78707..............  K flow/funct image w/o      ..................  S.................         0404       5.0935      $324.42       $84.10       $64.88
                      drug.
78708..............  K flow/funct image w/drug.  CH................  S.................         0404       5.0935      $324.42       $84.10       $64.88
78709..............  K flow/funct image,         CH................  S.................         0404       5.0935      $324.42       $84.10       $64.88
                      multiple.
78710..............  Kidney imaging (3D).......  ..................  S.................         0404       5.0935      $324.42       $84.10       $64.88
78725..............  Kidney function study.....  ..................  S.................         0389       1.5806      $100.67       $33.80       $20.13
78730..............  Urinary bladder retention.  ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
78740..............  Ureteral reflux study.....  ..................  S.................         0404       5.0935      $324.42       $84.10       $64.88
78761..............  Testicular imaging w/flow.  ..................  S.................         0404       5.0935      $324.42       $84.10       $64.88
78799..............  Genitourinary nuclear exam  ..................  S.................         0404       5.0935      $324.42       $84.10       $64.88
78800..............  Tumor imaging, limited      ..................  S.................         0406       4.4988      $286.54       $98.10       $57.31
                      area.
78801..............  Tumor imaging, mult areas.  ..................  S.................         0406       4.4988      $286.54       $98.10       $57.31
78802..............  Tumor imaging, whole body.  CH................  S.................         0414       7.4985      $477.60      $190.92       $95.52
78803..............  Tumor imaging (3D)........  CH................  S.................         0414       7.4985      $477.60      $190.92       $95.52
78804..............  Tumor imaging, whole body.  ..................  S.................         0408      16.0595    $1,022.88  ...........      $204.58
78805..............  Abscess imaging, ltd area.  CH................  S.................         0414       7.4985      $477.60      $190.92       $95.52
78806..............  Abscess imaging, whole      CH................  S.................         0414       7.4985      $477.60      $190.92       $95.52
                      body.
78807..............  Nuclear localization/       CH................  S.................         0414       7.4985      $477.60      $190.92       $95.52
                      abscess.
78811..............  Tumor imaging (pet),        ..................  S.................         0308      17.3837    $1,107.22  ...........      $221.44
                      limited.
78812..............  Tumor image (pet)/skul-     ..................  S.................         0308      17.3837    $1,107.22  ...........      $221.44
                      thigh.
78813..............  Tumor image (pet) full      ..................  S.................         0308      17.3837    $1,107.22  ...........      $221.44
                      body.
78814..............  Tumor image pet/ct,         CH................  S.................         0308      17.3837    $1,107.22  ...........      $221.44
                      limited.
78815..............  Tumorimage pet/ct skul-     CH................  S.................         0308      17.3837    $1,107.22  ...........      $221.44
                      thigh.
78816..............  Tumor image pet/ct full     CH................  S.................         0308      17.3837    $1,107.22  ...........      $221.44
                      body.
78890..............  Nuclear medicine data proc  ..................  N.................  ...........  ...........  ...........  ...........  ...........
78891..............  Nuclear med data proc.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
78999..............  Nuclear diagnostic exam...  ..................  S.................         0389       1.5806      $100.67       $33.80       $20.13
79005..............  Nuclear rx, oral admin....  ..................  S.................         0407       3.4563      $220.14       $78.10       $44.03
79101..............  Nuclear rx, iv admin......  ..................  S.................         0407       3.4563      $220.14       $78.10       $44.03
79200..............  Nuclear rx, intracav admin  ..................  S.................         0413       5.4891      $349.62  ...........       $69.92
79300..............  Nuclr rx, interstit         ..................  S.................         0407       3.4563      $220.14       $78.10       $44.03
                      colloid.
79403..............  Hematopoietic nuclear tx..  ..................  S.................         0413       5.4891      $349.62  ...........       $69.92
79440..............  Nuclear rx, intra-          ..................  S.................         0413       5.4891      $349.62  ...........       $69.92
                      articular.
79445..............  Nuclear rx, intra-arterial  ..................  S.................         0407       3.4563      $220.14       $78.10       $44.03
79999..............  Nuclear medicine therapy..  ..................  S.................         0407       3.4563      $220.14       $78.10       $44.03
80048..............  Basic metabolic panel.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80050..............  General health panel......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
80051..............  Electrolyte panel.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80053..............  Comprehen metabolic panel.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80055..............  Obstetric panel...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
80061..............  Lipid panel...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80069..............  Renal function panel......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80074..............  Acute hepatitis panel.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80076..............  Hepatic function panel....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80100..............  Drug screen, qualitate/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      multi.
80101..............  Drug screen, single.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80102..............  Drug confirmation.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80103..............  Drug analysis, tissue prep  ..................  N.................  ...........  ...........  ...........  ...........  ...........
80150..............  Assay of amikacin.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80152..............  Assay of amitriptyline....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80154..............  Assay of benzodiazepines..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80156..............  Assay, carbamazepine,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      total.
80157..............  Assay, carbamazepine, free  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80158..............  Assay of cyclosporine.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80160..............  Assay of desipramine......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80162..............  Assay of digoxin..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80164..............  Assay, dipropylacetic acid  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80166..............  Assay of doxepin..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80168..............  Assay of ethosuximide.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80170..............  Assay of gentamicin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 42980]]

 
80172..............  Assay of gold.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80173..............  Assay of haloperidol......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80174..............  Assay of imipramine.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80176..............  Assay of lidocaine........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80178..............  Assay of lithium..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80182..............  Assay of nortriptyline....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80184..............  Assay of phenobarbital....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80185..............  Assay of phenytoin, total.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80186..............  Assay of phenytoin, free..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80188..............  Assay of primidone........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80190..............  Assay of procainamide.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80192..............  Assay of procainamide.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80194..............  Assay of quinidine........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80195..............  Assay of sirolimus........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80196..............  Assay of salicylate.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80197..............  Assay of tacrolimus.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80198..............  Assay of theophylline.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80200..............  Assay of tobramycin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80201..............  Assay of topiramate.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80202..............  Assay of vancomycin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80299..............  Quantitative assay, drug..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80400..............  Acth stimulation panel....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80402..............  Acth stimulation panel....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80406..............  Acth stimulation panel....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80408..............  Aldosterone suppression     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eval.
80410..............  Calcitonin stimul panel...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80412..............  CRH stimulation panel.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80414..............  Testosterone response.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80415..............  Estradiol response panel..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80416..............  Renin stimulation panel...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80417..............  Renin stimulation panel...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80418..............  Pituitary evaluation panel  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80420..............  Dexamethasone panel.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80422..............  Glucagon tolerance panel..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80424..............  Glucagon tolerance panel..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80426..............  Gonadotropin hormone panel  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80428..............  Growth hormone panel......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80430..............  Growth hormone panel......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80432..............  Insulin suppression panel.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80434..............  Insulin tolerance panel...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80435..............  Insulin tolerance panel...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80436..............  Metyrapone panel..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80438..............  TRH stimulation panel.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80439..............  TRH stimulation panel.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80440..............  TRH stimulation panel.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80500..............  Lab pathology consultation  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
80502..............  Lab pathology consultation  ..................  X.................         0342       0.0928        $5.91        $2.00        $1.18
81000..............  Urinalysis, nonauto w/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      scope.
81001..............  Urinalysis, auto w/scope..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81002..............  Urinalysis nonauto w/o      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      scope.
81003..............  Urinalysis, auto, w/o       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      scope.
81005..............  Urinalysis................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81007..............  Urine screen for bacteria.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81015..............  Microscopic exam of urine.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81020..............  Urinalysis, glass test....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81025..............  Urine pregnancy test......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81050..............  Urinalysis, volume measure  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81099..............  Urinalysis test procedure.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82000..............  Assay of blood              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      acetaldehyde.
82003..............  Assay of acetaminophen....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82009..............  Test for acetone/ketones..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82010..............  Acetone assay.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82013..............  Acetylcholinesterase assay  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82016..............  Acylcarnitines, qual......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82017..............  Acylcarnitines, quant.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82024..............  Assay of acth.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82030..............  Assay of adp & amp........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82040..............  Assay of serum albumin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82042..............  Assay of urine albumin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82043..............  Microalbumin, quantitative  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82044..............  Microalbumin, semiquant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82045..............  Albumin, ischemia modified  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82055..............  Assay of ethanol..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82075..............  Assay of breath ethanol...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82085..............  Assay of aldolase.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82088..............  Assay of aldosterone......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82101..............  Assay of urine alkaloids..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82103..............  Alpha-1-antitrypsin, total  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 42981]]

 
82104..............  Alpha-1-antitrypsin, pheno  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82105..............  Alpha-fetoprotein, serum..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82106..............  Alpha-fetoprotein,          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      amniotic.
82107..............  Alpha-fetoprotein l3......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82108..............  Assay of aluminum.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82120..............  Amines, vaginal fluid qual  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82127..............  Amino acid, single qual...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82128..............  Amino acids, mult qual....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82131..............  Amino acids, single quant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82135..............  Assay, aminolevulinic acid  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82136..............  Amino acids, quant, 2-5...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82139..............  Amino acids, quan, 6 or     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      more.
82140..............  Assay of ammonia..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82143..............  Amniotic fluid scan.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82145..............  Assay of amphetamines.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82150..............  Assay of amylase..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82154..............  Androstanediol glucuronide  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82157..............  Assay of androstenedione..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82160..............  Assay of androsterone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82163..............  Assay of angiotensin II...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82164..............  Angiotensin I enzyme test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82172..............  Assay of apolipoprotein...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82175..............  Assay of arsenic..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82180..............  Assay of ascorbic acid....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82190..............  Atomic absorption.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82205..............  Assay of barbiturates.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82232..............  Assay of beta-2 protein...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82239..............  Bile acids, total.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82240..............  Bile acids, cholylglycine.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82247..............  Bilirubin, total..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82248..............  Bilirubin, direct.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82252..............  Fecal bilirubin test......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82261..............  Assay of biotinidase......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82270..............  Occult blood, feces.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82271..............  Occult blood, other         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sources.
82272..............  Occult blood, feces,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      single.
82274..............  Assay test for blood,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fecal.
82286..............  Assay of bradykinin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82300..............  Assay of cadmium..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82306..............  Assay of vitamin D........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82307..............  Assay of vitamin D........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82308..............  Assay of calcitonin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82310..............  Assay of calcium..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82330..............  Assay of calcium..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82331..............  Calcium infusion test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82340..............  Assay of calcium in urine.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82355..............  Calculus analysis, qual...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82360..............  Calculus assay, quant.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82365..............  Calculus spectroscopy.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82370..............  X-ray assay, calculus.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82373..............  Assay, c-d transfer         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      measure.
82374..............  Assay, blood carbon         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dioxide.
82375..............  Assay, blood carbon         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      monoxide.
82376..............  Test for carbon monoxide..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82378..............  Carcinoembryonic antigen..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82379..............  Assay of carnitine........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82380..............  Assay of carotene.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82382..............  Assay, urine                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      catecholamines.
82383..............  Assay, blood                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      catecholamines.
82384..............  Assay, three                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      catecholamines.
82387..............  Assay of cathepsin-d......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82390..............  Assay of ceruloplasmin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82397..............  Chemiluminescent assay....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82415..............  Assay of chloramphenicol..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82435..............  Assay of blood chloride...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82436..............  Assay of urine chloride...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82438..............  Assay, other fluid          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      chlorides.
82441..............  Test for                    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      chlorohydrocarbons.
82465..............  Assay, bld/serum            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cholesterol.
82480..............  Assay, serum                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cholinesterase.
82482..............  Assay, rbc cholinesterase.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82485..............  Assay, chondroitin sulfate  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82486..............  Gas/liquid chromatography.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82487..............  Paper chromatography......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82488..............  Paper chromatography......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82489..............  Thin layer chromatography.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82491..............  Chromotography, quant,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sing.
82492..............  Chromotography, quant,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mult.

[[Page 42982]]

 
82495..............  Assay of chromium.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82507..............  Assay of citrate..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82520..............  Assay of cocaine..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82523..............  Collagen crosslinks.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82525..............  Assay of copper...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82528..............  Assay of corticosterone...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82530..............  Cortisol, free............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82533..............  Total cortisol............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82540..............  Assay of creatine.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82541..............  Column chromotography,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      qual.
82542..............  Column chromotography,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
82543..............  Column chromotograph/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      isotope.
82544..............  Column chromotograph/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      isotope.
82550..............  Assay of ck (cpk).........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82552..............  Assay of cpk in blood.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82553..............  Creatine, MB fraction.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82554..............  Creatine, isoforms........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82565..............  Assay of creatinine.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82570..............  Assay of urine creatinine.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82575..............  Creatinine clearance test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82585..............  Assay of cryofibrinogen...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82595..............  Assay of cryoglobulin.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82600..............  Assay of cyanide..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82607..............  Vitamin B-12..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82608..............  B-12 binding capacity.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82615..............  Test for urine cystines...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82626..............  Dehydroepiandrosterone....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82627..............  Dehydroepiandrosterone....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82633..............  Desoxycorticosterone......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82634..............  Deoxycortisol.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82638..............  Assay of dibucaine number.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82646..............  Assay of dihydrocodeinone.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82649..............  Assay of dihydromorphinone  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82651..............  Assay of                    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dihydrotestosterone.
82652..............  Assay of dihydroxyvitamin   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      d.
82654..............  Assay of dimethadione.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82656..............  Pancreatic elastase, fecal  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82657..............  Enzyme cell activity......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82658..............  Enzyme cell activity, ra..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82664..............  Electrophoretic test......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82666..............  Assay of epiandrosterone..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82668..............  Assay of erythropoietin...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82670..............  Assay of estradiol........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82671..............  Assay of estrogens........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82672..............  Assay of estrogen.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82677..............  Assay of estriol..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82679..............  Assay of estrone..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82690..............  Assay of ethchlorvynol....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82693..............  Assay of ethylene glycol..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82696..............  Assay of etiocholanolone..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82705..............  Fats/lipids, feces, qual..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82710..............  Fats/lipids, feces, quant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82715..............  Assay of fecal fat........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82725..............  Assay of blood fatty acids  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82726..............  Long chain fatty acids....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82728..............  Assay of ferritin.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82731..............  Assay of fetal fibronectin  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82735..............  Assay of fluoride.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82742..............  Assay of flurazepam.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82746..............  Blood folic acid serum....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82747..............  Assay of folic acid, rbc..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82757..............  Assay of semen fructose...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82759..............  Assay of rbc galactokinase  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82760..............  Assay of galactose........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82775..............  Assay galactose             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      transferase.
82776..............  Galactose transferase test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82784..............  Assay of gammaglobulin igm  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82785..............  Assay of gammaglobulin ige  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82787..............  Igg 1, 2, 3 or 4, each....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82800..............  Blood pH..................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82803..............  Blood gases: pH, pO2 &      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pCO2.
82805..............  Blood gases W/02            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      saturation.
82810..............  Blood gases, O2 sat only..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82820..............  Hemoglobin-oxygen affinity  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82926..............  Assay of gastric acid.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82928..............  Assay of gastric acid.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82938..............  Gastrin test..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82941..............  Assay of gastrin..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 42983]]

 
82943..............  Assay of glucagon.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82945..............  Glucose other fluid.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82946..............  Glucagon tolerance test...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82947..............  Assay, glucose, blood       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
82948..............  Reagent strip/blood         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      glucose.
82950..............  Glucose test..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82951..............  Glucose tolerance test      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      (GTT).
82952..............  GTT-added samples.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82953..............  Glucose-tolbutamide test..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82955..............  Assay of g6pd enzyme......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82960..............  Test for G6PD enzyme......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82962..............  Glucose blood test........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82963..............  Assay of glucosidase......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82965..............  Assay of gdh enzyme.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82975..............  Assay of glutamine........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82977..............  Assay of GGT..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82978..............  Assay of glutathione......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82979..............  Assay, rbc glutathione....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82980..............  Assay of glutethimide.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82985..............  Glycated protein..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83001..............  Gonadotropin (FSH)........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83002..............  Gonadotropin (LH).........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83003..............  Assay, growth hormone       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      (hgh).
83008..............  Assay of guanosine........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83009..............  H pylori (c-13), blood....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83010..............  Assay of haptoglobin,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
83012..............  Assay of haptoglobins.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83013..............  H pylori (c-13), breath...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83014..............  H pylori drug admin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83015..............  Heavy metal screen........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83018..............  Quantitative screen,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      metals.
83020..............  Hemoglobin electrophoresis  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83021..............  Hemoglobin chromotography.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83026..............  Hemoglobin, copper sulfate  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83030..............  Fetal hemoglobin, chemical  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83033..............  Fetal hemoglobin assay,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      qual.
83036..............  Glycosylated hemoglobin     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
83037..............  Glycosylated hb, home       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      device.
83045..............  Blood methemoglobin test..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83050..............  Blood methemoglobin assay.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83051..............  Assay of plasma hemoglobin  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83055..............  Blood sulfhemoglobin test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83060..............  Blood sulfhemoglobin assay  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83065..............  Assay of hemoglobin heat..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83068..............  Hemoglobin stability        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      screen.
83069..............  Assay of urine hemoglobin.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83070..............  Assay of hemosiderin, qual  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83071..............  Assay of hemosiderin,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
83080..............  Assay of b hexosaminidase.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83088..............  Assay of histamine........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83090..............  Assay of homocystine......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83150..............  Assay of for hva..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83491..............  Assay of corticosteroids..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83497..............  Assay of 5-hiaa...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83498..............  Assay of progesterone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83499..............  Assay of progesterone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83500..............  Assay, free hydroxyproline  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83505..............  Assay, total                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      hydroxyproline.
83516..............  Immunoassay, nonantibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83518..............  Immunoassay, dipstick.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83519..............  Immunoassay, nonantibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83520..............  Immunoassay, RIA..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83525..............  Assay of insulin..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83527..............  Assay of insulin..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83528..............  Assay of intrinsic factor.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83540..............  Assay of iron.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83550..............  Iron binding test.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83570..............  Assay of idh enzyme.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83582..............  Assay of ketogenic          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      steroids.
83586..............  Assay 17- ketosteroids....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83593..............  Fractionation,              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ketosteroids.
83605..............  Assay of lactic acid......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83615..............  Lactate (LD) (LDH) enzyme.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83625..............  Assay of ldh enzymes......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83630..............  Lactoferrin, fecal (qual).  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83631..............  Lactoferrin, fecal (quant)  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83632..............  Placental lactogen........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83633..............  Test urine for lactose....  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 42984]]

 
83634..............  Assay of urine for lactose  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83655..............  Assay of lead.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83661..............  L/s ratio, fetal lung.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83662..............  Foam stability, fetal lung  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83663..............  Fluoro polarize, fetal      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lung.
83664..............  Lamellar bdy, fetal lung..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83670..............  Assay of lap enzyme.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83690..............  Assay of lipase...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83695..............  Assay of lipoprotein(a)...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83698..............  Assay lipoprotein pla2....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83700..............  Lipopro bld,                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      electrophoretic.
83701..............  Lipoprotein bld, hr         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fraction.
83704..............  Lipoprotein, bld, by nmr..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83718..............  Assay of lipoprotein......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83719..............  Assay of blood lipoprotein  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83721..............  Assay of blood lipoprotein  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83727..............  Assay of lrh hormone......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83735..............  Assay of magnesium........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83775..............  Assay of md enzyme........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83785..............  Assay of manganese........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83788..............  Mass spectrometry qual....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83789..............  Mass spectrometry quant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83805..............  Assay of meprobamate......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83825..............  Assay of mercury..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83835..............  Assay of metanephrines....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83840..............  Assay of methadone........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83857..............  Assay of methemalbumin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83858..............  Assay of methsuximide.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83864..............  Mucopolysaccharides.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83866..............  Mucopolysaccharides screen  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83872..............  Assay synovial fluid mucin  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83873..............  Assay of csf protein......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83874..............  Assay of myoglobin........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83880..............  Natriuretic peptide.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83883..............  Assay, nephelometry not     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      spec.
83885..............  Assay of nickel...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83887..............  Assay of nicotine.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83890..............  Molecule isolate..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83891..............  Molecule isolate nucleic..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83892..............  Molecular diagnostics.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83893..............  Molecule dot/slot/blot....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83894..............  Molecule gel electrophor..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83896..............  Molecular diagnostics.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83897..............  Molecule nucleic transfer.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83898..............  Molecule nucleic ampli,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
83900..............  Molecule nucleic ampli 2    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      seq.
83901..............  Molecule nucleic ampli      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      addon.
83902..............  Molecular diagnostics.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83903..............  Molecule mutation scan....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83904..............  Molecule mutation identify  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83905..............  Molecule mutation identify  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83906..............  Molecule mutation identify  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83907..............  Lyse cells for nucleic ext  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83908..............  Nucleic acid, signal ampli  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83909..............  Nucleic acid, high          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      resolute.
83912..............  Genetic examination.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83913..............  Molecular, rna              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stabilization.
83914..............  Mutation ident ola/sbce/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      aspe.
83915..............  Assay of nucleotidase.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83916..............  Oligoclonal bands.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83918..............  Organic acids, total,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
83919..............  Organic acids, qual, each.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83921..............  Organic acid, single,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
83925..............  Assay of opiates..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83930..............  Assay of blood osmolality.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83935..............  Assay of urine osmolality.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83937..............  Assay of osteocalcin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83945..............  Assay of oxalate..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83950..............  Oncoprotein, her-2/neu....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83970..............  Assay of parathormone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83986..............  Assay of body fluid         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      acidity.
83992..............  Assay for phencyclidine...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84022..............  Assay of phenothiazine....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84030..............  Assay of blood pku........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84035..............  Assay of phenylketones....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84060..............  Assay acid phosphatase....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84061..............  Phosphatase, forensic exam  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84066..............  Assay prostate phosphatase  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 42985]]

 
84075..............  Assay alkaline phosphatase  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84078..............  Assay alkaline phosphatase  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84080..............  Assay alkaline              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      phosphatases.
84081..............  Amniotic fluid enzyme test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84085..............  Assay of rbc pg6d enzyme..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84087..............  Assay phosphohexose         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      enzymes.
84100..............  Assay of phosphorus.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84105..............  Assay of urine phosphorus.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84106..............  Test for porphobilinogen..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84110..............  Assay of porphobilinogen..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84119..............  Test urine for porphyrins.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84120..............  Assay of urine porphyrins.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84126..............  Assay of feces porphyrins.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84127..............  Assay of feces porphyrins.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84132..............  Assay of serum potassium..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84133..............  Assay of urine potassium..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84134..............  Assay of prealbumin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84135..............  Assay of pregnanediol.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84138..............  Assay of pregnanetriol....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84140..............  Assay of pregnenolone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84143..............  Assay of 17-                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      hydroxypregneno.
84144..............  Assay of progesterone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84146..............  Assay of prolactin........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84150..............  Assay of prostaglandin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84152..............  Assay of psa, complexed...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84153..............  Assay of psa, total.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84154..............  Assay of psa, free........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84155..............  Assay of protein, serum...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84156..............  Assay of protein, urine...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84157..............  Assay of protein, other...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84160..............  Assay of protein, any       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      source.
84163..............  Pappa, serum..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84165..............  Protein e-phoresis, serum.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84166..............  Protein e-phoresis/urine/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      csf.
84181..............  Western blot test.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84182..............  Protein, western blot test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84202..............  Assay RBC protoporphyrin..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84203..............  Test RBC protoporphyrin...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84206..............  Assay of proinsulin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84207..............  Assay of vitamin b-6......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84210..............  Assay of pyruvate.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84220..............  Assay of pyruvate kinase..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84228..............  Assay of quinine..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84233..............  Assay of estrogen.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84234..............  Assay of progesterone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84235..............  Assay of endocrine hormone  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84238..............  Assay, nonendocrine         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      receptor.
84244..............  Assay of renin............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84252..............  Assay of vitamin b-2......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84255..............  Assay of selenium.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84260..............  Assay of serotonin........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84270..............  Assay of sex hormone        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      globul.
84275..............  Assay of sialic acid......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84285..............  Assay of silica...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84295..............  Assay of serum sodium.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84300..............  Assay of urine sodium.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84302..............  Assay of sweat sodium.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84305..............  Assay of somatomedin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84307..............  Assay of somatostatin.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84311..............  Spectrophotometry.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84315..............  Body fluid specific         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gravity.
84375..............  Chromatogram assay, sugars  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84376..............  Sugars, single, qual......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84377..............  Sugars, multiple, qual....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84378..............  Sugars, single, quant.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84379..............  Sugars multiple quant.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84392..............  Assay of urine sulfate....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84402..............  Assay of testosterone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84403..............  Assay of total              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      testosterone.
84425..............  Assay of vitamin b-1......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84430..............  Assay of thiocyanate......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84432..............  Assay of thyroglobulin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84436..............  Assay of total thyroxine..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84437..............  Assay of neonatal           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thyroxine.
84439..............  Assay of free thyroxine...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84442..............  Assay of thyroid activity.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84443..............  Assay thyroid stim hormone  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84445..............  Assay of tsi..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 42986]]

 
84446..............  Assay of vitamin e........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84449..............  Assay of transcortin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84450..............  Transferase (AST) (SGOT)..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84460..............  Alanine amino (ALT) (SGPT)  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84466..............  Assay of transferrin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84478..............  Assay of triglycerides....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84479..............  Assay of thyroid (t3 or     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t4).
84480..............  Assay, triiodothyronine     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      (t3).
84481..............  Free assay (FT-3).........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84482..............  T3 reverse................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84484..............  Assay of troponin, quant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84485..............  Assay duodenal fluid        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      trypsin.
84488..............  Test feces for trypsin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84490..............  Assay of feces for trypsin  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84510..............  Assay of tyrosine.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84512..............  Assay of troponin, qual...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84520..............  Assay of urea nitrogen....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84525..............  Urea nitrogen semi-quant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84540..............  Assay of urine/urea-n.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84545..............  Urea-N clearance test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84550..............  Assay of blood/uric acid..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84560..............  Assay of urine/uric acid..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84577..............  Assay of feces/             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      urobilinogen.
84578..............  Test urine urobilinogen...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84580..............  Assay of urine              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      urobilinogen.
84583..............  Assay of urine              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      urobilinogen.
84585..............  Assay of urine vma........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84586..............  Assay of vip..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84588..............  Assay of vasopressin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84590..............  Assay of vitamin a........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84591..............  Assay of nos vitamin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84597..............  Assay of vitamin k........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84600..............  Assay of volatiles........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84620..............  Xylose tolerance test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84630..............  Assay of zinc.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84681..............  Assay of c-peptide........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84702..............  Chorionic gonadotropin      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
84703..............  Chorionic gonadotropin      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      assay.
84830..............  Ovulation tests...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84999..............  Clinical chemistry test...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85002..............  Bleeding time test........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85004..............  Automated diff wbc count..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85007..............  Bl smear w/diff wbc count.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85008..............  Bl smear w/o diff wbc       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      count.
85009..............  Manual diff wbc count b-    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      coat.
85013..............  Spun microhematocrit......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85014..............  Hematocrit................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85018..............  Hemoglobin................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85025..............  Complete cbc w/auto diff    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wbc.
85027..............  Complete cbc, automated...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85032..............  Manual cell count, each...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85041..............  Automated rbc count.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85044..............  Manual reticulocyte count.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85045..............  Automated reticulocyte      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      count.
85046..............  Reticyte/hgb concentrate..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85048..............  Automated leukocyte count.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85049..............  Automated platelet count..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85055..............  Reticulated platelet assay  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85060..............  Blood smear interpretation  ..................  B.................  ...........  ...........  ...........  ...........  ...........
85097..............  Bone marrow interpretation  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
85130..............  Chromogenic substrate       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      assay.
85170..............  Blood clot retraction.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85175..............  Blood clot lysis time.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85210..............  Blood clot factor II test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85220..............  Blood clot factor V test..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85230..............  Blood clot factor VII test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85240..............  Blood clot factor VIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85244..............  Blood clot factor VIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85245..............  Blood clot factor VIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85246..............  Blood clot factor VIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85247..............  Blood clot factor VIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85250..............  Blood clot factor IX test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85260..............  Blood clot factor X test..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85270..............  Blood clot factor XI test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85280..............  Blood clot factor XII test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85290..............  Blood clot factor XIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85291..............  Blood clot factor XIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85292..............  Blood clot factor assay...  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 42987]]

 
85293..............  Blood clot factor assay...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85300..............  Antithrombin III test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85301..............  Antithrombin III test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85302..............  Blood clot inhibitor        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      antigen.
85303..............  Blood clot inhibitor test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85305..............  Blood clot inhibitor assay  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85306..............  Blood clot inhibitor test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85307..............  Assay activated protein c.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85335..............  Factor inhibitor test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85337..............  Thrombomodulin............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85345..............  Coagulation time..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85347..............  Coagulation time..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85348..............  Coagulation time..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85360..............  Euglobulin lysis..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85362..............  Fibrin degradation          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      products.
85366..............  Fibrinogen test...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85370..............  Fibrinogen test...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85378..............  Fibrin degrade, semiquant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85379..............  Fibrin degradation, quant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85380..............  Fibrin degradation, vte...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85384..............  Fibrinogen................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85385..............  Fibrinogen................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85390..............  Fibrinolysins screen......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85396..............  Clotting assay, whole       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      blood.
85400..............  Fibrinolytic plasmin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85410..............  Fibrinolytic antiplasmin..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85415..............  Fibrinolytic plasminogen..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85420..............  Fibrinolytic plasminogen..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85421..............  Fibrinolytic plasminogen..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85441..............  Heinz bodies, direct......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85445..............  Heinz bodies, induced.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85460..............  Hemoglobin, fetal.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85461..............  Hemoglobin, fetal.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85475..............  Hemolysin.................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85520..............  Heparin assay.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85525..............  Heparin neutralization....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85530..............  Heparin-protamine           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tolerance.
85536..............  Iron stain peripheral       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      blood.
85540..............  Wbc alkaline phosphatase..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85547..............  RBC mechanical fragility..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85549..............  Muramidase................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85555..............  RBC osmotic fragility.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85557..............  RBC osmotic fragility.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85576..............  Blood platelet aggregation  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85597..............  Platelet neutralization...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85610..............  Prothrombin time..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85611..............  Prothrombin test..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85612..............  Viper venom prothrombin     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      time.
85613..............  Russell viper venom,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      diluted.
85635..............  Reptilase test............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85651..............  Rbc sed rate, nonautomated  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85652..............  Rbc sed rate, automated...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85660..............  RBC sickle cell test......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85670..............  Thrombin time, plasma.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85675..............  Thrombin time, titer......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85705..............  Thromboplastin inhibition.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85730..............  Thromboplastin time,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      partial.
85732..............  Thromboplastin time,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      partial.
85810..............  Blood viscosity             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      examination.
85999..............  Hematology procedure......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86000..............  Agglutinins, febrile......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86001..............  Allergen specific igg.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86003..............  Allergen specific IgE.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86005..............  Allergen specific IgE.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86021..............  WBC antibody                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      identification.
86022..............  Platelet antibodies.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86023..............  Immunoglobulin assay......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86038..............  Antinuclear antibodies....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86039..............  Antinuclear antibodies      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      (ANA).
86060..............  Antistreptolysin o, titer.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86063..............  Antistreptolysin o, screen  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86077..............  Physician blood bank        ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
                      service.
86078..............  Physician blood bank        ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
                      service.
86079..............  Physician blood bank        ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
                      service.
86140..............  C-reactive protein........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86141..............  C-reactive protein, hs....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86146..............  Glycoprotein antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86147..............  Cardiolipin antibody......  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 42988]]

 
86148..............  Phospholipid antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86155..............  Chemotaxis assay..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86156..............  Cold agglutinin, screen...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86157..............  Cold agglutinin, titer....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86160..............  Complement, antigen.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86161..............  Complement/function         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      activity.
86162..............  Complement, total (CH50)..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86171..............  Complement fixation, each.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86185..............  Counterimmunoelectrophores  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      is.
86200..............  Ccp antibody..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86215..............  Deoxyribonuclease,          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      antibody.
86225..............  DNA antibody..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86226..............  DNA antibody, single        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      strand.
86235..............  Nuclear antigen antibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86243..............  Fc receptor...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86255..............  Fluorescent antibody,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      screen.
86256..............  Fluorescent antibody,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      titer.
86277..............  Growth hormone antibody...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86280..............  Hemagglutination            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inhibition.
86294..............  Immunoassay, tumor, qual..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86300..............  Immunoassay, tumor, ca 15-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      3.
86301..............  Immunoassay, tumor, ca 19-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      9.
86304..............  Immunoassay, tumor, ca 125  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86308..............  Heterophile antibodies....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86309..............  Heterophile antibodies....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86310..............  Heterophile antibodies....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86316..............  Immunoassay, tumor other..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86317..............  Immunoassay,infectious      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      agent.
86318..............  Immunoassay,infectious      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      agent.
86320..............  Serum                       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      immunoelectrophoresis.
86325..............  Other                       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      immunoelectrophoresis.
86327..............  Immunoelectrophoresis       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      assay.
86329..............  Immunodiffusion...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86331..............  Immunodiffusion             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ouchterlony.
86332..............  Immune complex assay......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86334..............  Immunofix e-phoresis,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      serum.
86335..............  Immunfix e-phorsis/urine/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      csf.
86336..............  Inhibin A.................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86337..............  Insulin antibodies........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86340..............  Intrinsic factor antibody.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86341..............  Islet cell antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86343..............  Leukocyte histamine         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      release.
86344..............  Leukocyte phagocytosis....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86353..............  Lymphocyte transformation.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86355..............  B cells, total count......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86357..............  Nk cells, total count.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86359..............  T cells, total count......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86360..............  T cell, absolute count/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ratio.
86361..............  T cell, absolute count....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86367..............  Stem cells, total count...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86376..............  Microsomal antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86378..............  Migration inhibitory        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      factor.
86382..............  Neutralization test, viral  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86384..............  Nitroblue tetrazolium dye.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86403..............  Particle agglutination      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
86406..............  Particle agglutination      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
86430..............  Rheumatoid factor test....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86431..............  Rheumatoid factor, quant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86480..............  Tb test, cell immun         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      measure.
86485..............  Skin test, candida........  ..................  X.................         0341       0.0879        $5.60        $2.20        $1.12
86490..............  Coccidioidomycosis skin     ..................  X.................         0341       0.0879        $5.60        $2.20        $1.12
                      test.
86510..............  Histoplasmosis skin test..  ..................  X.................         0341       0.0879        $5.60        $2.20        $1.12
86580..............  TB intradermal test.......  ..................  X.................         0341       0.0879        $5.60        $2.20        $1.12
86586..............  Skin test, unlisted.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86590..............  Streptokinase, antibody...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86592..............  Blood serology,             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      qualitative.
86593..............  Blood serology,             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quantitative.
86602..............  Antinomyces antibody......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86603..............  Adenovirus antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86606..............  Aspergillus antibody......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86609..............  Bacterium antibody........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86611..............  Bartonella antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86612..............  Blastomyces antibody......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86615..............  Bordetella antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86617..............  Lyme disease antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86618..............  Lyme disease antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86619..............  Borrelia antibody.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86622..............  Brucella antibody.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 42989]]

 
86625..............  Campylobacter antibody....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86628..............  Candida antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86631..............  Chlamydia antibody........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86632..............  Chlamydia igm antibody....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86635..............  Coccidioides antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86638..............  Q fever antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86641..............  Cryptococcus antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86644..............  CMV antibody..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86645..............  CMV antibody, IgM.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86648..............  Diphtheria antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86651..............  Encephalitis antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86652..............  Encephalitis antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86653..............  Encephalitis antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86654..............  Encephalitis antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86658..............  Enterovirus antibody......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86663..............  Epstein-barr antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86664..............  Epstein-barr antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86665..............  Epstein-barr antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86666..............  Ehrlichia antibody........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86668..............  Francisella tularensis....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86671..............  Fungus antibody...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86674..............  Giardia lamblia antibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86677..............  Helicobacter pylori.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86682..............  Helminth antibody.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86684..............  Hemophilus influenza......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86687..............  Htlv-i antibody...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86688..............  Htlv-ii antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86689..............  HTLV/HIV confirmatory test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86692..............  Hepatitis, delta agent....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86694..............  Herpes simplex test.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86695..............  Herpes simplex test.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86696..............  Herpes simplex type 2.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86698..............  Histoplasma...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86701..............  HIV-1.....................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86702..............  HIV-2.....................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86703..............  HIV-1/HIV-2, single assay.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86704..............  Hep b core antibody, total  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86705..............  Hep b core antibody, igm..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86706..............  Hep b surface antibody....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86707..............  Hep be antibody...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86708..............  Hep a antibody, total.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86709..............  Hep a antibody, igm.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86710..............  Influenza virus antibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86713..............  Legionella antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86717..............  Leishmania antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86720..............  Leptospira antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86723..............  Listeria monocytogenes ab.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86727..............  Lymph choriomeningitis ab.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86729..............  Lympho venereum antibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86732..............  Mucormycosis antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86735..............  Mumps antibody............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86738..............  Mycoplasma antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86741..............  Neisseria meningitidis....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86744..............  Nocardia antibody.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86747..............  Parvovirus antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86750..............  Malaria antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86753..............  Protozoa antibody nos.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86756..............  Respiratory virus antibody  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86757..............  Rickettsia antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86759..............  Rotavirus antibody........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86762..............  Rubella antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86765..............  Rubeola antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86768..............  Salmonella antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86771..............  Shigella antibody.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86774..............  Tetanus antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86777..............  Toxoplasma antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86778..............  Toxoplasma antibody, igm..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86781..............  Treponema pallidum,         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      confirm.
86784..............  Trichinella antibody......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86787..............  Varicella-zoster antibody.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86788..............  West nile virus ab, igm...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86789..............  West nile virus antibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86790..............  Virus antibody nos........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86793..............  Yersinia antibody.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86800..............  Thyroglobulin antibody....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86803..............  Hepatitis c ab test.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86804..............  Hep c ab test, confirm....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86805..............  Lymphocytotoxicity assay..  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 42990]]

 
86806..............  Lymphocytotoxicity assay..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86807..............  Cytotoxic antibody          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      screening.
86808..............  Cytotoxic antibody          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      screening.
86812..............  HLA typing, A, B, or C....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86813..............  HLA typing, A, B, or C....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86816..............  HLA typing, DR/DQ.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86817..............  HLA typing, DR/DQ.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86821..............  Lymphocyte culture, mixed.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86822..............  Lymphocyte culture, primed  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86849..............  Immunology procedure......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86850..............  RBC antibody screen.......  ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
86860..............  RBC antibody elution......  ..................  X.................         0346       0.3464       $22.06  ...........        $4.41
86870..............  RBC antibody                ..................  X.................         0346       0.3464       $22.06  ...........        $4.41
                      identification.
86880..............  Coombs test, direct.......  ..................  X.................         0409       0.1246        $7.94        $2.20        $1.59
86885..............  Coombs test, indirect,      ..................  X.................         0409       0.1246        $7.94        $2.20        $1.59
                      qual.
86886..............  Coombs test, indirect,      ..................  X.................         0409       0.1246        $7.94        $2.20        $1.59
                      titer.
86890..............  Autologous blood process..  ..................  X.................         0347       0.8166       $52.01       $11.20       $10.40
86891..............  Autologous blood, op        ..................  X.................         0346       0.3464       $22.06  ...........        $4.41
                      salvage.
86900..............  Blood typing, ABO.........  ..................  X.................         0409       0.1246        $7.94        $2.20        $1.59
86901..............  Blood typing, Rh (D)......  ..................  X.................         0409       0.1246        $7.94        $2.20        $1.59
86903..............  Blood typing, antigen       ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
                      screen.
86904..............  Blood typing, patient       ..................  X.................         0346       0.3464       $22.06  ...........        $4.41
                      serum.
86905..............  Blood typing, RBC antigens  ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
86906..............  Blood typing, Rh phenotype  ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
86910..............  Blood typing, paternity     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      test.
86911..............  Blood typing, antigen       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      system.
86920..............  Compatibility test, spin..  ..................  X.................         0346       0.3464       $22.06  ...........        $4.41
86921..............  Compatibility test,         ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
                      incubate.
86922..............  Compatibility test,         ..................  X.................         0346       0.3464       $22.06  ...........        $4.41
                      antiglob.
86923..............  Compatibility test,         ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
                      electric.
86927..............  Plasma, fresh frozen......  ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
86930..............  Frozen blood prep.........  ..................  X.................         0347       0.8166       $52.01       $11.20       $10.40
86931..............  Frozen blood thaw.........  ..................  X.................         0347       0.8166       $52.01       $11.20       $10.40
86932..............  Frozen blood freeze/thaw..  ..................  X.................         0347       0.8166       $52.01       $11.20       $10.40
86940..............  Hemolysins/agglutinins,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      auto.
86941..............  Hemolysins/agglutinins....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86945..............  Blood product/irradiation.  ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
86950..............  Leukacyte transfusion.....  ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
86960..............  Vol reduction of blood/     ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
                      prod.
86965..............  Pooling blood platelets...  ..................  X.................         0346       0.3464       $22.06  ...........        $4.41
86970..............  RBC pretreatment..........  ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
86971..............  RBC pretreatment..........  ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
86972..............  RBC pretreatment..........  ..................  X.................         0346       0.3464       $22.06  ...........        $4.41
86975..............  RBC pretreatment, serum...  ..................  X.................         0346       0.3464       $22.06  ...........        $4.41
86976..............  RBC pretreatment, serum...  ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
86977..............  RBC pretreatment, serum...  ..................  X.................         0346       0.3464       $22.06  ...........        $4.41
86978..............  RBC pretreatment, serum...  ..................  X.................         0346       0.3464       $22.06  ...........        $4.41
86985..............  Split blood or products...  ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
86999..............  Transfusion procedure.....  ..................  X.................         0345       0.2211       $14.08  ...........        $2.82
87001..............  Small animal inoculation..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87003..............  Small animal inoculation..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87015..............  Specimen concentration....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87040..............  Blood culture for bacteria  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87045..............  Feces culture, bacteria...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87046..............  Stool cultr, bacteria,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
87070..............  Culture, bacteria, other..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87071..............  Culture bacteri aerobic     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      othr.
87073..............  Culture bacteria anaerobic  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87075..............  Cultr bacteria, except      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      blood.
87076..............  Culture anaerobe ident,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
87077..............  Culture aerobic identify..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87081..............  Culture screen only.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87084..............  Culture of specimen by kit  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87086..............  Urine culture/colony count  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87088..............  Urine bacteria culture....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87101..............  Skin fungi culture........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87102..............  Fungus isolation culture..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87103..............  Blood fungus culture......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87106..............  Fungi identification,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      yeast.
87107..............  Fungi identification, mold  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87109..............  Mycoplasma................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87110..............  Chlamydia culture.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87116..............  Mycobacteria culture......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87118..............  Mycobacteric                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      identification.
87140..............  Culture type                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      immunofluoresc.
87143..............  Culture typing, glc/hplc..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87147..............  Culture type, immunologic.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87149..............  Culture type, nucleic acid  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 42991]]

 
87152..............  Culture type pulse field    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gel.
87158..............  Culture typing, added       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      method.
87164..............  Dark field examination....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87166..............  Dark field examination....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87168..............  Macroscopic exam arthropod  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87169..............  Macroscopic exam parasite.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87172..............  Pinworm exam..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87176..............  Tissue homogenization,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cultr.
87177..............  Ova and parasites smears..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87181..............  Microbe susceptible,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      diffuse.
87184..............  Microbe susceptible, disk.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87185..............  Microbe susceptible,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      enzyme.
87186..............  Microbe susceptible, mic..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87187..............  Microbe susceptible, mlc..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87188..............  Microbe suscept,            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      macrobroth.
87190..............  Microbe suscept,            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mycobacteri.
87197..............  Bactericidal level, serum.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87205..............  Smear, gram stain.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87206..............  Smear, fluorescent/acid     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stai.
87207..............  Smear, special stain......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87209..............  Smear, complex stain......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87210..............  Smear, wet mount, saline/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ink.
87220..............  Tissue exam for fungi.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87230..............  Assay, toxin or antitoxin.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87250..............  Virus inoculate, eggs/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      animal.
87252..............  Virus inoculation, tissue.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87253..............  Virus inoculate tissue,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      addl.
87254..............  Virus inoculation, shell    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      via.
87255..............  Genet virus isolate, hsv..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87260..............  Adenovirus ag, if.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87265..............  Pertussis ag, if..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87267..............  Enterovirus antibody, dfa.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87269..............  Giardia ag, if............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87270..............  Chlamydia trachomatis ag,   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      if.
87271..............  Cryptosporidum/gardia ag,   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      if.
87272..............  Cryptosporidium ag, if....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87273..............  Herpes simplex 2, ag, if..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87274..............  Herpes simplex 1, ag, if..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87275..............  Influenza b, ag, if.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87276..............  Influenza a, ag, if.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87277..............  Legionella micdadei, ag,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      if.
87278..............  Legion pneumophilia ag, if  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87279..............  Parainfluenza, ag, if.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87280..............  Respiratory syncytial ag,   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      if.
87281..............  Pneumocystis carinii, ag,   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      if.
87283..............  Rubeola, ag, if...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87285..............  Treponema pallidum, ag, if  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87290..............  Varicella zoster, ag, if..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87299..............  Antibody detection, nos,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      if.
87300..............  Ag detection, polyval, if.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87301..............  Adenovirus ag, eia........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87305..............  Aspergillus ag, eia.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87320..............  Chylmd trach ag, eia......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87324..............  Clostridium ag, eia.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87327..............  Cryptococcus neoform ag,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eia.
87328..............  Cryptosporidium ag, eia...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87329..............  Giardia ag, eia...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87332..............  Cytomegalovirus ag, eia...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87335..............  E coli 0157 ag, eia.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87336..............  Entamoeb hist dispr, ag,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eia.
87337..............  Entamoeb hist group, ag,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eia.
87338..............  Hpylori, stool, eia.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87339..............  H pylori ag, eia..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87340..............  Hepatitis b surface ag,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eia.
87341..............  Hepatitis b surface, ag,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eia.
87350..............  Hepatitis be ag, eia......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87380..............  Hepatitis delta ag, eia...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87385..............  Histoplasma capsul ag, eia  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87390..............  Hiv-1 ag, eia.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87391..............  Hiv-2 ag, eia.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87400..............  Influenza a/b, ag, eia....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87420..............  Resp syncytial ag, eia....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87425..............  Rotavirus ag, eia.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87427..............  Shiga-like toxin ag, eia..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87430..............  Strep a ag, eia...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87449..............  Ag detect nos, eia, mult..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87450..............  Ag detect nos, eia, single  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87451..............  Ag detect polyval, eia,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mult.

[[Page 42992]]

 
87470..............  Bartonella, dna, dir probe  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87471..............  Bartonella, dna, amp probe  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87472..............  Bartonella, dna, quant....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87475..............  Lyme dis, dna, dir probe..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87476..............  Lyme dis, dna, amp probe..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87477..............  Lyme dis, dna, quant......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87480..............  Candida, dna, dir probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87481..............  Candida, dna, amp probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87482..............  Candida, dna, quant.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87485..............  Chylmd pneum, dna, dir      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87486..............  Chylmd pneum, dna, amp      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87487..............  Chylmd pneum, dna, quant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87490..............  Chylmd trach, dna, dir      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87491..............  Chylmd trach, dna, amp      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87492..............  Chylmd trach, dna, quant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87495..............  Cytomeg, dna, dir probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87496..............  Cytomeg, dna, amp probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87497..............  Cytomeg, dna, quant.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87498..............  Enterovirus, dna, amp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87510..............  Gardner vag, dna, dir       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87511..............  Gardner vag, dna, amp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87512..............  Gardner vag, dna, quant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87515..............  Hepatitis b, dna, dir       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87516..............  Hepatitis b, dna, amp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87517..............  Hepatitis b, dna, quant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87520..............  Hepatitis c, rna, dir       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87521..............  Hepatitis c, rna, amp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87522..............  Hepatitis c, rna, quant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87525..............  Hepatitis g, dna, dir       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87526..............  Hepatitis g, dna, amp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87527..............  Hepatitis g, dna, quant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87528..............  Hsv, dna, dir probe.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87529..............  Hsv, dna, amp probe.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87530..............  Hsv, dna, quant...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87531..............  Hhv-6, dna, dir probe.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87532..............  Hhv-6, dna, amp probe.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87533..............  Hhv-6, dna, quant.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87534..............  Hiv-1, dna, dir probe.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87535..............  Hiv-1, dna, amp probe.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87536..............  Hiv-1, dna, quant.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87537..............  Hiv-2, dna, dir probe.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87538..............  Hiv-2, dna, amp probe.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87539..............  Hiv-2, dna, quant.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87540..............  Legion pneumo, dna, dir     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prob.
87541..............  Legion pneumo, dna, amp     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prob.
87542..............  Legion pneumo, dna, quant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87550..............  Mycobacteria, dna, dir      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87551..............  Mycobacteria, dna, amp      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87552..............  Mycobacteria, dna, quant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87555..............  M.tuberculo, dna, dir       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87556..............  M.tuberculo, dna, amp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87557..............  M.tuberculo, dna, quant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87560..............  M.avium-intra, dna, dir     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prob.
87561..............  M.avium-intra, dna, amp     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prob.
87562..............  M.avium-intra, dna, quant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87580..............  M.pneumon, dna, dir probe.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87581..............  M.pneumon, dna, amp probe.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87582..............  M.pneumon, dna, quant.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87590..............  N.gonorrhoeae, dna, dir     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prob.
87591..............  N.gonorrhoeae, dna, amp     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prob.
87592..............  N.gonorrhoeae, dna, quant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87620..............  Hpv, dna, dir probe.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87621..............  Hpv, dna, amp probe.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87622..............  Hpv, dna, quant...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87640..............  Staph a, dna, amp probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87641..............  Mr-staph, dna, amp probe..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87650..............  Strep a, dna, dir probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87651..............  Strep a, dna, amp probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87652..............  Strep a, dna, quant.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87653..............  Strep b, dna, amp probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87660..............  Trichomonas vagin, dir      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87797..............  Detect agent nos, dna, dir  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87798..............  Detect agent nos, dna, amp  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87799..............  Detect agent nos, dna,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
87800..............  Detect agnt mult, dna,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      direc.
87801..............  Detect agnt mult, dna,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ampli.
87802..............  Strep b assay w/optic.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87803..............  Clostridium toxin a w/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      optic.

[[Page 42993]]

 
87804..............  Influenza assay w/optic...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87807..............  Rsv assay w/optic.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87808..............  Trichomonas assay w/optic.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87810..............  Chylmd trach assay w/optic  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87850..............  N. gonorrhoeae assay w/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      optic.
87880..............  Strep a assay w/optic.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87899..............  Agent nos assay w/optic...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87900..............  Phenotype, infect agent     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      drug.
87901..............  Genotype, dna, hiv reverse  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t.
87902..............  Genotype, dna, hepatitis C  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87903..............  Phenotype, dna hiv w/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      culture.
87904..............  Phenotype, dna hiv w/clt    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      add.
87999..............  Microbiology procedure....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88000..............  Autopsy (necropsy), gross.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88005..............  Autopsy (necropsy), gross.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88007..............  Autopsy (necropsy), gross.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88012..............  Autopsy (necropsy), gross.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88014..............  Autopsy (necropsy), gross.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88016..............  Autopsy (necropsy), gross.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88020..............  Autopsy (necropsy),         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complete.
88025..............  Autopsy (necropsy),         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complete.
88027..............  Autopsy (necropsy),         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complete.
88028..............  Autopsy (necropsy),         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complete.
88029..............  Autopsy (necropsy),         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complete.
88036..............  Limited autopsy...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88037..............  Limited autopsy...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88040..............  Forensic autopsy            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      (necropsy).
88045..............  Coroner's autopsy           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      (necropsy).
88099..............  Necropsy (autopsy)          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
88104..............  Cytopath fl nongyn, smears  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88106..............  Cytopath fl nongyn, filter  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88107..............  Cytopath fl nongyn, sm/     CH................  X.................         0343       0.5372       $34.22       $10.80        $6.84
                      fltr.
88108..............  Cytopath, concentrate tech  CH................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88112..............  Cytopath, cell enhance      ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
                      tech.
88125..............  Forensic cytopathology....  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88130..............  Sex chromatin               ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      identification.
88140..............  Sex chromatin               ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      identification.
88141..............  Cytopath, c/v, interpret..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
88142..............  Cytopath, c/v, thin layer.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88143..............  Cytopath c/v thin layer     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      redo.
88147..............  Cytopath, c/v, automated..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88148..............  Cytopath, c/v, auto         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rescreen.
88150..............  Cytopath, c/v, manual.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88152..............  Cytopath, c/v, auto redo..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88153..............  Cytopath, c/v, redo.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88154..............  Cytopath, c/v, select.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88155..............  Cytopath, c/v, index add-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      on.
88160..............  Cytopath smear, other       ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
                      source.
88161..............  Cytopath smear, other       ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
                      source.
88162..............  Cytopath smear, other       CH................  X.................         0343       0.5372       $34.22       $10.80        $6.84
                      source.
88164..............  Cytopath tbs, c/v, manual.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88165..............  Cytopath tbs, c/v, redo...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88166..............  Cytopath tbs, c/v, auto     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      redo.
88167..............  Cytopath tbs, c/v, select.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88172..............  Cytopathology eval of fna.  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88173..............  Cytopath eval, fna, report  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88174..............  Cytopath, c/v auto, in      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fluid.
88175..............  Cytopath c/v auto fluid     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      redo.
88182..............  Cell marker study.........  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88184..............  Flowcytometry/ tc, 1        ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
                      marker.
88185..............  Flowcytometry/tc, add-on..  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88187..............  Flowcytometry/read, 2-8...  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88188..............  Flowcytometry/read, 9-15..  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88189..............  Flowcytometry/read, 16 & >  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88199..............  Cytopathology procedure...  ..................  X.................         0342       0.0928        $5.91        $2.00        $1.18
88230..............  Tissue culture, lymphocyte  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88233..............  Tissue culture, skin/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      biopsy.
88235..............  Tissue culture, placenta..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88237..............  Tissue culture, bone        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      marrow.
88239..............  Tissue culture, tumor.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88240..............  Cell cryopreserve/storage.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88241..............  Frozen cell preparation...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88245..............  Chromosome analysis, 20-25  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88248..............  Chromosome analysis, 50-    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      100.
88249..............  Chromosome analysis, 100..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88261..............  Chromosome analysis, 5....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88262..............  Chromosome analysis, 15-20  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88263..............  Chromosome analysis, 45...  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 42994]]

 
88264..............  Chromosome analysis, 20-25  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88267..............  Chromosome analys,          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      placenta.
88269..............  Chromosome analys,          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      amniotic.
88271..............  Cytogenetics, dna probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88272..............  Cytogenetics, 3-5.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88273..............  Cytogenetics, 10-30.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88274..............  Cytogenetics, 25-99.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88275..............  Cytogenetics, 100-300.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88280..............  Chromosome karyotype study  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88283..............  Chromosome banding study..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88285..............  Chromosome count,           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      additional.
88289..............  Chromosome study,           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      additional.
88291..............  Cyto/molecular report.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
88299..............  Cytogenetic study.........  ..................  X.................         0342       0.0928        $5.91        $2.00        $1.18
88300..............  Surgical path, gross......  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88302..............  Tissue exam by pathologist  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88304..............  Tissue exam by pathologist  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88305..............  Tissue exam by pathologist  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88307..............  Tissue exam by pathologist  ..................  X.................         0344       0.8586       $54.69       $15.60       $10.94
88309..............  Tissue exam by pathologist  ..................  X.................         0344       0.8586       $54.69       $15.60       $10.94
88311..............  Decalcify tissue..........  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88312..............  Special stains............  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88313..............  Special stains............  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88314..............  Histochemical stain.......  CH................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88318..............  Chemical histochemistry...  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88319..............  Enzyme histochemistry.....  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88321..............  Microslide consultation...  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88323..............  Microslide consultation...  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88325..............  Comprehensive review of     ..................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      data.
88329..............  Path consult introp.......  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
88331..............  Path consult intraop, 1     ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
                      bloc.
88332..............  Path consult intraop,       ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
                      add'l.
88333..............  Intraop cyto path consult,  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
                      1.
88334..............  Intraop cyto path consult,  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
                      2.
88342..............  Immunohistochemistry......  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88346..............  Immunofluorescent study...  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88347..............  Immunofluorescent study...  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88348..............  Electron microscopy.......  ..................  X.................         0661       2.8336      $180.48       $62.00       $36.10
88349..............  Scanning electron           ..................  X.................         0661       2.8336      $180.48       $62.00       $36.10
                      microscopy.
88355..............  Analysis, skeletal muscle.  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
88356..............  Analysis, nerve...........  ..................  X.................         0344       0.8586       $54.69       $15.60       $10.94
88358..............  Analysis, tumor...........  ..................  X.................         0344       0.8586       $54.69       $15.60       $10.94
88360..............  Tumor immunohistochem/      ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
                      manual.
88361..............  Tumor immunohistochem/      ..................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      comput.
88362..............  Nerve teasing preparations  ..................  X.................         0344       0.8586       $54.69       $15.60       $10.94
88365..............  Insitu hybridization        ..................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      (fish).
88367..............  Insitu hybridization, auto  ..................  X.................         0344       0.8586       $54.69       $15.60       $10.94
88368..............  Insitu hybridization,       CH................  X.................         0343       0.5372       $34.22       $10.80        $6.84
                      manual.
88371..............  Protein, western blot       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tissue.
88372..............  Protein analysis w/probe..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88380..............  Microdissection...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
88384..............  Eval molecular probes, 11-  ..................  X.................         0433       0.2482       $15.81        $5.90        $3.16
                      50.
88385..............  Eval molecul probes, 51-    ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
                      250.
88386..............  Eval molecul probes, 251-   ..................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      500.
88399..............  Surgical pathology          ..................  X.................         0342       0.0928        $5.91        $2.00        $1.18
                      procedure.
88400..............  Bilirubin total transcut..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89049..............  Chct for mal hyperthermia.  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
89050..............  Body fluid cell count.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89051..............  Body fluid cell count.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89055..............  Leukocyte assessment,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fecal.
89060..............  Exam,synovial fluid         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      crystals.
89100..............  Sample intestinal contents  ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
89105..............  Sample intestinal contents  ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
89125..............  Specimen fat stain........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89130..............  Sample stomach contents...  ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
89132..............  Sample stomach contents...  ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
89135..............  Sample stomach contents...  ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
89136..............  Sample stomach contents...  ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
89140..............  Sample stomach contents...  ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
89141..............  Sample stomach contents...  ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
89160..............  Exam feces for meat fibers  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89190..............  Nasal smear for             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eosinophils.
89220..............  Sputum specimen collection  ..................  X.................         0343       0.5372       $34.22       $10.80        $6.84
89225..............  Starch granules, feces....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89230..............  Collect sweat for test....  CH................  X.................         0343       0.5372       $34.22       $10.80        $6.84
89235..............  Water load test...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89240..............  Pathology lab procedure...  ..................  X.................         0342       0.0928        $5.91        $2.00        $1.18
89250..............  Cultr oocyte/embryo <4      CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      days.

[[Page 42995]]

 
89251..............  Cultr oocyte/embryo <4      CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      days.
89253..............  Embryo hatching...........  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89254..............  Oocyte identification.....  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89255..............  Prepare embryo for          CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      transfer.
89257..............  Sperm identification......  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89258..............  Cryopreservation;           CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      embryo(s).
89259..............  Cryopreservation, sperm...  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89260..............  Sperm isolation, simple...  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89261..............  Sperm isolation, complex..  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89264..............  Identify sperm tissue.....  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89268..............  Insemination of oocytes...  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89272..............  Extended culture of         CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      oocytes.
89280..............  Assist oocyte               CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      fertilization.
89281..............  Assist oocyte               CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      fertilization.
89290..............  Biopsy, oocyte polar body.  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89291..............  Biopsy, oocyte polar body.  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89300..............  Semen analysis w/huhner...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89310..............  Semen analysis w/count....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89320..............  Semen analysis, complete..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89321..............  Semen analysis & motility.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89325..............  Sperm antibody test.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89329..............  Sperm evaluation test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89330..............  Evaluation, cervical mucus  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89335..............  Cryopreserve testicular     CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      tiss.
89342..............  Storage/year; embryo(s)...  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89343..............  Storage/year; sperm/semen.  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89344..............  Storage/year; reprod        CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      tissue.
89346..............  Storage/year; oocyte(s)...  CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
89352..............  Thawing cryopresrved;       CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      embryo.
89353..............  Thawing cryopresrved;       CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      sperm.
89354..............  Thaw cryoprsvrd; reprod     CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      tiss.
89356..............  Thawing cryopresrved;       CH................  X.................         0344       0.8586       $54.69       $15.60       $10.94
                      oocyte.
90281..............  Human ig, im..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90283..............  Human ig, iv..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90287..............  Botulinum antitoxin.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90288..............  Botulism ig, iv...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90291..............  Cmv ig, iv................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90296..............  Diphtheria antitoxin......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90371..............  Hep b ig, im..............  ..................  K.................         1630  ...........      $132.42  ...........       $26.48
90375..............  Rabies ig, im/sc..........  ..................  K.................         9133  ...........       $64.82  ...........       $12.96
90376..............  Rabies ig, heat treated...  ..................  K.................         9134  ...........       $69.40  ...........       $13.88
90378..............  Rsv ig, im, 50mg..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90379..............  Rsv ig, iv................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90384..............  Rh ig, full-dose, im......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90385..............  Rh ig, minidose, im.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90386..............  Rh ig, iv.................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90389..............  Tetanus ig, im............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90393..............  Vaccina ig, im............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90396..............  Varicella-zoster ig, im...  ..................  K.................         9135  ...........      $121.58  ...........       $24.32
90399..............  Immune globulin...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90465..............  Immune admin 1 inj, < 8     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      yrs.
90466..............  Immune admin addl inj, < 8  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      y.
90467..............  Immune admin o or n, < 8    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      yrs.
90468..............  Immune admin o/n, addl < 8  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      y.
90471..............  Immunization admin........  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
90472..............  Immunization admin, each    ..................  S.................         0436       0.2201       $14.02  ...........        $2.80
                      add.
90473..............  Immune admin oral/nasal...  ..................  S.................         0436       0.2201       $14.02  ...........        $2.80
90474..............  Immune admin oral/nasal     ..................  S.................         0436       0.2201       $14.02  ...........        $2.80
                      addl.
90476..............  Adenovirus vaccine, type 4  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90477..............  Adenovirus vaccine, type 7  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90581..............  Anthrax vaccine, sc.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90585..............  Bcg vaccine, percut.......  ..................  K.................         9137  ...........      $112.56  ...........       $22.51
90586..............  Bcg vaccine, intravesical.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90632..............  Hep a vaccine, adult im...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90633..............  Hep a vacc, ped/adol, 2     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      dose.
90634..............  Hep a vacc, ped/adol, 3     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      dose.
90636..............  Hep a/hep b vacc, adult im  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90645..............  Hib vaccine, hboc, im.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90646..............  Hib vaccine, prp-d, im....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90647..............  Hib vaccine, prp-omp, im..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90648..............  Hib vaccine, prp-t, im....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90649..............  H papilloma vacc 3 dose im  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90655..............  Flu vaccine no preserv 6-   ..................  L.................  ...........  ...........  ...........  ...........  ...........
                      35m.
90656..............  Flu vaccine no preserv 3 &  ..................  L.................  ...........  ...........  ...........  ...........  ...........
                      >.
90657..............  Flu vaccine, 3 yrs, im....  ..................  L.................  ...........  ...........  ...........  ...........  ...........
90658..............  Flu vaccine, 3 yrs & >, im  ..................  L.................  ...........  ...........  ...........  ...........  ...........
90660..............  Flu vaccine, nasal........  ..................  L.................  ...........  ...........  ...........  ...........  ...........
90665..............  Lyme disease vaccine, im..  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 42996]]

 
90669..............  Pneumococcal vacc, ped <5.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90675..............  Rabies vaccine, im........  ..................  K.................         9139  ...........      $145.53  ...........       $29.11
90676..............  Rabies vaccine, id........  ..................  K.................         9140       1.9483      $124.09  ...........       $24.82
90680..............  Rotovirus vacc 3 dose,      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      oral.
90690..............  Typhoid vaccine, oral.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90691..............  Typhoid vaccine, im.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90692..............  Typhoid vaccine, h-p, sc/   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      id.
90693..............  Typhoid vaccine, akd, sc..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90698..............  Dtap-hib-ip vaccine, im...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90700..............  Dtap vaccine, < 7 yrs, im.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90701..............  Dtp vaccine, im...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90702..............  Dt vaccine < 7, im........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90703..............  Tetanus vaccine, im.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90704..............  Mumps vaccine, sc.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90705..............  Measles vaccine, sc.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90706..............  Rubella vaccine, sc.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90707..............  Mmr vaccine, sc...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90708..............  Measles-rubella vaccine,    ..................  K.................         9141       0.9593       $61.10  ...........       $12.22
                      sc.
90710..............  Mmrv vaccine, sc..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90712..............  Oral poliovirus vaccine...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90713..............  Poliovirus, ipv, sc/im....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90714..............  Td vaccine no prsrv >/= 7   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      im.
90715..............  Tdap vaccine >7 im........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90716..............  Chicken pox vaccine, sc...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90717..............  Yellow fever vaccine, sc..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90718..............  Td vaccine > 7, im........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90719..............  Diphtheria vaccine, im....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90720..............  Dtp/hib vaccine, im.......  CH................  N.................  ...........  ...........  ...........  ...........  ...........
90721..............  Dtap/hib vaccine, im......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90723..............  Dtap-hep b-ipv vaccine, im  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90725..............  Cholera vaccine,            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injectable.
90727..............  Plague vaccine, im........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
90732..............  Pneumococcal vaccine......  ..................  L.................  ...........  ...........  ...........  ...........  ...........
90733..............  Meningococcal vaccine, sc.  ..................  K.................         9143  ...........       $88.59  ...........       $17.72
90734..............  Meningococcal vaccine, im.  ..................  K.................         9145       1.1309       $72.03  ...........       $14.41
90735..............  Encephalitis vaccine, sc..  ..................  K.................         9144  ...........       $98.17  ...........       $19.63
90736..............  Zoster vacc, sc...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90740..............  Hepb vacc, ill pat 3 dose   ..................  F.................  ...........  ...........  ...........  ...........  ...........
                      im.
90743..............  Hep b vacc, adol, 2 dose,   ..................  F.................  ...........  ...........  ...........  ...........  ...........
                      im.
90744..............  Hepb vacc ped/adol 3 dose   ..................  F.................  ...........  ...........  ...........  ...........  ...........
                      im.
90746..............  Hep b vaccine, adult, im..  ..................  F.................  ...........  ...........  ...........  ...........  ...........
90747..............  Hepb vacc, ill pat 4 dose   ..................  F.................  ...........  ...........  ...........  ...........  ...........
                      im.
90748..............  Hep b/hib vaccine, im.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90749..............  Vaccine toxoid............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90760..............  Hydration iv infusion,      ..................  S.................         0440        1.831      $116.62  ...........       $23.32
                      init.
90761..............  Hydrate iv infusion, add-   ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
                      on.
90765..............  Ther/proph/diag iv inf,     ..................  S.................         0440        1.831      $116.62  ...........       $23.32
                      init.
90766..............  Ther/proph/dg iv inf, add-  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
                      on.
90767..............  Tx/proph/dg addl seq iv     ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
                      inf.
90768..............  Ther/diag concurrent inf..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90772..............  Ther/proph/diag inj, sc/im  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
90773..............  Ther/proph/diag inj, ia...  ..................  S.................         0438        0.831       $52.93  ...........       $10.59
90774..............  Ther/proph/diag inj, iv     ..................  S.................         0438        0.831       $52.93  ...........       $10.59
                      push.
90775..............  Ther/proph/diag inj add-on  ..................  S.................         0438        0.831       $52.93  ...........       $10.59
90779..............  Ther/prop/diag inj/inf      ..................  S.................         0436       0.2201       $14.02  ...........        $2.80
                      proc.
90801..............  Psy dx interview..........  CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
90802..............  Intac psy dx interview....  CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
90804..............  Psytx, office, 20-30 min..  CH................  Q.................         0322       1.2454       $79.32  ...........       $15.86
90805..............  Psytx, off, 20-30 min w/    CH................  Q.................         0322       1.2454       $79.32  ...........       $15.86
                      e&m.
90806..............  Psytx, off, 45-50 min.....  CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
90807..............  Psytx, off, 45-50 min w/    CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
                      e&m.
90808..............  Psytx, office, 75-80 min..  CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
90809..............  Psytx, off, 75-80, w/e&m..  CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
90810..............  Intac psytx, off, 20-30     CH................  Q.................         0322       1.2454       $79.32  ...........       $15.86
                      min.
90811..............  Intac psytx, 20-30, w/e&m.  CH................  Q.................         0322       1.2454       $79.32  ...........       $15.86
90812..............  Intac psytx, off, 45-50     CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
                      min.
90813..............  Intac psytx, 45-50 min w/   CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
                      e&m.
90814..............  Intac psytx, off, 75-80     CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
                      min.
90815..............  Intac psytx, 75-80 w/e&m..  CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
90816..............  Psytx, hosp, 20-30 min....  CH................  Q.................         0322       1.2454       $79.32  ...........       $15.86
90817..............  Psytx, hosp, 20-30 min w/   CH................  Q.................         0322       1.2454       $79.32  ...........       $15.86
                      e&m.
90818..............  Psytx, hosp, 45-50 min....  CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
90819..............  Psytx, hosp, 45-50 min w/   CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
                      e&m.
90821..............  Psytx, hosp, 75-80 min....  CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
90822..............  Psytx, hosp, 75-80 min w/   CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
                      e&m.
90823..............  Intac psytx, hosp, 20-30    CH................  Q.................         0322       1.2454       $79.32  ...........       $15.86
                      min.
90824..............  Intac psytx, hsp 20-30 w/   CH................  Q.................         0322       1.2454       $79.32  ...........       $15.86
                      e&m.
90826..............  Intac psytx, hosp, 45-50    CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
                      min.

[[Page 42997]]

 
90827..............  Intac psytx, hsp 45-50 w/   CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
                      e&m.
90828..............  Intac psytx, hosp, 75-80    CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
                      min.
90829..............  Intac psytx, hsp 75-80 w/   CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
                      e&m.
90845..............  Psychoanalysis............  CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
90846..............  Family psytx w/o patient..  CH................  Q.................         0324       2.2233      $141.61  ...........       $28.32
90847..............  Family psytx w/patient....  CH................  Q.................         0324       2.2233      $141.61  ...........       $28.32
90849..............  Multiple family group       CH................  Q.................         0325       1.0119       $64.45       $14.04       $12.89
                      psytx.
90853..............  Group psychotherapy.......  CH................  Q.................         0325       1.0119       $64.45       $14.04       $12.89
90857..............  Intac group psytx.........  CH................  Q.................         0325       1.0119       $64.45       $14.04       $12.89
90862..............  Medication management.....  CH................  Q.................         0605       1.0016       $63.79  ...........       $12.76
90865..............  Narcosynthesis............  CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
90870..............  Electroconvulsive therapy.  ..................  S.................         0320       5.9448      $378.64       $80.00       $75.73
90875..............  Psychophysiological         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      therapy.
90876..............  Psychophysiological         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      therapy.
90880..............  Hypnotherapy..............  CH................  Q.................         0323        1.672      $106.49  ...........       $21.30
90882..............  Environmental manipulation  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90885..............  Psy evaluation of records.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90887..............  Consultation with family..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90889..............  Preparation of report.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90899..............  Psychiatric service/        CH................  Q.................         0322       1.2454       $79.32  ...........       $15.86
                      therapy.
90901..............  Biofeedback train, any      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      meth.
90911..............  Biofeedback peri/uro/       CH................  T.................         0126        1.085       $69.11       $16.40       $13.82
                      rectal.
90918..............  ESRD related services,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      month.
90919..............  ESRD related services,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      month.
90920..............  ESRD related services,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      month.
90921..............  ESRD related services,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      month.
90922..............  ESRD related services, day  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90923..............  Esrd related services, day  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90924..............  Esrd related services, day  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90925..............  Esrd related services, day  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90935..............  Hemodialysis, one           ..................  S.................         0170       6.7915      $432.57  ...........       $86.51
                      evaluation.
90937..............  Hemodialysis, repeated      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      eval.
90940..............  Hemodialysis access study.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90945..............  Dialysis, one evaluation..  ..................  S.................         0170       6.7915      $432.57  ...........       $86.51
90947..............  Dialysis, repeated eval...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90989..............  Dialysis training,          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      complete.
90993..............  Dialysis training, incompl  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90997..............  Hemoperfusion.............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90999..............  Dialysis procedure........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
91000..............  Esophageal intubation.....  ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
91010..............  Esophagus motility study..  ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
91011..............  Esophagus motility study..  ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
91012..............  Esophagus motility study..  ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
91020..............  Gastric motility studies..  ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
91022..............  Duodenal motility study...  ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
91030..............  Acid perfusion of           ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
                      esophagus.
91034..............  Gastroesophageal reflux     ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
                      test.
91035..............  G-esoph reflx tst w/        ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
                      electrod.
91037..............  Esoph imped function test.  ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
91038..............  Esoph imped funct test >    ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
                      1h.
91040..............  Esoph balloon distension    ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
                      tst.
91052..............  Gastric analysis test.....  ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
91055..............  Gastric intubation for      ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
                      smear.
91065..............  Breath hydrogen test......  ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
91100..............  Pass intestine bleeding     ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
                      tube.
91105..............  Gastric intubation          ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
                      treatment.
91110..............  Gi tract capsule endoscopy  ..................  T.................         0142       9.6264      $613.13      $152.70      $122.63
91111..............  Esophageal capsule          ..................  T.................         0141        8.673      $552.41      $143.30      $110.48
                      endoscopy.
91120..............  Rectal sensation test.....  ..................  T.................         0126        1.085       $69.11       $16.40       $13.82
91122..............  Anal pressure record......  ..................  T.................         0164       2.1659      $137.95  ...........       $27.59
91123..............  Irrigate fecal impaction..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
91132..............  Electrogastrography.......  ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
91133..............  Electrogastrography w/test  ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
91299..............  Gastroenterology procedure  ..................  X.................         0360       1.6383      $104.35       $33.80       $20.87
92002..............  Eye exam, new patient.....  ..................  V.................         0605       1.0016       $63.79  ...........       $12.76
92004..............  Eye exam, new patient.....  ..................  V.................         0606       1.3665       $87.04  ...........       $17.41
92012..............  Eye exam established pat..  ..................  V.................         0604       0.8381       $53.38  ...........       $10.68
92014..............  Eye exam & treatment......  ..................  V.................         0605       1.0016       $63.79  ...........       $12.76
92015..............  Refraction................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92018..............  New eye exam & treatment..  ..................  T.................         0699      14.2784      $909.43  ...........      $181.89
92019..............  Eye exam & treatment......  ..................  T.................         0699      14.2784      $909.43  ...........      $181.89
92020..............  Special eye evaluation....  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
92025..............  Corneal topography........  ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
92060..............  Special eye evaluation....  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
92065..............  Orthoptic/pleoptic          ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      training.
92070..............  Fitting of contact lens...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
92081..............  Visual field                ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      examination(s).
92082..............  Visual field                ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      examination(s).

[[Page 42998]]

 
92083..............  Visual field                ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      examination(s).
92100..............  Serial tonometry exam(s)..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
92120..............  Tonography & eye            ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      evaluation.
92130..............  Water provocation           ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      tonography.
92135..............  Opthalmic dx imaging......  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
92136..............  Ophthalmic biometry.......  ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
92140..............  Glaucoma provocative tests  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
92225..............  Special eye exam, initial.  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
92226..............  Special eye exam,           ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      subsequent.
92230..............  Eye exam with photos......  ..................  S.................         0231       2.3117      $147.24  ...........       $29.45
92235..............  Eye exam with photos......  ..................  S.................         0231       2.3117      $147.24  ...........       $29.45
92240..............  Icg angiography...........  ..................  S.................         0231       2.3117      $147.24  ...........       $29.45
92250..............  Eye exam with photos......  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
92260..............  Ophthalmoscopy/dynamometry  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
92265..............  Eye muscle evaluation.....  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
92270..............  Electro-oculography.......  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
92275..............  Electroretinography.......  ..................  S.................         0231       2.3117      $147.24  ...........       $29.45
92283..............  Color vision examination..  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
92284..............  Dark adaptation eye exam..  ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
92285..............  Eye photography...........  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
92286..............  Internal eye photography..  ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
92287..............  Internal eye photography..  ..................  S.................         0698       1.1576       $73.73  ...........       $14.75
92310..............  Contact lens fitting......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92311..............  Contact lens fitting......  CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
92312..............  Contact lens fitting......  CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
92313..............  Contact lens fitting......  CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
92314..............  Prescription of contact     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      lens.
92315..............  Prescription of contact     CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      lens.
92316..............  Prescription of contact     CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      lens.
92317..............  Prescription of contact     CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      lens.
92325..............  Modification of contact     CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      lens.
92326..............  Replacement of contact      CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      lens.
92340..............  Fitting of spectacles.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92341..............  Fitting of spectacles.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92342..............  Fitting of spectacles.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92352..............  Special spectacles fitting  CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
92353..............  Special spectacles fitting  CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
92354..............  Special spectacles fitting  CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
92355..............  Special spectacles fitting  CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
92358..............  Eye prosthesis service....  CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
92370..............  Repair & adjust spectacles  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92371..............  Repair & adjust spectacles  CH................  S.................         0230       0.7379       $47.00  ...........        $9.40
92499..............  Eye service or procedure..  ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
92502..............  Ear and throat examination  ..................  T.................         0251       2.5765      $164.11  ...........       $32.82
92504..............  Ear microscopy examination  ..................  N.................  ...........  ...........  ...........  ...........  ...........
92506..............  Speech/hearing evaluation.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92507..............  Speech/hearing therapy....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92508..............  Speech/hearing therapy....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92511..............  Nasopharyngoscopy.........  ..................  T.................         0071       0.8256       $52.58       $11.20       $10.52
92512..............  Nasal function studies....  ..................  X.................         0363       0.8542       $54.41       $17.40       $10.88
92516..............  Facial nerve function test  ..................  X.................         0660       1.4408       $91.77       $28.00       $18.35
92520..............  Laryngeal function studies  ..................  X.................         0660       1.4408       $91.77       $28.00       $18.35
92526..............  Oral function therapy.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92531..............  Spontaneous nystagmus       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      study.
92532..............  Positional nystagmus test.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
92533..............  Caloric vestibular test...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
92534..............  Optokinetic nystagmus test  ..................  N.................  ...........  ...........  ...........  ...........  ...........
92541..............  Spontaneous nystagmus test  ..................  X.................         0363       0.8542       $54.41       $17.40       $10.88
92542..............  Positional nystagmus test.  ..................  X.................         0363       0.8542       $54.41       $17.40       $10.88
92543..............  Caloric vestibular test...  ..................  X.................         0660       1.4408       $91.77       $28.00       $18.35
92544..............  Optokinetic nystagmus test  ..................  X.................         0363       0.8542       $54.41       $17.40       $10.88
92545..............  Oscillating tracking test.  ..................  X.................         0363       0.8542       $54.41       $17.40       $10.88
92546..............  Sinusoidal rotational test  ..................  X.................         0660       1.4408       $91.77       $28.00       $18.35
92547..............  Supplemental electrical     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      test.
92548..............  Posturography.............  ..................  X.................         0660       1.4408       $91.77       $28.00       $18.35
92551..............  Pure tone hearing test,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      air.
92552..............  Pure tone audiometry, air.  ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
92553..............  Audiometry, air & bone....  ..................  X.................         0365        1.281       $81.59       $18.50       $16.32
92555..............  Speech threshold            ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
                      audiometry.
92556..............  Speech audiometry,          ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
                      complete.
92557..............  Comprehensive hearing test  ..................  X.................         0365        1.281       $81.59       $18.50       $16.32
92559..............  Group audiometric testing.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92560..............  Bekesy audiometry, screen.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92561..............  Bekesy audiometry,          ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
                      diagnosis.
92562..............  Loudness balance test.....  ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
92563..............  Tone decay hearing test...  ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
92564..............  Sisi hearing test.........  ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
92565..............  Stenger test, pure tone...  ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67

[[Page 42999]]

 
92567..............  Tympanometry..............  ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
92568..............  Acoustic refl threshold     ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
                      tst.
92569..............  Acoustic reflex decay test  ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
92571..............  Filtered speech hearing     ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
                      test.
92572..............  Staggered spondaic word     ..................  X.................         0366       1.8646      $118.76       $26.10       $23.75
                      test.
92575..............  Sensorineural acuity test.  ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
92576..............  Synthetic sentence test...  ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
92577..............  Stenger test, speech......  ..................  X.................         0366       1.8646      $118.76       $26.10       $23.75
92579..............  Visual audiometry (vra)...  ..................  X.................         0365        1.281       $81.59       $18.50       $16.32
92582..............  Conditioning play           ..................  X.................         0365        1.281       $81.59       $18.50       $16.32
                      audiometry.
92583..............  Select picture audiometry.  ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
92584..............  Electrocochleography......  CH................  S.................         0216        2.768      $176.30  ...........       $35.26
92585..............  Auditor evoke potent,       ..................  S.................         0216        2.768      $176.30  ...........       $35.26
                      compre.
92586..............  Auditor evoke potent,       ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
                      limit.
92587..............  Evoked auditory test......  ..................  X.................         0363       0.8542       $54.41       $17.40       $10.88
92588..............  Evoked auditory test......  ..................  X.................         0660       1.4408       $91.77       $28.00       $18.35
92590..............  Hearing aid exam, one ear.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92591..............  Hearing aid exam, both      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ears.
92592..............  Hearing aid check, one ear  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92593..............  Hearing aid check, both     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ears.
92594..............  Electro hearng aid test,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      one.
92595..............  Electro hearng aid tst,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      both.
92596..............  Ear protector evaluation..  ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
92597..............  Oral speech device eval...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92601..............  Cochlear implt f/up exam <  ..................  X.................         0366       1.8646      $118.76       $26.10       $23.75
                      7.
92602..............  Reprogram cochlear implt <  ..................  X.................         0366       1.8646      $118.76       $26.10       $23.75
                      7.
92603..............  Cochlear implt f/up exam 7  ..................  X.................         0366       1.8646      $118.76       $26.10       $23.75
                      >.
92604..............  Reprogram cochlear implt 7  ..................  X.................         0366       1.8646      $118.76       $26.10       $23.75
                      >.
92605..............  Eval for nonspeech device   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rx.
92606..............  Non-speech device service.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92607..............  Ex for speech device rx,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      1hr.
92608..............  Ex for speech device rx     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      addl.
92609..............  Use of speech device        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      service.
92610..............  Evaluate swallowing         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      function.
92611..............  Motion fluoroscopy/swallow  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92612..............  Endoscopy swallow tst       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      (fees).
92613..............  Endoscopy swallow tst       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      (fees).
92614..............  Laryngoscopic sensory test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92615..............  Eval laryngoscopy sense     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tst.
92616..............  Fees w/laryngeal sense      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
92617..............  Interprt fees/laryngeal     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      test.
92620..............  Auditory function, 60 min.  ..................  X.................         0365        1.281       $81.59       $18.50       $16.32
92621..............  Auditory function, + 15     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      min.
92625..............  Tinnitus assessment.......  ..................  X.................         0365        1.281       $81.59       $18.50       $16.32
92626..............  Eval aud rehab status.....  ..................  X.................         0365        1.281       $81.59       $18.50       $16.32
92627..............  Eval aud status rehab add-  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
92630..............  Aud rehab pre-ling hear     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      loss.
92633..............  Aud rehab postling hear     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      loss.
92640..............  Aud brainstem implt         ..................  X.................         0365        1.281       $81.59       $18.50       $16.32
                      programg.
92700..............  Ent procedure/service.....  ..................  X.................         0364       0.4448       $28.33        $6.98        $5.67
92950..............  Heart/lung resuscitation    ..................  S.................         0094       2.5547      $162.72       $46.20       $32.54
                      cpr.
92953..............  Temporary external pacing.  ..................  S.................         0094       2.5547      $162.72       $46.20       $32.54
92960..............  Cardioversion electric,     ..................  S.................         0679       5.5905      $356.08       $95.30       $71.22
                      ext.
92961..............  Cardioversion, electric,    ..................  S.................         0679       5.5905      $356.08       $95.30       $71.22
                      int.
92970..............  Cardioassist, internal....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
92971..............  Cardioassist, external....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
92973..............  Percut coronary             ..................  T.................         0088      39.8001    $2,534.99      $655.20      $507.00
                      thrombectomy.
92974..............  Cath place, cardio          ..................  T.................         0103      15.2572      $971.78  ...........      $194.36
                      brachytx.
92975..............  Dissolve clot, heart        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vessel.
92977..............  Dissolve clot, heart        ..................  T.................         0676       2.5179      $160.37  ...........       $32.07
                      vessel.
92978..............  Intravasc us, heart add-on  CH................  N.................  ...........  ...........  ...........  ...........  ...........
92979..............  Intravasc us, heart add-on  CH................  N.................  ...........  ...........  ...........  ...........  ...........
92980..............  Insert intracoronary stent  ..................  T.................         0104      89.0212    $5,670.03  ...........    $1,134.01
92981..............  Insert intracoronary stent  ..................  T.................         0104      89.0212    $5,670.03  ...........    $1,134.01
92982..............  Coronary artery dilation..  ..................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
92984..............  Coronary artery dilation..  ..................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
92986..............  Revision of aortic valve..  ..................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
92987..............  Revision of mitral valve..  ..................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
92990..............  Revision of pulmonary       ..................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
                      valve.
92992..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
92993..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
92995..............  Coronary atherectomy......  ..................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83
92996..............  Coronary atherectomy add-   ..................  T.................         0082      88.7717    $5,654.14  ...........    $1,130.83
                      on.
92997..............  Pul art balloon repr,       CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
                      percut.
92998..............  Pul art balloon repr,       CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
                      percut.
93000..............  Electrocardiogram,          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      complete.
93005..............  Electrocardiogram, tracing  ..................  S.................         0099       0.3912       $24.92  ...........        $4.98
93010..............  Electrocardiogram report..  ..................  B.................  ...........  ...........  ...........  ...........  ...........

