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

2012

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

Copayment Minimum Unadjusted Copayment

00100 Anesth salivary

gland N

00102 Anesth repair of cleft

lip N

00103 Anesth

blepharoplasty N

00104 Anesth

electroshock N

00120 Anesth ear

surgery N

00124 Anesth ear

exam N

00126 Anesth

tympanotomy N

00140 Anesth procedures on

eye N

00142 Anesth lens

surgery N

00144 Anesth corneal

transplant N

00145 Anesth vitreoretinal

surg N

00147 Anesth

iridectomy N

00148 Anesth eye

exam N

00160 Anesth nose/sinus

surgery N

00162 Anesth nose/sinus

surgery N

00164 Anesth biopsy of

nose N

00170 Anesth procedure on

mouth N

00172 Anesth cleft palate

repair N

00174 Anesth pharyngealsurgery N

00176 Anesth pharyngeal

surgery C

00190 Anesth face/skull bone

surg N

00192 Anesth facial bone

surgery C

00210 Anesth cranial surg

nos N

00211 Anesth cran surg

hemotoma C

00212 Anesth skull

drainage N

00214 Anesth skull

drainage C

00215 Anesth skull

repair/fract C

00216 Anesth head vessel

surgery N

00218 Anesth special head

surgery N

00220 Anesth intrcrn

nerve N

00222 Anesth head nerve

surgery N

00300 Anesth

head/neck/ptrunk N

00320 Anesth neck organ

1yr/> N

00322 Anesth biopsy of

thyroid N

00326 Anesth larynx/trach < 1

yr N

00350 Anesth neck vessel

surgery N

00352 Anesth neck vessel

surgery N

00400 Anesth skin

ext/per/atrunk N

00402 Anesth surgery of

breast N

00404 Anesth surgery ofbreast N

00406 Anesth surgery of

breast N

00410 Anesth correct heart

rhythm N

00450 Anesth surgery of

shoulder N

00452 Anesth surgery of

shoulder C

00454 Anesth collar bone

biopsy N

00470 Anesth removal of

rib N

00472 Anesth chest wall

repair N

00474 Anesth surgery of

rib C

00500 Anesth esophageal

surgery N

00520 Anesth chest

procedure N

00522 Anesth chest lining

biopsy N

00524 Anesth chest

drainage C

00528 Anes mediascpy & dx

thorscpy N

00529 Anes medscpy&thorscpy 1

lung N

00530 Anesth pacemaker

insertion N

00532 Anesth vascular

access N

00534 Anesth

cardioverter/defib N

00537 Anesth cardiac

electrophys N

00539 Anesth trach-bronch

reconst N

00540 Anesth chest

surgery C

00541 Anesth one lung

ventilation N00542 Anesth remvl

pleura C

00546 Anesth lung chest wall

surg C

00548 Anesth trachea bronchi

surg N

00550 Anesth sternal

debridement N

00560 Anesth heart surg w/o

pump C

00561 Anesth heart surg < 1

yr C

00562 Anesth hrt surg w/pmp age

1+ C

00563 Anesth heart surg

w/arrest N

00566 Anesth cabg w/o

pump N

00567 Anesth cabg

w/pump C

00580 Anesth heart/lung

transplnt C

00600 Anesth spine cord

surgery N

00604 Anesth sitting

procedure C

00620 Anesth spine cord

surgery N

00622 Anesth removal of

nerves C

00625 Anes spine tranthor w/o

vent N

00626 Anes spine transthor

w/vent N

00630 Anesth spine cord

surgery N

00632 Anesth removal of

nerves C

00634 Anesth for

chemonucleolysis N

00635 Anesth lumbar

puncture N00640 Anesth spine

manipulation N

00670 Anesth spine cord

surgery C

00700 Anesth abdominal wall

surg N

00702 Anesth for liver

biopsy N

00730 Anesth abdominal wall

surg N

00740 Anesth upper gi

visualize N

00750 Anesth repair of

hernia N

00752 Anesth repair of

hernia N

00754 Anesth repair of

hernia N

00756 Anesth repair of

hernia N

00770 Anesth blood vessel

repair N

00790 Anesth surg upper

abdomen N

00792 Anesth hemorr/excise

liver C

00794 Anesth pancreas

removal C

00796 Anesth for liver

transplant C

00797 Anesth surgery for

obesity N

00800 Anesth abdominal wall

surg N

00802 Anesth fat layer

removal C

00810 Anesth low intestine

scope N

00820 Anesth abdominal wall

surg N

00830 Anesth repair of

hernia N

00832 Anesth repair ofhernia N

00834 Anesth hernia repair < 1

yr N

00836 Anesth hernia repair

preemie N

00840 Anesth surg lower

abdomen N

00842 Anesth

amniocentesis N

00844 Anesth pelvis

surgery C

00846 Anesth

hysterectomy C

00848 Anesth pelvic organ

surg C

00851 Anesth tubal

ligation N

00860 Anesth surgery of

abdomen N

00862 Anesth kidney/ureter

surg N

00864 Anesth removal of

bladder C

00865 Anesth removal of

prostate C

00866 Anesth removal of

adrenal C

00868 Anesth kidney

transplant C

00870 Anesth bladder stone

surg N

00872 Anesth kidney stone

destruct N

00873 Anesth kidney stone

destruct N

00880 Anesth abdomen vessel

surg N

00882 Anesth major vein

ligation C

00902 Anesth anorectal

surgery N

00904 Anesth perineal

surgery C00906 Anesth removal of

vulva N

00908 Anesth removal of

prostate C

00910 Anesth bladder

surgery N

00912 Anesth bladder tumor

surg N

00914 Anesth removal of

prostate N

00916 Anesth bleeding

control N

00918 Anesth stone

removal N

00920 Anesth genitalia

surgery N

00921 Anesth

vasectomy N

00922 Anesth sperm duct

surgery N

00924 Anesth testis

exploration N

00926 Anesth removal of

testis N

00928 Anesth removal of

testis N

00930 Anesth testis

suspension N

00932 Anesth amputation of

penis C

00934 Anesth penis nodes

removal C

00936 Anesth penis nodes

removal C

00938 Anesth insert penis

device N

00940 Anesth vaginal

procedures N

00942 Anesth surg on

vag/urethral N

00944 Anesth vaginal

hysterectomy C00948 Anesth repair of

cervix N

00950 Anesth vaginal

endoscopy N

00952 Anesth

hysteroscope/graph N

01112 Anesth bone

aspirate/bx N

01120 Anesth pelvis

surgery N

01130 Anesth body cast

procedure N

01140 Anesth amputation at

pelvis C

01150 Anesth pelvic tumor

surgery C

01160 Anesth pelvis

procedure N

01170 Anesth pelvis

surgery N

01173 Anesth fx repair

pelvis N

01180 Anesth pelvis nerve

removal N

01190 Anesth pelvis nerve

removal N

01200 Anesth hip joint

procedure N

01202 Anesth arthroscopy of

hip N

01210 Anesth hip joint

surgery N

01212 Anesth hip

disarticulation C

01214 Anesth hip

arthroplasty C

01215 Anesth revise hip

repair N

01220 Anesth procedure on

femur N

01230 Anesth surgery offemur N

01232 Anesth amputation of

femur C

01234 Anesth radical femur

surg C

01250 Anesth upper leg

surgery N

01260 Anesth upper leg veins

surg N

01270 Anesth thigh arteries

surg N

01272 Anesth femoral artery

surg C

01274 Anesth femoral

embolectomy C

01320 Anesth knee area

surgery N

01340 Anesth knee area

procedure N

01360 Anesth knee area

surgery N

01380 Anesth knee joint

procedure N

01382 Anesth dx knee

arthroscopy N

01390 Anesth knee area

procedure N

01392 Anesth knee area

surgery N

01400 Anesth knee joint

surgery N

01402 Anesth knee

arthroplasty C

01404 Anesth amputation at

knee C

01420 Anesth knee joint

casting N

01430 Anesth knee veins

surgery N

01432 Anesth knee vessel

surg N

01440 Anesth knee arteriessurg N

01442 Anesth knee artery

surg C

01444 Anesth knee artery

repair C

01462 Anesth lower leg

procedure N

01464 Anesth ankle/ft

arthroscopy N

01470 Anesth lower leg

surgery N

01472 Anesth achilles tendon

surg N

01474 Anesth lower leg

surgery N

01480 Anesth lower leg bone

surg N

01482 Anesth radical leg

surgery N

01484 Anesth lower leg

revision N

01486 Anesth ankle

replacement C

01490 Anesth lower leg

casting N

01500 Anesth leg arteries

surg N

01502 Anesth lwr leg

embolectomy C

01520 Anesth lower leg vein

surg N

01522 Anesth lower leg vein

surg N

01610 Anesth surgery of

shoulder N

01620 Anesth shoulder

procedure N

01622 Anes dx shoulder

arthroscopy N

01630 Anesth surgery of

shoulder N01634 Anesth shoulder joint

amput C

01636 Anesth forequarter

amput C

01638 Anesth shoulder

replacement C

01650 Anesth shoulder artery

surg N

01652 Anesth shoulder vessel

surg C

01654 Anesth shoulder vessel

surg C

01656 Anesth arm-leg vessel

surg C

01670 Anesth shoulder vein

surg N

01680 Anesth shoulder

casting N

01682 Anesth airplane

cast N

01710 Anesth elbow area

surgery N

01712 Anesth uppr arm tendon

surg N

01714 Anesth uppr arm tendon

surg N

01716 Anesth biceps tendon

repair N

01730 Anesth uppr arm

procedure N

01732 Anesth dx elbow

arthroscopy N

01740 Anesth upper arm

surgery N

01742 Anesth humerus

surgery N

01744 Anesth humerus

repair N

01756 Anesth radical humerus

surg C

01758 Anesth humeral lesion

surg N

01760 Anesth elbowreplacement N

01770 Anesth uppr arm artery

surg N

01772 Anesth uppr arm

embolectomy N

01780 Anesth upper arm vein

surg N

01782 Anesth uppr arm vein

repair N

01810 Anesth lower arm

surgery N

01820 Anesth lower arm

procedure N

01829 Anesth dx wrist

arthroscopy N

01830 Anesth lower arm

surgery N

01832 Anesth wrist

replacement N

01840 Anesth lwr arm artery

surg N

01842 Anesth lwr arm

embolectomy N

01844 Anesth vascular shunt

surg N

01850 Anesth lower arm vein

surg N

01852 Anesth lwr arm vein

repair N

01860 Anesth lower arm

casting N

01916 Anesth dx

arteriography N

01920 Anesth catheterize

heart N

01922 Anesth cat or mri

scan N

01924 Anes ther interven rad

art N

01925 Anes ther interven radcar N

01926 Anes tx interv rad

hrt/cran N

01930 Anes ther interven rad

vei N

01931 Anes ther interven rad

tip N

01932 Anes tx interv rad th

vein N

01933 Anes tx interv rad cran

vein N

01935 Anesth perc img dx sp

proc N

01936 Anesth perc img tx sp

proc N

01951 Anesth burn less 4

percent N

01952 Anesth burn 4-9

percent N

01953 Anesth burn each 9

percent N

01958 Anesth antepartum

manipul N

01960 Anesth 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

procedure N

01967 Anesth/analg vag

delivery N

01968 Anes/analg cs deliver

add-on N

01969 Anesth/analg cs hyst

add-on N

01990 Support for organ

donor C01991 Anesth nerve

block/inj N

01992 Anesth n block/inj

prone N

01996 Hosp manage cont drug

admin N

01999 Unlisted anesth

procedure N

10021 Fna w/o

image T 0002 1.6118 $112.85

. $22.57

10022 Fna

w/image T 0004 4.5721 $320.12

. $64.03

10040 Acne

surgery T 0013 0.8768 $61.39

. $12.28

10060 Drainage of skin

abscess T 0006 1.4209 $99.49

. $19.90

10061 Drainage of skin

abscess T 0006 1.4209 $99.49

. $19.90

10080 Drainage of pilonidal

cyst T 0006 1.4209 $99.49

. $19.90

10081 Drainage of pilonidal

cyst T 0007 12.8082 $896.78

. $179.36

10120 Remove foreign

body T 0016 2.7597 $193.22

. $38.65

10121 Remove foreign

body T 0021 16.9957 "$1,189.97"

. $238.00

10140 Drainage of

hematoma/fluid T 0007 12.8082 $896.78

. $179.36

10160 Puncture drainage of

lesion T 0006 1.4209 $99.49

. $19.90

10180 Complex drainage

wound T 0008 20.5510 "$1,438.90"

. $287.78

11000 Debride infected

skin T 0016 2.7597 $193.22

. $38.65

11001 Debride infected skinadd-on T 0013 0.8768 $61.39

. $12.28

11004 Debride genitalia &

perineum C

11005 Debride abdom

wall C

11006 Debride genit/per/abdom

wall C

11008 Remove mesh from abd

wall C

11010 Debride skin at fx

site T 0019 4.3953 $307.74

. $61.55

11011 Debride skin musc at fx

site T 0019 4.3953 $307.74

. $61.55

11012 Deb skin bone at fx

site T 0019 4.3953 $307.74

. $61.55

11042 Deb subq tissue 20 sq

cm/< T 0016 2.7597 $193.22

. $38.65

11043 Deb musc/fascia 20 sq

cm/< T 0016 2.7597 $193.22

. $38.65

11044 Deb bone 20 sq

cm/< T 0020 8.2918 $580.56

. $116.12

11045 Deb subq tissue

add-on T 0016 2.7597 $193.22

. $38.65

11046 Deb musc/fascia

add-on T 0016 2.7597 $193.22

. $38.65

11047 Deb bone

add-on T 0020 8.2918 $580.56

. $116.12

11055 Trim skin

lesion T 0013 0.8768 $61.39

. $12.28

11056 Trim skin lesions 2 to

4 T 0013 0.8768 $61.39

. $12.28

11057 Trim skin lesions over

4 CH T 0015 1.4966 $104.79

. $20.96

11100 Biopsy skin

lesion T 0015 1.4966 $104.79

. $20.9611101 Biopsy skin

add-on T 0013 0.8768 $61.39

. $12.28

11200 Removal of skin

tags T 0013 0.8768 $61.39

. $12.28

11201 Remove skin tags

add-on T 0013 0.8768 $61.39

. $12.28

11300 Shave skin

lesion T 0013 0.8768 $61.39

. $12.28

11301 Shave skin

lesion T 0013 0.8768 $61.39

. $12.28

11302 Shave skin

lesion T 0013 0.8768 $61.39

. $12.28

11303 Shave skin

lesion T 0015 1.4966 $104.79

. $20.96

11305 Shave skin

lesion T 0013 0.8768 $61.39

. $12.28

11306 Shave skin

lesion T 0013 0.8768 $61.39

. $12.28

11307 Shave skin

lesion T 0013 0.8768 $61.39

. $12.28

11308 Shave skin

lesion CH T 0015 1.4966 $104.79

. $20.96

11310 Shave skin

lesion T 0013 0.8768 $61.39

. $12.28

11311 Shave skin

lesion T 0013 0.8768 $61.39

. $12.28

11312 Shave skin

lesion CH T 0015 1.4966 $104.79

. $20.96

11313 Shave skin

lesion CH T 0015 1.4966 $104.79

. $20.96

11400 Exc tr-ext b9+marg 0.5 <

cm T 0019 4.3953 $307.74

. $61.55

11401 Exc tr-ext b9+marg 0.6-1cm T 0019 4.3953 $307.74

. $61.55

11402 Exc tr-ext b9+marg 1.1-2

cm T 0019 4.3953 $307.74

. $61.55

11403 Exc tr-ext b9+marg 2.1-3

cm T 0020 8.2918 $580.56

. $116.12

11404 Exc tr-ext b9+marg 3.1-4

cm T 0021 16.9957 "$1,189.97"

. $238.00

11406 Exc tr-ext b9+marg > 4.0

cm T 0021 16.9957 "$1,189.97"

. $238.00

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

< T 0020 8.2918 $580.56

. $116.12

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

0.6-1 T 0020 8.2918 $580.56

. $116.12

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

1.1-2 T 0020 8.2918 $580.56

. $116.12

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

2.1-3 T 0021 16.9957 "$1,189.97"

. $238.00

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

3.1-4 T 0021 16.9957 "$1,189.97"

. $238.00

11426 Exc h-f-nk-sp b9+marg > 4

cm T 0022 23.2636 "$1,628.82" $350.74 $325.77

11440 Exc face-mm b9+marg 0.5 <

cm T 0019 4.3953 $307.74

. $61.55

11441 Exc face-mm b9+marg 0.6-1

cm T 0019 4.3953 $307.74

. $61.55

11442 Exc face-mm b9+marg 1.1-2

cm T 0020 8.2918 $580.56

. $116.12

11443 Exc face-mm b9+marg 2.1-3

cm T 0020 8.2918 $580.56

. $116.12

11444 Exc face-mm b9+marg 3.1-4

cm T 0020 8.2918 $580.56

. $116.12

11446 Exc face-mm b9+marg > 4

cm T 0022 23.2636 "$1,628.82" $350.74 $325.7711450 Removal sweat gland

lesion T 0022 23.2636 "$1,628.82" $350.74 $325.77

11451 Removal sweat gland

lesion T 0022 23.2636 "$1,628.82" $350.74 $325.77

11462 Removal sweat gland

lesion T 0022 23.2636 "$1,628.82" $350.74 $325.77

11463 Removal sweat gland

lesion T 0022 23.2636 "$1,628.82" $350.74 $325.77

11470 Removal sweat gland

lesion T 0022 23.2636 "$1,628.82" $350.74 $325.77

11471 Removal sweat gland

lesion T 0022 23.2636 "$1,628.82" $350.74 $325.77

11600 Exc tr-ext mal+marg 0.5 <

cm T 0020 8.2918 $580.56

. $116.12

11601 Exc tr-ext mal+marg 0.6-1

cm T 0019 4.3953 $307.74

. $61.55

11602 Exc tr-ext mal+marg 1.1-2

cm T 0019 4.3953 $307.74

. $61.55

11603 Exc tr-ext mal+marg 2.1-3

cm T 0020 8.2918 $580.56

. $116.12

11604 Exc tr-ext mal+marg 3.1-4

cm T 0020 8.2918 $580.56

. $116.12

11606 Exc tr-ext mal+marg > 4

cm T 0021 16.9957 "$1,189.97"