[[Page 43000]]

 
93012..............  Transmission of ecg.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93014..............  Report on transmitted ecg.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93015..............  Cardiovascular stress test  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93016..............  Cardiovascular stress test  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93017..............  Cardiovascular stress test  ..................  X.................         0100       2.8631      $182.36       $41.40       $36.47
93018..............  Cardiovascular stress test  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93024..............  Cardiac drug stress test..  ..................  X.................         0100       2.8631      $182.36       $41.40       $36.47
93025..............  Microvolt t-wave assess...  ..................  X.................         0100       2.8631      $182.36       $41.40       $36.47
93040..............  Rhythm ECG with report....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93041..............  Rhythm ECG, tracing.......  ..................  S.................         0099       0.3912       $24.92  ...........        $4.98
93042..............  Rhythm ECG, report........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93224..............  ECG monitor/report, 24 hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93225..............  ECG monitor/record, 24 hrs  ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
93226..............  ECG monitor/report, 24 hrs  ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
93227..............  ECG monitor/review, 24 hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93230..............  ECG monitor/report, 24 hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93231..............  Ecg monitor/record, 24 hrs  ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
93232..............  ECG monitor/report, 24 hrs  ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
93233..............  ECG monitor/review, 24 hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93235..............  ECG monitor/report, 24 hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93236..............  ECG monitor/report, 24 hrs  ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
93237..............  ECG monitor/review, 24 hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93268..............  ECG record/review.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93270..............  ECG recording.............  ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
93271..............  Ecg/monitoring and          ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
                      analysis.
93272..............  Ecg/review, interpret only  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93278..............  ECG/signal-averaged.......  CH................  X.................         0340       0.6416       $40.87  ...........        $8.17
93303..............  Echo transthoracic........  ..................  S.................         0269       6.5908      $419.79  ...........       $83.96
93304..............  Echo transthoracic........  ..................  S.................         0697       4.8072      $306.18  ...........       $61.24
93307..............  Echo exam of heart........  ..................  S.................         0269       6.5908      $419.79  ...........       $83.96
93308..............  Echo exam of heart........  ..................  S.................         0697       4.8072      $306.18  ...........       $61.24
93312..............  Echo transesophageal......  ..................  S.................         0270         8.42      $536.30      $141.30      $107.26
93313..............  Echo transesophageal......  ..................  S.................         0270         8.42      $536.30      $141.30      $107.26
93314..............  Echo transesophageal......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93315..............  Echo transesophageal......  ..................  S.................         0270         8.42      $536.30      $141.30      $107.26
93316..............  Echo transesophageal......  ..................  S.................         0270         8.42      $536.30      $141.30      $107.26
93317..............  Echo transesophageal......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93318..............  Echo transesophageal        ..................  S.................         0270         8.42      $536.30      $141.30      $107.26
                      intraop.
93320..............  Doppler echo exam, heart..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93321..............  Doppler echo exam, heart..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93325..............  Doppler color flow add-on.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93350..............  Echo transthoracic........  CH................  S.................         0697       4.8072      $306.18  ...........       $61.24
93501..............  Right heart                 ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
                      catheterization.
93503..............  Insert/place heart          ..................  T.................         0103      15.2572      $971.78  ...........      $194.36
                      catheter.
93505..............  Biopsy of heart lining....  ..................  T.................         0103      15.2572      $971.78  ...........      $194.36
93508..............  Cath placement,             ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
                      angiography.
93510..............  Left heart catheterization  ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
93511..............  Left heart catheterization  ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
93514..............  Left heart catheterization  ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
93524..............  Left heart catheterization  ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
93526..............  Rt & lT heart catheters...  ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
93527..............  Rt & lT heart catheters...  ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
93528..............  Rt & lT heart catheters...  ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
93529..............  Rt, lt heart                ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
                      catheterization.
93530..............  Rt heart cath, congenital.  ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
93531..............  R & l heart cath,           ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
                      congenital.
93532..............  R & l heart cath,           ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
                      congenital.
93533..............  R & l heart cath,           ..................  T.................         0080      39.8631    $2,539.00      $838.90      $507.80
                      congenital.
93539..............  Injection, cardiac cath...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93540..............  Injection, cardiac cath...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93541..............  Injection for lung          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      angiogram.
93542..............  Injection for heart x-rays  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93543..............  Injection for heart x-rays  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93544..............  Injection for aortography.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93545..............  Inject for coronary x-rays  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93555..............  Imaging, cardiac cath.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93556..............  Imaging, cardiac cath.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93561..............  Cardiac output measurement  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93562..............  Cardiac output measurement  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93571..............  Heart flow reserve measure  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93572..............  Heart flow reserve measure  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93580..............  Transcath closure of asd..  ..................  T.................         0434     141.9601    $9,041.86  ...........    $1,808.37
93581..............  Transcath closure of vsd..  ..................  T.................         0434     141.9601    $9,041.86  ...........    $1,808.37
93600..............  Bundle of His recording...  CH................  S.................         0084      10.2918      $655.52  ...........      $131.10
93602..............  Intra-atrial recording....  CH................  S.................         0084      10.2918      $655.52  ...........      $131.10
93603..............  Right ventricular           CH................  S.................         0084      10.2918      $655.52  ...........      $131.10
                      recording.
93609..............  Map tachycardia, add-on...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93610..............  Intra-atrial pacing.......  CH................  S.................         0084      10.2918      $655.52  ...........      $131.10

[[Page 43001]]

 
93612..............  Intraventricular pacing...  CH................  S.................         0084      10.2918      $655.52  ...........      $131.10
93613..............  Electrophys map 3d, add-on  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93615..............  Esophageal recording......  CH................  S.................         0084      10.2918      $655.52  ...........      $131.10
93616..............  Esophageal recording......  CH................  S.................         0084      10.2918      $655.52  ...........      $131.10
93618..............  Heart rhythm pacing.......  CH................  S.................         0084      10.2918      $655.52  ...........      $131.10
93619..............  Electrophysiology           CH................  Q.................         0085      48.6296    $3,097.37  ...........      $619.47
                      evaluation.
93620..............  Electrophysiology           CH................  Q.................         0085      48.6296    $3,097.37  ...........      $619.47
                      evaluation.
93621..............  Electrophysiology           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      evaluation.
93622..............  Electrophysiology           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      evaluation.
93623..............  Stimulation, pacing heart.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93624..............  Electrophysiologic study..  ..................  T.................         0085      48.6296    $3,097.37  ...........      $619.47
93631..............  Heart pacing, mapping.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93640..............  Evaluation heart device...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93641..............  Electrophysiology           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      evaluation.
93642..............  Electrophysiology           ..................  S.................         0084      10.2918      $655.52  ...........      $131.10
                      evaluation.
93650..............  Ablate heart dysrhythm      CH................  Q.................         0085      48.6296    $3,097.37  ...........      $619.47
                      focus.
93651..............  Ablate heart dysrhythm      CH................  Q.................         0086      90.7639    $5,781.03  ...........    $1,156.21
                      focus.
93652..............  Ablate heart dysrhythm      CH................  Q.................         0086      90.7639    $5,781.03  ...........    $1,156.21
                      focus.
93660..............  Tilt table evaluation.....  ..................  S.................         0101       4.4249      $281.84      $100.20       $56.37
93662..............  Intracardiac ecg (ice)....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93668..............  Peripheral vascular rehab.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
93701..............  Bioimpedance, thoracic....  ..................  S.................         0099       0.3912       $24.92  ...........        $4.98
93720..............  Total body plethysmography  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93721..............  Plethysmography tracing...  ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
93722..............  Plethysmography report....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93724..............  Analyze pacemaker system..  ..................  S.................         0690        0.359       $22.87        $8.60        $4.57
93727..............  Analyze ilr system........  ..................  S.................         0690        0.359       $22.87        $8.60        $4.57
93731..............  Analyze pacemaker system..  ..................  S.................         0690        0.359       $22.87        $8.60        $4.57
93732..............  Analyze pacemaker system..  ..................  S.................         0690        0.359       $22.87        $8.60        $4.57
93733..............  Telephone analy, pacemaker  ..................  S.................         0690        0.359       $22.87        $8.60        $4.57
93734..............  Analyze pacemaker system..  ..................  S.................         0690        0.359       $22.87        $8.60        $4.57
93735..............  Analyze pacemaker system..  ..................  S.................         0690        0.359       $22.87        $8.60        $4.57
93736..............  Telephonic analy,           ..................  S.................         0690        0.359       $22.87        $8.60        $4.57
                      pacemaker.
93740..............  Temperature gradient        ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
                      studies.
93741..............  Analyze ht pace device      ..................  S.................         0689       0.5936       $37.81  ...........        $7.56
                      sngl.
93742..............  Analyze ht pace device      ..................  S.................         0689       0.5936       $37.81  ...........        $7.56
                      sngl.
93743..............  Analyze ht pace device      ..................  S.................         0689       0.5936       $37.81  ...........        $7.56
                      dual.
93744..............  Analyze ht pace device      ..................  S.................         0689       0.5936       $37.81  ...........        $7.56
                      dual.
93745..............  Set-up cardiovert-          ..................  S.................         0689       0.5936       $37.81  ...........        $7.56
                      defibrill.
93760..............  Cephalic thermogram.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
93762..............  Peripheral thermogram.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
93770..............  Measure venous pressure...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93784..............  Ambulatory BP monitoring..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
93786..............  Ambulatory BP recording...  ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
93788..............  Ambulatory BP analysis....  ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
93790..............  Review/report BP recording  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93797..............  Cardiac rehab.............  CH................  B.................  ...........  ...........  ...........  ...........  ...........
93798..............  Cardiac rehab/monitor.....  CH................  B.................  ...........  ...........  ...........  ...........  ...........
93799..............  Cardiovascular procedure..  ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
93875..............  Extracranial study........  ..................  S.................         0096       1.5254       $97.16       $37.60       $19.43
93880..............  Extracranial study........  ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
93882..............  Extracranial study........  ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
93886..............  Intracranial study........  ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
93888..............  Intracranial study........  ..................  S.................         0265       0.9925       $63.22       $23.60       $12.64
93890..............  Tcd, vasoreactivity study.  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
93892..............  Tcd, emboli detect w/o inj  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
93893..............  Tcd, emboli detect w/inj..  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
93922..............  Extremity study...........  ..................  S.................         0096       1.5254       $97.16       $37.60       $19.43
93923..............  Extremity study...........  ..................  S.................         0096       1.5254       $97.16       $37.60       $19.43
93924..............  Extremity study...........  ..................  S.................         0096       1.5254       $97.16       $37.60       $19.43
93925..............  Lower extremity study.....  ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
93926..............  Lower extremity study.....  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
93930..............  Upper extremity study.....  ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
93931..............  Upper extremity study.....  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
93965..............  Extremity study...........  ..................  S.................         0096       1.5254       $97.16       $37.60       $19.43
93970..............  Extremity study...........  ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
93971..............  Extremity study...........  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
93975..............  Vascular study............  ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
93976..............  Vascular study............  ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
93978..............  Vascular study............  CH................  S.................         0267       2.4859      $158.33       $60.50       $31.67
93979..............  Vascular study............  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
93980..............  Penile vascular study.....  ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
93981..............  Penile vascular study.....  CH................  S.................         0267       2.4859      $158.33       $60.50       $31.67
93990..............  Doppler flow testing......  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
94002..............  Vent mgmt inpat, init day.  ..................  S.................         0079       2.6745      $170.35  ...........       $34.07
94003..............  Vent mgmt inpat, subq day.  ..................  S.................         0079       2.6745      $170.35  ...........       $34.07
94004..............  Vent mgmt nf per day......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
94005..............  Home vent mgmt supervision  ..................  B.................  ...........  ...........  ...........  ...........  ...........

[[Page 43002]]

 
94010..............  Breathing capacity test...  ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
94014..............  Patient recorded            ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
                      spirometry.
94015..............  Patient recorded            ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
                      spirometry.
94016..............  Review patient spirometry.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
94060..............  Evaluation of wheezing....  ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
94070..............  Evaluation of wheezing....  ..................  X.................         0369       2.7874      $177.54       $44.10       $35.51
94150..............  Vital capacity test.......  ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
94200..............  Lung function test (MBC/    ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
                      MVV).
94240..............  Residual lung capacity....  ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
94250..............  Expired gas collection....  ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
94260..............  Thoracic gas volume.......  ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
94350..............  Lung nitrogen washout       ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
                      curve.
94360..............  Measure airflow resistance  ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
94370..............  Breath airway closing       ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
                      volume.
94375..............  Respiratory flow volume     CH................  X.................         0368       0.9541       $60.77       $22.70       $12.15
                      loop.
94400..............  CO2 breathing response      ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
                      curve.
94450..............  Hypoxia response curve....  ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
94452..............  Hast w/report.............  ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
94453..............  Hast w/oxygen titrate.....  ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
94610..............  Surfactant admin thru tube  ..................  S.................         0077       0.3904       $24.87        $7.70        $4.97
94620..............  Pulmonary stress test/      ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
                      simple.
94621..............  Pulm stress test/complex..  ..................  X.................         0369       2.7874      $177.54       $44.10       $35.51
94640..............  Airway inhalation           ..................  S.................         0077       0.3904       $24.87        $7.70        $4.97
                      treatment.
94642..............  Aerosol inhalation          ..................  S.................         0078       1.3636       $86.85  ...........       $17.37
                      treatment.
94644..............  Cbt, 1st hour.............  ..................  S.................         0078       1.3636       $86.85  ...........       $17.37
94645..............  Cbt, each addl hour.......  ..................  S.................         0078       1.3636       $86.85  ...........       $17.37
94660..............  Pos airway pressure, CPAP.  CH................  S.................         0078       1.3636       $86.85  ...........       $17.37
94662..............  Neg press ventilation, cnp  ..................  S.................         0079       2.6745      $170.35  ...........       $34.07
94664..............  Evaluate pt use of inhaler  ..................  S.................         0077       0.3904       $24.87        $7.70        $4.97
94667..............  Chest wall manipulation...  ..................  S.................         0077       0.3904       $24.87        $7.70        $4.97
94668..............  Chest wall manipulation...  ..................  S.................         0077       0.3904       $24.87        $7.70        $4.97
94680..............  Exhaled air analysis, o2..  CH................  X.................         0368       0.9541       $60.77       $22.70       $12.15
94681..............  Exhaled air analysis, o2/   ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
                      co2.
94690..............  Exhaled air analysis......  ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
94720..............  Monoxide diffusing          ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
                      capacity.
94725..............  Membrane diffusion          ..................  X.................         0368       0.9541       $60.77       $22.70       $12.15
                      capacity.
94750..............  Pulmonary compliance study  CH................  X.................         0368       0.9541       $60.77       $22.70       $12.15
94760..............  Measure blood oxygen level  ..................  N.................  ...........  ...........  ...........  ...........  ...........
94761..............  Measure blood oxygen level  ..................  N.................  ...........  ...........  ...........  ...........  ...........
94762..............  Measure blood oxygen level  CH................  Q.................         0097       1.0396       $66.22       $23.70       $13.24
94770..............  Exhaled carbon dioxide      ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
                      test.
94772..............  Breath recording, infant..  ..................  X.................         0369       2.7874      $177.54       $44.10       $35.51
94774..............  Ped home apnea rec, compl.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
94775..............  Ped home apnea rec, hk-up.  ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
94776..............  Ped home apnea rec, downld  ..................  X.................         0097       1.0396       $66.22       $23.70       $13.24
94777..............  Ped home apnea rec, report  ..................  B.................  ...........  ...........  ...........  ...........  ...........
94799..............  Pulmonary service/          ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
                      procedure.
95004..............  Percut allergy skin tests.  ..................  X.................         0381       0.3014       $19.20  ...........        $3.84
95010..............  Percut allergy titrate      ..................  X.................         0381       0.3014       $19.20  ...........        $3.84
                      test.
95012..............  Exhaled nitric oxide meas.  ..................  X.................         0367       0.5955       $37.93       $14.38        $7.59
95015..............  Id allergy titrate-drug/    ..................  X.................         0381       0.3014       $19.20  ...........        $3.84
                      bug.
95024..............  Id allergy test, drug/bug.  ..................  X.................         0381       0.3014       $19.20  ...........        $3.84
95027..............  Id allergy titrate-         ..................  X.................         0381       0.3014       $19.20  ...........        $3.84
                      airborne.
95028..............  Id allergy test-delayed     ..................  X.................         0381       0.3014       $19.20  ...........        $3.84
                      type.
95044..............  Allergy patch tests.......  ..................  X.................         0381       0.3014       $19.20  ...........        $3.84
95052..............  Photo patch test..........  ..................  X.................         0381       0.3014       $19.20  ...........        $3.84
95056..............  Photosensitivity tests....  ..................  X.................         0370       1.1024       $70.22  ...........       $14.04
95060..............  Eye allergy tests.........  ..................  X.................         0370       1.1024       $70.22  ...........       $14.04
95065..............  Nose allergy test.........  ..................  X.................         0381       0.3014       $19.20  ...........        $3.84
95070..............  Bronchial allergy tests...  ..................  X.................         0369       2.7874      $177.54       $44.10       $35.51
95071..............  Bronchial allergy tests...  ..................  X.................         0369       2.7874      $177.54       $44.10       $35.51
95075..............  Ingestion challenge test..  ..................  X.................         0361       4.0867      $260.29       $83.20       $52.06
95115..............  Immunotherapy, one          ..................  S.................         0436       0.2201       $14.02  ...........        $2.80
                      injection.
95117..............  Immunotherapy injections..  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
95120..............  Immunotherapy, one          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      injection.
95125..............  Immunotherapy, many         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      antigens.
95130..............  Immunotherapy, insect       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      venom.
95131..............  Immunotherapy, insect       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      venoms.
95132..............  Immunotherapy, insect       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      venoms.
95133..............  Immunotherapy, insect       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      venoms.
95134..............  Immunotherapy, insect       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      venoms.
95144..............  Antigen therapy services..  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
95145..............  Antigen therapy services..  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
95146..............  Antigen therapy services..  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
95147..............  Antigen therapy services..  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
95148..............  Antigen therapy services..  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
95149..............  Antigen therapy services..  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
95165..............  Antigen therapy services..  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14

[[Page 43003]]

 
95170..............  Antigen therapy services..  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
95180..............  Rapid desensitization.....  ..................  X.................         0370       1.1024       $70.22  ...........       $14.04
95199..............  Allergy immunology          ..................  X.................         0381       0.3014       $19.20  ...........        $3.84
                      services.
95250..............  Glucose monitoring, cont..  CH................  X.................         0097       1.0396       $66.22       $23.70       $13.24
95251..............  Gluc monitor, cont, phys    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      i&r.
95805..............  Multiple sleep latency      ..................  S.................         0209      11.5647      $736.59      $268.70      $147.32
                      test.
95806..............  Sleep study, unattended...  ..................  S.................         0213       2.3476      $149.53       $53.50       $29.91
95807..............  Sleep study, attended.....  ..................  S.................         0209      11.5647      $736.59      $268.70      $147.32
95808..............  Polysomnography, 1-3......  ..................  S.................         0209      11.5647      $736.59      $268.70      $147.32
95810..............  Polysomnography, 4 or more  ..................  S.................         0209      11.5647      $736.59      $268.70      $147.32
95811..............  Polysomnography w/cpap....  ..................  S.................         0209      11.5647      $736.59      $268.70      $147.32
95812..............  Eeg, 41-60 minutes........  ..................  S.................         0213       2.3476      $149.53       $53.50       $29.91
95813..............  Eeg, over 1 hour..........  ..................  S.................         0213       2.3476      $149.53       $53.50       $29.91
95816..............  Eeg, awake and drowsy.....  ..................  S.................         0213       2.3476      $149.53       $53.50       $29.91
95819..............  Eeg, awake and asleep.....  ..................  S.................         0213       2.3476      $149.53       $53.50       $29.91
95822..............  Eeg, coma or sleep only...  ..................  S.................         0213       2.3476      $149.53       $53.50       $29.91
95824..............  Eeg, cerebral death only..  CH................  S.................         0216        2.768      $176.30  ...........       $35.26
95827..............  Eeg, all night recording..  ..................  S.................         0213       2.3476      $149.53       $53.50       $29.91
95829..............  Surgery electrocorticogram  CH................  N.................  ...........  ...........  ...........  ...........  ...........
95830..............  Insert electrodes for EEG.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
95831..............  Limb muscle testing,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      manual.
95832..............  Hand muscle testing,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      manual.
95833..............  Body muscle testing,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      manual.
95834..............  Body muscle testing,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      manual.
95851..............  Range of motion             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      measurements.
95852..............  Range of motion             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      measurements.
95857..............  Tensilon test.............  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
95860..............  Muscle test, one limb.....  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
95861..............  Muscle test, 2 limbs......  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
95863..............  Muscle test, 3 limbs......  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
95864..............  Muscle test, 4 limbs......  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
95865..............  Muscle test, larynx.......  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
95866..............  Muscle test, hemidiaphragm  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
95867..............  Muscle test cran nerv       ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
                      unilat.
95868..............  Muscle test cran nerve      ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
                      bilat.
95869..............  Muscle test, thor           CH................  S.................         0218       1.1861       $75.55  ...........       $15.11
                      paraspinal.
95870..............  Muscle test, nonparaspinal  ..................  S.................         0215       0.5746       $36.60  ...........        $7.32
95872..............  Muscle test, one fiber....  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
95873..............  Guide nerv destr, elec      CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      stim.
95874..............  Guide nerv destr, needle    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      emg.
95875..............  Limb exercise test........  ..................  S.................         0215       0.5746       $36.60  ...........        $7.32
95900..............  Motor nerve conduction      ..................  S.................         0215       0.5746       $36.60  ...........        $7.32
                      test.
95903..............  Motor nerve conduction      ..................  S.................         0215       0.5746       $36.60  ...........        $7.32
                      test.
95904..............  Sense nerve conduction      ..................  S.................         0215       0.5746       $36.60  ...........        $7.32
                      test.
95920..............  Intraop nerve test add-on.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
95921..............  Autonomic nerv function     ..................  S.................         0215       0.5746       $36.60  ...........        $7.32
                      test.
95922..............  Autonomic nerv function     ..................  S.................         0215       0.5746       $36.60  ...........        $7.32
                      test.
95923..............  Autonomic nerv function     CH................  S.................         0218       1.1861       $75.55  ...........       $15.11
                      test.
95925..............  Somatosensory testing.....  ..................  S.................         0216        2.768      $176.30  ...........       $35.26
95926..............  Somatosensory testing.....  ..................  S.................         0216        2.768      $176.30  ...........       $35.26
95927..............  Somatosensory testing.....  ..................  S.................         0216        2.768      $176.30  ...........       $35.26
95928..............  C motor evoked, uppr limbs  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
95929..............  C motor evoked, lwr limbs.  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
95930..............  Visual evoked potential     ..................  S.................         0216        2.768      $176.30  ...........       $35.26
                      test.
95933..............  Blink reflex test.........  ..................  S.................         0215       0.5746       $36.60  ...........        $7.32
95934..............  H-reflex test.............  ..................  S.................         0215       0.5746       $36.60  ...........        $7.32
95936..............  H-reflex test.............  ..................  S.................         0215       0.5746       $36.60  ...........        $7.32
95937..............  Neuromuscular junction      CH................  S.................         0218       1.1861       $75.55  ...........       $15.11
                      test.
95950..............  Ambulatory eeg monitoring.  ..................  S.................         0209      11.5647      $736.59      $268.70      $147.32
95951..............  EEG monitoring/videorecord  ..................  S.................         0209      11.5647      $736.59      $268.70      $147.32
95953..............  EEG monitoring/computer...  ..................  S.................         0209      11.5647      $736.59      $268.70      $147.32
95954..............  EEG monitoring/giving       CH................  S.................         0218       1.1861       $75.55  ...........       $15.11
                      drugs.
95955..............  EEG during surgery........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
95956..............  Eeg monitoring, cable/      ..................  S.................         0209      11.5647      $736.59      $268.70      $147.32
                      radio.
95957..............  EEG digital analysis......  CH................  N.................  ...........  ...........  ...........  ...........  ...........
95958..............  EEG monitoring/function     ..................  S.................         0213       2.3476      $149.53       $53.50       $29.91
                      test.
95961..............  Electrode stimulation,      ..................  S.................         0216        2.768      $176.30  ...........       $35.26
                      brain.
95962..............  Electrode stim, brain add-  ..................  S.................         0216        2.768      $176.30  ...........       $35.26
                      on.
95965..............  Meg, spontaneous..........  CH................  S.................         0067      61.5205    $3,918.43  ...........      $783.69
95966..............  Meg, evoked, single.......  CH................  S.................         0065      17.1992    $1,095.47  ...........      $219.09
95967..............  Meg, evoked, each add'l...  CH................  S.................         0065      17.1992    $1,095.47  ...........      $219.09
95970..............  Analyze neurostim, no prog  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
95971..............  Analyze neurostim, simple.  ..................  S.................         0692       1.9206      $122.33       $30.10       $24.47
95972..............  Analyze neurostim, complex  CH................  S.................         0663       1.6671      $106.18  ...........       $21.24
95973..............  Analyze neurostim, complex  ..................  S.................         0663       1.6671      $106.18  ...........       $21.24
95974..............  Cranial neurostim, complex  CH................  S.................         0663       1.6671      $106.18  ...........       $21.24
95975..............  Cranial neurostim, complex  ..................  S.................         0692       1.9206      $122.33       $30.10       $24.47
95978..............  Analyze neurostim brain/1h  ..................  S.................         0692       1.9206      $122.33       $30.10       $24.47

[[Page 43004]]

 
95979..............  Analyz neurostim brain      ..................  S.................         0663       1.6671      $106.18  ...........       $21.24
                      addon.
95990..............  Spin/brain pump refil &     ..................  T.................         0125       2.3262      $148.16  ...........       $29.63
                      main.
95991..............  Spin/brain pump refil &     ..................  T.................         0125       2.3262      $148.16  ...........       $29.63
                      main.
95999..............  Neurological procedure....  ..................  S.................         0215       0.5746       $36.60  ...........        $7.32
96000..............  Motion analysis, video/3d.  ..................  S.................         0216        2.768      $176.30  ...........       $35.26
96001..............  Motion test w/ft press      ..................  S.................         0216        2.768      $176.30  ...........       $35.26
                      meas.
96002..............  Dynamic surface emg.......  ..................  S.................         0218       1.1861       $75.55  ...........       $15.11
96003..............  Dynamic fine wire emg.....  ..................  S.................         0215       0.5746       $36.60  ...........        $7.32
96004..............  Phys review of motion       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      tests.
96020..............  Functional brain mapping..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
96040..............  Genetic counseling, 30 min  ..................  B.................  ...........  ...........  ...........  ...........  ...........
96101..............  Psycho testing by psych/    CH................  Q.................         0382       2.6763      $170.46  ...........       $34.09
                      phys.
96102..............  Psycho testing by           CH................  Q.................         0373       1.8183      $115.81  ...........       $23.16
                      technician.
96103..............  Psycho testing admin by     CH................  Q.................         0373       1.8183      $115.81  ...........       $23.16
                      comp.
96105..............  Assessment of aphasia.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
96110..............  Developmental test, lim...  CH................  Q.................         0373       1.8183      $115.81  ...........       $23.16
96111..............  Developmental test, extend  CH................  Q.................         0382       2.6763      $170.46  ...........       $34.09
96116..............  Neurobehavioral status      CH................  Q.................         0382       2.6763      $170.46  ...........       $34.09
                      exam.
96118..............  Neuropsych tst by psych/    CH................  Q.................         0382       2.6763      $170.46  ...........       $34.09
                      phys.
96119..............  Neuropsych testing by tec.  CH................  Q.................         0382       2.6763      $170.46  ...........       $34.09
96120..............  Neuropsych tst admin w/     CH................  Q.................         0373       1.8183      $115.81  ...........       $23.16
                      comp.
96150..............  Assess hlth/behave, init..  CH................  Q.................         0432        0.302       $19.24  ...........        $3.85
96151..............  Assess hlth/behave, subseq  CH................  Q.................         0432        0.302       $19.24  ...........        $3.85
96152..............  Intervene hlth/behave,      CH................  Q.................         0432        0.302       $19.24  ...........        $3.85
                      indiv.
96153..............  Intervene hlth/behave,      CH................  Q.................         0432        0.302       $19.24  ...........        $3.85
                      group.
96154..............  Interv hlth/behav, fam w/   CH................  Q.................         0432        0.302       $19.24  ...........        $3.85
                      pt.
96155..............  Interv hlth/behav fam no    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pt.
96401..............  Chemo, anti-neopl, sq/im..  ..................  S.................         0438        0.831       $52.93  ...........       $10.59
96402..............  Chemo hormon antineopl sq/  ..................  S.................         0438        0.831       $52.93  ...........       $10.59
                      im.
96405..............  Chemo intralesional, up to  ..................  S.................         0438        0.831       $52.93  ...........       $10.59
                      7.
96406..............  Chemo intralesional over 7  ..................  S.................         0438        0.831       $52.93  ...........       $10.59
96409..............  Chemo, iv push, sngl drug.  ..................  S.................         0439       1.7152      $109.25  ...........       $21.85
96411..............  Chemo, iv push, addl drug.  ..................  S.................         0439       1.7152      $109.25  ...........       $21.85
96413..............  Chemo, iv infusion, 1 hr..  ..................  S.................         0441       2.4378      $155.27  ...........       $31.05
96415..............  Chemo, iv infusion, addl    ..................  S.................         0438        0.831       $52.93  ...........       $10.59
                      hr.
96416..............  Chemo prolong infuse w/     ..................  S.................         0441       2.4378      $155.27  ...........       $31.05
                      pump.
96417..............  Chemo iv infus each addl    ..................  S.................         0438        0.831       $52.93  ...........       $10.59
                      seq.
96420..............  Chemo, ia, push tecnique..  ..................  S.................         0439       1.7152      $109.25  ...........       $21.85
96422..............  Chemo ia infusion up to 1   ..................  S.................         0441       2.4378      $155.27  ...........       $31.05
                      hr.
96423..............  Chemo ia infuse each addl   ..................  S.................         0438        0.831       $52.93  ...........       $10.59
                      hr.
96425..............  Chemotherapy,infusion       ..................  S.................         0441       2.4378      $155.27  ...........       $31.05
                      method.
96440..............  Chemotherapy,               ..................  S.................         0441       2.4378      $155.27  ...........       $31.05
                      intracavitary.
96445..............  Chemotherapy,               ..................  S.................         0441       2.4378      $155.27  ...........       $31.05
                      intracavitary.
96450..............  Chemotherapy, into CNS....  ..................  S.................         0441       2.4378      $155.27  ...........       $31.05
96521..............  Refill/maint, portable      ..................  S.................         0440        1.831      $116.62  ...........       $23.32
                      pump.
96522..............  Refill/maint pump/resvr     ..................  S.................         0440        1.831      $116.62  ...........       $23.32
                      syst.
96523..............  Irrig drug delivery device  ..................  Q.................         0624       0.5763       $36.71       $12.60        $7.34
96542..............  Chemotherapy injection....  ..................  S.................         0438        0.831       $52.93  ...........       $10.59
96549..............  Chemotherapy, unspecified.  ..................  S.................         0436       0.2201       $14.02  ...........        $2.80
96567..............  Photodynamic tx, skin.....  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
96570..............  Photodynamic tx, 30 min...  ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
96571..............  Photodynamic tx, addl 15    ..................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      min.
96900..............  Ultraviolet light therapy.  ..................  S.................         0001       0.5204       $33.15        $7.00        $6.63
96902..............  Trichogram................  ..................  N.................  ...........  ...........  ...........  ...........  ...........
96904..............  Whole body photography....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
96910..............  Photochemotherapy with UV-  ..................  S.................         0001       0.5204       $33.15        $7.00        $6.63
                      B.
96912..............  Photochemotherapy with UV-  ..................  S.................         0001       0.5204       $33.15        $7.00        $6.63
                      A.
96913..............  Photochemotherapy, UV-A or  ..................  S.................         0683       2.9292      $186.57  ...........       $37.31
                      B.
96920..............  Laser tx, skin < 250 sq cm  CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
96921..............  Laser tx, skin 250-500 sq   CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      cm.
96922..............  Laser tx, skin > 500 sq cm  CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
96999..............  Dermatological procedure..  CH................  T.................         0012       0.2682       $17.08  ...........        $3.42
97001..............  Pt evaluation.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97002..............  Pt re-evaluation..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97003..............  Ot evaluation.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97004..............  Ot re-evaluation..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97005..............  Athletic train eval.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
97006..............  Athletic train reeval.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
97010..............  Hot or cold packs therapy.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97012..............  Mechanical traction         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      therapy.
97014..............  Electric stimulation        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      therapy.
97016..............  Vasopneumatic device        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      therapy.
97018..............  Paraffin bath therapy.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97022..............  Whirlpool therapy.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97024..............  Diathermy eg, microwave...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97026..............  Infrared therapy..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97028..............  Ultraviolet therapy.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97032..............  Electrical stimulation....  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 43005]]

 
97033..............  Electric current therapy..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97034..............  Contrast bath therapy.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97035..............  Ultrasound therapy........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97036..............  Hydrotherapy..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97039..............  Physical therapy treatment  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97110..............  Therapeutic exercises.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97112..............  Neuromuscular reeducation.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97113..............  Aquatic therapy/exercises.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97116..............  Gait training therapy.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97124..............  Massage therapy...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97139..............  Physical medicine           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
97140..............  Manual therapy............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97150..............  Group therapeutic           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      procedures.
97530..............  Therapeutic activities....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97532..............  Cognitive skills            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      development.
97533..............  Sensory integration.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97535..............  Self care mngment training  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97537..............  Community/work              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      reintegration.
97542..............  Wheelchair mngment          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      training.
97545..............  Work hardening............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97546..............  Work hardening add-on.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97597..............  Active wound care/20 cm or  CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      <.
97598..............  Active wound care > 20 cm.  CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
97602..............  Wound(s) care non-          CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      selective.
97605..............  Neg press wound tx, < 50    CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
                      cm.
97606..............  Neg press wound tx, > 50    CH................  T.................         0015       1.5119       $96.30  ...........       $19.26
                      cm.
97750..............  Physical performance test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97755..............  Assistive technology        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      assess.
97760..............  Orthotic mgmt and training  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97761..............  Prosthetic training.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97762..............  C/o for orthotic/prosth     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      use.
97799..............  Physical medicine           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
97802..............  Medical nutrition, indiv,   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
97803..............  Med nutrition, indiv,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      subseq.
97804..............  Medical nutrition, group..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97810..............  Acupunct w/o stimul 15 min  ..................  E.................  ...........  ...........  ...........  ...........  ...........
97811..............  Acupunct w/o stimul addl    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      15m.
97813..............  Acupunct w/stimul 15 min..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
97814..............  Acupunct w/stimul addl 15m  ..................  E.................  ...........  ...........  ...........  ...........  ...........
98925..............  Osteopathic manipulation..  ..................  S.................         0060       0.4877       $31.06  ...........        $6.21
98926..............  Osteopathic manipulation..  ..................  S.................         0060       0.4877       $31.06  ...........        $6.21
98927..............  Osteopathic manipulation..  ..................  S.................         0060       0.4877       $31.06  ...........        $6.21
98928..............  Osteopathic manipulation..  ..................  S.................         0060       0.4877       $31.06  ...........        $6.21
98929..............  Osteopathic manipulation..  ..................  S.................         0060       0.4877       $31.06  ...........        $6.21
98940..............  Chiropractic manipulation.  ..................  S.................         0060       0.4877       $31.06  ...........        $6.21
98941..............  Chiropractic manipulation.  ..................  S.................         0060       0.4877       $31.06  ...........        $6.21
98942..............  Chiropractic manipulation.  ..................  S.................         0060       0.4877       $31.06  ...........        $6.21
98943..............  Chiropractic manipulation.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
98960..............  Self-mgmt educ & train, 1   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pt.
98961..............  Self-mgmt educ/train, 2-4   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pt.
98962..............  Self-mgmt educ/train, 5-8   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pt.
99000..............  Specimen handling.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99001..............  Specimen handling.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99002..............  Device handling...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99024..............  Postop follow-up visit....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99026..............  In-hospital on call         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      service.
99027..............  Out-of-hosp on call         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      service.
99050..............  Medical services after hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99051..............  Med serv, eve/wkend/        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      holiday.
99053..............  Med serv 10pm-8am, 24 hr    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fac.
99056..............  Med service out of office.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99058..............  Office emergency care.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99060..............  Out of office emerg med     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      serv.
99070..............  Special supplies..........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99071..............  Patient education           ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      materials.
99075..............  Medical testimony.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99078..............  Group health education....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99080..............  Special reports or forms..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99082..............  Unusual physician travel..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99090..............  Computer data analysis....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99091..............  Collect/review data from    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      pt.
99100..............  Special anesthesia service  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99116..............  Anesthesia with             ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      hypothermia.
99135..............  Special anesthesia          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
99140..............  Emergency anesthesia......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99143..............  Mod cs by same phys, < 5    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      yrs.
99144..............  Mod cs by same phys, 5 yrs  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      +.
99145..............  Mod cs by same phys add-on  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 43006]]

 
99148..............  Mod cs diff phys < 5 yrs..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99149..............  Mod cs diff phys 5 yrs +..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99150..............  Mod cs diff phys add-on...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99170..............  Anogenital exam, child....  ..................  T.................         0191       0.1414        $9.01        $2.50        $1.80
99172..............  Ocular function screen....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99173..............  Visual acuity screen......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99175..............  Induction of vomiting.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99183..............  Hyperbaric oxygen therapy.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99185..............  Regional hypothermia......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99186..............  Total body hypothermia....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99190..............  Special pump services.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99191..............  Special pump services.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99192..............  Special pump services.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99195..............  Phlebotomy................  CH................  X.................         0624       0.5763       $36.71       $12.60        $7.34
99199..............  Special service/proc/       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      report.
99201..............  Office/outpatient visit,    ..................  V.................         0604       0.8381       $53.38  ...........       $10.68
                      new.
99202..............  Office/outpatient visit,    ..................  V.................         0605       1.0016       $63.79  ...........       $12.76
                      new.
99203..............  Office/outpatient visit,    ..................  V.................         0606       1.3665       $87.04  ...........       $17.41
                      new.
99204..............  Office/outpatient visit,    ..................  V.................         0607       1.7181      $109.43  ...........       $21.89
                      new.
99205..............  Office/outpatient visit,    ..................  V.................         0608       2.2077      $140.62  ...........       $28.12
                      new.
99211..............  Office/outpatient visit,    ..................  V.................         0604       0.8381       $53.38  ...........       $10.68
                      est.
99212..............  Office/outpatient visit,    ..................  V.................         0605       1.0016       $63.79  ...........       $12.76
                      est.
99213..............  Office/outpatient visit,    ..................  V.................         0605       1.0016       $63.79  ...........       $12.76
                      est.
99214..............  Office/outpatient visit,    ..................  V.................         0606       1.3665       $87.04  ...........       $17.41
                      est.
99215..............  Office/outpatient visit,    ..................  V.................         0607       1.7181      $109.43  ...........       $21.89
                      est.
99217..............  Observation care discharge  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99218..............  Observation care..........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99219..............  Observation care..........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99220..............  Observation care..........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99221..............  Initial hospital care.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99222..............  Initial hospital care.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99223..............  Initial hospital care.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99231..............  Subsequent hospital care..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99232..............  Subsequent hospital care..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99233..............  Subsequent hospital care..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99234..............  Observ/hosp same date.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99235..............  Observ/hosp same date.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99236..............  Observ/hosp same date.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99238..............  Hospital discharge day....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99239..............  Hospital discharge day....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99241..............  Office consultation.......  CH................  B.................  ...........  ...........  ...........  ...........  ...........
99242..............  Office consultation.......  CH................  B.................  ...........  ...........  ...........  ...........  ...........
99243..............  Office consultation.......  CH................  B.................  ...........  ...........  ...........  ...........  ...........
99244..............  Office consultation.......  CH................  B.................  ...........  ...........  ...........  ...........  ...........
99245..............  Office consultation.......  CH................  B.................  ...........  ...........  ...........  ...........  ...........
99251..............  Inpatient consultation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99252..............  Inpatient consultation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99253..............  Inpatient consultation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99254..............  Inpatient consultation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99255..............  Inpatient consultation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99281..............  Emergency dept visit......  ..................  V.................         0609       0.8271       $52.68       $12.70       $10.54
99282..............  Emergency dept visit......  ..................  V.................         0613       1.3789       $87.83       $21.00       $17.57
99283..............  Emergency dept visit......  ..................  V.................         0614       2.1716      $138.32       $34.50       $27.66
99284..............  Emergency dept visit......  ..................  V.................         0615       3.5191      $224.14       $48.40       $44.83
99285..............  Emergency dept visit......  ..................  V.................         0616       5.4765      $348.81       $75.10       $69.76
99288..............  Direct advanced life        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      support.
99289..............  Ped crit care transport...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99290..............  Ped crit care transport     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      addl.
99291..............  Critical care, first hour.  ..................  S.................         0617       6.8478      $436.16      $111.50       $87.23
99292..............  Critical care, add'l 30     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      min.
99293..............  Ped critical care, initial  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99294..............  Ped critical care, subseq.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99295..............  Neonate crit care, initial  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99296..............  Neonate critical care       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      subseq.
99298..............  Ic for lbw infant < 1500    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      gm.
99299..............  Ic, lbw infant 1500-2500    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      gm.
99300..............  Ic, infant pbw 2501-5000    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      gm.
99304..............  Nursing facility care,      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      init.
99305..............  Nursing facility care,      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      init.
99306..............  Nursing facility care,      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      init.
99307..............  Nursing fac care, subseq..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99308..............  Nursing fac care, subseq..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99309..............  Nursing fac care, subseq..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99310..............  Nursing fac care, subseq..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99315..............  Nursing fac discharge day.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99316..............  Nursing fac discharge day.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99318..............  Annual nursing fac          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      assessmnt.
99324..............  Domicil/r-home visit new    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.

[[Page 43007]]

 
99325..............  Domicil/r-home visit new    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99326..............  Domicil/r-home visit new    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99327..............  Domicil/r-home visit new    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99328..............  Domicil/r-home visit new    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99334..............  Domicil/r-home visit est    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99335..............  Domicil/r-home visit est    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99336..............  Domicil/r-home visit est    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99337..............  Domicil/r-home visit est    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99339..............  Domicil/r-home care         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      supervis.
99340..............  Domicil/r-home care         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      supervis.
99341..............  Home visit, new patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99342..............  Home visit, new patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99343..............  Home visit, new patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99344..............  Home visit, new patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99345..............  Home visit, new patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99347..............  Home visit, est patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99348..............  Home visit, est patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99349..............  Home visit, est patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99350..............  Home visit, est patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99354..............  Prolonged service, office.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99355..............  Prolonged service, office.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99356..............  Prolonged service,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      inpatient.
99357..............  Prolonged service,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      inpatient.
99358..............  Prolonged serv, w/o         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      contact.
99359..............  Prolonged serv, w/o         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      contact.
99360..............  Physician standby services  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99361..............  Physician/team conference.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99362..............  Physician/team conference.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99363..............  Anticoag mgmt, init.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99364..............  Anticoag mgmt, subseq.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99371..............  Physician phone             ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      consultation.
99372..............  Physician phone             ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      consultation.
99373..............  Physician phone             ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      consultation.
99374..............  Home health care            ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      supervision.
99375..............  Home health care            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      supervision.
99377..............  Hospice care supervision..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99378..............  Hospice care supervision..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99379..............  Nursing fac care            ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      supervision.
99380..............  Nursing fac care            ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      supervision.
99381..............  Init pm e/m, new pat, inf.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99382..............  Init pm e/m, new pat 1-4    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      yrs.
99383..............  Prev visit, new, age 5-11.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99384..............  Prev visit, new, age 12-17  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99385..............  Prev visit, new, age 18-39  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99386..............  Prev visit, new, age 40-64  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99387..............  Init pm e/m, new pat 65+    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      yrs.
99391..............  Per pm reeval, est pat,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      inf.
99392..............  Prev visit, est, age 1-4..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99393..............  Prev visit, est, age 5-11.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99394..............  Prev visit, est, age 12-17  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99395..............  Prev visit, est, age 18-39  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99396..............  Prev visit, est, age 40-64  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99397..............  Per pm reeval est pat 65+   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      yr.
99401..............  Preventive counseling,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      indiv.
99402..............  Preventive counseling,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      indiv.
99403..............  Preventive counseling,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      indiv.
99404..............  Preventive counseling,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      indiv.
99411..............  Preventive counseling,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      group.
99412..............  Preventive counseling,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      group.
99420..............  Health risk assessment      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      test.
99429..............  Unlisted preventive         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      service.
99431..............  Initial care, normal        ..................  V.................         0605       1.0016       $63.79  ...........       $12.76
                      newborn.
99432..............  Newborn care, not in hosp.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99433..............  Normal newborn care/        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      hospital.
99435..............  Newborn discharge day hosp  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99436..............  Attendance, birth.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99440..............  Newborn resuscitation.....  ..................  S.................         0094       2.5547      $162.72       $46.20       $32.54
99450..............  Basic life disability exam  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99455..............  Work related disability     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      exam.
99456..............  Disability examination....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99499..............  Unlisted e&m service......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99500..............  Home visit, prenatal......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99501..............  Home visit, postnatal.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99502..............  Home visit, nb care.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99503..............  Home visit, resp therapy..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99504..............  Home visit mech ventilator  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99505..............  Home visit, stoma care....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99506..............  Home visit, im injection..  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 43008]]

 
99507..............  Home visit, cath maintain.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99509..............  Home visit day life         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      activity.
99510..............  Home visit, sing/m/fam      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      couns.
99511..............  Home visit, fecal/enema     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mgmt.
99512..............  Home visit for              ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      hemodialysis.
99600..............  Home visit nos............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99601..............  Home infusion/visit, 2 hrs  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99602..............  Home infusion, each addtl   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      hr.
A0021..............  Outside state ambulance     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      serv.
A0080..............  Noninterest escort in non   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      er.
A0090..............  Interest escort in non er.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A0100..............  Nonemergency transport      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      taxi.
A0110..............  Nonemergency transport bus  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A0120..............  Noner transport mini-bus..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A0130..............  Noner transport wheelch     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      van.
A0140..............  Nonemergency transport air  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A0160..............  Noner transport case        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      worker.
A0170..............  Transport parking fees/     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tolls.
A0180..............  Noner transport lodgng      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      recip.
A0190..............  Noner transport meals       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      recip.
A0200..............  Noner transport lodgng      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      escrt.
A0210..............  Noner transport meals       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      escort.
A0225..............  Neonatal emergency          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      transport.
A0380..............  Basic life support mileage  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0382..............  Basic support routine       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      suppls.
A0384..............  Bls defibrillation          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      supplies.
A0390..............  Advanced life support       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mileag.
A0392..............  Als defibrillation          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      supplies.
A0394..............  Als IV drug therapy         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      supplies.
A0396..............  Als esophageal intub        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      suppls.
A0398..............  Als routine disposble       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      suppls.
A0420..............  Ambulance waiting 1/2 hr..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0422..............  Ambulance 02 life           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sustaining.
A0424..............  Extra ambulance attendant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0425..............  Ground mileage............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0426..............  Als 1.....................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0427..............  ALS1-emergency............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0428..............  bls.......................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0429..............  BLS-emergency.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0430..............  Fixed wing air transport..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0431..............  Rotary wing air transport.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0432..............  PI volunteer ambulance co.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0433..............  als 2.....................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0434..............  Specialty care transport..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0435..............  Fixed wing air mileage....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0436..............  Rotary wing air mileage...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0888..............  Noncovered ambulance        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mileage.
A0998..............  Ambulance response/         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      treatment.
A0999..............  Unlisted ambulance service  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4206..............  1 CC sterile                ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      syringe&needle.
A4207..............  2 CC sterile                ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      syringe&needle.
A4208..............  3 CC sterile                ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      syringe&needle.
A4209..............  5+ CC sterile               ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      syringe&needle.
A4210..............  Nonneedle injection device  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4211..............  Supp for self-adm           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      injections.
A4212..............  Non coring needle or        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      stylet.
A4213..............  20+ CC syringe only.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4215..............  Sterile needle............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4216..............  Sterile water/saline, 10    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ml.
A4217..............  Sterile water/saline, 500   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ml.
A4218..............  Sterile saline or water...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4220..............  Infusion pump refill kit..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4221..............  Maint drug infus cath per   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wk.
A4222..............  Infusion supplies with      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pump.
A4223..............  Infusion supplies w/o pump  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4230..............  Infus insulin pump non      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      needl.
A4231..............  Infusion insulin pump       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      needle.
A4232..............  Syringe w/needle insulin    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      3cc.
A4233..............  Alkalin batt for glucose    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mon.
A4234..............  J-cell batt for glucose     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mon.
A4235..............  Lithium batt for glucose    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mon.
A4236..............  Silvr oxide batt glucose    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mon.
A4244..............  Alcohol or peroxide per     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pint.
A4245..............  Alcohol wipes per box.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4246..............  Betadine/phisohex solution  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4247..............  Betadine/iodine swabs/      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      wipes.
A4248..............  Chlorhexidine antisept....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4250..............  Urine reagent strips/       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tablets.

[[Page 43009]]

 
A4253..............  Blood glucose/reagent       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      strips.
A4255..............  Glucose monitor platforms.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4256..............  Calibrator solution/chips.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4257..............  Replace Lensshield          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      Cartridge.
A4258..............  Lancet device each........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4259..............  Lancets per box...........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4261..............  Cervical cap contraceptive  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4262..............  Temporary tear duct plug..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4263..............  Permanent tear duct plug..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4265..............  Paraffin..................  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4266..............  Diaphragm.................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4267..............  Male condom...............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4268..............  Female condom.............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4269..............  Spermicide................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4270..............  Disposable endoscope        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      sheath.
A4280..............  Brst prsths adhsv attchmnt  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4281..............  Replacement breastpump      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tube.
A4282..............  Replacement breastpump      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      adpt.
A4283..............  Replacement breastpump cap  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4284..............  Replcmnt breast pump        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      shield.
A4285..............  Replcmnt breast pump        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bottle.
A4286..............  Replcmnt breastpump lok     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ring.
A4290..............  Sacral nerve stim test      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      lead.
A4300..............  Cath impl vasc access       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      portal.
A4301..............  Implantable access syst     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      perc.
A4305..............  Drug delivery system        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      [gE]50 ML.
A4306..............  Drug delivery system        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      [lE]50 ml.
A4310..............  Insert tray w/o bag/cath..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4311..............  Catheter w/o bag 2-way      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      latex.
A4312..............  Cath w/o bag 2-way          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      silicone.
A4313..............  Catheter w/bag 3-way......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4314..............  Cath w/drainage 2-way       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      latex.
A4315..............  Cath w/drainage 2-way       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      silcne.
A4316..............  Cath w/drainage 3-way.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4320..............  Irrigation tray...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4321..............  Cath therapeutic irrig      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      agent.
A4322..............  Irrigation syringe........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4326..............  Male external catheter....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4327..............  Fem urinary collect dev     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cup.
A4328..............  Fem urinary collect pouch.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4330..............  Stool collection pouch....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4331..............  Extension drainage tubing.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4332..............  Lube sterile packet.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4333..............  Urinary cath anchor device  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4334..............  Urinary cath leg strap....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4335..............  Incontinence supply.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4338..............  Indwelling catheter latex.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4340..............  Indwelling catheter         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      special.
A4344..............  Cath indw foley 2 way       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      silicn.
A4346..............  Cath indw foley 3 way.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4349..............  Disposable male external    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cat.
A4351..............  Straight tip urine          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      catheter.
A4352..............  Coude tip urinary catheter  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4353..............  Intermittent urinary cath.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4354..............  Cath insertion tray w/bag.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4355..............  Bladder irrigation tubing.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4356..............  Ext ureth clmp or compr     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dvc.
A4357..............  Bedside drainage bag......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4358..............  Urinary leg or abdomen bag  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4361..............  Ostomy face plate.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4362..............  Solid skin barrier........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4363..............  Ostomy clamp, replacement.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4364..............  Adhesive, liquid or equal.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4365..............  Adhesive remover wipes....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4366..............  Ostomy vent...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4367..............  Ostomy belt...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4368..............  Ostomy filter.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4369..............  Skin barrier liquid per oz  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4371..............  Skin barrier powder per oz  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4372..............  Skin barrier solid 4x4      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equiv.
A4373..............  Skin barrier with flange..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4375..............  Drainable plastic pch w     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fcpl.
A4376..............  Drainable rubber pch w      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fcplt.
A4377..............  Drainable plstic pch w/o    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fp.
A4378..............  Drainable rubber pch w/o    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fp.
A4379..............  Urinary plastic pouch w     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fcpl.
A4380..............  Urinary rubber pouch w      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fcplt.
A4381..............  Urinary plastic pouch w/o   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fp.

[[Page 43010]]

 
A4382..............  Urinary hvy plstc pch w/o   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fp.
A4383..............  Urinary rubber pouch w/o    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fp.
A4384..............  Ostomy faceplt/silicone     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ring.
A4385..............  Ost skn barrier sld ext     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wear.
A4387..............  Ost clsd pouch w att st     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      barr.
A4388..............  Drainable pch w ex wear     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      barr.
A4389..............  Drainable pch w st wear     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      barr.
A4390..............  Drainable pch ex wear       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      convex.
A4391..............  Urinary pouch w ex wear     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      barr.
A4392..............  Urinary pouch w st wear     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      barr.
A4393..............  Urine pch w ex wear bar     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      conv.
A4394..............  Ostomy pouch liq deodorant  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4395..............  Ostomy pouch solid          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      deodorant.
A4396..............  Peristomal hernia supprt    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      blt.
A4397..............  Irrigation supply sleeve..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4398..............  Ostomy irrigation bag.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4399..............  Ostomy irrig cone/cath w    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      brs.
A4400..............  Ostomy irrigation set.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4402..............  Lubricant per ounce.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4404..............  Ostomy ring each..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4405..............  Nonpectin based ostomy      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      paste.
A4406..............  Pectin based ostomy paste.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4407..............  Ext wear ost skn barr       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      [lE]4sq''.
A4408..............  Ext wear ost skn barr       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      >4sq''.
A4409..............  Ost skn barr convex [lE]4   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sq i.
A4410..............  Ost skn barr extnd >4 sq..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4411..............  Ost skn barr extnd =4sq...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4412..............  Ost pouch drain high        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      output.
A4413..............  2 pc drainable ost pouch..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4414..............  Ost sknbar w/o conv[lE]4    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sq in.
A4415..............  Ost skn barr w/o conv >4    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sqi.
A4416..............  Ost pch clsd w barrier/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      filtr.
A4417..............  Ost pch w bar/bltinconv/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fltr.
A4418..............  Ost pch clsd w/o bar w      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      filtr.
A4419..............  Ost pch for bar w flange/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flt.
A4420..............  Ost pch clsd for bar w lk   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fl.
A4421..............  Ostomy supply misc........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4422..............  Ost pouch absorbent         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      material.
A4423..............  Ost pch for bar w lk fl/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fltr.
A4424..............  Ost pch drain w bar &       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      filter.
A4425..............  Ost pch drain for barrier   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fl.
A4426..............  Ost pch drain 2 piece       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      system.
A4427..............  Ost pch drain/barr lk flng/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      f.
A4428..............  Urine ost pouch w faucet/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tap.
A4429..............  Urine ost pouch w           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bltinconv.
A4430..............  Ost urine pch w b/bltin     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      conv.
A4431..............  Ost pch urine w barrier/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tapv.
A4432..............  Os pch urine w bar/fange/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tap.
A4433..............  Urine ost pch bar w lock    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fln.
A4434..............  Ost pch urine w lock flng/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ft.
A4450..............  Non-waterproof tape.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4452..............  Waterproof tape...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4455..............  Adhesive remover per ounce  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4458..............  Reusable enema bag........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4461..............  Surgicl dress hold non-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      reuse.
A4463..............  Surgical dress holder       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      reuse.
A4465..............  Non-elastic extremity       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      binder.
A4470..............  Gravlee jet washer........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4480..............  Vabra aspirator...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4481..............  Tracheostoma filter.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4483..............  Moisture exchanger........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4490..............  Above knee surgical         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      stocking.
A4495..............  Thigh length surg stocking  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4500..............  Below knee surgical         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      stocking.
A4510..............  Full length surg stocking.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4520..............  Incontinence garment        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anytype.
A4550..............  Surgical trays............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
A4554..............  Disposable underpads......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4556..............  Electrodes, pair..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4557..............  Lead wires, pair..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4558..............  Conductive gel or paste...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4559..............  Coupling gel or paste.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4561..............  Pessary rubber, any type..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4562..............  Pessary, non rubber,any     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      type.
A4565..............  Slings....................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4570..............  Splint....................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4575..............  Hyperbaric o2 chamber       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      disps.
A4580..............  Cast supplies (plaster)...  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 43011]]

 
A4590..............  Special casting material..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4595..............  TENS suppl 2 lead per       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      month.
A4600..............  Sleeve, inter limb comp     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      dev.
A4601..............  Lith ion batt, non-pros     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      use.
A4604..............  Tubing with heating         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      element.
A4605..............  Trach suction cath close    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      sys.
A4606..............  Oxygen probe used w         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      oximeter.
A4608..............  Transtracheal oxygen cath.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4611..............  Heavy duty battery........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4612..............  Battery cables............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4613..............  Battery charger...........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4614..............  Hand-held PEFR meter......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4615..............  Cannula nasal.............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4616..............  Tubing (oxygen) per foot..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4617..............  Mouth piece...............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4618..............  Breathing circuits........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4619..............  Face tent.................  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4620..............  Variable concentration      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mask.
A4623..............  Tracheostomy inner cannula  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4624..............  Tracheal suction tube.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4625..............  Trach care kit for new      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      trach.
A4626..............  Tracheostomy cleaning       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      brush.
A4627..............  Spacer bag/reservoir......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4628..............  Oropharyngeal suction cath  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4629..............  Tracheostomy care kit.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4630..............  Repl bat t.e.n.s. own by    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pt.
A4633..............  Uvl replacement bulb......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4634..............  Replacement bulb th         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lightbox.
A4635..............  Underarm crutch pad.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4636..............  Handgrip for cane etc.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4637..............  Repl tip cane/crutch/       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      walker.
A4638..............  Repl batt pulse gen sys...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4639..............  Infrared ht sys replcmnt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pad.
A4640..............  Alternating pressure pad..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4641..............  Radiopharm dx agent noc...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4642..............  In111 satumomab...........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A4649..............  Surgical supplies.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4651..............  Calibrated microcap tube..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4652..............  Microcapillary tube         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sealant.
A4653..............  PD catheter anchor belt...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4657..............  Syringe w/wo needle.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4660..............  Sphyg/bp app w cuff and     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stet.
A4663..............  Dialysis blood pressure     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cuff.
A4670..............  Automatic bp monitor, dial  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4671..............  Disposable cycler set.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
A4672..............  Drainage ext line,          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dialysis.
A4673..............  Ext line w easy lock        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      connect.
A4674..............  Chem/antisept solution,     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      8oz.
A4680..............  Activated carbon filter,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ea.
A4690..............  Dialyzer, each............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4706..............  Bicarbonate conc sol per    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gal.
A4707..............  Bicarbonate conc pow per    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pac.
A4708..............  Acetate conc sol per        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gallon.
A4709..............  Acid conc sol per gallon..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4714..............  Treated water per gallon..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4719..............  ``Y set'' tubing..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4720..............  Dialysat sol fld vol >      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      249cc.
A4721..............  Dialysat sol fld vol >      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      999cc.
A4722..............  Dialys sol fld vol >        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      1999cc.
A4723..............  Dialys sol fld vol >        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2999cc.
A4724..............  Dialys sol fld vol >        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      3999cc.
A4725..............  Dialys sol fld vol >        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4999cc.
A4726..............  Dialys sol fld vol >        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      5999cc.
A4728..............  Dialysate solution, non-    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dex.
A4730..............  Fistula cannulation set,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ea.
A4736..............  Topical anesthetic, per     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gram.
A4737..............  Inj anesthetic per 10 ml..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4740..............  Shunt accessory...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4750..............  Art or venous blood tubing  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4755..............  Comb art/venous blood       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tubing.
A4760..............  Dialysate sol test kit,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
A4765..............  Dialysate conc pow per      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pack.
A4766..............  Dialysate conc sol add 10   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ml.
A4770..............  Blood collection tube/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      vacuum.
A4771..............  Serum clotting time tube..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4772..............  Blood glucose test strips.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4773..............  Occult blood test strips..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4774..............  Ammonia test strips.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 43012]]

 
A4802..............  Protamine sulfate per 50    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mg.
A4860..............  Disposable catheter tips..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4870..............  Plumb/elec wk hm hemo       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equip.
A4890..............  Repair/maint cont hemo      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equip.
A4911..............  Drain bag/bottle..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4913..............  Misc dialysis supplies noc  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4918..............  Venous pressure clamp.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4927..............  Non-sterile gloves........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4928..............  Surgical mask.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4929..............  Tourniquet for dialysis,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ea.
A4930..............  Sterile, gloves per pair..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4931..............  Reusable oral thermometer.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4932..............  Reusable rectal             ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      thermometer.
A5051..............  Pouch clsd w barr attached  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5052..............  Clsd ostomy pouch w/o barr  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5053..............  Clsd ostomy pouch           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      faceplate.
A5054..............  Clsd ostomy pouch w/flange  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5055..............  Stoma cap.................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5061..............  Pouch drainable w barrier   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      at.
A5062..............  Drnble ostomy pouch w/o     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      barr.
A5063..............  Drain ostomy pouch w/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flange.
A5071..............  Urinary pouch w/barrier...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5072..............  Urinary pouch w/o barrier.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5073..............  Urinary pouch on barr w/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flng.
A5081..............  Continent stoma plug......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5082..............  Continent stoma catheter..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5093..............  Ostomy accessory convex     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inse.
A5102..............  Bedside drain btl w/wo      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tube.
A5105..............  Urinary suspensory........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5112..............  Urinary leg bag...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5113..............  Latex leg strap...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5114..............  Foam/fabric leg strap.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5120..............  Skin barrier, wipe or swab  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5121..............  Solid skin barrier 6x6....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5122..............  Solid skin barrier 8x8....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5126..............  Disk/foam pad +or-          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adhesive.
A5131..............  Appliance cleaner.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5200..............  Percutaneous catheter       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      anchor.
A5500..............  Diab shoe for density       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      insert.
A5501..............  Diabetic custom molded      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      shoe.
A5503..............  Diabetic shoe w/roller/     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      rockr.
A5504..............  Diabetic shoe with wedge..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A5505..............  Diab shoe w/metatarsal bar  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A5506..............  Diabetic shoe w/off set     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      heel.
A5507..............  Modification diabetic shoe  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A5508..............  Diabetic deluxe shoe......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A5510..............  Compression form shoe       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      insert.
A5512..............  Multi den insert direct     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      form.
A5513..............  Multi den insert custom     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mold.
A6000..............  Wound warming wound cover.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6010..............  Collagen based wound        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      filler.
A6011..............  Collagen gel/paste wound    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fil.
A6021..............  Collagen dressing [lE]16    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sq in.
A6022..............  Collagen drsg>6[lE]48 sq    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6023..............  Collagen dressing >48 sq    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6024..............  Collagen dsg wound filler.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6025..............  Silicone gel sheet, each..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6154..............  Wound pouch each..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6196..............  Alginate dressing [lE]16    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sq in.
A6197..............  Alginate drsg >16 [lE]48    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sq in.
A6198..............  alginate dressing > 48 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6199..............  Alginate drsg wound filler  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6200..............  Compos drsg [lE]16 no       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      border.
A6201..............  Compos drsg >16[lE]48 no    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6202..............  Compos drsg >48 no border.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6203..............  Composite drsg [lE] 16 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6204..............  Composite drsg >16[lE]48    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sq in.
A6205..............  Composite drsg > 48 sq in.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6206..............  Contact layer [lE] 16 sq    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6207..............  Contact layer >16[lE] 48    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sq in.
A6208..............  Contact layer > 48 sq in..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6209..............  Foam drsg [lE]16 sq in w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6210..............  Foam drg >16[lE]48 sq in w/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      o b.
A6211..............  Foam drg > 48 sq in w/o     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      brdr.
A6212..............  Foam drg [lE]16 sq in w/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      border.
A6213..............  Foam drg >16[lE]48 sq in w/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6214..............  Foam drg > 48 sq in w/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      border.
A6215..............  Foam dressing wound filler  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 43013]]

 
A6216..............  Non-sterile gauze[lE]16 sq  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6217..............  Non-sterile gauze>16[lE]48  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sq.
A6218..............  Non-sterile gauze > 48 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6219..............  Gauze [lE] 16 sq in w/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      border.
A6220..............  Gauze >16 [lE]48 sq in w/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bordr.
A6221..............  Gauze > 48 sq in w/border.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6222..............  Gauze [lE]16 in no w/sal w/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      o b.
A6223..............  Gauze >16[lE]48 no w/sal w/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      o b.
A6224..............  Gauze > 48 in no w/sal w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6228..............  Gauze [lE] 16 sq in water/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sal.
A6229..............  Gauze >16[lE]48 sq in watr/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sal.
A6230..............  Gauze > 48 sq in water/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      salne.
A6231..............  Hydrogel dsg[lE]16 sq in..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6232..............  Hydrogel dsg>16[lE]48 sq    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6233..............  Hydrogel dressing >48 sq    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6234..............  Hydrocolld drg [lE]16 w/o   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6235..............  Hydrocolld drg >16[lE]48 w/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      o b.
A6236..............  Hydrocolld drg > 48 in w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6237..............  Hydrocolld drg [lE]16 in w/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6238..............  Hydrocolld drg >16[lE]48 w/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6239..............  Hydrocolld drg > 48 in w/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6240..............  Hydrocolld drg filler       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      paste.
A6241..............  Hydrocolloid drg filler     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dry.
A6242..............  Hydrogel drg [lE]16 in w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6243..............  Hydrogel drg >16[lE]48 w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6244..............  Hydrogel drg >48 in w/o     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6245..............  Hydrogel drg [lE] 16 in w/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6246..............  Hydrogel drg >16[lE]48 in   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      w/b.
A6247..............  Hydrogel drg > 48 sq in w/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6248..............  Hydrogel drsg gel filler..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6250..............  Skin seal protect           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      moisturizr.
A6251..............  Absorpt drg [lE]16 sq in w/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      o b.
A6252..............  Absorpt drg >16 [lE]48 w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6253..............  Absorpt drg > 48 sq in w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6254..............  Absorpt drg [lE]16 sq in w/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6255..............  Absorpt drg >16[lE]48 in w/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6256..............  Absorpt drg > 48 sq in w/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6257..............  Transparent film [lE] 16    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sq in.
A6258..............  Transparent film >16[lE]48  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6259..............  Transparent film > 48 sq    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6260..............  Wound cleanser any type/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      size.
A6261..............  Wound filler gel/paste /oz  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6262..............  Wound filler dry form /     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gram.
A6266..............  Impreg gauze no h20/sal/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      yard.
A6402..............  Sterile gauze [lE] 16 sq    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6403..............  Sterile gauze>16 [lE] 48    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sq in.
A6404..............  Sterile gauze > 48 sq in..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6407..............  Packing strips, non-impreg  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6410..............  Sterile eye pad...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6411..............  Non-sterile eye pad.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6412..............  Occlusive eye patch.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6441..............  Pad band w[gE]3'' <5''/yd.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6442..............  Conform band n/s w<3''/yd.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6443..............  Conform band n/s            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      w[gE]3''<5''/yd.
A6444..............  Conform band n/s w[gE]5''/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      yd.
A6445..............  Conform band s w <3''/yd..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6446..............  Conform band s w[gE]3''     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      <5''/yd.
A6447..............  Conform band s w [gE]5''/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      yd.
A6448..............  Lt compres band <3''/yd...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6449..............  Lt compres band [gE]3''     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      <5''/yd.
A6450..............  Lt compres band [gE]5''/yd  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6451..............  Mod compres band            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      w[gE]3''<5''/yd.
A6452..............  High compres band           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      w[gE]3''<5''yd.
A6453..............  Self-adher band w <3''/yd.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6454..............  Self-adher band w[gE]3''    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      <5''/yd.
A6455..............  Self-adher band [gE]5''/yd  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6456..............  Zinc paste band w           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      [gE]3''<5''/yd.
A6457..............  Tubular dressing..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6501..............  Compres burngarment         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bodysuit.
A6502..............  Compres burngarment         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      chinstrp.
A6503..............  Compres burngarment         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      facehood.
A6504..............  Cmprsburngarment glove-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wrist.
A6505..............  Cmprsburngarment glove-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      elbow.
A6506..............  Cmprsburngrmnt glove-       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      axilla.
A6507..............  Cmprs burngarment foot-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      knee.
A6508..............  Cmprs burngarment foot-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thigh.
A6509..............  Compres burn garment        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jacket.
A6510..............  Compres burn garment        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      leotard.

[[Page 43014]]

 
A6511..............  Compres burn garment panty  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6512..............  Compres burn garment, noc.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6513..............  Compress burn mask face/    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      neck.
A6530..............  Compression stocking BK18-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      30.
A6531..............  Compression stocking BK30-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      40.
A6532..............  Compression stocking BK40-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      50.
A6533..............  Gc stocking thighlngth 18-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      30.
A6534..............  Gc stocking thighlngth 30-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      40.
A6535..............  Gc stocking thighlngth 40-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      50.
A6536..............  Gc stocking full lngth 18-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      30.
A6537..............  Gc stocking full lngth 30-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      40.
A6538..............  Gc stocking full lngth 40-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      50.
A6539..............  Gc stocking waistlngth 18-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      30.
A6540..............  Gc stocking waistlngth 30-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      40.
A6541..............  Gc stocking waistlngth 40-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      50.
A6542..............  Gc stocking custom made...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6543..............  Gc stocking lymphedema....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6544..............  Gc stocking garter belt...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6549..............  G compression stocking....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6550..............  Neg pres wound ther drsg    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      set.
A7000..............  Disposable canister for     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pump.
A7001..............  Nondisposable pump          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      canister.
A7002..............  Tubing used w suction pump  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7003..............  Nebulizer administration    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      set.
A7004..............  Disposable nebulizer sml    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      vol.
A7005..............  Nondisposable nebulizer     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      set.
A7006..............  Filtered nebulizer admin    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      set.
A7007..............  Lg vol nebulizer            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      disposable.
A7008..............  Disposable nebulizer        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      prefill.
A7009..............  Nebulizer reservoir bottle  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7010..............  Disposable corrugated       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tubing.
A7011..............  Nondispos corrugated        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tubing.
A7012..............  Nebulizer water collec      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      devic.
A7013..............  Disposable compressor       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      filter.
A7014..............  Compressor nondispos        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      filter.
A7015..............  Aerosol mask used w         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      nebulize.
A7016..............  Nebulizer dome &            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mouthpiece.
A7017..............  Nebulizer not used w        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      oxygen.
A7018..............  Water distilled w/          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      nebulizer.
A7025..............  Replace chest compress      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      vest.
A7026..............  Replace chst cmprss sys     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      hose.
A7030..............  CPAP full face mask.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7031..............  Replacement facemask        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      interfa.
A7032..............  Replacement nasal cushion.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7033..............  Replacement nasal pillows.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7034..............  Nasal application device..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7035..............  Pos airway press headgear.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7036..............  Pos airway press chinstrap  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7037..............  Pos airway pressure tubing  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7038..............  Pos airway pressure filter  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7039..............  Filter, non disposable w    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pap.
A7040..............  One way chest drain valve.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7041..............  Water seal drain container  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7042..............  Implanted pleural catheter  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7043..............  Vacuum drainagebottle/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tubing.
A7044..............  PAP oral interface........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7045..............  Repl exhalation port for    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      PAP.
A7046..............  Repl water chamber, PAP     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      dev.
A7501..............  Tracheostoma valve w        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      diaphra.
A7502..............  Replacement diaphragm/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fplate.
A7503..............  HMES filter holder or cap.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7504..............  Tracheostoma HMES filter..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7505..............  HMES or trach valve         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      housing.
A7506..............  HMES/trachvalve             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adhesivedisk.
A7507..............  Integrated filter & holder  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7508..............  Housing & Integrated        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      Adhesiv.
A7509..............  Heat & moisture exchange    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sys.
A7520..............  Trach/laryn tube non-       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cuffed.
A7521..............  Trach/laryn tube cuffed...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7522..............  Trach/laryn tube stainless  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7523..............  Tracheostomy shower         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      protect.
A7524..............  Tracheostoma stent/stud/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bttn.
A7525..............  Tracheostomy mask.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7526..............  Tracheostomy tube collar..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7527..............  Trach/laryn tube plug/stop  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A8000..............  Soft protect helmet prefab  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A8001..............  Hard protect helmet prefab  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A8002..............  Soft protect helmet custom  ..................  Y.................  ...........  ...........  ...........  ...........  ...........

[[Page 43015]]

 
A8003..............  Hard protect helmet custom  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A8004..............  Repl soft interface,        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      helmet.
A9150..............  Misc/exper non-prescript    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dru.
A9152..............  Single vitamin nos........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9153..............  Multi-vitamin nos.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9180..............  Lice treatment, topical...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9270..............  Non-covered item or         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      service.
A9275..............  Disp home glucose monitor.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9279..............  Monitoring feature/         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      deviceNOC.
A9280..............  Alert device, noc.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9281..............  Reaching/grabbing device..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9282..............  Wig any type..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9300..............  Exercise equipment........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9500..............  Tc99m sestamibi...........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9502..............  Tc99m tetrofosmin.........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9503..............  Tc99m medronate...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9504..............  Tc99m apcitide............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9505..............  TL201 thallium............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9507..............  In111 capromab............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9508..............  I131 iodobenguate, dx.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9510..............  Tc99m disofenin...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9512..............  Tc99m pertechnetate.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9516..............  I123 iodide cap, dx.......  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9517..............  I131 iodide cap, rx.......  CH................  K.................         1064  ...........       $16.22  ...........        $3.24
A9521..............  Tc99m exametazime.........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9524..............  I131 serum albumin, dx....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9526..............  Nitrogen N-13 ammonia.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9527..............  Iodine I-125 sodium iodide  CH................  K.................         2632       0.4494       $28.62  ...........        $5.72
A9528..............  Iodine I-131 iodide cap,    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      dx.
A9529..............  I131 iodide sol, dx.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9530..............  I131 iodide sol, rx.......  CH................  K.................         1150  ...........       $11.74  ...........        $2.35
A9531..............  I131 max 100uCi...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9532..............  I125 serum albumin, dx....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9535..............  Injection, methylene blue.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9536..............  Tc99m depreotide..........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9537..............  Tc99m mebrofenin..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9538..............  Tc99m pyrophosphate.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9539..............  Tc99m pentetate...........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9540..............  Tc99m MAA.................  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9541..............  Tc99m sulfur colloid......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9542..............  In111 ibritumomab, dx.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9543..............  Y90 ibritumomab, rx.......  CH................  K.................         1643  ...........   $12,030.02  ...........    $2,406.00
A9544..............  I131 tositumomab, dx......  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9545..............  I131 tositumomab, rx......  CH................  K.................         1645  ...........    $8,283.41  ...........    $1,656.68
A9546..............  Co57/58...................  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9547..............  In111 oxyquinoline........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9548..............  In111 pentetate...........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9550..............  Tc99m gluceptate..........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9551..............  Tc99m succimer............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9552..............  F18 fdg...................  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9553..............  Cr51 chromate.............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9554..............  I125 iothalamate, dx......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9555..............  Rb82 rubidium.............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9556..............  Ga67 gallium..............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9557..............  Tc99m bicisate............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9558..............  Xe133 xenon 10mci.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9559..............  Co57 cyano................  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9560..............  Tc99m labeled rbc.........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9561..............  Tc99m oxidronate..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9562..............  Tc99m mertiatide..........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9563..............  P32 Na phosphate..........  CH................  K.................         1675  ...........      $118.02  ...........       $23.60
A9564..............  P32 chromic phosphate.....  CH................  K.................         1676  ...........      $122.17  ...........       $24.43
A9565..............  In111 pentetreotide.......  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9566..............  Tc99m fanolesomab.........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9567..............  Technetium TC-99m aerosol.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9568..............  Technetium tc99m            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      arcitumomab.
A9600..............  Sr89 strontium............  CH................  K.................         0701  ...........      $610.07  ...........      $122.01
A9605..............  Sm 153 lexidronm..........  CH................  K.................         0702  ...........    $1,446.05  ...........      $289.21
A9698..............  Non-rad contrast            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      materialNOC.
A9699..............  Radiopharm rx agent noc...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9700..............  Echocardiography Contrast.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
A9900..............  Supply/accessory/service..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A9901..............  Delivery/set up/dispensing  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A9999..............  DME supply or accessory,    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      nos.
B4034..............  Enter feed supkit syr by    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      day.
B4035..............  Enteral feed supp pump per  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      d.
B4036..............  Enteral feed sup kit grav   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      by.
B4081..............  Enteral ng tubing w/        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      stylet.