. $238.00

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

< T 0020 8.2918 $580.56

. $116.12

11621 Exc s/n/h/f/g mal+mrg

0.6-1 T 0019 4.3953 $307.74

. $61.55

11622 Exc s/n/h/f/g mal+mrg

1.1-2 T 0020 8.2918 $580.56

. $116.12

11623 Exc s/n/h/f/g mal+mrg

2.1-3 T 0021 16.9957 "$1,189.97"

. $238.00

11624 Exc s/n/h/f/g mal+mrg3.1-4 T 0021 16.9957 "$1,189.97"

. $238.00

11626 Exc s/n/h/f/g mal+mrg > 4

cm T 0022 23.2636 "$1,628.82" $350.74 $325.77

11640 Exc f/e/e/n/l mal+mrg

0.5cm< T 0019 4.3953 $307.74

. $61.55

11641 Exc f/e/e/n/l mal+mrg

0.6-1 T 0019 4.3953 $307.74

. $61.55

11642 Exc f/e/e/n/l mal+mrg

1.1-2 T 0019 4.3953 $307.74

. $61.55

11643 Exc f/e/e/n/l mal+mrg

2.1-3 T 0020 8.2918 $580.56

. $116.12

11644 Exc f/e/e/n/l mal+mrg

3.1-4 T 0021 16.9957 "$1,189.97"

. $238.00

11646 Exc f/e/e/n/l mal+mrg > 4

cm T 0022 23.2636 "$1,628.82" $350.74 $325.77

11719 Trim

nail(s) T 0012 0.3878 $27.15

. $5.43

11720 Debride nail

1-5 T 0013 0.8768 $61.39

. $12.28

11721 Debride nail 6 or

more T 0013 0.8768 $61.39

. $12.28

11730 Removal of nail

plate T 0013 0.8768 $61.39

. $12.28

11732 Remove nail plate

add-on T 0013 0.8768 $61.39

. $12.28

11740 Drain blood from under

nail T 0012 0.3878 $27.15

. $5.43

11750 Removal of nail

bed T 0019 4.3953 $307.74

. $61.55

11752 Remove nail bed/finger

tip T 0022 23.2636 "$1,628.82" $350.74 $325.77

11755 Biopsy nail

unit T 0019 4.3953 $307.74

. $61.5511760 Repair of nail

bed T 0133 1.1922 $83.47 $23.34 $16.70

11762 Reconstruction of nail

bed T 0136 16.7703 "$1,174.19"

. $234.84

11765 Excision of nail fold

toe T 0013 0.8768 $61.39

. $12.28

11770 Removal of pilonidal

lesion T 0022 23.2636 "$1,628.82" $350.74 $325.77

11771 Removal of pilonidal

lesion T 0022 23.2636 "$1,628.82" $350.74 $325.77

11772 Removal of pilonidal

lesion T 0022 23.2636 "$1,628.82" $350.74 $325.77

11900 Injection into skin

lesions T 0013 0.8768 $61.39

. $12.28

11901 Added skin lesions

injection T 0013 0.8768 $61.39

. $12.28

11920 Correct skin color

defects T 0134 3.2354 $226.53

. $45.31

11921 Correct skin color

defects T 0134 3.2354 $226.53

. $45.31

11922 Correct skin color

defects T 0134 3.2354 $226.53

. $45.31

11950 Therapy for contour

defects CH T 0134 3.2354 $226.53

. $45.31

11951 Therapy for contour

defects CH T 0134 3.2354 $226.53

. $45.31

11952 Therapy for contour

defects CH T 0134 3.2354 $226.53

. $45.31

11954 Therapy for contour

defects T 0133 1.1922 $83.47 $23.34 $16.70

11960 Insert tissue

expander(s) T 0137 21.4409 "$1,501.21"

. $300.25

11970 Replace tissueexpander T 0051 47.5032 "$3,325.98"

. $665.20

11971 Remove tissue

expander(s) T 0022 23.2636 "$1,628.82" $350.74 $325.77

11975 Insert contraceptive

cap CH D

11976 Removal of contraceptive

cap T 0019 4.3953 $307.74

. $61.55

11977 Removal/reinsert contra

cap CH D

11980 Implant hormone

pellet(s) X 0340 0.6499 $45.50

. $9.10

11981 Insert drug implant

device X 0340 0.6499 $45.50

. $9.10

11982 Remove drug implant

device X 0340 0.6499 $45.50

. $9.10

11983 Remove/insert drug

implant X 0340 0.6499 $45.50

. $9.10

12001 Repair superficial

wound(s) T 0133 1.1922 $83.47 $23.34 $16.70

12002 Repair superficial

wound(s) T 0133 1.1922 $83.47 $23.34 $16.70

12004 Repair superficial

wound(s) T 0133 1.1922 $83.47 $23.34 $16.70

12005 Repair superficial

wound(s) T 0133 1.1922 $83.47 $23.34 $16.70

12006 Repair superficial

wound(s) T 0133 1.1922 $83.47 $23.34 $16.70

12007 Repair superficial

wound(s) T 0133 1.1922 $83.47 $23.34 $16.70

12011 Repair superficial

wound(s) T 0133 1.1922 $83.47 $23.34 $16.70

12013 Repair superficial

wound(s) T 0133 1.1922 $83.47 $23.34 $16.70

12014 Repair superficialwound(s) T 0133 1.1922 $83.47 $23.34 $16.70

12015 Repair superficial

wound(s) T 0133 1.1922 $83.47 $23.34 $16.70

12016 Repair superficial

wound(s) T 0133 1.1922 $83.47 $23.34 $16.70

12017 Repair superficial

wound(s) T 0133 1.1922 $83.47 $23.34 $16.70

12018 Repair superficial

wound(s) CH T 0134 3.2354 $226.53

. $45.31

12020 Closure of split

wound T 0135 4.9271 $344.98

. $69.00

12021 Closure of split

wound T 0134 3.2354 $226.53

. $45.31

12031 Intmd wnd repair

s/a/t/ext CH T 0134 3.2354 $226.53

. $45.31

12032 Intmd wnd repair

s/a/t/ext T 0134 3.2354 $226.53

. $45.31

12034 Intmd wnd repair

s/tr/ext CH T 0134 3.2354 $226.53

. $45.31

12035 Intmd wnd repair

s/a/t/ext CH T 0134 3.2354 $226.53

. $45.31

12036 Intmd wnd repair

s/a/t/ext T 0134 3.2354 $226.53

. $45.31

12037 Intmd wnd repair

s/tr/ext T 0134 3.2354 $226.53

. $45.31

12041 Intmd wnd repair

n-hf/genit T 0133 1.1922 $83.47 $23.34 $16.70

12042 Intmd wnd repair

n-hf/genit CH T 0134 3.2354 $226.53

. $45.31

12044 Intmd wnd repair

n-hf/genit CH T 0134 3.2354 $226.53

. $45.31

12045 Intmd wnd repair

n-hf/genit T 0134 3.2354 $226.53

. $45.3112046 Intmd wnd repair

n-hf/genit T 0134 3.2354 $226.53

. $45.31

12047 Intmd wnd repair

n-hf/genit T 0134 3.2354 $226.53

. $45.31

12051 Intmd wnd repair

face/mm T 0134 3.2354 $226.53

. $45.31

12052 Intmd wnd repair

face/mm CH T 0134 3.2354 $226.53

. $45.31

12053 Intmd wnd repair

face/mm CH T 0134 3.2354 $226.53

. $45.31

12054 Intmd wnd repair

face/mm T 0133 1.1922 $83.47 $23.34 $16.70

12055 Intmd wnd repair

face/mm T 0134 3.2354 $226.53

. $45.31

12056 Intmd wnd repair

face/mm T 0134 3.2354 $226.53

. $45.31

12057 Intmd wnd repair

face/mm T 0134 3.2354 $226.53

. $45.31

13100 Repair of wound or

lesion T 0135 4.9271 $344.98

. $69.00

13101 Repair of wound or

lesion T 0135 4.9271 $344.98

. $69.00

13102 Repair wound/lesion

add-on CH T 0134 3.2354 $226.53

. $45.31

13120 Repair of wound or

lesion T 0134 3.2354 $226.53

. $45.31

13121 Repair of wound or

lesion T 0134 3.2354 $226.53

. $45.31

13122 Repair wound/lesion

add-on T 0133 1.1922 $83.47 $23.34 $16.70

13131 Repair of wound or

lesion T 0134 3.2354 $226.53

. $45.31

13132 Repair of wound orlesion T 0135 4.9271 $344.98

. $69.00

13133 Repair wound/lesion

add-on T 0134 3.2354 $226.53

. $45.31

13150 Repair of wound or

lesion T 0135 4.9271 $344.98

. $69.00

13151 Repair of wound or

lesion T 0135 4.9271 $344.98

. $69.00

13152 Repair of wound or

lesion T 0135 4.9271 $344.98

. $69.00

13153 Repair wound/lesion

add-on T 0134 3.2354 $226.53

. $45.31

13160 Late closure of

wound T 0137 21.4409 "$1,501.21"

. $300.25

14000 Skin tissue

rearrangement T 0136 16.7703 "$1,174.19"

. $234.84

14001 Skin tissue

rearrangement T 0136 16.7703 "$1,174.19"

. $234.84

14020 Skin tissue

rearrangement T 0136 16.7703 "$1,174.19"

. $234.84

14021 Skin tissue

rearrangement T 0136 16.7703 "$1,174.19"

. $234.84

14040 Skin tissue

rearrangement T 0136 16.7703 "$1,174.19"

. $234.84

14041 Skin tissue

rearrangement T 0136 16.7703 "$1,174.19"

. $234.84

14060 Skin tissue

rearrangement T 0136 16.7703 "$1,174.19"

. $234.84

14061 Skin tissue

rearrangement T 0136 16.7703 "$1,174.19"

. $234.84

14301 Skin tissue

rearrangement T 0137 21.4409 "$1,501.21"

. $300.25

14302 Skin tissue rearrange

add-on T 0137 21.4409 "$1,501.21"

. $300.2514350 Skin tissue

rearrangement T 0137 21.4409 "$1,501.21"

. $300.25

15002 Wound prep

trk/arm/leg T 0135 4.9271 $344.98

. $69.00

15003 Wound prep addl 100

cm T 0135 4.9271 $344.98

. $69.00

15004 Wound prep

f/n/hf/g CH T 0134 3.2354 $226.53

. $45.31

15005 Wnd prep f/n/hf/g addl

cm T 0135 4.9271 $344.98

. $69.00

15040 Harvest cultured skin

graft T 0134 3.2354 $226.53

. $45.31

15050 Skin pinch

graft CH T 0134 3.2354 $226.53

. $45.31

15100 Skin splt grft

trnk/arm/leg T 0137 21.4409 "$1,501.21"

. $300.25

15101 Skin splt grft t/a/l

add-on T 0137 21.4409 "$1,501.21"

. $300.25

15110 Epidrm autogrft

trnk/arm/leg T 0135 4.9271 $344.98

. $69.00

15111 Epidrm autogrft t/a/l

add-on T 0135 4.9271 $344.98

. $69.00

15115 Epidrm a-grft

face/nck/hf/g T 0135 4.9271 $344.98

. $69.00

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

addl CH T 0134 3.2354 $226.53

. $45.31

15120 Skn splt a-grft

fac/nck/hf/g T 0137 21.4409 "$1,501.21"

. $300.25

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

add T 0137 21.4409 "$1,501.21"

. $300.25

15130 Derm autograft

trnk/arm/leg T 0136 16.7703 "$1,174.19"

. $234.84

15131 Derm autograft t/a/ladd-on T 0136 16.7703 "$1,174.19"

. $234.84

15135 Derm autograft

face/nck/hf/g T 0136 16.7703 "$1,174.19"

. $234.84

15136 Derm autograft f/n/hf/g

add T 0136 16.7703 "$1,174.19"

. $234.84

15150 Cult skin grft

t/arm/leg CH T 0134 3.2354 $226.53

. $45.31

15151 Cult skin grft t/a/l

addl CH T 0134 3.2354 $226.53

. $45.31

15152 Cult skin graft t/a/l

+% CH T 0134 3.2354 $226.53

. $45.31

15155 Cult skin graft

f/n/hf/g CH T 0134 3.2354 $226.53

. $45.31

15156 Cult skin grft f/n/hfg

add CH T 0134 3.2354 $226.53

. $45.31

15157 Cult epiderm grft f/n/hfg

+% CH T 0134 3.2354 $226.53

. $45.31

15170 Acell graft

trunk/arms/legs CH D

15171 Acell graft t/arm/leg

add-on CH D

15175 Acellular graft

f/n/hf/g CH D

15176 Acell graft f/n/hf/g

add-on CH D

15200 Skin full graft

trunk T 0136 16.7703 "$1,174.19"

. $234.84

15201 Skin full graft trunk

add-on T 0136 16.7703 "$1,174.19"

. $234.84

15220 Skin full graft

sclp/arm/leg T 0136 16.7703 "$1,174.19"

. $234.84

15221 Skin full graft

add-on T 0135 4.9271 $344.98

. $69.00

15240 Skin full grft

face/genit/hf T 0136 16.7703 "$1,174.19"

. $234.8415241 Skin full graft

add-on CH T 0134 3.2354 $226.53

. $45.31

15260 Skin full graft een &

lips T 0136 16.7703 "$1,174.19"

. $234.84

15261 Skin full graft

add-on T 0136 16.7703 "$1,174.19"

. $234.84

15271 Skin sub graft

trnk/arm/leg NI T 0134 3.2354 $226.53

. $45.31

15272 Skin sub graft t/a/l

add-on NI T 0133 1.1922 $83.47 $23.34 $16.70

15273 Skin sub grft t/arm/lg

child NI T 0135 4.9271 $344.98

. $69.00

15274 Skn sub grft t/a/l child

add NI T 0134 3.2354 $226.53

. $45.31

15275 Skin sub graft

face/nk/hf/g NI T 0134 3.2354 $226.53

. $45.31

15276 Skin sub graft f/n/hf/g

addl NI T 0133 1.1922 $83.47 $23.34 $16.70

15277 Skn sub grft f/n/hf/g

child NI T 0135 4.9271 $344.98

. $69.00

15278 Skn sub grft f/n/hf/g ch

add NI T 0134 3.2354 $226.53

. $45.31

15300 Apply skinallogrft

t/arm/lg CH D

15301 Apply sknallogrft t/a/l

addl CH D

15320 Apply skin allogrft

f/n/hf/g CH D

15321 Aply sknallogrft f/n/hfg

add CH D

15330 Aply acell alogrft

t/arm/leg CH D

15331 Aply acell grft t/a/l

add-on CH D

15335 Apply acell graftf/n/hf/g CH D

15336 Aply acell grft f/n/hf/g

add CH D

15340 Apply cult skin

substitute CH D

15341 Apply cult skin sub

add-on CH D

15360 Apply cult derm sub

t/a/l CH D

15361 Aply cult derm sub t/a/l

add CH D

15365 Apply cult derm sub

f/n/hf/g CH D

15366 Apply cult derm f/hf/g

add CH D

15400 Apply skin xenograft

t/a/l CH D

15401 Apply skn xenogrft t/a/l

add CH D

15420 Apply skin xgraft

f/n/hf/g CH D

15421 Apply skn xgrft f/n/hf/g

add CH D

15430 Apply acellular

xenograft CH D

15431 Apply acellular xgraft

add CH D

15570 Form skin pedicle

flap T 0137 21.4409 "$1,501.21"

. $300.25

15572 Form skin pedicle

flap T 0137 21.4409 "$1,501.21"

. $300.25

15574 Form skin pedicle

flap T 0137 21.4409 "$1,501.21"

. $300.25

15576 Form skin pedicle

flap T 0137 21.4409 "$1,501.21"

. $300.25

15600 Skin

graft T 0137 21.4409 "$1,501.21"

. $300.25

15610 Skin

graft T 0137 21.4409 "$1,501.21"

. $300.2515620 Skin

graft T 0137 21.4409 "$1,501.21"

. $300.25

15630 Skin

graft T 0137 21.4409 "$1,501.21"

. $300.25

15650 Transfer skin pedicle

flap T 0137 21.4409 "$1,501.21"

. $300.25

15731 Forehead flap w/vasc

pedicle T 0137 21.4409 "$1,501.21"

. $300.25

15732 Muscle-skin graft

head/neck T 0137 21.4409 "$1,501.21"

. $300.25

15734 Muscle-skin graft

trunk T 0137 21.4409 "$1,501.21"

. $300.25

15736 Muscle-skin graft

arm T 0137 21.4409 "$1,501.21"

. $300.25

15738 Muscle-skin graft

leg T 0137 21.4409 "$1,501.21"

. $300.25

15740 Island pedicle flap

graft T 0136 16.7703 "$1,174.19"

. $234.84

15750 Neurovascular pedicle

graft T 0137 21.4409 "$1,501.21"

. $300.25

15756 Free myo/skin flap

microvasc C

15757 Free skin flap

microvasc C

15758 Free fascial flap

microvasc C

15760 Composite skin

graft T 0137 21.4409 "$1,501.21"

. $300.25

15770 Derma-fat-fascia

graft T 0137 21.4409 "$1,501.21"

. $300.25

15775 Hair transplant punch

grafts T 0133 1.1922 $83.47 $23.34 $16.70

15776 Hair transplant punch

grafts T 0133 1.1922 $83.47 $23.34 $16.7015777 Acellular derm matrix

implt NI T 0136 16.7703 "$1,174.19"