[[Page 43016]]

 
B4082..............  Enteral ng tubing w/o       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      stylet.
B4083..............  Enteral stomach tube        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      levine.
B4086..............  Gastrostomy/jejunostomy     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tube.
B4100..............  Food thickener oral.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
B4102..............  EF adult fluids and         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      electro.
B4103..............  EF ped fluid and            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      electrolyte.
B4104..............  Additive for enteral        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      formula.
B4149..............  EF blenderized foods......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4150..............  EF complet w/intact         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      nutrient.
B4152..............  EF calorie dense>/=1.5Kcal  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4153..............  EF hydrolyzed/amino acids.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4154..............  EF spec metabolic           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      noninherit.
B4155..............  EF incomplete/modular.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4157..............  EF special metabolic        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      inherit.
B4158..............  EF ped complete intact nut  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4159..............  EF ped complete soy based.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4160..............  EF ped caloric dense>/      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      =0.7kc.
B4161..............  EF ped hydrolyzed/amino     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      acid.
B4162..............  EF ped specmetabolic        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      inherit.
B4164..............  Parenteral 50% dextrose     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      solu.
B4168..............  Parenteral sol amino acid   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      3..
B4172..............  Parenteral sol amino acid   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      5..
B4176..............  Parenteral sol amino acid   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      7-.
B4178..............  Parenteral sol amino acid   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      >.
B4180..............  Parenteral sol carb > 50%.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4185..............  Parenteral sol 10 gm        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      lipids.
B4189..............  Parenteral sol amino acid   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      &.
B4193..............  Parenteral sol 52-73 gm     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      prot.
B4197..............  Parenteral sol 74-100 gm    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pro.
B4199..............  Parenteral sol > 100gm      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      prote.
B4216..............  Parenteral nutrition        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      additiv.
B4220..............  Parenteral supply kit       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      premix.
B4222..............  Parenteral supply kit       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      homemi.
B4224..............  Parenteral administration   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ki.
B5000..............  Parenteral sol renal-       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      amirosy.
B5100..............  Parenteral sol hepatic-     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      fream.
B5200..............  Parenteral sol stres-brnch  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      c.
B9000..............  Enter infusion pump w/o     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      alrm.
B9002..............  Enteral infusion pump w/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ala.
B9004..............  Parenteral infus pump       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      portab.
B9006..............  Parenteral infus pump       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      statio.
B9998..............  Enteral supp not otherwise  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      c.
B9999..............  Parenteral supp not othrws  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      c.
C1300..............  HYPERBARIC Oxygen.........  ..................  S.................         0659       1.5679       $99.86  ...........       $19.97
C1713..............  Anchor/screw bn/bn,tis/bn.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1714..............  Cath, trans atherectomy,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      dir.
C1715..............  Brachytherapy needle......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1716..............  Brachytx source, Gold 198.  CH................  K.................         1716       0.5016       $31.95  ...........        $6.39
C1717..............  Brachytx source, HDR Ir-    CH................  K.................         1717       2.7225      $173.40  ...........       $34.68
                      192.
C1718..............  Brachytx source, Iodine     CH................  B.................  ...........  ...........  ...........  ...........  ...........
                      125.
C1719..............  Brachytx sour,Non-HDR Ir-   CH................  K.................         1719       0.9012       $57.40  ...........       $11.48
                      192.
C1720..............  Brachytx sour, Palladium    CH................  B.................  ...........  ...........  ...........  ...........  ...........
                      103.
C1721..............  AICD, dual chamber........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1722..............  AICD, single chamber......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1724..............  Cath, trans                 ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      atherec,rotation.
C1725..............  Cath, translumin non-laser  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1726..............  Cath, bal dil, non-         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vascular.
C1727..............  Cath, bal tis dis, non-vas  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1728..............  Cath, brachytx seed adm...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1729..............  Cath, drainage............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1730..............  Cath, EP, 19 or few elect.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1731..............  Cath, EP, 20 or more elec.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1732..............  Cath, EP, diag/abl, 3D/     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vect.
C1733..............  Cath, EP, othr than cool-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      tip.
C1750..............  Cath, hemodialysis,long-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      term.
C1751..............  Cath, inf, per/cent/        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      midline.
C1752..............  Cath,hemodialysis,short-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      term.
C1753..............  Cath, intravas ultrasound.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1754..............  Catheter, intradiscal.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1755..............  Catheter, intraspinal.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1756..............  Cath, pacing, transesoph..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1757..............  Cath, thrombectomy/         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      embolect.
C1758..............  Catheter, ureteral........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1759..............  Cath, intra                 ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      echocardiography.
C1760..............  Closure dev, vasc.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1762..............  Conn tiss, human(inc        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      fascia).
C1763..............  Conn tiss, non-human......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1764..............  Event recorder, cardiac...  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 43017]]

 
C1765..............  Adhesion barrier..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1766..............  Intro/sheath,strble,non-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      peel.
C1767..............  Generator, neuro non-       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      recharg.
C1768..............  Graft, vascular...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1769..............  Guide wire................  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1770..............  Imaging coil, MR,           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      insertable.
C1771..............  Rep dev, urinary, w/sling.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1772..............  Infusion pump,              ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      programmable.
C1773..............  Ret dev, insertable.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1776..............  Joint device (implantable)  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1777..............  Lead, AICD, endo single     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      coil.
C1778..............  Lead, neurostimulator.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1779..............  Lead, pmkr, transvenous     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      VDD.
C1780..............  Lens, intraocular (new      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      tech).
C1781..............  Mesh (implantable)........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1782..............  Morcellator...............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1783..............  Ocular imp, aqueous drain   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      de.
C1784..............  Ocular dev, intraop, det    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ret.
C1785..............  Pmkr, dual, rate-resp.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1786..............  Pmkr, single, rate-resp...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1787..............  Patient progr, neurostim..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1788..............  Port, indwelling, imp.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1789..............  Prosthesis, breast, imp...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1813..............  Prosthesis, penile,         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inflatab.
C1814..............  Retinal tamp, silicone oil  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1815..............  Pros, urinary sph, imp....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1816..............  Receiver/transmitter,       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      neuro.
C1817..............  Septal defect imp sys.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1818..............  Integrated                  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      keratoprosthesis.
C1819..............  Tissue localization-        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      excision.
C1820..............  Generator neuro rechg bat   CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      sy.
C1821..............  Interspinous implant......  ..................  H.................         1821  ...........  ...........  ...........  ...........
C1874..............  Stent, coated/cov w/del     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      sys.
C1875..............  Stent, coated/cov w/o del   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      sy.
C1876..............  Stent, non-coa/non-cov w/   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      del.
C1877..............  Stent, non-coat/cov w/o     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      del.
C1878..............  Matrl for vocal cord......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1879..............  Tissue marker, implantable  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1880..............  Vena cava filter..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1881..............  Dialysis access system....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1882..............  AICD, other than sing/dual  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1883..............  Adapt/ext, pacing/neuro     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      lead.
C1884..............  Embolization Protect syst.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1885..............  Cath, translumin angio      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      laser.
C1887..............  Catheter, guiding.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1888..............  Endovas non-cardiac abl     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      cath.
C1891..............  Infusion pump,non-prog,     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      perm.
C1892..............  Intro/sheath,fixed,peel-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      away.
C1893..............  Intro/sheath, fixed,non-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      peel.
C1894..............  Intro/sheath, non-laser...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1895..............  Lead, AICD, endo dual coil  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1896..............  Lead, AICD, non sing/dual.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1897..............  Lead, neurostim test kit..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1898..............  Lead, pmkr, other than      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      trans.
C1899..............  Lead, pmkr/AICD             ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      combination.
C1900..............  Lead, coronary venous.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2614..............  Probe, perc lumb disc.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2615..............  Sealant, pulmonary, liquid  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2616..............  Brachytx source, Yttrium-   CH................  K.................         2616     187.5212   $11,943.79  ...........    $2,388.76
                      90.
C2617..............  Stent, non-cor, tem w/o     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      del.
C2618..............  Probe, cryoablation.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2619..............  Pmkr, dual, non rate-resp.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2620..............  Pmkr, single, non rate-     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      resp.
C2621..............  Pmkr, other than sing/dual  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2622..............  Prosthesis, penile, non-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inf.
C2625..............  Stent, non-cor, tem w/del   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      sy.
C2626..............  Infusion pump, non-         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      prog,temp.
C2627..............  Cath, suprapubic/           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      cystoscopic.
C2628..............  Catheter, occlusion.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2629..............  Intro/sheath, laser.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2630..............  Cath, EP, cool-tip........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2631..............  Rep dev, urinary, w/o       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      sling.
C2633..............  Brachytx source, Cesium-    CH................  B.................  ...........  ...........  ...........  ...........  ...........
                      131.
C2634..............  Brachytx source, HA, I-125  CH................  K.................         2634       0.4699       $29.93  ...........        $5.99
C2635..............  Brachytx source, HA, P-103  CH................  K.................         2635       0.7389       $47.06  ...........        $9.41
C2636..............  Brachytx linear source,P-   CH................  K.................         2636       0.5824       $37.09  ...........        $7.42
                      103.
C2637..............  Brachytx, Ytterbium-169...  CH................  B.................  ...........  ...........  ...........  ...........  ...........
C8900..............  MRA w/cont, abd...........  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58

[[Page 43018]]

 
C8901..............  MRA w/o cont, abd.........  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
C8902..............  MRA w/o fol w/cont, abd...  ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
C8903..............  MRI w/cont, breast, uni...  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
C8904..............  MRI w/o cont, breast, uni.  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
C8905..............  MRI w/o fol w/cont, brst,   ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
                      un.
C8906..............  MRI w/cont, breast, bi....  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
C8907..............  MRI w/o cont, breast, bi..  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
C8908..............  MRI w/o fol w/cont,         ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
                      breast,.
C8909..............  MRA w/cont, chest.........  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
C8910..............  MRA w/o cont, chest.......  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
C8911..............  MRA w/o fol w/cont, chest.  ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
C8912..............  MRA w/cont, lwr ext.......  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
C8913..............  MRA w/o cont, lwr ext.....  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
C8914..............  MRA w/o fol w/cont, lwr     ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
                      ext.
C8918..............  MRA w/cont, pelvis........  ..................  S.................         0284       6.7963      $432.88      $148.40       $86.58
C8919..............  MRA w/o cont, pelvis......  ..................  S.................         0336       5.7101      $363.69      $139.50       $72.74
C8920..............  MRA w/o fol w/cont, pelvis  ..................  S.................         0337       8.6689      $552.15      $199.50      $110.43
C8957..............  Prolonged IV inf, req pump  ..................  S.................         0441       2.4378      $155.27  ...........       $31.05
C9003..............  Palivizumab, per 50 mg....  ..................  K.................         9003  ...........      $677.97  ...........      $135.59
C9113..............  Inj pantoprazole sodium,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      via.
C9121..............  Injection, argatroban.....  ..................  K.................         9121  ...........       $17.87  ...........        $3.57
C9232..............  Injection, idursulfase....  ..................  G.................         9232  ...........      $455.03  ...........       $91.01
C9233..............  Injection, ranibizumab....  ..................  G.................         9233  ...........    $2,030.92  ...........      $406.18
C9234..............  Inj, alglucosidase alfa...  ..................  K.................         9234  ...........      $126.00  ...........       $25.20
C9235..............  Injection, panitumumab....  ..................  G.................         9235  ...........       $84.80  ...........       $16.96
C9350..............  Porous collagen tube per    ..................  G.................         9350  ...........      $485.91  ...........       $97.18
                      cm.
C9351..............  Acellular derm tissue       ..................  G.................         9351  ...........       $41.59  ...........        $8.32
                      percm2.
C9399..............  Unclassified drugs or       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      biolog.
C9716..............  Radiofrequency energy to    ..................  T.................         0150      30.5544    $1,946.10      $437.10      $389.22
                      anu.
C9723..............  Dyn IR Perf Img...........  ..................  S.................         1502  ...........       $75.00  ...........       $15.00
C9724..............  EPS gast cardia plic......  ..................  T.................         0422       24.648    $1,569.91      $445.06      $313.98
C9725..............  Place endorectal app......  ..................  S.................         1507  ...........      $550.00  ...........      $110.00
C9726..............  Rxt breast appl place/      ..................  S.................         1508  ...........      $650.00  ...........      $130.00
                      remov.
C9727..............  Insert palate implants....  ..................  S.................         1510  ...........      $850.00  ...........      $170.00
D0120..............  Periodic oral evaluation..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0140..............  Limit oral eval problm      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      focus.
D0145..............  Oral evaluation, pt < 3yrs  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0150..............  Comprehensve oral           ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      evaluation.
D0160..............  Extensv oral eval prob      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      focus.
D0170..............  Re-eval,est pt,problem      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      focus.
D0180..............  Comp periodontal            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      evaluation.
D0210..............  Intraor complete film       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      series.
D0220..............  Intraoral periapical first  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      f.
D0230..............  Intraoral periapical ea     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      add.
D0240..............  Intraoral occlusal film...  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D0250..............  Extraoral first film......  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D0260..............  Extraoral ea additional     ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      film.
D0270..............  Dental bitewing single      ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      film.
D0272..............  Dental bitewings two films  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D0273..............  Bitewings - three films...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0274..............  Dental bitewings four       ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      films.
D0277..............  Vert bitewings-sev to       ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      eight.
D0290..............  Dental film skull/facial    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bon.
D0310..............  Dental saliography........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0320..............  Dental tmj arthrogram incl  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      i.
D0321..............  Dental other tmj films....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0322..............  Dental tomographic survey.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0330..............  Dental panoramic film.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0340..............  Dental cephalometric film.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0350..............  Oral/facial photo images..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0360..............  Cone beam ct..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0362..............  Cone beam, two dimensional  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0363..............  Cone beam, three            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dimensional.
D0415..............  Collection of               ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      microorganisms.
D0416..............  Viral culture.............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0421..............  Gen tst suscept oral        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      disease.
D0425..............  Caries susceptibility test  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0431..............  Diag tst detect mucos       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      abnorm.
D0460..............  Pulp vitality test........  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D0470..............  Diagnostic casts..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0472..............  Gross exam, prep & report.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0473..............  Micro exam, prep & report.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0474..............  Micro w exam of surg        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      margins.
D0475..............  Decalcification procedure.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0476..............  Spec stains for             ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      microorganis.
D0477..............  Spec stains not for         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      microorg.
D0478..............  Immunohistochemical stains  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0479..............  Tissue in-situ              ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      hybridization.

[[Page 43019]]

 
D0480..............  Cytopath smear prep &       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      report.
D0481..............  Electron microscopy         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      diagnost.
D0482..............  Direct immunofluorescence.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0483..............  Indirect                    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      immunofluorescence.
D0484..............  Consult slides prep         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      elsewher.
D0485..............  Consult inc prep of slides  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0486..............  Accession of brush biopsy.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0502..............  Other oral pathology        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      procedu.
D0999..............  Unspecified diagnostic      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      proce.
D1110..............  Dental prophylaxis adult..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D1120..............  Dental prophylaxis child..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D1203..............  Topical fluor w/o prophy    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      chi.
D1204..............  Topical fluor w/o prophy    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      adu.
D1206..............  Topical fluoride varnish..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D1310..............  Nutri counsel-control       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      caries.
D1320..............  Tobacco counseling........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D1330..............  Oral hygiene instruction..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D1351..............  Dental sealant per tooth..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D1510..............  Space maintainer fxd        ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      unilat.
D1515..............  Fixed bilat space           ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      maintainer.
D1520..............  Remove unilat space         ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      maintain.
D1525..............  Remove bilat space          ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      maintain.
D1550..............  Recement space maintainer.  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D1555..............  Remove fix space            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maintainer.
D2140..............  Amalgam one surface         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      permanen.
D2150..............  Amalgam two surfaces        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      permane.
D2160..............  Amalgam three surfaces      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      perma.
D2161..............  Amalgam 4 or > surfaces     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      perm.
D2330..............  Resin one surface-anterior  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2331..............  Resin two surfaces-         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anterior.
D2332..............  Resin three surfaces-       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anterio.
D2335..............  Resin 4/> surf or w incis   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      an.
D2390..............  Ant resin-based cmpst       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D2391..............  Post 1 srfc resinbased      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cmpst.
D2392..............  Post 2 srfc resinbased      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cmpst.
D2393..............  Post 3 srfc resinbased      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cmpst.
D2394..............  Post [gE]4srfc resinbase    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cmpst.
D2410..............  Dental gold foil one        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surface.
D2420..............  Dental gold foil two        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surface.
D2430..............  Dental gold foil three      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfa.
D2510..............  Dental inlay metalic 1      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D2520..............  Dental inlay metallic 2     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D2530..............  Dental inlay metl 3/more    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D2542..............  Dental onlay metallic 2     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D2543..............  Dental onlay metallic 3     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D2544..............  Dental onlay metl 4/more    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D2610..............  Inlay porcelain/ceramic 1   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      su.
D2620..............  Inlay porcelain/ceramic 2   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      su.
D2630..............  Dental onlay porc 3/more    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D2642..............  Dental onlay porcelin 2     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D2643..............  Dental onlay porcelin 3     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D2644..............  Dental onlay porc 4/more    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D2650..............  Inlay composite/resin one   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      su.
D2651..............  Inlay composite/resin two   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      su.
D2652..............  Dental inlay resin 3/mre    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D2662..............  Dental onlay resin 2        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surface.
D2663..............  Dental onlay resin 3        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surface.
D2664..............  Dental onlay resin 4/mre    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D2710..............  Crown resin-based indirect  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2712..............  Crown 3/4 resin-based       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      compos.
D2720..............  Crown resin w/ high noble   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      me.
D2721..............  Crown resin w/ base metal.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2722..............  Crown resin w/ noble metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2740..............  Crown porcelain/ceramic     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      subs.
D2750..............  Crown porcelain w/ h noble  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      m.
D2751..............  Crown porcelain fused base  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      m.
D2752..............  Crown porcelain w/ noble    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      met.
D2780..............  Crown 3/4 cast hi noble     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      met.
D2781..............  Crown 3/4 cast base metal.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2782..............  Crown 3/4 cast noble metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2783..............  Crown 3/4 porcelain/        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ceramic.
D2790..............  Crown full cast high noble  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      m.
D2791..............  Crown full cast base metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2792..............  Crown full cast noble       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D2794..............  Crown-titanium............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2799..............  Provisional crown.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2910..............  Recement inlay onlay or     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      part.
D2915..............  Recement cast or prefab     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      post.

[[Page 43020]]

 
D2920..............  Dental recement crown.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2930..............  Prefab stnlss steel crwn    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pri.
D2931..............  Prefab stnlss steel crown   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pe.
D2932..............  Prefabricated resin crown.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2933..............  Prefab stainless steel      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D2934..............  Prefab steel crown primary  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2940..............  Dental sedative filling...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2950..............  Core build-up incl any      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pins.
D2951..............  Tooth pin retention.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2952..............  Post and core cast + crown  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2953..............  Each addtnl cast post.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2954..............  Prefab post/core + crown..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2955..............  Post removal..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2957..............  Each addtnl prefab post...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2960..............  Laminate labial veneer....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2961..............  Lab labial veneer resin...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2962..............  Lab labial veneer           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      porcelain.
D2971..............  Add proc construct new      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D2975..............  Coping....................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2980..............  Crown repair..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2999..............  Dental unspec restorative   ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      pr.
D3110..............  Pulp cap direct...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3120..............  Pulp cap indirect.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3220..............  Therapeutic pulpotomy.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3221..............  Gross pulpal debridement..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3230..............  Pulpal therapy anterior     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      prim.
D3240..............  Pulpal therapy posterior    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pri.
D3310..............  Anterior..................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3320..............  Root canal therapy 2        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      canals.
D3330..............  Root canal therapy 3        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      canals.
D3331..............  Non-surg tx root canal obs  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3332..............  Incomplete endodontic tx..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3333..............  Internal root repair......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3346..............  Retreat root canal          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anterior.
D3347..............  Retreat root canal          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bicuspid.
D3348..............  Retreat root canal molar..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3351..............  Apexification/recalc        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      initial.
D3352..............  Apexification/recalc        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      interim.
D3353..............  Apexification/recalc final  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3410..............  Apicoect/perirad surg       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anter.
D3421..............  Root surgery bicuspid.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3425..............  Root surgery molar........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3426..............  Root surgery ea add root..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3430..............  Retrograde filling........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3450..............  Root amputation...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3460..............  Endodontic endosseous       ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      implan.
D3470..............  Intentional replantation..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3910..............  Isolation- tooth w rubb     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dam.
D3920..............  Tooth splitting...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3950..............  Canal prep/fitting of       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dowel.
D3999..............  Endodontic procedure......  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D4210..............  Gingivectomy/plasty per     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      quad.
D4211..............  Gingivectomy/plasty per     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      toot.
D4230..............  Ana crown exp 4 or> per     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      quad.
D4231..............  Ana crown exp 1-3 per quad  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4240..............  Gingival flap proc w/       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      planin.
D4241..............  Gngvl flap w rootplan 1-3   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      th.
D4245..............  Apically positioned flap..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4249..............  Crown lengthen hard tissue  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4260..............  Osseous surgery per         ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      quadrant.
D4261..............  Osseous surgl-              ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      3teethperquad.
D4263..............  Bone replce graft first     ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      site.
D4264..............  Bone replce graft each add  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D4265..............  Bio mtrls to aid soft/os    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      reg.
D4266..............  Guided tiss regen resorble  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4267..............  Guided tiss regen           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      nonresorb.
D4268..............  Surgical revision           ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      procedure.
D4270..............  Pedicle soft tissue graft   ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      pr.
D4271..............  Free soft tissue graft      ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      proc.
D4273..............  Subepithelial tissue graft  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D4274..............  Distal/proximal wedge proc  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4275..............  Soft tissue allograft.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4276..............  Con tissue w dble ped       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      graft.
D4320..............  Provision splnt             ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      intracoronal.
D4321..............  Provisional splint          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      extracoro.
D4341..............  Periodontal scaling & root  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4342..............  Periodontal scaling 1-      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      3teeth.
D4355..............  Full mouth debridement....  ..................  S.................         0330        9.278      $590.94  ...........      $118.19

[[Page 43021]]

 
D4381..............  Localized delivery          ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      antimicro.
D4910..............  Periodontal maint           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      procedures.
D4920..............  Unscheduled dressing        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      change.
D4999..............  Unspecified periodontal     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      proc.
D5110..............  Dentures complete           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxillary.
D5120..............  Dentures complete mandible  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5130..............  Dentures immediat           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxillary.
D5140..............  Dentures immediat mandible  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5211..............  Dentures maxill part resin  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5212..............  Dentures mand part resin..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5213..............  Dentures maxill part metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5214..............  Dentures mandibl part       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D5225..............  Maxillary part denture      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      flex.
D5226..............  Mandibular part denture     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      flex.
D5281..............  Removable partial denture.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5410..............  Dentures adjust cmplt       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxil.
D5411..............  Dentures adjust cmplt mand  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5421..............  Dentures adjust part        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxill.
D5422..............  Dentures adjust part        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mandbl.
D5510..............  Dentur repr broken compl    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bas.
D5520..............  Replace denture teeth       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complt.
D5610..............  Dentures repair resin base  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5620..............  Rep part denture cast       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      frame.
D5630..............  Rep partial denture clasp.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5640..............  Replace part denture teeth  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5650..............  Add tooth to partial        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      denture.
D5660..............  Add clasp to partial        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      denture.
D5670..............  Replc tth&acrlc on mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      frmwk.
D5671..............  Replc tth&acrlc mandibular  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5710..............  Dentures rebase cmplt       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxil.
D5711..............  Dentures rebase cmplt mand  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5720..............  Dentures rebase part        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxill.
D5721..............  Dentures rebase part        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mandbl.
D5730..............  Denture reln cmplt maxil    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ch.
D5731..............  Denture reln cmplt mand     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      chr.
D5740..............  Denture reln part maxil     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      chr.
D5741..............  Denture reln part mand chr  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5750..............  Denture reln cmplt max lab  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5751..............  Denture reln cmplt mand     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      lab.
D5760..............  Denture reln part maxil     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      lab.
D5761..............  Denture reln part mand lab  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5810..............  Denture interm cmplt        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxill.
D5811..............  Denture interm cmplt        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mandbl.
D5820..............  Denture interm part maxill  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5821..............  Denture interm part mandbl  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5850..............  Denture tiss conditn        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxill.
D5851..............  Denture tiss condtin        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mandbl.
D5860..............  Overdenture complete......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5861..............  Overdenture partial.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5862..............  Precision attachment......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5867..............  Replacement of precision    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      att.
D5875..............  Prosthesis modification...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5899..............  Removable prosthodontic     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      proc.
D5911..............  Facial moulage sectional..  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D5912..............  Facial moulage complete...  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D5913..............  Nasal prosthesis..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5914..............  Auricular prosthesis......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5915..............  Orbital prosthesis........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5916..............  Ocular prosthesis.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5919..............  Facial prosthesis.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5922..............  Nasal septal prosthesis...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5923..............  Ocular prosthesis interim.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5924..............  Cranial prosthesis........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5925..............  Facial augmentation         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      implant.
D5926..............  Replacement nasal           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      prosthesis.
D5927..............  Auricular replacement.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5928..............  Orbital replacement.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5929..............  Facial replacement........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5931..............  Surgical obturator........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5932..............  Postsurgical obturator....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5933..............  Refitting of obturator....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5934..............  Mandibular flange           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      prosthesis.
D5935..............  Mandibular denture prosth.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5936..............  Temp obturator prosthesis.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5937..............  Trismus appliance.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5951..............  Feeding aid...............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5952..............  Pediatric speech aid......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5953..............  Adult speech aid..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 43022]]

 
D5954..............  Superimposed prosthesis...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5955..............  Palatal lift prosthesis...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5958..............  Intraoral con def inter     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      plt.
D5959..............  Intraoral con def mod       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      palat.
D5960..............  Modify speech aid           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      prosthesis.
D5982..............  Surgical stent............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5983..............  Radiation applicator......  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D5984..............  Radiation shield..........  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D5985..............  Radiation cone locator....  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D5986..............  Fluoride applicator.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5987..............  Commissure splint.........  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D5988..............  Surgical splint...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5999..............  Maxillofacial prosthesis..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6010..............  Odontics endosteal implant  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6012..............  Endosteal implant.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6040..............  Odontics eposteal implant.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6050..............  Odontics transosteal        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      implnt.
D6053..............  Implnt/abtmnt spprt remv    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dnt.
D6054..............  Implnt/abtmnt spprt         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      remvprtl.
D6055..............  Implant connecting bar....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6056..............  Prefabricated abutment....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6057..............  Custom abutment...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6058..............  Abutment supported crown..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6059..............  Abutment supported mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6060..............  Abutment supported mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6061..............  Abutment supported mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6062..............  Abutment supported mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6063..............  Abutment supported mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6064..............  Abutment supported mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6065..............  Implant supported crown...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6066..............  Implant supported mtl       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6067..............  Implant supported mtl       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6068..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6069..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6070..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6071..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6072..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6073..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6074..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6075..............  Implant supported retainer  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6076..............  Implant supported retainer  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6077..............  Implant supported retainer  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6078..............  Implnt/abut suprtd fixd     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dent.
D6079..............  Implnt/abut suprtd fixd     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dent.
D6080..............  Implant maintenance.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6090..............  Repair implant............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6091..............  Repl semi/precision attach  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6092..............  Recement supp crown.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6093..............  Recement supp part denture  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6094..............  Abut support crown          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      titanium.
D6095..............  Odontics repr abutment....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6100..............  Removal of implant........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6190..............  Radio/surgical implant      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      index.
D6194..............  Abut support retainer       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      titani.
D6199..............  Implant procedure.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6205..............  Pontic-indirect resin       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      based.
D6210..............  Prosthodont high noble      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D6211..............  Bridge base metal cast....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6212..............  Bridge noble metal cast...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6214..............  Pontic titanium...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6240..............  Bridge porcelain high       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      noble.
D6241..............  Bridge porcelain base       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D6242..............  Bridge porcelain nobel      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D6245..............  Bridge porcelain/ceramic..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6250..............  Bridge resin w/high noble.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6251..............  Bridge resin base metal...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6252..............  Bridge resin w/noble metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6253..............  Provisional pontic........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6545..............  Dental retainr cast metl..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6548..............  Porcelain/ceramic retainer  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6600..............  Porcelain/ceramic inlay     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      2srf.
D6601..............  Porc/ceram inlay [gE] 3     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfac.
D6602..............  Cst hgh nble mtl inlay 2    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      srf.
D6603..............  Cst hgh nble mtl inlay      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      [gE]3sr.
D6604..............  Cst bse mtl inlay 2         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfaces.
D6605..............  Cst bse mtl inlay [gE] 3    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfa.
D6606..............  Cast noble metal inlay 2    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D6607..............  Cst noble mtl inlay [gE]3   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.

[[Page 43023]]

 
D6608..............  Onlay porc/crmc 2 surfaces  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6609..............  Onlay porc/crmc [gE]3       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfaces.
D6610..............  Onlay cst hgh nbl mtl 2     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      srfc.
D6611..............  Onlay cst hgh nbl mtl       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      [gE]3srf.
D6612..............  Onlay cst base mtl 2        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surface.
D6613..............  Onlay cst base mtl [gE]3    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfa.
D6614..............  Onlay cst nbl mtl 2         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfaces.
D6615..............  Onlay cst nbl mtl [gE]3     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfac.
D6624..............  Inlay titanium............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6634..............  Onlay titanium............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6710..............  Crown-indirect resin based  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6720..............  Retain crown resin w hi     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      nble.
D6721..............  Crown resin w/base metal..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6722..............  Crown resin w/noble metal.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6740..............  Crown porcelain/ceramic...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6750..............  Crown porcelain high noble  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6751..............  Crown porcelain base metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6752..............  Crown porcelain noble       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D6780..............  Crown 3/4 high noble metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6781..............  Crown 3/4 cast based metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6782..............  Crown 3/4 cast noble metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6783..............  Crown 3/4 porcelain/        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ceramic.
D6790..............  Crown full high noble       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D6791..............  Crown full base metal cast  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6792..............  Crown full noble metal      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cast.
D6793..............  Provisional retainer crown  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6794..............  Crown titanium............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6920..............  Dental connector bar......  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D6930..............  Dental recement bridge....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6940..............  Stress breaker............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6950..............  Precision attachment......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6970..............  Post & core plus retainer.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6972..............  Prefab post & core plus     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      reta.
D6973..............  Core build up for retainer  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6975..............  Coping metal..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6976..............  Each addtnl cast post.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6977..............  Each addtl prefab post....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6980..............  Bridge repair.............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6985..............  Pediatric partial denture   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D6999..............  Fixed prosthodontic proc..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7111..............  Extraction coronal          ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      remnants.
D7140..............  Extraction erupted tooth/   ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      exr.
D7210..............  Rem imp tooth w mucoper     ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      flp.
D7220..............  Impact tooth remov soft     ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      tiss.
D7230..............  Impact tooth remov part     ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      bony.
D7240..............  Impact tooth remov comp     ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      bony.
D7241..............  Impact tooth rem bony w/    ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      comp.
D7250..............  Tooth root removal........  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D7260..............  Oral antral fistula         ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      closure.
D7261..............  Primary closure sinus perf  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D7270..............  Tooth reimplantation......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7272..............  Tooth transplantation.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7280..............  Exposure impact tooth       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      orthod.
D7282..............  Mobilize erupted/malpos     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      toot.
D7283..............  Place device impacted       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      tooth.
D7285..............  Biopsy of oral tissue hard  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7286..............  Biopsy of oral tissue soft  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7287..............  Exfoliative cytolog         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      collect.
D7288..............  Brush biopsy..............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D7290..............  Repositioning of teeth....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7291..............  Transseptal fiberotomy....  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D7292..............  Screw retained plate......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7293..............  Temp anchorage dev w flap.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7294..............  Temp anchorage dev w/o      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      flap.
D7310..............  Alveoplasty w/ extraction.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7311..............  Alveoloplasty w/extract 1-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      3.
D7320..............  Alveoplasty w/o extraction  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7321..............  Alveoloplasty not w/        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      extracts.
D7340..............  Vestibuloplasty ridge       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      extens.
D7350..............  Vestibuloplasty exten       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      graft.
D7410..............  Rad exc lesion up to 1.25   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cm.
D7411..............  Excision benign             ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      lesion>1.25c.
D7412..............  Excision benign lesion      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      compl.
D7413..............  Excision malig              ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      lesion[lE]1.25c.
D7414..............  Excision malig              ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      lesion>1.25cm.
D7415..............  Excision malig les          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complicat.
D7440..............  Malig tumor exc to 1.25 cm  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7441..............  Malig tumor > 1.25 cm.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 43024]]

 
D7450..............  Rem odontogen cyst to       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      1.25cm.
D7451..............  Rem odontogen cyst > 1.25   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cm.
D7460..............  Rem nonodonto cyst to       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      1.25cm.
D7461..............  Rem nonodonto cyst > 1.25   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cm.
D7465..............  Lesion destruction........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7471..............  Rem exostosis any site....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7472..............  Removal of torus palatinus  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7473..............  Remove torus mandibularis.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7485..............  Surg reduct                 ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      osseoustuberosit.
D7490..............  Maxilla or mandible         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      resectio.
D7510..............  I&d absc intraoral soft     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tiss.
D7511..............  Incision/drain abscess      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      intra.
D7520..............  I&d abscess extraoral.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7521..............  Incision/drain abscess      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      extra.
D7530..............  Removal fb skin/areolar     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tiss.
D7540..............  Removal of fb reaction....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7550..............  Removal of sloughed off     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bone.
D7560..............  Maxillary sinusotomy......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7610..............  Maxilla open reduct simple  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7620..............  Clsd reduct simpl maxilla   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7630..............  Open red simpl mandible fx  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7640..............  Clsd red simpl mandible fx  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7650..............  Open red simp malar/zygom   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7660..............  Clsd red simp malar/zygom   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7670..............  Closd rductn splint         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      alveolus.
D7671..............  Alveolus open reduction...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7680..............  Reduct simple facial bone   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7710..............  Maxilla open reduct         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      compound.
D7720..............  Clsd reduct compd maxilla   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7730..............  Open reduct compd mandble   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7740..............  Clsd reduct compd mandble   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7750..............  Open red comp malar/zygma   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7760..............  Clsd red comp malar/zygma   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7770..............  Open reduc compd alveolus   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7771..............  Alveolus clsd reduc stblz   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      te.
D7780..............  Reduct compnd facial bone   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7810..............  Tmj open reduct-            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dislocation.
D7820..............  Closed tmp manipulation...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7830..............  Tmj manipulation under      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anest.
D7840..............  Removal of tmj condyle....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7850..............  Tmj meniscectomy..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7852..............  Tmj repair of joint disc..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7854..............  Tmj excisn of joint         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      membrane.
D7856..............  Tmj cutting of a muscle...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7858..............  Tmj reconstruction........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7860..............  Tmj cutting into joint....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7865..............  Tmj reshaping components..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7870..............  Tmj aspiration joint fluid  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7871..............  Lysis + lavage w catheters  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7872..............  Tmj diagnostic arthroscopy  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7873..............  Tmj arthroscopy lysis       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      adhesn.
D7874..............  Tmj arthroscopy disc        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      reposit.
D7875..............  Tmj arthroscopy             ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      synovectomy.
D7876..............  Tmj arthroscopy discectomy  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7877..............  Tmj arthroscopy             ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      debridement.
D7880..............  Occlusal orthotic           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      appliance.
D7899..............  Tmj unspecified therapy...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7910..............  Dent sutur recent wnd to    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      5cm.
D7911..............  Dental suture wound to 5    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cm.
D7912..............  Suture complicate wnd > 5   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cm.
D7920..............  Dental skin graft.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7940..............  Reshaping bone              ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      orthognathic.
D7941..............  Bone cutting ramus closed.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7943..............  Cutting ramus open w/graft  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7944..............  Bone cutting segmented....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7945..............  Bone cutting body mandible  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7946..............  Reconstruction maxilla      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      total.
D7947..............  Reconstruct maxilla         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      segment.
D7948..............  Reconstruct midface no      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      graft.
D7949..............  Reconstruct midface w/      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      graft.
D7950..............  Mandible graft............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7951..............  Sinus aug w bone/bone sup.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7953..............  Bone replacement graft....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7955..............  Repair maxillofacial        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      defects.
D7960..............  Frenulectomy/frenulotomy..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7963..............  Frenuloplasty.............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7970..............  Excision hyperplastic       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tissue.
D7971..............  Excision pericoronal        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      gingiva.

[[Page 43025]]

 
D7972..............  Surg redct fibrous          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tuberosit.
D7980..............  Sialolithotomy............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7981..............  Excision of salivary gland  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7982..............  Sialodochoplasty..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7983..............  Closure of salivary         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
D7990..............  Emergency tracheotomy.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7991..............  Dental coronoidectomy.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7995..............  Synthetic graft facial      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bones.
D7996..............  Implant mandible for        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      augment.
D7997..............  Appliance removal.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7998..............  Intraoral place of fix dev  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7999..............  Oral surgery procedure....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8010..............  Limited dental tx primary.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8020..............  Limited dental tx           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      transition.
D8030..............  Limited dental tx           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      adolescent.
D8040..............  Limited dental tx adult...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8050..............  Intercep dental tx primary  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8060..............  Intercep dental tx          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      transitn.
D8070..............  Compre dental tx            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      transition.
D8080..............  Compre dental tx            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      adolescent.
D8090..............  Compre dental tx adult....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8210..............  Orthodontic rem appliance   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tx.
D8220..............  Fixed appliance therapy     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      habt.
D8660..............  Preorthodontic tx visit...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8670..............  Periodic orthodontc tx      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      visit.
D8680..............  Orthodontic retention.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8690..............  Orthodontic treatment.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8691..............  Repair ortho appliance....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8692..............  Replacement retainer......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8693..............  Rebond/cement/repair        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retain.
D8999..............  Orthodontic procedure.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9110..............  Tx dental pain minor proc.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
D9120..............  Fix partial denture         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      section.
D9210..............  Dent anesthesia w/o         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
D9211..............  Regional block anesthesia.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9212..............  Trigeminal block            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anesthesia.
D9215..............  Local anesthesia..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9220..............  General anesthesia........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9221..............  General anesthesia ea ad    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      15m.
D9230..............  Analgesia.................  ..................  N.................  ...........  ...........  ...........  ...........  ...........
D9241..............  Intravenous sedation......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9242..............  IV sedation ea ad 30 m....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9248..............  Sedation (non-iv).........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
D9310..............  Dental consultation.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9410..............  Dental house call.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9420..............  Hospital call.............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9430..............  Office visit during hours.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9440..............  Office visit after hours..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9450..............  Case presentation tx plan.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9610..............  Dent therapeutic drug       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      inject.
D9612..............  Thera par drugs 2 or >      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      admin.
D9630..............  Other drugs/medicaments...  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D9910..............  Dent appl desensitizing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      med.
D9911..............  Appl desensitizing resin..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9920..............  Behavior management.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9930..............  Treatment of complications  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D9940..............  Dental occlusal guard.....  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D9941..............  Fabrication athletic guard  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9942..............  Repair/reline occlusal      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      guard.
D9950..............  Occlusion analysis........  ..................  S.................         0330        9.278      $590.94  ...........      $118.19
D9951..............  Limited occlusal            ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      adjustment.
D9952..............  Complete occlusal           ..................  S.................         0330        9.278      $590.94  ...........      $118.19
                      adjustment.
D9970..............  Enamel microabrasion......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9971..............  Odontoplasty 1-2 teeth....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9972..............  Extrnl bleaching per arch.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9973..............  Extrnl bleaching per tooth  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9974..............  Intrnl bleaching per tooth  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9999..............  Adjunctive procedure......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0100..............  Cane adjust/fixed with tip  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0105..............  Cane adjust/fixed quad/3    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pro.
E0110..............  Crutch forearm pair.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0111..............  Crutch forearm each.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0112..............  Crutch underarm pair wood.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0113..............  Crutch underarm each wood.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0114..............  Crutch underarm pair no     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wood.
E0116..............  Crutch underarm each no     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wood.
E0117..............  Underarm springassist       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      crutch.
E0118..............  Crutch substitute.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 43026]]

 
E0130..............  Walker rigid adjust/fixed   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ht.
E0135..............  Walker folding adjust/      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      fixed.
E0140..............  Walker w trunk support....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0141..............  Rigid wheeled walker adj/   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      fix.
E0143..............  Walker folding wheeled w/o  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      s.
E0144..............  Enclosed walker w rear      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      seat.
E0147..............  Walker variable wheel       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      resist.
E0148..............  Heavyduty walker no wheels  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0149..............  Heavy duty wheeled walker.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0153..............  Forearm crutch platform     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      atta.
E0154..............  Walker platform attachment  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0155..............  Walker wheel                ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      attachment,pair.
E0156..............  Walker seat attachment....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0157..............  Walker crutch attachment..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0158..............  Walker leg extenders set    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      of4.
E0159..............  Brake for wheeled walker..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0160..............  Sitz type bath or           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      equipment.
E0161..............  Sitz bath/equipment w/      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      faucet.
E0162..............  Sitz bath chair...........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0163..............  Commode chair with fixed    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E0165..............  Commode chair with          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      detacharm.
E0167..............  Commode chair pail or pan.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0168..............  Heavyduty/wide commode      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      chair.
E0170..............  Commode chair electric....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0171..............  Commode chair non-electric  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0172..............  Seat lift mechanism toilet  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0175..............  Commode chair foot rest...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0181..............  Press pad alternating w/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pum.
E0182..............  Replace pump, alt press     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pad.
E0184..............  Dry pressure mattress.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0185..............  Gel pressure mattress pad.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0186..............  Air pressure mattress.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0187..............  Water pressure mattress...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0188..............  Synthetic sheepskin pad...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0189..............  Lambswool sheepskin pad...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0190..............  Positioning cushion.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0191..............  Protector heel or elbow...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0193..............  Powered air flotation bed.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0194..............  Air fluidized bed.........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0196..............  Gel pressure mattress.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0197..............  Air pressure pad for        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mattres.
E0198..............  Water pressure pad for      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mattr.
E0199..............  Dry pressure pad for        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mattres.
E0200..............  Heat lamp without stand...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0202..............  Phototherapy light w/       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      photom.
E0203..............  Therapeutic lightbox        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tabletp.
E0205..............  Heat lamp with stand......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0210..............  Electric heat pad standard  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0215..............  Electric heat pad moist...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0217..............  Water circ heat pad w pump  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0218..............  Water circ cold pad w pump  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0220..............  Hot water bottle..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0221..............  Infrared heating pad        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      system.
E0225..............  Hydrocollator unit........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0230..............  Ice cap or collar.........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0231..............  Wound warming device......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0232..............  Warming card for NWT......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0235..............  Paraffin bath unit          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      portable.
E0236..............  Pump for water circulating  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      p.
E0238..............  Heat pad non-electric       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      moist.
E0239..............  Hydrocollator unit          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      portable.
E0240..............  Bath/shower chair.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0241..............  Bath tub wall rail........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0242..............  Bath tub rail floor.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0243..............  Toilet rail...............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0244..............  Toilet seat raised........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0245..............  Tub stool or bench........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0246..............  Transfer tub rail           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      attachment.
E0247..............  Trans bench w/wo comm open  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0248..............  HDtrans bench w/wo comm     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      open.
E0249..............  Pad water circulating heat  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      u.
E0250..............  Hosp bed fixed ht w/        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mattres.
E0251..............  Hosp bed fixd ht w/o        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mattres.
E0255..............  Hospital bed var ht w/      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mattr.
E0256..............  Hospital bed var ht w/o     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      matt.
E0260..............  Hosp bed semi-electr w/     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      matt.
E0261..............  Hosp bed semi-electr w/o    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mat.
E0265..............  Hosp bed total electr w/    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mat.

[[Page 43027]]

 
E0266..............  Hosp bed total elec w/o     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      matt.
E0270..............  Hospital bed institutional  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      t.
E0271..............  Mattress innerspring......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0272..............  Mattress foam rubber......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0273..............  Bed board.................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0274..............  Over-bed table............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0275..............  Bed pan standard..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0276..............  Bed pan fracture..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0277..............  Powered pres-redu air       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mattrs.
E0280..............  Bed cradle................  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0290..............  Hosp bed fx ht w/o rails w/ ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      m.
E0291..............  Hosp bed fx ht w/o rail w/  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      o.
E0292..............  Hosp bed var ht w/o rail w/ ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      o.
E0293..............  Hosp bed var ht w/o rail w/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      .
E0294..............  Hosp bed semi-elect w/      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mattr.
E0295..............  Hosp bed semi-elect w/o     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      matt.
E0296..............  Hosp bed total elect w/     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      matt.
E0297..............  Hosp bed total elect w/o    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mat.
E0300..............  Enclosed ped crib hosp      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      grade.
E0301..............  HD hosp bed, 350-600 lbs..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0302..............  Ex hd hosp bed > 600 lbs..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0303..............  Hosp bed hvy dty xtra wide  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0304..............  Hosp bed xtra hvy dty x     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      wide.
E0305..............  Rails bed side half length  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0310..............  Rails bed side full length  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0315..............  Bed accessory brd/tbl/      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      supprt.
E0316..............  Bed safety enclosure......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0325..............  Urinal male jug-type......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0326..............  Urinal female jug-type....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0350..............  Control unit bowel system.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0352..............  Disposable pack w/bowel     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      syst.
E0370..............  Air elevator for heel.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0371..............  Nonpower mattress overlay.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0372..............  Powered air mattress        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      overlay.
E0373..............  Nonpowered pressure         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mattress.
E0424..............  Stationary compressed gas   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      02.
E0425..............  Gas system stationary       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      compre.
E0430..............  Oxygen system gas portable  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0431..............  Portable gaseous 02.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0434..............  Portable liquid 02........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0435..............  Oxygen system liquid        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      portabl.
E0439..............  Stationary liquid 02......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0440..............  Oxygen system liquid        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      station.
E0441..............  Oxygen contents, gaseous..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0442..............  Oxygen contents, liquid...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0443..............  Portable 02 contents, gas.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0444..............  Portable 02 contents,       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      liquid.
E0445..............  Oximeter non-invasive.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0450..............  Vol control vent invasiv    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      int.
E0455..............  Oxygen tent excl croup/ped  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      t.
E0457..............  Chest shell...............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0459..............  Chest wrap................  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0460..............  Neg press vent portabl/     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      statn.
E0461..............  Vol control vent noninv     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      int.
E0462..............  Rocking bed w/ or w/o side  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      r.
E0463..............  Press supp vent invasive    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      int.
E0464..............  Press supp vent noninv int  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0470..............  RAD w/o backup non-inv      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      intfc.
E0471..............  RAD w/backup non inv        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      intrfc.
E0472..............  RAD w backup invasive       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      intrfc.
E0480..............  Percussor elect/pneum home  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      m.
E0481..............  Intrpulmnry percuss vent    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E0482..............  Cough stimulating device..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0483..............  Chest compression gen       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      system.
E0484..............  Non-elec oscillatory pep    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      dvc.
E0485..............  Oral device/appliance       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
E0486..............  Oral device/appliance       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cusfab.
E0500..............  Ippb all types............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0550..............  Humidif extens supple w     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ippb.
E0555..............  Humidifier for use w/       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      regula.
E0560..............  Humidifier supplemental w/  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      i.
E0561..............  Humidifier nonheated w PAP  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0562..............  Humidifier heated used w    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      PAP.
E0565..............  Compressor air power        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      source.
E0570..............  Nebulizer with compression  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0571..............  Aerosol compressor for      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      svneb.
E0572..............  Aerosol compressor adjust   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pr.
E0574..............  Ultrasonic generator w      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      svneb.

[[Page 43028]]

 
E0575..............  Nebulizer ultrasonic......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0580..............  Nebulizer for use w/        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      regulat.
E0585..............  Nebulizer w/ compressor &   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      he.
E0600..............  Suction pump portab hom     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      modl.
E0601..............  Cont airway pressure        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E0602..............  Manual breast pump........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0603..............  Electric breast pump......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0604..............  Hosp grade elec breast      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pump.
E0605..............  Vaporizer room type.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0606..............  Drainage board postural...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0607..............  Blood glucose monitor home  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0610..............  Pacemaker monitr audible/   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      vis.
E0615..............  Pacemaker monitr digital/   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      vis.
E0616..............  Cardiac event recorder....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
E0617..............  Automatic ext               ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      defibrillator.
E0618..............  Apnea monitor.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0619..............  Apnea monitor w recorder..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0620..............  Cap bld skin piercing       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      laser.
E0621..............  Patient lift sling or seat  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0625..............  Patient lift bathroom or    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      toi.
E0627..............  Seat lift incorp lift-      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      chair.
E0628..............  Seat lift for pt furn-      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      electr.
E0629..............  Seat lift for pt furn-non-  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      el.
E0630..............  Patient lift hydraulic....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0635..............  Patient lift electric.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0636..............  PT support & positioning    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E0637..............  Combination sit to stand    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E0638..............  Standing frame sys........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0639..............  Moveable patient lift       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      system.
E0640..............  Fixed patient lift system.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0641..............  Multi-position stnd fram    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E0642..............  Dynamic standing frame....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0650..............  Pneuma compresor non-       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      segment.
E0651..............  Pneum compressor segmental  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0652..............  Pneum compres w/cal         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pressure.
E0655..............  Pneumatic appliance half    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E0660..............  Pneumatic appliance full    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E0665..............  Pneumatic appliance full    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E0666..............  Pneumatic appliance half    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E0667..............  Seg pneumatic appl full     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E0668..............  Seg pneumatic appl full     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E0669..............  Seg pneumatic appli half    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E0671..............  Pressure pneum appl full    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E0672..............  Pressure pneum appl full    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E0673..............  Pressure pneum appl half    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E0675..............  Pneumatic compression       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E0676..............  Inter limb compress dev     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
E0691..............  Uvl pnl 2 sq ft or less...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0692..............  Uvl sys panel 4 ft........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0693..............  Uvl sys panel 6 ft........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0694..............  Uvl md cabinet sys 6 ft...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0700..............  Safety equipment..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0705..............  Transfer board or device..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E0710..............  Restraints any type.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0720..............  Tens two lead.............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0730..............  Tens four lead............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0731..............  Conductive garment for      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tens/.
E0740..............  Incontinence treatment      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      systm.
E0744..............  Neuromuscular stim for      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      scoli.
E0745..............  Neuromuscular stim for      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      shock.
E0746..............  Electromyograph             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      biofeedback.
E0747..............  Elec osteogen stim not      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      spine.
E0748..............  Elec osteogen stim spinal.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0749..............  Elec osteogen stim          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      implanted.
E0755..............  Electronic salivary reflex  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      s.
E0760..............  Osteogen ultrasound         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      stimltor.
E0761..............  Nontherm electromgntc       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      device.
E0762..............  Trans elec jt stim dev sys  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E0764..............  Functional                  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      neuromuscularstim.
E0765..............  Nerve stimulator for tx     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      n&v.
E0769..............  Electric wound treatment    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dev.
E0776..............  Iv pole...................  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0779..............  Amb infusion pump           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mechanical.
E0780..............  Mech amb infusion pump      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <8hrs.
E0781..............  External ambulatory infus   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pu.
E0782..............  Non-programble infusion     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      pump.
E0783..............  Programmable infusion pump  ..................  N.................  ...........  ...........  ...........  ...........  ...........
E0784..............  Ext amb infusn pump         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      insulin.

[[Page 43029]]

 
E0785..............  Replacement impl pump       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      cathet.
E0786..............  Implantable pump            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
E0791..............  Parenteral infusion pump    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      sta.
E0830..............  Ambulatory traction device  ..................  N.................  ...........  ...........  ...........  ...........  ...........
E0840..............  Tract frame attach          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      headboard.
E0849..............  Cervical pneum trac equip.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0850..............  Traction stand free         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      standing.
E0855..............  Cervical traction           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      equipment.
E0860..............  Tract equip cervical tract  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0870..............  Tract frame attach          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      footboard.
E0880..............  Trac stand free stand       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      extrem.
E0890..............  Traction frame attach       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pelvic.
E0900..............  Trac stand free stand       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pelvic.
E0910..............  Trapeze bar attached to     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      bed.
E0911..............  HD trapeze bar attach to    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      bed.
E0912..............  HD trapeze bar free         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      standing.
E0920..............  Fracture frame attached to  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
E0930..............  Fracture frame free         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      standing.
E0935..............  Cont pas motion exercise    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      dev.
E0936..............  CPM device, other than      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      knee.
E0940..............  Trapeze bar free standing.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0941..............  Gravity assisted traction   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      de.
E0942..............  Cervical head harness/      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      halter.
E0944..............  Pelvic belt/harness/boot..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0945..............  Belt/harness extremity....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0946..............  Fracture frame dual w       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cross.
E0947..............  Fracture frame attachmnts   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pe.
E0948..............  Fracture frame attachmnts   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ce.
E0950..............  Tray......................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0951..............  Loop heel.................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0952..............  Toe loop/holder, each.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0955..............  Cushioned headrest........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0956..............  W/c lateral trunk/hip       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      suppor.
E0957..............  W/c medial thigh support..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0958..............  Whlchr att- conv 1 arm      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      drive.
E0959..............  Amputee adapter...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E0960..............  W/c shoulder harness/       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      straps.
E0961..............  Wheelchair brake extension  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E0966..............  Wheelchair head rest        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      extensi.
E0967..............  Manual wc hand rim w        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      project.
E0968..............  Wheelchair commode seat...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0969..............  Wheelchair narrowing        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E0970..............  Wheelchair no. 2            ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      footplates.
E0971..............  Wheelchair anti-tipping     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      devi.
E0973..............  W/Ch access det adj         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      armrest.
E0974..............  W/Ch access anti-rollback.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E0978..............  W/C acc,saf belt pelv       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      strap.
E0980..............  Wheelchair safety vest....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0981..............  Seat upholstery,            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
E0982..............  Back upholstery,            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
E0983..............  Add pwr joystick..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0984..............  Add pwr tiller............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0985..............  W/c seat lift mechanism...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0986..............  Man w/c push-rim pow        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      assist.
E0990..............  Wheelchair elevating leg    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      res.
E0992..............  Wheelchair solid seat       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      insert.
E0994..............  Wheelchair arm rest.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0995..............  Wheelchair calf rest......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E1002..............  Pwr seat tilt.............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1003..............  Pwr seat recline..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1004..............  Pwr seat recline mech.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1005..............  Pwr seat recline pwr......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1006..............  Pwr seat combo w/o shear..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1007..............  Pwr seat combo w/shear....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1008..............  Pwr seat combo pwr shear..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1009..............  Add mech leg elevation....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1010..............  Add pwr leg elevation.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1011..............  Ped wc modify width         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      adjustm.
E1014..............  Reclining back add ped w/c  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1015..............  Shock absorber for man w/c  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1016..............  Shock absorber for power w/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      c.
E1017..............  HD shck absrbr for hd man   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
E1018..............  HD shck absrber for hd      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      powwc.
E1020..............  Residual limb support       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      system.
E1028..............  W/c manual swingaway......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1029..............  W/c vent tray fixed.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1030..............  W/c vent tray gimbaled....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1031..............  Rollabout chair with        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      casters.

[[Page 43030]]

 
E1035..............  Patient transfer system...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1037..............  Transport chair, ped size.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1038..............  Transport chair pt          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wt[lE]300lb.
E1039..............  Transport chair pt wt       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      >300lb.
E1050..............  Whelchr fxd full length     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      arms.
E1060..............  Wheelchair detachable arms  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1070..............  Wheelchair detachable foot  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      r.
E1083..............  Hemi-wheelchair fixed arms  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1084..............  Hemi-wheelchair detachable  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1085..............  Hemi-wheelchair fixed arms  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1086..............  Hemi-wheelchair detachable  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1087..............  Wheelchair lightwt fixed    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E1088..............  Wheelchair lightweight det  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1089..............  Wheelchair lightwt fixed    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E1090..............  Wheelchair lightweight det  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1092..............  Wheelchair wide w/ leg      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rests.
E1093..............  Wheelchair wide w/ foot     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rest.
E1100..............  Whchr s-recl fxd arm leg    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      res.
E1110..............  Wheelchair semi-recl        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      detach.
E1130..............  Whlchr stand fxd arm ft     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rest.
E1140..............  Wheelchair standard detach  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1150..............  Wheelchair standard w/ leg  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      r.
E1160..............  Wheelchair fixed arms.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1161..............  Manual adult wc w           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tiltinspac.
E1170..............  Whlchr ampu fxd arm leg     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rest.
E1171..............  Wheelchair amputee w/o leg  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      r.
E1172..............  Wheelchair amputee detach   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ar.
E1180..............  Wheelchair amputee w/ foot  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      r.
E1190..............  Wheelchair amputee w/ leg   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      re.
E1195..............  Wheelchair amputee heavy    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dut.
E1200..............  Wheelchair amputee fixed    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E1220..............  Whlchr special size/        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      constrc.
E1221..............  Wheelchair spec size w      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      foot.
E1222..............  Wheelchair spec size w/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E1223..............  Wheelchair spec size w      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      foot.
E1224..............  Wheelchair spec size w/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E1225..............  Manual semi-reclining back  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1226..............  Manual fully reclining      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      back.
E1227..............  Wheelchair spec sz spec ht  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1228..............  Wheelchair spec sz spec ht  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
E1229..............  Pediatric wheelchair NOS..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1230..............  Power operated vehicle....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1231..............  Rigid ped w/c tilt-in-      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      space.
E1232..............  Folding ped wc tilt-in-     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      space.
E1233..............  Rig ped wc tltnspc w/o      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      seat.
E1234..............  Fld ped wc tltnspc w/o      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      seat.
E1235..............  Rigid ped wc adjustable...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1236..............  Folding ped wc adjustable.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1237..............  Rgd ped wc adjstabl w/o     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      seat.
E1238..............  Fld ped wc adjstabl w/o     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      seat.
E1239..............  Ped power wheelchair NOS..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1240..............  Whchr litwt det arm leg     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rest.
E1250..............  Wheelchair lightwt fixed    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E1260..............  Wheelchair lightwt foot     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rest.
E1270..............  Wheelchair lightweight leg  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      r.
E1280..............  Whchr h-duty det arm leg    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      res.
E1285..............  Wheelchair heavy duty       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fixed.
E1290..............  Wheelchair hvy duty detach  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1295..............  Wheelchair heavy duty       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fixed.
E1296..............  Wheelchair special seat     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      heig.
E1297..............  Wheelchair special seat     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      dept.
E1298..............  Wheelchair spec seat depth/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      w.
E1300..............  Whirlpool portable........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E1310..............  Whirlpool non-portable....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1340..............  Repair for DME, per 15 min  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1353..............  Oxygen supplies regulator.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1355..............  Oxygen supplies stand/rack  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1372..............  Oxy suppl heater for        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      nebuliz.
E1390..............  Oxygen concentrator.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1391..............  Oxygen concentrator, dual.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1392..............  Portable oxygen             ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      concentrator.
E1399..............  Durable medical equipment   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mi.
E1405..............  O2/water vapor enrich w/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      heat.
E1406..............  O2/water vapor enrich w/o   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      he.
E1500..............  Centrifuge................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1510..............  Kidney dialysate delivry    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E1520..............  Heparin infusion pump.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1530..............  Replacement air bubble      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      detec.

[[Page 43031]]

 
E1540..............  Replacement pressure alarm  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1550..............  Bath conductivity meter...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1560..............  Replace blood leak          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      detector.
E1570..............  Adjustable chair for esrd   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pt.
E1575..............  Transducer protect/fld bar  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1580..............  Unipuncture control system  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1590..............  Hemodialysis machine......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1592..............  Auto interm peritoneal      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dialy.
E1594..............  Cycler dialysis machine...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1600..............  Deli/install chrg hemo      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equip.
E1610..............  Reverse osmosis h2o puri    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E1615..............  Deionizer H2O puri system.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1620..............  Replacement blood pump....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1625..............  Water softening system....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1630..............  Reciprocating peritoneal    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dia.
E1632..............  Wearable artificial kidney  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1634..............  Peritoneal dialysis clamp.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E1635..............  Compact travel              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      hemodialyzer.
E1636..............  Sorbent cartridges per 10.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1637..............  Hemostats for dialysis,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
E1639..............  Dialysis scale............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1699..............  Dialysis equipment noc....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1700..............  Jaw motion rehab system...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1701..............  Repl cushions for jaw       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      motion.
E1702..............  Repl measr scales jaw       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      motion.
E1800..............  Adjust elbow ext/flex       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E1801..............  SPS elbow device..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1802..............  Adjst forearm pro/sup       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E1805..............  Adjust wrist ext/flex       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E1806..............  SPS wrist device..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1810..............  Adjust knee ext/flex        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E1811..............  SPS knee device...........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1812..............  Knee ext/flex w act res     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ctrl.
E1815..............  Adjust ankle ext/flex       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E1816..............  SPS ankle device..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1818..............  SPS forearm device........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1820..............  Soft interface material...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1821..............  Replacement interface SPSD  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1825..............  Adjust finger ext/flex      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      devc.
E1830..............  Adjust toe ext/flex device  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1840..............  Adj shoulder ext/flex       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E1841..............  Static str shldr dev rom    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      adj.
E1902..............  AAC non-electronic board..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E2000..............  Gastric suction pump hme    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mdl.
E2100..............  Bld glucose monitor w       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      voice.
E2101..............  Bld glucose monitor w       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      lance.
E2120..............  Pulse gen sys tx endolymp   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      fl.
E2201..............  Man w/ch acc seat           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      w[gE]20''<24''.
E2202..............  Seat width 24-27 in.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2203..............  Frame depth less than 22    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      in.
E2204..............  Frame depth 22 to 25 in...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2205..............  Manual wc accessory,        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      handrim.
E2206..............  Complete wheel lock         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      assembly.
E2207..............  Crutch and cane holder....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2208..............  Cylinder tank carrier.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2209..............  Arm trough each...........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2210..............  Wheelchair bearings.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2211..............  Pneumatic propulsion tire.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2212..............  Pneumatic prop tire tube..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2213..............  Pneumatic prop tire insert  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2214..............  Pneumatic caster tire each  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2215..............  Pneumatic caster tire tube  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2216..............  Foam filled propulsion      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
E2217..............  Foam filled caster tire     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      each.
E2218..............  Foam propulsion tire each.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2219..............  Foam caster tire any size   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ea.
E2220..............  Solid propulsion tire each  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2221..............  Solid caster tire each....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2222..............  Solid caster integrated     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      whl.
E2223..............  Valve replacement only      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      each.
E2224..............  Propulsion whl excludes     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
E2225..............  Caster wheel excludes tire  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2226..............  Caster fork replacement     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      only.
E2291..............  Planar back for ped size    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
E2292..............  Planar seat for ped size    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
E2293..............  Contour back for ped size   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
E2294..............  Contour seat for ped size   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
E2300..............  Pwr seat elevation sys....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........

[[Page 43032]]

 
E2301..............  Pwr standing..............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2310..............  Electro connect btw         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      control.
E2311..............  Electro connect btw 2 sys.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2321..............  Hand interface joystick...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2322..............  Mult mech switches........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2323..............  Special joystick handle...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2324..............  Chin cup interface........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2325..............  Sip and puff interface....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2326..............  Breath tube kit...........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2327..............  Head control interface      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mech.
E2328..............  Head/extremity control      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      inter.
E2329..............  Head control                ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      nonproportional.
E2330..............  Head control proximity      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      switc.
E2331..............  Attendant control.........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2340..............  W/c wdth 20-23 in seat      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      frame.
E2341..............  W/c wdth 24-27 in seat      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      frame.
E2342..............  W/c dpth 20-21 in seat      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      frame.
E2343..............  W/c dpth 22-25 in seat      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      frame.
E2351..............  Electronic SGD interface..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2360..............  22nf nonsealed leadacid...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2361..............  22nf sealed leadacid        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      battery.
E2362..............  Gr24 nonsealed leadacid...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2363..............  Gr24 sealed leadacid        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      battery.
E2364..............  U1nonsealed leadacid        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      battery.
E2365..............  U1 sealed leadacid battery  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2366..............  Battery charger, single     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mode.
E2367..............  Battery charger, dual mode  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2368..............  Power wc motor replacement  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2369..............  Pwr wc gear box             ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
E2370..............  Pwr wc motor/gear box       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      combo.
E2371..............  Gr27 sealed leadacid        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      battery.
E2372..............  Gr27 non-sealed leadacid..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2373..............  Hand/chin ctrl spec         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      joystick.
E2374..............  Hand/chin ctrl std          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      joystick.
E2375..............  Non-expandable controller.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2376..............  Expandable controller,      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      repl.
E2377..............  Expandable controller,      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      initl.
E2381..............  Pneum drive wheel tire....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2382..............  Tube, pneum wheel drive     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
E2383..............  Insert, pneum wheel drive.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2384..............  Pneumatic caster tire.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2385..............  Tube, pneumatic caster      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
E2386..............  Foam filled drive wheel     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
E2387..............  Foam filled caster tire...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2388..............  Foam drive wheel tire.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2389..............  Foam caster tire..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2390..............  Solid drive wheel tire....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2391..............  Solid caster tire.........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2392..............  Solid caster tire,          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      integrate.
E2393..............  Valve, pneumatic tire tube  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2394..............  Drive wheel excludes tire.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2395..............  Caster wheel excludes tire  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2396..............  Caster fork...............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2399..............  Noc interface.............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2402..............  Neg press wound therapy     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pump.
E2500..............  SGD digitized pre-rec       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      [lE]8min.
E2502..............  SGD prerec msg >8min        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      [lE]20min.
E2504..............  SGD prerec msg>20min        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      [lE]40min.
E2506..............  SGD prerec msg > 40 min...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2508..............  SGD spelling phys contact.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2510..............  SGD w multi methods msg/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      accs.
E2511..............  SGD sftwre prgrm for PC/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      PDA.
E2512..............  SGD accessory, mounting     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E2599..............  SGD accessory noc.........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2601..............  Gen w/c cushion wdth < 22   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      in.
E2602..............  Gen w/c cushion wdth        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      [gE]22 in.
E2603..............  Skin protect wc cus wd      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <22in.
E2604..............  Skin protect wc cus         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wd[gE]22in.
E2605..............  Position wc cush wdth <22   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      in.
E2606..............  Position wc cush            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wdth[gE]22 in.
E2607..............  Skin pro/pos wc cus wd      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <22in.
E2608..............  Skin pro/pos wc cus         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wd[gE]22in.
E2609..............  Custom fabricate w/c        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cushion.
E2610..............  Powered w/c cushion.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E2611..............  Gen use back cush wdth      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <22in.
E2612..............  Gen use back cush           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wdth[gE]22in.
E2613..............  Position back cush wd       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <22in.
E2614..............  Position back cush          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wd[gE]22in.

[[Page 43033]]

 
E2615..............  Pos back post/lat wdth      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <22in.
E2616..............  Pos back post/lat           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wdth[gE]22in.
E2617..............  Custom fab w/c back         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cushion.
E2618..............  Wc acc solid seat supp      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      base.
E2619..............  Replace cover w/c seat      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cush.
E2620..............  WC planar back cush wd      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <22in.
E2621..............  WC planar back cush         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wd[gE]22in.
E8000..............  Posterior gait trainer....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E8001..............  Upright gait trainer......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E8002..............  Anterior gait trainer.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G0008..............  Admin influenza virus vac.  ..................  S.................         0350       0.4037       $25.71  ...........  ...........
G0009..............  Admin pneumococcal vaccine  ..................  S.................         0350       0.4037       $25.71  ...........  ...........
G0010..............  Admin hepatitis b vaccine.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0027..............  Semen analysis............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0101..............  CA screen;pelvic/breast     ..................  V.................         0604       0.8381       $53.38  ...........       $10.68
                      exam.
G0102..............  Prostate ca screening; dre  ..................  N.................  ...........  ...........  ...........  ...........  ...........
G0103..............  PSA screening.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0104..............  CA screen;flexi             ..................  S.................         0159       4.7799      $304.45  ...........       $76.11
                      sigmoidscope.
G0105..............  Colorectal scrn; hi risk    ..................  T.................         0158       8.0134      $510.40  ...........      $127.60
                      ind.
G0106..............  Colon CA screen;barium      ..................  S.................         0157       2.2613      $144.03  ...........       $28.81
                      enema.
G0108..............  Diab manage trn per indiv.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0109..............  Diab manage trn ind/group.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0117..............  Glaucoma scrn hgh risk      ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      direc.
G0118..............  Glaucoma scrn hgh risk      ..................  S.................         0230       0.7379       $47.00  ...........        $9.40
                      direc.
G0120..............  Colon ca scrn; barium       ..................  S.................         0157       2.2613      $144.03  ...........       $28.81
                      enema.
G0121..............  Colon ca scrn not hi rsk    ..................  T.................         0158       8.0134      $510.40  ...........      $127.60
                      ind.
G0122..............  Colon ca scrn; barium       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      enema.
G0123..............  Screen cerv/vag thin layer  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0124..............  Screen c/v thin layer by    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      MD.
G0127..............  Trim nail(s)..............  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
G0128..............  CORF skilled nursing        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      service.
G0129..............  Partial hosp prog service.  ..................  P.................         0033  ...........  ...........  ...........  ...........
G0130..............  Single energy x-ray study.  ..................  X.................         0260       0.7259       $46.23  ...........        $9.25
G0141..............  Scr c/v cyto,autosys and    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      md.
G0143..............  Scr c/v                     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cyto,thinlayer,rescr.
G0144..............  Scr c/v                     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cyto,thinlayer,rescr.
G0145..............  Scr c/v                     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cyto,thinlayer,rescr.
G0147..............  Scr c/v cyto, automated     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sys.
G0148..............  Scr c/v cyto, autosys,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rescr.
G0151..............  HHCP-serv of pt,ea 15 min.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0152..............  HHCP-serv of ot,ea 15 min.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0153..............  HHCP-svs of s/l path,ea     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      15mn.
G0154..............  HHCP-svs of rn,ea 15 min..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0155..............  HHCP-svs of csw,ea 15 min.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0156..............  HHCP-svs of aide,ea 15 min  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0166..............  Extrnl counterpulse, per    ..................  T.................         0678       1.7081      $108.79  ...........       $21.76
                      tx.
G0168..............  Wound closure by adhesive.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0173..............  Linear acc stereo radsur    ..................  S.................         0067      61.5205    $3,918.43  ...........      $783.69
                      com.
G0175..............  OPPS Service,sched team     ..................  V.................         0608       2.2077      $140.62  ...........       $28.12
                      conf.
G0176..............  OPPS/PHP;activity therapy.  ..................  P.................         0033  ...........  ...........  ...........  ...........
G0177..............  OPPS/PHP; train & educ      CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      serv.
G0179..............  MD recertification HHA PT.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G0180..............  MD certification HHA        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      patient.
G0181..............  Home health care            ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      supervision.
G0182..............  Hospice care supervision..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G0186..............  Dstry eye lesn,fdr vssl     ..................  T.................         0235         4.01      $255.41       $58.90       $51.08
                      tech.
G0202..............  Screeningmammographydigita  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      l.
G0204..............  Diagnosticmammographydigit  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      al.
G0206..............  Diagnosticmammographydigit  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      al.
G0219..............  PET img wholbod melano      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      nonco.
G0235..............  PET not otherwise           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      specified.
G0237..............  Therapeutic procd strg      CH................  S.................         0077       0.3904       $24.87        $7.70        $4.97
                      endur.
G0238..............  Oth resp proc, indiv......  CH................  S.................         0077       0.3904       $24.87        $7.70        $4.97
G0239..............  Oth resp proc, group......  CH................  S.................         0077       0.3904       $24.87        $7.70        $4.97
G0245..............  Initial foot exam pt lops.  ..................  V.................         0604       0.8381       $53.38  ...........       $10.68
G0246..............  Followup eval of foot pt    ..................  V.................         0605       1.0016       $63.79  ...........       $12.76
                      lop.
G0247..............  Routine footcare pt w lops  CH................  T.................         0013       0.8046       $51.25  ...........       $10.25
G0248..............  Demonstrate use home inr    CH................  X.................         0097       1.0396       $66.22       $23.70       $13.24
                      mon.
G0249..............  Provide test                CH................  X.................         0097       1.0396       $66.22       $23.70       $13.24
                      material,equipm.
G0250..............  MD review interpret of      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      test.
G0251..............  Linear acc based stero      ..................  S.................         0065      17.1992    $1,095.47  ...........      $219.09
                      radio.
G0252..............  PET imaging initial dx....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G0255..............  Current percep threshold    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tst.
G0257..............  Unsched dialysis ESRD pt    ..................  S.................         0170       6.7915      $432.57  ...........       $86.51
                      hos.
G0259..............  Inject for sacroiliac       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      joint.
G0260..............  Inj for sacroiliac jt       CH................  T.................         0207        7.137      $454.58  ...........       $90.92
                      anesth.
G0265..............  Cryopresevation             CH................  B.................  ...........  ...........  ...........  ...........  ...........
                      Freeze+stora.
G0266..............  Thawing + expansion froz    CH................  B.................  ...........  ...........  ...........  ...........  ...........
                      cel.

[[Page 43034]]

 
G0267..............  Bone marrow or psc harvest  CH................  B.................  ...........  ...........  ...........  ...........  ...........
G0268..............  Removal of impacted wax md  CH................  N.................  ...........  ...........  ...........  ...........  ...........
G0269..............  Occlusive device in vein    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      art.
G0270..............  MNT subs tx for change dx.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0271..............  Group MNT 2 or more 30      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mins.
G0275..............  Renal angio, cardiac cath.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
G0278..............  Iliac art angio,cardiac     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      cath.
G0281..............  Elec stim unattend for      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      press.
G0282..............  Elect stim wound care not   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pd.
G0283..............  Elec stim other than wound  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0288..............  Recon, CTA for surg plan..  CH................  Q.................         0417       2.3401      $149.05  ...........       $29.81
G0289..............  Arthro, loose body +        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      chondro.
G0290..............  Drug-eluting stents,        ..................  T.................         0656     118.8818    $7,571.94  ...........    $1,514.39
                      single.
G0291..............  Drug-eluting stents,each    ..................  T.................         0656     118.8818    $7,571.94  ...........    $1,514.39
                      add.
G0293..............  Non-cov surg proc,clin      ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
                      trial.
G0294..............  Non-cov proc, clinical      ..................  X.................         0340       0.6416       $40.87  ...........        $8.17
                      trial.
G0295..............  Electromagnetic therapy     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      onc.
G0297..............  Insert single chamber/cd..  CH................  B.................  ...........  ...........  ...........  ...........  ...........
G0298..............  Insert dual chamber/cd....  CH................  B.................  ...........  ...........  ...........  ...........  ...........
G0299..............  Inser/repos single          CH................  B.................  ...........  ...........  ...........  ...........  ...........
                      icd+leads.
G0300..............  Insert reposit lead         CH................  B.................  ...........  ...........  ...........  ...........  ...........
                      dual+gen.
G0302..............  Pre-op service LVRS         CH................  S.................         0209      11.5647      $736.59      $268.70      $147.32
                      complete.
G0303..............  Pre-op service LVRS 10-     CH................  S.................         0209      11.5647      $736.59      $268.70      $147.32
                      15dos.
G0304..............  Pre-op service LVRS 1-9     CH................  S.................         0213       2.3476      $149.53       $53.50       $29.91
                      dos.
G0305..............  Post op service LVRS min 6  CH................  S.................         0213       2.3476      $149.53       $53.50       $29.91
G0306..............  CBC/diffwbc w/o platelet..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0307..............  CBC without platelet......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0308..............  ESRD related svc 4+mo <     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      2yrs.
G0309..............  ESRD related svc 2-3mo      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      <2yrs.
G0310..............  ESRD related svc 1 vst      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      <2yrs.
G0311..............  ESRD related svs 4+mo 2-    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      11yr.
G0312..............  ESRD relate svs 2-3 mo 2-   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      11y.
G0313..............  ESRD related svs 1 mon 2-   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      11y.
G0314..............  ESRD related svs 4+ mo 12-  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      19.
G0315..............  ESRD related svs 2-3mo/12-  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      19.
G0316..............  ESRD related svs 1vis/12-   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      19y.
G0317..............  ESRD related svs 4+mo       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      20+yrs.
G0318..............  ESRD related svs 2-3 mo     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      20+y.
G0319..............  ESRD related svs 1visit     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      20+y.
G0320..............  ESD related svs home undr   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      2.
G0321..............  ESRDrelatedsvs home mo 2-   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      11y.
G0322..............  ESRD related svs hom mo12-  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      19.
G0323..............  ESRD related svs home mo    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      20+.
G0324..............  ESRD relate svs home/dy     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      <2yr.
G0325..............  ESRD relate home/day/ 2-    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      11yr.
G0326..............  ESRD relate home/dy 12-     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      19yr.
G0327..............  ESRD relate home/dy 20+yrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0328..............  Fecal blood scrn            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      immunoassay.
G0329..............  Electromagntic tx for       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ulcers.
G0332..............  Preadmin IV immunoglobulin  CH................  S.................         0430       0.6123       $39.00  ...........        $7.80
G0333..............  Dispense fee initial 30     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      day.
G0337..............  Hospice evaluation          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      preelecti.
G0339..............  Robot lin-radsurg com,      ..................  S.................         0067      61.5205    $3,918.43  ...........      $783.69
                      first.
G0340..............  Robt lin-radsurg fractx 2-  ..................  S.................         0066      47.3767    $3,017.56  ...........      $603.51
                      5.
G0341..............  Percutaneous islet          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      celltrans.
G0342..............  Laparoscopy islet cell      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      trans.
G0343..............  Laparotomy islet cell       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      transp.
G0344..............  Initial preventive exam...  ..................  V.................         0605       1.0016       $63.79  ...........       $12.76
G0364..............  Bone marrow aspirate        ..................  T.................         0002       1.1915       $75.89  ...........       $15.18
                      &biopsy.
G0365..............  Vessel mapping hemo access  ..................  S.................         0267       2.4859      $158.33       $60.50       $31.67
G0366..............  EKG for initial prevent     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      exam.
G0367..............  EKG tracing for initial     ..................  S.................         0099       0.3912       $24.92  ...........        $4.98
                      prev.
G0368..............  EKG interpret & report      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      preve.
G0372..............  MD service required for     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      PMD.
G0375..............  Smoke/tobacco counselng 3-  ..................  X.................         0031        0.166       $10.57  ...........        $2.11
                      10.
G0376..............  Smoke/tobacco counseling    ..................  X.................         0031        0.166       $10.57  ...........        $2.11
                      >10.
G0377..............  Administra Part D vaccine.  ..................  S.................         0437       0.4037       $25.71  ...........        $5.14
G0378..............  Hospital observation per    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      hr.
G0379..............  Direct admit hospital       ..................  Q.................         0604       0.8381       $53.38  ...........       $10.68
                      observ.
G0380..............  Lev 1 hosp type B ED visit  ..................  V.................         0604       0.8381       $53.38  ...........       $10.68
G0381..............  Lev 2 hosp type B ED visit  ..................  V.................         0605       1.0016       $63.79  ...........       $12.76
G0382..............  Lev 3 hosp type B ED visit  ..................  V.................         0606       1.3665       $87.04  ...........       $17.41
G0383..............  Lev 4 hosp type B ED visit  ..................  V.................         0607       1.7181      $109.43  ...........       $21.89
G0384..............  Lev 5 hosp type B ED visit  ..................  V.................         0608       2.2077      $140.62  ...........       $28.12
G0389..............  Ultrasound exam AAA screen  ..................  S.................         0266       1.5657       $99.72       $37.80       $19.94
G0390..............  Trauma Respons w/hosp       ..................  S.................         0618       5.6539      $360.11      $144.04       $72.02
                      criti.
G0392..............  AV fistula or graft         CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85
                      arterial.
G0393..............  AV fistula or graft venous  CH................  T.................         0083      46.0685    $2,934.24  ...........      $586.85

[[Page 43035]]

 
G0394..............  Blood occult                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test,colorectal.
G3001..............  Admin + supply,             ..................  S.................         0442      30.2249    $1,925.11  ...........      $385.02
                      tositumomab.
G8006..............  AMI pt recd aspirin at      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      arriv.
G8007..............  AMI pt did not receiv       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      aspiri.
G8008..............  AMI pt ineligible for       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      aspiri.
G8009..............  AMI pt recd Bblock at arr.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8010..............  AMI pt did not rec bblock.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8011..............  AMI pt inelig Bbloc at      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      arriv.
G8012..............  Pneum pt recv antibiotic 4  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      h.
G8013..............  Pneum pt w/o antibiotic 4   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      hr.
G8014..............  Pneum pt not elig           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antibiotic.
G8015..............  Diabetic pt w/ HBA1c>9%...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8016..............  Diabetic pt w/ HBA1c<or=9%  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8017..............  DM pt inelig for HBA1c      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      measu.
G8018..............  Care not provided for       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      HbA1c.
G8019..............  Diabetic pt w/LDL[gE]       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      100mg/dl.
G8020..............  Diab pt w/LDL< 100mg/dl...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8021..............  Diab pt inelig for LDL      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      meas.
G8022..............  Care not provided for LDL.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8023..............  DM pt w BP[gE]140/80......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8024..............  Diabetic pt wBP<140/80....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8025..............  Diabetic pt inelig for BP   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      me.
G8026..............  Diabet pt w no care re BP   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      me.
G8027..............  HF p w/LVSD on ACE-I/ARB..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8028..............  HF pt w/LVSD not on ACE-I/  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      AR.
G8029..............  HF pt not elig for ACE-I/   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ARB.
G8030..............  HF pt w/LVSD on Bblocker..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8031..............  HF pt w/LVSD not on         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      Bblocker.
G8032..............  HF pt not elig for          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      Bblocker.
G8033..............  PMI-CAD pt on Bblocker....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8034..............  PMI-CAD pt not on Bblocker  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8035..............  PMI-CAD pt inelig Bblocker  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8036..............  AMI-CAD pt doc on           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antiplatel.
G8037..............  AMI-CAD pt not docu on      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antip.
G8038..............  AMI-CAD inelig antiplate    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      mea.
G8039..............  CAD pt w/LDL>100mg/dl.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8040..............  CAD pt w/LDL<or=100mg/dl..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8041..............  CAD pt not eligible for     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      LDL.
G8051..............  Osteoporosis assess.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8052..............  Osteopor pt not assess....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8053..............  Pt inelig for osteopor      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      meas.
G8054..............  Falls assess not docum 12   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      mo.
G8055..............  Falls assess w/ 12 mon....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8056..............  Not elig for falls          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      assessmen.
G8057..............  Hearing assess receive....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8058..............  Pt w/o hearing assess.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8059..............  Pt inelig for hearing       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      assess.
G8060..............  Urinary incont pt assess..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8061..............  Pt not assess for urinary   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      in.
G8062..............  Pt not elig for urinary     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      inco.
G8075..............  ESRD pt w/ dialy of         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      URR[gE]65%.
G8076..............  ESRD pt w/ dialy of         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      URR<65%.
G8077..............  ESRD pt not elig for URR/   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      KtV.
G8078..............  ESRD pt w/Hct>or=33.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8079..............  ESRD pt w/Hct<33..........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8080..............  ESRD pt inelig for HCT/Hgb  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8081..............  ESRD pt w/ auto AV fistula  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8082..............  ESRD pt w other fistula...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8085..............  ESRD PT inelig auto AV      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      FISTU.
G8093..............  COPD pt rec smoking cessat  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8094..............  COPD pt w/o smoke cessat    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      int.
G8099..............  Osteopo pt given Ca+VitD    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      sup.
G8100..............  Osteop pt inelig for        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      Ca+VitD.
G8103..............  New dx osteo pt w/          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antiresorp.
G8104..............  Osteo pt inelig for         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antireso.
G8106..............  Bone dens meas test perf..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8107..............  Bone dens meas test inelig  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8108..............  Pt receiv influenza vacc..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8109..............  Pt w/o influenza vacc.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8110..............  Pt inelig for influenza     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      vacc.
G8111..............  Pt receiv mammogram.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8112..............  Pt not doc mammogram......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8113..............  Pt ineligible mammography.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8114..............  Care not provided for       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      mamogr.
G8115..............  Pt receiv pneumo vacc.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8116..............  Pt did not rec pneumo vacc  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8117..............  Pt was inelig for pneumo    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      vac.
G8126..............  Pt treat w/                 ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antidepress12wks.