. $234.84

15780 Abrasion treatment of

skin T 0022 23.2636 "$1,628.82" $350.74 $325.77

15781 Abrasion treatment of

skin T 0019 4.3953 $307.74

. $61.55

15782 Abrasion treatment of

skin T 0019 4.3953 $307.74

. $61.55

15783 Abrasion treatment of

skin T 0016 2.7597 $193.22

. $38.65

15786 Abrasion lesion

single T 0013 0.8768 $61.39

. $12.28

15787 Abrasion lesions

add-on T 0013 0.8768 $61.39

. $12.28

15788 Chemical peel face

epiderm T 0013 0.8768 $61.39

. $12.28

15789 Chemical peel face

dermal T 0015 1.4966 $104.79

. $20.96

15792 Chemical peel

nonfacial T 0015 1.4966 $104.79

. $20.96

15793 Chemical peel

nonfacial T 0013 0.8768 $61.39

. $12.28

15819 Plastic surgery

neck T 0134 3.2354 $226.53

. $45.31

15820 Revision of lower

eyelid T 0137 21.4409 "$1,501.21"

. $300.25

15821 Revision of lower

eyelid T 0137 21.4409 "$1,501.21"

. $300.25

15822 Revision of upper

eyelid T 0137 21.4409 "$1,501.21"

. $300.25

15823 Revision of upper

eyelid T 0137 21.4409 "$1,501.21"

. $300.25

15824 Removal of forehead

wrinkles T 0137 21.4409 "$1,501.21"

. $300.2515825 Removal of neck

wrinkles T 0137 21.4409 "$1,501.21"

. $300.25

15826 Removal of brow

wrinkles T 0137 21.4409 "$1,501.21"

. $300.25

15828 Removal of face

wrinkles T 0137 21.4409 "$1,501.21"

. $300.25

15829 Removal of skin

wrinkles T 0137 21.4409 "$1,501.21"

. $300.25

15830 Exc skin

abd T 0022 23.2636 "$1,628.82" $350.74 $325.77

15832 Excise excessive skin

tissue T 0022 23.2636 "$1,628.82" $350.74 $325.77

15833 Excise excessive skin

tissue T 0022 23.2636 "$1,628.82" $350.74 $325.77

15834 Excise excessive skin

tissue T 0022 23.2636 "$1,628.82" $350.74 $325.77

15835 Excise excessive skin

tissue T 0022 23.2636 "$1,628.82" $350.74 $325.77

15836 Excise excessive skin

tissue T 0021 16.9957 "$1,189.97"

. $238.00

15837 Excise excessive skin

tissue T 0021 16.9957 "$1,189.97"

. $238.00

15838 Excise excessive skin

tissue T 0021 16.9957 "$1,189.97"

. $238.00

15839 Excise excessive skin

tissue T 0021 16.9957 "$1,189.97"

. $238.00

15840 Graft for face nerve

palsy T 0137 21.4409 "$1,501.21"

. $300.25

15841 Graft for face nerve

palsy T 0137 21.4409 "$1,501.21"

. $300.25

15842 Flap for face nerve

palsy T 0137 21.4409 "$1,501.21"

. $300.2515845 Skin and muscle repair

face T 0137 21.4409 "$1,501.21"

. $300.25

15847 Exc skin abd

add-on T 0022 23.2636 "$1,628.82" $350.74 $325.77

15850 Removal of

sutures T 0016 2.7597 $193.22

. $38.65

15851 Removal of

sutures T 0016 2.7597 $193.22

. $38.65

15852 Dressing change not for

burn X 0340 0.6499 $45.50

. $9.10

15860 Test for blood flow in

graft X 0340 0.6499 $45.50

. $9.10

15876 Suction assisted

lipectomy T 0137 21.4409 "$1,501.21"

. $300.25

15877 Suction assisted

lipectomy T 0137 21.4409 "$1,501.21"

. $300.25

15878 Suction assisted

lipectomy T 0137 21.4409 "$1,501.21"

. $300.25

15879 Suction assisted

lipectomy T 0137 21.4409 "$1,501.21"

. $300.25

15920 Removal of tail bone

ulcer T 0019 4.3953 $307.74

. $61.55

15922 Removal of tail bone

ulcer T 0137 21.4409 "$1,501.21"

. $300.25

15931 Remove sacrum pressure

sore T 0022 23.2636 "$1,628.82" $350.74 $325.77

15933 Remove sacrum pressure

sore T 0022 23.2636 "$1,628.82" $350.74 $325.77

15934 Remove sacrum pressure

sore T 0137 21.4409 "$1,501.21"

. $300.25

15935 Remove sacrum pressure

sore T 0137 21.4409 "$1,501.21"

. $300.25

15936 Remove sacrum pressure

sore T 0136 16.7703 "$1,174.19"

. $234.8415937 Remove sacrum pressure

sore T 0137 21.4409 "$1,501.21"

. $300.25

15940 Remove hip pressure

sore T 0022 23.2636 "$1,628.82" $350.74 $325.77

15941 Remove hip pressure

sore T 0022 23.2636 "$1,628.82" $350.74 $325.77

15944 Remove hip pressure

sore T 0137 21.4409 "$1,501.21"

. $300.25

15945 Remove hip pressure

sore T 0137 21.4409 "$1,501.21"

. $300.25

15946 Remove hip pressure

sore T 0137 21.4409 "$1,501.21"

. $300.25

15950 Remove thigh pressure

sore T 0022 23.2636 "$1,628.82" $350.74 $325.77

15951 Remove thigh pressure

sore T 0022 23.2636 "$1,628.82" $350.74 $325.77

15952 Remove thigh pressure

sore T 0136 16.7703 "$1,174.19"

. $234.84

15953 Remove thigh pressure

sore T 0136 16.7703 "$1,174.19"

. $234.84

15956 Remove thigh pressure

sore T 0136 16.7703 "$1,174.19"

. $234.84

15958 Remove thigh pressure

sore T 0136 16.7703 "$1,174.19"

. $234.84

15999 Removal of pressure

sore T 0019 4.3953 $307.74

. $61.55

16000 Initial treatment of

burn(s) T 0013 0.8768 $61.39

. $12.28

16020 Dress/debrid p-thick burn

s T 0015 1.4966 $104.79

. $20.96

16025 Dress/debrid p-thick burn

m T 0015 1.4966 $104.79

. $20.9616030 Dress/debrid p-thick burn

l T 0015 1.4966 $104.79

. $20.96

16035 Incision of burn scab

initi T 0015 1.4966 $104.79

. $20.96

16036 Escharotomy addl

incision C

17000 Destruct premalg

lesion T 0013 0.8768 $61.39

. $12.28

17003 Destruct premalg les

2-14 T 0012 0.3878 $27.15

. $5.43

17004 Destroy premal lesions

15/> T 0016 2.7597 $193.22

. $38.65

17106 Destruction of skin

lesions T 0016 2.7597 $193.22

. $38.65

17107 Destruction of skin

lesions T 0016 2.7597 $193.22

. $38.65

17108 Destruction of skin

lesions T 0016 2.7597 $193.22

. $38.65

17110 Destruct b9 lesion

1-14 T 0013 0.8768 $61.39

. $12.28

17111 Destruct lesion 15 or

more T 0015 1.4966 $104.79

. $20.96

17250 Chemical cautery

tissue T 0015 1.4966 $104.79

. $20.96

17260 Destruction of skin

lesions T 0015 1.4966 $104.79

. $20.96

17261 Destruction of skin

lesions T 0015 1.4966 $104.79

. $20.96

17262 Destruction of skin

lesions T 0015 1.4966 $104.79

. $20.96

17263 Destruction of skin

lesions T 0015 1.4966 $104.79

. $20.96

17264 Destruction of skin

lesions T 0015 1.4966 $104.79

. $20.9617266 Destruction of skin

lesions T 0016 2.7597 $193.22

. $38.65

17270 Destruction of skin

lesions T 0015 1.4966 $104.79

. $20.96

17271 Destruction of skin

lesions T 0015 1.4966 $104.79

. $20.96

17272 Destruction of skin

lesions T 0015 1.4966 $104.79

. $20.96

17273 Destruction of skin

lesions T 0016 2.7597 $193.22

. $38.65

17274 Destruction of skin

lesions T 0016 2.7597 $193.22

. $38.65

17276 Destruction of skin

lesions T 0016 2.7597 $193.22

. $38.65

17280 Destruction of skin

lesions T 0015 1.4966 $104.79

. $20.96

17281 Destruction of skin

lesions T 0016 2.7597 $193.22

. $38.65

17282 Destruction of skin

lesions T 0016 2.7597 $193.22

. $38.65

17283 Destruction of skin

lesions T 0016 2.7597 $193.22

. $38.65

17284 Destruction of skin

lesions T 0016 2.7597 $193.22

. $38.65

17286 Destruction of skin

lesions T 0016 2.7597 $193.22

. $38.65

17311 Mohs 1 stage

h/n/hf/g T 0694 5.0714 $355.08 $88.08 $71.02

17312 Mohs addl

stage T 0694 5.0714 $355.08 $88.08 $71.02

17313 Mohs 1 stage

t/a/l T 0694 5.0714 $355.08 $88.08 $71.02

17314 Mohs addl staget/a/l T 0694 5.0714 $355.08 $88.08 $71.02

17315 Mohs surg addl

block T 0694 5.0714 $355.08 $88.08 $71.02

17340 Cryotherapy of

skin T 0013 0.8768 $61.39

. $12.28

17360 Skin peel

therapy CH T 0015 1.4966 $104.79

. $20.96

17380 Hair removal by

electrolysis CH T 0015 1.4966 $104.79

. $20.96

17999 Skin tissue

procedure T 0012 0.3878 $27.15

. $5.43

19000 Drainage of breast

lesion T 0004 4.5721 $320.12

. $64.03

19001 Drain breast lesion

add-on T 0002 1.6118 $112.85

. $22.57

19020 Incision of breast

lesion T 0008 20.5510 "$1,438.90"

. $287.78

19030 Injection for breast

x-ray N

19100 Bx breast percut w/o

image T 0004 4.5721 $320.12

. $64.03

19101 Biopsy of breast

open T 0028 25.5066 "$1,785.87"

. $357.18

19102 Bx breast percut

w/image T 0005 8.1596 $571.30

. $114.26

19103 Bx breast percut

w/device T 0037 15.3535 "$1,074.99" $227.40 $215.00

19105 Cryosurg ablate fa

each T 0029 33.3398 "$2,334.32" $580.94 $466.87

19110 Nipple

exploration T 0028 25.5066 "$1,785.87"

. $357.18

19112 Excise breast duct

fistula T 0028 25.5066 "$1,785.87"

. $357.1819120 Removal of breast

lesion T 0028 25.5066 "$1,785.87"

. $357.18

19125 Excision breast

lesion T 0028 25.5066 "$1,785.87"

. $357.18

19126 Excision addl breast

lesion T 0028 25.5066 "$1,785.87"

. $357.18

19260 Removal of chest wall

lesion T 0021 16.9957 "$1,189.97"

. $238.00

19271 Revision of chest

wall C

19272 Extensive chest wall

surgery C

19290 Place needle wire

breast N

19291 Place needle wire

breast N

19295 Place breast clip

percut Q1 0340 0.6499 $45.50

. $9.10

19296 Place po breast cath for

rad T 0648 62.4125 "$4,369.87"

. $873.98

19297 Place breast cath for

rad T 0648 62.4125 "$4,369.87"

. $873.98

19298 Place breast rad

tube/caths T 0648 62.4125 "$4,369.87"

. $873.98

19300 Removal of breast

tissue T 0028 25.5066 "$1,785.87"

. $357.18

19301 Partical

mastectomy T 0028 25.5066 "$1,785.87"

. $357.18

19302 P-mastectomy w/ln

removal T 0030 45.0217 "$3,152.24" $747.07 $630.45

19303 Mast simple

complete T 0029 33.3398 "$2,334.32" $580.94 $466.87

19304 Mast

subq T 0029 33.3398 "$2,334.32" $580.94 $466.87

19305 Mast

radical C19306 Mast rad urban

type C

19307 Mast mod

rad T 0030 45.0217 "$3,152.24" $747.07 $630.45

19316 Suspension of

breast T 0029 33.3398 "$2,334.32" $580.94 $466.87

19318 Reduction of large

breast T 0030 45.0217 "$3,152.24" $747.07 $630.45

19324 Enlarge

breast T 0030 45.0217 "$3,152.24" $747.07 $630.45

19325 Enlarge breast with

implant T 0648 62.4125 "$4,369.87"

. $873.98

19328 Removal of breast

implant T 0029 33.3398 "$2,334.32" $580.94 $466.87

19330 Removal of implant

material T 0029 33.3398 "$2,334.32" $580.94 $466.87

19340 Immediate breast

prosthesis T 0030 45.0217 "$3,152.24" $747.07 $630.45

19342 Delayed breast

prosthesis T 0648 62.4125 "$4,369.87"

. $873.98

19350 Breast

reconstruction T 0028 25.5066 "$1,785.87"

. $357.18

19355 Correct inverted

nipple(s) T 0029 33.3398 "$2,334.32" $580.94 $466.87

19357 Breast

reconstruction T 0648 62.4125 "$4,369.87"

. $873.98

19361 Breast reconstr w/lat

flap C

19364 Breast

reconstruction C

19366 Breast

reconstruction T 0029 33.3398 "$2,334.32" $580.94 $466.87

19367 Breast

reconstruction C19368 Breast

reconstruction C

19369 Breast

reconstruction C

19370 Surgery of breast

capsule T 0029 33.3398 "$2,334.32" $580.94 $466.87

19371 Removal of breast

capsule T 0029 33.3398 "$2,334.32" $580.94 $466.87

19380 Revise breast

reconstruction T 0030 45.0217 "$3,152.24" $747.07 $630.45

19396 Design custom breast

implant T 0029 33.3398 "$2,334.32" $580.94 $466.87

19499 Breast surgery

procedure T 0028 25.5066 "$1,785.87"

. $357.18

20005 I&d abscess

subfascial T 0020 8.2918 $580.56

. $116.12

20100 Explore wound

neck T 0252 7.4614 $522.42 $104.55 $104.49

20101 Explore wound

chest T 0137 21.4409 "$1,501.21"

. $300.25

20102 Explore wound

abdomen T 0137 21.4409 "$1,501.21"

. $300.25

20103 Explore wound

extremity T 0007 12.8082 $896.78

. $179.36

20150 Excise epiphyseal

bar T 0051 47.5032 "$3,325.98"

. $665.20

20200 Muscle

biopsy T 0021 16.9957 "$1,189.97"

. $238.00

20205 Deep muscle

biopsy T 0021 16.9957 "$1,189.97"

. $238.00

20206 Needle biopsy

muscle T 0005 8.1596 $571.30

. $114.26

20220 Bone biopsytrocar/needle T 0020 8.2918 $580.56

. $116.12

20225 Bone biopsy

trocar/needle T 0021 16.9957 "$1,189.97"

. $238.00

20240 Bone biopsy

excisional T 0022 23.2636 "$1,628.82" $350.74 $325.77

20245 Bone biopsy

excisional T 0022 23.2636 "$1,628.82" $350.74 $325.77

20250 Open bone

biopsy CH T 0050 32.4461 "$2,271.75"

. $454.35

20251 Open bone

biopsy CH T 0050 32.4461 "$2,271.75"

. $454.35

20500 Injection of sinus

tract T 0252 7.4614 $522.42 $104.55 $104.49

20501 Inject sinus tract for

x-ray N

20520 Removal of foreign

body T 0019 4.3953 $307.74

. $61.55

20525 Removal of foreign

body T 0022 23.2636 "$1,628.82" $350.74 $325.77

20526 Ther injection carp

tunnel T 0204 2.6055 $182.43

. $36.49

20527 Inj dupuytren cord

w/enzyme NI T 0204 2.6055 $182.43

. $36.49

20550 Inj tendon

sheath/ligament T 0204 2.6055 $182.43

. $36.49

20551 Inj tendon

origin/insertion T 0204 2.6055 $182.43

. $36.49

20552 Inj trigger point 1/2

muscl T 0204 2.6055 $182.43

. $36.49

20553 Inject trigger points =/>

3 T 0204 2.6055 $182.43

. $36.49

20555 Place ndl musc/tis for

rt T 0050 32.4461 "$2,271.75"

. $454.3520600 Drain/inject

joint/bursa T 0204 2.6055 $182.43

. $36.49

20605 Drain/inject

joint/bursa T 0204 2.6055 $182.43

. $36.49

20610 Drain/inject

joint/bursa T 0204 2.6055 $182.43

. $36.49

20612 Aspirate/inj ganglion

cyst T 0204 2.6055 $182.43

. $36.49

20615 Treatment of bone

cyst T 0004 4.5721 $320.12

. $64.03

20650 Insert and remove bone

pin CH T 0050 32.4461 "$2,271.75"

. $454.35

20660 Apply rem fixation

device T 0138 5.0454 $353.26

. $70.66

20661 Application of head

brace C

20662 Application of pelvis

brace T 0049 22.0797 "$1,545.93"

. $309.19

20663 Application of thigh

brace CH T 0050 32.4461 "$2,271.75"

. $454.35

20664 Application of

halo C

20665 Removal of fixation

device X 0340 0.6499 $45.50

. $9.10

20670 Removal of support

implant T 0021 16.9957 "$1,189.97"

. $238.00

20680 Removal of support

implant T 0022 23.2636 "$1,628.82" $350.74 $325.77

20690 Apply bone fixation

device T 0050 32.4461 "$2,271.75"

. $454.35

20692 Apply bone fixation

device T 0050 32.4461 "$2,271.75"

. $454.35

20693 Adjust bone fixation

device CH T 0050 32.4461 "$2,271.75"

. $454.3520694 Remove bone fixation

device T 0049 22.0797 "$1,545.93"

. $309.19

20696 Comp multiplane ext

fixation T 0050 32.4461 "$2,271.75"

. $454.35

20697 Comp ext fixate strut

change T 0139 18.9489 "$1,326.73"

. $265.35

20802 Replantation arm

complete C

20805 Replant forearm

complete C

20808 Replantation hand

complete C

20816 Replantation digit

complete C

20822 Replantation digit

complete T 0054 28.8625 "$2,020.84"

. $404.17

20824 Replantation thumb

complete C

20827 Replantation thumb

complete C

20838 Replantation foot

complete C

20900 Removal of bone for

graft T 0050 32.4461 "$2,271.75"

. $454.35

20902 Removal of bone for

graft T 0050 32.4461 "$2,271.75"

. $454.35

20910 Remove cartilage for

graft T 0137 21.4409 "$1,501.21"

. $300.25

20912 Remove cartilage for

graft T 0137 21.4409 "$1,501.21"

. $300.25

20920 Removal of fascia for

graft T 0136 16.7703 "$1,174.19"

. $234.84

20922 Removal of fascia for

graft T 0136 16.7703 "$1,174.19"

. $234.84

20924 Removal of tendon for

graft T 0050 32.4461 "$2,271.75"

. $454.35

20926 Removal of tissue forgraft T 0135 4.9271 $344.98

. $69.00

20930 Sp bone algrft morsel

add-on CH N

20931 Sp bone algrft struct

add-on CH N

20936 Sp bone agrft local

add-on C

20937 Sp bone agrft morsel

add-on C

20938 Sp bone agrft struct

add-on C

20950 Fluid pressure

muscle T 0006 1.4209 $99.49

. $19.90

20955 Fibula bone graft

microvasc C

20956 Iliac bone graft

microvasc C

20957 Mt bone graft

microvasc C

20962 Other bone graft

microvasc C

20969 Bone/skin graft

microvasc C

20970 Bone/skin graft iliac

crest C

20972 Bone/skin graft

metatarsal T 0056 58.4586 "$4,093.04"

. $818.61

20973 Bone/skin graft great

toe T 0056 58.4586 "$4,093.04"

. $818.61

20974 Electrical bone

stimulation A

20975 Electrical bone

stimulation N

20979 Us bone

stimulation X 0340 0.6499 $45.50

. $9.10

20982 Ablate bone tumor(s)

perq T 0051 47.5032 "$3,325.98"

. $665.20

20985 Cptr-asst dir ms

px N20999 Musculoskeletal

surgery T 0049 22.0797 "$1,545.93"

. $309.19

21010 Incision of jaw

joint T 0254 24.8895 "$1,742.66"

. $348.54

21011 Exc face les sc < 2

cm T 0020 8.2918 $580.56

. $116.12

21012 Exc face les sbq 2

cm/> T 0020 8.2918 $580.56

. $116.12

21013 Exc face tum deep < 2

cm T 0020 8.2918 $580.56

. $116.12

21014 Exc face tum deep 2

cm/> T 0020 8.2918 $580.56

. $116.12

21015 Resect face tum < 2

cm T 0021 16.9957 "$1,189.97"

. $238.00

21016 Resect face tum 2

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

21025 Excision of bone lower

jaw T 0256 45.0377 "$3,153.36"

. $630.68

21026 Excision of facial

bone(s) T 0256 45.0377 "$3,153.36"

. $630.68

21029 Contour of face bone

lesion T 0256 45.0377 "$3,153.36"

. $630.68

21030 Excise max/zygoma b9

tumor T 0254 24.8895 "$1,742.66"

. $348.54

21031 Remove exostosis

mandible T 0254 24.8895 "$1,742.66"

. $348.54

21032 Remove exostosis

maxilla T 0254 24.8895 "$1,742.66"

. $348.54

21034 Excise max/zygoma mal

tumor T 0256 45.0377 "$3,153.36"

. $630.68

21040 Excise mandible

lesion T 0254 24.8895 "$1,742.66"

. $348.54

21044 Removal of jaw bonelesion T 0256 45.0377 "$3,153.36"

. $630.68

21045 Extensive jaw

surgery C

21046 Remove mandible cyst

complex T 0256 45.0377 "$3,153.36"

. $630.68

21047 Excise lwr jaw cyst

w/repair T 0256 45.0377 "$3,153.36"

. $630.68

21048 Remove maxilla cyst

complex T 0256 45.0377 "$3,153.36"

. $630.68

21049 Excis uppr jaw cyst

w/repair T 0256 45.0377 "$3,153.36"

. $630.68

21050 Removal of jaw

joint T 0256 45.0377 "$3,153.36"

. $630.68

21060 Remove jaw joint

cartilage T 0256 45.0377 "$3,153.36"

. $630.68

21070 Remove coronoid

process T 0256 45.0377 "$3,153.36"

. $630.68

21073 Mnpj of tmj

w/anesth T 0252 7.4614 $522.42 $104.55 $104.49

21076 Prepare face/oral

prosthesis T 0254 24.8895 "$1,742.66"

. $348.54

21077 Prepare face/oral

prosthesis T 0256 45.0377 "$3,153.36"

. $630.68

21079 Prepare face/oral

prosthesis T 0256 45.0377 "$3,153.36"

. $630.68

21080 Prepare face/oral

prosthesis T 0256 45.0377 "$3,153.36"

. $630.68

21081 Prepare face/oral

prosthesis T 0256 45.0377 "$3,153.36"

. $630.68

21082 Prepare face/oral

prosthesis T 0256 45.0377 "$3,153.36"

. $630.68

21083 Prepare face/oral

prosthesis T 0256 45.0377 "$3,153.36"

. $630.6821084 Prepare face/oral

prosthesis T 0256 45.0377 "$3,153.36"

. $630.68

21085 Prepare face/oral

prosthesis T 0253 16.8699 "$1,181.16" $279.20 $236.24

21086 Prepare face/oral

prosthesis T 0256 45.0377 "$3,153.36"

. $630.68

21087 Prepare face/oral

prosthesis T 0256 45.0377 "$3,153.36"

. $630.68

21088 Prepare face/oral

prosthesis T 0256 45.0377 "$3,153.36"

. $630.68

21089 Prepare face/oral

prosthesis T 0250 1.0709 $74.98 $24.12 $15.00

21100 Maxillofacial

fixation T 0256 45.0377 "$3,153.36"

. $630.68

21110 Interdental

fixation T 0252 7.4614 $522.42 $104.55 $104.49

21116 Injection jaw joint

x-ray N

21120 Reconstruction of

chin T 0254 24.8895 "$1,742.66"

. $348.54

21121 Reconstruction of

chin T 0254 24.8895 "$1,742.66"

. $348.54

21122 Reconstruction of

chin T 0254 24.8895 "$1,742.66"

. $348.54

21123 Reconstruction of

chin T 0254 24.8895 "$1,742.66"

. $348.54

21125 Augmentation lower jaw

bone T 0254 24.8895 "$1,742.66"

. $348.54

21127 Augmentation lower jaw

bone T 0256 45.0377 "$3,153.36"

. $630.68

21137 Reduction of

forehead T 0254 24.8895 "$1,742.66"

. $348.54

21138 Reduction of

forehead T 0256 45.0377 "$3,153.36"

. $630.6821139 Reduction of

forehead T 0256 45.0377 "$3,153.36"

. $630.68

21141 Reconstruct midface

lefort C

21142 Reconstruct midface

lefort C

21143 Reconstruct midface

lefort C

21145 Reconstruct midface

lefort C

21146 Reconstruct midface

lefort C

21147 Reconstruct midface

lefort C

21150 Reconstruct midface

lefort T 0256 45.0377 "$3,153.36"

. $630.68

21151 Reconstruct midface

lefort C

21154 Reconstruct midface

lefort C

21155 Reconstruct midface

lefort C

21159 Reconstruct midface

lefort C

21160 Reconstruct midface

lefort C

21172 Reconstruct

orbit/forehead T 0256 45.0377 "$3,153.36"

. $630.68

21175 Reconstruct

orbit/forehead T 0256 45.0377 "$3,153.36"

. $630.68

21179 Reconstruct entire

forehead C

21180 Reconstruct entire

forehead C

21181 Contour cranial bone

lesion T 0254 24.8895 "$1,742.66"

. $348.54

21182 Reconstruct cranial

bone C

21183 Reconstruct cranial

bone C21184 Reconstruct cranial

bone C

21188 Reconstruction of

midface C

21193 Reconst lwr jaw w/o

graft T 0256 45.0377 "$3,153.36"

. $630.68

21194 Reconst lwr jaw

w/graft C

21195 Reconst lwr jaw w/o

fixation T 0256 45.0377 "$3,153.36"

. $630.68

21196 Reconst lwr jaw

w/fixation C

21198 Reconstr lwr jaw

segment T 0256 45.0377 "$3,153.36"

. $630.68

21199 Reconstr lwr jaw

w/advance T 0256 45.0377 "$3,153.36"

. $630.68

21206 Reconstruct upper jaw

bone T 0256 45.0377 "$3,153.36"

. $630.68

21208 Augmentation of facial

bones T 0256 45.0377 "$3,153.36"

. $630.68

21209 Reduction of facial

bones T 0256 45.0377 "$3,153.36"

. $630.68

21210 Face bone

graft T 0256 45.0377 "$3,153.36"

. $630.68

21215 Lower jaw bone

graft T 0256 45.0377 "$3,153.36"

. $630.68

21230 Rib cartilage

graft T 0256 45.0377 "$3,153.36"

. $630.68

21235 Ear cartilage

graft T 0254 24.8895 "$1,742.66"

. $348.54

21240 Reconstruction of jaw

joint T 0256 45.0377 "$3,153.36"

. $630.68

21242 Reconstruction of jaw

joint T 0256 45.0377 "$3,153.36"

. $630.68

21243 Reconstruction of jaw

joint T 0256 45.0377 "$3,153.36"

. $630.6821244 Reconstruction of lower

jaw T 0256 45.0377 "$3,153.36"

. $630.68

21245 Reconstruction of

jaw T 0256 45.0377 "$3,153.36"

. $630.68

21246 Reconstruction of

jaw T 0256 45.0377 "$3,153.36"

. $630.68

21247 Reconstruct lower jaw

bone C

21248 Reconstruction of

jaw T 0256 45.0377 "$3,153.36"

. $630.68

21249 Reconstruction of

jaw T 0256 45.0377 "$3,153.36"

. $630.68

21255 Reconstruct lower jaw

bone C

21256 Reconstruction of

orbit T 0256 45.0377 "$3,153.36"

. $630.68

21260 Revise eye

sockets T 0256 45.0377 "$3,153.36"

. $630.68

21261 Revise eye

sockets T 0256 45.0377 "$3,153.36"

. $630.68

21263 Revise eye

sockets T 0256 45.0377 "$3,153.36"

. $630.68

21267 Revise eye

sockets T 0256 45.0377 "$3,153.36"

. $630.68

21268 Revise eye

sockets C

21270 Augmentation cheek

bone T 0256 45.0377 "$3,153.36"

. $630.68

21275 Revision orbitofacial

bones T 0256 45.0377 "$3,153.36"

. $630.68

21280 Revision of

eyelid T 0256 45.0377 "$3,153.36"

. $630.68

21282 Revision of

eyelid T 0253 16.8699 "$1,181.16" $279.20 $236.2421295 Revision of jaw

muscle/bone T 0252 7.4614 $522.42 $104.55 $104.49

21296 Revision of jaw

muscle/bone T 0254 24.8895 "$1,742.66"

. $348.54

21299 Cranio/maxillofacial

surgery T 0250 1.0709 $74.98 $24.12 $15.00

21310 Treatment of nose

fracture T 0250 1.0709 $74.98 $24.12 $15.00

21315 Treatment of nose

fracture T 0253 16.8699 "$1,181.16" $279.20 $236.24

21320 Treatment of nose

fracture T 0253 16.8699 "$1,181.16" $279.20 $236.24

21325 Treatment of nose

fracture T 0254 24.8895 "$1,742.66"

. $348.54

21330 Treatment of nose

fracture T 0254 24.8895 "$1,742.66"

. $348.54

21335 Treatment of nose

fracture T 0254 24.8895 "$1,742.66"

. $348.54

21336 Treat nasal septal

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

21337 Treat nasal septal

fracture T 0253 16.8699 "$1,181.16" $279.20 $236.24

21338 Treat nasoethmoid

fracture T 0254 24.8895 "$1,742.66"

. $348.54

21339 Treat nasoethmoid

fracture T 0254 24.8895 "$1,742.66"

. $348.54

21340 Treatment of nose

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21343 Treatment of sinus

fracture C

21344 Treatment of sinus

fracture C

21345 Treat nose/jaw

fracture T 0254 24.8895 "$1,742.66"

. $348.5421346 Treat nose/jaw

fracture CH T 0254 24.8895 "$1,742.66"

. $348.54

21347 Treat nose/jaw

fracture C

21348 Treat nose/jaw

fracture C

21355 Treat cheek bone

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21356 Treat cheek bone

fracture T 0254 24.8895 "$1,742.66"

. $348.54

21360 Treat cheek bone

fracture T 0254 24.8895 "$1,742.66"

. $348.54

21365 Treat cheek bone

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21366 Treat cheek bone

fracture C

21385 Treat eye socket

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21386 Treat eye socket

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21387 Treat eye socket

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21390 Treat eye socket

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21395 Treat eye socket

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21400 Treat eye socket

fracture T 0252 7.4614 $522.42 $104.55 $104.49

21401 Treat eye socket

fracture T 0253 16.8699 "$1,181.16" $279.20 $236.24

21406 Treat eye socket

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21407 Treat eye socket

fracture T 0256 45.0377 "$3,153.36"

. $630.6821408 Treat eye socket

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21421 Treat mouth roof

fracture T 0254 24.8895 "$1,742.66"

. $348.54

21422 Treat mouth roof

fracture C

21423 Treat mouth roof

fracture C

21431 Treat craniofacial

fracture C

21432 Treat craniofacial

fracture C

21433 Treat craniofacial

fracture C

21435 Treat craniofacial

fracture C

21436 Treat craniofacial

fracture C

21440 Treat dental ridge

fracture T 0254 24.8895 "$1,742.66"

. $348.54

21445 Treat dental ridge

fracture T 0254 24.8895 "$1,742.66"

. $348.54

21450 Treat lower jaw

fracture T 0251 3.1150 $218.10

. $43.62

21451 Treat lower jaw

fracture T 0252 7.4614 $522.42 $104.55 $104.49

21452 Treat lower jaw

fracture T 0253 16.8699 "$1,181.16" $279.20 $236.24

21453 Treat lower jaw

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21454 Treat lower jaw

fracture T 0254 24.8895 "$1,742.66"

. $348.54

21461 Treat lower jaw

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21462 Treat lower jaw

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21465 Treat lower jawfracture T 0256 45.0377 "$3,153.36"

. $630.68

21470 Treat lower jaw

fracture T 0256 45.0377 "$3,153.36"

. $630.68

21480 Reset dislocated

jaw T 0250 1.0709 $74.98 $24.12 $15.00

21485 Reset dislocated

jaw T 0253 16.8699 "$1,181.16" $279.20 $236.24

21490 Repair dislocated

jaw T 0256 45.0377 "$3,153.36"

. $630.68

21495 Treat hyoid bone

fracture T 0253 16.8699 "$1,181.16" $279.20 $236.24

21497 Interdental

wiring T 0253 16.8699 "$1,181.16" $279.20 $236.24

21499 Head surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.00

21501 Drain neck/chest

lesion T 0008 20.5510 "$1,438.90"

. $287.78

21502 Drain chest

lesion T 0049 22.0797 "$1,545.93"

. $309.19

21510 Drainage of bone

lesion C

21550 Biopsy of

neck/chest T 0021 16.9957 "$1,189.97"

. $238.00

21552 Exc neck les sc 3

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

21554 Exc neck tum deep 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

21555 Exc neck les sc < 3

cm T 0021 16.9957 "$1,189.97"

. $238.00

21556 Exc neck tum deep < 5

cm T 0022 23.2636 "$1,628.82" $350.74 $325.77

21557 Resect neck tum < 5

cm T 0021 16.9957 "$1,189.97"

. $238.0021558 Resect neck tum 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

21600 Partial removal of

rib T 0050 32.4461 "$2,271.75"

. $454.35

21610 Partial removal of

rib T 0050 32.4461 "$2,271.75"

. $454.35

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 7.4614 $522.42 $104.55 $104.49

21700 Revision of neck

muscle T 0049 22.0797 "$1,545.93"

. $309.19

21705 Revision of neck

muscle/rib C

21720 Revision of neck

muscle T 0049 22.0797 "$1,545.93"

. $309.19

21725 Revision of neck

muscle T 0006 1.4209 $99.49

. $19.90

21740 Reconstruction of

sternum C

21742 Repair stern/nuss w/o

scope T 0051 47.5032 "$3,325.98"

. $665.20

21743 Repair sternum/nuss

w/scope T 0051 47.5032 "$3,325.98"

. $665.20

21750 Repair of sternum

separation C

21800 Treatment of rib

fracture T 0129 1.5020 $105.16

. $21.0421805 Treatment of rib

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

21810 Treatment of rib

fracture(s) C

21820 Treat sternum

fracture T 0129 1.5020 $105.16

. $21.04

21825 Treat sternum

fracture C

21899 Neck/chest surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.00

21920 Biopsy soft tissue of

back T 0020 8.2918 $580.56

. $116.12

21925 Biopsy soft tissue of

back T 0022 23.2636 "$1,628.82" $350.74 $325.77

21930 Exc back les sc < 3

cm T 0021 16.9957 "$1,189.97"

. $238.00

21931 Exc back les sc 3

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

21932 Exc back tum deep < 5

cm T 0021 16.9957 "$1,189.97"

. $238.00

21933 Exc back tum deep 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

21935 Resect back tum < 5

cm T 0021 16.9957 "$1,189.97"

. $238.00

21936 Resect back tum 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

22010 I&d p-spine

c/t/cerv-thor C

22015 I&d p-spine

l/s/ls C

22100 Remove part of neck

vertebra T 0208 50.7343 "$3,552.21"

. $710.45

22101 Remove part thorax

vertebra T 0208 50.7343 "$3,552.21"

. $710.4522102 Remove part lumbar

vertebra T 0208 50.7343 "$3,552.21"

. $710.45

22103 Remove extra spine

segment T 0208 50.7343 "$3,552.21"