[[Page 43036]]

 
G8127..............  Pt not treat w/             ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antidepres12w.
G8128..............  Pt inelig for antidepres    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      med.
G8129..............  Pt treat w/antidepres for   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      6m.
G8130..............  Pt not treat w/antidepres   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      6m.
G8131..............  Pt inelig for antidepres    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      med.
G8152..............  Pt w/AB 1 hr prior to       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      incisi.
G8153..............  Pt not doc for AB 1 hr      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prior.
G8154..............  Pt ineligi for AB therapy.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8155..............  Pt recd thromboemb          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prophylax.
G8156..............  Pt did not rec thromboembo  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8157..............  Pt ineligi for thrombolism  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8158..............  Pt recd CABG w/ IMA.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8159..............  Pt w/CABG w/o IMA.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8160..............  Pt inelig for CABG w/IMA..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8161..............  Iso CABG pt rec preop       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      bblock.
G8162..............  Iso CABG pt w/o preop       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      Bblock.
G8163..............  Iso CABG pt inelig for      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      preo.
G8164..............  Iso CABG pt w/prolng intub  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8165..............  Iso CABG pt w/o prolng      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      intub.
G8166..............  Iso CABG req surg rexpo...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8167..............  Iso CABG w/o surg explo...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8170..............  CEA/ext bypass pt on        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      aspirin.
G8171..............  Pt w/carot endarct/ext      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      bypas.
G8172..............  CEA/ext bypass pt not on    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      asp.
G8182..............  CAD pt care not prov LDL..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8183..............  HF/atrial fib pt on         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      warfarin.
G8184..............  HF/atrial fib pt inelig     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      warf.
G8185..............  Osteoarth pt w/ assess      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      pain.
G8186..............  Osteoarth pt inelig assess  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8191..............  Antibiotic given prior      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      surg.
G8192..............  Antib given prior surg      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      incis.
G8193..............  Antibio not doc prior surg  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8194..............  Pt not elig for antibiotic  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8195..............  Antibiotic given prior      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      surg.
G8196..............  Antibio not docum prior     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      surg.
G8197..............  Antib order prior to surg.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8198..............  Cefazolin documented        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ordered.
G8199..............  Cefazolin given             ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prophylaxis.
G8200..............  Cefazolin not docum prophy  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8201..............  Pt not eligi for cefazolin  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8202..............  Order given to d/c antibio  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8203..............  Antib was D/C 24hrs surg    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      tim.
G8204..............  MD not doc order to d/c     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      anti.
G8205..............  Pt not eligi for proph      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antib.
G8206..............  MD doc prophylactic AB      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      given.
G8207..............  Clini doc order to D/C      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antib.
G8208..............  Clini doc AB was D/C 48 h.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8209..............  Clinician did not doc.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8210..............  Clini doc pt ineligib anti  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8211..............  Clini doc proph AB giv....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8212..............  Clini order given for VTE.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8213..............  Clini given VTE prop......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8214..............  Clini not doc order VTE...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8215..............  Clini doc pt inelig VTE...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8216..............  Pt received DVT             ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prophylaxis.
G8217..............  Pt not received DVT proph.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8218..............  Pt inelig DVT prophylaxis.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8219..............  Received DVT proph day 2..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8220..............  Pt not rec DVT proph day 2  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8221..............  Pt inelig for DVT proph...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8222..............  Pt prescribe platelet at D/ ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      C.
G8223..............  Pt not doc for presc        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antipla.
G8224..............  Pt inelig for antiplat      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      proph.
G8225..............  Pt prescrib anticoag at D/  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      C.
G8226..............  Pt no prescr anticoa at D/  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      C.
G8227..............  Pt not doc to have perm/AF  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8228..............  Clin pt inelig anticoag D/  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      C.
G8229..............  Pt doc to have admin t-PA.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8230..............  Pt inelig t-PA isch         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      strok>3h.
G8231..............  Pt not doc for admin t-PA.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8232..............  Pt received dysphagia       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      screen.
G8234..............  Pt not doc dysphagia        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      screen.
G8235..............  Pt received NPO...........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8236..............  Pt inelig dysphagia screen  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8237..............  Pt doc rec rehab serv.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8238..............  Pt not doc to rec rehab     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      serv.
G8239..............  Inter carotid stenosis      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      <30%.
G8240..............  Inter carotid stenosis 30-  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      99%.

[[Page 43037]]

 
G8241..............  Pt inelig candidate ito     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      meas.
G8242..............  Pt doc to have CT/MRI w/    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      les.
G8243..............  Pt not doc MRI/CT w/o       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
G8245..............  Clini doc prese/abs alarm.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8246..............  Pt inelig hx w new/chg      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      mole.
G8247..............  Pt w/alarm symp upper endo  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8248..............  Pt w/one alarm symp not     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc.
G8249..............  Pt inelig for upper endo..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8250..............  Pt w/Barretts esoph endo    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      re.
G8251..............  Pt not doc w/Barretts,      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      endo.
G8252..............  Pt inelig for esophag biop  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8253..............  Pt rec order for barium...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8254..............  Pt w/no doc order for       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      barium.
G8255..............  Clini doc pt inelig bar     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      swal.
G8256..............  Clini doc rev D/C meds w/   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      med.
G8257..............  Pt not doc rev meds D/C...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8258..............  Pt inelig for d/c meds rev  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8259..............  Pt doc to hav decision      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      maker.
G8260..............  Pt not doc to have dec      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      maker.
G8261..............  Clin doc pt inelig dec      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      maker.
G8262..............  Pt doc assess uriny incon.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8263..............  Pt not doc assess urinary   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      in.
G8264..............  Pt inelig assess urinary    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      inc.
G8265..............  Pt doc rec charc urin       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      incon.
G8266..............  Pt not doc charc urin       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      incon.
G8267..............  Pt doc rec plan urinary     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      inco.
G8268..............  Pt not doc rec care urin    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      inc.
G8269..............  Clin not prov care urin     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      inco.
G8270..............  Pt receiv screen for fall.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8271..............  Pt no doc screen fall.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8272..............  Clin doc pt inelig fall     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      risk.
G8273..............  Clin not prov care scre     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      fall.
G8274..............  Clini not doc pres/abs      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      alarm.
G8275..............  Pt hx w/ new moles........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8276..............  Pt not doc mole change....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8277..............  Pt inelig for assess mole.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8278..............  Pt doc rec PE skin........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8279..............  Pt not doc rec PE.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8280..............  Pt inelig PE skin.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8281..............  Pt rec counsel for self-    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      exam.
G8282..............  Pt not doc to rec couns...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8283..............  Pt inelig for counsel.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8284..............  Pt doc to rec pres osteo..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8285..............  Pt did not rec pres osteo.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8286..............  Pt inelig to rec pres       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      osteo.
G8287..............  Clin not prov care for      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      pharm.
G8288..............  Pt doc rec Ca/Vit D.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8289..............  Pt not doc rec Ca/Vit D...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8290..............  Clin doc pt inelig Ca/Vit   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      D.
G8291..............  Clin no pro care pt Ca/Vit  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      D.
G8292..............  COPD pt w/spir results....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8293..............  COPD pt w/o spir results..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8294..............  COPD pt inelig spir         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      results.
G8295..............  COPD pt doc bronch ther...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8296..............  COPD pt not doc bronch      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ther.
G8297..............  COPD pt inelig bronch       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      therap.
G8298..............  Pt doc optic nerve eval...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8299..............  Pt not doc optic nerv eval  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8300..............  Pt inelig for optic nerv    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      eva.
G8301..............  Clin not prov care POAG...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8302..............  Pt doc w/ target IOP......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8303..............  Pt not doc w/ IOP.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8304..............  Clin doc pt inelig IOP....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8305..............  Clin not prov care POAG...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8306..............  POAG w/ IOP rec care plan.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8307..............  POAG w/ IOP no care plan..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8308..............  POAG w/ IOP not doc plan..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8309..............  Pt doc rec antioxidant....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8310..............  Pt not doc rec antiox.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8311..............  Pt inelig for antioxidant.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8312..............  Clin no prov care for       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antiox.
G8313..............  Pt doc rec macular exam...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8314..............  Pt not doc to rec mac exam  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8315..............  Clin doc pt inelig mac      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      exam.
G8316..............  Clin no pro care for mac    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      deg.
G8317..............  Pt doc to have visual func  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8318..............  Pt doc not have visual      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      func.
G8319..............  Pt inelig for vis func      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      stat.

[[Page 43038]]

 
G8320..............  Clin not prov care catarac  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8321..............  Pt doc to pre axial leng..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8322..............  Pt not doc pre axial leng.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8323..............  Pt inelig for pre surg      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      axial.
G8324..............  Clin not prov care for IOL  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8325..............  Pt rec fund exam prior      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      surg.
G8326..............  Pt not doc rec fundus exam  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8327..............  Pt inelig for pre surg      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      fundu.
G8328..............  Clin not prov care fund     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      eval.
G8329..............  Pt doc rec dilated macular  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8330..............  Pt not doc rec dilated mac  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8331..............  Pt inelig dilate fundus...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8332..............  Clin prov no care diabetic  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      r.
G8333..............  Pt doc to have macular      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      exam.
G8334..............  Doc of macular not giv MD.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8335..............  Clin doc pt inelig macular  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8336..............  Clin did not pro care       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      diabet.
G8337..............  Clin doc pt was test osteo  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8338..............  Clin not doc pt test osteo  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8339..............  Pt inelig for test osteo..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8340..............  Pt doc have DEXA..........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8341..............  Pt not doc for DEXA.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8342..............  Clin doc pt inelig DEXA...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8343..............  Clin not prov care DEXA...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8344..............  Pt doc have DEXA perform..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8345..............  Pt not doc have DEXA......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8346..............  Clin doc pt inelig DEXA...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8347..............  Clin not prov care DEXA...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8348..............  Int carotid stenosis meas.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8349..............  Pt inelig for doc of alarm  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8350..............  Pt doc 12 lead ECG........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8351..............  Pt not doc ECG............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8352..............  Pt inelig for ECG.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8353..............  Pt doc rec aspirin 24hrs    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ER.
G8354..............  Pt not rec aspirin prior    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ER.
G8355..............  Clin doc pt inelig aspirin  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8356..............  Pt doc to have ECG........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8357..............  Pt not doc to have ECG....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8358..............  Clin doc pt inelig ECG....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8359..............  Pt doc vital signs          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recorded.
G8360..............  Pt not doc vital signs      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recor.
G8361..............  Pt doc to have 02 SAT       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      assess.
G8362..............  Pt not doc 02 SAT assess..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8363..............  Clin doc pt inelig 02 SAT.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8364..............  Pt doc mental status        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      assess.
G8365..............  Pt not doc mental status..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8366..............  Pt doc to have empiric AB.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8367..............  Pt not doc have empiric AB  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8368..............  Clin doc pt inelig empiri   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      AB.
G9001..............  MCCD, initial rate........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9002..............  MCCD,maintenance rate.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9003..............  MCCD, risk adj hi, initial  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9004..............  MCCD, risk adj lo, initial  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9005..............  MCCD, risk adj,             ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      maintenance.
G9006..............  MCCD, Home monitoring.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9007..............  MCCD, sch team conf.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9008..............  Mccd,phys coor-care         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      ovrsght.
G9009..............  MCCD, risk adj, level 3...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9010..............  MCCD, risk adj, level 4...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9011..............  MCCD, risk adj, level 5...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9012..............  Other Specified Case Mgmt.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9013..............  ESRD demo bundle level I..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G9014..............  ESRD demo bundle-level II.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G9016..............  Demo-smoking cessation      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      coun.
G9017..............  Amantadine HCL 100mg oral.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9018..............  Zanamivir,inhalation pwd    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      10m.
G9019..............  Oseltamivir phosphate 75mg  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9020..............  Rimantadine HCL 100mg oral  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9033..............  Amantadine HCL oral brand.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9034..............  Zanamivir, inh pwdr, brand  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9035..............  Oseltamivir phosp, brand..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9036..............  Rimantadine HCL, brand....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9041..............  Low vision rehab            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      occupationa.
G9042..............  Low vision rehab orient/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mobi.
G9043..............  Low vision lowvision        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      therapi.
G9044..............  Low vision rehabilate       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      teache.
G9050..............  Oncology work-up            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      evaluation.
G9051..............  Oncology tx decision-mgmt.  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 43039]]

 
G9052..............  Onc surveillance for        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      disease.
G9053..............  Onc expectant management    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pt.
G9054..............  Onc supervision palliative  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G9055..............  Onc visit unspecified NOS.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G9056..............  Onc prac mgmt adheres       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      guide.
G9057..............  Onc pract mgmt differs      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      trial.
G9058..............  Onc prac mgmt disagree w/   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      gui.
G9059..............  Onc prac mgmt pt opt        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      alterna.
G9060..............  Onc prac mgmt dif pt        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      comorb.
G9061..............  Onc prac cond noadd by      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      guide.
G9062..............  Onc prac guide differs nos  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G9063..............  Onc dx nsclc stgI no        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      progres.
G9064..............  Onc dx nsclc stg2 no        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      progres.
G9065..............  Onc dx nsclc stg3A no       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      progre.
G9066..............  Onc dx nsclc stg3B-4        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      metasta.
G9067..............  Onc dx nsclc dx unknown     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      nos.
G9068..............  Onc dx sclc/nsclc limited.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9069..............  Onc dx sclc/nsclc ext at    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      dx.
G9070..............  Onc dx sclc/nsclc ext       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unknwn.
G9071..............  Onc dx brst stg1-2B         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      HR,nopro.
G9072..............  Onc dx brst stg1-2          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      noprogres.
G9073..............  Onc dx brst stg3-HR, no     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      pro.
G9074..............  Onc dx brst stg3-           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      noprogress.
G9075..............  Onc dx brst metastic/       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recur.
G9077..............  Onc dx prostate T1no        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      progres.
G9078..............  Onc dx prostate T2no        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      progres.
G9079..............  Onc dx prostate T3b-        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      T4noprog.
G9080..............  Onc dx prostate w/rise PSA  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9083..............  Onc dx prostate unknown     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
G9084..............  Onc dx colon t1-3,n1-2,no   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      pr.
G9085..............  Onc dx colon T4, N0 w/o     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prog.
G9086..............  Onc dx colon T1-4 no dx     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prog.
G9087..............  Onc dx colon metas evid dx  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9088..............  Onc dx colon metas noevid   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      dx.
G9089..............  Onc dx colon extent         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unknown.
G9090..............  Onc dx rectal T1-2 no       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      progr.
G9091..............  Onc dx rectal T3 N0 no      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prog.
G9092..............  Onc dx rectal T1-3,N1-      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      2noprg.
G9093..............  Onc dx rectal T4,N,M0 no    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prg.
G9094..............  Onc dx rectal M1 w/mets     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prog.
G9095..............  Onc dx rectal extent        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unknwn.
G9096..............  Onc dx esophag T1-T3        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      noprog.
G9097..............  Onc dx esophageal T4 no     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prog.
G9098..............  Onc dx esophageal mets      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recur.
G9099..............  Onc dx esophageal unknown.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9100..............  Onc dx gastric no           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recurrence.
G9101..............  Onc dx gastric p R1-        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      R2noprog.
G9102..............  Onc dx gastric              ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unresectable.
G9103..............  Onc dx gastric recurrent..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9104..............  Onc dx gastric unknown NOS  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9105..............  Onc dx pancreatc p R0 res   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      no.
G9106..............  Onc dx pancreatc p R1/R2    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      no.
G9107..............  Onc dx pancreatic           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unresectab.
G9108..............  Onc dx pancreatic unknwn    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
G9109..............  Onc dx head/neck T1-T2no    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prg.
G9110..............  Onc dx head/neck T3-4       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      noprog.
G9111..............  Onc dx head/neck M1 mets    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rec.
G9112..............  Onc dx head/neck ext        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unknown.
G9113..............  Onc dx ovarian stg1A-B no   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      pr.
G9114..............  Onc dx ovarian stg1A-B or   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      2.
G9115..............  Onc dx ovarian stg3/4       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      noprog.
G9116..............  Onc dx ovarian recurrence.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9117..............  Onc dx ovarian unknown NOS  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9123..............  Onc dx CML chronic phase..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9124..............  Onc dx CML acceler phase..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9125..............  Onc dx CML blast phase....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9126..............  Onc dx CML remission......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9128..............  Onc dx multi myeloma stage  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      I.
G9129..............  Onc dx mult myeloma stg2    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      hig.
G9130..............  Onc dx multi myeloma        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unknown.
G9131..............  Onc dx brst unknown NOS...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9132..............  Onc dx prostate mets no     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      cast.
G9133..............  Onc dx prostate clinical    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      met.
G9134..............  Onc NHLstg 1-2 no relap no  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9135..............  Onc dx NHL stg 3-4 not      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      relap.
G9136..............  Onc dx NHL trans to lg      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      Bcell.
G9137..............  Onc dx NHL relapse/         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      refractor.
G9138..............  Onc dx NHL stg unknown....  ..................  M.................  ...........  ...........  ...........  ...........  ...........

[[Page 43040]]

 
G9139..............  Onc dx CML dx status        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unknown.
GXXX1..............  MD serv cardiac rehab w/o   ..................  S.................         0095       0.5868       $37.38       $13.80        $7.48
                      EC.
GXXX2..............  MD serv cardiac rehab w     ..................  S.................         0095       0.5868       $37.38       $13.80        $7.48
                      ECG.
J0120..............  Tetracyclin injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0128..............  Abarelix injection........  ..................  K.................         9216  ...........       $67.97  ...........       $13.59
J0129..............  Abatacept injection.......  ..................  G.................         9230  ...........       $18.69  ...........        $3.74
J0130..............  Abciximab injection.......  ..................  K.................         1605  ...........      $409.26  ...........       $81.85
J0132..............  Acetylcysteine injection..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J0133..............  Acyclovir injection.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0135..............  Adalimumab injection......  ..................  K.................         1083  ...........      $316.02  ...........       $63.20
J0150..............  Injection adenosine 6 MG..  ..................  K.................         0379  ...........       $22.65  ...........        $4.53
J0152..............  Adenosine injection.......  ..................  K.................         0917  ...........       $68.50  ...........       $13.70
J0170..............  Adrenalin epinephrin        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inject.
J0180..............  Agalsidase beta injection.  ..................  K.................         9208  ...........      $126.00  ...........       $25.20
J0190..............  Inj biperiden lactate/5 mg  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J0200..............  Alatrofloxacin mesylate...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0205..............  Alglucerase injection.....  ..................  K.................         0900  ...........       $38.85  ...........        $7.77
J0207..............  Amifostine................  ..................  K.................         7000  ...........      $476.10  ...........       $95.22
J0210..............  Methyldopate hcl injection  ..................  K.................         2210  ...........       $10.01  ...........        $2.00
J0215..............  Alefacept.................  ..................  K.................         1633  ...........       $25.82  ...........        $5.16
J0256..............  Alpha 1 proteinase          ..................  K.................         0901  ...........        $3.24  ...........        $0.65
                      inhibitor.
J0270..............  Alprostadil for injection.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J0275..............  Alprostadil urethral        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      suppos.
J0278..............  Amikacin sulfate injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0280..............  Aminophyllin 250 MG inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0282..............  Amiodarone HCl............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0285..............  Amphotericin B............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0287..............  Amphotericin b lipid        ..................  K.................         9024  ...........       $10.28  ...........        $2.06
                      complex.
J0288..............  Ampho b cholesteryl         ..................  K.................         0735  ...........       $11.89  ...........        $2.38
                      sulfate.
J0289..............  Amphotericin b liposome     ..................  K.................         0736  ...........       $17.07  ...........        $3.41
                      inj.
J0290..............  Ampicillin 500 MG inj.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0295..............  Ampicillin sodium per 1.5   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      gm.
J0300..............  Amobarbital 125 MG inj....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0330..............  Succinycholine chloride     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0348..............  Anadulafungin injection...  ..................  G.................         0760  ...........        $1.91  ...........        $0.38
J0350..............  Injection anistreplase 30   ..................  K.................         1606      42.2935    $2,693.80  ...........      $538.76
                      u.
J0360..............  Hydralazine hcl injection.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0364..............  Apomorphine hydrochloride.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J0365..............  Aprotonin, 10,000 kiu.....  ..................  K.................         1682  ...........        $2.50  ...........        $0.50
J0380..............  Inj metaraminol bitartrate  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J0390..............  Chloroquine injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0395..............  Arbutamine HCl injection..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J0456..............  Azithromycin..............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0460..............  Atropine sulfate injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0470..............  Dimecaprol injection......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0475..............  Baclofen 10 MG injection..  ..................  K.................         9032  ...........      $195.18  ...........       $39.04
J0476..............  Baclofen intrathecal trial  ..................  K.................         1631  ...........       $70.92  ...........       $14.18
J0480..............  Basiliximab...............  ..................  K.................         1683  ...........    $1,347.14  ...........      $269.43
J0500..............  Dicyclomine injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0515..............  Inj benztropine mesylate..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0520..............  Bethanechol chloride        CH................  K.................         0879       0.5128       $32.66  ...........        $6.53
                      inject.
J0530..............  Penicillin g benzathine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0540..............  Penicillin g benzathine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0550..............  Penicillin g benzathine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0560..............  Penicillin g benzathine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0570..............  Penicillin g benzathine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0580..............  Penicillin g benzathine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0583..............  Bivalirudin...............  ..................  K.................         3041  ...........        $1.72  ...........        $0.34
J0585..............  Botulinum toxin a per unit  ..................  K.................         0902  ...........        $5.05  ...........        $1.01
J0587..............  Botulinum toxin type B....  ..................  K.................         9018  ...........        $8.30  ...........        $1.66
J0592..............  Buprenorphine               ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      hydrochloride.
J0594..............  Busulfan injection........  ..................  K.................         1178  ...........        $8.80  ...........        $1.76
J0595..............  Butorphanol tartrate 1 mg.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0600..............  Edetate calcium disodium    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0610..............  Calcium gluconate           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0620..............  Calcium glycer & lact/10    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ML.
J0630..............  Calcitonin salmon           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0636..............  Inj calcitriol per 0.1 mcg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0637..............  Caspofungin acetate.......  ..................  K.................         9019  ...........       $30.07  ...........        $6.01
J0640..............  Leucovorin calcium          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0670..............  Inj mepivacaine HCL/10 ml.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0690..............  Cefazolin sodium injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0692..............  Cefepime HCl for injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0694..............  Cefoxitin sodium injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0696..............  Ceftriaxone sodium          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0697..............  Sterile cefuroxime          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0698..............  Cefotaxime sodium           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0702..............  Betamethasone acet&sod      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      phosp.

[[Page 43041]]

 
J0704..............  Betamethasone sod phosp/4   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J0706..............  Caffeine citrate injection  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J0710..............  Cephapirin sodium           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0713..............  Inj ceftazidime per 500 mg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0715..............  Ceftizoxime sodium / 500    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J0720..............  Chloramphenicol sodium      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injec.
J0725..............  Chorionic gonadotropin/     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      1000u.
J0735..............  Clonidine hydrochloride...  ..................  K.................         0935  ...........       $62.86  ...........       $12.57
J0740..............  Cidofovir injection.......  ..................  K.................         9033  ...........      $754.62  ...........      $150.92
J0743..............  Cilastatin sodium           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0744..............  Ciprofloxacin iv..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0745..............  Inj codeine phosphate /30   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J0760..............  Colchicine injection......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0770..............  Colistimethate sodium inj.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0780..............  Prochlorperazine injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0795..............  Corticorelin ovine          ..................  K.................         1684  ...........        $4.26  ...........        $0.85
                      triflutal.
J0800..............  Corticotropin injection...  ..................  K.................         1280  ...........      $126.52  ...........       $25.30
J0835..............  Inj cosyntropin per 0.25    ..................  K.................         0835  ...........       $63.25  ...........       $12.65
                      MG.
J0850..............  Cytomegalovirus imm IV /    ..................  K.................         0903  ...........      $859.86  ...........      $171.97
                      vial.
J0878..............  Daptomycin injection......  ..................  K.................         9124  ...........        $0.33  ...........        $0.07
J0881..............  Darbepoetin alfa, non-esrd  ..................  K.................         1685  ...........        $3.11  ...........        $0.62
J0882..............  Darbepoetin alfa, esrd use  ..................  A.................  ...........  ...........  ...........  ...........  ...........
J0885..............  Epoetin alfa, non-esrd....  ..................  K.................         1686  ...........        $9.36  ...........        $1.87
J0886..............  Epoetin alfa 1000 units     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ESRD.
J0894..............  Decitabine injection......  ..................  G.................         9231       0.4157       $26.48  ...........        $5.30
J0895..............  Deferoxamine mesylate inj.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J0900..............  Testosterone enanthate inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0945..............  Brompheniramine maleate     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0970..............  Estradiol valerate          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J1000..............  Depo-estradiol cypionate    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1020..............  Methylprednisolone 20 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1030..............  Methylprednisolone 40 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1040..............  Methylprednisolone 80 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1051..............  Medroxyprogesterone inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1055..............  Medrxyprogester acetate     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1056..............  MA/EC                       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      contraceptiveinjection.
J1060..............  Testosterone cypionate 1    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ML.
J1070..............  Testosterone cypionat 100   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J1080..............  Testosterone cypionat 200   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J1094..............  Inj dexamethasone acetate.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1100..............  Dexamethasone sodium phos.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1110..............  Inj dihydroergotamine       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      mesylt.
J1120..............  Acetazolamid sodium         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injectio.
J1160..............  Digoxin injection.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1162..............  Digoxin immune fab (ovine)  ..................  K.................         1687  ...........      $511.48  ...........      $102.30
J1165..............  Phenytoin sodium injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1170..............  Hydromorphone injection...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1180..............  Dyphylline injection......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1190..............  Dexrazoxane HCl injection.  ..................  K.................         0726  ...........      $172.43  ...........       $34.49
J1200..............  Diphenhydramine hcl         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injectio.
J1205..............  Chlorothiazide sodium inj.  ..................  K.................         0747  ...........      $122.67  ...........       $24.53
J1212..............  Dimethyl sulfoxide 50% 50   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ML.
J1230..............  Methadone injection.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1240..............  Dimenhydrinate injection..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1245..............  Dipyridamole injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1250..............  Inj dobutamine HCL/250 mg.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1260..............  Dolasetron mesylate.......  ..................  K.................         0750  ...........        $6.05  ...........        $1.21
J1265..............  Dopamine injection........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1270..............  Injection, doxercalciferol  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1320..............  Amitriptyline injection...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1324..............  Enfuvirtide injection.....  ..................  K.................         0767  ...........       $22.69  ...........        $4.54
J1325..............  Epoprostenol injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1327..............  Eptifibatide injection....  ..................  K.................         1607  ...........       $15.90  ...........        $3.18
J1330..............  Ergonovine maleate          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J1335..............  Ertapenem injection.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1364..............  Erythro lactobionate /500   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J1380..............  Estradiol valerate 10 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1390..............  Estradiol valerate 20 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1410..............  Inj estrogen conjugate 25   ..................  K.................         9038  ...........       $60.32  ...........       $12.06
                      MG.
J1430..............  Ethanolamine oleate 100 mg  ..................  K.................         1688  ...........       $78.26  ...........       $15.65
J1435..............  Injection estrone per 1 MG  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1436..............  Etidronate disodium inj...  ..................  K.................         1436  ...........       $70.73  ...........       $14.15
J1438..............  Etanercept injection......  ..................  K.................         1608  ...........      $160.03  ...........       $32.01
J1440..............  Filgrastim 300 mcg          ..................  K.................         0728  ...........      $187.68  ...........       $37.54
                      injection.
J1441..............  Filgrastim 480 mcg          ..................  K.................         7049  ...........      $297.75  ...........       $59.55
                      injection.
J1450..............  Fluconazole...............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1451..............  Fomepizole, 15 mg.........  ..................  K.................         1689  ...........       $12.28  ...........        $2.46
J1452..............  Intraocular Fomivirsen na.  CH................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 43042]]

 
J1455..............  Foscarnet sodium injection  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J1457..............  Gallium nitrate injection.  CH................  K.................         0878  ...........        $1.47  ...........        $0.29
J1458..............  Galsulfase injection......  ..................  K.................         9224  ...........      $297.09  ...........       $59.42
J1460..............  Gamma globulin 1 CC inj...  ..................  K.................         3043  ...........       $11.31  ...........        $2.26
J1470..............  Gamma globulin 2 CC inj...  CH................  K.................         0898  ...........       $22.63  ...........        $4.53
J1480..............  Gamma globulin 3 CC inj...  CH................  K.................         0899  ...........       $33.93  ...........        $6.79
J1490..............  Gamma globulin 4 CC inj...  CH................  K.................         0904  ...........       $45.25  ...........        $9.05
J1500..............  Gamma globulin 5 CC inj...  CH................  K.................         0919  ...........       $56.56  ...........       $11.31
J1510..............  Gamma globulin 6 CC inj...  CH................  K.................         0920  ...........       $67.91  ...........       $13.58
J1520..............  Gamma globulin 7 CC inj...  CH................  K.................         0921  ...........       $79.14  ...........       $15.83
J1530..............  Gamma globulin 8 CC inj...  CH................  K.................         0922  ...........       $90.50  ...........       $18.10
J1540..............  Gamma globulin 9 CC inj...  CH................  K.................         0923  ...........      $101.88  ...........       $20.38
J1550..............  Gamma globulin 10 CC inj..  CH................  K.................         0924  ...........      $113.13  ...........       $22.63
J1560..............  Gamma globulin > 10 CC inj  CH................  K.................         0933  ...........      $113.13  ...........       $22.63
J1562..............  Immune globulin             ..................  K.................         0804  ...........       $12.60  ...........        $2.52
                      subcutaneous.
J1565..............  RSV-ivig..................  ..................  K.................         0906  ...........       $16.02  ...........        $3.20
J1566..............  Immune globulin, powder...  ..................  K.................         2731  ...........       $25.48  ...........        $5.10
J1567..............  Immune globulin, liquid...  ..................  K.................         2732  ...........       $30.28  ...........        $6.06
J1570..............  Ganciclovir sodium          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J1580..............  Garamycin gentamicin inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1590..............  Gatifloxacin injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1595..............  Injection glatiramer        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      acetate.
J1600..............  Gold sodium thiomaleate     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1610..............  Glucagon hydrochloride/1    ..................  K.................         9042  ...........       $65.64  ...........       $13.13
                      MG.
J1620..............  Gonadorelin hydroch/ 100    ..................  K.................         7005  ...........      $178.59  ...........       $35.72
                      mcg.
J1626..............  Granisetron HCl injection.  ..................  K.................         0764  ...........        $7.43  ...........        $1.49
J1630..............  Haloperidol injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1631..............  Haloperidol decanoate inj.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1640..............  Hemin, 1 mg...............  ..................  K.................         1690  ...........        $6.74  ...........        $1.35
J1642..............  Inj heparin sodium per 10   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      u.
J1644..............  Inj heparin sodium per      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      1000u.
J1645..............  Dalteparin sodium.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1650..............  Inj enoxaparin sodium.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1652..............  Fondaparinux sodium.......  CH................  K.................         0883  ...........        $5.82  ...........        $1.16
J1655..............  Tinzaparin sodium           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J1670..............  Tetanus immune globulin     ..................  K.................         1670  ...........       $96.35  ...........       $19.27
                      inj.
J1675..............  Histrelin acetate.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J1700..............  Hydrocortisone acetate inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1710..............  Hydrocortisone sodium ph    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1720..............  Hydrocortisone sodium succ  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      i.
J1730..............  Diazoxide injection.......  ..................  K.................         1740  ...........      $113.24  ...........       $22.65
J1740..............  Ibandronate sodium          ..................  G.................         9229  ...........      $138.71  ...........       $27.74
                      injection.
J1742..............  Ibutilide fumarate          ..................  K.................         9044  ...........      $264.40  ...........       $52.88
                      injection.
J1745..............  Infliximab injection......  ..................  K.................         7043  ...........       $53.25  ...........       $10.65
J1751..............  Iron dextran 165 injection  ..................  K.................         1691  ...........       $11.61  ...........        $2.32
J1752..............  Iron dextran 267 injection  ..................  K.................         1692  ...........       $10.32  ...........        $2.06
J1756..............  Iron sucrose injection....  ..................  K.................         9046  ...........        $0.37  ...........        $0.08
J1785..............  Injection imiglucerase /    ..................  K.................         0916  ...........        $3.89  ...........        $0.78
                      unit.
J1790..............  Droperidol injection......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1800..............  Propranolol injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1810..............  Droperidol/fentanyl inj...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J1815..............  Insulin injection.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1817..............  Insulin for insulin pump    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      use.
J1825..............  Interferon beta-1a........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J1830..............  Interferon beta-1b / .25    ..................  K.................         0910  ...........       $84.12  ...........       $16.82
                      MG.
J1835..............  Itraconazole injection....  ..................  K.................         9047  ...........       $38.05  ...........        $7.61
J1840..............  Kanamycin sulfate 500 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1850..............  Kanamycin sulfate 75 MG     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1885..............  Ketorolac tromethamine inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1890..............  Cephalothin sodium          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J1931..............  Laronidase injection......  ..................  K.................         9209  ...........       $23.64  ...........        $4.73
J1940..............  Furosemide injection......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1945..............  Lepirudin.................  ..................  K.................         1693  ...........      $153.42  ...........       $30.68
J1950..............  Leuprolide acetate /3.75    ..................  K.................         0800  ...........      $429.83  ...........       $85.97
                      MG.
J1955..............  Inj levocarnitine per 1 gm  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J1956..............  Levofloxacin injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1960..............  Levorphanol tartrate inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1980..............  Hyoscyamine sulfate inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1990..............  Chlordiazepoxide injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2001..............  Lidocaine injection.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2010..............  Lincomycin injection......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2020..............  Linezolid injection.......  ..................  K.................         9001  ...........       $24.93  ...........        $4.99
J2060..............  Lorazepam injection.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2150..............  Mannitol injection........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2170..............  Mecasermin injection......  ..................  K.................         0805  ...........       $11.81  ...........        $2.36
J2175..............  Meperidine hydrochl /100    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J2180..............  Meperidine/promethazine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J2185..............  Meropenem.................  CH................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 43043]]

 
J2210..............  Methylergonovin maleate     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J2248..............  Micafungin sodium           ..................  G.................         9227  ...........        $1.71  ...........        $0.34
                      injection.
J2250..............  Inj midazolam               ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      hydrochloride.
J2260..............  Inj milrinone lactate / 5   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J2270..............  Morphine sulfate injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2271..............  Morphine so4 injection      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      100mg.
J2275..............  Morphine sulfate injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2278..............  Ziconotide injection......  CH................  K.................         1694  ...........        $6.46  ...........        $1.29
J2280..............  Inj, moxifloxacin 100 mg..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2300..............  Inj nalbuphine              ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      hydrochloride.
J2310..............  Inj naloxone hydrochloride  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2315..............  Naltrexone, depot form....  ..................  K.................         0759  ...........        $1.88  ...........        $0.38
J2320..............  Nandrolone decanoate 50 MG  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2321..............  Nandrolone decanoate 100    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J2322..............  Nandrolone decanoate 200    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J2325..............  Nesiritide injection......  ..................  K.................         1695  ...........       $31.36  ...........        $6.27
J2353..............  Octreotide injection,       ..................  K.................         1207  ...........       $95.86  ...........       $19.17
                      depot.
J2354..............  Octreotide inj, non-depot.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2355..............  Oprelvekin injection......  ..................  K.................         7011  ...........      $244.98  ...........       $49.00
J2357..............  Omalizumab injection......  ..................  K.................         9300  ...........       $16.79  ...........        $3.36
J2360..............  Orphenadrine injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2370..............  Phenylephrine hcl           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J2400..............  Chloroprocaine hcl          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J2405..............  Ondansetron hcl injection.  ..................  K.................         0768  ...........        $3.37  ...........        $0.67
J2410..............  Oxymorphone hcl injection.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2425..............  Palifermin injection......  ..................  K.................         1696  ...........       $11.32  ...........        $2.26
J2430..............  Pamidronate disodium /30    ..................  K.................         0730  ...........       $30.49  ...........        $6.10
                      MG.
J2440..............  Papaverin hcl injection...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2460..............  Oxytetracycline injection.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2469..............  Palonosetron HCl..........  ..................  K.................         9210  ...........       $15.85  ...........        $3.17
J2501..............  Paricalcitol..............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2503..............  Pegaptanib sodium           CH................  K.................         1697  ...........    $1,054.70  ...........      $210.94
                      injection.
J2504..............  Pegademase bovine, 25 iu..  ..................  K.................         1739  ...........      $176.16  ...........       $35.23
J2505..............  Injection, pegfilgrastim    ..................  K.................         9119  ...........    $2,142.92  ...........      $428.58
                      6mg.
J2510..............  Penicillin g procaine inj.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2513..............  Pentastarch 10% solution..  CH................  K.................         0880       0.3707       $23.61  ...........        $4.72
J2515..............  Pentobarbital sodium inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2540..............  Penicillin g potassium inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2543..............  Piperacillin/tazobactam...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2545..............  Pentamidine isethionte/     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      300mg.
J2550..............  Promethazine hcl injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2560..............  Phenobarbital sodium inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2590..............  Oxytocin injection........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2597..............  Inj desmopressin acetate..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2650..............  Prednisolone acetate inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2670..............  Totazoline hcl injection..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2675..............  Inj progesterone per 50 MG  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2680..............  Fluphenazine decanoate 25   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J2690..............  Procainamide hcl injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2700..............  Oxacillin sodium injeciton  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2710..............  Neostigmine methylslfte     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J2720..............  Inj protamine sulfate/10    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J2725..............  Inj protirelin per 250 mcg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2730..............  Pralidoxime chloride inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2760..............  Phentolaine mesylate inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2765..............  Metoclopramide hcl          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J2770..............  Quinupristin/dalfopristin.  ..................  K.................         2770  ...........      $116.70  ...........       $23.34
J2780..............  Ranitidine hydrochloride    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J2783..............  Rasburicase...............  ..................  K.................         0738  ...........      $131.28  ...........       $26.26
J2788..............  Rho d immune globulin 50    ..................  K.................         9023  ...........       $26.41  ...........        $5.28
                      mcg.
J2790..............  Rho d immune globulin inj.  ..................  K.................         0884  ...........       $80.71  ...........       $16.14
J2792..............  Rho(D) immune globulin h,   ..................  K.................         1609  ...........       $15.76  ...........        $3.15
                      sd.
J2794..............  Risperidone, long acting..  ..................  K.................         9125  ...........        $4.80  ...........        $0.96
J2795..............  Ropivacaine HCl injection.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2800..............  Methocarbamol injection...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2805..............  Sincalide injection.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2810..............  Inj theophylline per 40 MG  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2820..............  Sargramostim injection....  ..................  K.................         0731  ...........       $25.08  ...........        $5.02
J2850..............  Inj secretin synthetic      ..................  K.................         1700  ...........       $20.12  ...........        $4.02
                      human.
J2910..............  Aurothioglucose injeciton.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2916..............  Na ferric gluconate         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      complex.
J2920..............  Methylprednisolone          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J2930..............  Methylprednisolone          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J2940..............  Somatrem injection........  ..................  K.................         2940       1.0916       $69.53  ...........       $13.91
J2941..............  Somatropin injection......  ..................  K.................         7034  ...........       $46.75  ...........        $9.35
J2950..............  Promazine hcl injection...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2993..............  Reteplase injection.......  ..................  K.................         9005  ...........      $891.03  ...........      $178.21
J2995..............  Inj streptokinase /250000   ..................  K.................         0911       1.1851       $75.48  ...........       $15.10
                      IU.

[[Page 43044]]

 
J2997..............  Alteplase recombinant.....  ..................  K.................         7048  ...........       $32.48  ...........        $6.50
J3000..............  Streptomycin injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3010..............  Fentanyl citrate injeciton  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3030..............  Sumatriptan succinate / 6   ..................  K.................         3030  ...........       $58.82  ...........       $11.76
                      MG.
J3070..............  Pentazocine injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3100..............  Tenecteplase injection....  ..................  K.................         9002  ...........    $2,024.13  ...........      $404.83
J3105..............  Terbutaline sulfate inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3110..............  Teriparatide injection....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J3120..............  Testosterone enanthate inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3130..............  Testosterone enanthate inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3140..............  Testosterone suspension     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J3150..............  Testosteron propionate inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3230..............  Chlorpromazine hcl          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J3240..............  Thyrotropin injection.....  ..................  K.................         9108  ...........      $758.16  ...........      $151.63
J3243..............  Tigecycline injection.....  ..................  G.................         9228  ...........        $0.91  ...........        $0.18
J3246..............  Tirofiban HCl.............  ..................  K.................         7041  ...........        $7.66  ...........        $1.53
J3250..............  Trimethobenzamide hcl inj.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3260..............  Tobramycin sulfate          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J3265..............  Injection torsemide 10 mg/  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ml.
J3280..............  Thiethylperazine maleate    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J3285..............  Treprostinil injection....  ..................  K.................         1701  ...........       $55.36  ...........       $11.07
J3301..............  Triamcinolone acetonide     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J3302..............  Triamcinolone diacetate     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J3303..............  Triamcinolone hexacetonl    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J3305..............  Inj trimetrexate            ..................  K.................         7045  ...........      $143.89  ...........       $28.78
                      glucoronate.
J3310..............  Perphenazine injeciton....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3315..............  Triptorelin pamoate.......  ..................  K.................         9122  ...........      $153.97  ...........       $30.79
J3320..............  Spectinomycn di-hcl inj...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J3350..............  Urea injection............  ..................  K.................         9051  ...........       $73.46  ...........       $14.69
J3355..............  Urofollitropin, 75 iu.....  ..................  K.................         1741  ...........       $50.22  ...........       $10.04
J3360..............  Diazepam injection........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3364..............  Urokinase 5000 IU           CH................  K.................         0881  ...........        $9.07  ...........        $1.81
                      injection.
J3365..............  Urokinase 250,000 IU inj..  ..................  K.................         7036  ...........      $453.41  ...........       $90.68
J3370..............  Vancomycin hcl injection..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3396..............  Verteporfin injection.....  ..................  K.................         1203  ...........        $8.84  ...........        $1.77
J3400..............  Triflupromazine hcl inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3410..............  Hydroxyzine hcl injection.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3411..............  Thiamine hcl 100 mg.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3415..............  Pyridoxine hcl 100 mg.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3420..............  Vitamin b12 injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3430..............  Vitamin k phytonadione inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3465..............  Injection, voriconazole...  ..................  K.................         1052  ...........        $4.94  ...........        $0.99
J3470..............  Hyaluronidase injection...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3471..............  Ovine, up to 999 USP units  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3472..............  Ovine, 1000 USP units.....  ..................  K.................         1703  ...........      $133.77  ...........       $26.75
J3473..............  Hyaluronidase recombinant.  ..................  G.................         0806  ...........        $0.40  ...........        $0.08
J3475..............  Inj magnesium sulfate.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3480..............  Inj potassium chloride....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3485..............  Zidovudine................  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3486..............  Ziprasidone mesylate......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3487..............  Zoledronic acid...........  ..................  K.................         9115  ...........      $204.09  ...........       $40.82
J3490..............  Drugs unclassified          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J3520..............  Edetate disodium per 150    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mg.
J3530..............  Nasal vaccine inhalation..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3535..............  Metered dose inhaler drug.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J3570..............  Laetrile amygdalin vit B17  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J3590..............  Unclassified biologics....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7030..............  Normal saline solution      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      infus.
J7040..............  Normal saline solution      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      infus.
J7042..............  5% dextrose/normal saline.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7050..............  Normal saline solution      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      infus.
J7060..............  5% dextrose/water.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7070..............  D5w infusion..............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7100..............  Dextran 40 infusion.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7110..............  Dextran 75 infusion.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7120..............  Ringers lactate infusion..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7130..............  Hypertonic saline solution  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7187..............  Inj Vonwillebrand factor    ..................  K.................         1704  ...........        $0.88  ...........        $0.18
                      IU.
J7189..............  Factor viia...............  ..................  K.................         1705  ...........        $1.11  ...........        $0.22
J7190..............  Factor viii...............  ..................  K.................         0925  ...........        $0.70  ...........        $0.14
J7191..............  Factor VIII (porcine).....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J7192..............  Factor viii recombinant...  ..................  K.................         0927  ...........        $1.07  ...........        $0.21
J7193..............  Factor IX non-recombinant.  ..................  K.................         0931  ...........        $0.89  ...........        $0.18
J7194..............  Factor ix complex.........  ..................  K.................         0928  ...........        $0.75  ...........        $0.15
J7195..............  Factor IX recombinant.....  ..................  K.................         0932  ...........        $0.99  ...........        $0.20
J7197..............  Antithrombin iii injection  ..................  K.................         0930  ...........        $1.62  ...........        $0.32
J7198..............  Anti-inhibitor............  ..................  K.................         0929  ...........        $1.35  ...........        $0.27
J7199..............  Hemophilia clot factor noc  ..................  B.................  ...........  ...........  ...........  ...........  ...........

[[Page 43045]]

 
J7300..............  Intraut copper              ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      contraceptive.
J7302..............  Levonorgestrel iu           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      contracept.
J7303..............  Contraceptive vaginal ring  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J7304..............  Contraceptive hormone       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      patch.
J7306..............  Levonorgestrel implant sys  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J7308..............  Aminolevulinic acid hcl     ..................  K.................         7308  ...........      $104.43  ...........       $20.89
                      top.
J7310..............  Ganciclovir long act        ..................  K.................         0913  ...........    $4,707.42  ...........      $941.48
                      implant.
J7311..............  Fluocinolone acetonide      CH................  K.................         9225  ...........   $19,162.50  ...........    $3,832.50
                      implt.
J7319..............  Sodium Hyaluronate          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      Injection.
J7330..............  Cultured chondrocytes       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      implnt.
J7340..............  Metabolic active D/E        ..................  K.................         1632  ...........       $28.51  ...........        $5.70
                      tissue.
J7341..............  Non-human, metabolic        CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      tissue.
J7342..............  Metabolically active        ..................  K.................         9054  ...........       $31.36  ...........        $6.27
                      tissue.
J7343..............  Nonmetabolic act d/e        ..................  K.................         1629  ...........       $18.13  ...........        $3.63
                      tissue.
J7344..............  Nonmetabolic active tissue  ..................  K.................         9156  ...........       $88.37  ...........       $17.67
J7345..............  Non-human, non-metab        ..................  K.................         0837  ...........       $35.76  ...........        $7.15
                      tissue.
J7346..............  Injectable human tissue...  ..................  K.................         9222  ...........      $728.44  ...........      $145.69
J7500..............  Azathioprine oral 50mg....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7501..............  Azathioprine parenteral...  ..................  K.................         0887  ...........       $47.99  ...........        $9.60
J7502..............  Cyclosporine oral 100 mg..  ..................  K.................         0888  ...........        $3.57  ...........        $0.71
J7504..............  Lymphocyte immune globulin  ..................  K.................         0890  ...........      $314.19  ...........       $62.84
J7505..............  Monoclonal antibodies.....  ..................  K.................         7038  ...........      $886.70  ...........      $177.34
J7506..............  Prednisone oral...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7507..............  Tacrolimus oral per 1 MG..  ..................  K.................         0891  ...........        $3.63  ...........        $0.73
J7509..............  Methylprednisolone oral...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7510..............  Prednisolone oral per 5 mg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7511..............  Antithymocyte globuln       ..................  K.................         9104  ...........      $324.66  ...........       $64.93
                      rabbit.
J7513..............  Daclizumab, parenteral....  ..................  K.................         1612  ...........      $297.03  ...........       $59.41
J7515..............  Cyclosporine oral 25 mg...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7516..............  Cyclosporin parenteral      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      250mg.
J7517..............  Mycophenolate mofetil oral  ..................  K.................         9015  ...........        $2.60  ...........        $0.52
J7518..............  Mycophenolic acid.........  ..................  K.................         9219  ...........        $2.25  ...........        $0.45
J7520..............  Sirolimus, oral...........  ..................  K.................         9020  ...........        $7.15  ...........        $1.43
J7525..............  Tacrolimus injection......  ..................  K.................         9006  ...........      $139.11  ...........       $27.82
J7599..............  Immunosuppressive drug noc  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7607..............  Levalbuterol comp con.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7608..............  Acetylcysteine inh sol u d  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7609..............  Albuterol comp unit.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7610..............  Albuterol comp con........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7611..............  Albuterol non-comp con....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7612..............  Levalbuterol non-comp con.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7613..............  Albuterol non-comp unit...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7614..............  Levalbuterol non-comp unit  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7615..............  Levalbuterol comp unit....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7620..............  Albuterol ipratrop non-     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      comp.
J7622..............  Beclomethasone comp unit..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7624..............  Betamethasone comp unit...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7626..............  Budesonide non-comp unit..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7627..............  Budesonide comp unit......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7628..............  Bitolterol mesylate comp    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      con.
J7629..............  Bitolterol mesylate comp    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      unt.
J7631..............  Cromolyn sodium inh sol u   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      d.
J7633..............  Budesonide non-comp con...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7634..............  Budesonide comp con.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7635..............  Atropine comp con.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7636..............  Atropine comp unit........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7637..............  Dexamethasone comp con....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7638..............  Dexamethasone comp unit...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7639..............  Dornase alpha inhal sol u   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      d.
J7640..............  Formoterol comp unit......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J7641..............  Flunisolide comp unit.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7642..............  Glycopyrrolate comp con...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7643..............  Glycopyrrolate comp unit..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7644..............  Ipratropium bromide non-    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      comp.
J7645..............  Ipratropium bromide comp..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7647..............  Isoetharine comp con......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7648..............  Isoetharine non-comp con..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7649..............  Isoetharine non-comp unit.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7650..............  Isoetharine comp unit.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7657..............  Isoproterenol comp con....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7658..............  Isoproterenol non-comp con  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7659..............  Isoproterenol non-comp      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      unit.
J7660..............  Isoproterenol comp unit...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7667..............  Metaproterenol comp con...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7668..............  Metaproterenol non-comp     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      con.
J7669..............  Metaproterenol non-comp     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      unit.
J7670..............  Metaproterenol comp unit..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7674..............  Methacholine chloride, neb  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 43046]]

 
J7680..............  Terbutaline sulf comp con.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7681..............  Terbutaline sulf comp unit  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7682..............  Tobramycin non-comp unit..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7683..............  Triamcinolone comp con....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7684..............  Triamcinolone comp unit...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7685..............  Tobramycin comp unit......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7699..............  Inhalation solution for     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      DME.
J7799..............  Non-inhalation drug for     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      DME.
J8498..............  Antiemetic rectal/supp NOS  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J8499..............  Oral prescrip drug non      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      chemo.
J8501..............  Oral aprepitant...........  CH................  K.................         0868  ...........        $5.02  ...........        $1.00
J8510..............  Oral busulfan.............  ..................  K.................         7015  ...........        $2.12  ...........        $0.42
J8515..............  Cabergoline, oral 0.25mg..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J8520..............  Capecitabine, oral, 150 mg  ..................  K.................         7042  ...........        $3.94  ...........        $0.79
J8521..............  Capecitabine, oral, 500 mg  CH................  K.................         0934  ...........       $13.12  ...........        $2.62
J8530..............  Cyclophosphamide oral 25    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J8540..............  Oral dexamethasone........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J8560..............  Etoposide oral 50 MG......  ..................  K.................         0802  ...........       $29.32  ...........        $5.86
J8565..............  Gefitinib oral............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J8597..............  Antiemetic drug oral NOS..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J8600..............  Melphalan oral 2 MG.......  CH................  K.................         0882       0.0681        $4.34  ...........        $0.87
J8610..............  Methotrexate oral 2.5 MG..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J8650..............  Nabilone oral.............  ..................  K.................         0808  ...........       $16.80  ...........        $3.36
J8700..............  Temozolomide..............  ..................  K.................         1086  ...........        $7.34  ...........        $1.47
J8999..............  Oral prescription drug      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      chemo.
J9000..............  Doxorubic hcl 10 MG vl      CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      chemo.
J9001..............  Doxorubicin hcl liposome    ..................  K.................         7046  ...........      $385.81  ...........       $77.16
                      inj.
J9010..............  Alemtuzumab injection.....  ..................  K.................         9110  ...........      $536.10  ...........      $107.22
J9015..............  Aldesleukin/single use      ..................  K.................         0807  ...........      $755.78  ...........      $151.16
                      vial.
J9017..............  Arsenic trioxide..........  ..................  K.................         9012  ...........       $33.84  ...........        $6.77
J9020..............  Asparaginase injection....  ..................  K.................         0814  ...........       $54.20  ...........       $10.84
J9025..............  Azacitidine injection.....  ..................  K.................         1709  ...........        $4.26  ...........        $0.85
J9027..............  Clofarabine injection.....  CH................  K.................         1710  ...........      $115.64  ...........       $23.13
J9031..............  Bcg live intravesical vac.  ..................  K.................         0809  ...........      $109.63  ...........       $21.93
J9035..............  Bevacizumab injection.....  ..................  K.................         9214  ...........       $56.98  ...........       $11.40
J9040..............  Bleomycin sulfate           ..................  K.................         0748  ...........       $35.52  ...........        $7.10
                      injection.
J9041..............  Bortezomib injection......  ..................  K.................         9207  ...........       $32.37  ...........        $6.47
J9045..............  Carboplatin injection.....  ..................  K.................         0811  ...........        $8.38  ...........        $1.68
J9050..............  Carmus bischl nitro inj...  ..................  K.................         0812  ...........      $138.52  ...........       $27.70
J9055..............  Cetuximab injection.......  ..................  K.................         9215  ...........       $49.34  ...........        $9.87
J9060..............  Cisplatin 10 MG injection.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9062..............  Cisplatin 50 MG injection.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J9065..............  Inj cladribine per 1 MG...  ..................  K.................         0858  ...........       $35.78  ...........        $7.16
J9070..............  Cyclophosphamide 100 MG     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9080..............  Cyclophosphamide 200 MG     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9090..............  Cyclophosphamide 500 MG     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9091..............  Cyclophosphamide 1.0 grm    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9092..............  Cyclophosphamide 2.0 grm    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9093..............  Cyclophosphamide            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      lyophilized.
J9094..............  Cyclophosphamide            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      lyophilized.
J9095..............  Cyclophosphamide            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      lyophilized.
J9096..............  Cyclophosphamide            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      lyophilized.
J9097..............  Cyclophosphamide            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      lyophilized.
J9098..............  Cytarabine liposome.......  ..................  K.................         1166  ...........      $391.31  ...........       $78.26
J9100..............  Cytarabine hcl 100 MG inj.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9110..............  Cytarabine hcl 500 MG inj.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J9120..............  Dactinomycin actinomycin d  ..................  K.................         0752  ...........      $488.78  ...........       $97.76
J9130..............  Dacarbazine 100 mg inj....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J9140..............  Dacarbazine 200 MG inj....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J9150..............  Daunorubicin..............  ..................  K.................         0820  ...........       $20.28  ...........        $4.06
J9151..............  Daunorubicin citrate        ..................  K.................         0821  ...........       $55.40  ...........       $11.08
                      liposom.
J9160..............  Denileukin diftitox, 300    ..................  K.................         1084  ...........    $1,393.32  ...........      $278.66
                      mcg.
J9165..............  Diethylstilbestrol          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J9170..............  Docetaxel.................  ..................  K.................         0823  ...........      $303.92  ...........       $60.78
J9175..............  Elliotts b solution per ml  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9178..............  Inj, epirubicin hcl, 2 mg.  ..................  K.................         1167  ...........       $21.01  ...........        $4.20
J9181..............  Etoposide 10 MG inj.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9182..............  Etoposide 100 MG inj......  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J9185..............  Fludarabine phosphate inj.  ..................  K.................         0842  ...........      $234.21  ...........       $46.84
J9190..............  Fluorouracil injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9200..............  Floxuridine injection.....  ..................  K.................         0827  ...........       $50.82  ...........       $10.16
J9201..............  Gemcitabine HCl...........  ..................  K.................         0828  ...........      $123.98  ...........       $24.80
J9202..............  Goserelin acetate implant.  ..................  K.................         0810  ...........      $196.81  ...........       $39.36
J9206..............  Irinotecan injection......  ..................  K.................         0830  ...........      $124.81  ...........       $24.96
J9208..............  Ifosfomide injection......  ..................  K.................         0831  ...........       $46.15  ...........        $9.23
J9209..............  Mesna injection...........  ..................  K.................         0732  ...........        $8.89  ...........        $1.78
J9211..............  Idarubicin hcl injection..  ..................  K.................         0832  ...........      $301.74  ...........       $60.35
J9212..............  Interferon alfacon-1......  ..................  K.................         0912  ...........        $4.60  ...........        $0.92

[[Page 43047]]

 
J9213..............  Interferon alfa-2a inj....  ..................  K.................         0834  ...........       $37.53  ...........        $7.51
J9214..............  Interferon alfa-2b inj....  ..................  K.................         0836  ...........       $13.75  ...........        $2.75
J9215..............  Interferon alfa-n3 inj....  ..................  K.................         0865  ...........        $9.03  ...........        $1.81
J9216..............  Interferon gamma 1-b inj..  ..................  K.................         0838  ...........      $287.13  ...........       $57.43
J9217..............  Leuprolide acetate          ..................  K.................         9217  ...........      $227.34  ...........       $45.47
                      suspnsion.
J9218..............  Leuprolide acetate          ..................  K.................         0861  ...........        $8.79  ...........        $1.76
                      injeciton.
J9219..............  Leuprolide acetate implant  ..................  K.................         7051  ...........    $1,696.96  ...........      $339.39
J9225..............  Histrelin implant.........  ..................  K.................         1711  ...........    $1,446.98  ...........      $289.40
J9230..............  Mechlorethamine hcl inj...  ..................  K.................         0751  ...........      $140.27  ...........       $28.05
J9245..............  Inj melphalan hydrochl 50   ..................  K.................         0840  ...........    $1,272.00  ...........      $254.40
                      MG.
J9250..............  Methotrexate sodium inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9260..............  Methotrexate sodium inj...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J9261..............  Nelarabine injection......  ..................  K.................         0825  ...........       $82.54  ...........       $16.51
J9263..............  Oxaliplatin...............  ..................  K.................         1738  ...........        $8.89  ...........        $1.78
J9264..............  Paclitaxel protein bound..  CH................  K.................         1712  ...........        $7.03  ...........        $1.41
J9265..............  Paclitaxel injection......  ..................  K.................         0863  ...........       $12.47  ...........        $2.49
J9266..............  Pegaspargase/singl dose     ..................  K.................         0843  ...........    $1,667.61  ...........      $333.52
                      vial.
J9268..............  Pentostatin injection.....  ..................  K.................         0844  ...........    $1,916.66  ...........      $383.33
J9270..............  Plicamycin (mithramycin)    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9280..............  Mitomycin 5 MG inj........  ..................  K.................         0862  ...........       $15.98  ...........        $3.20
J9290..............  Mitomycin 20 MG inj.......  CH................  K.................         0941  ...........       $63.93  ...........       $12.79
J9291..............  Mitomycin 40 MG inj.......  CH................  K.................         0942  ...........      $127.85  ...........       $25.57
J9293..............  Mitoxantrone hydrochl / 5   ..................  K.................         0864  ...........      $166.64  ...........       $33.33
                      MG.
J9300..............  Gemtuzumab ozogamicin.....  ..................  K.................         9004  ...........    $2,334.75  ...........      $466.95
J9305..............  Pemetrexed injection......  ..................  K.................         9213  ...........       $43.38  ...........        $8.68
J9310..............  Rituximab cancer treatment  ..................  K.................         0849  ...........      $491.54  ...........       $98.31
J9320..............  Streptozocin injection....  ..................  K.................         0850  ...........      $152.28  ...........       $30.46
J9340..............  Thiotepa injection........  ..................  K.................         0851  ...........       $40.32  ...........        $8.06
J9350..............  Topotecan.................  ..................  K.................         0852  ...........      $822.90  ...........      $164.58
J9355..............  Trastuzumab...............  ..................  K.................         1613  ...........       $57.33  ...........       $11.47
J9357..............  Valrubicin, 200 mg........  ..................  K.................         9167       3.4445      $219.39  ...........       $43.88
J9360..............  Vinblastine sulfate inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9370..............  Vincristine sulfate 1 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9375..............  Vincristine sulfate 2 MG    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9380..............  Vincristine sulfate 5 MG    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9390..............  Vinorelbine tartrate/10 mg  ..................  K.................         0855  ...........       $19.88  ...........        $3.98
J9395..............  Injection, Fulvestrant....  ..................  K.................         9120  ...........       $79.80  ...........       $15.96
J9600..............  Porfimer sodium...........  ..................  K.................         0856  ...........    $2,539.13  ...........      $507.83
J9999..............  Chemotherapy drug.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
K0001..............  Standard wheelchair.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0002..............  Stnd hemi (low seat)        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      whlchr.
K0003..............  Lightweight wheelchair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0004..............  High strength ltwt whlchr.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0005..............  Ultralightweight            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wheelchair.
K0006..............  Heavy duty wheelchair.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0007..............  Extra heavy duty            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wheelchair.
K0009..............  Other manual wheelchair/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      base.
K0010..............  Stnd wt frame power whlchr  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0011..............  Stnd wt pwr whlchr w        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      control.
K0012..............  Ltwt portbl power whlchr..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0014..............  Other power whlchr base...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0015..............  Detach non-adjus hght       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      armrst.
K0017..............  Detach adjust armrest base  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0018..............  Detach adjust armrst upper  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0019..............  Arm pad each..............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0020..............  Fixed adjust armrest pair.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0037..............  High mount flip-up          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      footrest.
K0038..............  Leg strap each............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0039..............  Leg strap h style each....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0040..............  Adjustable angle footplate  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0041..............  Large size footplate each.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0042..............  Standard size footplate     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      each.
K0043..............  Ftrst lower extension tube  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0044..............  Ftrst upper hanger bracket  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0045..............  Footrest complete assembly  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0046..............  Elevat legrst low           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      extension.
K0047..............  Elevat legrst up hangr      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      brack.
K0050..............  Ratchet assembly..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0051..............  Cam relese assem ftrst/     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      lgrst.
K0052..............  Swingaway detach footrest.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0053..............  Elevate footrest            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      articulate.
K0056..............  Seat ht <17 or [gE]21 ltwt  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
K0065..............  Spoke protectors..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0069..............  Rear whl complete solid     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
K0070..............  Rear whl compl pneum tire.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0071..............  Front castr compl pneum     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
K0072..............  Frnt cstr cmpl sem-pneum    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tir.
K0073..............  Caster pin lock each......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........

[[Page 43048]]

 
K0077..............  Front caster assem          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      complete.
K0098..............  Drive belt power            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wheelchair.
K0105..............  Iv hanger.................  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0108..............  W/c component-accessory     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
K0195..............  Elevating whlchair leg      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      rests.
K0455..............  Pump uninterrupted          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      infusion.
K0462..............  Temporary replacement       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      eqpmnt.
K0552..............  Supply/ext inf pump syr     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      type.
K0601..............  Repl batt silver oxide 1.5  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      v.
K0602..............  Repl batt silver oxide 3 v  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0603..............  Repl batt alkaline 1.5 v..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0604..............  Repl batt lithium 3.6 v...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0605..............  Repl batt lithium 4.5 v...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0606..............  AED garment w elec          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      analysis.
K0607..............  Repl batt for AED.........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0608..............  Repl garment for AED......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0609..............  Repl electrode for AED....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0669..............  Seat/back cus no sadmerc    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ver.
K0730..............  Ctrl dose inh drug deliv    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      sys.
K0733..............  12-24hr sealed lead acid..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0734..............  Adj skin pro w/c cus        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wd<22in.
K0735..............  Adj skin pro wc cus         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wd[gE]22in.
K0736..............  Adj skin pro/pos wc         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cus<22in.
K0737..............  Adj skin pro/pos wc         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cus[gE]22[gE].
K0738..............  Portable gas oxygen system  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0800..............  POV group 1 std up to       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      300lbs.
K0801..............  POV group 1 hd 301-450 lbs  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0802..............  POV group 1 vhd 451-600     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      lbs.
K0806..............  POV group 2 std up to       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      300lbs.
K0807..............  POV group 2 hd 301-450 lbs  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0808..............  POV group 2 vhd 451-600     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      lbs.
K0812..............  Power operated vehicle NOC  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0813..............  PWC gp 1 std port seat/     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      back.
K0814..............  PWC gp 1 std port cap       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      chair.
K0815..............  PWC gp 1 std seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0816..............  PWC gp 1 std cap chair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0820..............  PWC gp 2 std port seat/     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      back.
K0821..............  PWC gp 2 std port cap       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      chair.
K0822..............  PWC gp 2 std seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0823..............  PWC gp 2 std cap chair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0824..............  PWC gp 2 hd seat/back.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0825..............  PWC gp 2 hd cap chair.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0826..............  PWC gp 2 vhd seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0827..............  PWC gp vhd cap chair......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0828..............  PWC gp 2 xtra hd seat/back  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0829..............  PWC gp 2 xtra hd cap chair  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0830..............  PWC gp2 std seat elevate s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0831..............  PWC gp2 std seat elevate    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0835..............  PWC gp2 std sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0836..............  PWC gp2 std sing pow opt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0837..............  PWC gp 2 hd sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0838..............  PWC gp 2 hd sing pow opt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0839..............  PWC gp2 vhd sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0840..............  PWC gp2 xhd sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0841..............  PWC gp2 std mult pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0842..............  PWC gp2 std mult pow opt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0843..............  PWC gp2 hd mult pow opt s/  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0848..............  PWC gp 3 std seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0849..............  PWC gp 3 std cap chair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0850..............  PWC gp 3 hd seat/back.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0851..............  PWC gp 3 hd cap chair.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0852..............  PWC gp 3 vhd seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0853..............  PWC gp 3 vhd cap chair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0854..............  PWC gp 3 xhd seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0855..............  PWC gp 3 xhd cap chair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0856..............  PWC gp3 std sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0857..............  PWC gp3 std sing pow opt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0858..............  PWC gp3 hd sing pow opt s/  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0859..............  PWC gp3 hd sing pow opt     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0860..............  PWC gp3 vhd sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0861..............  PWC gp3 std mult pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0862..............  PWC gp3 hd mult pow opt s/  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0863..............  PWC gp3 vhd mult pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0864..............  PWC gp3 xhd mult pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0868..............  PWC gp 4 std seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0869..............  PWC gp 4 std cap chair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0870..............  PWC gp 4 hd seat/back.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0871..............  PWC gp 4 vhd seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........

[[Page 43049]]

 
K0877..............  PWC gp4 std sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0878..............  PWC gp4 std sing pow opt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0879..............  PWC gp4 hd sing pow opt s/  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0880..............  PWC gp4 vhd sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0884..............  PWc gp4 std mult pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0885..............  PWC gp4 std mult pow opt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0886..............  PWC gp4 hd mult pow s/b...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0890..............  PWC gp5 ped sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0891..............  PWC gp5 ped mult pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0898..............  Power wheelchair NOC......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0899..............  Pow mobil dev no SADMERC..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
L0112..............  Cranial cervical orthosis.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0120..............  Cerv flexible non-          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adjustable.
L0130..............  Flex thermoplastic collar   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mo.
L0140..............  Cervical semi-rigid         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adjustab.
L0150..............  Cerv semi-rig adj molded    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      chn.
L0160..............  Cerv semi-rig wire occ/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mand.
L0170..............  Cervical collar molded to   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pt.
L0172..............  Cerv col thermplas foam 2   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pi.
L0174..............  Cerv col foam 2 piece w     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thor.
L0180..............  Cer post col occ/man sup    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adj.
L0190..............  Cerv collar supp adj cerv   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ba.
L0200..............  Cerv col supp adj bar &     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thor.
L0210..............  Thoracic rib belt.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0220..............  Thor rib belt custom        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fabrica.
L0430..............  Dewall posture protector..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0450..............  TLSO flex prefab thoracic.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0452..............  tlso flex custom fab        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thoraci.
L0454..............  TLSO flex prefab sacrococ-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      T9.
L0456..............  TLSO flex prefab..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0458..............  TLSO 2Mod symphis-xipho     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pre.
L0460..............  TLSO2Mod symphysis-stern    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pre.
L0462..............  TLSO 3Mod sacro-scap pre..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0464..............  TLSO 4Mod sacro-scap pre..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0466..............  TLSO rigid frame pre soft   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ap.
L0468..............  TLSO rigid frame prefab     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pelv.
L0470..............  TLSO rigid frame pre        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      subclav.
L0472..............  TLSO rigid frame hyperex    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pre.
L0480..............  TLSO rigid plastic custom   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fa.
L0482..............  TLSO rigid lined custom     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fab.
L0484..............  TLSO rigid plastic cust     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fab.
L0486..............  TLSO rigidlined cust fab    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      two.
L0488..............  TLSO rigid lined pre one    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pie.
L0490..............  TLSO rigid plastic pre one  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0491..............  TLSO 2 piece rigid shell..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0492..............  TLSO 3 piece rigid shell..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0621..............  SIO flex pelvisacral        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L0622..............  SIO flex pelvisacral        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      custom.
L0623..............  SIO panel prefab..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0624..............  SIO panel custom..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0625..............  LO flexibl L1-below L5 pre  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0626..............  LO sag stays/panels pre-    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fab.
L0627..............  LO sagitt rigid panel       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L0628..............  LO flex w/o rigid stays     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pre.
L0629..............  LSO flex w/rigid stays      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cust.
L0630..............  LSO post rigid panel pre..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0631..............  LSO sag-coro rigid frame    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pre.
L0632..............  LSO sag rigid frame cust..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0633..............  LSO flexion control prefab  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0634..............  LSO flexion control custom  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0635..............  LSO sagit rigid panel       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L0636..............  LSO sagittal rigid panel    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cus.
L0637..............  LSO sag-coronal panel       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L0638..............  LSO sag-coronal panel       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      custom.
L0639..............  LSO s/c shell/panel prefab  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0640..............  LSO s/c shell/panel custom  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0700..............  Ctlso a-p-l control molded  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0710..............  Ctlso a-p-l control w/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inter.
L0810..............  Halo cervical into jckt     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      vest.
L0820..............  Halo cervical into body     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jack.
L0830..............  Halo cerv into milwaukee    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      typ.
L0859..............  MRI compatible system.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0861..............  Halo repl liner/interface.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0960..............  Post surgical support pads  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0970..............  Tlso corset front.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0972..............  Lso corset front..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0974..............  Tlso full corset..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0976..............  Lso full corset...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 43050]]

 
L0978..............  Axillary crutch extension.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0980..............  Peroneal straps pair......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0982..............  Stocking supp grips set of  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      f.
L0984..............  Protective body sock each.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0999..............  Add to spinal orthosis NOS  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1000..............  Ctlso milwauke initial      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      model.
L1001..............  CTLSO infant immobilizer..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1005..............  Tension based scoliosis     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      orth.
L1010..............  Ctlso axilla sling........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1020..............  Kyphosis pad..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1025..............  Kyphosis pad floating.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1030..............  Lumbar bolster pad........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1040..............  Lumbar or lumbar rib pad..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1050..............  Sternal pad...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1060..............  Thoracic pad..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1070..............  Trapezius sling...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1080..............  Outrigger.................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1085..............  Outrigger bil w/ vert       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extens.
L1090..............  Lumbar sling..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1100..............  Ring flange plastic/        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      leather.
L1110..............  Ring flange plas/leather    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mol.
L1120..............  Covers for upright each...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1200..............  Furnsh initial orthosis     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      only.
L1210..............  Lateral thoracic extension  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1220..............  Anterior thoracic           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extension.
L1230..............  Milwaukee type              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      superstructur.
L1240..............  Lumbar derotation pad.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1250..............  Anterior asis pad.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1260..............  Anterior thoracic           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      derotation.
L1270..............  Abdominal pad.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1280..............  Rib gusset (elastic) each.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1290..............  Lateral trochanteric pad..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1300..............  Body jacket mold to         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      patient.
L1310..............  Post-operative body jacket  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1499..............  Spinal orthosis NOS.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1500..............  Thkao mobility frame......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1510..............  Thkao standing frame......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1520..............  Thkao swivel walker.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1600..............  Abduct hip flex frejka w    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cvr.
L1610..............  Abduct hip flex frejka      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      covr.
L1620..............  Abduct hip flex pavlik      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      harne.
L1630..............  Abduct control hip semi-    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flex.
L1640..............  Pelv band/spread bar thigh  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L1650..............  HO abduction hip            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adjustable.
L1652..............  HO bi thighcuffs w sprdr    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bar.
L1660..............  HO abduction static         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      plastic.
L1680..............  Pelvic & hip control thigh  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L1685..............  Post-op hip abduct custom   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fa.
L1686..............  HO post-op hip abduction..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1690..............  Combination bilateral HO..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1700..............  Leg perthes orth toronto    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      typ.
L1710..............  Legg perthes orth           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      newington.
L1720..............  Legg perthes orthosis       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      trilat.
L1730..............  Legg perthes orth scottish  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      r.
L1755..............  Legg perthes patten bottom  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t.
L1800..............  Knee orthoses elas w stays  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1810..............  Ko elastic with joints....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1815..............  Elastic with condylar pads  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1820..............  Ko elas w/ condyle pads &   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jo.
L1825..............  Ko elastic knee cap.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1830..............  Ko immobilizer canvas       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      longit.
L1831..............  Knee orth pos locking       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      joint.
L1832..............  KO adj jnt pos rigid        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      support.
L1834..............  Ko w/0 joint rigid molded   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      to.
L1836..............  Rigid KO wo joints........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1840..............  Ko derot ant cruciate       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      custom.
L1843..............  KO single upright custom    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fit.
L1844..............  Ko w/adj jt rot cntrl       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molded.
L1845..............  Ko w/ adj flex/ext rotat    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cus.
L1846..............  Ko w adj flex/ext rotat     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mold.
L1847..............  KO adjustable w air         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      chambers.
L1850..............  Ko swedish type...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1855..............  Ko plas doub upright jnt    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mol.
L1858..............  Ko polycentric pneumatic    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pad.
L1860..............  Ko supracondylar socket     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mold.
L1870..............  Ko doub upright lacers      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molde.
L1880..............  Ko doub upright cuffs/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lacers.
L1900..............  Afo sprng wir drsflx calf   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bd.

[[Page 43051]]

 
L1901..............  Prefab ankle orthosis.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1902..............  Afo ankle gauntlet........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1904..............  Afo molded ankle gauntlet.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1906..............  Afo multiligamentus ankle   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      su.
L1907..............  AFO supramalleolar custom.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1910..............  Afo sing bar clasp attach   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sh.
L1920..............  Afo sing upright w/ adjust  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L1930..............  Afo plastic...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1932..............  Afo rig ant tib prefab TCF/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      =.
L1940..............  Afo molded to patient       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      plasti.
L1945..............  Afo molded plas rig ant     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tib.
L1950..............  Afo spiral molded to pt     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      plas.
L1951..............  AFO spiral prefabricated..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1960..............  Afo pos solid ank plastic   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mo.
L1970..............  Afo plastic molded w/ankle  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      j.
L1971..............  AFO w/ankle joint, prefab.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1980..............  Afo sing solid stirrup      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      calf.
L1990..............  Afo doub solid stirrup      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      calf.
L2000..............  Kafo sing fre stirr thi/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      calf.
L2005..............  KAFO sng/dbl mechanical     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      act.
L2010..............  Kafo sng solid stirrup w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      j.
L2020..............  Kafo dbl solid stirrup      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      band/.
L2030..............  Kafo dbl solid stirrup w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      j.
L2034..............  KAFO pla sin up w/wo k/a    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cus.
L2035..............  KAFO plastic pediatric      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      size.
L2036..............  Kafo plas doub free knee    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mol.
L2037..............  Kafo plas sing free knee    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mol.
L2038..............  Kafo w/o joint multi-axis   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      an.
L2040..............  Hkafo torsion bil rot       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      straps.
L2050..............  Hkafo torsion cable hip     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pelv.
L2060..............  Hkafo torsion ball bearing  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      j.
L2070..............  Hkafo torsion unilat rot    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      str.
L2080..............  Hkafo unilat torsion cable  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2090..............  Hkafo unilat torsion ball   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      br.
L2106..............  Afo tib fx cast plaster     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mold.
L2108..............  Afo tib fx cast molded to   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pt.
L2112..............  Afo tibial fracture soft..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2114..............  Afo tib fx semi-rigid.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2116..............  Afo tibial fracture rigid.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2126..............  Kafo fem fx cast            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thermoplas.
L2128..............  Kafo fem fx cast molded to  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L2132..............  Kafo femoral fx cast soft.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2134..............  Kafo fem fx cast semi-      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rigid.
L2136..............  Kafo femoral fx cast rigid  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2180..............  Plas shoe insert w ank      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      joint.
L2182..............  Drop lock knee............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2184..............  Limited motion knee joint.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2186..............  Adj motion knee jnt lerman  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t.
L2188..............  Quadrilateral brim........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2190..............  Waist belt................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2192..............  Pelvic band & belt thigh    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fla.
L2200..............  Limited ankle motion ea     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jnt.
L2210..............  Dorsiflexion assist each    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      joi.
L2220..............  Dorsi & plantar flex ass/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      res.
L2230..............  Split flat caliper stirr &  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L2232..............  Rocker bottom, contact AFO  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2240..............  Round caliper and plate     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      atta.
L2250..............  Foot plate molded stirrup   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      at.
L2260..............  Reinforced solid stirrup..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2265..............  Long tongue stirrup.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2270..............  Varus/valgus strap padded/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      li.
L2275..............  Plastic mod low ext pad/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      line.
L2280..............  Molded inner boot.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2300..............  Abduction bar jointed       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adjust.
L2310..............  Abduction bar-straight....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2320..............  Non-molded lacer..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2330..............  Lacer molded to patient     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mode.
L2335..............  Anterior swing band.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2340..............  Pre-tibial shell molded to  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L2350..............  Prosthetic type socket      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molde.
L2360..............  Extended steel shank......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2370..............  Patten bottom.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2375..............  Torsion ank & half solid    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sti.
L2380..............  Torsion straight knee       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      joint.
L2385..............  Straight knee joint heavy   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      du.
L2387..............  Add LE poly knee custom     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      KAFO.
L2390..............  Offset knee joint each....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2395..............  Offset knee joint heavy     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      duty.

[[Page 43052]]

 
L2397..............  Suspension sleeve lower     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ext.
L2405..............  Knee joint drop lock ea     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jnt.
L2415..............  Knee joint cam lock each    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      joi.
L2425..............  Knee disc/dial lock/adj     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flex.
L2430..............  Knee jnt ratchet lock ea    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jnt.
L2492..............  Knee lift loop drop lock    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rin.
L2500..............  Thi/glut/ischia wgt         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bearing.
L2510..............  Th/wght bear quad-lat brim  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      m.
L2520..............  Th/wght bear quad-lat brim  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L2525..............  Th/wght bear nar m-l brim   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mo.
L2526..............  Th/wght bear nar m-l brim   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cu.
L2530..............  Thigh/wght bear lacer non-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mo.
L2540..............  Thigh/wght bear lacer       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molded.
L2550..............  Thigh/wght bear high roll   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cu.
L2570..............  Hip clevis type 2 posit     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jnt.
L2580..............  Pelvic control pelvic       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sling.
L2600..............  Hip clevis/thrust bearing   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fr.
L2610..............  Hip clevis/thrust bearing   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lo.
L2620..............  Pelvic control hip heavy    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dut.
L2622..............  Hip joint adjustable        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flexion.
L2624..............  Hip adj flex ext abduct     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cont.
L2627..............  Plastic mold recipro hip &  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L2628..............  Metal frame recipro hip &   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ca.
L2630..............  Pelvic control band & belt  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      u.
L2640..............  Pelvic control band & belt  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
L2650..............  Pelv & thor control         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gluteal.
L2660..............  Thoracic control thoracic   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ba.
L2670..............  Thorac cont paraspinal      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      uprig.
L2680..............  Thorac cont lat support     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      upri.
L2750..............  Plating chrome/nickel pr    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bar.
L2755..............  Carbon graphite lamination  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2760..............  Extension per extension     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      per.
L2768..............  Ortho sidebar disconnect..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2770..............  Low ext orthosis per bar/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jnt.
L2780..............  Non-corrosive finish......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2785..............  Drop lock retainer each...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2795..............  Knee control full kneecap.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2800..............  Knee cap medial or lateral  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L2810..............  Knee control condylar pad.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2820..............  Soft interface below knee   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      se.
L2830..............  Soft interface above knee   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      se.
L2840..............  Tibial length sock fx or    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equ.
L2850..............  Femoral lgth sock fx or     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equa.
L2860..............  Torsion mechanism knee/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ankle.
L2999..............  Lower extremity orthosis    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
L3000..............  Ft insert ucb berkeley      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shell.
L3001..............  Foot insert remov molded    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      spe.
L3002..............  Foot insert plastazote or   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eq.
L3003..............  Foot insert silicone gel    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eac.
L3010..............  Foot longitudinal arch      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      suppo.
L3020..............  Foot longitud/metatarsal    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sup.
L3030..............  Foot arch support remov     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prem.
L3031..............  Foot lamin/prepreg          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      composite.
L3040..............  Ft arch suprt premold       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      longit.
L3050..............  Foot arch supp premold      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      metat.
L3060..............  Foot arch supp longitud/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      meta.
L3070..............  Arch suprt att to sho       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      longit.
L3080..............  Arch supp att to shoe       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      metata.
L3090..............  Arch supp att to shoe long/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      m.
L3100..............  Hallus-valgus nght dynamic  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L3140..............  Abduction rotation bar      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shoe.
L3150..............  Abduct rotation bar w/o     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shoe.
L3160..............  Shoe styled positioning     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dev.
L3170..............  Foot plastic heel           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stabilizer.
L3201..............  Oxford w supinat/pronat     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inf.
L3202..............  Oxford w/ supinat/pronator  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L3203..............  Oxford w/ supinator/        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pronator.
L3204..............  Hightop w/ supp/pronator    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inf.
L3206..............  Hightop w/ supp/pronator    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      chi.
L3207..............  Hightop w/ supp/pronator    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jun.
L3208..............  Surgical boot each infant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3209..............  Surgical boot each child..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3211..............  Surgical boot each junior.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3212..............  Benesch boot pair infant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3213..............  Benesch boot pair child...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3214..............  Benesch boot pair junior..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3215..............  Orthopedic ftwear ladies    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      oxf.
L3216..............  Orthoped ladies shoes dpth  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      i.