. $710.45

22110 Remove part of neck

vertebra C

22112 Remove part thorax

vertebra C

22114 Remove part lumbar

vertebra C

22116 Remove extra spine

segment C

22206 Cut spine 3 col

thor C

22207 Cut spine 3 col

lumb C

22208 Cut spine 3 col addl

seg C

22210 Revision of neck

spine C

22212 Revision of thorax

spine C

22214 Revision of lumbar

spine C

22216 Revise extra spine

segment C

22220 Revision of neck

spine C

22222 Revision of thorax

spine T 0208 50.7343 "$3,552.21"

. $710.45

22224 Revision of lumbar

spine C

22226 Revise extra spine

segment C

22305 Treat spine process

fracture T 0129 1.5020 $105.16

. $21.04

22310 Treat spine

fracture T 0138 5.0454 $353.26

. $70.66

22315 Treat spine

fracture T 0139 18.9489 "$1,326.73"

. $265.3522318 Treat odontoid fx w/o

graft C

22319 Treat odontoid fx

w/graft C

22325 Treat spine

fracture C

22326 Treat neck spine

fracture C

22327 Treat thorax spine

fracture C

22328 Treat each add spine

fx C

22505 Manipulation of

spine T 0045 15.4596 "$1,082.42" $268.44 $216.49

22520 Percut vertebroplasty

thor T 0050 32.4461 "$2,271.75"

. $454.35

22521 Percut vertebroplasty

lumb T 0050 32.4461 "$2,271.75"

. $454.35

22522 Percut vertebroplasty

addl T 0050 32.4461 "$2,271.75"

. $454.35

22523 Percut kyphoplasty

thor T 0052 88.8483 "$6,220.80"

. "$1,244.16"

22524 Percut kyphoplasty

lumbar T 0052 88.8483 "$6,220.80"

. "$1,244.16"

22525 Percut kyphoplasty

add-on T 0052 88.8483 "$6,220.80"

. "$1,244.16"

22526 Idet single

level E

22527 Idet 1 or more

levels E

22532 Lat thorax spine

fusion C

22533 Lat lumbar spine

fusion C

22534 Lat thor/lumb addl

seg C

22548 Neck spine

fusion C22551 Neck spine fuse&remov bel

c2 NI T 0208 50.7343 "$3,552.21"

. $710.45

22552 Addl neck spine

fusion C

22554 Neck spine

fusion NI T 0208 50.7343 "$3,552.21"

. $710.45

22556 Thorax spine

fusion C

22558 Lumbar spine

fusion C

22585 Additional spinal

fusion C

22590 Spine & skull spinal

fusion C

22595 Neck spinal

fusion C

22600 Neck spine

fusion C

22610 Thorax spine

fusion C

22612 Lumbar spine

fusion T 0208 50.7343 "$3,552.21"

. $710.45

22614 Spine fusion extra

segment T 0208 50.7343 "$3,552.21"

. $710.45

22630 Lumbar spine

fusion C

22632 Spine fusion extra

segment C

22633 Lumbar spine fusion

combined NI C

22634 Spine fusion extra

segment NI 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 C22812 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

22851 Apply spine prosth

device CH T 0050 32.4461 "$2,271.75"

. $454.35

22852 Remove spine fixation

device C

22855 Remove spine fixation

device C

22856 Cerv artific

diskectomy C

22857 Lumbar artif

diskectomy C

22861 Revise cerv artific

disc C

22862 Revise lumbar artifdisc C

22864 Remove cerv artif

disc C

22865 Remove lumb artif

disc C

22899 Spine surgery

procedure CH T 0050 32.4461 "$2,271.75"

. $454.35

22900 Exc abdl tum deep < 5

cm T 0022 23.2636 "$1,628.82" $350.74 $325.77

22901 Exc abdl tum deep 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

22902 Exc abd les sc < 3

cm T 0021 16.9957 "$1,189.97"

. $238.00

22903 Exc abd les sc 3

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

22904 Resect abd tum < 5

cm T 0021 16.9957 "$1,189.97"

. $238.00

22905 Resect abd tum 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

22999 Abdomen surgery

procedure T 0049 22.0797 "$1,545.93"

. $309.19

23000 Removal of calcium

deposits T 0021 16.9957 "$1,189.97"

. $238.00

23020 Release shoulder

joint CH T 0050 32.4461 "$2,271.75"

. $454.35

23030 Drain shoulder

lesion T 0008 20.5510 "$1,438.90"

. $287.78

23031 Drain shoulder

bursa T 0008 20.5510 "$1,438.90"

. $287.78

23035 Drain shoulder bone

lesion T 0049 22.0797 "$1,545.93"

. $309.19

23040 Exploratory shoulder

surgery T 0050 32.4461 "$2,271.75"

. $454.35

23044 Exploratory shoulder

surgery T 0050 32.4461 "$2,271.75"

. $454.3523065 Biopsy shoulder

tissues T 0020 8.2918 $580.56

. $116.12

23066 Biopsy shoulder

tissues T 0022 23.2636 "$1,628.82" $350.74 $325.77

23071 Exc shoulder les sc 3

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

23073 Exc shoulder tum deep 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

23075 Exc shoulder les sc < 3

cm T 0021 16.9957 "$1,189.97"

. $238.00

23076 Exc shoulder tum deep < 5

cm T 0021 16.9957 "$1,189.97"

. $238.00

23077 Resect shoulder tum < 5

cm T 0021 16.9957 "$1,189.97"

. $238.00

23078 Resect shoulder tum 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

23100 Biopsy of shoulder

joint T 0049 22.0797 "$1,545.93"

. $309.19

23101 Shoulder joint

surgery T 0050 32.4461 "$2,271.75"

. $454.35

23105 Remove shoulder joint

lining T 0050 32.4461 "$2,271.75"

. $454.35

23106 Incision of collarbone

joint T 0050 32.4461 "$2,271.75"

. $454.35

23107 Explore treat shoulder

joint T 0050 32.4461 "$2,271.75"

. $454.35

23120 Partial removal collar

bone T 0050 32.4461 "$2,271.75"

. $454.35

23125 Removal of collar

bone T 0050 32.4461 "$2,271.75"

. $454.35

23130 Remove shoulder bone

part T 0051 47.5032 "$3,325.98"

. $665.2023140 Removal of bone

lesion T 0049 22.0797 "$1,545.93"

. $309.19

23145 Removal of bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

23146 Removal of bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

23150 Removal of humerus

lesion T 0050 32.4461 "$2,271.75"

. $454.35

23155 Removal of humerus

lesion T 0050 32.4461 "$2,271.75"

. $454.35

23156 Removal of humerus

lesion T 0050 32.4461 "$2,271.75"

. $454.35

23170 Remove collar bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

23172 Remove shoulder blade

lesion T 0050 32.4461 "$2,271.75"

. $454.35

23174 Remove humerus

lesion T 0050 32.4461 "$2,271.75"

. $454.35

23180 Remove collar bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

23182 Remove shoulder blade

lesion T 0050 32.4461 "$2,271.75"

. $454.35

23184 Remove humerus

lesion T 0050 32.4461 "$2,271.75"

. $454.35

23190 Partial removal of

scapula T 0050 32.4461 "$2,271.75"

. $454.35

23195 Removal of head of

humerus T 0050 32.4461 "$2,271.75"

. $454.35

23200 Resect clavicle

tumor C

23210 Resect scapula

tumor C

23220 Resect prox humerus

tumor C

23330 Remove shoulder foreignbody T 0020 8.2918 $580.56

. $116.12

23331 Remove shoulder foreign

body T 0022 23.2636 "$1,628.82" $350.74 $325.77

23332 Remove shoulder foreign

body C

23350 Injection for shoulder

x-ray N

23395 Muscle transfer

shoulder/arm T 0051 47.5032 "$3,325.98"

. $665.20

23397 Muscle

transfers T 0052 88.8483 "$6,220.80"

. "$1,244.16"

23400 Fixation of shoulder

blade T 0050 32.4461 "$2,271.75"

. $454.35

23405 Incision of tendon &

muscle T 0050 32.4461 "$2,271.75"

. $454.35

23406 Incise tendon(s) &

muscle(s) T 0050 32.4461 "$2,271.75"

. $454.35

23410 Repair rotator cuff

acute T 0051 47.5032 "$3,325.98"

. $665.20

23412 Repair rotator cuff

chronic T 0051 47.5032 "$3,325.98"

. $665.20

23415 Release of shoulder

ligament T 0051 47.5032 "$3,325.98"

. $665.20

23420 Repair of

shoulder T 0051 47.5032 "$3,325.98"

. $665.20

23430 Repair biceps

tendon T 0051 47.5032 "$3,325.98"

. $665.20

23440 Remove/transplant

tendon CH T 0050 32.4461 "$2,271.75"

. $454.35

23450 Repair shoulder

capsule T 0052 88.8483 "$6,220.80"

. "$1,244.16"

23455 Repair shoulder

capsule T 0052 88.8483 "$6,220.80"

. "$1,244.16"

23460 Repair shouldercapsule T 0052 88.8483 "$6,220.80"

. "$1,244.16"

23462 Repair shoulder

capsule T 0051 47.5032 "$3,325.98"

. $665.20

23465 Repair shoulder

capsule T 0052 88.8483 "$6,220.80"

. "$1,244.16"

23466 Repair shoulder

capsule T 0051 47.5032 "$3,325.98"

. $665.20

23470 Reconstruct shoulder

joint T 0425 132.5319 "$9,279.35"

. "$1,855.87"

23472 Reconstruct shoulder

joint C

23480 Revision of collar

bone T 0051 47.5032 "$3,325.98"

. $665.20

23485 Revision of collar

bone T 0052 88.8483 "$6,220.80"

. "$1,244.16"

23490 Reinforce

clavicle T 0052 88.8483 "$6,220.80"

. "$1,244.16"

23491 Reinforce shoulder

bones T 0052 88.8483 "$6,220.80"

. "$1,244.16"

23500 Treat clavicle

fracture T 0129 1.5020 $105.16

. $21.04

23505 Treat clavicle

fracture T 0139 18.9489 "$1,326.73"

. $265.35

23515 Treat clavicle

fracture T 0064 68.1203 "$4,769.51"

. $953.91

23520 Treat clavicle

dislocation T 0138 5.0454 $353.26

. $70.66

23525 Treat clavicle

dislocation T 0138 5.0454 $353.26

. $70.66

23530 Treat clavicle

dislocation T 0063 49.8979 "$3,493.65"

. $698.73

23532 Treat clavicle

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.7723540 Treat clavicle

dislocation T 0129 1.5020 $105.16

. $21.04

23545 Treat clavicle

dislocation T 0138 5.0454 $353.26

. $70.66

23550 Treat clavicle

dislocation T 0063 49.8979 "$3,493.65"

. $698.73

23552 Treat clavicle

dislocation T 0063 49.8979 "$3,493.65"

. $698.73

23570 Treat shoulder blade

fx T 0129 1.5020 $105.16

. $21.04

23575 Treat shoulder blade

fx T 0138 5.0454 $353.26

. $70.66

23585 Treat scapula

fracture T 0064 68.1203 "$4,769.51"

. $953.91

23600 Treat humerus

fracture T 0129 1.5020 $105.16

. $21.04

23605 Treat humerus

fracture T 0139 18.9489 "$1,326.73"

. $265.35

23615 Treat humerus

fracture T 0064 68.1203 "$4,769.51"

. $953.91

23616 Treat humerus

fracture T 0064 68.1203 "$4,769.51"

. $953.91

23620 Treat humerus

fracture T 0129 1.5020 $105.16

. $21.04

23625 Treat humerus

fracture T 0139 18.9489 "$1,326.73"

. $265.35

23630 Treat humerus

fracture T 0064 68.1203 "$4,769.51"

. $953.91

23650 Treat shoulder

dislocation T 0129 1.5020 $105.16

. $21.04

23655 Treat shoulder

dislocation T 0045 15.4596 "$1,082.42" $268.44 $216.49

23660 Treat shoulder

dislocation T 0063 49.8979 "$3,493.65"

. $698.7323665 Treat

dislocation/fracture T 0138 5.0454 $353.26

. $70.66

23670 Treat

dislocation/fracture T 0064 68.1203 "$4,769.51"

. $953.91

23675 Treat

dislocation/fracture T 0129 1.5020 $105.16

. $21.04

23680 Treat

dislocation/fracture T 0063 49.8979 "$3,493.65"

. $698.73

23700 Fixation of

shoulder T 0045 15.4596 "$1,082.42" $268.44 $216.49

23800 Fusion of shoulder

joint T 0052 88.8483 "$6,220.80"

. "$1,244.16"

23802 Fusion of shoulder

joint T 0052 88.8483 "$6,220.80"

. "$1,244.16"

23900 Amputation of arm &

girdle C

23920 Amputation at shoulder

joint C

23921 Amputation follow-up

surgery T 0136 16.7703 "$1,174.19"

. $234.84

23929 Shoulder surgery

procedure T 0129 1.5020 $105.16

. $21.04

23930 Drainage of arm

lesion T 0008 20.5510 "$1,438.90"

. $287.78

23931 Drainage of arm

bursa T 0008 20.5510 "$1,438.90"

. $287.78

23935 Drain arm/elbow bone

lesion T 0049 22.0797 "$1,545.93"

. $309.19

24000 Exploratory elbow

surgery T 0050 32.4461 "$2,271.75"

. $454.35

24006 Release elbow

joint T 0050 32.4461 "$2,271.75"

. $454.35

24065 Biopsy arm/elbow soft

tissue T 0021 16.9957 "$1,189.97"

. $238.0024066 Biopsy arm/elbow soft

tissue T 0021 16.9957 "$1,189.97"

. $238.00

24071 Exc arm/elbow les sc 3

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

24073 Ex arm/elbow tum deep 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

24075 Exc arm/elbow les sc < 3

cm T 0021 16.9957 "$1,189.97"

. $238.00

24076 Ex arm/elbow tum deep < 5

cm T 0021 16.9957 "$1,189.97"

. $238.00

24077 Resect arm/elbow tum < 5

cm T 0021 16.9957 "$1,189.97"

. $238.00

24079 Resect arm/elbow tum 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

24100 Biopsy elbow joint

lining T 0049 22.0797 "$1,545.93"

. $309.19

24101 Explore/treat elbow

joint T 0050 32.4461 "$2,271.75"

. $454.35

24102 Remove elbow joint

lining T 0050 32.4461 "$2,271.75"

. $454.35

24105 Removal of elbow

bursa T 0049 22.0797 "$1,545.93"

. $309.19

24110 Remove humerus

lesion T 0049 22.0797 "$1,545.93"

. $309.19

24115 Remove/graft bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

24116 Remove/graft bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

24120 Remove elbow

lesion T 0049 22.0797 "$1,545.93"

. $309.19

24125 Remove/graft bone

lesion T 0050 32.4461 "$2,271.75"

. $454.3524126 Remove/graft bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

24130 Removal of head of

radius T 0050 32.4461 "$2,271.75"

. $454.35

24134 Removal of arm bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

24136 Remove radius bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

24138 Remove elbow bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

24140 Partial removal of arm

bone T 0050 32.4461 "$2,271.75"

. $454.35

24145 Partial removal of

radius T 0050 32.4461 "$2,271.75"

. $454.35

24147 Partial removal of

elbow T 0050 32.4461 "$2,271.75"

. $454.35

24149 Radical resection of

elbow T 0050 32.4461 "$2,271.75"

. $454.35

24150 Resect distal humerus

tumor T 0051 47.5032 "$3,325.98"

. $665.20

24152 Resect radius

tumor T 0051 47.5032 "$3,325.98"

. $665.20

24155 Removal of elbow

joint CH T 0050 32.4461 "$2,271.75"

. $454.35

24160 Remove elbow joint

implant T 0050 32.4461 "$2,271.75"

. $454.35

24164 Remove radius head

implant T 0050 32.4461 "$2,271.75"

. $454.35

24200 Removal of arm foreign

body T 0019 4.3953 $307.74

. $61.55

24201 Removal of arm foreign

body T 0021 16.9957 "$1,189.97"

. $238.00

24220 Injection for elbow

x-ray N24300 Manipulate elbow

w/anesth T 0045 15.4596 "$1,082.42" $268.44 $216.49

24301 Muscle/tendon

transfer T 0050 32.4461 "$2,271.75"

. $454.35

24305 Arm tendon

lengthening T 0050 32.4461 "$2,271.75"

. $454.35

24310 Revision of arm

tendon T 0049 22.0797 "$1,545.93"

. $309.19

24320 Repair of arm

tendon CH T 0050 32.4461 "$2,271.75"

. $454.35

24330 Revision of arm

muscles T 0052 88.8483 "$6,220.80"

. "$1,244.16"

24331 Revision of arm

muscles T 0051 47.5032 "$3,325.98"

. $665.20

24332 Tenolysis

triceps CH T 0050 32.4461 "$2,271.75"

. $454.35

24340 Repair of biceps

tendon T 0051 47.5032 "$3,325.98"

. $665.20

24341 Repair arm

tendon/muscle T 0051 47.5032 "$3,325.98"

. $665.20

24342 Repair of ruptured

tendon T 0051 47.5032 "$3,325.98"

. $665.20

24343 Repr elbow lat ligmnt

w/tiss T 0050 32.4461 "$2,271.75"

. $454.35

24344 Reconstruct elbow lat

ligmnt T 0052 88.8483 "$6,220.80"

. "$1,244.16"

24345 Repr elbw med ligmnt

w/tissu T 0050 32.4461 "$2,271.75"

. $454.35

24346 Reconstruct elbow med

ligmnt T 0052 88.8483 "$6,220.80"

. "$1,244.16"

24357 Repair elbow

perc T 0050 32.4461 "$2,271.75"

. $454.35

24358 Repair elbow w/debopen T 0050 32.4461 "$2,271.75"

. $454.35

24359 Repair elbow deb/attch

open T 0050 32.4461 "$2,271.75"

. $454.35

24360 Reconstruct elbow

joint T 0047 41.2873 "$2,890.77"

. $578.16

24361 Reconstruct elbow

joint T 0425 132.5319 "$9,279.35"

. "$1,855.87"

24362 Reconstruct elbow

joint T 0048 60.9147 "$4,265.00"

. $853.00

24363 Replace elbow

joint T 0425 132.5319 "$9,279.35"

. "$1,855.87"

24365 Reconstruct head of

radius T 0047 41.2873 "$2,890.77"

. $578.16

24366 Reconstruct head of

radius T 0425 132.5319 "$9,279.35"

. "$1,855.87"

24400 Revision of

humerus T 0052 88.8483 "$6,220.80"

. "$1,244.16"

24410 Revision of

humerus T 0051 47.5032 "$3,325.98"

. $665.20

24420 Revision of

humerus T 0051 47.5032 "$3,325.98"

. $665.20

24430 Repair of

humerus T 0052 88.8483 "$6,220.80"

. "$1,244.16"

24435 Repair humerus with

graft T 0052 88.8483 "$6,220.80"

. "$1,244.16"

24470 Revision of elbow

joint T 0051 47.5032 "$3,325.98"

. $665.20

24495 Decompression of

forearm T 0050 32.4461 "$2,271.75"

. $454.35

24498 Reinforce

humerus T 0052 88.8483 "$6,220.80"

. "$1,244.16"

24500 Treat humerus

fracture T 0129 1.5020 $105.16

. $21.0424505 Treat humerus

fracture T 0129 1.5020 $105.16

. $21.04

24515 Treat humerus

fracture T 0064 68.1203 "$4,769.51"

. $953.91

24516 Treat humerus

fracture T 0064 68.1203 "$4,769.51"

. $953.91

24530 Treat humerus

fracture T 0129 1.5020 $105.16

. $21.04

24535 Treat humerus

fracture T 0138 5.0454 $353.26

. $70.66

24538 Treat humerus

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

24545 Treat humerus

fracture T 0064 68.1203 "$4,769.51"

. $953.91

24546 Treat humerus

fracture T 0064 68.1203 "$4,769.51"

. $953.91

24560 Treat humerus

fracture T 0129 1.5020 $105.16

. $21.04

24565 Treat humerus

fracture T 0129 1.5020 $105.16

. $21.04

24566 Treat humerus

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

24575 Treat humerus

fracture T 0064 68.1203 "$4,769.51"

. $953.91

24576 Treat humerus

fracture T 0129 1.5020 $105.16

. $21.04

24577 Treat humerus

fracture T 0129 1.5020 $105.16

. $21.04

24579 Treat humerus

fracture T 0064 68.1203 "$4,769.51"

. $953.91

24582 Treat humerus

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

24586 Treat elbowfracture T 0064 68.1203 "$4,769.51"

. $953.91

24587 Treat elbow

fracture T 0064 68.1203 "$4,769.51"

. $953.91

24600 Treat elbow

dislocation T 0129 1.5020 $105.16

. $21.04

24605 Treat elbow

dislocation T 0045 15.4596 "$1,082.42" $268.44 $216.49

24615 Treat elbow

dislocation T 0064 68.1203 "$4,769.51"

. $953.91

24620 Treat elbow

fracture T 0139 18.9489 "$1,326.73"

. $265.35

24635 Treat elbow

fracture T 0064 68.1203 "$4,769.51"

. $953.91

24640 Treat elbow

dislocation T 0129 1.5020 $105.16

. $21.04

24650 Treat radius

fracture T 0129 1.5020 $105.16

. $21.04

24655 Treat radius

fracture T 0138 5.0454 $353.26

. $70.66

24665 Treat radius

fracture T 0063 49.8979 "$3,493.65"

. $698.73

24666 Treat radius

fracture T 0064 68.1203 "$4,769.51"

. $953.91

24670 Treat ulnar

fracture T 0129 1.5020 $105.16

. $21.04

24675 Treat ulnar

fracture T 0129 1.5020 $105.16

. $21.04

24685 Treat ulnar

fracture T 0063 49.8979 "$3,493.65"

. $698.73

24800 Fusion of elbow

joint T 0051 47.5032 "$3,325.98"

. $665.20

24802 Fusion/graft of elbow

joint T 0052 88.8483 "$6,220.80"

. "$1,244.16"24900 Amputation of upper

arm C

24920 Amputation of upper

arm C

24925 Amputation follow-up

surgery T 0049 22.0797 "$1,545.93"

. $309.19

24930 Amputation follow-up

surgery C

24931 Amputate upper arm &

implant C

24935 Revision of

amputation T 0052 88.8483 "$6,220.80"

. "$1,244.16"

24940 Revision of upper

arm C

24999 Upper arm/elbow

surgery T 0129 1.5020 $105.16

. $21.04

25000 Incision of tendon

sheath T 0049 22.0797 "$1,545.93"

. $309.19

25001 Incise flexor carpi

radialis T 0049 22.0797 "$1,545.93"

. $309.19

25020 Decompress forearm 1

space T 0050 32.4461 "$2,271.75"

. $454.35

25023 Decompress forearm 1

space T 0050 32.4461 "$2,271.75"

. $454.35

25024 Decompress forearm 2

spaces T 0050 32.4461 "$2,271.75"

. $454.35

25025 Decompress forearm 2

spaces T 0050 32.4461 "$2,271.75"

. $454.35

25028 Drainage of forearm

lesion T 0049 22.0797 "$1,545.93"

. $309.19

25031 Drainage of forearm

bursa T 0049 22.0797 "$1,545.93"

. $309.19

25035 Treat forearm bone

lesion T 0049 22.0797 "$1,545.93"

. $309.19

25040 Explore/treat wrist

joint T 0050 32.4461 "$2,271.75"

. $454.3525065 Biopsy forearm soft

tissues T 0020 8.2918 $580.56

. $116.12

25066 Biopsy forearm soft

tissues T 0022 23.2636 "$1,628.82" $350.74 $325.77

25071 Exc forearm les sc 3

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

25073 Exc forearm tum deep 3

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

25075 Exc forearm les sc < 3

cm T 0021 16.9957 "$1,189.97"

. $238.00

25076 Exc forearm tum deep < 3

cm T 0021 16.9957 "$1,189.97"

. $238.00

25077 Resect forearm/wrist

tum<3cm T 0021 16.9957 "$1,189.97"

. $238.00

25078 Resect forarm/wrist tum

3cm> T 0022 23.2636 "$1,628.82" $350.74 $325.77

25085 Incision of wrist

capsule T 0049 22.0797 "$1,545.93"

. $309.19

25100 Biopsy of wrist

joint T 0049 22.0797 "$1,545.93"

. $309.19

25101 Explore/treat wrist

joint T 0050 32.4461 "$2,271.75"

. $454.35

25105 Remove wrist joint

lining T 0050 32.4461 "$2,271.75"

. $454.35

25107 Remove wrist joint

cartilage T 0050 32.4461 "$2,271.75"

. $454.35

25109 Excise tendon

forearm/wrist T 0049 22.0797 "$1,545.93"

. $309.19

25110 Remove wrist tendon

lesion T 0049 22.0797 "$1,545.93"

. $309.19

25111 Remove wrist tendon

lesion T 0049 22.0797 "$1,545.93"

. $309.1925112 Reremove wrist tendon

lesion T 0049 22.0797 "$1,545.93"

. $309.19

25115 Remove wrist/forearm

lesion T 0049 22.0797 "$1,545.93"

. $309.19

25116 Remove wrist/forearm

lesion T 0049 22.0797 "$1,545.93"

. $309.19

25118 Excise wrist tendon

sheath T 0050 32.4461 "$2,271.75"

. $454.35

25119 Partial removal of

ulna T 0050 32.4461 "$2,271.75"

. $454.35

25120 Removal of forearm

lesion T 0050 32.4461 "$2,271.75"

. $454.35

25125 Remove/graft forearm

lesion T 0050 32.4461 "$2,271.75"

. $454.35

25126 Remove/graft forearm

lesion T 0050 32.4461 "$2,271.75"

. $454.35

25130 Removal of wrist

lesion T 0050 32.4461 "$2,271.75"

. $454.35

25135 Remove & graft wrist

lesion T 0050 32.4461 "$2,271.75"

. $454.35

25136 Remove & graft wrist

lesion T 0050 32.4461 "$2,271.75"

. $454.35

25145 Remove forearm bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

25150 Partial removal of

ulna T 0050 32.4461 "$2,271.75"

. $454.35

25151 Partial removal of

radius T 0050 32.4461 "$2,271.75"

. $454.35

25170 Resect radius/ulnar

tumor CH T 0050 32.4461 "$2,271.75"

. $454.35

25210 Removal of wrist

bone T 0050 32.4461 "$2,271.75"

. $454.35

25215 Removal of wrist

bones T 0050 32.4461 "$2,271.75"

. $454.3525230 Partial removal of

radius T 0050 32.4461 "$2,271.75"

. $454.35

25240 Partial removal of

ulna T 0050 32.4461 "$2,271.75"

. $454.35

25246 Injection for wrist

x-ray N

25248 Remove forearm foreign

body T 0049 22.0797 "$1,545.93"

. $309.19

25250 Removal of wrist

prosthesis T 0050 32.4461 "$2,271.75"

. $454.35

25251 Removal of wrist

prosthesis T 0050 32.4461 "$2,271.75"

. $454.35

25259 Manipulate wrist

w/anesthes T 0139 18.9489 "$1,326.73"

. $265.35

25260 Repair forearm

tendon/muscle T 0050 32.4461 "$2,271.75"

. $454.35

25263 Repair forearm

tendon/muscle T 0050 32.4461 "$2,271.75"

. $454.35

25265 Repair forearm

tendon/muscle T 0050 32.4461 "$2,271.75"

. $454.35

25270 Repair forearm

tendon/muscle T 0050 32.4461 "$2,271.75"

. $454.35

25272 Repair forearm

tendon/muscle T 0050 32.4461 "$2,271.75"

. $454.35

25274 Repair forearm

tendon/muscle T 0050 32.4461 "$2,271.75"

. $454.35

25275 Repair forearm tendon

sheath T 0050 32.4461 "$2,271.75"

. $454.35

25280 Revise wrist/forearm

tendon T 0050 32.4461 "$2,271.75"

. $454.35

25290 Incise wrist/forearm

tendon T 0050 32.4461 "$2,271.75"

. $454.35

25295 Release wrist/forearmtendon T 0049 22.0797 "$1,545.93"

. $309.19

25300 Fusion of tendons at

wrist T 0050 32.4461 "$2,271.75"

. $454.35

25301 Fusion of tendons at

wrist T 0050 32.4461 "$2,271.75"

. $454.35

25310 Transplant forearm

tendon CH T 0050 32.4461 "$2,271.75"

. $454.35

25312 Transplant forearm

tendon T 0051 47.5032 "$3,325.98"

. $665.20

25315 Revise palsy hand

tendon(s) CH T 0050 32.4461 "$2,271.75"

. $454.35

25316 Revise palsy hand

tendon(s) T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25320 Repair/revise wrist

joint T 0051 47.5032 "$3,325.98"

. $665.20

25332 Revise wrist

joint T 0047 41.2873 "$2,890.77"

. $578.16

25335 Realignment of

hand T 0051 47.5032 "$3,325.98"

. $665.20

25337 Reconstruct

ulna/radioulnar T 0051 47.5032 "$3,325.98"

. $665.20

25350 Revision of

radius T 0051 47.5032 "$3,325.98"

. $665.20

25355 Revision of

radius T 0051 47.5032 "$3,325.98"

. $665.20

25360 Revision of

ulna T 0051 47.5032 "$3,325.98"

. $665.20

25365 Revise radius &

ulna T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25370 Revise radius or

ulna T 0051 47.5032 "$3,325.98"

. $665.20

25375 Revise radius &

ulna T 0051 47.5032 "$3,325.98"

. $665.2025390 Shorten radius or

ulna T 0051 47.5032 "$3,325.98"

. $665.20

25391 Lengthen radius or

ulna T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25392 Shorten radius &

ulna T 0050 32.4461 "$2,271.75"

. $454.35

25393 Lengthen radius &

ulna T 0051 47.5032 "$3,325.98"

. $665.20

25394 Repair carpal bone

shorten T 0051 47.5032 "$3,325.98"

. $665.20

25400 Repair radius or

ulna T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25405 Repair/graft radius or

ulna T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25415 Repair radius &

ulna T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25420 Repair/graft radius &

ulna T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25425 Repair/graft radius or

ulna T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25426 Repair/graft radius &

ulna T 0051 47.5032 "$3,325.98"

. $665.20

25430 Vasc graft into carpal

bone T 0051 47.5032 "$3,325.98"

. $665.20

25431 Repair nonunion carpal

bone T 0051 47.5032 "$3,325.98"

. $665.20

25440 Repair/graft wrist

bone T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25441 Reconstruct wrist

joint T 0425 132.5319 "$9,279.35"

. "$1,855.87"

25442 Reconstruct wrist

joint T 0425 132.5319 "$9,279.35"

. "$1,855.87"

25443 Reconstruct wristjoint T 0048 60.9147 "$4,265.00"

. $853.00

25444 Reconstruct wrist

joint T 0048 60.9147 "$4,265.00"

. $853.00

25445 Reconstruct wrist

joint T 0048 60.9147 "$4,265.00"

. $853.00

25446 Wrist

replacement T 0425 132.5319 "$9,279.35"

. "$1,855.87"

25447 Repair wrist

joints T 0047 41.2873 "$2,890.77"

. $578.16

25449 Remove wrist joint

implant T 0047 41.2873 "$2,890.77"

. $578.16

25450 Revision of wrist

joint T 0051 47.5032 "$3,325.98"

. $665.20

25455 Revision of wrist

joint T 0051 47.5032 "$3,325.98"

. $665.20

25490 Reinforce

radius T 0051 47.5032 "$3,325.98"

. $665.20

25491 Reinforce

ulna T 0051 47.5032 "$3,325.98"

. $665.20

25492 Reinforce radius and

ulna T 0051 47.5032 "$3,325.98"

. $665.20

25500 Treat fracture of

radius T 0129 1.5020 $105.16

. $21.04

25505 Treat fracture of

radius T 0138 5.0454 $353.26

. $70.66

25515 Treat fracture of

radius T 0063 49.8979 "$3,493.65"

. $698.73

25520 Treat fracture of

radius T 0138 5.0454 $353.26

. $70.66

25525 Treat fracture of

radius T 0063 49.8979 "$3,493.65"

. $698.73

25526 Treat fracture of

radius T 0063 49.8979 "$3,493.65"

. $698.7325530 Treat fracture of

ulna T 0129 1.5020 $105.16

. $21.04

25535 Treat fracture of

ulna T 0129 1.5020 $105.16

. $21.04

25545 Treat fracture of

ulna T 0063 49.8979 "$3,493.65"

. $698.73

25560 Treat fracture radius &

ulna T 0129 1.5020 $105.16

. $21.04

25565 Treat fracture radius &

ulna T 0138 5.0454 $353.26

. $70.66

25574 Treat fracture radius &

ulna T 0064 68.1203 "$4,769.51"

. $953.91

25575 Treat fracture

radius/ulna T 0064 68.1203 "$4,769.51"

. $953.91

25600 Treat fracture

radius/ulna T 0129 1.5020 $105.16

. $21.04

25605 Treat fracture

radius/ulna T 0138 5.0454 $353.26

. $70.66

25606 Treat fx distal

radial T 0062 26.1202 "$1,828.83" $372.85 $365.77

25607 Treat fx rad

extra-articul T 0064 68.1203 "$4,769.51"

. $953.91

25608 Treat fx rad

intra-articul T 0064 68.1203 "$4,769.51"

. $953.91

25609 Treat fx radial 3+

frag T 0064 68.1203 "$4,769.51"

. $953.91

25622 Treat wrist bone

fracture T 0129 1.5020 $105.16

. $21.04

25624 Treat wrist bone

fracture T 0138 5.0454 $353.26

. $70.66

25628 Treat wrist bone

fracture T 0063 49.8979 "$3,493.65"

. $698.73

25630 Treat wrist bonefracture T 0129 1.5020 $105.16

. $21.04

25635 Treat wrist bone

fracture T 0129 1.5020 $105.16

. $21.04

25645 Treat wrist bone

fracture T 0063 49.8979 "$3,493.65"

. $698.73

25650 Treat wrist bone

fracture T 0129 1.5020 $105.16

. $21.04

25651 Pin ulnar styloid

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

25652 Treat fracture ulnar

styloid T 0063 49.8979 "$3,493.65"

. $698.73

25660 Treat wrist

dislocation T 0129 1.5020 $105.16

. $21.04

25670 Treat wrist

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

25671 Pin radioulnar

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

25675 Treat wrist

dislocation T 0129 1.5020 $105.16

. $21.04

25676 Treat wrist

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

25680 Treat wrist

fracture T 0129 1.5020 $105.16

. $21.04

25685 Treat wrist

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

25690 Treat wrist

dislocation T 0139 18.9489 "$1,326.73"

. $265.35

25695 Treat wrist

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

25800 Fusion of wrist

joint T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25805 Fusion/graft of wrist

joint T 0052 88.8483 "$6,220.80"

. "$1,244.16"25810 Fusion/graft of wrist

joint T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25820 Fusion of hand

bones T 0051 47.5032 "$3,325.98"

. $665.20

25825 Fuse hand bones with

graft T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25830 Fusion radioulnar

jnt/ulna T 0052 88.8483 "$6,220.80"

. "$1,244.16"

25900 Amputation of

forearm C

25905 Amputation of

forearm C

25907 Amputation follow-up

surgery T 0049 22.0797 "$1,545.93"

. $309.19

25909 Amputation follow-up

surgery T 0049 22.0797 "$1,545.93"

. $309.19

25915 Amputation of

forearm C

25920 Amputate hand at

wrist C

25922 Amputate hand at

wrist T 0049 22.0797 "$1,545.93"

. $309.19

25924 Amputation follow-up

surgery C

25927 Amputation of

hand C

25929 Amputation follow-up

surgery T 0136 16.7703 "$1,174.19"

. $234.84

25931 Amputation follow-up

surgery T 0049 22.0797 "$1,545.93"