[[Page 43053]]

 
L3217..............  Ladies shoes hightop depth  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      i.
L3219..............  Orthopedic mens shoes       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      oxford.
L3221..............  Orthopedic mens shoes dpth  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      i.
L3222..............  Mens shoes hightop depth    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inl.
L3224..............  Woman's shoe oxford brace.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3225..............  Man's shoe oxford brace...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3230..............  Custom shoes depth inlay..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3250..............  Custom mold shoe remov      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prost.
L3251..............  Shoe molded to pt silicone  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L3252..............  Shoe molded plastazote      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cust.
L3253..............  Shoe molded plastazote      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cust.
L3254..............  Orth foot non-stndard size/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      w.
L3255..............  Orth foot non-standard      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      size/.
L3257..............  Orth foot add charge split  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L3260..............  Ambulatory surgical boot    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      eac.
L3265..............  Plastazote sandal each....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3300..............  Sho lift taper to           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      metatarsal.
L3310..............  Shoe lift elev heel/sole    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      neo.
L3320..............  Shoe lift elev heel/sole    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cor.
L3330..............  Lifts elevation metal       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extens.
L3332..............  Shoe lifts tapered to one-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ha.
L3334..............  Shoe lifts elevation heel / ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      i.
L3340..............  Shoe wedge sach...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3350..............  Shoe heel wedge...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3360..............  Shoe sole wedge outside     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sole.
L3370..............  Shoe sole wedge between     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sole.
L3380..............  Shoe clubfoot wedge.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3390..............  Shoe outflare wedge.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3400..............  Shoe metatarsal bar wedge   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ro.
L3410..............  Shoe metatarsal bar         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      between.
L3420..............  Full sole/heel wedge        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      btween.
L3430..............  Sho heel count plast        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      reinfor.
L3440..............  Heel leather reinforced...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3450..............  Shoe heel sach cushion      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      type.
L3455..............  Shoe heel new leather       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      standa.
L3460..............  Shoe heel new rubber        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      standar.
L3465..............  Shoe heel thomas with       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wedge.
L3470..............  Shoe heel thomas extend to  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
L3480..............  Shoe heel pad & depress     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      for.
L3485..............  Shoe heel pad removable     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      for.
L3500..............  Ortho shoe add leather      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      insol.
L3510..............  Orthopedic shoe add rub     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      insl.
L3520..............  O shoe add felt w leath     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      insl.
L3530..............  Ortho shoe add half sole..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3540..............  Ortho shoe add full sole..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3550..............  O shoe add standard toe     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tap.
L3560..............  O shoe add horseshoe toe    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tap.
L3570..............  O shoe add instep           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extension.
L3580..............  O shoe add instep velcro    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      clo.
L3590..............  O shoe convert to sof       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      counte.
L3595..............  Ortho shoe add march bar..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3600..............  Trans shoe calip plate      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      exist.
L3610..............  Trans shoe caliper plate    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      new.
L3620..............  Trans shoe solid stirrup    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      exi.
L3630..............  Trans shoe solid stirrup    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      new.
L3640..............  Shoe dennis browne splint   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bo.
L3649..............  Orthopedic shoe modifica    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
L3650..............  Shlder fig 8 abduct         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      restrain.
L3651..............  Prefab shoulder orthosis..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3652..............  Prefab dbl shoulder         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      orthosis.
L3660..............  Abduct restrainer           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      canvas&web.
L3670..............  Acromio/clavicular          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      canvas&we.
L3671..............  SO cap design w/o jnts CF.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3672..............  SO airplane w/o jnts CF...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3673..............  SO airplane w/joint CF....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3675..............  Canvas vest SO............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3677..............  SO hard plastic stabilizer  ..................  E.................  ...........  ...........  ...........  ...........  ...........
L3700..............  Elbow orthoses elas w       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stays.
L3701..............  Prefab elbow orthosis.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3702..............  EO w/o joints CF..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3710..............  Elbow elastic with metal    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      joi.
L3720..............  Forearm/arm cuffs free      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      motio.
L3730..............  Forearm/arm cuffs ext/flex  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      a.
L3740..............  Cuffs adj lock w/ active    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      con.
L3760..............  EO withjoint,               ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      Prefabricated.
L3762..............  Rigid EO wo joints........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3763..............  EWHO rigid w/o jnts CF....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3764..............  EWHO w/joint(s) CF........  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 43054]]

 
L3765..............  EWHFO rigid w/o jnts CF...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3766..............  EWHFO w/joint(s) CF.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3800..............  Whfo short opponen no       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      attach.
L3805..............  Whfo long opponens no       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      attach.
L3806..............  WHFO w/joint(s) custom fab  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3807..............  WHFO,no joint,              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefabricated.
L3808..............  WHFO, rigid w/o joints....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3810..............  Whfo thumb abduction bar..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3815..............  Whfo second m.p. abduction  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      a.
L3820..............  Whfo ip ext asst w/ mp ext  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L3825..............  Whfo m.p. extension stop..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3830..............  Whfo m.p. extension assist  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3835..............  Whfo m.p. spring extension  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      a.
L3840..............  Whfo spring swivel thumb..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3845..............  Whfo thumb ip ext ass w/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mp.
L3850..............  Action wrist w/ dorsiflex   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      as.
L3855..............  Whfo adj m.p. flexion       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      contro.
L3860..............  Whfo adj m.p. flex ctrl &   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      i..
L3890..............  Torsion mechanism wrist/    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      elbo.
L3900..............  Hinge extension/flex wrist/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      f.
L3901..............  Hinge ext/flex wrist        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      finger.
L3904..............  Whfo electric custom        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fitted.
L3905..............  WHO w/nontorsion jnt(s) CF  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3906..............  WHO w/o joints CF.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3907..............  Whfo wrst gauntlt thmb      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      spica.
L3908..............  Wrist cock-up non-molded..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3909..............  Prefab wrist orthosis.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3910..............  Whfo swanson design.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3911..............  Prefab hand finger          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      orthosis.
L3912..............  Flex glove w/elastic        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      finger.
L3913..............  HFO w/o joints CF.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3915..............  WHO w nontor jnt(s) prefab  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3916..............  Whfo wrist extens w/        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      outrigg.
L3917..............  Prefab metacarpl fx         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      orthosis.
L3918..............  HFO knuckle bender........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3919..............  HO w/o joints CF..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3920..............  Knuckle bender with         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      outrigge.
L3921..............  HFO w/joint(s) CF.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3922..............  Knuckle bend 2 seg to flex  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      j.
L3923..............  HFO w/o joints PF.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3924..............  Oppenheimer...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3926..............  Thomas suspension.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3928..............  Finger extension w/ clock   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sp.
L3930..............  Finger extension with       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wrist.
L3932..............  Safety pin spring wire....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3933..............  FO w/o joints CF..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3934..............  Safety pin modified.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3935..............  FO nontorsion joint CF....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3936..............  Palmer....................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3938..............  Dorsal wrist..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3940..............  Dorsal wrist w/ outrigger   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      at.
L3942..............  Reverse knuckle bender....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3944..............  Reverse knuckle bend w/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      outr.
L3946..............  HFO composite elastic.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3948..............  Finger knuckle bender.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3950..............  Oppenheimer w/ knuckle      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bend.
L3952..............  Oppenheimer w/ rev knuckle  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.
L3954..............  Spreading hand............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3956..............  Add joint upper ext         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      orthosis.
L3960..............  Sewho airplan desig abdu    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pos.
L3961..............  SEWHO cap design w/o jnts   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      CF.
L3962..............  Sewho erbs palsey design    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      abd.
L3964..............  Seo mobile arm sup att to   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
L3965..............  Arm supp att to wc rancho   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ty.
L3966..............  Mobile arm supports         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      reclinin.
L3967..............  SEWHO airplane w/o jnts CF  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3968..............  Friction dampening arm      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      supp.
L3969..............  Monosuspension arm/hand     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      supp.
L3970..............  Elevat proximal arm         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      support.
L3971..............  SEWHO cap design w/jnt(s)   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      CF.
L3972..............  Offset/lat rocker arm w/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ela.
L3973..............  SEWHO airplane w/jnt(s) CF  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3974..............  Mobile arm support          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      supinator.
L3975..............  SEWHFO cap design w/o jnt   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      CF.
L3976..............  SEWHFO airplane w/o jnts    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      CF.
L3977..............  SEWHFO cap desgn w/jnt(s)   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      CF.
L3978..............  SEWHFO airplane w/jnt(s)    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      CF.
L3980..............  Upp ext fx orthosis         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      humeral.

[[Page 43055]]

 
L3982..............  Upper ext fx orthosis rad/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ul.
L3984..............  Upper ext fx orthosis       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wrist.
L3985..............  Forearm hand fx orth w/ wr  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      h.
L3986..............  Humeral rad/ulna wrist fx   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      or.
L3995..............  Sock fracture or equal      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
L3999..............  Upper limb orthosis NOS...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4000..............  Repl girdle milwaukee orth  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4002..............  Replace strap, any          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      orthosis.
L4010..............  Replace trilateral socket   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      br.
L4020..............  Replace quadlat socket      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      brim.
L4030..............  Replace socket brim cust    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fit.
L4040..............  Replace molded thigh lacer  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4045..............  Replace non-molded thigh    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lac.
L4050..............  Replace molded calf lacer.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4055..............  Replace non-molded calf     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lace.
L4060..............  Replace high roll cuff....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4070..............  Replace prox & dist         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      upright.
L4080..............  Repl met band kafo-afo      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prox.
L4090..............  Repl met band kafo-afo      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      calf/.
L4100..............  Repl leath cuff kafo prox   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      th.
L4110..............  Repl leath cuff kafo-afo    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cal.
L4130..............  Replace pretibial shell...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4205..............  Ortho dvc repair per 15     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      min.
L4210..............  Orth dev repair/repl minor  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L4350..............  Ankle control orthosi       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L4360..............  Pneumati walking boot       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L4370..............  Pneumatic full leg splint.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4380..............  Pneumatic knee splint.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4386..............  Non-pneum walk boot prefab  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4392..............  Replace AFO soft interface  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4394..............  Replace foot drop spint...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4396..............  Static AFO................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4398..............  Foot drop splint recumbent  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5000..............  Sho insert w arch toe       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      filler.
L5010..............  Mold socket ank hgt w/ toe  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      f.
L5020..............  Tibial tubercle hgt w/ toe  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      f.
L5050..............  Ank symes mold sckt sach    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ft.
L5060..............  Symes met fr leath socket   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ar.
L5100..............  Molded socket shin sach     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      foot.
L5105..............  Plast socket jts/thgh       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lacer.
L5150..............  Mold sckt ext knee shin     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sach.
L5160..............  Mold socket bent knee shin  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L5200..............  Kne sing axis fric shin     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sach.
L5210..............  No knee/ankle joints w/ ft  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
L5220..............  No knee joint with artic    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ali.
L5230..............  Fem focal defic constant    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fri.
L5250..............  Hip canad sing axi cons     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fric.
L5270..............  Tilt table locking hip      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sing.
L5280..............  Hemipelvect canad sing      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      axis.
L5301..............  BK mold socket SACH ft      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      endo.
L5311..............  Knee disart, SACH ft, endo  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5321..............  AK open end SACH..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5331..............  Hip disart canadian SACH    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ft.
L5341..............  Hemipelvectomy canadian     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      SACH.
L5400..............  Postop dress & 1 cast chg   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bk.
L5410..............  Postop dsg bk ea add cast   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ch.
L5420..............  Postop dsg & 1 cast chg ak/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      d.
L5430..............  Postop dsg ak ea add cast   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ch.
L5450..............  Postop app non-wgt bear     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dsg.
L5460..............  Postop app non-wgt bear     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dsg.
L5500..............  Init bk ptb plaster direct  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5505..............  Init ak ischal plstr        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      direct.
L5510..............  Prep BK ptb plaster molded  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5520..............  Perp BK ptb thermopls       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      direct.
L5530..............  Prep BK ptb thermopls       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molded.
L5535..............  Prep BK ptb open end        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      socket.
L5540..............  Prep BK ptb laminated       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      socket.
L5560..............  Prep AK ischial plast       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molded.
L5570..............  Prep AK ischial direct      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      form.
L5580..............  Prep AK ischial thermo      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mold.
L5585..............  Prep AK ischial open end..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5590..............  Prep AK ischial laminated.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5595..............  Hip disartic sach           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thermopls.
L5600..............  Hip disart sach laminat     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mold.
L5610..............  Above knee hydracadence...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5611..............  Ak 4 bar link w/fric swing  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5613..............  Ak 4 bar ling w/hydraul     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      swig.
L5614..............  4-bar link above knee w/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      swng.

[[Page 43056]]

 
L5616..............  Ak univ multiplex sys       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      frict.
L5617..............  AK/BK self-aligning unit    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ea.
L5618..............  Test socket symes.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5620..............  Test socket below knee....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5622..............  Test socket knee            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      disarticula.
L5624..............  Test socket above knee....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5626..............  Test socket hip             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      disarticulat.
L5628..............  Test socket hemipelvectomy  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5629..............  Below knee acrylic socket.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5630..............  Syme typ expandabl wall     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sckt.
L5631..............  Ak/knee disartic acrylic    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      soc.
L5632..............  Symes type ptb brim design  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L5634..............  Symes type poster opening   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      so.
L5636..............  Symes type medial opening   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      so.
L5637..............  Below knee total contact..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5638..............  Below knee leather socket.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5639..............  Below knee wood socket....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5640..............  Knee disarticulat leather   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      so.
L5642..............  Above knee leather socket.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5643..............  Hip flex inner socket ext   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fr.
L5644..............  Above knee wood socket....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5645..............  Bk flex inner socket ext    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fra.
L5646..............  Below knee cushion socket.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5647..............  Below knee suction socket.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5648..............  Above knee cushion socket.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5649..............  Isch containmt/narrow m-l   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      so.
L5650..............  Tot contact ak/knee disart  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L5651..............  Ak flex inner socket ext    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fra.
L5652..............  Suction susp ak/knee        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      disart.
L5653..............  Knee disart expand wall     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sock.
L5654..............  Socket insert symes.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5655..............  Socket insert below knee..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5656..............  Socket insert knee          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      articulat.
L5658..............  Socket insert above knee..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5661..............  Multi-durometer symes.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5665..............  Multi-durometer below knee  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5666..............  Below knee cuff suspension  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5668..............  Socket insert w/o lock      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lower.
L5670..............  Bk molded supracondylar     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      susp.
L5671..............  BK/AK locking mechanism...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5672..............  Bk removable medial brim    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sus.
L5673..............  Socket insert w lock mech.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5676..............  Bk knee joints single axis  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L5677..............  Bk knee joints polycentric  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L5678..............  Bk joint covers pair......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5679..............  Socket insert w/o lock      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mech.
L5680..............  Bk thigh lacer non-molded.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5681..............  Intl custm cong/latyp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      insert.
L5682..............  Bk thigh lacer glut/ischia  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      m.
L5683..............  Initial custom socket       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      insert.
L5684..............  Bk fork strap.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5685..............  Below knee sus/seal sleeve  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5686..............  Bk back check.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5688..............  Bk waist belt webbing.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5690..............  Bk waist belt padded and    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lin.
L5692..............  Ak pelvic control belt      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      light.
L5694..............  Ak pelvic control belt pad/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      l.
L5695..............  Ak sleeve susp neoprene/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equa.
L5696..............  Ak/knee disartic pelvic     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      join.
L5697..............  Ak/knee disartic pelvic     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      band.
L5698..............  Ak/knee disartic silesian   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ba.
L5699..............  Shoulder harness..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5700..............  Replace socket below knee.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5701..............  Replace socket above knee.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5702..............  Replace socket hip........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5703..............  Symes ankle w/o (SACH)      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      foot.
L5704..............  Custom shape cover BK.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5705..............  Custom shape cover AK.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5706..............  Custom shape cvr knee       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      disart.
L5707..............  Custom shape cvr hip        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      disart.
L5710..............  Kne-shin exo sng axi mnl    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      loc.
L5711..............  Knee-shin exo mnl lock      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ultra.
L5712..............  Knee-shin exo frict swg &   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      st.
L5714..............  Knee-shin exo variable      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      frict.
L5716..............  Knee-shin exo mech stance   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ph.
L5718..............  Knee-shin exo frct swg &    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sta.
L5722..............  Knee-shin pneum swg frct    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      exo.
L5724..............  Knee-shin exo fluid swing   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ph.

[[Page 43057]]

 
L5726..............  Knee-shin ext jnts fld swg  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      e.
L5728..............  Knee-shin fluid swg &       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stance.
L5780..............  Knee-shin pneum/hydra       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pneum.
L5781..............  Lower limb pros vacuum      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pump.
L5782..............  HD low limb pros vacuum     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pump.
L5785..............  Exoskeletal bk ultralt      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mater.
L5790..............  Exoskeletal ak ultra-light  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      m.
L5795..............  Exoskel hip ultra-light     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mate.
L5810..............  Endoskel knee-shin mnl      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lock.
L5811..............  Endo knee-shin mnl lck      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ultra.
L5812..............  Endo knee-shin frct swg &   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      st.
L5814..............  Endo knee-shin hydral swg   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ph.
L5816..............  Endo knee-shin polyc mch    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sta.
L5818..............  Endo knee-shin frct swg &   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      st.
L5822..............  Endo knee-shin pneum swg    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      frc.
L5824..............  Endo knee-shin fluid swing  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L5826..............  Miniature knee joint......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5828..............  Endo knee-shin fluid swg/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sta.
L5830..............  Endo knee-shin pneum/swg    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pha.
L5840..............  Multi-axial knee/shin       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      system.
L5845..............  Knee-shin sys stance        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flexion.
L5848..............  Knee-shin sys hydraul       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stance.
L5850..............  Endo ak/hip knee extens     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      assi.
L5855..............  Mech hip extension assist.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5856..............  Elec knee-shin swing/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stance.
L5857..............  Elec knee-shin swing only.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5858..............  Stance phase only.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5910..............  Endo below knee alignable   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sy.
L5920..............  Endo ak/hip alignable       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      system.
L5925..............  Above knee manual lock....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5930..............  High activity knee frame..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5940..............  Endo bk ultra-light         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      material.
L5950..............  Endo ak ultra-light         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      material.
L5960..............  Endo hip ultra-light        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      materia.
L5962..............  Below knee flex cover       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      system.
L5964..............  Above knee flex cover       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      system.
L5966..............  Hip flexible cover system.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5968..............  Multiaxial ankle w          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dorsiflex.
L5970..............  Foot external keel sach     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      foot.
L5971..............  SACH foot, replacement....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5972..............  Flexible keel foot........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5974..............  Foot single axis ankle/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      foot.
L5975..............  Combo ankle/foot            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosthesis.
L5976..............  Energy storing foot.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5978..............  Ft prosth multiaxial ankl/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ft.
L5979..............  Multi-axial ankle/ft        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosth.
L5980..............  Flex foot system..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5981..............  Flex-walk sys low ext       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosth.
L5982..............  Exoskeletal axial rotation  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      u.
L5984..............  Endoskeletal axial          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rotation.
L5985..............  Lwr ext dynamic prosth      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pylon.
L5986..............  Multi-axial rotation unit.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5987..............  Shank ft w vert load pylon  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5988..............  Vertical shock reducing     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pylo.
L5990..............  User adjustable heel        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      height.
L5993..............  Heavy duty feature, foot..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5994..............  Heavy duty feature, knee..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5995..............  Lower ext pros heavyduty    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fea.
L5999..............  Lowr extremity prosthes     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
L6000..............  Par hand robin-aids thum    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rem.
L6010..............  Hand robin-aids little/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ring.
L6020..............  Part hand robin-aids no     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fing.
L6025..............  Part hand disart            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      myoelectric.
L6050..............  Wrst MLd sck flx hng tri    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pad.
L6055..............  Wrst mold sock w/exp        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      interfa.
L6100..............  Elb mold sock flex hinge    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pad.
L6110..............  Elbow mold sock suspension  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t.
L6120..............  Elbow mold doub splt soc    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ste.
L6130..............  Elbow stump activated lock  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      h.
L6200..............  Elbow mold outsid lock      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      hinge.
L6205..............  Elbow molded w/ expand      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inter.
L6250..............  Elbow inter loc elbow       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      forarm.
L6300..............  Shlder disart int lock      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      elbow.
L6310..............  Shoulder passive restor     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      comp.
L6320..............  Shoulder passive restor     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cap.
L6350..............  Thoracic intern lock elbow  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6360..............  Thoracic passive restor     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      comp.
L6370..............  Thoracic passive restor     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cap.

[[Page 43058]]

 
L6380..............  Postop dsg cast chg wrst/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      elb.
L6382..............  Postop dsg cast chg elb     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dis/.
L6384..............  Postop dsg cast chg shlder/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t.
L6386..............  Postop ea cast chg &        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      realign.
L6388..............  Postop applicat rigid dsg   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      on.
L6400..............  Below elbow prosth tiss     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shap.
L6450..............  Elb disart prosth tiss      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shap.
L6500..............  Above elbow prosth tiss     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shap.
L6550..............  Shldr disar prosth tiss     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shap.
L6570..............  Scap thorac prosth tiss     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shap.
L6580..............  Wrist/elbow bowden cable    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mol.
L6582..............  Wrist/elbow bowden cbl dir  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      f.
L6584..............  Elbow fair lead cable       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molded.
L6586..............  Elbow fair lead cable dir   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fo.
L6588..............  Shdr fair lead cable        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molded.
L6590..............  Shdr fair lead cable        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      direct.
L6600..............  Polycentric hinge pair....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6605..............  Single pivot hinge pair...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6610..............  Flexible metal hinge pair.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6611..............  Additional switch, ext      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      power.
L6615..............  Disconnect locking wrist    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      uni.
L6616..............  Disconnect insert locking   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wr.
L6620..............  Flexion/extension wrist     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      unit.
L6621..............  Flex/ext wrist w/wo         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      friction.
L6623..............  Spring-ass rot wrst w/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      latch.
L6624..............  Flex/ext/rotation wrist     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      unit.
L6625..............  Rotation wrst w/ cable      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lock.
L6628..............  Quick disconn hook adapter  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      o.
L6629..............  Lamination collar w/        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      couplin.
L6630..............  Stainless steel any wrist.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6632..............  Latex suspension sleeve     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
L6635..............  Lift assist for elbow.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6637..............  Nudge control elbow lock..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6638..............  Elec lock on manual pw      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      elbow.
L6639..............  Heavy duty elbow feature..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6640..............  Shoulder abduction joint    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pai.
L6641..............  Excursion amplifier pulley  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t.
L6642..............  Excursion amplifier lever   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ty.
L6645..............  Shoulder flexion-abduction  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      j.
L6646..............  Multipo locking shoulder    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jnt.
L6647..............  Shoulder lock actuator....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6648..............  Ext pwrd shlder lock/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      unlock.
L6650..............  Shoulder universal joint..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6655..............  Standard control cable      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extra.
L6660..............  Heavy duty control cable..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6665..............  Teflon or equal cable       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lining.
L6670..............  Hook to hand cable adapter  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6672..............  Harness chest/shlder        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      saddle.
L6675..............  Harness figure of 8 sing    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      con.
L6676..............  Harness figure of 8 dual    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      con.
L6677..............  UE triple control harness.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6680..............  Test sock wrist disart/bel  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      e.
L6682..............  Test sock elbw disart/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      above.
L6684..............  Test socket shldr disart/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tho.
L6686..............  Suction socket............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6687..............  Frame typ socket bel elbow/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      w.
L6688..............  Frame typ sock above elb/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dis.
L6689..............  Frame typ socket shoulder   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      di.
L6690..............  Frame typ sock interscap-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tho.
L6691..............  Removable insert each.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6692..............  Silicone gel insert or      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equal.
L6693..............  Lockingelbow forearm        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cntrbal.
L6694..............  Elbow socket ins use w/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lock.
L6695..............  Elbow socket ins use w/o    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lck.
L6696..............  Cus elbo skt in for con/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      atyp.
L6697..............  Cus elbo skt in not con/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      atyp.
L6698..............  Below/above elbow lock      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mech.
L6703..............  Term dev, passive hand      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mitt.
L6704..............  Term dev, sport/rec/work    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      att.
L6706..............  Term dev mech hook vol      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      open.
L6707..............  Term dev mech hook vol      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      close.
L6708..............  Term dev mech hand vol      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      open.
L6709..............  Term dev mech hand vol      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      close.
L6805..............  Term dev modifier wrist     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      unit.
L6810..............  Term dev precision pinch    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dev.
L6881..............  Term dev auto grasp         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      feature.
L6882..............  Microprocessor control      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      uplmb.
L6883..............  Replc sockt below e/w disa  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 43059]]

 
L6884..............  Replc sockt above elbow     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      disa.
L6885..............  Replc sockt shldr dis/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      interc.
L6890..............  Prefab glove for term       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      device.
L6895..............  Custom glove for term       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      device.
L6900..............  Hand restorat thumb/1       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      finger.
L6905..............  Hand restoration multiple   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fi.
L6910..............  Hand restoration no         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fingers.
L6915..............  Hand restoration replacmnt  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      g.
L6920..............  Wrist disarticul switch     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ctrl.
L6925..............  Wrist disart myoelectronic  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L6930..............  Below elbow switch control  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6935..............  Below elbow myoelectronic   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ct.
L6940..............  Elbow disarticulation       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      switch.
L6945..............  Elbow disart myoelectronic  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L6950..............  Above elbow switch control  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6955..............  Above elbow myoelectronic   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ct.
L6960..............  Shldr disartic switch       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      contro.
L6965..............  Shldr disartic              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      myoelectronic.
L6970..............  Interscapular-thor switch   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ct.
L6975..............  Interscap-thor              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      myoelectronic.
L7007..............  Adult electric hand.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7008..............  Pediatric electric hand...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7009..............  Adult electric hook.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7040..............  Prehensile actuator.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7045..............  Pediatric electric hook...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7170..............  Electronic elbow hosmer     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      swit.
L7180..............  Electronic elbow            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sequential.
L7181..............  Electronic elbo             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      simultaneous.
L7185..............  Electron elbow adolescent   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sw.
L7186..............  Electron elbow child        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      switch.
L7190..............  Elbow adolescent            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      myoelectron.
L7191..............  Elbow child myoelectronic   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ct.
L7260..............  Electron wrist rotator      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      otto.
L7261..............  Electron wrist rotator      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      utah.
L7266..............  Servo control steeper or    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equ.
L7272..............  Analogue control unb or     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equa.
L7274..............  Proportional ctl 12 volt    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      uta.
L7360..............  Six volt bat otto bock/eq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ea.
L7362..............  Battery chrgr six volt      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      otto.
L7364..............  Twelve volt battery utah/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equ.
L7366..............  Battery chrgr 12 volt utah/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      e.
L7367..............  Replacemnt lithium          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ionbatter.
L7368..............  Lithium ion battery         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      charger.
L7400..............  Add UE prost be/wd,         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ultlite.
L7401..............  Add UE prost a/e ultlite    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mat.
L7402..............  Add UE prost s/d ultlite    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mat.
L7403..............  Add UE prost b/e acrylic..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7404..............  Add UE prost a/e acrylic..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7405..............  Add UE prost s/d acrylic..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7499..............  Upper extremity prosthes    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
L7500..............  Prosthetic dvc repair       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      hourly.
L7510..............  Prosthetic device repair    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
L7520..............  Repair prosthesis per 15    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      min.
L7600..............  Prosthetic donning sleeve.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7900..............  Male vacuum erection        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      system.
L8000..............  Mastectomy bra............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8001..............  Breast prosthesis bra &     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      form.
L8002..............  Brst prsth bra & bilat      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      form.
L8010..............  Mastectomy sleeve.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8015..............  Ext breastprosthesis        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      garment.
L8020..............  Mastectomy form...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8030..............  Breast prosthesis silicone/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      e.
L8035..............  Custom breast prosthesis..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8039..............  Breast prosthesis NOS.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8040..............  Nasal prosthesis..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8041..............  Midfacial prosthesis......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8042..............  Orbital prosthesis........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8043..............  Upper facial prosthesis...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8044..............  Hemi-facial prosthesis....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8045..............  Auricular prosthesis......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8046..............  Partial facial prosthesis.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8047..............  Nasal septal prosthesis...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8048..............  Unspec maxillofacial        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosth.
L8049..............  Repair maxillofacial        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosth.
L8300..............  Truss single w/ standard    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pad.
L8310..............  Truss double w/ standard    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pad.
L8320..............  Truss addition to std pad   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wa.
L8330..............  Truss add to std pad        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      scrotal.

[[Page 43060]]

 
L8400..............  Sheath below knee.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8410..............  Sheath above knee.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8415..............  Sheath upper limb.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8417..............  Pros sheath/sock w gel      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cushn.
L8420..............  Prosthetic sock multi ply   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      BK.
L8430..............  Prosthetic sock multi ply   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      AK.
L8435..............  Pros sock multi ply upper   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lm.
L8440..............  Shrinker below knee.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8460..............  Shrinker above knee.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8465..............  Shrinker upper limb.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8470..............  Pros sock single ply BK...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8480..............  Pros sock single ply AK...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8485..............  Pros sock single ply upper  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      l.
L8499..............  Unlisted misc prosthetic    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ser.
L8500..............  Artificial larynx.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8501..............  Tracheostomy speaking       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      valve.
L8505..............  Artificial larynx,          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      accessory.
L8507..............  Trach-esoph voice pros pt   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
L8509..............  Trach-esoph voice pros md   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
L8510..............  Voice amplifier...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8511..............  Indwelling trach insert...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8512..............  Gel cap for trach voice     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pros.
L8513..............  Trach pros cleaning device  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8514..............  Repl trach puncture         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dilator.
L8515..............  Gel cap app device for      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      trach.
L8600..............  Implant breast silicone/eq  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8603..............  Collagen imp urinary 2.5    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ml.
L8606..............  Synthetic implnt urinary    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      1ml.
L8609..............  Artificial cornea.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8610..............  Ocular implant............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8612..............  Aqueous shunt prosthesis..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8613..............  Ossicular implant.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8614..............  Cochlear device...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8615..............  Coch implant headset        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      replace.
L8616..............  Coch implant microphone     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      repl.
L8617..............  Coch implant trans coil     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      repl.
L8618..............  Coch implant tran cable     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      repl.
L8619..............  Replace cochlear processor  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8621..............  Repl zinc air battery.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8622..............  Repl alkaline battery.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8623..............  Lith ion batt CID,non-      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      earlvl.
L8624..............  Lith ion batt CID, ear      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      level.
L8630..............  Metacarpophalangeal         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      implant.
L8631..............  MCP joint repl 2 pc or      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      more.
L8641..............  Metatarsal joint implant..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8642..............  Hallux implant............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8658..............  Interphalangeal joint       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      spacer.
L8659..............  Interphalangeal joint repl  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8670..............  Vascular graft, synthetic.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8680..............  Implt neurostim elctr each  ..................  B.................  ...........  ...........  ...........  ...........  ...........
L8681..............  Pt prgrm for implt          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      neurostim.
L8682..............  Implt neurostim radiofq     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      rec.
L8683..............  Radiofq trsmtr for implt    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      neu.
L8684..............  Radiof trsmtr implt scrl    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      neu.
L8685..............  Implt nrostm pls gen sng    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      rec.
L8686..............  Implt nrostm pls gen sng    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      non.
L8687..............  Implt nrostm pls gen dua    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      rec.
L8688..............  Implt nrostm pls gen dua    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      non.
L8689..............  External recharg sys        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      intern.
L8690..............  Aud osseo dev, int/ext      ..................  H.................         1032  ...........  ...........  ...........  ...........
                      comp.
L8691..............  Aud osseo dev ext snd       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      proces.
L8695..............  External recharg sys        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extern.
L8699..............  Prosthetic implant NOS....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L9900..............  O&P supply/accessory/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      service.
M0064..............  Visit for drug monitoring.  CH................  Q.................         0605       1.0016       $63.79  ...........       $12.76
M0075..............  Cellular therapy..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
M0076..............  Prolotherapy..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
M0100..............  Intragastric hypothermia..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
M0300..............  IV chelationtherapy.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
M0301..............  Fabric wrapping of          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aneurysm.
P2028..............  Cephalin floculation test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
P2029..............  Congo red blood test......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
P2031..............  Hair analysis.............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
P2033..............  Blood thymol turbidity....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
P2038..............  Blood mucoprotein.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
P3000..............  Screen pap by tech w md     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      supv.
P3001..............  Screening pap smear by      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      phys.
P7001..............  Culture bacterial urine...  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 43061]]

 
P9010..............  Whole blood for             ..................  K.................         0950       4.4374      $282.63  ...........       $56.53
                      transfusion.
P9011..............  Blood split unit..........  ..................  K.................         0967       2.1237      $135.26  ...........       $27.05
P9012..............  Cryoprecipitate each unit.  ..................  K.................         0952       0.6843       $43.59  ...........        $8.72
P9016..............  RBC leukocytes reduced....  ..................  K.................         0954        2.959      $188.47  ...........       $37.69
P9017..............  Plasma 1 donor frz w/in 8   ..................  K.................         9508       1.0902       $69.44  ...........       $13.89
                      hr.
P9019..............  Platelets, each unit......  ..................  K.................         0957       1.0834       $69.00  ...........       $13.80
P9020..............  Plaelet rich plasma unit..  ..................  K.................         0958       5.3744      $342.31  ...........       $68.46
P9021..............  Red blood cells unit......  ..................  K.................         0959       2.0343      $129.57  ...........       $25.91
P9022..............  Washed red blood cells      ..................  K.................         0960       4.2092      $268.10  ...........       $53.62
                      unit.
P9023..............  Frozen plasma, pooled, sd.  ..................  K.................         0949       1.1981       $76.31  ...........       $15.26
P9031..............  Platelets leukocytes        ..................  K.................         1013       1.7207      $109.60  ...........       $21.92
                      reduced.
P9032..............  Platelets, irradiated.....  ..................  K.................         9500       2.0742      $132.11  ...........       $26.42
P9033..............  Platelets leukoreduced      ..................  K.................         0968        2.028      $129.17  ...........       $25.83
                      irrad.
P9034..............  Platelets, pheresis.......  ..................  K.................         9507       7.0406      $448.44  ...........       $89.69
P9035..............  Platelet pheres             ..................  K.................         9501       7.9954      $509.25  ...........      $101.85
                      leukoreduced.
P9036..............  Platelet pheresis           ..................  K.................         9502       7.0075      $446.33  ...........       $89.27
                      irradiated.
P9037..............  Plate pheres leukoredu      ..................  K.................         1019      10.0408      $639.53  ...........      $127.91
                      irrad.
P9038..............  RBC irradiated............  ..................  K.................         9505       3.3259      $211.84  ...........       $42.37
P9039..............  RBC deglycerolized........  ..................  K.................         9504       5.7938      $369.02  ...........       $73.80
P9040..............  RBC leukoreduced            ..................  K.................         0969       3.8191      $243.25  ...........       $48.65
                      irradiated.
P9041..............  Albumin (human),5%, 50ml..  ..................  K.................         0961       0.3757       $23.93  ...........        $4.79
P9043..............  Plasma protein              ..................  K.................         0956       1.4392       $91.67  ...........       $18.33
                      fract,5%,50ml.
P9044..............  Cryoprecipitatereducedplas  ..................  K.................         1009       1.3131       $83.64  ...........       $16.73
                      ma.
P9045..............  Albumin (human), 5%, 250    ..................  K.................         0963       1.1351       $72.30  ...........       $14.46
                      ml.
P9046..............  Albumin (human), 25%, 20    ..................  K.................         0964       0.4448       $28.33  ...........        $5.67
                      ml.
P9047..............  Albumin (human), 25%, 50ml  ..................  K.................         0965       1.1679       $74.39  ...........       $14.88
P9048..............  Plasmaprotein               ..................  K.................         0966       3.9009      $248.46  ...........       $49.69
                      fract,5%,250ml.
P9050..............  Granulocytes, pheresis      ..................  K.................         9506      15.5519      $990.55  ...........      $198.11
                      unit.
P9051..............  Blood, l/r, cmv-neg.......  ..................  K.................         1010       2.3865      $152.00  ...........       $30.40
P9052..............  Platelets, hla-m, l/r,      ..................  K.................         1011       9.6766      $616.33  ...........      $123.27
                      unit.
P9053..............  Plt, pher, l/r cmv-neg,     ..................  K.................         1020      10.7802      $686.62  ...........      $137.32
                      irr.
P9054..............  Blood, l/r, froz/degly/     ..................  K.................         1016        3.352      $213.50  ...........       $42.70
                      wash.
P9055..............  Plt, aph/pher, l/r, cmv-    ..................  K.................         1017       7.7915      $496.26  ...........       $99.25
                      neg.
P9056..............  Blood, l/r, irradiated....  ..................  K.................         1018       2.4372      $155.23  ...........       $31.05
P9057..............  RBC, frz/deg/wsh, l/r,      ..................  K.................         1021       6.4694      $412.06  ...........       $82.41
                      irrad.
P9058..............  RBC, l/r, cmv-neg, irrad..  ..................  K.................         1022       4.6286      $294.81  ...........       $58.96
P9059..............  Plasma, frz between 8-      ..................  K.................         0955       1.2456       $79.34  ...........       $15.87
                      24hour.
P9060..............  Fr frz plasma donor         ..................  K.................         9503       1.1632       $74.09  ...........       $14.82
                      retested.
P9603..............  One-way allow prorated      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      miles.
P9604..............  One-way allow prorated      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      trip.
P9612..............  Catheterize for urine spec  ..................  A.................  ...........  ...........  ...........  ...........  ...........
P9615..............  Urine specimen collect      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      mult.
Q0035..............  Cardiokymography..........  ..................  X.................         0100       2.8631      $182.36       $41.40       $36.47
Q0081..............  Infusion ther other than    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      che.
Q0083..............  Chemo by other than         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      infusion.
Q0084..............  Chemotherapy by infusion..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q0085..............  Chemo by both infusion and  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      o.
Q0091..............  Obtaining screen pap smear  ..................  T.................         0191       0.1414        $9.01        $2.50        $1.80
Q0092..............  Set up port xray equipment  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q0111..............  Wet mounts/ w preparations  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0112..............  Potassium hydroxide preps.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0113..............  Pinworm examinations......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0114..............  Fern test.................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0115..............  Post-coital mucous exam...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0144..............  Azithromycin dihydrate,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      oral.
Q0163..............  Diphenhydramine HCl 50mg..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q0164..............  Prochlorperazine maleate    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      5mg.
Q0165..............  Prochlorperazine            ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      maleate10mg.
Q0166..............  Granisetron HCl 1 mg oral.  ..................  K.................         0765  ...........       $44.44  ...........        $8.89
Q0167..............  Dronabinol 2.5mg oral.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q0168..............  Dronabinol 5mg oral.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q0169..............  Promethazine HCl 12.5mg     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      oral.
Q0170..............  Promethazine HCl 25 mg      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      oral.
Q0171..............  Chlorpromazine HCl 10mg     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      oral.
Q0172..............  Chlorpromazine HCl 25mg     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      oral.
Q0173..............  Trimethobenzamide HCl       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      250mg.
Q0174..............  Thiethylperazine            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      maleate10mg.
Q0175..............  Perphenazine 4mg oral.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q0176..............  Perphenazine 8mg oral.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q0177..............  Hydroxyzine pamoate 25mg..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q0178..............  Hydroxyzine pamoate 50mg..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q0179..............  Ondansetron HCl 8mg oral..  ..................  K.................         0769  ...........       $36.21  ...........        $7.24
Q0180..............  Dolasetron mesylate oral..  ..................  K.................         0763  ...........       $47.07  ...........        $9.41
Q0181..............  Unspecified oral anti-      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      emetic.
Q0480..............  Driver pneumatic vad, rep.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0481..............  Microprcsr cu elec vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0482..............  Microprcsr cu combo vad,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0483..............  Monitor elec vad, rep.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 43062]]

 
Q0484..............  Monitor elec or comb vad    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0485..............  Monitor cable elec vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0486..............  Mon cable elec/pneum vad    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0487..............  Leads any type vad, rep     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      only.
Q0488..............  Pwr pack base elec vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0489..............  Pwr pck base combo vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0490..............  Emr pwr source elec vad,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0491..............  Emr pwr source combo vad    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0492..............  Emr pwr cbl elec vad, rep.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0493..............  Emr pwr cbl combo vad, rep  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0494..............  Emr hd pmp elec/combo, rep  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0495..............  Charger elec/combo vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0496..............  Battery elec/combo vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0497..............  Bat clps elec/comb vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0498..............  Holster elec/combo vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0499..............  Belt/vest elec/combo vad    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0500..............  Filters elec/combo vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0501..............  Shwr cov elec/combo vad,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0502..............  Mobility cart pneum vad,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0503..............  Battery pneum vad           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      replacemnt.
Q0504..............  Pwr adpt pneum vad, rep     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      veh.
Q0505..............  Miscl supply/accessory vad  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0510..............  Dispens fee                 ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      immunosupressive.
Q0511..............  Sup fee                     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      antiem,antica,immuno.
Q0512..............  Px sup fee anti-can sub     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pres.
Q0513..............  Disp fee inhal drugs/30     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      days.
Q0514..............  Disp fee inhal drugs/90     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      days.
Q0515..............  Sermorelin acetate          ..................  K.................         3050  ...........        $1.74  ...........        $0.35
                      injection.
Q1003..............  NTIOL category 3..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q1004..............  Ntiol category 4..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q1005..............  Ntiol category 5..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q2004..............  Bladder calculi irrig sol.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q2009..............  Fosphenytoin, 50 mg.......  ..................  K.................         7028  ...........        $5.50  ...........        $1.10
Q2017..............  Teniposide, 50 mg.........  ..................  K.................         7035  ...........      $261.93  ...........       $52.39
Q3001..............  Brachytherapy               ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      Radioelements.
Q3014..............  Telehealth facility fee...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q3025..............  IM inj interferon beta 1-a  ..................  K.................         9022  ...........      $113.49  ...........       $22.70
Q3026..............  Subc inj interferon beta-   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      1a.
Q3031..............  Collagen skin test........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q4001..............  Cast sup body cast plaster  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4002..............  Cast sup body cast          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fiberglas.
Q4003..............  Cast sup shoulder cast      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plstr.
Q4004..............  Cast sup shoulder cast      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgl.
Q4005..............  Cast sup long arm adult     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plst.
Q4006..............  Cast sup long arm adult     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrg.
Q4007..............  Cast sup long arm ped       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plster.
Q4008..............  Cast sup long arm ped       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgls.
Q4009..............  Cast sup sht arm adult      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plstr.
Q4010..............  Cast sup sht arm adult      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgl.
Q4011..............  Cast sup sht arm ped        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plaster.
Q4012..............  Cast sup sht arm ped        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrglas.
Q4013..............  Cast sup gauntlet plaster.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4014..............  Cast sup gauntlet           ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fiberglass.
Q4015..............  Cast sup gauntlet ped       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plster.
Q4016..............  Cast sup gauntlet ped       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgls.
Q4017..............  Cast sup lng arm splint     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plst.
Q4018..............  Cast sup lng arm splint     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrg.
Q4019..............  Cast sup lng arm splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      p.
Q4020..............  Cast sup lng arm splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      f.
Q4021..............  Cast sup sht arm splint     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plst.
Q4022..............  Cast sup sht arm splint     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrg.
Q4023..............  Cast sup sht arm splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      p.
Q4024..............  Cast sup sht arm splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      f.
Q4025..............  Cast sup hip spica plaster  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4026..............  Cast sup hip spica          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fiberglas.
Q4027..............  Cast sup hip spica ped      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plstr.
Q4028..............  Cast sup hip spica ped      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgl.
Q4029..............  Cast sup long leg plaster.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4030..............  Cast sup long leg           ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fiberglass.
Q4031..............  Cast sup lng leg ped        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plaster.
Q4032..............  Cast sup lng leg ped        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgls.
Q4033..............  Cast sup lng leg cylinder   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pl.
Q4034..............  Cast sup lng leg cylinder   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fb.
Q4035..............  Cast sup lngleg cylndr ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      p.
Q4036..............  Cast sup lngleg cylndr ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      f.
Q4037..............  Cast sup shrt leg plaster.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4038..............  Cast sup shrt leg           ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fiberglass.
Q4039..............  Cast sup shrt leg ped       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plster.

[[Page 43063]]

 
Q4040..............  Cast sup shrt leg ped       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgls.
Q4041..............  Cast sup lng leg splnt      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plstr.
Q4042..............  Cast sup lng leg splnt      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgl.
Q4043..............  Cast sup lng leg splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      p.
Q4044..............  Cast sup lng leg splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      f.
Q4045..............  Cast sup sht leg splnt      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plstr.
Q4046..............  Cast sup sht leg splnt      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgl.
Q4047..............  Cast sup sht leg splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      p.
Q4048..............  Cast sup sht leg splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      f.
Q4049..............  Finger splint, static.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4050..............  Cast supplies unlisted....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4051..............  Splint supplies misc......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4079..............  Natalizumab injection.....  CH................  K.................         9126  ...........        $7.45  ...........        $1.49
Q4080..............  Iloprost inhalation         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      solution.
Q4081..............  Epoetin alfa, 100 units     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ESRD.
Q4082..............  Drug/bio NOC part B drug    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      CAP.
Q4083..............  Hyalgan/supartz inj per     ..................  K.................         0873  ...........      $103.86  ...........       $20.77
                      dose.
Q4084..............  Synvisc inj per dose......  ..................  K.................         0874  ...........      $184.89  ...........       $36.98
Q4085..............  Euflexxa inj per dose.....  ..................  K.................         0875  ...........      $115.19  ...........       $23.04
Q4086..............  Orthovisc inj per dose....  ..................  K.................         0877  ...........      $196.47  ...........       $39.29
Q5001..............  Hospice in patient home...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q5002..............  Hospice in assisted living  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q5003..............  Hospice in LT/non-skilled   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      NF.
Q5004..............  Hospice in SNF............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q5005..............  Hospice, inpatient          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      hospital.
Q5006..............  Hospice in hospice          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      facility.
Q5007..............  Hospice in LTCH...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q5008..............  Hospice in inpatient psych  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q5009..............  Hospice care, NOS.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q9945..............  LOCM [lE]149 mg/ml iodine,  CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      1ml.
Q9946..............  LOCM 150-199mg/ml           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9947..............  LOCM 200-249mg/ml           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9948..............  LOCM 250-299mg/ml           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9949..............  LOCM 300-349mg/ml           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9950..............  LOCM 350-399mg/ml           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9951..............  LOCM [gE] 400 mg/ml         CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9952..............  Inj Gad-base MR             CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      contrast,1ml.
Q9953..............  Inj Fe-based MR             CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      contrast,1ml.
Q9954..............  Oral MR contrast, 100 ml..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
Q9955..............  Inj perflexane lip          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      micros,ml.
Q9956..............  Inj octafluoropropane       CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      mic,ml.
Q9957..............  Inj perflutren lip          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      micros,ml.
Q9958..............  HOCM [lE]149 mg/ml iodine,  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      1ml.
Q9959..............  HOCM 150-199mg/ml           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9960..............  HOCM 200-249mg/ml           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9961..............  HOCM 250-299mg/ml           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9962..............  HOCM 300-349mg/ml           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9963..............  HOCM 350-399mg/ml           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9964..............  HOCM[gE] 400mg/ml iodine,   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      1ml.
R0070..............  Transport portable x-ray..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
R0075..............  Transport port x-ray        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      multipl.
R0076..............  Transport portable EKG....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
V2020..............  Vision svcs frames          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      purchases.
V2025..............  Eyeglasses delux frames...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V2100..............  Lens spher single plano     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.00.
V2101..............  Single visn sphere 4.12-    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      7.00.
V2102..............  Singl visn sphere 7.12-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      20.00.
V2103..............  Spherocylindr 4.00d/12-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.00d.
V2104..............  Spherocylindr 4.00d/2.12-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4d.
V2105..............  Spherocylinder 4.00d/4.25-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      6d.
V2106..............  Spherocylinder 4.00d/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      >6.00d.
V2107..............  Spherocylinder 4.25d/12-2d  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2108..............  Spherocylinder 4.25d/2.12-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4d.
V2109..............  Spherocylinder 4.25d/4.25-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      6d.
V2110..............  Spherocylinder 4.25d/over   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      6d.
V2111..............  Spherocylindr 7.25d/.25-    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.25.
V2112..............  Spherocylindr 7.25d/2.25-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4d.
V2113..............  Spherocylindr 7.25d/4.25-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      6d.
V2114..............  Spherocylinder over 12.00d  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2115..............  Lens lenticular bifocal...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2118..............  Lens aniseikonic single...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2121..............  Lenticular lens, single...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2199..............  Lens single vision not oth  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
V2200..............  Lens spher bifoc plano      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.00d.
V2201..............  Lens sphere bifocal 4.12-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      7.0.
V2202..............  Lens sphere bifocal 7.12-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      20..
V2203..............  Lens sphcyl bifocal 4.00d/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      .1.
V2204..............  Lens sphcy bifocal 4.00d/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.1.

[[Page 43064]]

 
V2205..............  Lens sphcy bifocal 4.00d/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.2.
V2206..............  Lens sphcy bifocal 4.00d/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ove.
V2207..............  Lens sphcy bifocal 4.25-7d/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ..
V2208..............  Lens sphcy bifocal 4.25-7/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2..
V2209..............  Lens sphcy bifocal 4.25-7/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4..
V2210..............  Lens sphcy bifocal 4.25-7/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ov.
V2211..............  Lens sphcy bifo 7.25-12/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      .25-.
V2212..............  Lens sphcyl bifo 7.25-12/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.2.
V2213..............  Lens sphcyl bifo 7.25-12/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.2.
V2214..............  Lens sphcyl bifocal over    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      12..
V2215..............  Lens lenticular bifocal...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2218..............  Lens aniseikonic bifocal..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2219..............  Lens bifocal seg width      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      over.
V2220..............  Lens bifocal add over       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      3.25d.
V2221..............  Lenticular lens, bifocal..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2299..............  Lens bifocal speciality...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2300..............  Lens sphere trifocal 4.00d  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2301..............  Lens sphere trifocal 4.12-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      7..
V2302..............  Lens sphere trifocal 7.12-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      20.
V2303..............  Lens sphcy trifocal 4.0/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      .12-.
V2304..............  Lens sphcy trifocal 4.0/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.25.
V2305..............  Lens sphcy trifocal 4.0/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.25.
V2306..............  Lens sphcyl trifocal 4.00/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      >6.
V2307..............  Lens sphcy trifocal 4.25-7/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ..
V2308..............  Lens sphc trifocal 4.25-7/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2..
V2309..............  Lens sphc trifocal 4.25-7/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4..
V2310..............  Lens sphc trifocal 4.25-7/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      >6.
V2311..............  Lens sphc trifo 7.25-12/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      .25-.
V2312..............  Lens sphc trifo 7.25-12/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.25.
V2313..............  Lens sphc trifo 7.25-12/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.25.
V2314..............  Lens sphcyl trifocal over   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      12.
V2315..............  Lens lenticular trifocal..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2318..............  Lens aniseikonic trifocal.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2319..............  Lens trifocal seg width >   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      28.
V2320..............  Lens trifocal add over      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      3.25d.
V2321..............  Lenticular lens, trifocal.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2399..............  Lens trifocal speciality..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2410..............  Lens variab asphericity     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sing.
V2430..............  Lens variable asphericity   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bi.
V2499..............  Variable asphericity lens.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2500..............  Contact lens pmma           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      spherical.
V2501..............  Cntct lens pmma-toric/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prism.
V2502..............  Contact lens pmma bifocal.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2503..............  Cntct lens pmma color       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      vision.
V2510..............  Cntct gas permeable         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sphericl.
V2511..............  Cntct toric prism ballast.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2512..............  Cntct lens gas permbl       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bifocl.
V2513..............  Contact lens extended wear  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2520..............  Contact lens hydrophilic..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2521..............  Cntct lens hydrophilic      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      toric.
V2522..............  Cntct lens hydrophil        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bifocl.
V2523..............  Cntct lens hydrophil        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extend.
V2530..............  Contact lens gas            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      impermeable.
V2531..............  Contact lens gas permeable  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2599..............  Contact lens/es other type  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2600..............  Hand held low vision aids.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2610..............  Single lens spectacle       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mount.
V2615..............  Telescop/othr compound      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lens.
V2623..............  Plastic eye prosth custom.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2624..............  Polishing artifical eye...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2625..............  Enlargemnt of eye           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosthesis.
V2626..............  Reduction of eye            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosthesis.
V2627..............  Scleral cover shell.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2628..............  Fabrication & fitting.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2629..............  Prosthetic eye other type.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2630..............  Anter chamber intraocul     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      lens.
V2631..............  Iris support intraoclr      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      lens.
V2632..............  Post chmbr intraocular      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      lens.
V2700..............  Balance lens..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2702..............  Deluxe lens feature.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V2710..............  Glass/plastic slab off      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prism.
V2715..............  Prism lens/es.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2718..............  Fresnell prism press-on     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lens.
V2730..............  Special base curve........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2744..............  Tint photochromatic lens/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      es.
V2745..............  Tint, any color/solid/grad  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2750..............  Anti-reflective coating...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2755..............  UV lens/es................  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 43065]]

 
V2756..............  Eye glass case............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V2760..............  Scratch resistant coating.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2761..............  Mirror coating............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
V2762..............  Polarization, any lens....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2770..............  Occluder lens/es..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2780..............  Oversize lens/es..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2781..............  Progressive lens per lens.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
V2782..............  Lens, 1.54-1.65 p/1.60-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      1.79g.
V2783..............  Lens, [gE] 1.66 p/[gE]1.80  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      g.
V2784..............  Lens polycarb or equal....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2785..............  Corneal tissue processing.  ..................  F.................  ...........  ...........  ...........  ...........  ...........
V2786..............  Occupational multifocal     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lens.
V2788..............  Presbyopia-correct          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      function.
V2790..............  Amniotic membrane.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
V2797..............  Vis item/svc in other code  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2799..............  Miscellaneous vision        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      service.
V5008..............  Hearing screening.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5010..............  Assessment for hearing aid  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5011..............  Hearing aid fitting/        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      checking.
V5014..............  Hearing aid repair/         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      modifying.
V5020..............  Conformity evaluation.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5030..............  Body-worn hearing aid air.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5040..............  Body-worn hearing aid bone  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5050..............  Hearing aid monaural in     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ear.
V5060..............  Behind ear hearing aid....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5070..............  Glasses air conduction....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5080..............  Glasses bone conduction...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5090..............  Hearing aid dispensing fee  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5095..............  Implant mid ear hearing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pros.
V5100..............  Body-worn bilat hearing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
V5110..............  Hearing aid dispensing fee  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5120..............  Body-worn binaur hearing    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
V5130..............  In ear binaural hearing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
V5140..............  Behind ear binaur hearing   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ai.
V5150..............  Glasses binaural hearing    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
V5160..............  Dispensing fee binaural...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5170..............  Within ear cros hearing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
V5180..............  Behind ear cros hearing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
V5190..............  Glasses cros hearing aid..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5200..............  Cros hearing aid dispens    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fee.
V5210..............  In ear bicros hearing aid.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5220..............  Behind ear bicros hearing   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ai.
V5230..............  Glasses bicros hearing aid  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5240..............  Dispensing fee bicros.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5241..............  Dispensing fee, monaural..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5242..............  Hearing aid, monaural, cic  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5243..............  Hearing aid, monaural, itc  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5244..............  Hearing aid, prog, mon,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cic.
V5245..............  Hearing aid, prog, mon,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      itc.
V5246..............  Hearing aid, prog, mon,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ite.
V5247..............  Hearing aid, prog, mon,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bte.
V5248..............  Hearing aid, binaural, cic  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5249..............  Hearing aid, binaural, itc  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5250..............  Hearing aid, prog, bin,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cic.
V5251..............  Hearing aid, prog, bin,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      itc.
V5252..............  Hearing aid, prog, bin,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ite.
V5253..............  Hearing aid, prog, bin,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bte.
V5254..............  Hearing id, digit, mon,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cic.
V5255..............  Hearing aid, digit, mon,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      itc.
V5256..............  Hearing aid, digit, mon,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ite.
V5257..............  Hearing aid, digit, mon,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bte.
V5258..............  Hearing aid, digit, bin,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cic.
V5259..............  Hearing aid, digit, bin,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      itc.
V5260..............  Hearing aid, digit, bin,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ite.
V5261..............  Hearing aid, digit, bin,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bte.
V5262..............  Hearing aid, disp,          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      monaural.
V5263..............  Hearing aid, disp,          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      binaural.
V5264..............  Ear mold/insert...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5265..............  Ear mold/insert, disp.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5266..............  Battery for hearing device  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5267..............  Hearing aid supply/         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      accessory.
V5268..............  ALD Telephone Amplifier...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5269..............  Alerting device, any type.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5270..............  ALD, TV amplifier, any      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      type.
V5271..............  ALD, TV caption decoder...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5272..............  Tdd.......................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5273..............  ALD for cochlear implant..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5274..............  ALD unspecified...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 43066]]

 
V5275..............  Ear impression............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5298..............  Hearing aid noc...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5299..............  Hearing service...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
V5336..............  Repair communication        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      device.
V5362..............  Speech screening..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5363..............  Language screening........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5364..............  Dysphagia screening.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 43067]]


    Addendum BB.--Proposed ASC Covered Ancillary Services Integral to Covered Surgical Procedures for CY 2008
                          (Including Ancillary Services for Which Payment is Packaged)
----------------------------------------------------------------------------------------------------------------
                                                                                        Proposed CY
                                                          Comment          Payment          2008     Proposed CY
           HCPCS code             Short descriptor       indicator        indicator       payment        2008
                                                                                           weight      payment
----------------------------------------------------------------------------------------------------------------
0028T..........................  Dexa body           ................  N1.............  ...........  ...........
                                  composition study.
0042T..........................  Ct perfusion w/     ................  N1.............  ...........  ...........
                                  contrast, cbf.
054T...........................  Bone surgery using  CH..............  N1.............  ...........  ...........
                                  computer.
0055T..........................  Bone surgery using  CH..............  N1.............  ...........  ...........
                                  computer.
0056T..........................  Bone surgery using  CH..............  N1.............  ...........  ...........
                                  computer.
0067T..........................  Ct colonography;dx  ................  Z2.............       3.1487      $130.36
0071T..........................  U/s leiomyomata     ................  Z2.............      61.5205    $2,546.95
                                  ablate <200.
0072T..........................  U/s leiomyomata     ................  Z2.............      61.5205    $2,546.95
                                  ablate >200.
0073T..........................  Delivery, comp      ................  Z2.............       5.7275      $237.12
                                  imrt.
0126T..........................  Chd risk imt study  ................  N1.............  ...........  ...........
0144T..........................  CT heart wo dye;    ................  Z2.............       1.6768       $69.42
                                  qual calc.
0145T..........................  CT heart w/wo dye   ................  Z2.............       4.9887      $206.53
                                  funct.
0146T..........................  CCTA w/wo dye.....  ................  Z2.............       4.9887      $206.53
0147T..........................  CCTA w/wo, quan     ................  Z2.............       4.9887      $206.53
                                  calcium.
0148T..........................  CCTA w/wo, strxr..  ................  Z2.............       4.9887      $206.53
0149T..........................  CCTA w/wo, strxr    ................  Z2.............       4.9887      $206.53
                                  quan calc.
0150T..........................  CCTA w/wo, disease  ................  Z2.............       4.9887      $206.53
                                  strxr.
0151T..........................  CT heart funct add- ................  Z2.............       1.6768       $69.42
                                  on.
0159T..........................  Cad breast mri....  ................  N1.............  ...........  ...........
0174T..........................  Cad cxr with        ................  N1.............  ...........  ...........
                                  interp.
0175T..........................  Cad cxr remote....  ................  N1.............  ...........  ...........
70010..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  brain.
70015..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  brain.
70030..........................  X-ray eye for       ................  Z3.............       0.3957       $16.38
                                  foreign body.
70100..........................  X-ray exam of jaw.  ................  Z3.............       0.4534       $18.77
70110..........................  X-ray exam of jaw.  ................  Z3.............       0.5442       $22.53
70120..........................  X-ray exam of       ................  Z3.............       0.5111       $21.16
                                  mastoids.
70130..........................  X-ray exam of       ................  Z2.............       0.7259       $30.05
                                  mastoids.
70134..........................  X-ray exam of       ................  Z3.............       0.6266       $25.94
                                  middle ear.
70140..........................  X-ray exam of       ................  Z3.............       0.4534       $18.77
                                  facial bones.
70150..........................  X-ray exam of       ................  Z3.............       0.6348       $26.28
                                  facial bones.
70160..........................  X-ray exam of       ................  Z3.............       0.4700       $19.46
                                  nasal bones.
70170..........................  X-ray exam of tear  CH..............  N1.............  ...........  ...........
                                  duct.
70190..........................  X-ray exam of eye   ................  Z3.............       0.5196       $21.51
                                  sockets.
70200..........................  X-ray exam of eye   ................  Z3.............       0.6348       $26.28
                                  sockets.
70210..........................  X-ray exam of       ................  Z3.............       0.4700       $19.46
                                  sinuses.
70220..........................  X-ray exam of       ................  Z3.............       0.5855       $24.24
                                  sinuses.
70240..........................  X-ray exam,         ................  Z3.............       0.3957       $16.38
                                  pituitary saddle.
70250..........................  X-ray exam of       ................  Z3.............       0.5111       $21.16
                                  skull.
70260..........................  X-ray exam of       ................  Z3.............       0.6761       $27.99
                                  skull.
70300..........................  X-ray exam of       ................  Z3.............       0.1978        $8.19
                                  teeth.
70310..........................  X-ray exam of       ................  Z3.............       0.4865       $20.14
                                  teeth.
70320..........................  Full mouth x-ray    ................  Z2.............       0.5739       $23.76
                                  of teeth.
70328..........................  X-ray exam of jaw   ................  Z3.............       0.4287       $17.75
                                  joint.
70330..........................  X-ray exam of jaw   ................  Z3.............       0.7174       $29.70
                                  joints.
70332..........................  X-ray exam of jaw   CH..............  N1.............  ...........  ...........
                                  joint.
70336..........................  Magnetic image,     ................  Z2.............       5.0067      $207.28
                                  jaw joint.
70350..........................  X-ray head for      ................  Z3.............       0.2638       $10.92
                                  orthodontia.
70355..........................  Panoramic x-ray of  ................  Z3.............       0.3297       $13.65
                                  jaws.
70360..........................  X-ray exam of neck  ................  Z3.............       0.3792       $15.70
70370..........................  Throat x-ray &      ................  Z3.............       1.1708       $48.47
                                  fluoroscopy.
70371..........................  Speech evaluation,  ................  Z2.............       1.3270       $54.94
                                  complex.
70373..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  larynx.
70380..........................  X-ray exam of       ................  Z3.............       0.5855       $24.24
                                  salivary gland.
70390..........................  X-ray exam of       CH..............  N1.............  ...........  ...........
                                  salivary duct.
70450..........................  Ct head/brain w/o   ................  Z2.............       3.1487      $130.36
                                  dye.
70460..........................  Ct head/brain w/    ................  Z2.............       4.5485      $188.31
                                  dye.
70470..........................  Ct head/brain w/o   ................  Z2.............       5.3374      $220.97
                                  & w/dye.
70480..........................  Ct orbit/ear/fossa  ................  Z2.............       3.1487      $130.36
                                  w/o dye.
70481..........................  Ct orbit/ear/fossa  ................  Z2.............       4.5485      $188.31
                                  w/dye.
70482..........................  Ct orbit/ear/fossa  ................  Z2.............       5.3374      $220.97
                                  w/o&w/dye.
70486..........................  Ct maxillofacial w/ ................  Z2.............       3.1487      $130.36
                                  o dye.
70487..........................  Ct maxillofacial w/ ................  Z2.............       4.5485      $188.31
                                  dye.
70488..........................  Ct maxillofacial w/ ................  Z2.............       5.3374      $220.97
                                  o & w/dye.
70490..........................  Ct soft tissue      ................  Z2.............       3.1487      $130.36
                                  neck w/o dye.
70491..........................  Ct soft tissue      ................  Z2.............       4.5485      $188.31
                                  neck w/dye.
70492..........................  Ct sft tsue nck w/  ................  Z2.............       5.3374      $220.97
                                  o & w/dye.
70496..........................  Ct angiography,     ................  Z2.............       5.2818      $218.67
                                  head.

[[Page 43068]]

 
70498..........................  Ct angiography,     ................  Z2.............       5.2818      $218.67
                                  neck.
70540..........................  Mri orbit/face/     ................  Z2.............       5.7101      $236.40
                                  neck w/o dye.
70542..........................  Mri orbit/face/     ................  Z2.............       6.7963      $281.37
                                  neck w/dye.
70543..........................  Mri orbt/fac/nck w/ ................  Z2.............       8.6689      $358.89
                                  o & w/dye.
70544..........................  Mr angiography      ................  Z2.............       5.7101      $236.40
                                  head w/o dye.
70545..........................  Mr angiography      ................  Z2.............       6.7963      $281.37
                                  head w/dye.
70546..........................  Mr angiograph head  ................  Z2.............       8.6689      $358.89
                                  w/o&w/dye.
70547..........................  Mr angiography      ................  Z2.............       5.7101      $236.40
                                  neck w/o dye.
70548..........................  Mr angiography      ................  Z2.............       6.7963      $281.37
                                  neck w/dye.
70549..........................  Mr angiograph neck  ................  Z2.............       8.6689      $358.89
                                  w/o&w/dye.
70551..........................  Mri brain w/o dye.  ................  Z2.............       5.7101      $236.40
70552..........................  Mri brain w/dye...  ................  Z2.............       6.7963      $281.37
70553..........................  Mri brain w/o & w/  ................  Z2.............       8.6689      $358.89
                                  dye.
70554..........................  Fmri brain by tech  ................  Z2.............       5.7101      $236.40
70555..........................  Fmri brain by phys/ ................  Z2.............       5.7101      $236.40
                                  psych.
70557..........................  Mri brain w/o dye.  ................  Z2.............       5.7101      $236.40
70558..........................  Mri brain w/dye...  ................  Z2.............       6.7963      $281.37
70559..........................  Mri brain w/o & w/  ................  Z2.............       8.6689      $358.89
                                  dye.
71010..........................  Chest x-ray.......  ................  Z3.............       0.3464       $14.34
71015..........................  Chest x-ray.......  ................  Z3.............       0.4205       $17.41
71020..........................  Chest x-ray.......  ................  Z3.............       0.4618       $19.12
71021..........................  Chest x-ray.......  ................  Z3.............       0.5524       $22.87
71022..........................  Chest x-ray.......  ................  Z3.............       0.6266       $25.94
71023..........................  Chest x-ray and     ................  Z3.............       0.8906       $36.87
                                  fluoroscopy.
71030..........................  Chest x-ray.......  ................  Z3.............       0.6514       $26.97
71034..........................  Chest x-ray and     ................  Z2.............       1.3270       $54.94
                                  fluoroscopy.
71035..........................  Chest x-ray.......  ................  Z3.............       0.5029       $20.82
71040..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  bronchi.
71060..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  bronchi.
71090..........................  X-ray & pacemaker   CH..............  N1.............  ...........  ...........
                                  insertion.
71100..........................  X-ray exam of ribs  ................  Z3.............       0.4534       $18.77
71101..........................  X-ray exam of ribs/ ................  Z3.............       0.5442       $22.53
                                  chest.
71110..........................  X-ray exam of ribs  ................  Z3.............       0.6019       $24.92
71111..........................  X-ray exam of ribs/ ................  Z3.............       0.7585       $31.40
                                  chest.
71120..........................  X-ray exam of       ................  Z3.............       0.4947       $20.48
                                  breastbone.
71130..........................  X-ray exam of       ................  Z3.............       0.5688       $23.55
                                  breastbone.
71250..........................  Ct thorax w/o dye.  ................  Z2.............       3.1487      $130.36
71260..........................  Ct thorax w/dye...  ................  Z2.............       4.5485      $188.31
71270..........................  Ct thorax w/o & w/  ................  Z2.............       5.3374      $220.97
                                  dye.
71275..........................  Ct angiography,     ................  Z2.............       5.2818      $218.67
                                  chest.
71550..........................  Mri chest w/o dye.  ................  Z2.............       5.7101      $236.40
71551..........................  Mri chest w/dye...  ................  Z2.............       6.7963      $281.37
71552..........................  Mri chest w/o & w/  ................  Z2.............       8.6689      $358.89
                                  dye.
72010..........................  X-ray exam of       ................  Z2.............       0.7259       $30.05
                                  spine.
72020..........................  X-ray exam of       ................  Z3.............       0.3382       $14.00
                                  spine.
72040..........................  X-ray exam of neck  ................  Z3.............       0.5278       $21.85
                                  spine.
72050..........................  X-ray exam of neck  ................  Z3.............       0.7585       $31.40
                                  spine.
72052..........................  X-ray exam of neck  ................  Z3.............       0.9812       $40.62
                                  spine.
72069..........................  X-ray exam of       ................  Z3.............       0.4783       $19.80
                                  trunk spine.
72070..........................  X-ray exam of       ................  Z3.............       0.4947       $20.48
                                  thoracic spine.
72072..........................  X-ray exam of       ................  Z3.............       0.5771       $23.89
                                  thoracic spine.
72074..........................  X-ray exam of       ................  Z3.............       0.7256       $30.04
                                  thoracic spine.
72080..........................  X-ray exam of       ................  Z3.............       0.5278       $21.85
                                  trunk spine.
72090..........................  X-ray exam of       ................  Z3.............       0.6432       $26.63
                                  trunk spine.
72100..........................  X-ray exam of       ................  Z3.............       0.5771       $23.89
                                  lower spine.
72110..........................  X-ray exam of       ................  Z3.............       0.7915       $32.77
                                  lower spine.
72114..........................  X-ray exam of       ................  Z3.............       1.0720       $44.38
                                  lower spine.
72120..........................  X-ray exam of       ................  Z3.............       0.7751       $32.09
                                  lower spine.
72125..........................  Ct neck spine w/o   ................  Z2.............       3.1487      $130.36
                                  dye.
72126..........................  Ct neck spine w/    CH..............  Z3.............       5.9614      $246.80
                                  dye.
72127..........................  Ct neck spine w/o   ................  Z2.............       5.3374      $220.97
                                  & w/dye.
72128..........................  Ct chest spine w/o  ................  Z2.............       3.1487      $130.36
                                  dye.
72129..........................  Ct chest spine w/   ................  Z2.............       4.5485      $188.31
                                  dye.
72130..........................  Ct chest spine w/o  ................  Z2.............       5.3374      $220.97
                                  & w/dye.
72131..........................  Ct lumbar spine w/  ................  Z2.............       3.1487      $130.36
                                  o dye.
72132..........................  Ct lumbar spine w/  CH..............  Z3.............       5.9529      $246.45
                                  dye.
72133..........................  Ct lumbar spine w/  ................  Z2.............       5.3374      $220.97
                                  o & w/dye.
72141..........................  Mri neck spine w/o  ................  Z2.............       5.7101      $236.40
                                  dye.

[[Page 43069]]

 
72142..........................  Mri neck spine w/   ................  Z2.............       6.7963      $281.37
                                  dye.
72146..........................  Mri chest spine w/  ................  Z2.............       5.7101      $236.40
                                  o dye.
72147..........................  Mri chest spine w/  ................  Z2.............       6.7963      $281.37
                                  dye.
72148..........................  Mri lumbar spine w/ ................  Z2.............       5.7101      $236.40
                                  o dye.
72149..........................  Mri lumbar spine w/ ................  Z2.............       6.7963      $281.37
                                  dye.
72156..........................  Mri neck spine w/o  ................  Z2.............       8.6689      $358.89
                                  & w/dye.
72157..........................  Mri chest spine w/  ................  Z2.............       8.6689      $358.89
                                  o & w/dye.
72158..........................  Mri lumbar spine w/ ................  Z2.............       8.6689      $358.89
                                  o & w/dye.
72170..........................  X-ray exam of       ................  Z3.............       0.3957       $16.38
                                  pelvis.
72190..........................  X-ray exam of       ................  Z3.............       0.5937       $24.58
                                  pelvis.
72191..........................  Ct angiograph pelv  ................  Z2.............       5.2818      $218.67
                                  w/o&w/dye.
72192..........................  Ct pelvis w/o dye.  ................  Z2.............       3.1487      $130.36
72193..........................  Ct pelvis w/dye...  ................  Z2.............       4.5485      $188.31
72194..........................  Ct pelvis w/o & w/  ................  Z2.............       5.3374      $220.97
                                  dye.
72195..........................  Mri pelvis w/o dye  ................  Z2.............       5.7101      $236.40
72196..........................  Mri pelvis w/dye..  ................  Z2.............       6.7963      $281.37
72197..........................  Mri pelvis w/o & w/ ................  Z2.............       8.6689      $358.89
                                  dye.
72200..........................  X-ray exam          ................  Z3.............       0.4370       $18.09
                                  sacroiliac joints.
72202..........................  X-ray exam          ................  Z3.............       0.5278       $21.85
                                  sacroiliac joints.
72220..........................  X-ray exam of       ................  Z3.............       0.4452       $18.43
                                  tailbone.
72240..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  neck spine.
72255..........................  Contrast x-ray,     CH..............  N1.............  ...........  ...........
                                  thorax spine.
72265..........................  Contrast x-ray,     CH..............  N1.............  ...........  ...........
                                  lower spine.
72270..........................  Contrast x-ray,     CH..............  N1.............  ...........  ...........
                                  spine.
72275..........................  Epidurography.....  CH..............  N1.............  ...........  ...........
72285..........................  X-ray c/t spine     CH..............  N1.............  ...........  ...........
                                  disk.
72291..........................  Perq                CH..............  N1.............  ...........  ...........
                                  vertebroplasty,
                                  fluor.
72292..........................  Perq                CH..............  N1.............  ...........  ...........
                                  vertebroplasty,
                                  ct.
72295..........................  X-ray of lower      CH..............  N1.............  ...........  ...........
                                  spine disk.
73000..........................  X-ray exam of       ................  Z3.............       0.4205       $17.41
                                  collar bone.
73010..........................  X-ray exam of       ................  Z3.............       0.4287       $17.75
                                  shoulder blade.
73020..........................  X-ray exam of       ................  Z3.............       0.3546       $14.68
                                  shoulder.
73030..........................  X-ray exam of       ................  Z3.............       0.4370       $18.09
                                  shoulder.
73040..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  shoulder.
73050..........................  X-ray exam of       ................  Z3.............       0.5442       $22.53
                                  shoulders.
73060..........................  X-ray exam of       ................  Z3.............       0.4452       $18.43
                                  humerus.
73070..........................  X-ray exam of       ................  Z3.............       0.4205       $17.41
                                  elbow.
73080..........................  X-ray exam of       ................  Z3.............       0.5196       $21.51
                                  elbow.
73085..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  elbow.
73090..........................  X-ray exam of       ................  Z3.............       0.4205       $17.41
                                  forearm.
73092..........................  X-ray exam of arm,  ................  Z3.............       0.4205       $17.41
                                  infant.
73100..........................  X-ray exam of       ................  Z3.............       0.4205       $17.41
                                  wrist.
73110..........................  X-ray exam of       ................  Z3.............       0.5111       $21.16
                                  wrist.
73115..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  wrist.
73120..........................  X-ray exam of hand  ................  Z3.............       0.4041       $16.73
73130..........................  X-ray exam of hand  ................  Z3.............       0.4618       $19.12
73140..........................  X-ray exam of       ................  Z3.............       0.4287       $17.75
                                  finger(s).
73200..........................  Ct upper extremity  ................  Z2.............       3.1487      $130.36
                                  w/o dye.
73201..........................  Ct upper extremity  ................  Z2.............       4.5485      $188.31
                                  w/dye.
73202..........................  Ct uppr extremity   ................  Z2.............       5.3374      $220.97
                                  w/o&w/dye.
73206..........................  Ct angio upr extrm  ................  Z2.............       5.2818      $218.67
                                  w/o&w/dye.
73218..........................  Mri upper           ................  Z2.............       5.7101      $236.40
                                  extremity w/o dye.
73219..........................  Mri upper           ................  Z2.............       6.7963      $281.37
                                  extremity w/dye.
73220..........................  Mri uppr extremity  ................  Z2.............       8.6689      $358.89
                                  w/o&w/dye.
73221..........................  Mri joint upr       ................  Z2.............       5.7101      $236.40
                                  extrem w/o dye.
73222..........................  Mri joint upr       ................  Z2.............       6.7963      $281.37
                                  extrem w/dye.
73223..........................  Mri joint upr extr  ................  Z2.............       8.6689      $358.89
                                  w/o&w/dye.
73500..........................  X-ray exam of hip.  ................  Z3.............       0.3710       $15.36
73510..........................  X-ray exam of hip.  ................  Z3.............       0.5196       $21.51
73520..........................  X-ray exam of hips  ................  Z3.............       0.5606       $23.21
73525..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  hip.
73530..........................  X-ray exam of hip.  CH..............  N1.............  ...........  ...........
73540..........................  X-ray exam of       ................  Z3.............       0.5360       $22.19
                                  pelvis & hips.
73542..........................  X-ray exam,         CH..............  N1.............  ...........  ...........
                                  sacroiliac joint.
73550..........................  X-ray exam of       ................  Z3.............       0.4370       $18.09
                                  thigh.
73560..........................  X-ray exam of       ................  Z3.............       0.4287       $17.75
                                  knee, 1 or 2.
73562..........................  X-ray exam of       ................  Z3.............       0.5029       $20.82
                                  knee, 3.
73564..........................  X-ray exam, knee,   ................  Z3.............       0.5771       $23.89
                                  4 or more.

[[Page 43070]]

 
73565..........................  X-ray exam of       ................  Z3.............       0.4370       $18.09
                                  knees.
73580..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  knee joint.
73590..........................  X-ray exam of       ................  Z3.............       0.4123       $17.07
                                  lower leg.
73592..........................  X-ray exam of leg,  ................  Z3.............       0.4205       $17.41
                                  infant.
73600..........................  X-ray exam of       ................  Z3.............       0.4041       $16.73
                                  ankle.
73610..........................  X-ray exam of       ................  Z3.............       0.4700       $19.46
                                  ankle.
73615..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  ankle.
73620..........................  X-ray exam of foot  ................  Z3.............       0.3957       $16.38
73630..........................  X-ray exam of foot  ................  Z3.............       0.4618       $19.12
73650..........................  X-ray exam of heel  ................  Z3.............       0.3957       $16.38
73660..........................  X-ray exam of       ................  Z3.............       0.4123       $17.07
                                  toe(s).
73700..........................  Ct lower extremity  ................  Z2.............       3.1487      $130.36
                                  w/o dye.
73701..........................  Ct lower extremity  ................  Z2.............       4.5485      $188.31
                                  w/dye.
73702..........................  Ct lwr extremity w/ ................  Z2.............       5.3374      $220.97
                                  o&w/dye.
73706..........................  Ct angio lwr extr   ................  Z2.............       5.2818      $218.67
                                  w/o&w/dye.
73718..........................  Mri lower           ................  Z2.............       5.7101      $236.40
                                  extremity w/o dye.
73719..........................  Mri lower           ................  Z2.............       6.7963      $281.37
                                  extremity w/dye.
73720..........................  Mri lwr extremity   ................  Z2.............       8.6689      $358.89
                                  w/o&w/dye.
73721..........................  Mri jnt of lwr      ................  Z2.............       5.7101      $236.40
                                  extre w/o dye.
73722..........................  Mri joint of lwr    ................  Z2.............       6.7963      $281.37
                                  extr w/dye.
73723..........................  Mri joint lwr extr  ................  Z2.............       8.6689      $358.89
                                  w/o&w/dye.
74000..........................  X-ray exam of       ................  Z3.............       0.3792       $15.70
                                  abdomen.
74010..........................  X-ray exam of       ................  Z3.............       0.5278       $21.85
                                  abdomen.
74020..........................  X-ray exam of       ................  Z3.............       0.5442       $22.53
                                  abdomen.
74022..........................  X-ray exam series,  ................  Z3.............       0.6514       $26.97
                                  abdomen.
74150..........................  Ct abdomen w/o dye  ................  Z2.............       3.1487      $130.36
74160..........................  Ct abdomen w/dye..  ................  Z2.............       4.5485      $188.31
74170..........................  Ct abdomen w/o & w/ ................  Z2.............       5.3374      $220.97
                                  dye.
74175..........................  Ct angio abdom w/o  ................  Z2.............       5.2818      $218.67
                                  & w/dye.
74181..........................  Mri abdomen w/o     ................  Z2.............       5.7101      $236.40
                                  dye.
74182..........................  Mri abdomen w/dye.  ................  Z2.............       6.7963      $281.37
74183..........................  Mri abdomen w/o &   ................  Z2.............       8.6689      $358.89
                                  w/dye.
74190..........................  X-ray exam of       CH..............  N1.............  ...........  ...........
                                  peritoneum.
74210..........................  Contrst x-ray exam  ................  Z3.............       1.1543       $47.79
                                  of throat.
74220..........................  Contrast x-ray,     ................  Z3.............       1.2367       $51.20
                                  esophagus.
74230..........................  Cine/vid x-ray,     ................  Z3.............       1.2534       $51.89
                                  throat/esoph.
74235..........................  Remove esophagus    CH..............  N1.............  ...........  ...........
                                  obstruction.
74240..........................  X-ray exam, upper   ................  Z3.............       1.4263       $59.05
                                  gi tract.
74241..........................  X-ray exam, upper   ................  Z2.............       1.4387       $59.56
                                  gi tract.
74245..........................  X-ray exam, upper   ................  Z2.............       2.2875       $94.70
                                  gi tract.
74246..........................  Contrst x-ray uppr  ................  Z2.............       1.4387       $59.56
                                  gi tract.
74247..........................  Contrst x-ray uppr  ................  Z2.............       1.4387       $59.56
                                  gi tract.
74249..........................  Contrst x-ray uppr  ................  Z2.............       2.2875       $94.70
                                  gi tract.
74250..........................  X-ray exam of       CH..............  Z2.............       1.4387       $59.56
                                  small bowel.
74251..........................  X-ray exam of       ................  Z2.............       2.2875       $94.70
                                  small bowel.
74260..........................  X-ray exam of       ................  Z2.............       1.4387       $59.56
                                  small bowel.
74270..........................  Contrast x-ray      ................  Z2.............       1.4387       $59.56
                                  exam of colon.
74280..........................  Contrast x-ray      ................  Z2.............       2.2875       $94.70
                                  exam of colon.
74283..........................  Contrast x-ray      ................  Z2.............       1.4387       $59.56
                                  exam of colon.
74290..........................  Contrast x-ray,     ................  Z3.............       0.8906       $36.87
                                  gallbladder.
74291..........................  Contrast x-rays,    ................  Z3.............       0.7833       $32.43
                                  gallbladder.
74300..........................  X-ray bile ducts/   CH..............  N1.............  ...........  ...........
                                  pancreas.
74301..........................  X-rays at surgery   CH..............  N1.............  ...........  ...........
                                  add-on.
74305..........................  X-ray bile ducts/   CH..............  N1.............  ...........  ...........
                                  pancreas.
74320..........................  Contrast x-ray of   CH..............  N1.............  ...........  ...........
                                  bile ducts.
74327..........................  X-ray bile stone    CH..............  N1.............  ...........  ...........
                                  removal.
74328..........................  X-ray bile duct     ................  N1.............  ...........  ...........
                                  endoscopy.
74329..........................  X-ray for pancreas  ................  N1.............  ...........  ...........
                                  endoscopy.
74330..........................  X-ray bile/panc     ................  N1.............  ...........  ...........
                                  endoscopy.
74340..........................  X-ray guide for GI  CH..............  N1.............  ...........  ...........
                                  tube.
74350..........................  X-ray guide,        CH..............  N1.............  ...........  ...........
                                  stomach tube.
74355..........................  X-ray guide,        CH..............  N1.............  ...........  ...........
                                  intestinal tube.
74360..........................  X-ray guide, GI     CH..............  N1.............  ...........  ...........
                                  dilation.
74363..........................  X-ray, bile duct    CH..............  N1.............  ...........  ...........
                                  dilation.
74400..........................  Contrst x-ray,      ................  Z3.............       1.6737       $69.29
                                  urinary tract.
74410..........................  Contrst x-ray,      ................  Z3.............       1.8222       $75.44
                                  urinary tract.
74415..........................  Contrst x-ray,      ................  Z3.............       2.1273       $88.07
                                  urinary tract.
74420..........................  Contrst x-ray,      ................  Z2.............       2.6114      $108.11
                                  urinary tract.

[[Page 43071]]

 
74425..........................  Contrst x-ray,      CH..............  N1.............  ...........  ...........
                                  urinary tract.
74430..........................  Contrast x-ray,     CH..............  N1.............  ...........  ...........
                                  bladder.
74440..........................  X-ray, male         CH..............  N1.............  ...........  ...........
                                  genital tract.
74445..........................  X-ray exam of       CH..............  N1.............  ...........  ...........
                                  penis.
74450..........................  X-ray, urethra/     CH..............  N1.............  ...........  ...........
                                  bladder.
74455..........................  X-ray, urethra/     CH..............  N1.............  ...........  ...........
                                  bladder.
74470..........................  X-ray exam of       CH..............  N1.............  ...........  ...........
                                  kidney lesion.
74475..........................  X-ray control,      CH..............  N1.............  ...........  ...........
                                  cath insert.
74480..........................  X-ray control,      CH..............  N1.............  ...........  ...........
                                  cath insert.
74485..........................  X-ray guide, GU     CH..............  N1.............  ...........  ...........
                                  dilation.
74710..........................  X-ray measurement   ................  Z3.............       0.6514       $26.97
                                  of pelvis.
74740..........................  X-ray, female       CH..............  N1.............  ...........  ...........
                                  genital tract.
74742..........................  X-ray, fallopian    CH..............  N1.............  ...........  ...........
                                  tube.
74775..........................  X-ray exam of        CH.............  Z3.............       0.7998       $33.11
                                  perineum.
75552..........................  Heart mri for       ................  Z2.............       5.7101      $236.40
                                  morph w/o dye.
75553..........................  Heart mri for       ................  Z2.............       6.7963      $281.37
                                  morph w/dye.
75554..........................  Cardiac MRI/        ................  Z2.............       5.7101      $236.40
                                  function.
75555..........................  Cardiac MRI/        ................  Z2.............       5.7101      $236.40
                                  limited study.
75600..........................  Contrast x-ray      CH..............  N1.............  ...........  ...........
                                  exam of aorta.
75605..........................  Contrast x-ray      CH..............  N1.............  ...........  ...........
                                  exam of aorta.
75625..........................  Contrast x-ray      CH..............  N1.............  ...........  ...........
                                  exam of aorta.
75630..........................  X-ray aorta, leg    CH..............  N1.............  ...........  ...........
                                  arteries.
75635..........................  Ct angio abdominal  CH..............  N1.............  ...........  ...........
                                  arteries.
75650..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  head & neck.
75658..........................  Artery x-rays, arm  CH..............  N1.............  ...........  ...........
75660..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  head & neck.
75662..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  head & neck.
75665..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  head & neck.
75671..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  head & neck.
75676..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  neck.
75680..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  neck.
75685..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  spine.
75705..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  spine.
75710..........................  Artery x-rays, arm/ CH..............  N1.............  ...........  ...........
                                  leg.
75716..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  arms/legs.
75722..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  kidney.
75724..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  kidneys.
75726..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  abdomen.
75731..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  adrenal gland.
75733..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  adrenals.
75736..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  pelvis.
75741..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  lung.
75743..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  lungs.
75746..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  lung.
75756..........................  Artery x-rays,      CH..............  N1.............  ...........  ...........
                                  chest.
75774..........................  Artery x-ray, each  CH..............  N1.............  ...........  ...........
                                  vessel.
75790..........................  Visualize A-V       CH..............  N1.............  ...........  ...........
                                  shunt.
75801..........................  Lymph vessel x-     CH..............  N1.............  ...........  ...........
                                  ray, arm/leg.
75803..........................  Lymph vessel x-     CH..............  N1.............  ...........  ...........
                                  ray,arms/legs.
75805..........................  Lymph vessel x-     CH..............  N1.............  ...........  ...........
                                  ray, trunk.
75807..........................  Lymph vessel x-     CH..............  N1.............  ...........  ...........
                                  ray, trunk.
75809..........................  Nonvascular shunt,  CH..............  N1.............  ...........  ...........
                                  x-ray.
75810..........................  Vein x-ray, spleen/ CH..............  N1.............  ...........  ...........
                                  liver.
75820..........................  Vein x-ray, arm/    CH..............  N1.............  ...........  ...........
                                  leg.
75822..........................  Vein x-ray, arms/   CH..............  N1.............  ...........  ...........
                                  legs.
75825..........................  Vein x-ray, trunk.  CH..............  N1.............  ...........  ...........
75827..........................  Vein x-ray, chest.  CH..............  N1.............  ...........  ...........
75831..........................  Vein x-ray, kidney  CH..............  N1.............  ...........  ...........
75833..........................  Vein x-ray,         CH..............  N1.............  ...........  ...........
                                  kidneys.
75840..........................  Vein x-ray,         CH..............  N1.............  ...........  ...........
                                  adrenal gland.
75842..........................  Vein x-ray,         CH..............  N1.............  ...........  ...........
                                  adrenal glands.
75860..........................  Vein x-ray, neck..  CH..............  N1.............  ...........  ...........
75870..........................  Vein x-ray, skull.  CH..............  N1.............  ...........  ...........
75872..........................  Vein x-ray, skull.  CH..............  N1.............  ...........  ...........
75880..........................  Vein x-ray, eye     CH..............  N1.............  ...........  ...........
                                  socket.
75885..........................  Vein x-ray, liver.  CH..............  N1.............  ...........  ...........
75887..........................  Vein x-ray, liver.  CH..............  N1.............  ...........  ...........
75889..........................  Vein x-ray, liver.  CH..............  N1.............  ...........  ...........

[[Page 43072]]

 
75891..........................  Vein x-ray, liver.  CH..............  N1.............  ...........  ...........
75893..........................  Venous sampling by  ................  N1.............  ...........  ...........
                                  catheter.
75894..........................  X-rays, transcath   CH..............  N1.............  ...........  ...........
                                  therapy.
75896..........................  X-rays, transcath   CH..............  N1.............  ...........  ...........
                                  therapy.
75898..........................  Follow-up           CH..............  N1.............  ...........  ...........
                                  angiography.
75901..........................  Remove cva device   CH..............  N1.............  ...........  ...........
                                  obstruct.
75902..........................  Remove cva lumen    CH..............  N1.............  ...........  ...........
                                  obstruct.
75940..........................  X-ray placement,    CH..............  N1.............  ...........  ...........
                                  vein filter.
75945..........................  Intravascular us..  CH..............  N1.............  ...........  ...........
75946..........................  Intravascular us    CH..............  N1.............  ...........  ...........
                                  add-on.
75960..........................  Transcath iv stent  CH..............  N1.............  ...........  ...........
                                  rs&i.
75961..........................  Retrieval, broken   CH..............  N1.............  ...........  ...........
                                  catheter.
75962..........................  Repair arterial     CH..............  N1.............  ...........  ...........
                                  blockage.
75964..........................  Repair artery       CH..............  N1.............  ...........  ...........
                                  blockage, each.
75966..........................  Repair arterial     CH..............  N1.............  ...........  ...........
                                  blockage.
75968..........................  Repair artery       CH..............  N1.............  ...........  ...........
                                  blockage, each.
75970..........................  Vascular biopsy...  CH..............  N1.............  ...........  ...........
75978..........................  Repair venous       CH..............  N1.............  ...........  ...........
                                  blockage.
75980..........................  Contrast xray exam  CH..............  N1.............  ...........  ...........
                                  bile duct.
75982..........................  Contrast xray exam  CH..............  N1.............  ...........  ...........
                                  bile duct.
75984..........................  Xray control        CH..............  N1.............  ...........  ...........
                                  catheter change.
75989..........................  Abscess drainage    ................  N1.............  ...........  ...........
                                  under x-ray.
75992..........................  Atherectomy, x-ray  CH..............  N1.............  ...........  ...........
                                  exam.
75993..........................  Atherectomy, x-ray  CH..............  N1.............  ...........  ...........
                                  exam.
75994..........................  Atherectomy, x-ray  CH..............  N1.............  ...........  ...........
                                  exam.
75995..........................  Atherectomy, x-ray  CH..............  N1.............  ...........  ...........
                                  exam.
75996..........................  Atherectomy, x-ray  CH..............  N1.............  ...........  ...........
                                  exam.
76000..........................  Fluoroscope         CH..............  N1.............  ...........  ...........
                                  examination.
76001..........................  Fluoroscope exam,   ................  N1.............  ...........  ...........
                                  extensive.
76010..........................  X-ray, nose to      ................  Z3.............       0.4123       $17.07
                                  rectum.
76080..........................  X-ray exam of       CH..............  N1.............  ...........  ...........
                                  fistula.
76098..........................  X-ray exam, breast  ................  Z3.............       0.2804       $11.61
                                  specimen.
76100..........................  X-ray exam of body  ................  Z2.............       1.2024       $49.78
                                  section.
76101..........................  Complex body        ................  Z2.............       1.4802       $61.28
                                  section x-ray.
76102..........................  Complex body        ................  Z2.............       1.4802       $61.28
                                  section x-rays.
76120..........................  Cine/video x-rays.  ................  Z3.............       1.1379       $47.11
76125..........................  Cine/video x-rays   CH..............  N1.............  ...........  ...........
                                  add-on.
76150..........................  X-ray exam, dry     ................  Z3.............       0.4452       $18.43
                                  process.
76350..........................  Special x-ray       ................  N1.............  ...........  ...........
                                  contrast study.
76376..........................  3d render w/o       CH..............  N1.............  ...........  ...........
                                  postprocess.
76377..........................  3d rendering w/     CH..............  N1.............  ...........  ...........
                                  postprocess.
76380..........................  CAT scan follow-up  ................  Z2.............       1.6768       $69.42
                                  study.
76496..........................  Fluoroscopic        ................  Z2.............       1.3270       $54.94
                                  procedure.
76497..........................  Ct procedure......  ................  Z2.............       1.6768       $69.42
76498..........................  Mri procedure.....  ................  Z2.............       5.0067      $207.28
76499..........................  Radiographic        ................  Z2.............       0.7259       $30.05
                                  procedure.
76506..........................  Echo exam of head.  ................  Z2.............       0.9925       $41.09
76510..........................  Ophth us, b &       CH..............  Z3.............       1.5995       $66.22
                                  quant a.
76511..........................  Ophth us, quant a   ................  Z3.............       1.2534       $51.89
                                  only.
76512..........................  Ophth us, b w/non-  ................  Z3.............       1.0884       $45.06
                                  quant a.
76513..........................  Echo exam of eye,   ................  Z3.............       1.1626       $48.13
                                  water bath.
76514..........................  Echo exam of eye,   ................  Z3.............       0.0659        $2.73
                                  thickness.
76516..........................  Echo exam of eye..  ................  Z3.............       0.9070       $37.55
76519..........................  Echo exam of eye..  ................  Z3.............       0.9894       $40.96
76529..........................  Echo exam of eye..  ................  Z3.............       0.8575       $35.50
76536..........................  Us exam of head     CH..............  Z2.............       1.5657       $64.82
                                  and neck.
76604..........................  Us exam, chest....  ................  Z2.............       0.9925       $41.09
76645..........................  Us exam, breast(s)  ................  Z2.............       0.9925       $41.09
76700..........................  Us exam, abdom,     ................  Z2.............       1.5657       $64.82
                                  complete.
76705..........................  Echo exam of        ................  Z3.............       1.4512       $60.08
                                  abdomen.
76770..........................  Us exam abdo back   ................  Z2.............       1.5657       $64.82
                                  wall, comp.
76775..........................  Us exam abdo back   ................  Z3.............       1.4676       $60.76
                                  wall, lim.
76776..........................  Us exam k transpl   ................  Z2.............       1.5657       $64.82
                                  w/doppler.
76800..........................  Us exam, spinal     ................  Z3.............       1.4099       $58.37
                                  canal.
76801..........................  Ob us < 14 wks,     ................  Z2.............       1.5657       $64.82
                                  single fetus.
76802..........................  Ob us < 14 wks,     ................  Z3.............       0.7174       $29.70
                                  add l fetus.
76805..........................  Ob us >/= 14 wks,   ................  Z2.............       1.5657       $64.82
                                  sngl fetus.
76810..........................  Ob us >/= 14 wks,   ................  Z3.............       0.9812       $40.62
                                  addl fetus.

[[Page 43073]]

 
76811..........................  Ob us, detailed,    ................  Z3.............       2.4737      $102.41
                                  sngl fetus.
76812..........................  Ob us, detailed,    ................  Z2.............       0.9925       $41.09
                                  addl fetus.
76813..........................  Ob us nuchal meas,  ................  Z3.............       1.4430       $59.74
                                  1 gest.
76814..........................  Ob us nuchal meas,  ................  Z3.............       0.6925       $28.67
                                  add-on.
76815..........................  Ob us, limited,     ................  Z2.............       0.9925       $41.09
                                  fetus(s).
76816..........................  Ob us, follow-up,   ................  Z2.............       0.9925       $41.09
                                  per fetus.
76817..........................  Transvaginal us,    ................  Z2.............       0.9925       $41.09
                                  obstetric.
76818..........................  Fetal biophys       ................  Z3.............       1.4430       $59.74
                                  profile w/nst.
76819..........................  Fetal biophys       ................  Z3.............       1.2367       $51.20
                                  profil w/o nst.
76820..........................  Umbilical artery    ................  Z3.............       0.8329       $34.48
                                  echo.
76821..........................  Middle cerebral     ................  Z3.............       1.3440       $55.64
                                  artery echo.
76825..........................  Echo exam of fetal  ................  Z2.............       1.5657       $64.82
                                  heart.
76826..........................  Echo exam of fetal  CH..............  Z2.............       0.9925       $41.09
                                  heart.
76827..........................  Echo exam of fetal  CH..............  Z2.............       0.9925       $41.09
                                  heart.
76828..........................  Echo exam of fetal  ................  Z3.............       0.6514       $26.97
                                  heart.
76830..........................  Transvaginal us,    ................  Z2.............       1.5657       $64.82
                                  non-ob.
76831..........................  Echo exam, uterus.  ................  Z3.............       1.6572       $68.61
76856..........................  Us exam, pelvic,    ................  Z2.............       1.5657       $64.82
                                  complete.
76857..........................  Us exam, pelvic,    ................  Z2.............       0.9925       $41.09
                                  limited.
76870..........................  Us exam, scrotum..  ................  Z2.............       1.5657       $64.82
76872..........................  Us, transrectal...  ................  Z2.............       1.5657       $64.82
76873..........................  Echograp trans r,   ................  Z2.............       1.5657       $64.82
                                  pros study.
76880..........................  Us exam, extremity  ................  Z2.............       1.5657       $64.82
76885..........................  Us exam infant      ................  Z2.............       0.9925       $41.09
                                  hips, dynamic.
76886..........................  Us exam infant      ................  Z2.............       0.9925       $41.09
                                  hips, static.
76930..........................  Echo guide,         CH..............  N1.............  ...........  ...........
                                  cardiocentesis.
76932..........................  Echo guide for      CH..............  N1.............  ...........  ...........
                                  heart biopsy.
76936..........................  Echo guide for      CH..............  N1.............  ...........  ...........
                                  artery repair.
76937..........................  Us guide, vascular  ................  N1.............  ...........  ...........
                                  access.
76940..........................  Us guide, tissue    CH..............  N1.............  ...........  ...........
                                  ablation.
76941..........................  Echo guide for      CH..............  N1.............  ...........  ...........
                                  transfusion.
76942..........................  Echo guide for      CH..............  N1.............  ...........  ...........
                                  biopsy.
76945..........................  Echo guide, villus  CH..............  N1.............  ...........  ...........
                                  sampling.
76946..........................  Echo guide for      CH..............  N1.............  ...........  ...........
                                  amniocentesis.
76948..........................  Echo guide, ova     CH..............  N1.............  ...........  ...........
                                  aspiration.
76950..........................  Echo guidance       CH..............  N1.............  ...........  ...........
                                  radiotherapy.
76965..........................  Echo guidance       CH..............  N1.............  ...........  ...........
                                  radiotherapy.
76970..........................  Ultrasound exam     ................  Z2.............       0.9925       $41.09
                                  follow-up.
76975..........................  GI endoscopic       CH..............  N1.............  ...........  ...........
                                  ultrasound.
76977..........................  Us bone density     ................  Z3.............       0.3792       $15.70
                                  measure.
76998..........................  Us guide, intraop.  CH..............  N1.............  ...........  ...........
76999..........................  Echo examination    ................  Z2.............       0.9925       $41.09
                                  procedure.
77001..........................  Fluoroguide for     ................  N1.............  ...........  ...........
                                  vein device.
77002..........................  Needle              ................  N1.............  ...........  ...........
                                  localization by
                                  xray.
77003..........................  Fluoroguide for     ................  N1.............  ...........  ...........
                                  spine inject.
77011..........................  Ct scan for         CH..............  N1.............  ...........  ...........
                                  localization.
77012..........................  Ct scan for needle  CH..............  N1.............  ...........  ...........
                                  biopsy.
77013..........................  Ct guide for        CH..............  N1.............  ...........  ...........
                                  tissue ablation.
77014..........................  Ct scan for         CH..............  N1.............  ...........  ...........
                                  therapy guide.
77021..........................  Mr guidance for     CH..............  N1.............  ...........  ...........
                                  needle place.
77022..........................  Mri for tissue      CH..............  N1.............  ...........  ...........
                                  ablation.
77031..........................  Stereotact guide    CH..............  N1.............  ...........  ...........
                                  for brst bx.
77032..........................  Guidance for        CH..............  N1.............  ...........  ...........
                                  needle, breast.
77053..........................  X-ray of mammary    CH..............  N1.............  ...........  ...........
                                  duct.
77054..........................  X-ray of mammary    CH..............  N1.............  ...........  ...........
                                  ducts.
77071..........................  X-ray stress view.  ................  Z3.............       0.3051       $12.63
77072..........................  X-rays for bone     ................  Z3.............       0.2886       $11.95
                                  age.
77073..........................  X-rays, bone        ................  Z3.............       0.5855       $24.24
                                  length studies.
77074..........................  X-rays, bone        ................  Z3.............       0.8988       $37.21
                                  survey, limited.
77075..........................  X-rays, bone        ................  Z2.............       1.2024       $49.78
                                  survey complete.
77076..........................  X-rays, bone        ................  Z2.............       0.7259       $30.05
                                  survey, infant.
77077..........................  Joint survey,       CH..............  Z2.............       0.7259       $30.05
                                  single view.
77078..........................  Ct bone density,    ................  Z2.............       1.1920       $49.35
                                  axial.
77079..........................  Ct bone density,    CH..............  Z2.............       1.6768       $69.42
                                  peripheral.
77080..........................  Dxa bone density,   ................  Z2.............       1.1920       $49.35
                                  axial.
77081..........................  Dxa bone density/   CH..............  Z3.............       0.5196       $21.51
                                  peripheral.
77082..........................  Dxa bone density,   ................  Z3.............       0.5442       $22.53
                                  vert fx.
77083..........................  Radiographic        ................  Z3.............       0.4947       $20.48
                                  absorptiometry.

[[Page 43074]]

 
77084..........................  Magnetic image,     ................  Z2.............       5.0067      $207.28
                                  bone marrow.
77280..........................  Sbrt management...  ................  Z2.............       1.6409       $67.93
77285..........................  Set radiation       ................  Z2.............       4.1775      $172.95
                                  therapy field.
77290..........................  Set radiation       ................  Z2.............       4.1775      $172.95
                                  therapy field.
77295..........................  Set radiation       ................  Z3.............      13.9592      $577.91
                                  therapy field.
77299..........................  Radiation therapy   ................  Z2.............       1.6409       $67.93
                                  planning.
77300..........................  Radiation therapy   ................  Z3.............       0.9565       $39.60
                                  dose plan.
77301..........................  Radiotherapy dose   ................  Z2.............      14.0797      $582.90
                                  plan, imrt.
77305..........................  Teletx isodose      ................  Z3.............       1.0389       $43.01
                                  plan simple.
77310..........................  Teletx isodose      ................  Z3.............       1.3357       $55.30
                                  plan intermed.
77315..........................  Teletx isodose      ................  Z3.............       1.7396       $72.02
                                  plan complex.
77321..........................  Special teletx      ................  Z3.............       2.1601       $89.43
                                  port plan.
77326..........................  Brachytx isodose    ................  Z2.............       1.6409       $67.93
                                  calc simp.
77327..........................  Brachytx isodose    ................  Z3.............       2.9271      $121.18
                                  calc interm.
77328..........................  Brachytx isodose    ................  Z3.............       3.9164      $162.14
                                  plan compl.
77331..........................  Special radiation   ................  Z3.............       0.4205       $17.41
                                  dosimetry.
77332..........................  Radiation           ................  Z3.............       1.1130       $46.08
                                  treatment aid(s).
77333..........................  Radiation           ................  Z3.............       0.8821       $36.52
                                  treatment aid(s).
77334..........................  Radiation           ................  Z3.............       2.2923       $94.90
                                  treatment aid(s).
77336..........................  Radiation physics   ................  Z2.............       1.6409       $67.93
                                  consult.
77370..........................  Radiation physics   ................  Z2.............       1.6409       $67.93
                                  consult.
77371..........................  Srs, multisource..  ................  Z3.............      24.8261    $1,027.80
77399..........................  External radiation  ................  Z2.............       1.6409       $67.93
                                  dosimetry.
77401..........................  Radiation           ................  Z3.............       0.9234       $38.23
                                  treatment
                                  delivery.
77402..........................  Radiation           ................  Z2.............       1.5000       $62.10
                                  treatment
                                  delivery.
77403..........................  Radiation           ................  Z2.............       1.5000       $62.10
                                  treatment
                                  delivery.
77404..........................  Radiation           ................  Z2.............       1.5000       $62.10
                                  treatment
                                  delivery.
77406..........................  Radiation           ................  Z2.............       1.5000       $62.10
                                  treatment
                                  delivery.
77407..........................  Radiation           ................  Z2.............       1.5000       $62.10
                                  treatment
                                  delivery.
77408..........................  Radiation           ................  Z2.............       1.5000       $62.10
                                  treatment
                                  delivery.
77409..........................  Radiation           ................  Z2.............       1.5000       $62.10
                                  treatment
                                  delivery.
77411..........................  Radiation           ................  Z2.............       2.2933       $94.94
                                  treatment
                                  delivery.
77412..........................  Radiation           ................  Z2.............       2.2933       $94.94
                                  treatment
                                  delivery.
77413..........................  Radiation           ................  Z2.............       2.2933       $94.94
                                  treatment
                                  delivery.
77414..........................  Radiation           ................  Z2.............       2.2933       $94.94
                                  treatment
                                  delivery.
77416..........................  Radiation           ................  Z2.............       2.2933       $94.94
                                  treatment
                                  delivery.
77417..........................  Radiology port      CH..............  N1.............  ...........  ...........
                                  film(s).
77418..........................  Radiation tx        ................  Z2.............       5.7275      $237.12
                                  delivery, imrt.
77421..........................  Stereoscopic x-ray  CH..............  N1.............  ...........  ...........
                                  guidance.
77422..........................  Neutron beam tx,    ................  Z2.............       2.2933       $94.94
                                  simple.
77423..........................  Neutron beam tx,    ................  Z2.............       2.2933       $94.94
                                  complex.
77435..........................  Sbrt management...  ................  N1.............  ...........  ...........
77470..........................  Special radiation   ................  Z3.............       5.1039      $211.30
                                  treatment.
77520..........................  Proton trmt,        ................  Z2.............      13.2746      $549.57
                                  simple w/o comp.
77522..........................  Proton trmt,        ................  Z2.............      13.2746      $549.57
                                  simple w/comp.
77523..........................  Proton trmt,        ................  Z2.............      15.8841      $657.60
                                  intermediate.
77525..........................  Proton treatment,   ................  Z2.............      15.8841      $657.60
                                  complex.
77600..........................  Hyperthermia        CH..............  Z3.............       5.1862      $214.71
                                  treatment.
77605..........................  Hyperthermia        ................  Z2.............       6.0275      $249.54
                                  treatment.
77610..........................  Hyperthermia        ................  Z2.............       6.0275      $249.54
                                  treatment.
77615..........................  Hyperthermia        ................  Z2.............       6.0275      $249.54
                                  treatment.
77620..........................  Hyperthermia        CH..............  Z3.............       5.2440      $217.10
                                  treatment.
77750..........................  Infuse radioactive  ................  Z3.............       1.7481       $72.37
                                  materials.
77761..........................  Apply intrcav       ................  Z3.............       3.1167      $129.03
                                  radiat simple.
77762..........................  Apply intrcav       ................  Z3.............       3.8505      $159.41
                                  radiat interm.
77763..........................  Apply intrcav       ................  Z3.............       4.9389      $204.47
                                  radiat compl.
77776..........................  Apply interstit     ................  Z3.............       3.2816      $135.86
                                  radiat simpl.
77777..........................  Apply interstit     ................  Z3.............       3.9742      $164.53
                                  radiat inter.
77778..........................  Apply interstit     ................  Z3.............       5.2440      $217.10
                                  radiat compl.
77781..........................  High intensity      ................  Z3.............      10.0097      $414.40
                                  brachytherapy.
77782..........................  High intensity      ................  Z2.............      11.6098      $480.65
                                  brachytherapy.
77783..........................  High intensity      ................  Z2.............      11.6098      $480.65
                                  brachytherapy.
77784..........................  High intensity      ................  Z2.............      11.6098      $480.65
                                  brachytherapy.
77789..........................  Apply surface       ................  Z3.............       0.8657       $35.84
                                  radiation.
77790..........................  Radiation handling  ................  N1.............  ...........  ...........
77799..........................  Radium/             ................  Z2.............       8.3915      $347.41
                                  radioisotope
                                  therapy.
78000..........................  Thyroid, single     ................  Z3.............       1.1213       $46.42
                                  uptake.
78001..........................  Thyroid, multiple   ................  Z3.............       1.4263       $59.05
                                  uptakes.

[[Page 43075]]

 
78003..........................  Thyroid suppress/   ................  Z3.............       1.1295       $46.76
                                  stimul.
78006..........................  Thyroid imaging     ................  Z2.............       2.8272      $117.05
                                  with uptake.
78007..........................  Thyroid image,      ................  Z3.............       2.2179       $91.82
                                  mult uptakes.
78010..........................  Thyroid imaging...  ................  Z3.............       2.3746       $98.31
78011..........................  Thyroid imaging     CH..............  Z3.............       2.7457      $113.67
                                  with flow.
78015..........................  Thyroid met         ................  Z3.............       3.1249      $129.37
                                  imaging.
78016..........................  Thyroid met         ................  Z2.............       4.4988      $186.25
                                  imaging/studies.
78018..........................  Thyroid met         ................  Z2.............       4.4988      $186.25
                                  imaging, body.
78020..........................  Thyroid met uptake  CH..............  N1.............  ...........  ...........
78070..........................  Parathyroid         CH..............  Z3.............       3.0343      $125.62
                                  nuclear imaging.
78075..........................  Adrenal nuclear     ................  Z2.............       3.6540      $151.28
                                  imaging.
78099..........................  Endocrine nuclear   ................  Z2.............       2.8272      $117.05
                                  procedure.
78102..........................  Bone marrow         ................  Z3.............       2.4406      $101.04
                                  imaging, ltd.
78103..........................  Bone marrow         ................  Z3.............       3.3804      $139.95
                                  imaging, mult.
78104..........................  Bone marrow         CH..............  Z3.............       4.0732      $168.63
                                  imaging, body.
78110..........................  Plasma volume,      ................  Z3.............       1.2285       $50.86
                                  single.
78111..........................  Plasma volume,      ................  Z3.............       1.8882       $78.17
                                  multiple.
78120..........................  Red cell mass,      ................  Z3.............       1.5171       $62.81
                                  single.
78121..........................  Red cell mass,      ................  Z3.............       2.0447       $84.65
                                  multiple.
78122..........................  Blood volume......  ................  Z3.............       2.7374      $113.33
78130..........................  Red cell survival   ................  Z3.............       2.4983      $103.43
                                  study.
78135..........................  Red cell survival   CH..............  Z3.............       5.3923      $223.24
                                  kinetics.
78140..........................  Red cell            ................  Z3.............       2.7126      $112.30
                                  sequestration.
78185..........................  Spleen imaging....  ................  Z3.............       3.0012      $124.25
78190..........................  Platelet survival,  ................  Z2.............       3.2810      $135.83
                                  kinetics.
78191..........................  Platelet survival.  ................  Z2.............       3.2810      $135.83
78195..........................  Lymph system        ................  Z2.............       4.1916      $173.53
                                  imaging.
78199..........................  Blood/lymph         ................  Z2.............       4.1916      $173.53
                                  nuclear exam.
78201..........................  Liver imaging.....  ................  Z3.............       2.7870      $115.38
78202..........................  Liver imaging with  ................  Z3.............       3.2650      $135.17
                                  flow.
78205..........................  Liver imaging (3D)  ................  Z3.............       4.4524      $184.33
78206..........................  Liver image (3d)    ................  Z2.............       4.5297      $187.53
                                  with flow.
78215..........................  Liver and spleen    ................  Z3.............       3.0754      $127.32
                                  imaging.
78216..........................  Liver & spleen      ................  Z3.............       2.4983      $103.43
                                  image/flow.
78220..........................  Liver function      ................  Z3.............       2.6961      $111.62
                                  study.
78223..........................  Hepatobiliary       ................  Z2.............       4.5297      $187.53
                                  imaging.
78230..........................  Salivary gland      ................  Z3.............       2.5065      $103.77
                                  imaging.
78231..........................  Serial salivary     ................  Z3.............       2.3582       $97.63
                                  imaging.
78232..........................  Salivary gland      ................  Z3.............       2.5065      $103.77
                                  function exam.
78258..........................  Esophageal          ................  Z3.............       3.3476      $138.59
                                  motility study.
78261..........................  Gastric mucosa      ................  Z2.............       3.8546      $159.58
                                  imaging.
78262..........................  Gastroesophageal    ................  Z2.............       3.8546      $159.58
                                  reflux exam.
78264..........................  Gastric emptying    ................  Z2.............       3.8546      $159.58
                                  study.
78270..........................  Vit B-12            ................  Z3.............       1.3853       $57.35
                                  absorption exam.
78271..........................  Vit b-12 absrp      ................  Z3.............       1.4181       $58.71
                                  exam, int fac.
78272..........................  Vit B-12 absorp,    ................  Z3.............       1.7563       $72.71
                                  combined.
78278..........................  Acute GI blood      ................  Z2.............       3.8546      $159.58
                                  loss imaging.
78282..........................  GI protein loss     ................  Z2.............       3.8546      $159.58
                                  exam.
78290..........................  Meckel's divert     ................  Z2.............       3.8546      $159.58
                                  exam.
78291..........................  Leveen/shunt        ................  Z3.............       3.6196      $149.85
                                  patency exam.
78299..........................  GI nuclear          ................  Z2.............       3.8546      $159.58
                                  procedure.
78300..........................  Bone imaging,       ................  Z3.............       2.6302      $108.89
                                  limited area.
78305..........................  Bone imaging,       ................  Z3.............       3.5949      $148.83
                                  multiple areas.
78306..........................  Bone imaging,       CH..............  Z2.............       3.9566      $163.80
                                  whole body.
78315..........................  Bone imaging, 3     ................  Z2.............       3.9566      $163.80
                                  phase.
78320..........................  Bone imaging (3D).  ................  Z2.............       3.9566      $163.80
78399..........................  Musculoskeletal     ................  Z2.............       3.9566      $163.80
                                  nuclear exam.
78414..........................  Non-imaging heart   ................  Z2.............       5.4404      $225.23
                                  function.
78428..........................  Cardiac shunt       ................  Z3.............       2.9106      $120.50
                                  imaging.
78445..........................  Vascular flow       CH..............  Z3.............       2.5065      $103.77
                                  imaging.
78456..........................  Acute venous        ................  Z2.............       3.0424      $125.96
                                  thrombus image.
78457..........................  Venous thrombosis   CH..............  Z3.............       2.8857      $119.47
                                  imaging.
78458..........................  Ven thrombosis      ................  Z2.............       3.0424      $125.96
                                  images, bilat.
78459..........................  Heart muscle        ................  Z2.............      42.5674    $1,762.29
                                  imaging (PET).
78460..........................  Heart muscle        ................  Z3.............       2.7210      $112.65
                                  blood, single.
78461..........................  Heart muscle        ................  Z3.............       3.3886      $140.29
                                  blood, multiple.
78464..........................  Heart image (3d),   CH..............  Z3.............       5.0708      $209.93
                                  single.
78465..........................  Heart image (3d),   CH..............  Z3.............       9.1935      $380.61
                                  multiple.

[[Page 43076]]

 
78466..........................  Heart infarct       ................  Z3.............       2.7952      $115.72
                                  image.
78468..........................  Heart infarct       ................  Z3.............       3.7350      $154.63
                                  image (ef).
78469..........................  Heart infarct       CH..............  Z3.............       4.5019      $186.38
                                  image (3D).
78472..........................  Gated heart,        CH..............  Z3.............       4.5430      $188.08
                                  planar, single.
78473..........................  Gated heart,        ................  Z2.............       5.4404      $225.23
                                  multiple.
78478..........................  Heart wall motion   CH..............  N1.............  ...........  ...........
                                  add-on.
78480..........................  Heart function add- CH..............  N1.............  ...........  ...........
                                  on.
78481..........................  Heart first pass,   ................  Z3.............       3.9988      $165.55
                                  single.
78483..........................  Heart first pass,   ................  Z2.............       5.4404      $225.23
                                  multiple.
78491..........................  Heart image (pet),  ................  Z2.............      42.5674    $1,762.29
                                  single.
78492..........................  Heart image (pet),  ................  Z2.............      42.5674    $1,762.29
                                  multiple.
78494..........................  Heart image, spect  CH..............  Z3.............       5.2109      $215.73
78496..........................  Heart first pass    CH..............  N1.............  ...........  ...........
                                  add-on.
78499..........................  Cardiovascular      ................  Z2.............       5.4404      $225.23
                                  nuclear exam.
78580..........................  Lung perfusion      ................  Z2.............       3.2976      $136.52
                                  imaging.
78584..........................  Lung V/Q image      ................  Z3.............       2.3911       $98.99
                                  single breath.
78585..........................  Lung V/Q imaging..  ................  Z2.............       5.1617      $213.69
78586..........................  Aerosol lung        ................  Z3.............       2.6879      $111.28
                                  image, single.
78587..........................  Aerosol lung        ................  Z3.............       3.2734      $135.52
                                  image, multiple.
78588..........................  Perfusion lung      ................  Z3.............       4.6420      $192.18
                                  image.
78591..........................  Vent image, 1       ................  Z3.............       2.7870      $115.38
                                  breath, 1 proj.
78593..........................  Vent image, 1       ................  Z3.............       3.2899      $136.20
                                  proj, gas.
78594..........................  Vent image, mult    ................  Z2.............       3.2976      $136.52
                                  proj, gas.
78596..........................  Lung differential   ................  Z2.............       5.1617      $213.69
                                  function.
78599..........................  Respiratory         ................  Z2.............       3.2976      $136.52
                                  nuclear exam.
78600..........................  Brain imaging, ltd  ................  Z3.............       3.2568      $134.83
                                  static.
78601..........................  Brain imaging, ltd  CH..............  Z2.............       3.3325      $137.97
                                  w/flow.
78605..........................  Brain imaging,      ................  Z3.............       3.2568      $134.83
                                  complete.
78606..........................  Brain imaging,      CH..............  Z3.............       4.9389      $204.47
                                  compl w/flow.
78607..........................  Brain imaging (3D)  CH..............  Z3.............       6.8599      $284.00
78608..........................  Brain imaging       ................  Z2.............      17.3837      $719.69
                                  (PET).
78610..........................  Brain flow imaging  ................  Z3.............       2.3829       $98.65
                                  only.
78615..........................  Cerebral vascular   ................  Z3.............       3.7186      $153.95
                                  flow image.
78630..........................  Cerebrospinal       CH..............  Z3.............       5.4582      $225.97
                                  fluid scan.
78635..........................  CSF                 CH..............  Z3.............       4.4688      $185.01
                                  ventriculography.
78645..........................  CSF shunt           ................  Z2.............       3.3325      $137.97
                                  evaluation.
78647..........................  Cerebrospinal       CH..............  Z3.............       6.5056      $269.33
                                  fluid scan.
78650..........................  CSF leakage         CH..............  Z3.............       5.2853      $218.81
                                  imaging.
78660..........................  Nuclear exam of     ................  Z3.............       2.5147      $104.11
                                  tear flow.
78699..........................  Nervous system      ................  Z2.............       3.3325      $137.97
                                  nuclear exam.
78700..........................  Kidney imaging,     ................  Z3.............       2.9766      $123.23
                                  morphol.
78701..........................  Kidney imaging      ................  Z3.............       3.5618      $147.46
                                  with flow.
78707..........................  Kflow/funct image   CH..............  Z3.............       3.9082      $161.80
                                  w/o drug.
78708..........................  Kflow/funct image   ................  Z3.............       3.0589      $126.64
                                  w/drug.
78709..........................  Kflow/funct image,  ................  Z2.............       5.0935      $210.87
                                  multiple.
78710..........................  Kidney imaging      CH..............  Z3.............       4.4771      $185.35
                                  (3D).
78725..........................  Kidney function     ................  Z2.............       1.5806       $65.44
                                  study.
78730..........................  Urinary bladder     ................  Z2.............       0.6416       $26.56
                                  retention.
78740..........................  Ureteral reflux     ................  Z3.............       3.0507      $126.30
                                  study.
78761..........................  Testicular imaging  ................  Z3.............       3.2321      $133.81
                                  w/flow.
78799..........................  Genitourinary       ................  Z2.............       5.0935      $210.87
                                  nuclear exam.
78800..........................  Tumor imaging,      ................  Z3.............       3.0589      $126.64
                                  limited area.
78801..........................  Tumor imaging,      ................  Z3.............       4.0732      $168.63
                                  mult areas.
78802..........................  Tumor imaging,      CH..............  Z3.............       5.4336      $224.95
                                  whole body.
78803..........................  Tumor imaging (3D)  CH..............  Z3.............       6.8188      $282.30
78804..........................  Tumor imaging,      CH..............  Z3.............      10.3807      $429.76
                                  whole body.
78805..........................  Abscess imaging,    ................  Z3.............       3.0012      $124.25
                                  ltd area.
78806..........................  Abscess imaging,    CH..............  Z3.............       5.8870      $243.72
                                  whole body.
78807..........................  Nuclear             CH..............  Z3.............       6.7116      $277.86
                                  localization/
                                  abscess.
78811..........................  Tumor imaging       ................  Z2.............      17.3837      $719.69
                                  (pet), limited.
78812..........................  Tumor image (pet)/  ................  Z2.............      17.3837      $719.69
                                  skul-thigh.
78813..........................  Tumor image (pet)   ................  Z2.............      17.3837      $719.69
                                  full body.
78814..........................  Tumor image pet/    ................  Z2.............      17.3837      $719.69
                                  ct, limited.
78815..........................  Tumorimage pet/ct   ................  Z2.............      17.3837      $719.69
                                  skul-thigh.
78816..........................  Tumor image pet/ct  ................  Z2.............      17.3837      $719.69
                                  full body.
78890..........................  Nuclear medicine    ................  N1.............  ...........  ...........
                                  data proc.
78891..........................  Nuclear med data    ................  N1.............  ...........  ...........
                                  proc.
78999..........................  Nuclear diagnostic  ................  Z2.............       1.5806       $65.44
                                  exam.

[[Page 43077]]

 
79005..........................  Nuclear rx, oral    ................  Z3.............       1.5913       $65.88
                                  admin.
79101..........................  Nuclear rx, iv      ................  Z3.............       1.6572       $68.61
                                  admin.
79200..........................  Nuclear rx,         ................  Z3.............       1.7150       $71.00
                                  intracav admin.
79300..........................  Nuclr rx,           ................  Z2.............       3.4563      $143.09
                                  interstit colloid.
79403..........................  Hematopoietic       ................  Z3.............       2.6384      $109.23
                                  nuclear tx.
79440..........................  Nuclear rx, intra-  ................  Z3.............       1.5418       $63.83
                                  articular.
79445..........................  Nuclear rx, intra-  ................  Z2.............       3.4563      $143.09
                                  arterial.
79999..........................  Nuclear medicine    ................  Z2.............       3.4563      $143.09
                                  therapy.
90371..........................  Hep b ig, im......  ................  K2.............  ...........      $132.42
90375..........................  Rabies ig, im/sc..  ................  K2.............  ...........       $64.82
90376..........................  Rabies ig, heat     ................  K2.............  ...........       $69.40
                                  treated.
90396..........................  Varicella-zoster    ................  K2.............  ...........      $121.58
                                  ig, im.
90585..........................  Bcg vaccine,        ................  K2.............  ...........      $112.56
                                  percut.
90675..........................  Rabies vaccine, im  ................  K2.............  ...........      $145.53
90676..........................  Rabies vaccine, id  ................  K2.............  ...........      $124.09
90708..........................  Measles-rubella     ................  K2.............  ...........       $61.10
                                  vaccine, sc.
90720..........................  Dtp/hib vaccine,    CH..............  N1.............  ...........  ...........
                                  im.
90727..........................  Plague vaccine, im  CH..............  N1.............  ...........  ...........
90733..........................  Meningococcal       ................  K2.............  ...........       $88.59
                                  vaccine, sc.
90734..........................  Meningococcal       ................  K2.............  ...........       $72.03
                                  vaccine, im.
90735..........................  Encephalitis        ................  K2.............  ...........       $98.17
                                  vaccine, sc.
A4218..........................  Sterile saline or   ................  N1.............  ...........  ...........
                                  water.
A4220..........................  Infusion pump       ................  N1.............  ...........  ...........
                                  refill kit.
A4248..........................  Chlorhexidine       ................  N1.............  ...........  ...........
                                  antisept.
A4262..........................  Temporary tear      ................  N1.............  ...........  ...........
                                  duct plug.
A4263..........................  Permanent tear      ................  N1.............  ...........  ...........
                                  duct plug.
A4270..........................  Disposable          ................  N1.............  ...........  ...........
                                  endoscope sheath.
A4300..........................  Cath impl vasc      ................  N1.............  ...........  ...........
                                  access portal.
A4301..........................  Implantable access  ................  N1.............  ...........  ...........
                                  syst perc.
A4305..........................  Drug delivery       ................  N1.............  ...........  ...........
                                  system >=50 ML.
A4306..........................  Drug delivery       ................  N1.............  ...........  ...........
                                  system <=50 ml.
A9527..........................  Iodine I-125        CH..............  H2.............  ...........       $28.62
                                  sodium iodide.
A9698..........................  Non-rad contrast    ................  N1.............  ...........  ...........
                                  materialNOC.
C1713..........................  Anchor/screw bn/    ................  N1.............  ...........  ...........
                                  bn,tis/bn.
C1714..........................  Cath, trans         ................  N1.............  ...........  ...........
                                  atherectomy, dir.
C1715..........................  Brachytherapy       ................  N1.............  ...........  ...........
                                  needle.
C1716..........................  Brachytx source,    CH..............  H2.............  ...........       $31.95
                                  Gold 198.
C1717..........................  Brachytx source,    CH..............  H2.............  ...........      $173.40
                                  HDR Ir-192.
C1719..........................  Brachytx sour,Non-  CH..............  H2.............  ...........       $57.40
                                  HDR Ir-192.
C1721..........................  AICD, dual chamber  ................  N1.............  ...........  ...........
C1722..........................  AICD, single        ................  N1.............  ...........  ...........
                                  chamber.
C1724..........................  Cath, trans         ................  N1.............  ...........  ...........
                                  atherec,rotation.
C1725..........................  Cath, translumin    ................  N1.............  ...........  ...........
                                  non-laser.
C1726..........................  Cath, bal dil, non- ................  N1.............  ...........  ...........
                                  vascular.
C1727..........................  Cath, bal tis dis,  ................  N1.............  ...........  ...........
                                  non-vas.
C1728..........................  Cath, brachytx      ................  N1.............  ...........  ...........
                                  seed adm.
C1729..........................  Cath, drainage....  ................  N1.............  ...........  ...........
C1730..........................  Cath, EP, 19 or     ................  N1.............  ...........  ...........
                                  few elect.
C1731..........................  Cath, EP, 20 or     ................  N1.............  ...........  ...........
                                  more elec.
C1732..........................  Cath, EP, diag/     ................  N1.............  ...........  ...........
                                  abl, 3D/vect.
C1733..........................  Cath, EP, othr      ................  N1.............  ...........  ...........
                                  than cool-tip.
C1750..........................  Cath,               ................  N1.............  ...........  ...........
                                  hemodialysis,long-
                                  term.
C1751..........................  Cath, inf, per/     ................  N1.............  ...........  ...........
                                  cent/midline.
C1752..........................  Cath,hemodialysis,  ................  N1.............  ...........  ...........
                                  short-term.
C1753..........................  Cath, intravas      ................  N1.............  ...........  ...........
                                  ultrasound.
C1754..........................  Catheter,           ................  N1.............  ...........  ...........
                                  intradiscal.
C1755..........................  Catheter,           ................  N1.............  ...........  ...........
                                  intraspinal.
C1756..........................  Cath, pacing,       ................  N1.............  ...........  ...........
                                  transesoph.
C1757..........................  Cath, thrombectomy/ ................  N1.............  ...........  ...........
                                  embolect.
C1758..........................  Catheter, ureteral  ................  N1.............  ...........  ...........
C1759..........................  Cath, intra         ................  N1.............  ...........  ...........
                                  echocardiography.
C1760..........................  Closure dev, vasc.  ................  N1.............  ...........  ...........
C1762..........................  Conn tiss,          ................  N1.............  ...........  ...........
                                  human(inc fascia).
C1763..........................  Conn tiss, non-     ................  N1.............  ...........  ...........
                                  human.
C1764..........................  Event recorder,     ................  N1.............  ...........  ...........
                                  cardiac.
C1765..........................  Adhesion barrier..  ................  N1.............  ...........  ...........
C1766..........................  Intro/              ................  N1.............  ...........  ...........
                                  sheath,strble,non-
                                  peel.
C1767..........................  Generator, neuro    ................  N1.............  ...........  ...........
                                  non-recharg.

[[Page 43078]]

 
C1768..........................  Graft, vascular...  ................  N1.............  ...........  ...........
C1769..........................  Guide wire........  ................  N1.............  ...........  ...........
C1770..........................  Imaging coil, MR,   ................  N1.............  ...........  ...........
                                  insertable.
C1771..........................  Rep dev, urinary,   ................  N1.............  ...........  ...........
                                  w/sling.
C1772..........................  Infusion pump,      ................  N1.............  ...........  ...........
                                  programmable.
C1773..........................  Ret dev,            ................  N1.............  ...........  ...........
                                  insertable.
C1776..........................  Joint device        ................  N1.............  ...........  ...........
                                  (implantable).
C1777..........................  Lead, AICD, endo    ................  N1.............  ...........  ...........
                                  single coil.
C1778..........................  Lead,               ................  N1.............  ...........  ...........
                                  neurostimulator.
C1779..........................  Lead, pmkr,         ................  N1.............  ...........  ...........
                                  transvenous VDD.
C1780..........................  Lens, intraocular   ................  N1.............  ...........  ...........
                                  (new tech).
C1781..........................  Mesh (implantable)  ................  N1.............  ...........  ...........
C1782..........................  Morcellator.......  ................  N1.............  ...........  ...........
C1783..........................  Ocular imp,         ................  N1.............  ...........  ...........
                                  aqueous drain de.
C1784..........................  Ocular dev,         ................  N1.............  ...........  ...........
                                  intraop, det ret.
C1785..........................  Pmkr, dual, rate-   ................  N1.............  ...........  ...........
                                  resp.
C1786..........................  Pmkr, single, rate- ................  N1.............  ...........  ...........
                                  resp.
C1787..........................  Patient progr,      ................  N1.............  ...........  ...........
                                  neurostim.
C1788..........................  Port, indwelling,   ................  N1.............  ...........  ...........
                                  imp.
C1789..........................  Prosthesis,         ................  N1.............  ...........  ...........
                                  breast, imp.
C1813..........................  Prosthesis,         ................  N1.............  ...........  ...........
                                  penile, inflatab.
C1814..........................  Retinal tamp,       ................  N1.............  ...........  ...........
                                  silicone oil.
C1815..........................  Pros, urinary sph,  ................  N1.............  ...........  ...........
                                  imp.
C1816..........................  Receiver/           ................  N1.............  ...........  ...........
                                  transmitter,
                                  neuro.
C1817..........................  Septal defect imp   ................  N1.............  ...........  ...........
                                  sys.
C1818..........................  Integrated          ................  N1.............  ...........  ...........
                                  keratoprosthesis.
C1819..........................  Tissue              ................  N1.............  ...........  ...........
                                  localization-
                                  excision.
C1820..........................  Generator neuro     CH..............  N1.............  ...........  ...........
                                  rechg bat sy.
C1821..........................  Interspinous        ................  J7.............  ...........  ...........
                                  implant.
C1874..........................  Stent, coated/cov   ................  N1.............  ...........  ...........
                                  w/del sys.
C1875..........................  Stent, coated/cov   ................  N1.............  ...........  ...........
                                  w/o del sy.
C1876..........................  Stent, non-coa/non- ................  N1.............  ...........  ...........
                                  cov w/del.
C1877..........................  Stent, non-coat/    ................  N1.............  ...........  ...........
                                  cov w/o del.
C1878..........................  Matrl for vocal     ................  N1.............  ...........  ...........
                                  cord.
C1879..........................  Tissue marker,      ................  N1.............  ...........  ...........
                                  implantable.
C1880..........................  Vena cava filter..  ................  N1.............  ...........  ...........
C1881..........................  Dialysis access     ................  N1.............  ...........  ...........
                                  system.
C1882..........................  AICD, other than    ................  N1.............  ...........  ...........
                                  sing/dual.
C1883..........................  Adapt/ext, pacing/  ................  N1.............  ...........  ...........
                                  neuro lead.
C1884..........................  Embolization        ................  N1.............  ...........  ...........
                                  Protect syst.
C1885..........................  Cath, translumin    ................  N1.............  ...........  ...........
                                  angio laser.
C1887..........................  Catheter, guiding.  ................  N1.............  ...........  ...........
C1888..........................  Endovas non-        ................  N1.............  ...........  ...........
                                  cardiac abl cath.
C1891..........................  Infusion pump,non-  ................  N1.............  ...........  ...........
                                  prog, perm.
C1892..........................  Intro/              ................  N1.............  ...........  ...........
                                  sheath,fixed,peel-
                                  away.
C1893..........................  Intro/sheath,       ................  N1.............  ...........  ...........
                                  fixed,non-peel.
C1894..........................  Intro/sheath, non-  ................  N1.............  ...........  ...........
                                  laser.
C1895..........................  Lead, AICD, endo    ................  N1.............  ...........  ...........
                                  dual coil.
C1896..........................  Lead, AICD, non     ................  N1.............  ...........  ...........
                                  sing/dual.
C1897..........................  Lead, neurostim     ................  N1.............  ...........  ...........
                                  test kit.
C1898..........................  Lead, pmkr, other   ................  N1.............  ...........  ...........
                                  than trans.
C1899..........................  Lead, pmkr/AICD     ................  N1.............  ...........  ...........
                                  combination.
C1900..........................  Lead, coronary      ................  N1.............  ...........  ...........
                                  venous.
C2614..........................  Probe, perc lumb    ................  N1.............  ...........  ...........
                                  disc.
C2615..........................  Sealant,            ................  N1.............  ...........  ...........
                                  pulmonary, liquid.
C2616..........................  Brachytx source,    CH..............  H2.............  ...........   $11,943.79
                                  Yttrium-90.
C2617..........................  Stent, non-cor,     ................  N1.............  ...........  ...........
                                  tem w/o del.
C2618..........................  Probe,              ................  N1.............  ...........  ...........
                                  cryoablation.
C2619..........................  Pmkr, dual, non     ................  N1.............  ...........  ...........
                                  rate-resp.
C2620..........................  Pmkr, single, non   ................  N1.............  ...........  ...........
                                  rate-resp.
C2621..........................  Pmkr, other than    ................  N1.............  ...........  ...........
                                  sing/dual.
C2622..........................  Prosthesis,         ................  N1.............  ...........  ...........
                                  penile, non-inf.
C2625..........................  Stent, non-cor,     ................  N1.............  ...........  ...........
                                  tem w/del sy.
C2626..........................  Infusion pump, non- ................  N1.............  ...........  ...........
                                  prog,temp.
C2627..........................  Cath, suprapubic/   ................  N1.............  ...........  ...........
                                  cystoscopic.
C2628..........................  Catheter,           ................  N1.............  ...........  ...........
                                  occlusion.
C2629..........................  Intro/sheath,       ................  N1.............  ...........  ...........
                                  laser.
C2630..........................  Cath, EP, cool-tip  ................  N1.............  ...........  ...........

[[Page 43079]]

 
C2631..........................  Rep dev, urinary,   ................  N1.............  ...........  ...........
                                  w/o sling.
C2634..........................  Brachytx source,    CH..............  H2.............  ...........       $29.93
                                  HA, I-125.
C2635..........................  Brachytx source,    CH..............  H2.............  ...........       $47.06
                                  HA, P-103.
C2636..........................  Brachytx linear     CH..............  H2.............  ...........       $37.09
                                  source,P-103.
C8900..........................  MRA w/cont, abd...  ................  Z2.............       6.7963      $281.37
C8901..........................  MRA w/o cont, abd.  ................  Z2.............       5.7101      $236.40
C8902..........................  MRA w/o fol w/      ................  Z2.............       8.6689      $358.89
                                  cont, abd.
C8903..........................  MRI w/cont,         ................  Z2.............       6.7963      $281.37
                                  breast, uni.
C8904..........................  MRI w/o cont,       ................  Z2.............       5.7101      $236.40
                                  breast, uni.
C8905..........................  MRI w/o fol w/      ................  Z2.............       8.6689      $358.89
                                  cont, brst, un.
C8906..........................  MRI w/cont,         ................  Z2.............       6.7963      $281.37
                                  breast, bi.
C8907..........................  MRI w/o cont,       ................  Z2.............       5.7101      $236.40
                                  breast, bi.
C8908..........................  MRI w/o fol w/      ................  Z2.............       8.6689      $358.89
                                  cont, breast,.
C8909..........................  MRA w/cont, chest.  ................  Z2.............       6.7963      $281.37
C8910..........................  MRA w/o cont,       ................  Z2.............       5.7101      $236.40
                                  chest.
C8911..........................  MRA w/o fol w/      ................  Z2.............       8.6689      $358.89
                                  cont, chest.
C8912..........................  MRA w/cont, lwr     ................  Z2.............       6.7963      $281.37
                                  ext.
C8913..........................  MRA w/o cont, lwr   ................  Z2.............       5.7101      $236.40
                                  ext.
C8914..........................  MRA w/o fol w/      ................  Z2.............       8.6689      $358.89
                                  cont, lwr ext.
C8918..........................  MRA w/cont, pelvis  ................  Z2.............       6.7963      $281.37
C8919..........................  MRA w/o cont,       ................  Z2.............       5.7101      $236.40
                                  pelvis.
C8920..........................  MRA w/o fol w/      ................  Z2.............       8.6689      $358.89
                                  cont, pelvis.
C9003..........................  Palivizumab, per    ................  K2.............  ...........      $677.97
                                  50 mg.
C9113..........................  Inj pantoprazole    ................  N1.............  ...........  ...........
                                  sodium, via.
C9121..........................  Injection,          ................  K2.............  ...........       $17.87
                                  argatroban.
C9232..........................  Injection,          ................  K2.............  ...........      $455.03
                                  idursulfase.
C9233..........................  Injection,          ................  K2.............  ...........    $2,030.92
                                  ranibizumab.
C9234..........................  Inj, alglucosidase  ................  K2.............  ...........        $1.26
                                  alfa.
C9235..........................  Injection,          ................  K2.............  ...........       $84.80
                                  panitumumab.
C9350..........................  Porous collagen     ................  K2.............  ...........      $485.91
                                  tube per cm.
C9351..........................  Acellular derm      ................  K2.............  ...........       $41.59
                                  tissue percm2.
C9399..........................  Unclassified drugs  ................  K7.............  ...........  ...........
                                  or biolog.
E0616..........................  Cardiac event       ................  N1.............  ...........  ...........
                                  recorder.
E0749..........................  Elec osteogen stim  ................  N1.............  ...........  ...........
                                  implanted.
E0782..........................  Non-programble      ................  N1.............  ...........  ...........
                                  infusion pump.
E0783..........................  Programmable        ................  N1.............  ...........  ...........
                                  infusion pump.
E0785..........................  Replacement impl    ................  N1.............  ...........  ...........
                                  pump cathet.
E0786..........................  Implantable pump    ................  N1.............  ...........  ...........
                                  replacement.
G0130..........................  Single energy x-    ................  Z3.............       0.5278       $21.85
                                  ray study.
G0173..........................  Linear acc stereo   ................  Z2.............      61.5205    $2,546.95
                                  radsur com.
G0251..........................  Linear acc based    ................  Z2.............      17.1992      $712.05
                                  stero radio.
G0259..........................  Inject for          ................  N1.............  ...........  ...........
                                  sacroiliac joint.
G0269..........................  Occlusive device    ................  N1.............  ...........  ...........
                                  in vein art.
G0288..........................  Recon, CTA for      CH..............  N1.............  ...........  ...........
                                  surg plan.
G0289..........................  Arthro, loose body  ................  N1.............  ...........  ...........
                                  + chondro.
G0339..........................  Robot lin-radsurg   ................  Z2.............      61.5205    $2,546.95
                                  com, first.
G0340..........................  Robt lin-radsurg    ................  Z2.............      47.3767    $1,961.40
                                  fractx 2-5.
J0120..........................  Tetracyclin         ................  N1.............  ...........  ...........
                                  injection.
J0128..........................  Abarelix injection  ................  K2.............  ...........       $67.97
J0129..........................  Abatacept           ................  K2.............  ...........       $18.69
                                  injection.
J0130..........................  Abciximab           ................  K2.............  ...........      $409.26
                                  injection.
J0132..........................  Acetylcysteine      CH..............  N1.............  ...........  ...........
                                  injection.
J0133..........................  Acyclovir           ................  N1.............  ...........  ...........
                                  injection.
J0135..........................  Adalimumab          ................  K2.............  ...........      $316.02
                                  injection.
J0150..........................  Injection           ................  K2.............  ...........       $22.65
                                  adenosine 6 MG.
J0152..........................  Adenosine           ................  K2.............  ...........       $68.50
                                  injection.
J0170..........................  Adrenalin           ................  N1.............  ...........  ...........
                                  epinephrin inject.
J0180..........................  Agalsidase beta     ................  K2.............  ...........        $1.26
                                  injection.
J0190..........................  Inj biperiden       CH..............  N1.............  ...........  ...........
                                  lactate/5 mg.
J0200..........................  Alatrofloxacin      ................  N1.............  ...........  ...........
                                  mesylate.
J0205..........................  Alglucerase         ................  K2.............  ...........       $38.85
                                  injection.
J0207..........................  Amifostine........  ................  K2.............  ...........      $476.10
J0210..........................  Methyldopate hcl    ................  K2.............  ...........       $10.01
                                  injection.
J0215..........................  Alefacept.........  ................  K2.............  ...........       $25.82
J0256..........................  Alpha 1 proteinase  ................  K2.............  ...........        $3.24
                                  inhibitor.
J0278..........................  Amikacin sulfate    ................  N1.............  ...........  ...........
                                  injection.
J0280..........................  Aminophyllin 250    ................  N1.............  ...........  ...........
                                  MG inj.
J0282..........................  Amiodarone HCl....  ................  N1.............  ...........  ...........

[[Page 43080]]

 
J0285..........................  Amphotericin B....  ................  N1.............  ...........  ...........
J0287..........................  Amphotericin b      ................  K2.............  ...........       $10.28
                                  lipid complex.
J0288..........................  Ampho b             ................  K2.............  ...........       $11.89
                                  cholesteryl
                                  sulfate.
J0289..........................  Amphotericin b      ................  K2.............  ...........       $17.07
                                  liposome inj.
J0290..........................  Ampicillin 500 MG   ................  N1.............  ...........  ...........
                                  inj.
J0295..........................  Ampicillin sodium   ................  N1.............  ...........  ...........
                                  per 1.5 gm.
J0300..........................  Amobarbital 125 MG  ................  N1.............  ...........  ...........
                                  inj.
J0330..........................  Succinycholine      ................  N1.............  ...........  ...........
                                  chloride inj.
J0348..........................  Anadulafungin       ................  K2.............  ...........        $1.91
                                  injection.
J0350..........................  Injection           ................  K2.............  ...........    $2,693.80
                                  anistreplase 30 u.
J0360..........................  Hydralazine hcl     ................  N1.............  ...........  ...........
                                  injection.
J0364..........................  Apomorphine         CH..............  N1.............  ...........  ...........
                                  hydrochloride.
J0365..........................  Aprotonin, 10,000   ................  K2.............  ...........        $2.50
                                  kiu.
J0380..........................  Inj metaraminol     CH..............  N1.............  ...........  ...........
                                  bitartrate.
J0390..........................  Chloroquine         ................  N1.............  ...........  ...........
                                  injection.
J0395..........................  Arbutamine HCl      CH..............  N1.............  ...........  ...........
                                  injection.
J0456..........................  Azithromycin......  ................  N1.............  ...........  ...........
J0460..........................  Atropine sulfate    ................  N1.............  ...........  ...........
                                  injection.
J0470..........................  Dimecaprol          ................  N1.............  ...........  ...........
                                  injection.
J0475..........................  Baclofen 10 MG      ................  K2.............  ...........      $195.18
                                  injection.
J0476..........................  Baclofen            ................  K2.............  ...........       $70.92
                                  intrathecal trial.
J0480..........................  Basiliximab.......  ................  K2.............  ...........    $1,347.14
J0500..........................  Dicyclomine         ................  N1.............  ...........  ...........
                                  injection.
J0515..........................  Inj benztropine     ................  N1.............  ...........  ...........
                                  mesylate.
J0520..........................  Bethanechol         CH..............  K2.............  ...........       $32.66
                                  chloride inject.
J0530..........................  Penicillin g        ................  N1.............  ...........  ...........
                                  benzathine inj.
J0540..........................  Penicillin g        ................  N1.............  ...........  ...........
                                  benzathine inj.
J0550..........................  Penicillin g        ................  N1.............  ...........  ...........
                                  benzathine inj.
J0560..........................  Penicillin g        ................  N1.............  ...........  ...........
                                  benzathine inj.
J0570..........................  Penicillin g        ................  N1.............  ...........  ...........
                                  benzathine inj.
J0580..........................  Penicillin g        ................  N1.............  ...........  ...........
                                  benzathine inj.
J0583..........................  Bivalirudin.......  ................  K2.............  ...........        $1.72
J0585..........................  Botulinum toxin a   ................  K2.............  ...........        $5.05
                                  per unit.
J0587..........................  Botulinum toxin     ................  K2.............  ...........        $8.30
                                  type B.
J0592..........................  Buprenorphine       ................  N1.............  ...........  ...........
                                  hydrochloride.
J0594..........................  Busulfan injection  ................  K2.............  ...........        $8.80
J0595..........................  Butorphanol         ................  N1.............  ...........  ...........
                                  tartrate 1 mg.
J0600..........................  Edetate calcium     CH..............  N1.............  ...........  ...........
                                  disodium inj.
J0610..........................  Calcium gluconate   ................  N1.............  ...........  ...........
                                  injection.
J0620..........................  Calcium glycer &    ................  N1.............  ...........  ...........
                                  lact/10 ML.
J0630..........................  Calcitonin salmon   ................  N1.............  ...........  ...........
                                  injection.
J0636..........................  Inj calcitriol per  ................  N1.............  ...........  ...........
                                  0.1 mcg.
J0637..........................  Caspofungin         ................  K2.............  ...........       $30.07
                                  acetate.
J0640..........................  Leucovorin calcium  ................  N1.............  ...........  ...........
                                  injection.
J0670..........................  Inj mepivacaine     ................  N1.............  ...........  ...........
                                  HCL/10 ml.
J0690..........................  Cefazolin sodium    ................  N1.............  ...........  ...........
                                  injection.
J0692..........................  Cefepime HCl for    ................  N1.............  ...........  ...........
                                  injection.
J0694..........................  Cefoxitin sodium    ................  N1.............  ...........  ...........
                                  injection.
J0696..........................  Ceftriaxone sodium  ................  N1.............  ...........  ...........
                                  injection.
J0697..........................  Sterile cefuroxime  ................  N1.............  ...........  ...........
                                  injection.
J0698..........................  Cefotaxime sodium   ................  N1.............  ...........  ...........
                                  injection.
J0702..........................  Betamethasone       ................  N1.............  ...........  ...........
                                  acet&sod phosp.
J0704..........................  Betamethasone sod   ................  N1.............  ...........  ...........
                                  phosp/4 MG.
J0706..........................  Caffeine citrate    CH..............  N1.............  ...........  ...........
                                  injection.
J0710..........................  Cephapirin sodium   ................  N1.............  ...........  ...........
                                  injection.
J0713..........................  Inj ceftazidime     ................  N1.............  ...........  ...........
                                  per 500 mg.
J0715..........................  Ceftizoxime sodium  ................  N1.............  ...........  ...........
                                  / 500 MG.
J0720..........................  Chloramphenicol     ................  N1.............  ...........  ...........
                                  sodium injec.
J0725..........................  Chorionic           ................  N1.............  ...........  ...........
                                  gonadotropin/
                                  1000u.
J0735..........................  Clonidine           ................  K2.............  ...........       $62.86
                                  hydrochloride.
J0740..........................  Cidofovir           ................  K2.............  ...........      $754.62
                                  injection.
J0743..........................  Cilastatin sodium   ................  N1.............  ...........  ...........
                                  injection.
J0744..........................  Ciprofloxacin iv..  ................  N1.............  ...........  ...........
J0745..........................  Inj codeine         ................  N1.............  ...........  ...........
                                  phosphate /30 MG.
J0760..........................  Colchicine          ................  N1.............  ...........  ...........
                                  injection.
J0770..........................  Colistimethate      ................  N1.............  ...........  ...........
                                  sodium inj.
J0780..........................  Prochlorperazine    ................  N1.............  ...........  ...........
                                  injection.
J0795..........................  Corticorelin ovine  ................  K2.............  ...........        $4.26
                                  triflutal.

[[Page 43081]]

 
J0800..........................  Corticotropin       ................  K2.............  ...........      $126.52
                                  injection.
J0835..........................  Inj cosyntropin     ................  K2.............  ...........       $63.25
                                  per 0.25 MG.
J0850..........................  Cytomegalovirus     ................  K2.............  ...........      $859.86
                                  imm IV /vial.
J0878..........................  Daptomycin          ................  K2.............  ...........        $0.33
                                  injection.
J0881..........................  Darbepoetin alfa,   ................  K2.............  ...........        $3.11
                                  non-esrd.
J0885..........................  Epoetin alfa, non-  ................  K2.............  ...........        $9.36
                                  esrd.
J0894..........................  Decitabine          ................  K2.............  ...........       $26.48
                                  injection.
J0895..........................  Deferoxamine        CH..............  N1.............  ...........  ...........
                                  mesylate inj.
J0900..........................  Testosterone        ................  N1.............  ...........  ...........
                                  enanthate inj.
J0945..........................  Brompheniramine     ................  N1.............  ...........  ...........
                                  maleate inj.
J0970..........................  Estradiol valerate  ................  N1.............  ...........  ...........
                                  injection.
J1000..........................  Depo-estradiol      ................  N1.............  ...........  ...........
                                  cypionate inj.
J1020..........................  Methylprednisolone  ................  N1.............  ...........  ...........
                                  20 MG inj.
J1030..........................  Methylprednisolone  ................  N1.............  ...........  ...........
                                  40 MG inj.
J1040..........................  Methylprednisolone  ................  N1.............  ...........  ...........
                                  80 MG inj.
J1051..........................  Medroxyprogesteron  ................  N1.............  ...........  ...........
                                  e inj.
J1060..........................  Testosterone        ................  N1.............  ...........  ...........
                                  cypionate 1 ML.
J1070..........................  Testosterone        ................  N1.............  ...........  ...........
                                  cypionat 100 MG.
J1080..........................  Testosterone        ................  N1.............  ...........  ...........
                                  cypionat 200 MG.
J1094..........................  Inj dexamethasone   ................  N1.............  ...........  ...........
                                  acetate.
J1100..........................  Dexamethasone       ................  N1.............  ...........  ...........
                                  sodium phos.
J1110..........................  Inj                 ................  N1.............  ...........  ...........
                                  dihydroergotamine
                                  mesylt.
J1120..........................  Acetazolamid        ................  N1.............  ...........  ...........
                                  sodium injectio.
J1160..........................  Digoxin injection.  ................  N1.............  ...........  ...........
J1162..........................  Digoxin immune fab  ................  K2.............  ...........      $511.48
                                  (ovine).
J1165..........................  Phenytoin sodium    ................  N1.............  ...........  ...........
                                  injection.
J1170..........................  Hydromorphone       ................  N1.............  ...........  ...........
                                  injection.
J1180..........................  Dyphylline          ................  N1.............  ...........  ...........
                                  injection.
J1190..........................  Dexrazoxane HCl     ................  K2.............  ...........      $172.43
                                  injection.
J1200..........................  Diphenhydramine     ................  N1.............  ...........  ...........
                                  hcl injectio.
J1205..........................  Chlorothiazide      ................  K2.............  ...........      $122.67
                                  sodium inj.
J1212..........................  Dimethyl sulfoxide  ................  N1.............  ...........  ...........
                                  50% 50 ML.
J1230..........................  Methadone           ................  N1.............  ...........  ...........
                                  injection.
J1240..........................  Dimenhydrinate      ................  N1.............  ...........  ...........
                                  injection.
J1245..........................  Dipyridamole        ................  N1.............  ...........  ...........
                                  injection.
J1250..........................  Inj dobutamine HCL/ ................  N1.............  ...........  ...........
                                  250 mg.
J1260..........................  Dolasetron          ................  K2.............  ...........        $6.05
                                  mesylate.
J1265..........................  Dopamine injection  ................  N1.............  ...........  ...........
J1270..........................  Injection,          ................  N1.............  ...........  ...........
                                  doxercalciferol.
J1320..........................  Amitriptyline       ................  N1.............  ...........  ...........
                                  injection.
J1324..........................  Enfuvirtide         ................  K2.............  ...........       $22.69
                                  injection.
J1325..........................  Epoprostenol        ................  N1.............  ...........  ...........
                                  injection.
J1327..........................  Eptifibatide        ................  K2.............  ...........       $15.90
                                  injection.
J1330..........................  Ergonovine maleate  CH..............  N1.............  ...........  ...........
                                  injection.
J1335..........................  Ertapenem           ................  N1.............  ...........  ...........
                                  injection.
J1364..........................  Erythro             ................  N1.............  ...........  ...........
                                  lactobionate /500
                                  MG.
J1380..........................  Estradiol valerate  ................  N1.............  ...........  ...........
                                  10 MG inj.
J1390..........................  Estradiol valerate  ................  N1.............  ...........  ...........
                                  20 MG inj.
J1410..........................  Inj estrogen        ................  K2.............  ...........       $60.32
                                  conjugate 25 MG.
J1430..........................  Ethanolamine        ................  K2.............  ...........       $78.26
                                  oleate 100 mg.
J1435..........................  Injection estrone   ................  N1.............  ...........  ...........
                                  per 1 MG.
J1436..........................  Etidronate          ................  K2.............  ...........       $70.73
                                  disodium inj.
J1438..........................  Etanercept          ................  K2.............  ...........      $160.03
                                  injection.
J1440..........................  Filgrastim 300 mcg  ................  K2.............  ...........      $187.68
                                  injection.
J1441..........................  Filgrastim 480 mcg  ................  K2.............  ...........      $297.75
                                  injection.
J1450..........................  Fluconazole.......  ................  N1.............  ...........  ...........
J1451..........................  Fomepizole, 15 mg.  ................  K2.............  ...........       $12.28
J1452..........................  Intraocular         CH..............  N1.............  ...........  ...........
                                  Fomivirsen na.
J1455..........................  Foscarnet sodium    CH..............  N1.............  ...........  ...........
                                  injection.
J1457..........................  Gallium nitrate     CH..............  K2.............  ...........        $1.47
                                  injection.
J1458..........................  Galsulfase          ................  K2.............  ...........      $297.09
                                  injection.
J1460..........................  Gamma globulin 1    ................  K2.............  ...........       $11.31
                                  CC inj.
J1470..........................  Gamma globulin 2    CH..............  K2.............  ...........       $22.63
                                  CC inj.
J1480..........................  Gamma globulin 3    CH..............  K2.............  ...........       $33.93
                                  CC inj.
J1490..........................  Gamma globulin 4    CH..............  K2.............  ...........       $45.25
                                  CC inj.
J1500..........................  Gamma globulin 5    CH..............  K2.............  ...........       $56.56
                                  CC inj.
J1510..........................  Gamma globulin 6    CH..............  K2.............  ...........       $67.91
                                  CC inj.
J1520..........................  Gamma globulin 7    CH..............  K2.............  ...........       $79.14
                                  CC inj.

[[Page 43082]]

 
J1530..........................  Gamma globulin 8    CH..............  K2.............  ...........       $90.50
                                  CC inj.
J1540..........................  Gamma globulin 9    CH..............  K2.............  ...........      $101.88
                                  CC inj.
J1550..........................  Gamma globulin 10   CH..............  K2.............  ...........      $113.13
                                  CC inj.
J1560..........................  Gamma globulin >    CH..............  K2.............  ...........      $113.13
                                  10 CC inj.
J1562..........................  Immune globulin     ................  K2.............  ...........       $12.60
                                  subcutaneous.
J1565..........................  RSV-ivig..........  ................  K2.............  ...........       $16.02
J1566..........................  Immune globulin,    ................  K2.............  ...........       $25.48
                                  powder.
J1567..........................  Immune globulin,    ................  K2.............  ...........       $30.28
                                  liquid.
J1570..........................  Ganciclovir sodium  ................  N1.............  ...........  ...........
                                  injection.
J1580..........................  Garamycin           ................  N1.............  ...........  ...........
                                  gentamicin inj.
J1590..........................  Gatifloxacin        ................  N1.............  ...........  ...........
                                  injection.
J1595..........................  Injection           ................  N1.............  ...........  ...........
                                  glatiramer
                                  acetate.
J1600..........................  Gold sodium         ................  N1.............  ...........  ...........
                                  thiomaleate inj.
J1610..........................  Glucagon            ................  K2.............  ...........       $65.64
                                  hydrochloride/1
                                  MG.
J1620..........................  Gonadorelin         ................  K2.............  ...........      $178.59
                                  hydroch/ 100 mcg.
J1626..........................  Granisetron HCl     ................  K2.............  ...........        $7.43
                                  injection.
J1630..........................  Haloperidol         ................  N1.............  ...........  ...........
                                  injection.
J1631..........................  Haloperidol         ................  N1.............  ...........  ...........
                                  decanoate inj.
J1640..........................  Hemin, 1 mg.......  ................  K2.............  ...........        $6.74
J1642..........................  Inj heparin sodium  ................  N1.............  ...........  ...........
                                  per 10 u.
J1644..........................  Inj heparin sodium  ................  N1.............  ...........  ...........
                                  per 1000u.
J1645..........................  Dalteparin sodium.  ................  N1.............  ...........  ...........
J1650..........................  Inj enoxaparin      ................  N1.............  ...........  ...........
                                  sodium.
J1652..........................  Fondaparinux        CH..............  K2.............  ...........        $5.82
                                  sodium.
J1655..........................  Tinzaparin sodium   CH..............  N1.............  ...........  ...........
                                  injection.
J1670..........................  Tetanus immune      ................  K2.............  ...........       $96.35
                                  globulin inj.
J1700..........................  Hydrocortisone      ................  N1.............  ...........  ...........
                                  acetate inj.
J1710..........................  Hydrocortisone      ................  N1.............  ...........  ...........
                                  sodium ph inj.
J1720..........................  Hydrocortisone      ................  N1.............  ...........  ...........
                                  sodium succ i.
J1730..........................  Diazoxide           ................  K2.............  ...........      $113.24
                                  injection.
J1740..........................  Ibandronate sodium  ................  K2.............  ...........      $138.71
                                  injection.
J1742..........................  Ibutilide fumarate  ................  K2.............  ...........      $264.40
                                  injection.
J1745..........................  Infliximab          ................  K2.............  ...........       $53.25
                                  injection.
J1751..........................  Iron dextran 165    ................  K2.............  ...........       $11.61
                                  injection.
J1752..........................  Iron dextran 267    ................  K2.............  ...........       $10.32
                                  injection.
J1756..........................  Iron sucrose        ................  K2.............  ...........        $0.37
                                  injection.
J1785..........................  Injection           ................  K2.............  ...........        $3.89
                                  imiglucerase /
                                  unit.
J1790..........................  Droperidol          ................  N1.............  ...........  ...........
                                  injection.
J1800..........................  Propranolol         ................  N1.............  ...........  ...........
                                  injection.
J1815..........................  Insulin injection.  ................  N1.............  ...........  ...........
J1817..........................  Insulin for         ................  N1.............  ...........  ...........
                                  insulin pump use.
J1830..........................  Interferon beta-1b  ................  K2.............  ...........       $84.12
                                  / .25 MG.
J1835..........................  Itraconazole        ................  K2.............  ...........       $38.05
                                  injection.
J1840..........................  Kanamycin sulfate   ................  N1.............  ...........  ...........
                                  500 MG inj.
J1850..........................  Kanamycin sulfate   ................  N1.............  ...........  ...........
                                  75 MG inj.
J1885..........................  Ketorolac           ................  N1.............  ...........  ...........
                                  tromethamine inj.
J1890..........................  Cephalothin sodium  ................  N1.............  ...........  ...........
                                  injection.
J1931..........................  Laronidase          ................  K2.............  ...........       $23.64
                                  injection.
J1940..........................  Furosemide          ................  N1.............  ...........  ...........
                                  injection.
J1945..........................  Lepirudin.........  ................  K2.............  ...........      $153.42
J1950..........................  Leuprolide acetate  ................  K2.............  ...........      $429.83
                                  /3.75 MG.
J1956..........................  Levofloxacin        ................  N1.............  ...........  ...........
                                  injection.
J1960..........................  Levorphanol         ................  N1.............  ...........  ...........
                                  tartrate inj.
J1980..........................  Hyoscyamine         ................  N1.............  ...........  ...........
                                  sulfate inj.
J1990..........................  Chlordiazepoxide    ................  N1.............  ...........  ...........
                                  injection.
J2001..........................  Lidocaine           ................  N1.............  ...........  ...........
                                  injection.
J2010..........................  Lincomycin          ................  N1.............  ...........  ...........
                                  injection.
J2020..........................  Linezolid           ................  K2.............  ...........       $24.93
                                  injection.
J2060..........................  Lorazepam           ................  N1.............  ...........  ...........
                                  injection.
J2150..........................  Mannitol injection  ................  N1.............  ...........  ...........
J2170..........................  Mecasermin          ................  K2.............  ...........       $11.81
                                  injection.
J2175..........................  Meperidine          ................  N1.............  ...........  ...........
                                  hydrochl /100 MG.
J2180..........................  Meperidine/         ................  N1.............  ...........  ...........
                                  promethazine inj.
J2185..........................  Meropenem.........  CH..............  N1.............  ...........  ...........
J2210..........................  Methylergonovin     ................  N1.............  ...........  ...........
                                  maleate inj.
J2248..........................  Micafungin sodium   ................  K2.............  ...........        $1.71
                                  injection.
J2250..........................  Inj midazolam       ................  N1.............  ...........  ...........
                                  hydrochloride.
J2260..........................  Inj milrinone       ................  N1.............  ...........  ...........
                                  lactate / 5 MG.