. $309.19

25999 Forearm or wrist

surgery T 0129 1.5020 $105.16

. $21.04

26010 Drainage of finger

abscess T 0006 1.4209 $99.49

. $19.90

26011 Drainage of finger

abscess T 0007 12.8082 $896.78

. $179.3626020 Drain hand tendon

sheath T 0053 17.1902 "$1,203.59" $253.49 $240.72

26025 Drainage of palm

bursa T 0053 17.1902 "$1,203.59" $253.49 $240.72

26030 Drainage of palm

bursas T 0053 17.1902 "$1,203.59" $253.49 $240.72

26034 Treat hand bone

lesion T 0053 17.1902 "$1,203.59" $253.49 $240.72

26035 Decompress

fingers/hand T 0053 17.1902 "$1,203.59" $253.49 $240.72

26037 Decompress

fingers/hand T 0053 17.1902 "$1,203.59" $253.49 $240.72

26040 Release palm

contracture T 0053 17.1902 "$1,203.59" $253.49 $240.72

26045 Release palm

contracture T 0054 28.8625 "$2,020.84"

. $404.17

26055 Incise finger tendon

sheath T 0053 17.1902 "$1,203.59" $253.49 $240.72

26060 Incision of finger

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.72

26070 Explore/treat hand

joint T 0053 17.1902 "$1,203.59" $253.49 $240.72

26075 Explore/treat finger

joint T 0053 17.1902 "$1,203.59" $253.49 $240.72

26080 Explore/treat finger

joint T 0053 17.1902 "$1,203.59" $253.49 $240.72

26100 Biopsy hand joint

lining T 0053 17.1902 "$1,203.59" $253.49 $240.72

26105 Biopsy finger joint

lining T 0053 17.1902 "$1,203.59" $253.49 $240.72

26110 Biopsy finger joint

lining T 0053 17.1902 "$1,203.59" $253.49 $240.72

26111 Exc hand les sc 1.5cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

26113 Exc hand tum deep 1.5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

26115 Exc hand les sc < 1.5

cm T 0021 16.9957 "$1,189.97"

. $238.00

26116 Exc hand tum deep < 1.5

cm T 0021 16.9957 "$1,189.97"

. $238.00

26117 Exc hand tum ra < 3

cm T 0021 16.9957 "$1,189.97"

. $238.00

26118 Exc hand tum ra 3

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

26121 Release palm

contracture T 0054 28.8625 "$2,020.84"

. $404.17

26123 Release palm

contracture T 0054 28.8625 "$2,020.84"

. $404.17

26125 Release palm

contracture T 0053 17.1902 "$1,203.59" $253.49 $240.72

26130 Remove wrist joint

lining T 0053 17.1902 "$1,203.59" $253.49 $240.72

26135 Revise finger joint

each T 0054 28.8625 "$2,020.84"

. $404.17

26140 Revise finger joint

each T 0053 17.1902 "$1,203.59" $253.49 $240.72

26145 Tendon excision

palm/finger T 0053 17.1902 "$1,203.59" $253.49 $240.72

26160 Remove tendon sheath

lesion T 0053 17.1902 "$1,203.59" $253.49 $240.72

26170 Removal of palm tendon

each T 0053 17.1902 "$1,203.59" $253.49 $240.72

26180 Removal of finger

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.72

26185 Remove finger

bone T 0053 17.1902 "$1,203.59" $253.49 $240.7226200 Remove hand bone

lesion T 0053 17.1902 "$1,203.59" $253.49 $240.72

26205 Remove/graft bone

lesion T 0054 28.8625 "$2,020.84"

. $404.17

26210 Removal of finger

lesion T 0053 17.1902 "$1,203.59" $253.49 $240.72

26215 Remove/graft finger

lesion T 0053 17.1902 "$1,203.59" $253.49 $240.72

26230 Partial removal of hand

bone T 0053 17.1902 "$1,203.59" $253.49 $240.72

26235 Partial removal finger

bone T 0053 17.1902 "$1,203.59" $253.49 $240.72

26236 Partial removal finger

bone T 0053 17.1902 "$1,203.59" $253.49 $240.72

26250 Extensive hand

surgery T 0053 17.1902 "$1,203.59" $253.49 $240.72

26260 Resect prox finger

tumor T 0053 17.1902 "$1,203.59" $253.49 $240.72

26262 Resect distal finger

tumor T 0053 17.1902 "$1,203.59" $253.49 $240.72

26320 Removal of implant from

hand T 0021 16.9957 "$1,189.97"

. $238.00

26340 Manipulate finger

w/anesth T 0138 5.0454 $353.26

. $70.66

26341 Manipulat palm cord post

inj NI T 0138 5.0454 $353.26

. $70.66

26350 Repair finger/hand

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26352 Repair/graft hand

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26356 Repair finger/hand

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26357 Repair finger/handtendon T 0054 28.8625 "$2,020.84"

. $404.17

26358 Repair/graft hand

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26370 Repair finger/hand

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26372 Repair/graft hand

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26373 Repair finger/hand

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26390 Revise hand/finger

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26392 Repair/graft hand

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26410 Repair hand

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.72

26412 Repair/graft hand

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26415 Excision hand/finger

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26416 Graft hand or finger

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26418 Repair finger

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.72

26420 Repair/graft finger

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26426 Repair finger/hand

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26428 Repair/graft finger

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26432 Repair finger

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.72

26433 Repair finger

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.7226434 Repair/graft finger

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26437 Realignment of

tendons T 0053 17.1902 "$1,203.59" $253.49 $240.72

26440 Release palm/finger

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.72

26442 Release palm & finger

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26445 Release hand/finger

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.72

26449 Release forearm/hand

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26450 Incision of palm

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.72

26455 Incision of finger

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.72

26460 Incise hand/finger

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.72

26471 Fusion of finger

tendons T 0053 17.1902 "$1,203.59" $253.49 $240.72

26474 Fusion of finger

tendons T 0053 17.1902 "$1,203.59" $253.49 $240.72

26476 Tendon

lengthening T 0053 17.1902 "$1,203.59" $253.49 $240.72

26477 Tendon

shortening T 0053 17.1902 "$1,203.59" $253.49 $240.72

26478 Lengthening of hand

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.72

26479 Shortening of hand

tendon T 0053 17.1902 "$1,203.59" $253.49 $240.72

26480 Transplant hand

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26483 Transplant/graft handtendon T 0054 28.8625 "$2,020.84"

. $404.17

26485 Transplant palm

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26489 Transplant/graft palm

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26490 Revise thumb

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26492 Tendon transfer with

graft T 0054 28.8625 "$2,020.84"

. $404.17

26494 Hand tendon/muscle

transfer T 0054 28.8625 "$2,020.84"

. $404.17

26496 Revise thumb

tendon T 0054 28.8625 "$2,020.84"

. $404.17

26497 Finger tendon

transfer T 0054 28.8625 "$2,020.84"

. $404.17

26498 Finger tendon

transfer T 0054 28.8625 "$2,020.84"

. $404.17

26499 Revision of

finger T 0054 28.8625 "$2,020.84"

. $404.17

26500 Hand tendon

reconstruction T 0053 17.1902 "$1,203.59" $253.49 $240.72

26502 Hand tendon

reconstruction T 0054 28.8625 "$2,020.84"

. $404.17

26508 Release thumb

contracture T 0053 17.1902 "$1,203.59" $253.49 $240.72

26510 Thumb tendon

transfer T 0054 28.8625 "$2,020.84"

. $404.17

26516 Fusion of knuckle

joint T 0054 28.8625 "$2,020.84"

. $404.17

26517 Fusion of knuckle

joints T 0054 28.8625 "$2,020.84"

. $404.17

26518 Fusion of knuckle

joints T 0054 28.8625 "$2,020.84"

. $404.1726520 Release knuckle

contracture T 0053 17.1902 "$1,203.59" $253.49 $240.72

26525 Release finger

contracture T 0053 17.1902 "$1,203.59" $253.49 $240.72

26530 Revise knuckle

joint T 0047 41.2873 "$2,890.77"

. $578.16

26531 Revise knuckle with

implant T 0048 60.9147 "$4,265.00"

. $853.00

26535 Revise finger

joint T 0047 41.2873 "$2,890.77"

. $578.16

26536 Revise/implant finger

joint T 0048 60.9147 "$4,265.00"

. $853.00

26540 Repair hand

joint T 0053 17.1902 "$1,203.59" $253.49 $240.72

26541 Repair hand joint with

graft T 0054 28.8625 "$2,020.84"

. $404.17

26542 Repair hand joint with

graft T 0053 17.1902 "$1,203.59" $253.49 $240.72

26545 Reconstruct finger

joint T 0054 28.8625 "$2,020.84"

. $404.17

26546 Repair nonunion

hand T 0054 28.8625 "$2,020.84"

. $404.17

26548 Reconstruct finger

joint T 0054 28.8625 "$2,020.84"

. $404.17

26550 Construct thumb

replacement T 0054 28.8625 "$2,020.84"

. $404.17

26551 Great toe-hand

transfer C

26553 Single transfer

toe-hand C

26554 Double transfer

toe-hand C

26555 Positional change of

finger T 0054 28.8625 "$2,020.84"

. $404.1726556 Toe joint

transfer C

26560 Repair of web

finger T 0053 17.1902 "$1,203.59" $253.49 $240.72

26561 Repair of web

finger T 0054 28.8625 "$2,020.84"

. $404.17

26562 Repair of web

finger T 0054 28.8625 "$2,020.84"

. $404.17

26565 Correct metacarpal

flaw T 0054 28.8625 "$2,020.84"

. $404.17

26567 Correct finger

deformity T 0054 28.8625 "$2,020.84"

. $404.17

26568 Lengthen

metacarpal/finger T 0054 28.8625 "$2,020.84"

. $404.17

26580 Repair hand

deformity T 0053 17.1902 "$1,203.59" $253.49 $240.72

26587 Reconstruct extra

finger T 0053 17.1902 "$1,203.59" $253.49 $240.72

26590 Repair finger

deformity T 0053 17.1902 "$1,203.59" $253.49 $240.72

26591 Repair muscles of

hand T 0054 28.8625 "$2,020.84"

. $404.17

26593 Release muscles of

hand T 0053 17.1902 "$1,203.59" $253.49 $240.72

26596 Excision constricting

tissue T 0053 17.1902 "$1,203.59" $253.49 $240.72

26600 Treat metacarpal

fracture T 0129 1.5020 $105.16

. $21.04

26605 Treat metacarpal

fracture T 0129 1.5020 $105.16

. $21.04

26607 Treat metacarpal

fracture T 0139 18.9489 "$1,326.73"

. $265.35

26608 Treat metacarpal

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.7726615 Treat metacarpal

fracture T 0063 49.8979 "$3,493.65"

. $698.73

26641 Treat thumb

dislocation T 0129 1.5020 $105.16

. $21.04

26645 Treat thumb

fracture T 0138 5.0454 $353.26

. $70.66

26650 Treat thumb

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

26665 Treat thumb

fracture T 0063 49.8979 "$3,493.65"

. $698.73

26670 Treat hand

dislocation T 0129 1.5020 $105.16

. $21.04

26675 Treat hand

dislocation T 0129 1.5020 $105.16

. $21.04

26676 Pin hand

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

26685 Treat hand

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

26686 Treat hand

dislocation T 0064 68.1203 "$4,769.51"

. $953.91

26700 Treat knuckle

dislocation T 0129 1.5020 $105.16

. $21.04

26705 Treat knuckle

dislocation T 0129 1.5020 $105.16

. $21.04

26706 Pin knuckle

dislocation T 0139 18.9489 "$1,326.73"

. $265.35

26715 Treat knuckle

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

26720 Treat finger fracture

each T 0129 1.5020 $105.16

. $21.04

26725 Treat finger fracture

each T 0129 1.5020 $105.16

. $21.04

26727 Treat finger fractureeach T 0062 26.1202 "$1,828.83" $372.85 $365.77

26735 Treat finger fracture

each T 0062 26.1202 "$1,828.83" $372.85 $365.77

26740 Treat finger fracture

each T 0129 1.5020 $105.16

. $21.04

26742 Treat finger fracture

each T 0129 1.5020 $105.16

. $21.04

26746 Treat finger fracture

each T 0062 26.1202 "$1,828.83" $372.85 $365.77

26750 Treat finger fracture

each T 0129 1.5020 $105.16

. $21.04

26755 Treat finger fracture

each T 0129 1.5020 $105.16

. $21.04

26756 Pin finger fracture

each T 0062 26.1202 "$1,828.83" $372.85 $365.77

26765 Treat finger fracture

each T 0062 26.1202 "$1,828.83" $372.85 $365.77

26770 Treat finger

dislocation T 0129 1.5020 $105.16

. $21.04

26775 Treat finger

dislocation T 0045 15.4596 "$1,082.42" $268.44 $216.49

26776 Pin finger

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

26785 Treat finger

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

26820 Thumb fusion with

graft T 0054 28.8625 "$2,020.84"

. $404.17

26841 Fusion of

thumb T 0054 28.8625 "$2,020.84"

. $404.17

26842 Thumb fusion with

graft T 0054 28.8625 "$2,020.84"

. $404.17

26843 Fusion of hand

joint T 0054 28.8625 "$2,020.84"

. $404.1726844 Fusion/graft of hand

joint T 0054 28.8625 "$2,020.84"

. $404.17

26850 Fusion of

knuckle T 0054 28.8625 "$2,020.84"

. $404.17

26852 Fusion of knuckle with

graft T 0054 28.8625 "$2,020.84"

. $404.17

26860 Fusion of finger

joint T 0054 28.8625 "$2,020.84"

. $404.17

26861 Fusion of finger jnt

add-on T 0054 28.8625 "$2,020.84"

. $404.17

26862 Fusion/graft of finger

joint T 0054 28.8625 "$2,020.84"

. $404.17

26863 Fuse/graft added

joint T 0054 28.8625 "$2,020.84"

. $404.17

26910 Amputate metacarpal

bone T 0054 28.8625 "$2,020.84"

. $404.17

26951 Amputation of

finger/thumb T 0053 17.1902 "$1,203.59" $253.49 $240.72

26952 Amputation of

finger/thumb T 0053 17.1902 "$1,203.59" $253.49 $240.72

26989 Hand/finger

surgery T 0129 1.5020 $105.16

. $21.04

26990 Drainage of pelvis

lesion T 0049 22.0797 "$1,545.93"

. $309.19

26991 Drainage of pelvis

bursa T 0049 22.0797 "$1,545.93"

. $309.19

26992 Drainage of bone

lesion C

27000 Incision of hip

tendon T 0049 22.0797 "$1,545.93"

. $309.19

27001 Incision of hip

tendon T 0050 32.4461 "$2,271.75"

. $454.35

27003 Incision of hip

tendon T 0050 32.4461 "$2,271.75"

. $454.3527005 Incision of hip

tendon C

27006 Incision of hip

tendons T 0050 32.4461 "$2,271.75"

. $454.35

27025 Incision of hip/thigh

fascia C

27027 Buttock

fasciotomy CH T 0050 32.4461 "$2,271.75"

. $454.35

27030 Drainage of hip

joint C

27033 Exploration of hip

joint T 0051 47.5032 "$3,325.98"

. $665.20

27035 Denervation of hip

joint CH T 0050 32.4461 "$2,271.75"

. $454.35

27036 Excision of hip

joint/muscle C

27040 Biopsy of soft

tissues T 0020 8.2918 $580.56

. $116.12

27041 Biopsy of soft

tissues T 0020 8.2918 $580.56

. $116.12

27043 Exc hip pelvis les sc 3

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

27045 Exc hip/pelv tum deep 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

27047 Exc hip/pelvis les sc < 3

cm T 0021 16.9957 "$1,189.97"

. $238.00

27048 Exc hip/pelv tum deep < 5

cm T 0021 16.9957 "$1,189.97"

. $238.00

27049 Resect hip/pelv tum < 5

cm T 0021 16.9957 "$1,189.97"

. $238.00

27050 Biopsy of sacroiliac

joint T 0049 22.0797 "$1,545.93"

. $309.19

27052 Biopsy of hip

joint T 0049 22.0797 "$1,545.93"

. $309.1927054 Removal of hip joint

lining C

27057 Buttock fasciotomy

w/dbrdmt T 0049 22.0797 "$1,545.93"

. $309.19

27059 Resect hip/pelv tum 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

27060 Removal of ischial

bursa T 0049 22.0797 "$1,545.93"

. $309.19

27062 Remove femur

lesion/bursa T 0049 22.0797 "$1,545.93"

. $309.19

27065 Remove hip bone les

super T 0049 22.0797 "$1,545.93"

. $309.19

27066 Remove hip bone les

deep T 0050 32.4461 "$2,271.75"

. $454.35

27067 Remove/graft hip bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

27070 Part remove hip bone

super C

27071 Part removal hip bone

deep C

27075 Resect hip

tumor C

27076 Resect hip tum incl

acetabul C

27077 Resect hip tum w/innom

bone C

27078 Rsect hip tum incl

femur C

27080 Removal of tail

bone T 0050 32.4461 "$2,271.75"

. $454.35

27086 Remove hip foreign

body T 0020 8.2918 $580.56

. $116.12

27087 Remove hip foreign

body T 0049 22.0797 "$1,545.93"

. $309.19

27090 Removal of hip

prosthesis C

27091 Removal of hipprosthesis C

27093 Injection for hip

x-ray N

27095 Injection for hip

x-ray N

27096 Inject sacroiliac

joint B

27097 Revision of hip

tendon T 0050 32.4461 "$2,271.75"

. $454.35

27098 Transfer tendon to

pelvis T 0050 32.4461 "$2,271.75"

. $454.35

27100 Transfer of abdominal

muscle T 0051 47.5032 "$3,325.98"

. $665.20

27105 Transfer of spinal

muscle T 0051 47.5032 "$3,325.98"

. $665.20

27110 Transfer of iliopsoas

muscle T 0051 47.5032 "$3,325.98"