[[Page 43083]]

 
J2270..........................  Morphine sulfate    ................  N1.............  ...........  ...........
                                  injection.
J2271..........................  Morphine so4        ................  N1.............  ...........  ...........
                                  injection 100mg.
J2275..........................  Morphine sulfate    ................  N1.............  ...........  ...........
                                  injection.
J2278..........................  Ziconotide          ................  K2.............  ...........        $6.46
                                  injection.
J2280..........................  Inj, moxifloxacin   ................  N1.............  ...........  ...........
                                  100 mg.
J2300..........................  Inj nalbuphine      ................  N1.............  ...........  ...........
                                  hydrochloride.
J2310..........................  Inj naloxone        ................  N1.............  ...........  ...........
                                  hydrochloride.
J2315..........................  Naltrexone, depot   ................  K2.............  ...........        $1.88
                                  form.
J2320..........................  Nandrolone          ................  N1.............  ...........  ...........
                                  decanoate 50 MG.
J2321..........................  Nandrolone          ................  N1.............  ...........  ...........
                                  decanoate 100 MG.
J2322..........................  Nandrolone          ................  N1.............  ...........  ...........
                                  decanoate 200 MG.
J2325..........................  Nesiritide          ................  K2.............  ...........       $31.36
                                  injection.
J2353..........................  Octreotide          ................  K2.............  ...........       $95.86
                                  injection, depot.
J2354..........................  Octreotide inj,     ................  N1.............  ...........  ...........
                                  non-depot.
J2355..........................  Oprelvekin          ................  K2.............  ...........      $244.98
                                  injection.
J2357..........................  Omalizumab          ................  K2.............  ...........       $16.79
                                  injection.
J2360..........................  Orphenadrine        ................  N1.............  ...........  ...........
                                  injection.
J2370..........................  Phenylephrine hcl   ................  N1.............  ...........  ...........
                                  injection.
J2400..........................  Chloroprocaine hcl  ................  N1.............  ...........  ...........
                                  injection.
J2405..........................  Ondansetron hcl     ................  K2.............  ...........        $3.37
                                  injection.
J2410..........................  Oxymorphone hcl     ................  N1.............  ...........  ...........
                                  injection.
J2425..........................  Palifermin          ................  K2.............  ...........       $11.32
                                  injection.
J2430..........................  Pamidronate         ................  K2.............  ...........       $30.49
                                  disodium /30 MG.
J2440..........................  Papaverin hcl       ................  N1.............  ...........  ...........
                                  injection.
J2460..........................  Oxytetracycline     ................  N1.............  ...........  ...........
                                  injection.
J2469..........................  Palonosetron HCl..  ................  K2.............  ...........       $15.85
J2501..........................  Paricalcitol......  ................  N1.............  ...........  ...........
J2503..........................  Pegaptanib sodium   ................  K2.............  ...........    $1,054.70
                                  injection.
J2504..........................  Pegademase bovine,  ................  K2.............  ...........      $176.16
                                  25 iu.
J2505..........................  Injection,          ................  K2.............  ...........    $2,142.92
                                  pegfilgrastim 6mg.
J2510..........................  Penicillin g        ................  N1.............  ...........  ...........
                                  procaine inj.
J2513..........................  Pentastarch 10%     CH..............  K2.............  ...........       $23.61
                                  solution.
J2515..........................  Pentobarbital       ................  N1.............  ...........  ...........
                                  sodium inj.
J2540..........................  Penicillin g        ................  N1.............  ...........  ...........
                                  potassium inj.
J2543..........................  Piperacillin/       ................  N1.............  ...........  ...........
                                  tazobactam.
J2550..........................  Promethazine hcl    ................  N1.............  ...........  ...........
                                  injection.
J2560..........................  Phenobarbital       ................  N1.............  ...........  ...........
                                  sodium inj.
J2590..........................  Oxytocin injection  ................  N1.............  ...........  ...........
J2597..........................  Inj desmopressin    ................  N1.............  ...........  ...........
                                  acetate.
J2650..........................  Prednisolone        ................  N1.............  ...........  ...........
                                  acetate inj.
J2670..........................  Totazoline hcl      ................  N1.............  ...........  ...........
                                  injection.
J2675..........................  Inj progesterone    ................  N1.............  ...........  ...........
                                  per 50 MG.
J2680..........................  Fluphenazine        ................  N1.............  ...........  ...........
                                  decanoate 25 MG.
J2690..........................  Procainamide hcl    ................  N1.............  ...........  ...........
                                  injection.
J2700..........................  Oxacillin sodium    ................  N1.............  ...........  ...........
                                  injeciton.
J2710..........................  Neostigmine         ................  N1.............  ...........  ...........
                                  methylslfte inj.
J2720..........................  Inj protamine       ................  N1.............  ...........  ...........
                                  sulfate/10 MG.
J2725..........................  Inj protirelin per  ................  N1.............  ...........  ...........
                                  250 mcg.
J2730..........................  Pralidoxime         ................  N1.............  ...........  ...........
                                  chloride inj.
J2760..........................  Phentolaine         ................  N1.............  ...........  ...........
                                  mesylate inj.
J2765..........................  Metoclopramide hcl  ................  N1.............  ...........  ...........
                                  injection.
J2770..........................  Quinupristin/       ................  K2.............  ...........      $116.70
                                  dalfopristin.
J2780..........................  Ranitidine          ................  N1.............  ...........  ...........
                                  hydrochloride inj.
J2783..........................  Rasburicase.......  ................  K2.............  ...........      $131.28
J2788..........................  Rho d immune        ................  K2.............  ...........       $26.41
                                  globulin 50 mcg.
J2790..........................  Rho d immune        ................  K2.............  ...........       $80.71
                                  globulin inj.
J2792..........................  Rho(D) immune       ................  K2.............  ...........       $15.76
                                  globulin h, sd.
J2794..........................  Risperidone, long   ................  K2.............  ...........        $4.80
                                  acting.
J2795..........................  Ropivacaine HCl     ................  N1.............  ...........  ...........
                                  injection.
J2800..........................  Methocarbamol       ................  N1.............  ...........  ...........
                                  injection.
J2805..........................  Sincalide           ................  N1.............  ...........  ...........
                                  injection.
J2810..........................  Inj theophylline    ................  N1.............  ...........  ...........
                                  per 40 MG.
J2820..........................  Sargramostim        ................  K2.............  ...........       $25.08
                                  injection.
J2850..........................  Inj secretin        ................  K2.............  ...........       $20.12
                                  synthetic human.
J2910..........................  Aurothioglucose     ................  N1.............  ...........  ...........
                                  injeciton.
J2916..........................  Na ferric           ................  N1.............  ...........  ...........
                                  gluconate complex.
J2920..........................  Methylprednisolone  ................  N1.............  ...........  ...........
                                  injection.
J2930..........................  Methylprednisolone  ................  N1.............  ...........  ...........
                                  injection.

[[Page 43084]]

 
J2940..........................  Somatrem injection  ................  K2.............  ...........       $69.53
J2941..........................  Somatropin          ................  K2.............  ...........       $46.75
                                  injection.
J2950..........................  Promazine hcl       ................  N1.............  ...........  ...........
                                  injection.
J2993..........................  Reteplase           ................  K2.............  ...........      $891.03
                                  injection.
J2995..........................  Inj streptokinase / ................  K2.............  ...........       $75.48
                                  250000 IU.
J2997..........................  Alteplase           ................  K2.............  ...........       $32.48
                                  recombinant.
J3000..........................  Streptomycin        ................  N1.............  ...........  ...........
                                  injection.
J3010..........................  Fentanyl citrate    ................  N1.............  ...........  ...........
                                  injeciton.
J3030..........................  Sumatriptan         ................  K2.............  ...........       $58.82
                                  succinate / 6 MG.
J3070..........................  Pentazocine         ................  N1.............  ...........  ...........
                                  injection.
J3100..........................  Tenecteplase        ................  K2.............  ...........    $2,024.13
                                  injection.
J3105..........................  Terbutaline         ................  N1.............  ...........  ...........
                                  sulfate inj.
J3120..........................  Testosterone        ................  N1.............  ...........  ...........
                                  enanthate inj.
J3130..........................  Testosterone        ................  N1.............  ...........  ...........
                                  enanthate inj.
J3140..........................  Testosterone        ................  N1.............  ...........  ...........
                                  suspension inj.
J3150..........................  Testosteron         ................  N1.............  ...........  ...........
                                  propionate inj.
J3230..........................  Chlorpromazine hcl  ................  N1.............  ...........  ...........
                                  injection.
J3240..........................  Thyrotropin         ................  K2.............  ...........      $758.16
                                  injection.
J3243..........................  Tigecycline         ................  K2.............  ...........        $0.91
                                  injection.
J3246..........................  Tirofiban HCl.....  ................  K2.............  ...........        $7.66
J3250..........................  Trimethobenzamide   ................  N1.............  ...........  ...........
                                  hcl inj.
J3260..........................  Tobramycin sulfate  ................  N1.............  ...........  ...........
                                  injection.
J3265..........................  Injection           ................  N1.............  ...........  ...........
                                  torsemide 10 mg/
                                  ml.
J3280..........................  Thiethylperazine    ................  N1.............  ...........  ...........
                                  maleate inj.
J3285..........................  Treprostinil        ................  K2.............  ...........       $55.36
                                  injection.
J3301..........................  Triamcinolone       ................  N1.............  ...........  ...........
                                  acetonide inj.
J3302..........................  Triamcinolone       ................  N1.............  ...........  ...........
                                  diacetate inj.
J3303..........................  Triamcinolone       ................  N1.............  ...........  ...........
                                  hexacetonl inj.
J3305..........................  Inj trimetrexate    ................  K2.............  ...........      $143.89
                                  glucoronate.
J3310..........................  Perphenazine        ................  N1.............  ...........  ...........
                                  injeciton.
J3315..........................  Triptorelin         ................  K2.............  ...........      $153.97
                                  pamoate.
J3320..........................  Spectinomycn di-    CH..............  N1.............  ...........  ...........
                                  hcl inj.
J3350..........................  Urea injection....  ................  K2.............  ...........       $73.46
J3355..........................  Urofollitropin, 75  ................  K2.............  ...........       $50.22
                                  iu.
J3360..........................  Diazepam injection  ................  N1.............  ...........  ...........
J3364..........................  Urokinase 5000 IU   CH..............  K2.............  ...........        $9.07
                                  injection.
J3365..........................  Urokinase 250,000   ................  K2.............  ...........      $453.41
                                  IU inj.
J3370..........................  Vancomycin hcl      ................  N1.............  ...........  ...........
                                  injection.
J3396..........................  Verteporfin         ................  K2.............  ...........        $8.84
                                  injection.
J3400..........................  Triflupromazine     ................  N1.............  ...........  ...........
                                  hcl inj.
J3410..........................  Hydroxyzine hcl     ................  N1.............  ...........  ...........
                                  injection.
J3411..........................  Thiamine hcl 100    ................  N1.............  ...........  ...........
                                  mg.
J3415..........................  Pyridoxine hcl 100  ................  N1.............  ...........  ...........
                                  mg.
J3420..........................  Vitamin b12         ................  N1.............  ...........  ...........
                                  injection.
J3430..........................  Vitamin k           ................  N1.............  ...........  ...........
                                  phytonadione inj.
J3465..........................  Injection,          ................  K2.............  ...........        $4.94
                                  voriconazole.
J3470..........................  Hyaluronidase       ................  N1.............  ...........  ...........
                                  injection.
J3471..........................  Ovine, up to 999    ................  N1.............  ...........  ...........
                                  USP units.
J3472..........................  Ovine, 1000 USP     ................  K2.............  ...........      $133.77
                                  units.
J3473..........................  Hyaluronidase       ................  K2.............  ...........        $0.40
                                  recombinant.
J3475..........................  Inj magnesium       ................  N1.............  ...........  ...........
                                  sulfate.
J3480..........................  Inj potassium       ................  N1.............  ...........  ...........
                                  chloride.
J3485..........................  Zidovudine........  ................  N1.............  ...........  ...........
J3486..........................  Ziprasidone         ................  N1.............  ...........  ...........
                                  mesylate.
J3487..........................  Zoledronic acid...  ................  K2.............  ...........      $204.09
J3490..........................  Drugs unclassified  ................  N1.............  ...........  ...........
                                  injection.
J3530..........................  Nasal vaccine       ................  N1.............  ...........  ...........
                                  inhalation.
J3590..........................  Unclassified        ................  N1.............  ...........  ...........
                                  biologics.
J7030..........................  Normal saline       ................  N1.............  ...........  ...........
                                  solution infus.
J7040..........................  Normal saline       ................  N1.............  ...........  ...........
                                  solution infus.
J7042..........................  5% dextrose/normal  ................  N1.............  ...........  ...........
                                  saline.
J7050..........................  Normal saline       ................  N1.............  ...........  ...........
                                  solution infus.
J7060..........................  5% dextrose/water.  ................  N1.............  ...........  ...........
J7070..........................  D5w infusion......  ................  N1.............  ...........  ...........
J7100..........................  Dextran 40          ................  N1.............  ...........  ...........
                                  infusion.
J7110..........................  Dextran 75          ................  N1.............  ...........  ...........
                                  infusion.
J7120..........................  Ringers lactate     ................  N1.............  ...........  ...........
                                  infusion.
J7130..........................  Hypertonic saline   ................  N1.............  ...........  ...........
                                  solution.

[[Page 43085]]

 
J7187..........................  Inj Vonwillebrand   ................  K2.............  ...........        $0.88
                                  factor IU.
J7189..........................  Factor viia.......  ................  K2.............  ...........        $1.11
J7190..........................  Factor viii.......  ................  K2.............  ...........        $0.70
J7191..........................  Factor VIII         CH..............  N1.............  ...........  ...........
                                  (porcine).
J7192..........................  Factor viii         ................  K2.............  ...........        $1.07
                                  recombinant.
J7193..........................  Factor IX non-      ................  K2.............  ...........        $0.89
                                  recombinant.
J7194..........................  Factor ix complex.  ................  K2.............  ...........        $0.75
J7195..........................  Factor IX           ................  K2.............  ...........        $0.99
                                  recombinant.
J7197..........................  Antithrombin iii    ................  K2.............  ...........        $1.62
                                  injection.
J7198..........................  Anti-inhibitor....  ................  K2.............  ...........        $1.35
J7308..........................  Aminolevulinic      ................  K2.............  ...........      $104.43
                                  acid hcl top.
J7310..........................  Ganciclovir long    ................  K2.............  ...........    $4,707.42
                                  act implant.
J7311..........................  Fluocinolone        ................  K2.............  ...........   $19,162.50
                                  acetonide implt.
J7340..........................  Metabolic active D/ ................  K2.............  ...........       $28.51
                                  E tissue.
J7341..........................  Non-human,          CH..............  N1.............  ...........  ...........
                                  metabolic tissue.
J7342..........................  Metabolically       ................  K2.............  ...........       $31.36
                                  active tissue.
J7343..........................  Nonmetabolic act d/ ................  K2.............  ...........       $18.13
                                  e tissue.
J7344..........................  Nonmetabolic        ................  K2.............  ...........       $88.37
                                  active tissue.
J7345..........................  Non-human, non-     ................  K2.............  ...........       $35.76
                                  metab tissue.
J7346..........................  Injectable human    ................  K2.............  ...........      $728.44
                                  tissue.
J7500..........................  Azathioprine oral   ................  N1.............  ...........  ...........
                                  50mg.
J7501..........................  Azathioprine        ................  K2.............  ...........       $47.99
                                  parenteral.
J7502..........................  Cyclosporine oral   ................  K2.............  ...........        $3.57
                                  100 mg.
J7504..........................  Lymphocyte immune   ................  K2.............  ...........      $314.19
                                  globulin.
J7505..........................  Monoclonal          ................  K2.............  ...........      $886.70
                                  antibodies.
J7506..........................  Prednisone oral...  ................  N1.............  ...........  ...........
J7507..........................  Tacrolimus oral     ................  K2.............  ...........        $3.63
                                  per 1 MG.
J7509..........................  Methylprednisolone  ................  N1.............  ...........  ...........
                                  oral.
J7510..........................  Prednisolone oral   ................  N1.............  ...........  ...........
                                  per 5 mg.
J7511..........................  Antithymocyte       ................  K2.............  ...........      $324.66
                                  globuln rabbit.
J7513..........................  Daclizumab,         ................  K2.............  ...........      $297.03
                                  parenteral.
J7515..........................  Cyclosporine oral   ................  N1.............  ...........  ...........
                                  25 mg.
J7516..........................  Cyclosporin         ................  N1.............  ...........  ...........
                                  parenteral 250mg.
J7517..........................  Mycophenolate       ................  K2.............  ...........        $2.60
                                  mofetil oral.
J7518..........................  Mycophenolic acid.  ................  K2.............  ...........        $2.25
J7520..........................  Sirolimus, oral...  ................  K2.............  ...........        $7.15
J7525..........................  Tacrolimus          ................  K2.............  ...........      $139.11
                                  injection.
J7599..........................  Immunosuppressive   ................  N1.............  ...........  ...........
                                  drug noc.
J7674..........................  Methacholine        ................  N1.............  ...........  ...........
                                  chloride, neb.
J7799..........................  Non-inhalation      ................  N1.............  ...........  ...........
                                  drug for DME.
J8501..........................  Oral aprepitant...  ................  K2.............  ...........        $5.02
J8510..........................  Oral busulfan.....  ................  K2.............  ...........        $2.12
J8520..........................  Capecitabine,       ................  K2.............  ...........        $3.94
                                  oral, 150 mg.
J8521..........................  Capecitabine,       CH..............  K2.............  ...........       $13.12
                                  oral, 500 mg.
J8530..........................  Cyclophosphamide    ................  N1.............  ...........  ...........
                                  oral 25 MG.
J8540..........................  Oral dexamethasone  ................  N1.............  ...........  ...........
J8560..........................  Etoposide oral 50   ................  K2.............  ...........       $29.32
                                  MG.
J8597..........................  Antiemetic drug     ................  N1.............  ...........  ...........
                                  oral NOS.
J8600..........................  Melphalan oral 2    CH..............  K2.............  ...........        $4.34
                                  MG.
J8610..........................  Methotrexate oral   ................  N1.............  ...........  ...........
                                  2.5 MG.
J8650..........................  Nabilone oral.....  ................  K2.............  ...........       $16.80
J8700..........................  Temozolomide......  ................  K2.............  ...........        $7.34
J9000..........................  Doxorubic hcl 10    CH..............  N1.............  ...........  ...........
                                  MG vl chemo.
J9001..........................  Doxorubicin hcl     ................  K2.............  ...........      $385.81
                                  liposome inj.
J9010..........................  Alemtuzumab         ................  K2.............  ...........      $536.10
                                  injection.
J9015..........................  Aldesleukin/single  ................  K2.............  ...........      $755.78
                                  use vial.
J9017..........................  Arsenic trioxide..  ................  K2.............  ...........       $33.84
J9020..........................  Asparaginase        ................  K2.............  ...........       $54.20
                                  injection.
J9025..........................  Azacitidine         ................  K2.............  ...........        $4.26
                                  injection.
J9027..........................  Clofarabine         ................  K2.............  ...........      $115.64
                                  injection.
J9031..........................  Bcg live            ................  K2.............  ...........      $109.63
                                  intravesical vac.
J9035..........................  Bevacizumab         ................  K2.............  ...........       $56.98
                                  injection.
J9040..........................  Bleomycin sulfate   ................  K2.............  ...........       $35.52
                                  injection.
J9041..........................  Bortezomib          ................  K2.............  ...........       $32.37
                                  injection.
J9045..........................  Carboplatin         ................  K2.............  ...........        $8.38
                                  injection.
J9050..........................  Carmus bischl       ................  K2.............  ...........      $138.52
                                  nitro inj.
J9055..........................  Cetuximab           ................  K2.............  ...........       $49.34
                                  injection.
J9060..........................  Cisplatin 10 MG     ................  N1.............  ...........  ...........
                                  injection.

[[Page 43086]]

 
J9062..........................  Cisplatin 50 MG     CH..............  N1.............  ...........  ...........
                                  injection.
J9065..........................  Inj cladribine per  ................  K2.............  ...........       $35.78
                                  1 MG.
J9070..........................  Cyclophosphamide    ................  N1.............  ...........  ...........
                                  100 MG inj.
J9080..........................  Cyclophosphamide    CH..............  N1.............  ...........  ...........
                                  200 MG inj.
J9090..........................  Cyclophosphamide    CH..............  N1.............  ...........  ...........
                                  500 MG inj.
J9091..........................  Cyclophosphamide    CH..............  N1.............  ...........  ...........
                                  1.0 grm inj.
J9092..........................  Cyclophosphamide    CH..............  N1.............  ...........  ...........
                                  2.0 grm inj.
J9093..........................  Cyclophosphamide    CH..............  N1.............  ...........  ...........
                                  lyophilized.
J9094..........................  Cyclophosphamide    CH..............  N1.............  ...........  ...........
                                  lyophilized.
J9095..........................  Cyclophosphamide    CH..............  N1.............  ...........  ...........
                                  lyophilized.
J9096..........................  Cyclophosphamide    CH..............  N1.............  ...........  ...........
                                  lyophilized.
J9097..........................  Cyclophosphamide    CH..............  N1.............  ...........  ...........
                                  lyophilized.
J9098..........................  Cytarabine          ................  K2.............  ...........      $391.31
                                  liposome.
J9100..........................  Cytarabine hcl 100  ................  N1.............  ...........  ...........
                                  MG inj.
J9110..........................  Cytarabine hcl 500  CH..............  N1.............  ...........  ...........
                                  MG inj.
J9120..........................  Dactinomycin        ................  K2.............  ...........      $488.78
                                  actinomycin d.
J9130..........................  Dacarbazine 100 mg  CH..............  N1.............  ...........  ...........
                                  inj.
J9140..........................  Dacarbazine 200 MG  CH..............  N1.............  ...........  ...........
                                  inj.
J9150..........................  Daunorubicin......  ................  K2.............  ...........       $20.28
J9151..........................  Daunorubicin        ................  K2.............  ...........       $55.40
                                  citrate liposom.
J9160..........................  Denileukin          ................  K2.............  ...........    $1,393.32
                                  diftitox, 300 mcg.
J9165..........................  Diethylstilbestrol  ................  N1.............  ...........  ...........
                                  injection.
J9170..........................  Docetaxel.........  ................  K2.............  ...........      $303.92
J9175..........................  Elliotts b          ................  N1.............  ...........  ...........
                                  solution per ml.
J9178..........................  Inj, epirubicin     ................  K2.............  ...........       $21.01
                                  hcl, 2 mg.
J9181..........................  Etoposide 10 MG     ................  N1.............  ...........  ...........
                                  inj.
J9182..........................  Etoposide 100 MG    CH..............  N1.............  ...........  ...........
                                  inj.
J9185..........................  Fludarabine         ................  K2.............  ...........      $234.21
                                  phosphate inj.
J9190..........................  Fluorouracil        ................  N1.............  ...........  ...........
                                  injection.
J9200..........................  Floxuridine         ................  K2.............  ...........       $50.82
                                  injection.
J9201..........................  Gemcitabine HCl...  ................  K2.............  ...........      $123.98
J9202..........................  Goserelin acetate   ................  K2.............  ...........      $196.81
                                  implant.
J9206..........................  Irinotecan          ................  K2.............  ...........      $124.81
                                  injection.
J9208..........................  Ifosfomide          ................  K2.............  ...........       $46.15
                                  injection.
J9209..........................  Mesna injection...  ................  K2.............  ...........        $8.89
J9211..........................  Idarubicin hcl      ................  K2.............  ...........      $301.74
                                  injection.
J9212..........................  Interferon alfacon- ................  K2.............  ...........        $4.60
                                  1.
J9213..........................  Interferon alfa-2a  ................  K2.............  ...........       $37.53
                                  inj.
J9214..........................  Interferon alfa-2b  ................  K2.............  ...........       $13.75
                                  inj.
J9215..........................  Interferon alfa-n3  ................  K2.............  ...........        $9.03
                                  inj.
J9216..........................  Interferon gamma 1- ................  K2.............  ...........      $287.13
                                  b inj.
J9217..........................  Leuprolide acetate  ................  K2.............  ...........      $227.34
                                  suspnsion.
J9218..........................  Leuprolide acetate  ................  K2.............  ...........        $8.79
                                  injeciton.
J9219..........................  Leuprolide acetate  ................  K2.............  ...........    $1,696.96
                                  implant.
J9225..........................  Histrelin implant.  ................  K2.............  ...........    $1,446.98
J9230..........................  Mechlorethamine     ................  K2.............  ...........      $140.27
                                  hcl inj.
J9245..........................  Inj melphalan       ................  K2.............  ...........       $12.72
                                  hydrochl 50 MG.
J9250..........................  Methotrexate        ................  N1.............  ...........  ...........
                                  sodium inj.
J9260..........................  Methotrexate        CH..............  N1.............  ...........  ...........
                                  sodium inj.
J9261..........................  Nelarabine          ................  K2.............  ...........       $82.54
                                  injection.
J9263..........................  Oxaliplatin.......  ................  K2.............  ...........        $8.89
J9264..........................  Paclitaxel protein  ................  K2.............  ...........        $7.03
                                  bound.
J9265..........................  Paclitaxel          ................  K2.............  ...........       $12.47
                                  injection.
J9266..........................  Pegaspargase/singl  ................  K2.............  ...........    $1,667.61
                                  dose vial.
J9268..........................  Pentostatin         ................  K2.............  ...........    $1,916.66
                                  injection.
J9270..........................  Plicamycin          CH..............  N1.............  ...........  ...........
                                  (mithramycin) inj.
J9280..........................  Mitomycin 5 MG inj  ................  K2.............  ...........       $15.98
J9290..........................  Mitomycin 20 MG     CH..............  K2.............  ...........       $63.93
                                  inj.
J9291..........................  Mitomycin 40 MG     CH..............  K2.............  ...........      $127.85
                                  inj.
J9293..........................  Mitoxantrone        ................  K2.............  ...........      $166.64
                                  hydrochl / 5 MG.
J9300..........................  Gemtuzumab          ................  K2.............  ...........    $2,334.75
                                  ozogamicin.
J9305..........................  Pemetrexed          ................  K2.............  ...........       $43.38
                                  injection.
J9310..........................  Rituximab cancer    ................  K2.............  ...........      $491.54
                                  treatment.
J9320..........................  Streptozocin        ................  K2.............  ...........      $152.28
                                  injection.
J9340..........................  Thiotepa injection  ................  K2.............  ...........       $40.32
J9350..........................  Topotecan.........  ................  K2.............  ...........      $822.90
J9355..........................  Trastuzumab.......  ................  K2.............  ...........       $57.33
J9357..........................  Valrubicin, 200 mg  ................  K2.............  ...........      $219.39

[[Page 43087]]

 
J9360..........................  Vinblastine         ................  N1.............  ...........  ...........
                                  sulfate inj.
J9370..........................  Vincristine         ................  N1.............  ...........  ...........
                                  sulfate 1 MG inj.
J9375..........................  Vincristine         CH..............  N1.............  ...........  ...........
                                  sulfate 2 MG inj.
J9380..........................  Vincristine         CH..............  N1.............  ...........  ...........
                                  sulfate 5 MG inj.
J9390..........................  Vinorelbine         ................  K2.............  ...........       $19.88
                                  tartrate/10 mg.
J9395..........................  Injection,          ................  K2.............  ...........       $79.80
                                  Fulvestrant.
J9600..........................  Porfimer sodium...  ................  K2.............  ...........    $2,539.13
J9999..........................  Chemotherapy drug.  ................  N1.............  ...........  ...........
L8600..........................  Implant breast      ................  N1.............  ...........  ...........
                                  silicone/eq.
L8603..........................  Collagen imp        ................  N1.............  ...........  ...........
                                  urinary 2.5 ml.
L8606..........................  Synthetic implnt    ................  N1.............  ...........  ...........
                                  urinary 1ml.
L8609..........................  Artificial cornea.  ................  N1.............  ...........  ...........
L8610..........................  Ocular implant....  ................  N1.............  ...........  ...........
L8612..........................  Aqueous shunt       ................  N1.............  ...........  ...........
                                  prosthesis.
L8613..........................  Ossicular implant.  ................  N1.............  ...........  ...........
L8614..........................  Cochlear device...  ................  N1.............  ...........  ...........
L8630..........................  Metacarpophalangea  ................  N1.............  ...........  ...........
                                  l implant.
L8631..........................  MCP joint repl 2    ................  N1.............  ...........  ...........
                                  pc or more.
L8641..........................  Metatarsal joint    ................  N1.............  ...........  ...........
                                  implant.
L8642..........................  Hallux implant....  ................  N1.............  ...........  ...........
L8658..........................  Interphalangeal     ................  N1.............  ...........  ...........
                                  joint spacer.
L8659..........................  Interphalangeal     ................  N1.............  ...........  ...........
                                  joint repl.
L8670..........................  Vascular graft,     ................  N1.............  ...........  ...........
                                  synthetic.
L8682..........................  Implt neurostim     ................  N1.............  ...........  ...........
                                  radiofq rec.
L8690..........................  Aud osseo dev, int/ ................  J7.............  ...........  ...........
                                  ext comp.
L8699..........................  Prosthetic implant  ................  N1.............  ...........  ...........
                                  NOS.
Q0163..........................  Diphenhydramine     ................  N1.............  ...........  ...........
                                  HCl 50mg.
Q0164..........................  Prochlorperazine    ................  N1.............  ...........  ...........
                                  maleate 5mg.
Q0166..........................  Granisetron HCl 1   ................  K2.............  ...........       $44.44
                                  mg oral.
Q0167..........................  Dronabinol 2.5mg    ................  N1.............  ...........  ...........
                                  oral.
Q0169..........................  Promethazine HCl    ................  N1.............  ...........  ...........
                                  12.5mg oral.
Q0171..........................  Chlorpromazine HCl  ................  N1.............  ...........  ...........
                                  10mg oral.
Q0173..........................  Trimethobenzamide   ................  N1.............  ...........  ...........
                                  HCl 250mg.
Q0174..........................  Thiethylperazine    ................  N1.............  ...........  ...........
                                  maleate10mg.
Q0175..........................  Perphenazine 4mg    ................  N1.............  ...........  ...........
                                  oral.
Q0177..........................  Hydroxyzine         ................  N1.............  ...........  ...........
                                  pamoate 25mg.
Q0179..........................  Ondansetron HCl     ................  K2.............  ...........       $36.21
                                  8mg oral.
Q0180..........................  Dolasetron          ................  K2.............  ...........       $47.07
                                  mesylate oral.
Q0515..........................  Sermorelin acetate  ................  K2.............  ...........        $1.74
                                  injection.
Q1003..........................  NTIOL category 3..  ................  L6.............  ...........       $50.00
Q2004..........................  Bladder calculi     ................  N1.............  ...........  ...........
                                  irrig sol.
Q2009..........................  Fosphenytoin, 50    ................  K2.............  ...........        $5.50
                                  mg.
Q2017..........................  Teniposide, 50 mg.  ................  K2.............  ...........      $261.93
Q3025..........................  IM inj interferon   ................  K2.............  ...........      $113.49
                                  beta 1-a.
Q4079..........................  Natalizumab         ................  K2.............  ...........        $7.45
                                  injection.
Q4083..........................  Hyalgan/supartz     ................  K2.............  ...........      $103.86
                                  inj per dose.
Q4084..........................  Synvisc inj per     ................  K2.............  ...........      $184.89
                                  dose.
Q4085..........................  Euflexxa inj per    ................  K2.............  ...........      $115.19
                                  dose.
Q4086..........................  Orthovisc inj per   ................  K2.............  ...........      $196.47
                                  dose.
Q9945..........................  LOCM <=149 mg/ml    CH..............  N1.............  ...........  ...........
                                  iodine, 1ml.
Q9946..........................  LOCM 150-199mg/ml   CH..............  N1.............  ...........  ...........
                                  iodine,1ml.
Q9947..........................  LOCM 200-249mg/ml   CH..............  N1.............  ...........  ...........
                                  iodine,1ml.
Q9948..........................  LOCM 250-299mg/ml   CH..............  N1.............  ...........  ...........
                                  iodine,1ml.
Q9949..........................  LOCM 300-349mg/ml   CH..............  N1.............  ...........  ...........
                                  iodine,1ml.
Q9950..........................  LOCM 350-399mg/ml   CH..............  N1.............  ...........  ...........
                                  iodine,1ml.
Q9951..........................  LOCM >= 400 mg/ml   CH..............  N1.............  ...........  ...........
                                  iodine,1ml.
Q9952..........................  Inj Gad-base MR     CH..............  N1.............  ...........  ...........
                                  contrast,1ml.
Q9953..........................  Inj Fe-based MR     CH..............  N1.............  ...........  ...........
                                  contrast,1ml.
Q9954..........................  Oral MR contrast,   CH..............  N1.............  ...........  ...........
                                  100 ml.
Q9955..........................  Inj perflexane lip  CH..............  N1.............  ...........  ...........
                                  micros,ml.
Q9956..........................  Inj                 CH..............  N1.............  ...........  ...........
                                  octafluoropropane
                                  mic,ml.
Q9957..........................  Inj perflutren lip  CH..............  N1.............  ...........  ...........
                                  micros,ml.
Q9958..........................  HOCM <=149 mg/ml    ................  N1.............  ...........  ...........
                                  iodine, 1ml.
Q9959..........................  HOCM 150-199mg/ml   ................  N1.............  ...........  ...........
                                  iodine,1ml.
Q9960..........................  HOCM 200-249mg/ml   ................  N1.............  ...........  ...........
                                  iodine,1ml.
Q9961..........................  HOCM 250-299mg/ml   ................  N1.............  ...........  ...........
                                  iodine,1ml.
Q9962..........................  HOCM 300-349mg/ml   ................  N1.............  ...........  ...........
                                  iodine,1ml.
Q9963..........................  HOCM 350-399mg/ml   ................  N1.............  ...........  ...........
                                  iodine,1ml.

[[Page 43088]]

 
Q9964..........................  HOCM>= 400mg/ml     ................  N1.............  ...........  ...........
                                  iodine, 1ml.
V2630..........................  Anter chamber       ................  N1.............  ...........  ...........
                                  intraocul lens.
V2631..........................  Iris support        ................  N1.............  ...........  ...........
                                  intraoclr lens.
V2632..........................  Post chmbr          ................  N1.............  ...........  ...........
                                  intraocular lens.
V2785..........................  Corneal tissue      ................  F4.............  ...........  ...........
                                  processing.
V2790..........................  Amniotic membrane.  ................  N1.............  ...........  ...........
----------------------------------------------------------------------------------------------------------------


[[Page 43089]]


          Addendum D1.--Proposed OPPS Payment Status Indicators
------------------------------------------------------------------------
                                                         OPPS payment
            Indicator              Item/Code/Service        status
------------------------------------------------------------------------
A...............................  <bullet> Services   Not paid under
                                   furnished to a      OPPS. Paid by
                                   hospital            fiscal
                                   outpatient that     intermediaries
                                   are paid under a    under a fee
                                   fee schedule or     schedule or
                                   payment system      payment system
                                   other than OPPS,    other than OPPS.
                                   for example:
                                  <bullet> Ambulance
                                   Services.
                                  <bullet> Clinical
                                   Diagnostic
                                   Laboratory
                                   Services.
                                  <bullet> Non-
                                   Implantable
                                   Prosthetic and
                                   Orthotic Devices.
                                  <bullet> EPO for
                                   ESRD Patients.
                                  <bullet> Physical,
                                   Occupational, and
                                   Speech Therapy.
                                  <bullet> Routine
                                   Dialysis Services
                                   for ESRD Patients
                                   Provided in a
                                   Certified
                                   Dialysis Unit of
                                   a Hospital.
                                  <bullet>
                                   Diagnostic
                                   Mammography.
                                  <bullet> Screening
                                   Mammography.
------------------------------------------------------------------------
B...............................  Codes that are not  Not paid under
                                   recognized by       OPPS.
                                   OPPS when
                                   submitted on an
                                   outpatient
                                   hospital Part B
                                   bill type (12x
                                   and 13x).
                                                      <bullet> May be
                                                       paid by
                                                       intermediaries
                                                       when submitted on
                                                       a different bill
                                                       type, for
                                                       example, 75x
                                                       (CORF), but not
                                                       paid under OPPS.
                                                      <bullet> An
                                                       alternate code
                                                       that is
                                                       recognized by
                                                       OPPS when
                                                       submitted on an
                                                       outpatient
                                                       hospital Part B
                                                       bill type (12x
                                                       and 13x) may be
                                                       available.
------------------------------------------------------------------------
C...............................  Inpatient           Not paid under
                                   Procedures.         OPPS. Admit
                                                       patient. Bill as
                                                       inpatient.
------------------------------------------------------------------------
D...............................  Discontinued Codes  Not paid under
                                                       OPPS or any other
                                                       Medicare payment
                                                       system.
------------------------------------------------------------------------
E...............................   Items, Codes, and  Not paid under
                                   Services:           OPPS or any other
                                                       Medicare payment
                                                       system.
                                  <bullet> That are
                                   not covered by
                                   Medicare based on
                                   statutory
                                   exclusion.
                                  <bullet> That are
                                   not covered by
                                   Medicare for
                                   reasons other
                                   than statutory
                                   exclusion.
                                  <bullet> That are
                                   not recognized by
                                   Medicare but for
                                   which an
                                   alternate code
                                   for the same item
                                   or service may be
                                   available.
                                  <bullet> For which
                                   separate payment
                                   is not provided
                                   by Medicare.
------------------------------------------------------------------------
F...............................  Corneal Tissue      Not paid under
                                   Acquisition;        OPPS. Paid at
                                   Certain CRNA        reasonable cost.
                                   Services and
                                   Hepatitis B
                                   Vaccines.
------------------------------------------------------------------------
G...............................  Pass-Through Drugs  Paid under OPPS;
                                   and Biologicals.    Separate APC
                                                       payment includes
                                                       pass through
                                                       amount.
------------------------------------------------------------------------
H...............................  Pass-Through         Separate cost-
                                   Device Categories.  based pass-
                                                       through payment;
                                                       Not subject to
                                                       coinsurance.
------------------------------------------------------------------------
K...............................  (1) Non-Pass-       (1) Paid under
                                   Through Drugs and   OPPS; Separate
                                   Biologicals.        APC payment.
                                  (2) Therapeutic     (2) Paid under
                                   Radiopharmaceutic   OPPS; Separate
                                   als.                APC payment.
                                  (3) Brachytherapy   (3) Paid under
                                   Sources.            OPPS; Separate
                                                       APC payment.
                                  (4) Blood and       (4) Paid under
                                   Blood Products.     OPPS; Separate
                                                       APC payment.
------------------------------------------------------------------------
L...............................  Influenza Vaccine;  Not paid under
                                   Pneumococcal        OPPS. Paid at
                                   Pneumonia Vaccine.  reasonable cost;
                                                       Not subject to
                                                       deductible or
                                                       coinsurance.
------------------------------------------------------------------------
M...............................  Items and Services  Not paid under
                                   Not Billable to     OPPS.
                                   the Fiscal
                                   Intermediary.
------------------------------------------------------------------------
N...............................  Items and Services  Paid under OPPS;
                                   Packaged into APC   Payment is
                                   Rates.              packaged into
                                                       payment for other
                                                       services,
                                                       including
                                                       outliers.
                                                       Therefore, there
                                                       is no separate
                                                       APC payment.
------------------------------------------------------------------------
P...............................  Partial             Paid under OPPS;
                                   Hospitalization.    Per diem APC
                                                       payment.
------------------------------------------------------------------------
Q...............................  Packaged Services   Paid under OPPS;
                                   Subject to          Addendum B
                                   Separate Payment    displays APC
                                   Under OPPS          assignments when
                                   Payment Criteria.   services are
                                                       separately
                                                       payable.
                                                      (1) Separate APC
                                                       payment based on
                                                       OPPS payment
                                                       criteria.
                                                      (2) If criteria
                                                       are not met,
                                                       payment is
                                                       packaged into
                                                       payment for other
                                                       services,
                                                       including
                                                       outliers.
                                                       Therefore, there
                                                       is no separate
                                                       APC payment.
------------------------------------------------------------------------
S...............................  Significant         Paid under OPPS;
                                   Procedure, Not      Separate APC
                                   Discounted when     payment.
                                   Multiple.
------------------------------------------------------------------------

[[Page 43090]]

 
T...............................  Significant         Paid under OPPS;
                                   Procedure,          Separate APC
                                   Multiple            payment.
                                   Reduction Applies.
------------------------------------------------------------------------
V...............................  Clinic or           Paid under OPPS;
                                   Emergency           Separate APC
                                   Department Visit.   payment.
------------------------------------------------------------------------
Y...............................  Non-Implantable     Not paid under
                                   Durable Medical     OPPS. All
                                   Equipment.          institutional
                                                       providers other
                                                       than home health
                                                       agencies bill to
                                                       DMERC.
------------------------------------------------------------------------
X...............................  Ancillary Services  Paid under OPPS;
                                                       Separate APC
                                                       payment.
------------------------------------------------------------------------


[[Page 43091]]


             Addendum D2.--Proposed OPPS Comment Indicators
------------------------------------------------------------------------
   Comment indicator                       Descriptor
------------------------------------------------------------------------
NI....................  New code, interim APC assignment; comments will
                         be accepted on the interim APC assignment for
                         the new code.
CH....................  Active HCPCS code in current year and next
                         calendar year, status indicator and/or APC
                         assignment has changed; or active HCPCS code
                         that is discontinued at the end of the current
                         calendar year.
------------------------------------------------------------------------


[[Page 43092]]


             Addendum DD1.--Proposed ASC Payment Indicators
------------------------------------------------------------------------
       Indicator                  Payment indicator definition
------------------------------------------------------------------------
A2....................  Surgical procedure on ASC list in CY 2007;
                         payment based on OPPS relative payment weight.
D5....................  Deleted/discontinued code; no payment made.
F4....................  Corneal tissue acquisition; paid at reasonable
                         cost.
G2....................  Non office-based surgical procedure added in CY
                         2008 or later; payment based on OPPS relative
                         payment weight.
H2....................  Brachytherapy source paid separately when
                         provided integral to a surgical procedure on
                         ASC list; payment based on OPPS rate.
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 service/item; no separate payment made.
P2....................  Office-based surgical procedure added to ASC
                         list in CY 2008 or later with Medicare
                         Physician Fee Schedule (MPFS) nonfacility
                         practice expense (PE) relative value units
                         (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.
------------------------------------------------------------------------


[[Page 43093]]


             Addendum DD2.--Proposed ASC Comment Indicators
------------------------------------------------------------------------
       Indicator                  Comment indicator definition
------------------------------------------------------------------------
CH....................  Active HCPCS code in current year and next
                         calendar year, payment indicator has changed;
                         or active HCPCS code that is newly recognized
                         as payable in an ASC; or active HCPCS code that
                         is discontinued at the end of the current
                         calendar year.
NI....................  New code, interim payment; comments will be
                         accepted on the interim payment indicator for
                         the new code.
------------------------------------------------------------------------


[[Page 43094]]


 Addendum E.--Proposed HCPCS Codes That Would Be Paid Only as Inpatient
                         Procedures for CY 2008
------------------------------------------------------------------------
     HCPCS code                 Short descriptor                 SI
------------------------------------------------------------------------
00176...............  Anesth, pharyngeal surgery..........             C
00192...............  Anesth, facial bone surgery.........             C
00214...............  Anesth, skull drainage..............             C
00215...............  Anesth, skull repair/fract..........             C
00452...............  Anesth, surgery of shoulder.........             C
00474...............  Anesth, surgery of rib(s)...........             C
00524...............  Anesth, chest drainage..............             C
00540...............  Anesth, chest surgery...............             C
00542...............  Anesth, release of lung.............             C
00546...............  Anesth, lung,chest wall surg........             C
00560...............  Anesth, heart surg w/o pump.........             C
00561...............  Anesth, heart surg < age 1..........             C
00562...............  Anesth, heart surg w/pump...........             C
00580...............  Anesth, heart/lung transplnt........             C
00604...............  Anesth, sitting procedure...........             C
00622...............  Anesth, removal of nerves...........             C
00632...............  Anesth, removal of nerves...........             C
00670...............  Anesth, spine, cord surgery.........             C
00792...............  Anesth, hemorr/excise liver.........             C
00794...............  Anesth, pancreas removal............             C
00796...............  Anesth, for liver transplant........             C
00802...............  Anesth, fat layer removal...........             C
00844...............  Anesth, pelvis surgery..............             C
00846...............  Anesth, hysterectomy................             C
00848...............  Anesth, pelvic organ surg...........             C
00864...............  Anesth, removal of bladder..........             C
00865...............  Anesth, removal of prostate.........             C
00866...............  Anesth, removal of adrenal..........             C
00868...............  Anesth, kidney transplant...........             C
00882...............  Anesth, major vein ligation.........             C
00904...............  Anesth, perineal surgery............             C
00908...............  Anesth, removal of prostate.........             C
00932...............  Anesth, amputation of penis.........             C
00934...............  Anesth, penis, nodes removal........             C
00936...............  Anesth, penis, nodes removal........             C
00944...............  Anesth, vaginal hysterectomy........             C
01140...............  Anesth, amputation at pelvis........             C
01150...............  Anesth, pelvic tumor surgery........             C
01212...............  Anesth, hip disarticulation.........             C
01214...............  Anesth, hip arthroplasty............             C
01232...............  Anesth, amputation of femur.........             C
01234...............  Anesth, radical femur surg..........             C
01272...............  Anesth, femoral artery surg.........             C
01274...............  Anesth, femoral embolectomy.........             C
01402...............  Anesth, knee arthroplasty...........             C
01404...............  Anesth, amputation at knee..........             C
01442...............  Anesth, knee artery surg............             C
01444...............  Anesth, knee artery repair..........             C
01486...............  Anesth, ankle replacement...........             C
01502...............  Anesth, lwr leg embolectomy.........             C
01632...............  Anesth, surgery of shoulder.........             C
01634...............  Anesth, shoulder joint amput........             C
01636...............  Anesth, forequarter amput...........             C
01638...............  Anesth, shoulder replacement........             C
01652...............  Anesth, shoulder vessel surg........             C
01654...............  Anesth, shoulder vessel surg........             C
01656...............  Anesth, arm-leg vessel surg.........             C
01756...............  Anesth, radical humerus surg........             C
01990...............  Support for organ donor.............             C
11004...............  Debride genitalia & perineum........             C
11005...............  Debride abdom wall..................             C
11006...............  Debride genit/per/abdom wall........             C
11008...............  Remove mesh from abd wall...........             C
15756...............  Free myo/skin flap microvasc........             C
15757...............  Free skin flap, microvasc...........             C
15758...............  Free fascial flap, microvasc........             C
16036...............  Escharotomy; add'l incision.........             C
19271...............  Revision of chest wall..............             C
19272...............  Extensive chest wall surgery........             C
19305...............  Mast, radical.......................             C
19306...............  Mast, rad, urban type...............             C

[[Page 43095]]

 
19361...............  Breast reconstr w/lat flap..........             C
19364...............  Breast reconstruction...............             C
19367...............  Breast reconstruction...............             C
19368...............  Breast reconstruction...............             C
19369...............  Breast reconstruction...............             C
20660...............  Apply, rem fixation device..........             C
20661...............  Application of head brace...........             C
20664...............  Halo brace application..............             C
20802...............  Replantation, arm, complete.........             C
20805...............  Replant forearm, complete...........             C
20808...............  Replantation hand, complete.........             C
20816...............  Replantation digit, complete........             C
20824...............  Replantation thumb, complete........             C
20827...............  Replantation thumb, complete........             C
20838...............  Replantation foot, complete.........             C
20930...............  Spinal bone allograft...............             C
20931...............  Spinal bone allograft...............             C
20936...............  Spinal bone autograft...............             C
20937...............  Spinal bone autograft...............             C
20938...............  Spinal bone autograft...............             C
20955...............  Fibula bone graft, microvasc........             C
20956...............  Iliac bone graft, microvasc.........             C
20957...............  Mt bone graft, microvasc............             C
20962...............  Other bone graft, microvasc.........             C
20969...............  Bone/skin graft, microvasc..........             C
20970...............  Bone/skin graft, iliac crest........             C
21045...............  Extensive jaw surgery...............             C
21141...............  Reconstruct midface, lefort.........             C
21142...............  Reconstruct midface, lefort.........             C
21143...............  Reconstruct midface, lefort.........             C
21145...............  Reconstruct midface, lefort.........             C
21146...............  Reconstruct midface, lefort.........             C
21147...............  Reconstruct midface, lefort.........             C
21151...............  Reconstruct midface, lefort.........             C
21154...............  Reconstruct midface, lefort.........             C
21155...............  Reconstruct midface, lefort.........             C
21159...............  Reconstruct midface, lefort.........             C
21160...............  Reconstruct midface, lefort.........             C
21172...............  Reconstruct orbit/forehead..........             C
21179...............  Reconstruct entire forehead.........             C
21180...............  Reconstruct entire forehead.........             C
21182...............  Reconstruct cranial bone............             C
21183...............  Reconstruct cranial bone............             C
21184...............  Reconstruct cranial bone............             C
21188...............  Reconstruction of midface...........             C
21193...............  Reconst lwr jaw w/o graft...........             C
21194...............  Reconst lwr jaw w/graft.............             C
21196...............  Reconst lwr jaw w/fixation..........             C
21247...............  Reconstruct lower jaw bone..........             C
21255...............  Reconstruct lower jaw bone..........             C
21256...............  Reconstruction of orbit.............             C
21268...............  Revise eye sockets..................             C
21343...............  Treatment of sinus fracture.........             C
21344...............  Treatment of sinus fracture.........             C
21346...............  Treat nose/jaw fracture.............             C
21347...............  Treat nose/jaw fracture.............             C
21348...............  Treat nose/jaw fracture.............             C
21366...............  Treat cheek bone fracture...........             C
21386...............  Treat eye socket fracture...........             C
21387...............  Treat eye socket fracture...........             C
21395...............  Treat eye socket fracture...........             C
21422...............  Treat mouth roof fracture...........             C
21423...............  Treat mouth roof fracture...........             C
21431...............  Treat craniofacial fracture.........             C
21432...............  Treat craniofacial fracture.........             C
21433...............  Treat craniofacial fracture.........             C
21435...............  Treat craniofacial fracture.........             C
21436...............  Treat craniofacial fracture.........             C
21510...............  Drainage of bone lesion.............             C
21615...............  Removal of rib......................             C

[[Page 43096]]

 
21616...............  Removal of rib and nerves...........             C
21620...............  Partial removal of sternum..........             C
21627...............  Sternal debridement.................             C
21630...............  Extensive sternum surgery...........             C
21632...............  Extensive sternum surgery...........             C
21705...............  Revision of neck muscle/rib.........             C
21740...............  Reconstruction of sternum...........             C
21750...............  Repair of sternum separation........             C
21810...............  Treatment of rib fracture(s)........             C
21825...............  Treat sternum fracture..............             C
22010...............  I&d, p-spine, c/t/cerv-thor.........             C
22015...............  I&d, p-spine, l/s/ls................             C
22110...............  Remove part of neck vertebra........             C
22112...............  Remove part, thorax vertebra........             C
22114...............  Remove part, lumbar vertebra........             C
22116...............  Remove extra spine segment..........             C
22210...............  Revision of neck spine..............             C
22212...............  Revision of thorax spine............             C
22214...............  Revision of lumbar spine............             C
22216...............  Revise, extra spine segment.........             C
22220...............  Revision of neck spine..............             C
22224...............  Revision of lumbar spine............             C
22226...............  Revise, extra spine segment.........             C
22318...............  Treat odontoid fx w/o graft.........             C
22319...............  Treat odontoid fx w/graft...........             C
22325...............  Treat spine fracture................             C
22326...............  Treat neck spine fracture...........             C
22327...............  Treat thorax spine fracture.........             C
22328...............  Treat each add spine fx.............             C
22532...............  Lat thorax spine fusion.............             C
22533...............  Lat lumbar spine fusion.............             C
22534...............  Lat thor/lumb, addl seg.............             C
22548...............  Neck spine fusion...................             C
22554...............  Neck spine fusion...................             C
22556...............  Thorax spine fusion.................             C
22558...............  Lumbar spine fusion.................             C
22585...............  Additional spinal fusion............             C
22590...............  Spine & skull spinal fusion.........             C
22595...............  Neck spinal fusion..................             C
22600...............  Neck spine fusion...................             C
22610...............  Thorax spine fusion.................             C
22630...............  Lumbar spine fusion.................             C
22632...............  Spine fusion, extra segment.........             C
22800...............  Fusion of spine.....................             C
22802...............  Fusion of spine.....................             C
22804...............  Fusion of spine.....................             C
22808...............  Fusion of spine.....................             C
22810...............  Fusion of spine.....................             C
22812...............  Fusion of spine.....................             C
22818...............  Kyphectomy, 1-2 segments............             C
22819...............  Kyphectomy, 3 or more...............             C
22830...............  Exploration of spinal fusion........             C
22840...............  Insert spine fixation device........             C
22841...............  Insert spine fixation device........             C
22842...............  Insert spine fixation device........             C
22843...............  Insert spine fixation device........             C
22844...............  Insert spine fixation device........             C
22845...............  Insert spine fixation device........             C
22846...............  Insert spine fixation device........             C
22847...............  Insert spine fixation device........             C
22848...............  Insert pelv fixation device.........             C
22849...............  Reinsert spinal fixation............             C
22850...............  Remove spine fixation device........             C
22852...............  Remove spine fixation device........             C
22855...............  Remove spine fixation device........             C
22857...............  Lumbar artif diskectomy.............             C
22862...............  Revise lumbar artif disc............             C
22865...............  Remove lumb artif disc..............             C
23200...............  Removal of collar bone..............             C
23210...............  Removal of shoulder blade...........             C

[[Page 43097]]

 
23220...............  Partial removal of humerus..........             C
23221...............  Partial removal of humerus..........             C
23222...............  Partial removal of humerus..........             C
23332...............  Remove shoulder foreign body........             C
23472...............  Reconstruct shoulder joint..........             C
23900...............  Amputation of arm & girdle..........             C
23920...............  Amputation at shoulder joint........             C
24900...............  Amputation of upper arm.............             C
24920...............  Amputation of upper arm.............             C
24930...............  Amputation follow-up surgery........             C
24931...............  Amputate upper arm & implant........             C
24940...............  Revision of upper arm...............             C
25900...............  Amputation of forearm...............             C
25905...............  Amputation of forearm...............             C
25909...............  Amputation follow-up surgery........             C
25915...............  Amputation of forearm...............             C
25920...............  Amputate hand at wrist..............             C
25924...............  Amputation follow-up surgery........             C
25927...............  Amputation of hand..................             C
26551...............  Great toe-hand transfer.............             C
26553...............  Single transfer, toe-hand...........             C
26554...............  Double transfer, toe-hand...........             C
26556...............  Toe joint transfer..................             C
26992...............  Drainage of bone lesion.............             C
27005...............  Incision of hip tendon..............             C
27025...............  Incision of hip/thigh fascia........             C
27030...............  Drainage of hip joint...............             C
27036...............  Excision of hip joint/muscle........             C
27054...............  Removal of hip joint lining.........             C
27070...............  Partial removal of hip bone.........             C
27071...............  Partial removal of hip bone.........             C
27075...............  Extensive hip surgery...............             C
27076...............  Extensive hip surgery...............             C
27077...............  Extensive hip surgery...............             C
27078...............  Extensive hip surgery...............             C
27079...............  Extensive hip surgery...............             C
27090...............  Removal of hip prosthesis...........             C
27091...............  Removal of hip prosthesis...........             C
27120...............  Reconstruction of hip socket........             C
27122...............  Reconstruction of hip socket........             C
27125...............  Partial hip replacement.............             C
27130...............  Total hip arthroplasty..............             C
27132...............  Total hip arthroplasty..............             C
27134...............  Revise hip joint replacement........             C
27137...............  Revise hip joint replacement........             C
27138...............  Revise hip joint replacement........             C
27140...............  Transplant femur ridge..............             C
27146...............  Incision of hip bone................             C
27147...............  Revision of hip bone................             C
27151...............  Incision of hip bones...............             C
27156...............  Revision of hip bones...............             C
27158...............  Revision of pelvis..................             C
27161...............  Incision of neck of femur...........             C
27165...............  Incision/fixation of femur..........             C
27170...............  Repair/graft femur head/neck........             C
27175...............  Treat slipped epiphysis.............             C
27176...............  Treat slipped epiphysis.............             C
27177...............  Treat slipped epiphysis.............             C
27178...............  Treat slipped epiphysis.............             C
27179...............  Revise head/neck of femur...........             C
27181...............  Treat slipped epiphysis.............             C
27185...............  Revision of femur epiphysis.........             C
27187...............  Reinforce hip bones.................             C
27215...............  Treat pelvic fracture(s)............             C
27217...............  Treat pelvic ring fracture..........             C
27218...............  Treat pelvic ring fracture..........             C
27222...............  Treat hip socket fracture...........             C
27226...............  Treat hip wall fracture.............             C
27227...............  Treat hip fracture(s)...............             C
27228...............  Treat hip fracture(s)...............             C

[[Page 43098]]

 
27232...............  Treat thigh fracture................             C
27236...............  Treat thigh fracture................             C
27240...............  Treat thigh fracture................             C
27244...............  Treat thigh fracture................             C
27245...............  Treat thigh fracture................             C
27248...............  Treat thigh fracture................             C
27253...............  Treat hip dislocation...............             C
27254...............  Treat hip dislocation...............             C
27258...............  Treat hip dislocation...............             C
27259...............  Treat hip dislocation...............             C
27280...............  Fusion of sacroiliac joint..........             C
27282...............  Fusion of pubic bones...............             C
27284...............  Fusion of hip joint.................             C
27286...............  Fusion of hip joint.................             C
27290...............  Amputation of leg at hip............             C
27295...............  Amputation of leg at hip............             C
27303...............  Drainage of bone lesion.............             C
27365...............  Extensive leg surgery...............             C
27445...............  Revision of knee joint..............             C
27447...............  Total knee arthroplasty.............             C
27448...............  Incision of thigh...................             C
27450...............  Incision of thigh...................             C
27454...............  Realignment of thigh bone...........             C
27455...............  Realignment of knee.................             C
27457...............  Realignment of knee.................             C
27465...............  Shortening of thigh bone............             C
27466...............  Lengthening of thigh bone...........             C
27468...............  Shorten/lengthen thighs.............             C
27470...............  Repair of thigh.....................             C
27472...............  Repair/graft of thigh...............             C
27477...............  Surgery to stop leg growth..........             C
27479...............  Surgery to stop leg growth..........             C
27485...............  Surgery to stop leg growth..........             C
27486...............  Revise/replace knee joint...........             C
27487...............  Revise/replace knee joint...........             C
27488...............  Removal of knee prosthesis..........             C
27495...............  Reinforce thigh.....................             C
27506...............  Treatment of thigh fracture.........             C
27507...............  Treatment of thigh fracture.........             C
27511...............  Treatment of thigh fracture.........             C
27513...............  Treatment of thigh fracture.........             C
27514...............  Treatment of thigh fracture.........             C
27519...............  Treat thigh fx growth plate.........             C
27535...............  Treat knee fracture.................             C
27536...............  Treat knee fracture.................             C
27540...............  Treat knee fracture.................             C
27556...............  Treat knee dislocation..............             C
27557...............  Treat knee dislocation..............             C
27558...............  Treat knee dislocation..............             C
27580...............  Fusion of knee......................             C
27590...............  Amputate leg at thigh...............             C
27591...............  Amputate leg at thigh...............             C
27592...............  Amputate leg at thigh...............             C
27596...............  Amputation follow-up surgery........             C
27598...............  Amputate lower leg at knee..........             C
27645...............  Extensive lower leg surgery.........             C
27646...............  Extensive lower leg surgery.........             C
27702...............  Reconstruct ankle joint.............             C
27703...............  Reconstruction, ankle joint.........             C
27712...............  Realignment of lower leg............             C
27715...............  Revision of lower leg...............             C
27724...............  Repair/graft of tibia...............             C
27725...............  Repair of lower leg.................             C
27727...............  Repair of lower leg.................             C
27880...............  Amputation of lower leg.............             C
27881...............  Amputation of lower leg.............             C
27882...............  Amputation of lower leg.............             C
27886...............  Amputation follow-up surgery........             C
27888...............  Amputation of foot at ankle.........             C
28800...............  Amputation of midfoot...............             C

[[Page 43099]]

 
28805...............  Amputation thru metatarsal..........             C
31225...............  Removal of upper jaw................             C
31230...............  Removal of upper jaw................             C
31290...............  Nasal/sinus endoscopy, surg.........             C
31291...............  Nasal/sinus endoscopy, surg.........             C
31360...............  Removal of larynx...................             C
31365...............  Removal of larynx...................             C
31367...............  Partial removal of larynx...........             C
31368...............  Partial removal of larynx...........             C
31370...............  Partial removal of larynx...........             C
31375...............  Partial removal of larynx...........             C
31380...............  Partial removal of larynx...........             C
31382...............  Partial removal of larynx...........             C
31390...............  Removal of larynx & pharynx.........             C
31395...............  Reconstruct larynx & pharynx........             C
31584...............  Treat larynx fracture...............             C
31587...............  Revision of larynx..................             C
31725...............  Clearance of airways................             C
31760...............  Repair of windpipe..................             C
31766...............  Reconstruction of windpipe..........             C
31770...............  Repair/graft of bronchus............             C
31775...............  Reconstruct bronchus................             C
31780...............  Reconstruct windpipe................             C
31781...............  Reconstruct windpipe................             C
31786...............  Remove windpipe lesion..............             C
31800...............  Repair of windpipe injury...........             C
31805...............  Repair of windpipe injury...........             C
32035...............  Exploration of chest................             C
32036...............  Exploration of chest................             C
32095...............  Biopsy through chest wall...........             C
32100...............  Exploration/biopsy of chest.........             C
32110...............  Explore/repair chest................             C
32120...............  Re-exploration of chest.............             C
32124...............  Explore chest free adhesions........             C
32140...............  Removal of lung lesion(s)...........             C
32141...............  Remove/treat lung lesions...........             C
32150...............  Removal of lung lesion(s)...........             C
32151...............  Remove lung foreign body............             C
32160...............  Open chest heart massage............             C
32200...............  Drain, open, lung lesion............             C
32215...............  Treat chest lining..................             C
32220...............  Release of lung.....................             C
32225...............  Partial release of lung.............             C
32310...............  Removal of chest lining.............             C
32320...............  Free/remove chest lining............             C
32402...............  Open biopsy chest lining............             C
32440...............  Removal of lung.....................             C
32442...............  Sleeve pneumonectomy................             C
32445...............  Removal of lung.....................             C
32480...............  Partial removal of lung.............             C
32482...............  Bilobectomy.........................             C
32484...............  Segmentectomy.......................             C
32486...............  Sleeve lobectomy....................             C
32488...............  Completion pneumonectomy............             C
32491...............  Lung volume reduction...............             C
32500...............  Partial removal of lung.............             C
32501...............  Repair bronchus add-on..............             C
32503...............  Resect apical lung tumor............             C
32504...............  Resect apical lung tum/chest........             C
32540...............  Removal of lung lesion..............             C
32650...............  Thoracoscopy, surgical..............             C
32651...............  Thoracoscopy, surgical..............             C
32652...............  Thoracoscopy, surgical..............             C
32653...............  Thoracoscopy, surgical..............             C
32654...............  Thoracoscopy, surgical..............             C
32655...............  Thoracoscopy, surgical..............             C
32656...............  Thoracoscopy, surgical..............             C
32657...............  Thoracoscopy, surgical..............             C
32658...............  Thoracoscopy, surgical..............             C
32659...............  Thoracoscopy, surgical..............             C

[[Page 43100]]

 
32660...............  Thoracoscopy, surgical..............             C
32661...............  Thoracoscopy, surgical..............             C
32662...............  Thoracoscopy, surgical..............             C
32663...............  Thoracoscopy, surgical..............             C
32664...............  Thoracoscopy, surgical..............             C
32665...............  Thoracoscopy, surgical..............             C
32800...............  Repair lung hernia..................             C
32810...............  Close chest after drainage..........             C
32815...............  Close bronchial fistula.............             C
32820...............  Reconstruct injured chest...........             C
32850...............  Donor pneumonectomy.................             C
32851...............  Lung transplant, single.............             C
32852...............  Lung transplant with bypass.........             C
32853...............  Lung transplant, double.............             C
32854...............  Lung transplant with bypass.........             C
32855...............  Prepare donor lung, single..........             C
32856...............  Prepare donor lung, double..........             C
32900...............  Removal of rib(s)...................             C
32905...............  Revise & repair chest wall..........             C
32906...............  Revise & repair chest wall..........             C
32940...............  Revision of lung....................             C
32997...............  Total lung lavage...................             C
33015...............  Incision of heart sac...............             C
33020...............  Incision of heart sac...............             C
33025...............  Incision of heart sac...............             C
33030...............  Partial removal of heart sac........             C
33031...............  Partial removal of heart sac........             C
33050...............  Removal of heart sac lesion.........             C
33120...............  Removal of heart lesion.............             C
33130...............  Removal of heart lesion.............             C
33140...............  Heart revascularize (tmr)...........             C
33141...............  Heart tmr w/other procedure.........             C
33202...............  Insert epicard eltrd, open..........             C
33203...............  Insert epicard eltrd, endo..........             C
33236...............  Remove electrode/thoracotomy........             C
33237...............  Remove electrode/thoracotomy........             C
33238...............  Remove electrode/thoracotomy........             C
33243...............  Remove eltrd/thoracotomy............             C
33250...............  Ablate heart dysrhythm focus........             C
33251...............  Ablate heart dysrhythm focus........             C
33254...............  Ablate atria, lmtd..................             C
33255...............  Ablate atria w/o bypass, ext........             C
33256...............  Ablate atria w/bypass, exten........             C
33261...............  Ablate heart dysrhythm focus........             C
33265...............  Ablate atria w/bypass, endo.........             C
33266...............  Ablate atria w/o bypass endo........             C
33300...............  Repair of heart wound...............             C
33305...............  Repair of heart wound...............             C
33310...............  Exploratory heart surgery...........             C
33315...............  Exploratory heart surgery...........             C
33320...............  Repair major blood vessel(s)........             C
33321...............  Repair major vessel.................             C
33322...............  Repair major blood vessel(s)........             C
33330...............  Insert major vessel graft...........             C
33332...............  Insert major vessel graft...........             C
33335...............  Insert major vessel graft...........             C
33400...............  Repair of aortic valve..............             C
33401...............  Valvuloplasty, open.................             C
33403...............  Valvuloplasty, w/cp bypass..........             C
33404...............  Prepare heart-aorta conduit.........             C
33405...............  Replacement of aortic valve.........             C
33406...............  Replacement of aortic valve.........             C
33410...............  Replacement of aortic valve.........             C
33411...............  Replacement of aortic valve.........             C
33412...............  Replacement of aortic valve.........             C
33413...............  Replacement of aortic valve.........             C
33414...............  Repair of aortic valve..............             C
33415...............  Revision, subvalvular tissue........             C
33416...............  Revise ventricle muscle.............             C
33417...............  Repair of aortic valve..............             C

[[Page 43101]]

 
33420...............  Revision of mitral valve............             C
33422...............  Revision of mitral valve............             C
33425...............  Repair of mitral valve..............             C
33426...............  Repair of mitral valve..............             C
33427...............  Repair of mitral valve..............             C
33430...............  Replacement of mitral valve.........             C
33460...............  Revision of tricuspid valve.........             C
33463...............  Valvuloplasty, tricuspid............             C
33464...............  Valvuloplasty, tricuspid............             C
33465...............  Replace tricuspid valve.............             C
33468...............  Revision of tricuspid valve.........             C
33470...............  Revision of pulmonary valve.........             C
33471...............  Valvotomy, pulmonary valve..........             C
33472...............  Revision of pulmonary valve.........             C
33474...............  Revision of pulmonary valve.........             C
33475...............  Replacement, pulmonary valve........             C
33476...............  Revision of heart chamber...........             C
33478...............  Revision of heart chamber...........             C
33496...............  Repair, prosth valve clot...........             C
33500...............  Repair heart vessel fistula.........             C
33501...............  Repair heart vessel fistula.........             C
33502...............  Coronary artery correction..........             C
33503...............  Coronary artery graft...............             C
33504...............  Coronary artery graft...............             C
33505...............  Repair artery w/tunnel..............             C
33506...............  Repair artery, translocation........             C
33507...............  Repair art, intramural..............             C
33510...............  CABG, vein, single..................             C
33511...............  CABG, vein, two.....................             C
33512...............  CABG, vein, three...................             C
33513...............  CABG, vein, four....................             C
33514...............  CABG, vein, five....................             C
33516...............  Cabg, vein, six or more.............             C
33517...............  CABG, artery-vein, single...........             C
33518...............  CABG, artery-vein, two..............             C
33519...............  CABG, artery-vein, three............             C
33521...............  CABG, artery-vein, four.............             C
33522...............  CABG, artery-vein, five.............             C
33523...............  Cabg, art-vein, six or more.........             C
33530...............  Coronary artery, bypass/reop........             C
33533...............  CABG, arterial, single..............             C
33534...............  CABG, arterial, two.................             C
33535...............  CABG, arterial, three...............             C
33536...............  Cabg, arterial, four or more........             C
33542...............  Removal of heart lesion.............             C
33545...............  Repair of heart damage..............             C
33548...............  Restore/remodel, ventricle..........             C
33572...............  Open coronary endarterectomy........             C
33600...............  Closure of valve....................             C
33602...............  Closure of valve....................             C
33606...............  Anastomosis/artery-aorta............             C
33608...............  Repair anomaly w/conduit............             C
33610...............  Repair by enlargement...............             C
33611...............  Repair double ventricle.............             C
33612...............  Repair double ventricle.............             C
33615...............  Repair, modified fontan.............             C
33617...............  Repair single ventricle.............             C
33619...............  Repair single ventricle.............             C
33641...............  Repair heart septum defect..........             C
33645...............  Revision of heart veins.............             C
33647...............  Repair heart septum defects.........             C
33660...............  Repair of heart defects.............             C
33665...............  Repair of heart defects.............             C
33670...............  Repair of heart chambers............             C
33675...............  Close mult vsd......................             C
33676...............  Close mult vsd w/resection..........             C
33677...............  Cl mult vsd w/rem pul band..........             C
33681...............  Repair heart septum defect..........             C
33684...............  Repair heart septum defect..........             C
33688...............  Repair heart septum defect..........             C

[[Page 43102]]

 
33690...............  Reinforce pulmonary artery..........             C
33692...............  Repair of heart defects.............             C
33694...............  Repair of heart defects.............             C
33697...............  Repair of heart defects.............             C
33702...............  Repair of heart defects.............             C
33710...............  Repair of heart defects.............             C
33720...............  Repair of heart defect..............             C
33722...............  Repair of heart defect..............             C
33724...............  Repair venous anomaly...............             C
33726...............  Repair pul venous stenosis..........             C
33730...............  Repair heart-vein defect(s).........             C
33732...............  Repair heart-vein defect............             C
33735...............  Revision of heart chamber...........             C
33736...............  Revision of heart chamber...........             C
33737...............  Revision of heart chamber...........             C
33750...............  Major vessel shunt..................             C
33755...............  Major vessel shunt..................             C
33762...............  Major vessel shunt..................             C
33764...............  Major vessel shunt & graft..........             C
33766...............  Major vessel shunt..................             C
33767...............  Major vessel shunt..................             C
33768...............  Cavopulmonary shunting..............             C
33770...............  Repair great vessels defect.........             C
33771...............  Repair great vessels defect.........             C
33774...............  Repair great vessels defect.........             C
33775...............  Repair great vessels defect.........             C
33776...............  Repair great vessels defect.........             C
33777...............  Repair great vessels defect.........             C
33778...............  Repair great vessels defect.........             C
33779...............  Repair great vessels defect.........             C
33780...............  Repair great vessels defect.........             C
33781...............  Repair great vessels defect.........             C
33786...............  Repair arterial trunk...............             C
33788...............  Revision of pulmonary artery........             C
33800...............  Aortic suspension...................             C
33802...............  Repair vessel defect................             C
33803...............  Repair vessel defect................             C
33813...............  Repair septal defect................             C
33814...............  Repair septal defect................             C
33820...............  Revise major vessel.................             C
33822...............  Revise major vessel.................             C
33824...............  Revise major vessel.................             C
33840...............  Remove aorta constriction...........             C
33845...............  Remove aorta constriction...........             C
33851...............  Remove aorta constriction...........             C
33852...............  Repair septal defect................             C
33853...............  Repair septal defect................             C
33860...............  Ascending aortic graft..............             C
33861...............  Ascending aortic graft..............             C
33863...............  Ascending aortic graft..............             C
33870...............  Transverse aortic arch graft........             C
33875...............  Thoracic aortic graft...............             C
33877...............  Thoracoabdominal graft..............             C
33880...............  Endovasc taa repr incl subcl........             C
33881...............  Endovasc taa repr w/o subcl.........             C
33883...............  Insert endovasc prosth, taa.........             C
33884...............  Endovasc prosth, taa, add-on........             C
33886...............  Endovasc prosth, delayed............             C
33889...............  Artery transpose/endovas taa........             C
33891...............  Car-car bp grft/endovas taa.........             C
33910...............  Remove lung artery emboli...........             C
33915...............  Remove lung artery emboli...........             C
33916...............  Surgery of great vessel.............             C
33917...............  Repair pulmonary artery.............             C
33920...............  Repair pulmonary atresia............             C
33922...............  Transect pulmonary artery...........             C
33924...............  Remove pulmonary shunt..............             C
33925...............  Rpr pul art unifocal w/o cpb........             C
33926...............  Repr pul art, unifocal w/cpb........             C
33930...............  Removal of donor heart/lung.........             C

[[Page 43103]]

 
33933...............  Prepare donor heart/lung............             C
33935...............  Transplantation, heart/lung.........             C
33940...............  Removal of donor heart..............             C
33944...............  Prepare donor heart.................             C
33945...............  Transplantation of heart............             C
33960...............  External circulation assist.........             C
33961...............  External circulation assist.........             C
33967...............  Insert ia percut device.............             C
33968...............  Remove aortic assist device.........             C
33970...............  Aortic circulation assist...........             C
33971...............  Aortic circulation assist...........             C
33973...............  Insert balloon device...............             C
33974...............  Remove intra-aortic balloon.........             C
33975...............  Implant ventricular device..........             C
33976...............  Implant ventricular device..........             C
33977...............  Remove ventricular device...........             C
33978...............  Remove ventricular device...........             C
33979...............  Insert intracorporeal device........             C
33980...............  Remove intracorporeal device........             C
34001...............  Removal of artery clot..............             C
34051...............  Removal of artery clot..............             C
34151...............  Removal of artery clot..............             C
34401...............  Removal of vein clot................             C
34451...............  Removal of vein clot................             C
34502...............  Reconstruct vena cava...............             C
34800...............  Endovas aaa repr w/sm tube..........             C
34802...............  Endovas aaa repr w/2-p part.........             C
34803...............  Endovas aaa repr w/3-p part.........             C
34804...............  Endovas aaa repr w/1-p part.........             C
34805...............  Endovas aaa repr w/long tube........             C
34808...............  Endovas iliac a device addon........             C
34812...............  Xpose for endoprosth, femorl........             C
34813...............  Femoral endovas graft add-on........             C
34820...............  Xpose for endoprosth, iliac.........             C
34825...............  Endovasc extend prosth, init........             C
34826...............  Endovasc exten prosth, add'l........             C
34830...............  Open aortic tube prosth repr........             C
34831...............  Open aortoiliac prosth repr.........             C
34832...............  Open aortofemor prosth repr.........             C
34833...............  Xpose for endoprosth, iliac.........             C
34834...............  Xpose, endoprosth, brachial.........             C
34900...............  Endovasc iliac repr w/graft.........             C
35001...............  Repair defect of artery.............             C
35002...............  Repair artery rupture, neck.........             C
35005...............  Repair defect of artery.............             C
35013...............  Repair artery rupture, arm..........             C
35021...............  Repair defect of artery.............             C
35022...............  Repair artery rupture, chest........             C
35045...............  Repair defect of arm artery.........             C
35081...............  Repair defect of artery.............             C
35082...............  Repair artery rupture, aorta........             C
35091...............  Repair defect of artery.............             C
35092...............  Repair artery rupture, aorta........             C
35102...............  Repair defect of artery.............             C
35103...............  Repair artery rupture, groin........             C
35111...............  Repair defect of artery.............             C
35112...............  Repair artery rupture,spleen........             C
35121...............  Repair defect of artery.............             C
35122...............  Repair artery rupture, belly........             C
35131...............  Repair defect of artery.............             C
35132...............  Repair artery rupture, groin........             C
35141...............  Repair defect of artery.............             C
35142...............  Repair artery rupture, thigh........             C
35151...............  Repair defect of artery.............             C
35152...............  Repair artery rupture, knee.........             C
35182...............  Repair blood vessel lesion..........             C
35189...............  Repair blood vessel lesion..........             C
35211...............  Repair blood vessel lesion..........             C
35216...............  Repair blood vessel lesion..........             C
35221...............  Repair blood vessel lesion..........             C

[[Page 43104]]

 
35241...............  Repair blood vessel lesion..........             C
35246...............  Repair blood vessel lesion..........             C
35251...............  Repair blood vessel lesion..........             C
35271...............  Repair blood vessel lesion..........             C
35276...............  Repair blood vessel lesion..........             C
35281...............  Repair blood vessel lesion..........             C
35301...............  Rechanneling of artery..............             C
35302...............  Rechanneling of artery..............             C
35303...............  Rechanneling of artery..............             C
35304...............  Rechanneling of artery..............             C
35305...............  Rechanneling of artery..............             C
35306...............  Rechanneling of artery..............             C
35311...............  Rechanneling of artery..............             C
35331...............  Rechanneling of artery..............             C
35341...............  Rechanneling of artery..............             C
35351...............  Rechanneling of artery..............             C
35355...............  Rechanneling of artery..............             C
35361...............  Rechanneling of artery..............             C
35363...............  Rechanneling of artery..............             C
35371...............  Rechanneling of artery..............             C
35372...............  Rechanneling of artery..............             C
35390...............  Reoperation, carotid add-on.........             C
35400...............  Angioscopy..........................             C
35450...............  Repair arterial blockage............             C
35452...............  Repair arterial blockage............             C
35454...............  Repair arterial blockage............             C
35456...............  Repair arterial blockage............             C
35480...............  Atherectomy, open...................             C
35481...............  Atherectomy, open...................             C
35482...............  Atherectomy, open...................             C
35483...............  Atherectomy, open...................             C
35501...............  Artery bypass graft.................             C
35506...............  Artery bypass graft.................             C
35508...............  Artery bypass graft.................             C
35509...............  Artery bypass graft.................             C
35510...............  Artery bypass graft.................             C
35511...............  Artery bypass graft.................             C
35512...............  Artery bypass graft.................             C
35515...............  Artery bypass graft.................             C
35516...............  Artery bypass graft.................             C
35518...............  Artery bypass graft.................             C
35521...............  Artery bypass graft.................             C
35522...............  Artery bypass graft.................             C
35525...............  Artery bypass graft.................             C
35526...............  Artery bypass graft.................             C
35531...............  Artery bypass graft.................             C
35533...............  Artery bypass graft.................             C
35536...............  Artery bypass graft.................             C
35537...............  Artery bypass graft.................             C
35538...............  Artery bypass graft.................             C
35539...............  Artery bypass graft.................             C
35540...............  Artery bypass graft.................             C
35548...............  Artery bypass graft.................             C
35549...............  Artery bypass graft.................             C
35551...............  Artery bypass graft.................             C
35556...............  Artery bypass graft.................             C
35558...............  Artery bypass graft.................             C
35560...............  Artery bypass graft.................             C
35563...............  Artery bypass graft.................             C
35565...............  Artery bypass graft.................             C
35566...............  Artery bypass graft.................             C
35571...............  Artery bypass graft.................             C
35583...............  Vein bypass graft...................             C
35585...............  Vein bypass graft...................             C
35587...............  Vein bypass graft...................             C
35600...............  Harvest artery for cabg.............             C
35601...............  Artery bypass graft.................             C
35606...............  Artery bypass graft.................             C
35612...............  Artery bypass graft.................             C
35616...............  Artery bypass graft.................             C

[[Page 43105]]

 
35621...............  Artery bypass graft.................             C
35623...............  Bypass graft, not vein..............             C
35626...............  Artery bypass graft.................             C
35631...............  Artery bypass graft.................             C
35636...............  Artery bypass graft.................             C
35637...............  Artery bypass graft.................             C
35638...............  Artery bypass graft.................             C
35642...............  Artery bypass graft.................             C
35645...............  Artery bypass graft.................             C
35646...............  Artery bypass graft.................             C
35647...............  Artery bypass graft.................             C
35650...............  Artery bypass graft.................             C
35651...............  Artery bypass graft.................             C
35654...............  Artery bypass graft.................             C
35656...............  Artery bypass graft.................             C
35661...............  Artery bypass graft.................             C
35663...............  Artery bypass graft.................             C
35665...............  Artery bypass graft.................             C
35666...............  Artery bypass graft.................             C
35671...............  Artery bypass graft.................             C
35681...............  Composite bypass graft..............             C
35682...............  Composite bypass graft..............             C
35683...............  Composite bypass graft..............             C
35691...............  Arterial transposition..............             C
35693...............  Arterial transposition..............             C
35694...............  Arterial transposition..............             C
35695...............  Arterial transposition..............             C
35697...............  Reimplant artery each...............             C
35700...............  Reoperation, bypass graft...........             C
35701...............  Exploration, carotid artery.........             C
35721...............  Exploration, femoral artery.........             C
35741...............  Exploration popliteal artery........             C
35800...............  Explore neck vessels................             C
35820...............  Explore chest vessels...............             C
35840...............  Explore abdominal vessels...........             C
35870...............  Repair vessel graft defect..........             C
35901...............  Excision, graft, neck...............             C
35905...............  Excision, graft, thorax.............             C
35907...............  Excision, graft, abdomen............             C
36660...............  Insertion catheter, artery..........             C
36822...............  Insertion of cannula(s).............             C
36823...............  Insertion of cannula(s).............             C
37140...............  Revision of circulation.............             C
37145...............  Revision of circulation.............             C
37160...............  Revision of circulation.............             C
37180...............  Revision of circulation.............             C
37181...............  Splice spleen/kidney veins..........             C
37182...............  Insert hepatic shunt (tips).........             C
37215...............  Transcath stent, cca w/eps..........             C
37616...............  Ligation of chest artery............             C
37617...............  Ligation of abdomen artery..........             C
37618...............  Ligation of extremity artery........             C
37660...............  Revision of major vein..............             C
37788...............  Revascularization, penis............             C
38100...............  Removal of spleen, total............             C
38101...............  Removal of spleen, partial..........             C
38102...............  Removal of spleen, total............             C
38115...............  Repair of ruptured spleen...........             C
38380...............  Thoracic duct procedure.............             C
38381...............  Thoracic duct procedure.............             C
38382...............  Thoracic duct procedure.............             C
38562...............  Removal, pelvic lymph nodes.........             C
38564...............  Removal, abdomen lymph nodes........             C
38724...............  Removal of lymph nodes, neck........             C
38746...............  Remove thoracic lymph nodes.........             C
38747...............  Remove abdominal lymph nodes........             C
38765...............  Remove groin lymph nodes............             C
38770...............  Remove pelvis lymph nodes...........             C
38780...............  Remove abdomen lymph nodes..........             C
39000...............  Exploration of chest................             C

[[Page 43106]]

 
39010...............  Exploration of chest................             C
39200...............  Removal chest lesion................             C
39220...............  Removal chest lesion................             C
39499...............  Chest procedure.....................             C
39501...............  Repair diaphragm laceration.........             C
39502...............  Repair paraesophageal hernia........             C
39503...............  Repair of diaphragm hernia..........             C
39520...............  Repair of diaphragm hernia..........             C
39530...............  Repair of diaphragm hernia..........             C
39531...............  Repair of diaphragm hernia..........             C
39540...............  Repair of diaphragm hernia..........             C
39541...............  Repair of diaphragm hernia..........             C
39545...............  Revision of diaphragm...............             C
39560...............  Resect diaphragm, simple............             C
39561...............  Resect diaphragm, complex...........             C
39599...............  Diaphragm surgery procedure.........             C
41130...............  Partial removal of tongue...........             C
41135...............  Tongue and neck surgery.............             C
41140...............  Removal of tongue...................             C
41145...............  Tongue removal, neck surgery........             C
41150...............  Tongue, mouth, jaw surgery..........             C
41153...............  Tongue, mouth, neck surgery.........             C
41155...............  Tongue, jaw, & neck surgery.........             C
42426...............  Excise parotid gland/lesion.........             C
42845...............  Extensive surgery of throat.........             C
42894...............  Revision of pharyngeal walls........             C
42953...............  Repair throat, esophagus............             C
42961...............  Control throat bleeding.............             C
42971...............  Control nose/throat bleeding........             C
43045...............  Incision of esophagus...............             C
43100...............  Excision of esophagus lesion........             C
43101...............  Excision of esophagus lesion........             C
43107...............  Removal of esophagus................             C
43108...............  Removal of esophagus................             C
43112...............  Removal of esophagus................             C
43113...............  Removal of esophagus................             C
43116...............  Partial removal of esophagus........             C
43117...............  Partial removal of esophagus........             C
43118...............  Partial removal of esophagus........             C
43121...............  Partial removal of esophagus........             C
43122...............  Partial removal of esophagus........             C
43123...............  Partial removal of esophagus........             C
43124...............  Removal of esophagus................             C
43135...............  Removal of esophagus pouch..........             C
43300...............  Repair of esophagus.................             C
43305...............  Repair esophagus and fistula........             C
43310...............  Repair of esophagus.................             C
43312...............  Repair esophagus and fistula........             C
43313...............  Esophagoplasty congenital...........             C
43314...............  Tracheo-esophagoplasty cong.........             C
43320...............  Fuse esophagus & stomach............             C
43324...............  Revise esophagus & stomach..........             C
43325...............  Revise esophagus & stomach..........             C
43326...............  Revise esophagus & stomach..........             C
43330...............  Repair of esophagus.................             C
43331...............  Repair of esophagus.................             C
43340...............  Fuse esophagus & intestine..........             C
43341...............  Fuse esophagus & intestine..........             C
43350...............  Surgical opening, esophagus.........             C
43351...............  Surgical opening, esophagus.........             C
43352...............  Surgical opening, esophagus.........             C
43360...............  Gastrointestinal repair.............             C
43361...............  Gastrointestinal repair.............             C
43400...............  Ligate esophagus veins..............             C
43401...............  Esophagus surgery for veins.........             C
43405...............  Ligate/staple esophagus.............             C
43410...............  Repair esophagus wound..............             C
43415...............  Repair esophagus wound..............             C
43420...............  Repair esophagus opening............             C
43425...............  Repair esophagus opening............             C

[[Page 43107]]

 
43460...............  Pressure treatment esophagus........             C
43496...............  Free jejunum flap, microvasc........             C
43500...............  Surgical opening of stomach.........             C
43501...............  Surgical repair of stomach..........             C
43502...............  Surgical repair of stomach..........             C
43520...............  Incision of pyloric muscle..........             C
43605...............  Biopsy of stomach...................             C
43610...............  Excision of stomach lesion..........             C
43611...............  Excision of stomach lesion..........             C
43620...............  Removal of stomach..................             C
43621...............  Removal of stomach..................             C
43622...............  Removal of stomach..................             C
43631...............  Removal of stomach, partial.........             C
43632...............  Removal of stomach, partial.........             C
43633...............  Removal of stomach, partial.........             C
43634...............  Removal of stomach, partial.........             C
43635...............  Removal of stomach, partial.........             C
43640...............  Vagotomy & pylorus repair...........             C
43641...............  Vagotomy & pylorus repair...........             C
43644...............  Lap gastric bypass/roux-en-y........             C
43645...............  Lap gastr bypass incl smll i........             C
43770...............  Lap, place gastr adjust band........             C
43771...............  Lap, revise adjust gast band........             C
43772...............  Lap, remove adjust gast band........             C
43773...............  Lap, change adjust gast band........             C
43774...............  Lap remov adj gast band/port........             C
43800...............  Reconstruction of pylorus...........             C
43810...............  Fusion of stomach and bowel.........             C
43820...............  Fusion of stomach and bowel.........             C
43825...............  Fusion of stomach and bowel.........             C
43832...............  Place gastrostomy tube..............             C
43840...............  Repair of stomach lesion............             C
43843...............  Gastroplasty w/o v-band.............             C
43845...............  Gastroplasty duodenal switch........             C
43846...............  Gastric bypass for obesity..........             C
43847...............  Gastric bypass incl small i.........             C
43848...............  Revision gastroplasty...............             C
43850...............  Revise stomach-bowel fusion.........             C
43855...............  Revise stomach-bowel fusion.........             C
43860...............  Revise stomach-bowel fusion.........             C
43865...............  Revise stomach-bowel fusion.........             C
43880...............  Repair stomach-bowel fistula........             C
43881...............  Impl/redo electrd, antrum...........             C
43882...............  Revise/remove electrd antrum........             C
44005...............  Freeing of bowel adhesion...........             C
44010...............  Incision of small bowel.............             C
44015...............  Insert needle cath bowel............             C
44020...............  Explore small intestine.............             C
44021...............  Decompress small bowel..............             C
44025...............  Incision of large bowel.............             C
44050...............  Reduce bowel obstruction............             C
44055...............  Correct malrotation of bowel........             C
44110...............  Excise intestine lesion(s)..........             C
44111...............  Excision of bowel lesion(s).........             C
44120...............  Removal of small intestine..........             C
44121...............  Removal of small intestine..........             C
44125...............  Removal of small intestine..........             C
44126...............  Enterectomy w/o taper, cong.........             C
44127...............  Enterectomy w/taper, cong...........             C
44128...............  Enterectomy cong, add-on............             C
44130...............  Bowel to bowel fusion...............             C
44132...............  Enterectomy, cadaver donor..........             C
44133...............  Enterectomy, live donor.............             C
44135...............  Intestine transplnt, cadaver........             C
44136...............  Intestine transplant, live..........             C
44137...............  Remove intestinal allograft.........             C
44139...............  Mobilization of colon...............             C
44140...............  Partial removal of colon............             C
44141...............  Partial removal of colon............             C
44143...............  Partial removal of colon............             C

[[Page 43108]]

 
44144...............  Partial removal of colon............             C
44145...............  Partial removal of colon............             C
44146...............  Partial removal of colon............             C
44147...............  Partial removal of colon............             C
44150...............  Removal of colon....................             C
44151...............  Removal of colon/ileostomy..........             C
44155...............  Removal of colon/ileostomy..........             C
44156...............  Removal of colon/ileostomy..........             C
44157...............  Colectomy w/ileoanal anast..........             C
44158...............  Colectomy w/neo-rectum pouch........             C
44160...............  Removal of colon....................             C
44187...............  Lap, ileo/jejuno-stomy..............             C
44188...............  Lap, colostomy......................             C
44202...............  Lap, enterectomy....................             C
44203...............  Lap resect s/intestine, addl........             C
44204...............  Laparo partial colectomy............             C
44205...............  Lap colectomy part w/ileum..........             C
44210...............  Laparo total proctocolectomy........             C
44211...............  Lap colectomy w/proctectomy.........             C
44212...............  Laparo total proctocolectomy........             C
44227...............  Lap, close enterostomy..............             C
44300...............  Open bowel to skin..................             C
44310...............  Ileostomy/jejunostomy...............             C
44314...............  Revision of ileostomy...............             C
44316...............  Devise bowel pouch..................             C
44320...............  Colostomy...........................             C
44322...............  Colostomy with biopsies.............             C
44345...............  Revision of colostomy...............             C
44346...............  Revision of colostomy...............             C
44602...............  Suture, small intestine.............             C
44603...............  Suture, small intestine.............             C
44604...............  Suture, large intestine.............             C
44605...............  Repair of bowel lesion..............             C
44615...............  Intestinal stricturoplasty..........             C
44620...............  Repair bowel opening................             C
44625...............  Repair bowel opening................             C
44626...............  Repair bowel opening................             C
44640...............  Repair bowel-skin fistula...........             C
44650...............  Repair bowel fistula................             C
44660...............  Repair bowel-bladder fistula........             C
44661...............  Repair bowel-bladder fistula........             C
44680...............  Surgical revision, intestine........             C
44700...............  Suspend bowel w/prosthesis..........             C
44715...............  Prepare donor intestine.............             C
44720...............  Prep donor intestine/venous.........             C
44721...............  Prep donor intestine/artery.........             C
44800...............  Excision of bowel pouch.............             C
44820...............  Excision of mesentery lesion........             C
44850...............  Repair of mesentery.................             C
44899...............  Bowel surgery procedure.............             C
44900...............  Drain app abscess, open.............             C
44950...............  Appendectomy........................             C
44955...............  Appendectomy add-on.................             C
44960...............  Appendectomy........................             C
45110...............  Removal of rectum...................             C
45111...............  Partial removal of rectum...........             C
45112...............  Removal of rectum...................             C
45113...............  Partial proctectomy.................             C
45114...............  Partial removal of rectum...........             C
45116...............  Partial removal of rectum...........             C
45119...............  Remove rectum w/reservoir...........             C
45120...............  Removal of rectum...................             C
45121...............  Removal of rectum and colon.........             C
45123...............  Partial proctectomy.................             C
45126...............  Pelvic exenteration.................             C
45130...............  Excision of rectal prolapse.........             C
45135...............  Excision of rectal prolapse.........             C
45136...............  Excise ileoanal reservior...........             C
45395...............  Lap, removal of rectum..............             C
45397...............  Lap, remove rectum w/pouch..........             C

[[Page 43109]]

 
45400...............  Laparoscopic proc...................             C
45402...............  Lap proctopexy w/sig resect.........             C
45540...............  Correct rectal prolapse.............             C
45550...............  Repair rectum/remove sigmoid........             C
45562...............  Exploration/repair of rectum........             C
45563...............  Exploration/repair of rectum........             C
45800...............  Repair rect/bladder fistula.........             C
45805...............  Repair fistula w/colostomy..........             C
45820...............  Repair rectourethral fistula........             C
45825...............  Repair fistula w/colostomy..........             C
46705...............  Repair of anal stricture............             C
46710...............  Repr per/vag pouch sngl proc........             C
46712...............  Repr per/vag pouch dbl proc.........             C
46715...............  Rep perf anoper fistu...............             C
46716...............  Rep perf anoper/vestib fistu........             C
46730...............  Construction of absent anus.........             C
46735...............  Construction of absent anus.........             C
46740...............  Construction of absent anus.........             C
46742...............  Repair of imperforated anus.........             C
46744...............  Repair of cloacal anomaly...........             C
46746...............  Repair of cloacal anomaly...........             C
46748...............  Repair of cloacal anomaly...........             C
46751...............  Repair of anal sphincter............             C
47010...............  Open drainage, liver lesion.........             C
47015...............  Inject/aspirate liver cyst..........             C
47100...............  Wedge biopsy of liver...............             C
47120...............  Partial removal of liver............             C
47122...............  Extensive removal of liver..........             C
47125...............  Partial removal of liver............             C
47130...............  Partial removal of liver............             C
47133...............  Removal of donor liver..............             C
47135...............  Transplantation of liver............             C
47136...............  Transplantation of liver............             C
47140...............  Partial removal, donor liver........             C
47141...............  Partial removal, donor liver........             C
47142...............  Partial removal, donor liver........             C
47143...............  Prep donor liver, whole.............             C
47144...............  Prep donor liver, 3-segment.........             C
47145...............  Prep donor liver, lobe split........             C
47146...............  Prep donor liver/venous.............             C
47147...............  Prep donor liver/arterial...........             C
47300...............  Surgery for liver lesion............             C
47350...............  Repair liver wound..................             C
47360...............  Repair liver wound..................             C
47361...............  Repair liver wound..................             C
47362...............  Repair liver wound..................             C
47380...............  Open ablate liver tumor rf..........             C
47381...............  Open ablate liver tumor cryo........             C
47400...............  Incision of liver duct..............             C
47420...............  Incision of bile duct...............             C
47425...............  Incision of bile duct...............             C
47460...............  Incise bile duct sphincter..........             C
47480...............  Incision of gallbladder.............             C
47550...............  Bile duct endoscopy add-on..........             C
47570...............  Laparo cholecystoenterostomy........             C
47600...............  Removal of gallbladder..............             C
47605...............  Removal of gallbladder..............             C
47610...............  Removal of gallbladder..............             C
47612...............  Removal of gallbladder..............             C
47620...............  Removal of gallbladder..............             C
47700...............  Exploration of bile ducts...........             C
47701...............  Bile duct revision..................             C
47711...............  Excision of bile duct tumor.........             C
47712...............  Excision of bile duct tumor.........             C
47715...............  Excision of bile duct cyst..........             C
47719...............  Fusion of bile duct cyst............             C
47720...............  Fuse gallbladder & bowel............             C
47721...............  Fuse upper gi structures............             C
47740...............  Fuse gallbladder & bowel............             C
47741...............  Fuse gallbladder & bowel............             C

[[Page 43110]]

 
47760...............  Fuse bile ducts and bowel...........             C
47765...............  Fuse liver ducts & bowel............             C
47780...............  Fuse bile ducts and bowel...........             C
47785...............  Fuse bile ducts and bowel...........             C
47800...............  Reconstruction of bile ducts........             C
47801...............  Placement, bile duct support........             C
47802...............  Fuse liver duct & intestine.........             C
47900...............  Suture bile duct injury.............             C
48000...............  Drainage of abdomen.................             C
48001...............  Placement of drain, pancreas........             C
48020...............  Removal of pancreatic stone.........             C
48100...............  Biopsy of pancreas, open............             C
48105...............  Resect/debride pancreas.............             C
48120...............  Removal of pancreas lesion..........             C
48140...............  Partial removal of pancreas.........             C
48145...............  Partial removal of pancreas.........             C
48146...............  Pancreatectomy......................             C
48148...............  Removal of pancreatic duct..........             C
48150...............  Partial removal of pancreas.........             C
48152...............  Pancreatectomy......................             C
48153...............  Pancreatectomy......................             C
48154...............  Pancreatectomy......................             C
48155...............  Removal of pancreas.................             C
48400...............  Injection, intraop add-on...........             C
48500...............  Surgery of pancreatic cyst..........             C
48510...............  Drain pancreatic pseudocyst.........             C
48520...............  Fuse pancreas cyst and bowel........             C
48540...............  Fuse pancreas cyst and bowel........             C
48545...............  Pancreatorrhaphy....................             C
48547...............  Duodenal exclusion..................             C
48548...............  Fuse pancreas and bowel.............             C
48551...............  Prep donor pancreas.................             C
48552...............  Prep donor pancreas/venous..........             C
48554...............  Transpl allograft pancreas..........             C
48556...............  Removal, allograft pancreas.........             C
49000...............  Exploration of abdomen..............             C
49002...............  Reopening of abdomen................             C
49010...............  Exploration behind abdomen..........             C
49020...............  Drain abdominal abscess.............             C
49040...............  Drain, open, abdom abscess..........             C
49060...............  Drain, open, retrop abscess.........             C
49062...............  Drain to peritoneal cavity..........             C
49201...............  Remove abdom lesion, complex........             C
49215...............  Excise sacral spine tumor...........             C
49220...............  Multiple surgery, abdomen...........             C
49255...............  Removal of omentum..................             C
49425...............  Insert abdomen-venous drain.........             C
49428...............  Ligation of shunt...................             C
49605...............  Repair umbilical lesion.............             C
49606...............  Repair umbilical lesion.............             C
49610...............  Repair umbilical lesion.............             C
49611...............  Repair umbilical lesion.............             C
49900...............  Repair of abdominal wall............             C
49904...............  Omental flap, extra-abdom...........             C
49905...............  Omental flap, intra-abdom...........             C
49906...............  Free omental flap, microvasc........             C
50010...............  Exploration of kidney...............             C
50040...............  Drainage of kidney..................             C
50045...............  Exploration of kidney...............             C
50060...............  Removal of kidney stone.............             C
50065...............  Incision of kidney..................             C
50070...............  Incision of kidney..................             C
50075...............  Removal of kidney stone.............             C
50100...............  Revise kidney blood vessels.........             C
50120...............  Exploration of kidney...............             C
50125...............  Explore and drain kidney............             C
50130...............  Removal of kidney stone.............             C
50135...............  Exploration of kidney...............             C
50205...............  Biopsy of kidney....................             C
50220...............  Remove kidney, open.................             C

[[Page 43111]]

 
50225...............  Removal kidney open, complex........             C
50230...............  Removal kidney open, radical........             C
50234...............  Removal of kidney & ureter..........             C
50236...............  Removal of kidney & ureter..........             C
50240...............  Partial removal of kidney...........             C
50250...............  Cryoablate renal mass open..........             C
50280...............  Removal of kidney lesion............             C
50290...............  Removal of kidney lesion............             C
50300...............  Remove cadaver donor kidney.........             C
50320...............  Remove kidney, living donor.........             C
50323...............  Prep cadaver renal allograft........             C
50325...............  Prep donor renal graft..............             C
50327...............  Prep renal graft/venous.............             C
50328...............  Prep renal graft/arterial...........             C
50329...............  Prep renal graft/ureteral...........             C
50340...............  Removal of kidney...................             C
50360...............  Transplantation of kidney...........             C
50365...............  Transplantation of kidney...........             C
50370...............  Remove transplanted kidney..........             C
50380...............  Reimplantation of kidney............             C
50400...............  Revision of kidney/ureter...........             C
50405...............  Revision of kidney/ureter...........             C
50500...............  Repair of kidney wound..............             C
50520...............  Close kidney-skin fistula...........             C
50525...............  Repair renal-abdomen fistula........             C
50526...............  Repair renal-abdomen fistula........             C
50540...............  Revision of horseshoe kidney........             C
50545...............  Laparo radical nephrectomy..........             C
50546...............  Laparoscopic nephrectomy............             C
50547...............  Laparo removal donor kidney.........             C
50548...............  Laparo remove w/ureter..............             C
50600...............  Exploration of ureter...............             C
50605...............  Insert ureteral support.............             C
50610...............  Removal of ureter stone.............             C
50620...............  Removal of ureter stone.............             C
50630...............  Removal of ureter stone.............             C
50650...............  Removal of ureter...................             C
50660...............  Removal of ureter...................             C
50700...............  Revision of ureter..................             C
50715...............  Release of ureter...................             C
50722...............  Release of ureter...................             C
50725...............  Release/revise ureter...............             C
50727...............  Revise ureter.......................             C
50728...............  Revise ureter.......................             C
50740...............  Fusion of ureter & kidney...........             C
50750...............  Fusion of ureter & kidney...........             C
50760...............  Fusion of ureters...................             C
50770...............  Splicing of ureters.................             C
50780...............  Reimplant ureter in bladder.........             C
50782...............  Reimplant ureter in bladder.........             C
50783...............  Reimplant ureter in bladder.........             C
50785...............  Reimplant ureter in bladder.........             C
50800...............  Implant ureter in bowel.............             C
50810...............  Fusion of ureter & bowel............             C
50815...............  Urine shunt to intestine............             C
50820...............  Construct bowel bladder.............             C
50825...............  Construct bowel bladder.............             C
50830...............  Revise urine flow...................             C
50840...............  Replace ureter by bowel.............             C
50845...............  Appendico-vesicostomy...............             C
50860...............  Transplant ureter to skin...........             C
50900...............  Repair of ureter....................             C
50920...............  Closure ureter/skin fistula.........             C
50930...............  Closure ureter/bowel fistula........             C
50940...............  Release of ureter...................             C
51060...............  Removal of ureter stone.............             C
51525...............  Removal of bladder lesion...........             C
51530...............  Removal of bladder lesion...........             C
51550...............  Partial removal of bladder..........             C
51555...............  Partial removal of bladder..........             C

[[Page 43112]]

 
51565...............  Revise bladder & ureter(s)..........             C
51570...............  Removal of bladder..................             C
51575...............  Removal of bladder & nodes..........             C
51580...............  Remove bladder/revise tract.........             C
51585...............  Removal of bladder & nodes..........             C
51590...............  Remove bladder/revise tract.........             C
51595...............  Remove bladder/revise tract.........             C
51596...............  Remove bladder/create pouch.........             C
51597...............  Removal of pelvic structures........             C
51800...............  Revision of bladder/urethra.........             C
51820...............  Revision of urinary tract...........             C
51840...............  Attach bladder/urethra..............             C
51841...............  Attach bladder/urethra..............             C
51845...............  Repair bladder neck.................             C
51860...............  Repair of bladder wound.............             C
51865...............  Repair of bladder wound.............             C
51900...............  Repair bladder/vagina lesion........             C
51920...............  Close bladder-uterus fistula........             C
51925...............  Hysterectomy/bladder repair.........             C
51940...............  Correction of bladder defect........             C
51960...............  Revision of bladder & bowel.........             C
51980...............  Construct bladder opening...........             C
53415...............  Reconstruction of urethra...........             C
53448...............  Remov/replc ur sphinctr comp........             C
54125...............  Removal of penis....................             C
54130...............  Remove penis & nodes................             C
54135...............  Remove penis & nodes................             C
54332...............  Revise penis/urethra................             C
54336...............  Revise penis/urethra................             C
54390...............  Repair penis and bladder............             C
54411...............  Remov/replc penis pros, comp........             C
54417...............  Remv/replc penis pros, compl........             C
54430...............  Revision of penis...................             C
54535...............  Extensive testis surgery............             C
54650...............  Orchiopexy (Fowler-Stephens)........             C
55605...............  Incise sperm duct pouch.............             C
55650...............  Remove sperm duct pouch.............             C
55801...............  Removal of prostate.................             C
55810...............  Extensive prostate surgery..........             C
55812...............  Extensive prostate surgery..........             C
55815...............  Extensive prostate surgery..........             C
55821...............  Removal of prostate.................             C
55831...............  Removal of prostate.................             C
55840...............  Extensive prostate surgery..........             C
55842...............  Extensive prostate surgery..........             C
55845...............  Extensive prostate surgery..........             C
55862...............  Extensive prostate surgery..........             C
55865...............  Extensive prostate surgery..........             C
55866...............  Laparo radical prostatectomy........             C
56630...............  Extensive vulva surgery.............             C
56631...............  Extensive vulva surgery.............             C
56632...............  Extensive vulva surgery.............             C
56633...............  Extensive vulva surgery.............             C
56634...............  Extensive vulva surgery.............             C
56637...............  Extensive vulva surgery.............             C
56640...............  Extensive vulva surgery.............             C
57110...............  Remove vagina wall, complete........             C
57111...............  Remove vagina tissue, compl.........             C
57112...............  Vaginectomy w/nodes, compl..........             C
57270...............  Repair of bowel pouch...............             C
57280...............  Suspension of vagina................             C
57296...............  Revise vag graft, open abd..........             C
57305...............  Repair rectum-vagina fistula........             C
57307...............  Fistula repair & colostomy..........             C
57308...............  Fistula repair, transperine.........             C
57311...............  Repair urethrovaginal lesion........             C
57531...............  Removal of cervix, radical..........             C
57540...............  Removal of residual cervix..........             C
57545...............  Remove cervix/repair pelvis.........             C
58140...............  Myomectomy abdom method.............             C

[[Page 43113]]

 
58146...............  Myomectomy abdom complex............             C
58150...............  Total hysterectomy..................             C
58152...............  Total hysterectomy..................             C
58180...............  Partial hysterectomy................             C
58200...............  Extensive hysterectomy..............             C
58210...............  Extensive hysterectomy..............             C
58240...............  Removal of pelvis contents..........             C
58267...............  Vag hyst w/urinary repair...........             C
58275...............  Hysterectomy/revise vagina..........             C
58280...............  Hysterectomy/revise vagina..........             C
58285...............  Extensive hysterectomy..............             C
58293...............  Vag hyst w/uro repair, compl........             C
58400...............  Suspension of uterus................             C
58410...............  Suspension of uterus................             C
58520...............  Repair of ruptured uterus...........             C
58540...............  Revision of uterus..................             C
58548...............  Lap radical hyst....................             C
58605...............  Division of fallopian tube..........             C
58611...............  Ligate oviduct(s) add-on............             C
58700...............  Removal of fallopian tube...........             C
58720...............  Removal of ovary/tube(s)............             C
58740...............  Revise fallopian tube(s)............             C
58750...............  Repair oviduct......................             C
58752...............  Revise ovarian tube(s)..............             C
58760...............  Remove tubal obstruction............             C
58822...............  Drain ovary abscess, percut.........             C
58825...............  Transposition, ovary(s).............             C
58940...............  Removal of ovary(s).................             C
58943...............  Removal of ovary(s).................             C
58950...............  Resect ovarian malignancy...........             C
58951...............  Resect ovarian malignancy...........             C
58952...............  Resect ovarian malignancy...........             C
58953...............  Tah, rad dissect for debulk.........             C
58954...............  Tah rad debulk/lymph remove.........             C
58956...............  Bso, omentectomy w/tah..............             C
58957...............  Resect recurrent gyn mal............             C
58958...............  Resect recur gyn mal w/lym..........             C
58960...............  Exploration of abdomen..............             C
59120...............  Treat ectopic pregnancy.............             C
59121...............  Treat ectopic pregnancy.............             C
59130...............  Treat ectopic pregnancy.............             C
59135...............  Treat ectopic pregnancy.............             C
59136...............  Treat ectopic pregnancy.............             C
59140...............  Treat ectopic pregnancy.............             C
59325...............  Revision of cervix..................             C
59350...............  Repair of uterus....................             C
59514...............  Cesarean delivery only..............             C
59525...............  Remove uterus after cesarean........             C
59620...............  Attempted vbac delivery only........             C
59830...............  Treat uterus infection..............             C
59850...............  Abortion............................             C
59851...............  Abortion............................             C
59852...............  Abortion............................             C
59855...............  Abortion............................             C
59856...............  Abortion............................             C
59857...............  Abortion............................             C
60254...............  Extensive thyroid surgery...........             C
60270...............  Removal of thyroid..................             C
60505...............  Explore parathyroid glands..........             C
60521...............  Removal of thymus gland.............             C
60522...............  Removal of thymus gland.............             C
60540...............  Explore adrenal gland...............             C
60545...............  Explore adrenal gland...............             C
60600...............  Remove carotid body lesion..........             C
60605...............  Remove carotid body lesion..........             C
60650...............  Laparoscopy adrenalectomy...........             C
61105...............  Twist drill hole....................             C
61107...............  Drill skull for implantation........             C
61108...............  Drill skull for drainage............             C
61120...............  Burr hole for puncture..............             C

[[Page 43114]]

 
61140...............  Pierce skull for biopsy.............             C
61150...............  Pierce skull for drainage...........             C
61151...............  Pierce skull for drainage...........             C
61154...............  Pierce skull & remove clot..........             C
61156...............  Pierce skull for drainage...........             C
61210...............  Pierce skull, implant device........             C
61250...............  Pierce skull & explore..............             C
61253...............  Pierce skull & explore..............             C
61304...............  Open skull for exploration..........             C
61305...............  Open skull for exploration..........             C
61312...............  Open skull for drainage.............             C
61313...............  Open skull for drainage.............             C
61314...............  Open skull for drainage.............             C
61315...............  Open skull for drainage.............             C
61316...............  Implt cran bone flap to abdo........             C
61320...............  Open skull for drainage.............             C
61321...............  Open skull for drainage.............             C
61322...............  Decompressive craniotomy............             C
61323...............  Decompressive lobectomy.............             C
61332...............  Explore/biopsy eye socket...........             C
61333...............  Explore orbit/remove lesion.........             C
61340...............  Subtemporal decompression...........             C
61343...............  Incise skull (press relief).........             C
61345...............  Relieve cranial pressure............             C
61440...............  Incise skull for surgery............             C
61450...............  Incise skull for surgery............             C
61458...............  Incise skull for brain wound........             C
61460...............  Incise skull for surgery............             C
61470...............  Incise skull for surgery............             C
61480...............  Incise skull for surgery............             C
61490...............  Incise skull for surgery............             C
61500...............  Removal of skull lesion.............             C
61501...............  Remove infected skull bone..........             C
61510...............  Removal of brain lesion.............             C
61512...............  Remove brain lining lesion..........             C
61514...............  Removal of brain abscess............             C
61516...............  Removal of brain lesion.............             C
61517...............  Implt brain chemotx add-on..........             C
61518...............  Removal of brain lesion.............             C
61519...............  Remove brain lining lesion..........             C
61520...............  Removal of brain lesion.............             C
61521...............  Removal of brain lesion.............             C
61522...............  Removal of brain abscess............             C
61524...............  Removal of brain lesion.............             C
61526...............  Removal of brain lesion.............             C
61530...............  Removal of brain lesion.............             C
61531...............  Implant brain electrodes............             C
61533...............  Implant brain electrodes............             C
61534...............  Removal of brain lesion.............             C
61535...............  Remove brain electrodes.............             C
61536...............  Removal of brain lesion.............             C
61537...............  Removal of brain tissue.............             C
61538...............  Removal of brain tissue.............             C
61539...............  Removal of brain tissue.............             C
61540...............  Removal of brain tissue.............             C
61541...............  Incision of brain tissue............             C
61542...............  Removal of brain tissue.............             C
61543...............  Removal of brain tissue.............             C
61544...............  Remove & treat brain lesion.........             C
61545...............  Excision of brain tumor.............             C
61546...............  Removal of pituitary gland..........             C
61548...............  Removal of pituitary gland..........             C
61550...............  Release of skull seams..............             C
61552...............  Release of skull seams..............             C
61556...............  Incise skull/sutures................             C
61557...............  Incise skull/sutures................             C
61558...............  Excision of skull/sutures...........             C
61559...............  Excision of skull/sutures...........             C
61563...............  Excision of skull tumor.............             C
61564...............  Excision of skull tumor.............             C

[[Page 43115]]

 
61566...............  Removal of brain tissue.............             C
61567...............  Incision of brain tissue............             C
61570...............  Remove foreign body, brain..........             C
61571...............  Incise skull for brain wound........             C
61575...............  Skull base/brainstem surgery........             C
61576...............  Skull base/brainstem surgery........             C
61580...............  Craniofacial approach, skull........             C
61581...............  Craniofacial approach, skull........             C
61582...............  Craniofacial approach, skull........             C
61583...............  Craniofacial approach, skull........             C
61584...............  Orbitocranial approach/skull........             C
61585...............  Orbitocranial approach/skull........             C
61586...............  Resect nasopharynx, skull...........             C
61590...............  Infratemporal approach/skull........             C
61591...............  Infratemporal approach/skull........             C
61592...............  Orbitocranial approach/skull........             C
61595...............  Transtemporal approach/skull........             C
61596...............  Transcochlear approach/skull........             C
61597...............  Transcondylar approach/skull........             C
61598...............  Transpetrosal approach/skull........             C
61600...............  Resect/excise cranial lesion........             C
61601...............  Resect/excise cranial lesion........             C
61605...............  Resect/excise cranial lesion........             C
61606...............  Resect/excise cranial lesion........             C
61607...............  Resect/excise cranial lesion........             C
61608...............  Resect/excise cranial lesion........             C
61609...............  Transect artery, sinus..............             C
61610...............  Transect artery, sinus..............             C
61611...............  Transect artery, sinus..............             C
61612...............  Transect artery, sinus..............             C
61613...............  Remove aneurysm, sinus..............             C
61615...............  Resect/excise lesion, skull.........             C
61616...............  Resect/excise lesion, skull.........             C
61618...............  Repair dura.........................             C
61619...............  Repair dura.........................             C
61624...............  Transcath occlusion, cns............             C
61680...............  Intracranial vessel surgery.........             C
61682...............  Intracranial vessel surgery.........             C
61684...............  Intracranial vessel surgery.........             C
61686...............  Intracranial vessel surgery.........             C
61690...............  Intracranial vessel surgery.........             C
61692...............  Intracranial vessel surgery.........             C
61697...............  Brain aneurysm repr, complx.........             C
61698...............  Brain aneurysm repr, complx.........             C
61700...............  Brain aneurysm repr, simple.........             C
61702...............  Inner skull vessel surgery..........             C
61703...............  Clamp neck artery...................             C
61705...............  Revise circulation to head..........             C
61708...............  Revise circulation to head..........             C
61710...............  Revise circulation to head..........             C
61711...............  Fusion of skull arteries............             C
61735...............  Incise skull/brain surgery..........             C
61750...............  Incise skull/brain biopsy...........             C
61751...............  Brain biopsy w/ct/mr guide..........             C
61760...............  Implant brain electrodes............             C
61850...............  Implant neuroelectrodes.............             C
61860...............  Implant neuroelectrodes.............             C
61863...............  Implant neuroelectrode..............             C
61864...............  Implant neuroelectrde, addl.........             C
61867...............  Implant neuroelectrode..............             C
61868...............  Implant neuroelectrde, add'l........             C
61870...............  Implant neuroelectrodes.............             C
61875...............  Implant neuroelectrodes.............             C
62005...............  Treat skull fracture................             C
62010...............  Treatment of head injury............             C
62100...............  Repair brain fluid leakage..........             C
62115...............  Reduction of skull defect...........             C
62116...............  Reduction of skull defect...........             C
62117...............  Reduction of skull defect...........             C
62120...............  Repair skull cavity lesion..........             C

[[Page 43116]]

 
62121...............  Incise skull repair.................             C
62140...............  Repair of skull defect..............             C
62141...............  Repair of skull defect..............             C
62142...............  Remove skull plate/flap.............             C
62143...............  Replace skull plate/flap............             C
62145...............  Repair of skull & brain.............             C
62146...............  Repair of skull with graft..........             C
62147...............  Repair of skull with graft..........             C
62148...............  Retr bone flap to fix skull.........             C
62161...............  Dissect brain w/scope...............             C
62162...............  Remove colloid cyst w/scope.........             C
62163...............  Neuroendoscopy w/fb removal.........             C
62164...............  Remove brain tumor w/scope..........             C
62165...............  Remove pituit tumor w/scope.........             C
62180...............  Establish brain cavity shunt........             C
62190...............  Establish brain cavity shunt........             C
62192...............  Establish brain cavity shunt........             C
62200...............  Establish brain cavity shunt........             C
62201...............  Brain cavity shunt w/scope..........             C
62220...............  Establish brain cavity shunt........             C
62223...............  Establish brain cavity shunt........             C
62256...............  Remove brain cavity shunt...........             C
62258...............  Replace brain cavity shunt..........             C
63043...............  Laminotomy, add'l cervical..........             C
63044...............  Laminotomy, add'l lumbar............             C
63050...............  Cervical laminoplasty...............             C
63051...............  C-laminoplasty w/graft/plate........             C
63076...............  Neck spine disk surgery.............             C
63077...............  Spine disk surgery, thorax..........             C
63078...............  Spine disk surgery, thorax..........             C
63081...............  Removal of vertebral body...........             C
63082...............  Remove vertebral body add-on........             C
63085...............  Removal of vertebral body...........             C
63086...............  Remove vertebral body add-on........             C
63087...............  Removal of vertebral body...........             C
63088...............  Remove vertebral body add-on........             C
63090...............  Removal of vertebral body...........             C
63091...............  Remove vertebral body add-on........             C
63101...............  Removal of vertebral body...........             C
63102...............  Removal of vertebral body...........             C
63103...............  Remove vertebral body add-on........             C
63170...............  Incise spinal cord tract(s).........             C
63172...............  Drainage of spinal cyst.............             C
63173...............  Drainage of spinal cyst.............             C
63180...............  Revise spinal cord ligaments........             C
63182...............  Revise spinal cord ligaments........             C
63185...............  Incise spinal column/nerves.........             C
63190...............  Incise spinal column/nerves.........             C
63191...............  Incise spinal column/nerves.........             C
63194...............  Incise spinal column & cord.........             C
63195...............  Incise spinal column & cord.........             C
63196...............  Incise spinal column & cord.........             C
63197...............  Incise spinal column & cord.........             C
63198...............  Incise spinal column & cord.........             C
63199...............  Incise spinal column & cord.........             C
63200...............  Release of spinal cord..............             C
63250...............  Revise spinal cord vessels..........             C
63251...............  Revise spinal cord vessels..........             C
63252...............  Revise spinal cord vessels..........             C
63265...............  Excise intraspinal lesion...........             C
63266...............  Excise intraspinal lesion...........             C
63267...............  Excise intraspinal lesion...........             C
63268...............  Excise intraspinal lesion...........             C
63270...............  Excise intraspinal lesion...........             C
63271...............  Excise intraspinal lesion...........             C
63272...............  Excise intraspinal lesion...........             C
63273...............  Excise intraspinal lesion...........             C
63275...............  Biopsy/excise spinal tumor..........             C
63276...............  Biopsy/excise spinal tumor..........             C
63277...............  Biopsy/excise spinal tumor..........             C

[[Page 43117]]

 
63278...............  Biopsy/excise spinal tumor..........             C
63280...............  Biopsy/excise spinal tumor..........             C
63281...............  Biopsy/excise spinal tumor..........             C
63282...............  Biopsy/excise spinal tumor..........             C
63283...............  Biopsy/excise spinal tumor..........             C
63285...............  Biopsy/excise spinal tumor..........             C
63286...............  Biopsy/excise spinal tumor..........             C
63287...............  Biopsy/excise spinal tumor..........             C
63290...............  Biopsy/excise spinal tumor..........             C
63295...............  Repair of laminectomy defect........             C
63300...............  Removal of vertebral body...........             C
63301...............  Removal of vertebral body...........             C
63302...............  Removal of vertebral body...........             C
63303...............  Removal of vertebral body...........             C
63304...............  Removal of vertebral body...........             C
63305...............  Removal of vertebral body...........             C
63306...............  Removal of vertebral body...........             C
63307...............  Removal of vertebral body...........             C
63308...............  Remove vertebral body add-on........             C
63700...............  Repair of spinal herniation.........             C
63702...............  Repair of spinal herniation.........             C
63704...............  Repair of spinal herniation.........             C
63706...............  Repair of spinal herniation.........             C
63707...............  Repair spinal fluid leakage.........             C
63709...............  Repair spinal fluid leakage.........             C
63710...............  Graft repair of spine defect........             C
63740...............  Install spinal shunt................             C
64752...............  Incision of vagus nerve.............             C
64755...............  Incision of stomach nerves..........             C
64760...............  Incision of vagus nerve.............             C
64809...............  Remove sympathetic nerves...........             C
64818...............  Remove sympathetic nerves...........             C
64866...............  Fusion of facial/other nerve........             C
64868...............  Fusion of facial/other nerve........             C
65273...............  Repair of eye wound.................             C
69155...............  Extensive ear/neck surgery..........             C
69535...............  Remove part of temporal bone........             C
69554...............  Remove ear lesion...................             C
69950...............  Incise inner ear nerve..............             C
75900...............  Intravascular cath exchange.........             C
75952...............  Endovasc repair abdom aorta.........             C
75953...............  Abdom aneurysm endovas rpr..........             C
75954...............  Iliac aneurysm endovas rpr..........             C
75956...............  Xray, endovasc thor ao repr.........             C
75957...............  Xray, endovasc thor ao repr.........             C
75958...............  Xray, place prox ext thor ao........             C
75959...............  Xray, place dist ext thor ao........             C
92970...............  Cardioassist, internal..............             C
92971...............  Cardioassist, external..............             C
92975...............  Dissolve clot, heart vessel.........             C
92992...............  Revision of heart chamber...........             C
92993...............  Revision of heart chamber...........             C
99190...............  Special pump services...............             C
99191...............  Special pump services...............             C
99192...............  Special pump services...............             C
99251...............  Inpatient consultation..............             C
99252...............  Inpatient consultation..............             C
99253...............  Inpatient consultation..............             C
99254...............  Inpatient consultation..............             C
99255...............  Inpatient consultation..............             C
99293...............  Ped critical care, initial..........             C
99294...............  Ped critical care, subseq...........             C
99295...............  Neonate crit care, initial..........             C
99296...............  Neonate critical care subseq........             C
99298...............  Ic for lbw infant < 1500 gm.........             C
99299...............  Ic, lbw infant 1500-2500 gm.........             C
99356...............  Prolonged service, inpatient........             C
99357...............  Prolonged service, inpatient........             C
99433...............  Normal newborn care/hospital........             C
0024T...............  Transcath cardiac reduction.........             C

[[Page 43118]]

 
0048T...............  Implant ventricular device..........             C
0049T...............  External circulation assist.........             C
0050T...............  Removal circulation assist..........             C
0051T...............  Implant total heart system..........             C
0052T...............  Replace component heart syst........             C
0053T...............  Replace component heart syst........             C
0075T...............  Perq stent/chest vert art...........             C
0076T...............  S&i stent/chest vert art............             C
0077T...............  Cereb therm perfusion probe.........             C
0078T...............  Endovasc aort repr w/device.........             C
0079T...............  Endovasc visc extnsn repr...........             C
0080T...............  Endovasc aort repr rad s&i..........             C
0081T...............  Endovasc visc extnsn s&i............             C
0090T...............  Cervical artific disc...............             C
0092T...............  Artific disc addl...................             C
0093T...............  Cervical artific diskectomy.........             C
0095T...............  Artific diskectomy addl.............             C
0096T...............  Rev cervical artific disc...........             C
0098T...............  Rev artific disc addl...............             C
0153T...............  Tcath sensor aneurysm sac...........             C
0157T...............  Open impl gast curve electrd........             C
0158T...............  Open remv gast curve electrd........             C
0163T...............  Lumb artif diskectomy addl..........             C
0164T...............  Remove lumb artif disc addl.........             C
0165T...............  Revise lumb artif disc addl.........             C
0166T...............  Tcath vsd close w/o bypass..........             C
0167T...............  Tcath vsd close w bypass............             C
0169T...............  Place stereo cath brain.............             C
G0341...............  Percutaneous islet celltrans........             C
G0342...............  Laparoscopy islet cell trans........             C
G0343...............  Laparotomy islet cell transp........             C
------------------------------------------------------------------------


[[Page 43119]]


                                 Addendum L.--Proposed Out-Migration Adjustment
----------------------------------------------------------------------------------------------------------------
                                                Out-Migration
                 Provider No.                    adjustment                  Qualifying county name
----------------------------------------------------------------------------------------------------------------
010005.......................................          0.0322  MARSHALL
010008.......................................          0.0245  CRENSHAW
010009.......................................          0.0092  MORGAN
010010.......................................          0.0322  MARSHALL
010012.......................................          0.0182  DE KALB
010015.......................................          0.0043  CLARKE
010022.......................................          0.1106  CHEROKEE
010025.......................................          0.0235  CHAMBERS
010029.......................................          0.0281  LEE
010032.......................................          0.0320  RANDOLPH
010035.......................................          0.0263  CULLMAN
010038.......................................          0.0039  CALHOUN
010045.......................................          0.0216  FAYETTE
010047.......................................          0.0178  BUTLER
010052.......................................          0.0103  TALLAPOOSA
010054.......................................          0.0092  MORGAN
010061.......................................          0.0566  JACKSON
010065.......................................          0.0103  TALLAPOOSA
010078.......................................          0.0039  CALHOUN
010083.......................................          0.0125  BALDWIN
010085.......................................          0.0092  MORGAN
010091.......................................          0.0043  CLARKE
010100.......................................          0.0125  BALDWIN
010101.......................................          0.0209  TALLADEGA
010109.......................................          0.0451  PICKENS
010110.......................................          0.0302  BULLOCK
010125.......................................          0.0471  WINSTON
010128.......................................          0.0043  CLARKE
010129.......................................          0.0125  BALDWIN
010138.......................................          0.0113  SUMTER
010143.......................................          0.0263  CULLMAN
010146.......................................          0.0039  CALHOUN
010150.......................................          0.0178  BUTLER
010158.......................................          0.0067  FRANKLIN
010164.......................................          0.0209  TALLADEGA
013027.......................................          0.0125  BALDWIN
030040.......................................          0.0012  SANTA CRUZ
030067.......................................          0.0230  LAPAZ
040014.......................................          0.0163  WHITE
040019.......................................          0.0254  ST. FRANCIS
040039.......................................          0.0172  GREENE
040047.......................................          0.0117  RANDOLPH
040067.......................................          0.0008  COLUMBIA
040071.......................................          0.0149  JEFFERSON
040076.......................................          0.1001  HOT SPRING
040081.......................................          0.0358  PIKE
040100.......................................          0.0163  WHITE
050002.......................................          0.0009  ALAMEDA
050007.......................................          0.0141  SAN MATEO
050008.......................................          0.0026  SAN FRANCISCO
050009.......................................          0.0196  NAPA
050013.......................................          0.0196  NAPA
050014.......................................          0.0147  AMADOR
050016.......................................          0.0103  SAN LUIS OBISPO
050042.......................................          0.0184  TEHAMA
050043.......................................          0.0009  ALAMEDA
050047.......................................          0.0026  SAN FRANCISCO
050055.......................................          0.0026  SAN FRANCISCO
050069.......................................          0.0006  ORANGE
050070.......................................          0.0141  SAN MATEO
050073.......................................          0.0169  SOLANO
050075.......................................          0.0009  ALAMEDA
050076.......................................          0.0026  SAN FRANCISCO
050084.......................................          0.0135  SAN JOAQUIN
050089.......................................          0.0005  SAN BERNARDINO
050090.......................................          0.0085  SONOMA
050099.......................................          0.0005  SAN BERNARDINO
050101.......................................          0.0169  SOLANO
050113.......................................          0.0141  SAN MATEO
050118.......................................          0.0135  SAN JOAQUIN
050122.......................................          0.0135  SAN JOAQUIN

[[Page 43120]]

 
050129.......................................          0.0005  SAN BERNARDINO
050133.......................................          0.0186  YUBA
050136.......................................          0.0085  SONOMA
050140.......................................          0.0005  SAN BERNARDINO
050150.......................................          0.0357  NEVADA
050152.......................................          0.0026  SAN FRANCISCO
050167.......................................          0.0135  SAN JOAQUIN
050168.......................................          0.0006  ORANGE
050173.......................................          0.0006  ORANGE
050174.......................................          0.0085  SONOMA
050193.......................................          0.0006  ORANGE
050194.......................................          0.0052  SANTA CRUZ
050195.......................................          0.0009  ALAMEDA
050197.......................................          0.0141  SAN MATEO
050211.......................................          0.0009  ALAMEDA
050224.......................................          0.0006  ORANGE
050226.......................................          0.0006  ORANGE
050228.......................................          0.0026  SAN FRANCISCO
050230.......................................          0.0006  ORANGE
050232.......................................          0.0103  SAN LUIS OBISPO
050242.......................................          0.0052  SANTA CRUZ
050245.......................................          0.0005  SAN BERNARDINO
050264.......................................          0.0009  ALAMEDA
050272.......................................          0.0005  SAN BERNARDINO
050279.......................................          0.0005  SAN BERNARDINO
050283.......................................          0.0009  ALAMEDA
050289.......................................          0.0141  SAN MATEO
050291.......................................          0.0085  SONOMA
050298.......................................          0.0005  SAN BERNARDINO
050300.......................................          0.0005  SAN BERNARDINO
050305.......................................          0.0009  ALAMEDA
050313.......................................          0.0135  SAN JOAQUIN
050320.......................................          0.0009  ALAMEDA
050325.......................................          0.0046  TUOLUMNE
050327.......................................          0.0005  SAN BERNARDINO
050335.......................................          0.0046  TUOLUMNE
050336.......................................          0.0135  SAN JOAQUIN
050348.......................................          0.0006  ORANGE
050366.......................................          0.0025  CALAVERAS
050367.......................................          0.0169  SOLANO
050385.......................................          0.0085  SONOMA
050407.......................................          0.0026  SAN FRANCISCO
050426.......................................          0.0006  ORANGE
050444.......................................          0.0229  MERCED
050454.......................................          0.0026  SAN FRANCISCO
050457.......................................          0.0026  SAN FRANCISCO
050476.......................................          0.0275  LAKE
050488.......................................          0.0009  ALAMEDA
050494.......................................          0.0357  NEVADA
050506.......................................          0.0103  SAN LUIS OBISPO
050512.......................................          0.0009  ALAMEDA
050517.......................................          0.0005  SAN BERNARDINO
050526.......................................          0.0006  ORANGE
050528.......................................          0.0229  MERCED
050541.......................................          0.0141  SAN MATEO
050543.......................................          0.0006  ORANGE
050547.......................................          0.0085  SONOMA
050548.......................................          0.0006  ORANGE
050551.......................................          0.0006  ORANGE
050567.......................................          0.0006  ORANGE
050570.......................................          0.0006  ORANGE
050580.......................................          0.0006  ORANGE
050584.......................................          0.0005  SAN BERNARDINO
050586.......................................          0.0005  SAN BERNARDINO
050589.......................................          0.0006  ORANGE
050603.......................................          0.0006  ORANGE
050609.......................................          0.0006  ORANGE
050618.......................................          0.0005  SAN BERNARDINO
050633.......................................          0.0103  SAN LUIS OBISPO
050667.......................................          0.0196  NAPA
050668.......................................          0.0026  SAN FRANCISCO

[[Page 43121]]

 
050678.......................................          0.0006  ORANGE
050680.......................................          0.0169  SOLANO
050690.......................................          0.0085  SONOMA
050693.......................................          0.0006  ORANGE
050707.......................................          0.0141  SAN MATEO
050714.......................................          0.0052  SANTA CRUZ
050720.......................................          0.0006  ORANGE
050744.......................................          0.0006  ORANGE
050745.......................................          0.0006  ORANGE
050746.......................................          0.0006  ORANGE
050747.......................................          0.0006  ORANGE
050748.......................................          0.0135  SAN JOAQUIN
050754.......................................          0.0141  SAN MATEO
050756.......................................          0.0005  SAN BERNARDINO
052034.......................................          0.0009  ALAMEDA
052035.......................................          0.0006  ORANGE
052037.......................................          0.0005  SAN BERNARDINO
052039.......................................          0.0006  ORANGE
053034.......................................          0.0006  ORANGE
053037.......................................          0.0005  SAN BERNARDINO
053301.......................................          0.0009  ALAMEDA
053304.......................................          0.0006  ORANGE
054074.......................................          0.0169  SOLANO
054093.......................................          0.0005  SAN BERNARDINO
054110.......................................          0.0009  ALAMEDA
054111.......................................          0.0005  SAN BERNARDINO
054122.......................................          0.0196  NAPA
054123.......................................          0.0135  SAN JOAQUIN
060001.......................................          0.0045  WELD
060003.......................................          0.0075  BOULDER
060010.......................................          0.0153  LARIMER
060027.......................................          0.0075  BOULDER
060030.......................................          0.0153  LARIMER
060103.......................................          0.0075  BOULDER
060116.......................................          0.0075  BOULDER
064007.......................................          0.0075  BOULDER
080001.......................................          0.0063  NEW CASTLE
080003.......................................          0.0063  NEW CASTLE
083300.......................................          0.0063  NEW CASTLE
084002.......................................          0.0063  NEW CASTLE
100014.......................................          0.0059  VOLUSIA
100017.......................................          0.0059  VOLUSIA
100045.......................................          0.0059  VOLUSIA
100047.......................................          0.0026  CHARLOTTE
100068.......................................          0.0059  VOLUSIA
100072.......................................          0.0059  VOLUSIA
100077.......................................          0.0026  CHARLOTTE
100102.......................................          0.0125  COLUMBIA
100118.......................................          0.0179  FLAGLER
100156.......................................          0.0125  COLUMBIA
100232.......................................          0.0057  PUTNAM
100236.......................................          0.0026  CHARLOTTE
100252.......................................          0.0146  OKEECHOBEE
100290.......................................          0.0582  SUMTER
110023.......................................          0.0416  GORDON
110029.......................................          0.0056  HALL
110040.......................................          0.1727  JACKSON
110041.......................................          0.0624  HABERSHAM
110100.......................................          0.0789  JEFFERSON
110101.......................................          0.0067  COOK
110142.......................................          0.0202  EVANS
110146.......................................          0.0805  CAMDEN
110150.......................................          0.0227  BALDWIN
110187.......................................          0.0643  LUMPKIN
110190.......................................          0.0242  MACON
110205.......................................          0.0514  GILMER
130024.......................................          0.0422  BONNER
130049.......................................          0.0320  KOOTENAI
130066.......................................          0.0320  KOOTENAI
130067.......................................          0.0696  BINGHAM
130068.......................................          0.0320  KOOTENAI

[[Page 43122]]

 
140001.......................................          0.0362  FULTON
140026.......................................          0.0288  LA SALLE
140043.......................................          0.0055  WHITESIDE
140058.......................................          0.0125  MORGAN
140110.......................................          0.0288  LA SALLE
140160.......................................          0.0302  STEPHENSON
140161.......................................          0.0193  LIVINGSTON
140167.......................................          0.1055  IROQUOIS
140234.......................................          0.0288  LA SALLE
150006.......................................          0.0113  LA PORTE
150015.......................................          0.0113  LA PORTE
150022.......................................          0.0151  MONTGOMERY
150030.......................................          0.0186  HENRY
150072.......................................          0.0101  CASS
150076.......................................          0.0210  MARSHALL
150088.......................................          0.0111  MADISON
150091.......................................          0.0047  HUNTINGTON
150102.......................................          0.0103  STARKE
150113.......................................          0.0111  MADISON
150133.......................................          0.0167  KOSCIUSKO
150146.......................................          0.0319  NOBLE
154014.......................................          0.0167  KOSCIUSKO
160013.......................................          0.0179  MUSCATINE
160030.......................................          0.0040  STORY
160032.......................................          0.0235  JASPER
160080.......................................          0.0066  CLINTON
170137.......................................          0.0336  DOUGLAS
170150.......................................          0.0176  COWLEY
180012.......................................          0.0081  HARDIN
180017.......................................          0.0035  BARREN
180049.......................................          0.0497  MADISON
180064.......................................          0.0319  MONTGOMERY
180066.......................................          0.0449  LOGAN
180070.......................................          0.0240  GRAYSON
180079.......................................          0.0263  HARRISON
183028.......................................          0.0081  HARDIN
190003.......................................          0.0085  IBERIA
190015.......................................          0.0231  TANGIPAHOA
190017.......................................          0.0184  ST. LANDRY
190034.......................................          0.0188  VERMILION
190044.......................................          0.0258  ACADIA
190050.......................................          0.0044  BEAUREGARD
190053.......................................          0.0100  JEFFRSON DAVIS
190054.......................................          0.0085  IBERIA
190078.......................................          0.0184  ST. LANDRY
190086.......................................          0.0050  LINCOLN
190088.......................................          0.0410  WEBSTER
190099.......................................          0.0188  AVOYELLES
190106.......................................          0.0101  ALLEN
190116.......................................          0.0084  MOREHOUSE
190133.......................................          0.0101  ALLEN
190140.......................................          0.0034  FRANKLIN
190144.......................................          0.0410  WEBSTER
190145.......................................          0.0090  LA SALLE
190184.......................................          0.0161  CALDWELL
190190.......................................          0.0161  CALDWELL
190191.......................................          0.0184  ST. LANDRY
190246.......................................          0.0161  CALDWELL
190257.......................................          0.0050  LINCOLN
192022.......................................           0.005  LINCOLN
193044.......................................          0.0231  TANGIPAHOA
193047.......................................          0.0188  VERMILION
193069.......................................          0.0084  MOREHOUSE
200024.......................................          0.0092  ANDROSCOGGIN
200032.......................................          0.0466  OXFORD
200034.......................................          0.0092  ANDROSCOGGIN
200050.......................................          0.0223  HANCOCK
210001.......................................          0.0184  WASHINGTON
210023.......................................          0.0070  ANNE ARUNDEL
210028.......................................          0.0512  ST. MARYS
210043.......................................          0.0070  ANNE ARUNDEL

[[Page 43123]]

 
220002.......................................          0.0235  MIDDLESEX
220010.......................................          0.0461  ESSEX
220011.......................................          0.0235  MIDDLESEX
220029.......................................          0.0461  ESSEX
220033.......................................          0.0461  ESSEX
220035.......................................          0.0461  ESSEX
220049.......................................          0.0235  MIDDLESEX
220063.......................................          0.0235  MIDDLESEX
220070.......................................          0.0235  MIDDLESEX
220080.......................................          0.0461  ESSEX
220082.......................................          0.0235  MIDDLESEX
220084.......................................          0.0235  MIDDLESEX
220098.......................................          0.0235  MIDDLESEX
220101.......................................          0.0235  MIDDLESEX
220105.......................................          0.0235  MIDDLESEX
220171.......................................          0.0235  MIDDLESEX
220174.......................................          0.0461  ESSEX
222000.......................................          0.0235  MIDDLESEX
222026.......................................          0.0461  ESSEX
222044.......................................          0.0461  ESSEX
223026.......................................          0.0235  MIDDLESEX
224007.......................................          0.0235  MIDDLESEX
224022.......................................          0.0235  MIDDLESEX
224038.......................................          0.0235  MIDDLESEX
230003.......................................          0.0217  OTTAWA
230005.......................................          0.0473  LENAWEE
230013.......................................          0.0023  OAKLAND
230015.......................................          0.0297  ST. JOSEPH
230019.......................................          0.0023  OAKLAND
230021.......................................          0.0099  BERRIEN
230022.......................................          0.0212  BRANCH
230029.......................................          0.0023  OAKLAND
230035.......................................          0.0096  MONTCALM
230037.......................................          0.0211  HILLSDALE
230047.......................................          0.0018  MACOMB
230069.......................................          0.0209  LIVINGSTON
230071.......................................          0.0023  OAKLAND
230072.......................................          0.0217  OTTAWA
230075.......................................          0.0048  CALHOUN
230078.......................................          0.0099  BERRIEN
230092.......................................          0.0221  JACKSON
230093.......................................          0.0060  MECOSTA
230096.......................................          0.0297  ST. JOSEPH
230099.......................................          0.0230  MONROE
230121.......................................          0.0695  SHIAWASSEE
230130.......................................          0.0023  OAKLAND
230151.......................................          0.0023  OAKLAND
230174.......................................          0.0217  OTTAWA
230195.......................................          0.0018  MACOMB
230204.......................................          0.0018  MACOMB
230207.......................................          0.0023  OAKLAND
230208.......................................          0.0096  MONTCALM
230217.......................................          0.0048  CALHOUN
230222.......................................          0.0037  MIDLAND
230223.......................................          0.0023  OAKLAND
230227.......................................          0.0018  MACOMB
230254.......................................          0.0023  OAKLAND
230257.......................................          0.0018  MACOMB
230264.......................................          0.0018  MACOMB
230269.......................................          0.0023  OAKLAND
230277.......................................          0.0023  OAKLAND
230279.......................................          0.0209  LIVINGSTON
232023.......................................          0.0018  MACOMB
232025.......................................          0.0099  BERRIEN
232030.......................................          0.0023  OAKLAND
233025.......................................          0.0048  CALHOUN
234011.......................................          0.0023  OAKLAND
234021.......................................          0.0018  MACOMB
234023.......................................          0.0023  OAKLAND
240018.......................................          0.0872  GOODHUE
240044.......................................          0.0671  WINONA

[[Page 43124]]

 
240064.......................................          0.0130  ITASCA
240069.......................................          0.0301  STEELE
240071.......................................          0.0377  RICE
240117.......................................          0.0593  MOWER
240211.......................................          0.0386  PINE
250023.......................................          0.0430  PEARL RIVER
250040.......................................          0.0022  JACKSON
250117.......................................          0.0430  PEARL RIVER
250128.......................................          0.0393  PANOLA
250160.......................................          0.0393  PANOLA
260059.......................................          0.0127  LACLEDE
260064.......................................          0.0092  AUDRAIN
260097.......................................          0.0295  JOHNSON
270081.......................................          0.0237  MUSSELSHELL
280077.......................................          0.0057  DODGE
280123.......................................          0.0118  GAGE
290002.......................................          0.0280  LYON
300011.......................................          0.0069  HILLSBOROUGH
300012.......................................          0.0069  HILLSBOROUGH
300020.......................................          0.0069  HILLSBOROUGH
300034.......................................          0.0069  HILLSBOROUGH
310002.......................................          0.0264  ESSEX
310009.......................................          0.0264  ESSEX
310010.......................................          0.0092  MERCER
310011.......................................          0.0115  CAPE MAY
310013.......................................          0.0264  ESSEX
310018.......................................          0.0264  ESSEX
310021.......................................          0.0092  MERCER
310031.......................................          0.0130  BURLINGTON
310032.......................................          0.0027  CUMBERLAND
310038.......................................          0.0368  MIDDLESEX
310039.......................................          0.0368  MIDDLESEX
310044.......................................          0.0092  MERCER
310054.......................................          0.0264  ESSEX
310057.......................................          0.0130  BURLINGTON
310061.......................................          0.0130  BURLINGTON
310070.......................................          0.0368  MIDDLESEX
310076.......................................          0.0264  ESSEX
310083.......................................          0.0264  ESSEX
310092.......................................          0.0092  MERCER
310093.......................................          0.0264  ESSEX
310096.......................................          0.0264  ESSEX
310108.......................................          0.0368  MIDDLESEX
310110.......................................          0.0092  MERCER
310119.......................................          0.0264  ESSEX
310127.......................................          0.0130  BURLINGTON
313025.......................................          0.0264  ESSEX
313027.......................................          0.0092  MERCER
313032.......................................          0.013B  URLINGTON
313036.......................................          0.0027  CUMBERLAND
314011.......................................          0.0368  MIDDLESEX
314021.......................................          0.013B  URLINGTON
320003.......................................          0.0629  SAN MIGUEL
320011.......................................          0.0442  RIO ARRIBA
320018.......................................          0.0025  DONA ANA
320085.......................................          0.0025  DONA ANA
330004.......................................          0.0615  ULSTER
330008.......................................          0.0102  WYOMING
330010.......................................          0.0042  MONTGOMERY
330027.......................................          0.0149  NASSAU
330033.......................................          0.0205  CHENANGO
330047.......................................          0.0042  MONTGOMERY
330073.......................................          0.0122  GENESEE
330094.......................................          0.0463  COLUMBIA
330103.......................................          0.0121  CATTARAUGUS
330106.......................................          0.0149  NASSAU
330126.......................................          0.0675  ORANGE
330132.......................................          0.0121  CATTARAUGUS
330135.......................................          0.0675  ORANGE
330167.......................................          0.0149  NASSAU
330175.......................................          0.0241  CORTLAND

[[Page 43125]]

 
330181.......................................          0.0149  NASSAU
330182.......................................          0.0149  NASSAU
330191.......................................          0.0017  WARREN
330198.......................................          0.0149  NASSAU
330205.......................................          0.0675  ORANGE
330224.......................................          0.0615  ULSTER
330225.......................................          0.0149  NASSAU
330235.......................................          0.0281  CAYUGA
330259.......................................          0.0149  NASSAU
330264.......................................          0.0675  ORANGE
330331.......................................          0.0149  NASSAU
330332.......................................          0.0149  NASSAU
330372.......................................          0.0149  NASSAU
330386.......................................          0.0687  SULLIVAN
340020.......................................          0.0143  LEE
340021.......................................          0.0162  CLEVELAND
340024.......................................          0.0171  SAMPSON
340027.......................................          0.0125  LENOIR
340037.......................................          0.0162  CLEVELAND
340038.......................................          0.0253  BEAUFORT
340039.......................................          0.0101  IREDELL
340068.......................................          0.0094  COLUMBUS
340069.......................................          0.0083  WAKE
340070.......................................          0.0417  ALAMANCE
340071.......................................          0.0168  HARNETT
340073.......................................          0.0083  WAKE
340085.......................................          0.0250  DAVIDSON
340096.......................................          0.0250  DAVIDSON
340104.......................................          0.0162  CLEVELAND
340114.......................................          0.0083  WAKE
340124.......................................          0.0168  HARNETT
340126.......................................          0.0084  WILSON
340129.......................................          0.0101  IREDELL
340133.......................................          0.0242  MARTIN
340138.......................................          0.0083  WAKE
340144.......................................          0.0101  IREDELL
340145.......................................          0.0337  LINCOLN
340151.......................................          0.0053  HALIFAX
340173.......................................          0.0083  WAKE
344014.......................................          0.0083  WAKE
360002.......................................          0.0142  ASHLAND
360010.......................................          0.0076  TUSCARAWAS
360013.......................................          0.0136  SHELBY
360025.......................................          0.0072  ERIE
360036.......................................          0.0168  WAYNE
360040.......................................          0.0392  KNOX
360044.......................................          0.0124  DARKE
360065.......................................          0.0077  HURON
360071.......................................          0.0035  VAN WERT
360086.......................................          0.0187  CLARK
360096.......................................          0.0072  COLUMBIANA
360107.......................................          0.0095  SANDUSKY
360125.......................................          0.0137  ASHTABULA
360156.......................................          0.0095  SANDUSKY
360175.......................................          0.0176  CLINTON
360185.......................................          0.0072  COLUMBIANA
360187.......................................          0.0187  CLARK
360245.......................................          0.0137  ASHTABULA
362007.......................................          0.0095  SANDUSKY
370014.......................................          0.0363  BRYAN
370015.......................................          0.0369  MAYES
370023.......................................          0.0090  STEPHENS
370065.......................................          0.0097  CRAIG
370072.......................................          0.0260  LATIMER
370083.......................................          0.0051  PUSHMATAHA
370100.......................................          0.0101  CHOCTAW
370149.......................................          0.0292  POTTAWATOMIE
370156.......................................          0.0122  GARVIN
370169.......................................          0.0164  MCINTOSH
370172.......................................          0.0260  LATIMER
370214.......................................          0.0122  GARVIN

[[Page 43126]]

 
380022.......................................          0.0068  LINN
380029.......................................          0.0075  MARION
380051.......................................          0.0075  MARION
380056.......................................          0.0075  MARION
390008.......................................          0.0055  LAWRENCE
390016.......................................          0.0055  LAWRENCE
390030.......................................          0.0284  SCHUYLKILL
390031.......................................          0.0284  SCHUYLKILL
390044.......................................          0.0191  BERKS
390052.......................................          0.0044  CLEARFIELD
390065.......................................          0.0490  ADAMS
390066.......................................          0.0364  LEBANON
390086.......................................          0.0044  CLEARFIELD
390096.......................................          0.0191  BERKS
390113.......................................          0.0049  CRAWFORD
390122.......................................          0.0049  CRAWFORD
390138.......................................          0.0213  FRANKLIN
390146.......................................          0.0019  WARREN
390150.......................................          0.0019  GREENE
390151.......................................          0.0213  FRANKLIN
390162.......................................          0.0200  NORTHAMPTON
390181.......................................          0.0284  SCHUYLKILL
390183.......................................          0.0284  SCHUYLKILL
390201.......................................          0.1091  MONROE
390313.......................................          0.0284  SCHUYLKILL
393026.......................................          0.0191  BERKS
394020.......................................          0.0364  LEBANON
420007.......................................          0.0037  SPARTANBURG
420009.......................................          0.0113  OCONEE
420019.......................................          0.0142  CHESTER
420027.......................................          0.0145  ANDERSON
420030.......................................          0.0051  COLLETON
420039.......................................          0.0153  UNION
420043.......................................          0.0132  CHEROKEE
420062.......................................          0.0109  CHESTERFIELD
420069.......................................          0.0023  CLARENDON
420083.......................................          0.0037  SPARTANBURG
422004.......................................          0.0142  CHESTER
423029.......................................          0.0145  ANDERSON
430008.......................................          0.0537  BROOKINGS
430048.......................................          0.0055  LAWRENCE
430094.......................................          0.0055  LAWRENCE
440007.......................................          0.0226  COFFEE
440008.......................................          0.0449  HENDERSON
440016.......................................          0.0144  CARROLL
440024.......................................          0.0230  BRADLEY
440030.......................................          0.0056  HAMBLEN
440031.......................................          0.0025  ROANE
440033.......................................          0.0036  CAMPBELL
440035.......................................          0.0309  MONTGOMERY
440047.......................................          0.0338  GIBSON
440051.......................................          0.0071  MC NAIRY
440057.......................................          0.0028  CLAIBORNE
440060.......................................          0.0338  GIBSON
440067.......................................          0.0056  HAMBLEN
440070.......................................          0.0109  DECATUR
440081.......................................          0.0069  SEVIER
440084.......................................          0.0033  MONROE
440109.......................................          0.0070  HARDIN
440115.......................................          0.0338  GIBSON
440137.......................................          0.0763  BEDFORD
440144.......................................          0.0226  COFFEE
440148.......................................          0.0306  DE KALB
440153.......................................          0.0007  COCKE
440174.......................................          0.0310  HAYWOOD
440180.......................................          0.0036  CAMPBELL
440181.......................................          0.0361  HARDEMAN
440182.......................................          0.0144  CARROLL
440185.......................................          0.0230  BRADLEY
450032.......................................          0.0253  HARRISON
450039.......................................          0.0024  TARRANT

[[Page 43127]]

 
450052.......................................          0.0276  BOSQUE
450059.......................................          0.0074  COMAL
450064.......................................          0.0024  TARRANT
450087.......................................          0.0024  TARRANT
450090.......................................          0.0651  COOKE
450099.......................................          0.0143  GRAY
450135.......................................          0.0024  TARRANT
450137.......................................          0.0024  TARRANT
450144.......................................          0.0558  ANDREWS
450163.......................................          0.0053  KLEBERG
450192.......................................          0.0271  HILL
450194.......................................          0.0213  CHEROKEE
450210.......................................          0.0150  PANOLA
450224.......................................          0.0195  WOOD
450236.......................................          0.0389  HOPKINS
450270.......................................          0.0271  HILL
450283.......................................          0.0655  VAN ZANDT
450324.......................................          0.0132  GRAYSON
450347.......................................          0.0379  WALKER
450348.......................................          0.0058  FALLS
450370.......................................          0.0240  COLORADO
450389.......................................          0.0619  HENDERSON
450393.......................................          0.0132  GRAYSON
450395.......................................          0.0451  POLK
450419.......................................          0.0024  TARRANT
450438.......................................          0.0241  COLORADO
450451.......................................          0.0537  SOMERVELL
450460.......................................          0.0048  TYLER
450469.......................................          0.0132  GRAYSON
450497.......................................          0.0395  MONTAGUE
450539.......................................          0.0071  HALE
450547.......................................          0.0195  WOOD
450563.......................................          0.0024  TARRANT
450565.......................................          0.0486  PALO PINTO
450573.......................................          0.0115  JASPER
450596.......................................          0.0744  HOOD
450639.......................................          0.0024  TARRANT
450641.......................................          0.0395  MONTAGUE
450672.......................................          0.0024  TARRANT
450675.......................................          0.0024  TARRANT
450677.......................................          0.0024  TARRANT
450698.......................................          0.0135  LAMB
450747.......................................          0.0127  ANDERSON
450755.......................................          0.0294  HOCKLEY
450770.......................................          0.0182  MILAM
450779.......................................          0.0024  TARRANT
450813.......................................          0.0127  ANDERSON
450838.......................................          0.0115  JASPER
450872.......................................          0.0024  TARRANT
450880.......................................          0.0024  TARRANT
450884.......................................          0.0050  UPSHUR
450886.......................................          0.0024  TARRANT
450888.......................................          0.0024  TARRANT
452019.......................................          0.0024  TARRANT
452028.......................................          0.0024  TARRANT
452041.......................................          0.0132  GRAYSON
452088.......................................          0.0024  TARRANT
453040.......................................          0.0024  TARRANT
453041.......................................          0.0024  TARRANT
453042.......................................          0.0024  TARRANT
453089.......................................          0.0127  ANDERSON
453300.......................................          0.0024  TARRANT
454012.......................................          0.0024  TARRANT
460017.......................................          0.0364  BOX ELDER
460039.......................................          0.0364  BOX ELDER
490019.......................................          0.1081  CULPEPER
490084.......................................          0.0145  ESSEX
490110.......................................          0.0327  MONTGOMERY
500003.......................................          0.0164  SKAGIT
500007.......................................          0.0164  SKAGIT
500019.......................................          0.0140  LEWIS

[[Page 43128]]

 
500039.......................................          0.0101  KITSAP
500041.......................................          0.0020  COWLITZ
510018.......................................          0.0187  JACKSON
510047.......................................          0.0270  MARION
510077.......................................          0.0021  MINGO
520028.......................................          0.0297  GREEN
520035.......................................          0.0083  SHEBOYGAN
520044.......................................          0.0083  SHEBOYGAN
520057.......................................          0.0184  SAUK
520059.......................................          0.0189  RACINE
520060.......................................          0.0048  GREEN LAKE
520071.......................................          0.0174  JEFFERSON
520076.......................................          0.0159  DODGE
520095.......................................          0.0184  SAUK
520096.......................................          0.0189  RACINE
520102.......................................          0.0242  WALWORTH
520116.......................................          0.0174  JEFFERSON
522005.......................................          0.0189  RACINE
----------------------------------------------------------------------------------------------------------------


[[Page 43129]]


                 Addendum M.--Proposed HCPCS Codes for Assignment to Composite APCs for CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                                        Single code   Composite
      HCPCS code            Short descriptor              CI                 SI             APC          APC
                                                                                         assignment   assignment
----------------------------------------------------------------------------------------------------------------
90801.................  Psy dx interview........  CH...............  Q................         0323         0034
90802.................  Intac psy dx interview..  CH...............  Q................         0323         0034
90804.................  Psytx, office, 20-30 min  CH...............  Q................         0322         0034
90805.................  Psytx, off, 20-30 min w/  CH...............  Q................         0322         0034
                         e&m.
90806.................  Psytx, off, 45-50 min...  CH...............  Q................         0323         0034
90807.................  Psytx, off, 45-50 min w/  CH...............  Q................         0323         0034
                         e&m.
90808.................  Psytx, office, 75-80 min  CH...............  Q................         0323         0034
90809.................  Psytx, off, 75-80, w/e&m  CH...............  Q................         0323         0034
90810.................  Intac psytx, off, 20-30   CH...............  Q................         0322         0034
                         min.
90811.................  Intac psytx, 20-30, w/    CH...............  Q................         0322         0034
                         e&m.
90812.................  Intac psytx, off, 45-50   CH...............  Q................         0323         0034
                         minv.
90813.................  Intac psytx, 45-50 min w/ CH...............  Q................         0323         0034
                         e&m.
90814.................  Intac psytx, off, 75-80   CH...............  Q................         0323         0034
                         min.
90815.................  Intac psytx, 75-80 w/e&m  CH...............  Q................         0323         0034
90816.................  Psytx, hosp, 20-30 min..  CH...............  Q................         0322         0034
90817.................  Psytx, hosp, 20-30 min w/ CH...............  Q................         0322         0034
                         e&m.
90818.................  Psytx, hosp, 45-50 min..  CH...............  Q................         0323         0034
90819.................  Psytx, hosp, 45-50 min w/ CH...............  Q................         0323         0034
                         e&m.
90821.................  sytx, hosp, 75-80 min...  CH...............  Q................         0323         0034
90822.................  Psytx, hosp, 75-80 min w/ CH...............  Q................         0323         0034
                         e&m.
90823.................  Intac psytx, hosp, 20-30  CH...............  Q................         0322         0034
                         min.
90824.................  Intac psytx, hsp 20-30 w/ CH...............  Q................         0322         0034
                         e&m.
90826.................  Intac psytx, hosp, 45-50  CH...............  Q................         0323         0034
                         min.
90827.................  Intac psytx, hsp 45-50 w/ CH...............  Q................         0323         0034
                         e&m.
90828.................  Intac psytx, hosp, 75-80  CH...............  Q................         0323         0034
                         min.
90829.................  Intac psytx, hsp 75-80 w/ CH...............  Q................         0323         0034
                         e&m.
90845.................  Psychoanalysis..........  CH...............  Q................         0323         0034
90846.................  Family psytx w/o patient  CH...............  Q................         0324         0034
90847.................  Family psytx w/patient..  CH...............  Q................         0324         0034
90849.................  Multiple family group     CH...............  Q................         0325         0034
                         psytx.
90853.................  Group psychotherapy.....  CH...............  Q................         0325         0034
90857.................  Intac group psytx.......  CH...............  Q................         0325         0034
90862.................  Medication management...  CH...............  Q................         0605         0034
90865.................  Narcosynthesis..........  CH...............  Q................         0323         0034
90880.................  Hypnotherapy............  CH...............  Q................         0323         0034
90899.................  Psychiatric service/      CH...............  Q................         0322         0034
                         therapy.
96101.................  Psycho testing by pscy/   CH...............  Q................         0382         0034
                         phys.
96102.................  Psycho testing by         CH...............  Q................         0373         0034
                         technician.
96103.................  Psycho testing admin by   CH...............  Q................         0373         0034
                         comp.
96110.................  Developmental test, lim.  CH...............  Q................         0373         0034
96111.................  Developmental test,       CH...............  Q................         0382         0034
                         exten.
96116.................  Neurobehavioral status    CH...............  Q................         0382         0034
                         exam.
96118.................  Neuropsych test by pscyh/ CH...............  Q................         0382         0034
                         phys.
96119.................  Neuropscyh testing by     CH...............  Q................         0382         0034
                         tec.
96120.................  Neuropsych tst admin w/   CH...............  Q................         0373         0034
                         comp.
96150.................  Assess hlth/behave,       CH...............  Q................         0432         0034
                         initi.
96151.................  Assess hlth/behave,       CH...............  Q................         0432         0034
                         subseq.
96152.................  Intervene hlth/           CH...............  Q................         0432         0034
                         behave,indiv.
96153.................  Intervene hlth/bhave,     CH...............  Q................         0432         0034
                         group.
96154.................  Intevene hlth/behave,     CH...............  Q................         0432         0034
                         fam w/pt.
M0064.................  Visit for drug            CH...............  Q................         0605         0034
                         monitoring.
93619.................  Electrophysiology         CH...............  Q................         0085         8000
                         evaluation.
93620.................  Electrophysiology         CH...............  Q................         0085         8000
                         evaluation.
93650.................  Ablate heart dysrhythm    CH...............  Q................         0085         8000
                         focus.
93651.................  Ablate heart dysrhythm    CH...............  Q................         0086         8000
                         focus.
93652.................  Ablate heart dysrhythm    CH...............  Q................         0086         8000
                         focus.
55875.................  Transperi needle place,   CH...............  Q................         0163         8001
                         pros.
77778.................  Apply interstit radiat    CH...............  Q................         0651         8001
                         compl.
----------------------------------------------------------------------------------------------------------------

[FR Doc. 07-3509 Filed 7-16-07; 4:00 pm]
BILLING CODE 4120-01-P


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