. $665.20

27111 Transfer of iliopsoas

muscle T 0051 47.5032 "$3,325.98"

. $665.20

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 femurridge 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 T 0052 88.8483 "$6,220.80"

. "$1,244.16"

27181 Treat slipped

epiphysis C

27185 Revision of femur

epiphysis C

27187 Reinforce hip

bones C

27193 Treat pelvic ring

fracture T 0129 1.5020 $105.16

. $21.04

27194 Treat pelvic ring

fracture T 0045 15.4596 "$1,082.42" $268.44 $216.49

27200 Treat tail bone

fracture T 0129 1.5020 $105.16

. $21.04

27202 Treat tail bone

fracture T 0063 49.8979 "$3,493.65"

. $698.7327215 Treat pelvic

fracture(s) E

27216 Treat pelvic ring

fracture E

27217 Treat pelvic ring

fracture E

27218 Treat pelvic ring

fracture E

27220 Treat hip socket

fracture T 0129 1.5020 $105.16

. $21.04

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 0129 1.5020 $105.16

. $21.04

27232 Treat thigh

fracture C

27235 Treat thigh

fracture T 0050 32.4461 "$2,271.75"

. $454.35

27236 Treat thigh

fracture C

27238 Treat thigh

fracture T 0138 5.0454 $353.26

. $70.66

27240 Treat thigh

fracture C

27244 Treat thigh

fracture C

27245 Treat thigh

fracture C

27246 Treat thigh

fracture T 0138 5.0454 $353.26

. $70.66

27248 Treat thigh

fracture C27250 Treat hip

dislocation T 0129 1.5020 $105.16

. $21.04

27252 Treat hip

dislocation T 0045 15.4596 "$1,082.42" $268.44 $216.49

27253 Treat hip

dislocation C

27254 Treat hip

dislocation C

27256 Treat hip

dislocation T 0129 1.5020 $105.16

. $21.04

27257 Treat hip

dislocation T 0045 15.4596 "$1,082.42" $268.44 $216.49

27258 Treat hip

dislocation C

27259 Treat hip

dislocation C

27265 Treat hip

dislocation T 0129 1.5020 $105.16

. $21.04

27266 Treat hip

dislocation T 0045 15.4596 "$1,082.42" $268.44 $216.49

27267 Cltx thigh

fx T 0129 1.5020 $105.16

. $21.04

27268 Cltx thigh fx

w/mnpj C

27269 Optx thigh

fx C

27275 Manipulation of hip

joint T 0045 15.4596 "$1,082.42" $268.44 $216.49

27280 Fusion of sacroiliac

joint C

27282 Fusion of pubic

bones C

27284 Fusion of hip

joint C

27286 Fusion of hip

joint C27290 Amputation of leg at

hip C

27295 Amputation of leg at

hip C

27299 Pelvis/hip joint

surgery T 0129 1.5020 $105.16

. $21.04

27301 Drain thigh/knee

lesion T 0008 20.5510 "$1,438.90"

. $287.78

27303 Drainage of bone

lesion C

27305 Incise thigh tendon &

fascia T 0049 22.0797 "$1,545.93"

. $309.19

27306 Incision of thigh

tendon T 0049 22.0797 "$1,545.93"

. $309.19

27307 Incision of thigh

tendons CH T 0050 32.4461 "$2,271.75"

. $454.35

27310 Exploration of knee

joint T 0050 32.4461 "$2,271.75"

. $454.35

27323 Biopsy thigh soft

tissues T 0020 8.2918 $580.56

. $116.12

27324 Biopsy thigh soft

tissues T 0022 23.2636 "$1,628.82" $350.74 $325.77

27325 Neurectomy

hamstring T 0220 18.8921 "$1,322.75"

. $264.55

27326 Neurectomy

popliteal T 0220 18.8921 "$1,322.75"

. $264.55

27327 Exc thigh/knee les sc < 3

cm T 0022 23.2636 "$1,628.82" $350.74 $325.77

27328 Exc thigh/knee tum deep

<5cm T 0021 16.9957 "$1,189.97"

. $238.00

27329 Resect thigh/knee tum < 5

cm T 0021 16.9957 "$1,189.97"

. $238.00

27330 Biopsy knee joint

lining T 0050 32.4461 "$2,271.75"

. $454.35

27331 Explore/treat kneejoint T 0050 32.4461 "$2,271.75"

. $454.35

27332 Removal of knee

cartilage T 0050 32.4461 "$2,271.75"

. $454.35

27333 Removal of knee

cartilage T 0050 32.4461 "$2,271.75"

. $454.35

27334 Remove knee joint

lining T 0050 32.4461 "$2,271.75"

. $454.35

27335 Remove knee joint

lining T 0050 32.4461 "$2,271.75"

. $454.35

27337 Exc thigh/knee les sc 3

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

27339 Exc thigh/knee tum dep

5cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

27340 Removal of kneecap

bursa T 0049 22.0797 "$1,545.93"

. $309.19

27345 Removal of knee

cyst T 0049 22.0797 "$1,545.93"

. $309.19

27347 Remove knee

cyst T 0049 22.0797 "$1,545.93"

. $309.19

27350 Removal of

kneecap T 0050 32.4461 "$2,271.75"

. $454.35

27355 Remove femur

lesion T 0050 32.4461 "$2,271.75"

. $454.35

27356 Remove femur

lesion/graft T 0050 32.4461 "$2,271.75"

. $454.35

27357 Remove femur

lesion/graft T 0050 32.4461 "$2,271.75"

. $454.35

27358 Remove femur

lesion/fixation T 0050 32.4461 "$2,271.75"

. $454.35

27360 Partial removal leg

bone(s) T 0050 32.4461 "$2,271.75"

. $454.35

27364 Resect thigh/knee tum 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.7727365 Resect femur/knee

tumor C

27370 Injection for knee

x-ray N

27372 Removal of foreign

body T 0022 23.2636 "$1,628.82" $350.74 $325.77

27380 Repair of kneecap

tendon CH T 0050 32.4461 "$2,271.75"

. $454.35

27381 Repair/graft kneecap

tendon CH T 0050 32.4461 "$2,271.75"

. $454.35

27385 Repair of thigh

muscle CH T 0050 32.4461 "$2,271.75"

. $454.35

27386 Repair/graft of thigh

muscle CH T 0050 32.4461 "$2,271.75"

. $454.35

27390 Incision of thigh

tendon T 0049 22.0797 "$1,545.93"

. $309.19

27391 Incision of thigh

tendons T 0049 22.0797 "$1,545.93"

. $309.19

27392 Incision of thigh

tendons CH T 0050 32.4461 "$2,271.75"

. $454.35

27393 Lengthening of thigh

tendon T 0050 32.4461 "$2,271.75"

. $454.35

27394 Lengthening of thigh

tendons T 0050 32.4461 "$2,271.75"

. $454.35

27395 Lengthening of thigh

tendons T 0051 47.5032 "$3,325.98"

. $665.20

27396 Transplant of thigh

tendon T 0050 32.4461 "$2,271.75"

. $454.35

27397 Transplants of thigh

tendons T 0051 47.5032 "$3,325.98"

. $665.20

27400 Revise thigh

muscles/tendons T 0051 47.5032 "$3,325.98"

. $665.20

27403 Repair of knee

cartilage T 0050 32.4461 "$2,271.75"

. $454.3527405 Repair of knee

ligament T 0051 47.5032 "$3,325.98"

. $665.20

27407 Repair of knee

ligament T 0052 88.8483 "$6,220.80"

. "$1,244.16"

27409 Repair of knee

ligaments T 0052 88.8483 "$6,220.80"

. "$1,244.16"

27412 Autochondrocyte implant

knee T 0052 88.8483 "$6,220.80"

. "$1,244.16"

27415 Osteochondral knee

allograft T 0052 88.8483 "$6,220.80"

. "$1,244.16"

27416 Osteochondral knee

autograft T 0051 47.5032 "$3,325.98"

. $665.20

27418 Repair degenerated

kneecap T 0051 47.5032 "$3,325.98"

. $665.20

27420 Revision of unstable

kneecap T 0051 47.5032 "$3,325.98"

. $665.20

27422 Revision of unstable

kneecap T 0051 47.5032 "$3,325.98"

. $665.20

27424 Revision/removal of

kneecap T 0051 47.5032 "$3,325.98"

. $665.20

27425 Lat retinacular release

open T 0050 32.4461 "$2,271.75"

. $454.35

27427 Reconstruction

knee T 0052 88.8483 "$6,220.80"

. "$1,244.16"

27428 Reconstruction

knee T 0052 88.8483 "$6,220.80"

. "$1,244.16"

27429 Reconstruction

knee T 0052 88.8483 "$6,220.80"

. "$1,244.16"

27430 Revision of thigh

muscles T 0051 47.5032 "$3,325.98"

. $665.20

27435 Incision of knee

joint CH T 0050 32.4461 "$2,271.75"

. $454.35

27437 Revisekneecap T 0047 41.2873 "$2,890.77"

. $578.16

27438 Revise kneecap with

implant T 0048 60.9147 "$4,265.00"

. $853.00

27440 Revision of knee

joint T 0047 41.2873 "$2,890.77"

. $578.16

27441 Revision of knee

joint T 0047 41.2873 "$2,890.77"

. $578.16

27442 Revision of knee

joint T 0047 41.2873 "$2,890.77"

. $578.16

27443 Revision of knee

joint T 0047 41.2873 "$2,890.77"

. $578.16

27445 Revision of knee

joint C

27446 Revision of knee

joint T 0425 132.5319 "$9,279.35"

. "$1,855.87"

27447 Total knee

arthroplasty C

27448 Incision of

thigh C

27450 Incision of

thigh C

27454 Realignment of thigh

bone C

27455 Realignment of

knee C

27457 Realignment of

knee C

27465 Shortening of thigh

bone C

27466 Lengthening of thigh

bone C

27468 Shorten/lengthen

thighs C

27470 Repair of

thigh C

27472 Repair/graft of

thigh C

27475 Surgery to stop leg

growth T 0050 32.4461 "$2,271.75"

. $454.3527477 Surgery to stop leg

growth C

27479 Surgery to stop leg

growth T 0050 32.4461 "$2,271.75"

. $454.35

27485 Surgery to stop leg

growth C

27486 Revise/replace knee

joint C

27487 Revise/replace knee

joint C

27488 Removal of knee

prosthesis C

27495 Reinforce

thigh C

27496 Decompression of

thigh/knee T 0050 32.4461 "$2,271.75"

. $454.35

27497 Decompression of

thigh/knee T 0049 22.0797 "$1,545.93"

. $309.19

27498 Decompression of

thigh/knee T 0050 32.4461 "$2,271.75"

. $454.35

27499 Decompression of

thigh/knee T 0050 32.4461 "$2,271.75"

. $454.35

27500 Treatment of thigh

fracture T 0138 5.0454 $353.26

. $70.66

27501 Treatment of thigh

fracture T 0129 1.5020 $105.16

. $21.04

27502 Treatment of thigh

fracture T 0139 18.9489 "$1,326.73"

. $265.35

27503 Treatment of thigh

fracture T 0129 1.5020 $105.16

. $21.04

27506 Treatment of thigh

fracture C

27507 Treatment of thigh

fracture C

27508 Treatment of thigh

fracture T 0129 1.5020 $105.16

. $21.0427509 Treatment of thigh

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

27510 Treatment of thigh

fracture T 0138 5.0454 $353.26

. $70.66

27511 Treatment of thigh

fracture C

27513 Treatment of thigh

fracture C

27514 Treatment of thigh

fracture C

27516 Treat thigh fx growth

plate T 0129 1.5020 $105.16

. $21.04

27517 Treat thigh fx growth

plate T 0129 1.5020 $105.16

. $21.04

27519 Treat thigh fx growth

plate C

27520 Treat kneecap

fracture T 0129 1.5020 $105.16

. $21.04

27524 Treat kneecap

fracture T 0063 49.8979 "$3,493.65"

. $698.73

27530 Treat knee

fracture T 0129 1.5020 $105.16

. $21.04

27532 Treat knee

fracture T 0139 18.9489 "$1,326.73"

. $265.35

27535 Treat knee

fracture C

27536 Treat knee

fracture C

27538 Treat knee

fracture(s) T 0129 1.5020 $105.16

. $21.04

27540 Treat knee

fracture C

27550 Treat knee

dislocation T 0129 1.5020 $105.16

. $21.04

27552 Treat knee

dislocation T 0045 15.4596 "$1,082.42" $268.44 $216.49

27556 Treat kneedislocation C

27557 Treat knee

dislocation C

27558 Treat knee

dislocation C

27560 Treat kneecap

dislocation T 0129 1.5020 $105.16

. $21.04

27562 Treat kneecap

dislocation T 0045 15.4596 "$1,082.42" $268.44 $216.49

27566 Treat kneecap

dislocation T 0063 49.8979 "$3,493.65"

. $698.73

27570 Fixation of knee

joint T 0045 15.4596 "$1,082.42" $268.44 $216.49

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

surgery T 0049 22.0797 "$1,545.93"

. $309.19

27596 Amputation follow-up

surgery C

27598 Amputate lower leg at

knee C

27599 Leg surgery

procedure T 0129 1.5020 $105.16

. $21.04

27600 Decompression of lower

leg T 0049 22.0797 "$1,545.93"

. $309.19

27601 Decompression of lower

leg T 0049 22.0797 "$1,545.93"

. $309.19

27602 Decompression of lower

leg CH T 0050 32.4461 "$2,271.75"

. $454.35

27603 Drain lower leglesion T 0008 20.5510 "$1,438.90"

. $287.78

27604 Drain lower leg

bursa CH T 0050 32.4461 "$2,271.75"

. $454.35

27605 Incision of achilles

tendon T 0055 22.0963 "$1,547.09" $353.25 $309.42

27606 Incision of achilles

tendon T 0049 22.0797 "$1,545.93"

. $309.19

27607 Treat lower leg bone

lesion T 0049 22.0797 "$1,545.93"

. $309.19

27610 Explore/treat ankle

joint T 0050 32.4461 "$2,271.75"

. $454.35

27612 Exploration of ankle

joint T 0050 32.4461 "$2,271.75"

. $454.35

27613 Biopsy lower leg soft

tissue T 0020 8.2918 $580.56

. $116.12

27614 Biopsy lower leg soft

tissue T 0022 23.2636 "$1,628.82" $350.74 $325.77

27615 Resect leg/ankle tum < 5

cm T 0021 16.9957 "$1,189.97"

. $238.00

27616 Resect leg/ankle tum 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

27618 Exc leg/ankle tum < 3

cm T 0021 16.9957 "$1,189.97"

. $238.00

27619 Exc leg/ankle tum deep <5

cm T 0021 16.9957 "$1,189.97"

. $238.00

27620 Explore/treat ankle

joint T 0050 32.4461 "$2,271.75"

. $454.35

27625 Remove ankle joint

lining T 0050 32.4461 "$2,271.75"

. $454.35

27626 Remove ankle joint

lining T 0050 32.4461 "$2,271.75"

. $454.35

27630 Removal of tendon

lesion T 0049 22.0797 "$1,545.93"

. $309.1927632 Exc leg/ankle les sc 3

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

27634 Exc leg/ankle tum dep 5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

27635 Remove lower leg bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

27637 Remove/graft leg bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

27638 Remove/graft leg bone

lesion T 0050 32.4461 "$2,271.75"

. $454.35

27640 Partial removal of

tibia CH T 0050 32.4461 "$2,271.75"

. $454.35

27641 Partial removal of

fibula T 0050 32.4461 "$2,271.75"

. $454.35

27645 Resect tibia

tumor C

27646 Resect fibula

tumor C

27647 Resect talus/calcaneus

tum CH T 0050 32.4461 "$2,271.75"

. $454.35

27648 Injection for ankle

x-ray N

27650 Repair achilles

tendon T 0051 47.5032 "$3,325.98"

. $665.20

27652 Repair/graft achilles

tendon T 0052 88.8483 "$6,220.80"

. "$1,244.16"

27654 Repair of achilles

tendon T 0051 47.5032 "$3,325.98"

. $665.20

27656 Repair leg fascia

defect T 0049 22.0797 "$1,545.93"

. $309.19

27658 Repair of leg tendon

each T 0049 22.0797 "$1,545.93"

. $309.19

27659 Repair of leg tendon

each T 0049 22.0797 "$1,545.93"

. $309.1927664 Repair of leg tendon

each T 0050 32.4461 "$2,271.75"

. $454.35

27665 Repair of leg tendon

each T 0050 32.4461 "$2,271.75"

. $454.35

27675 Repair lower leg

tendons T 0049 22.0797 "$1,545.93"

. $309.19

27676 Repair lower leg

tendons T 0050 32.4461 "$2,271.75"

. $454.35

27680 Release of lower leg

tendon T 0050 32.4461 "$2,271.75"

. $454.35

27681 Release of lower leg

tendons T 0050 32.4461 "$2,271.75"

. $454.35

27685 Revision of lower leg

tendon T 0050 32.4461 "$2,271.75"

. $454.35

27686 Revise lower leg

tendons T 0050 32.4461 "$2,271.75"

. $454.35

27687 Revision of calf

tendon T 0050 32.4461 "$2,271.75"

. $454.35

27690 Revise lower leg

tendon T 0051 47.5032 "$3,325.98"

. $665.20

27691 Revise lower leg

tendon T 0051 47.5032 "$3,325.98"

. $665.20

27692 Revise additional leg

tendon T 0051 47.5032 "$3,325.98"

. $665.20

27695 Repair of ankle

ligament T 0050 32.4461 "$2,271.75"

. $454.35

27696 Repair of ankle

ligaments T 0050 32.4461 "$2,271.75"

. $454.35

27698 Repair of ankle

ligament T 0050 32.4461 "$2,271.75"

. $454.35

27700 Revision of ankle

joint T 0047 41.2873 "$2,890.77"

. $578.16

27702 Reconstruct ankle

joint C27703 Reconstruction ankle

joint C

27704 Removal of ankle

implant T 0049 22.0797 "$1,545.93"

. $309.19

27705 Incision of

tibia T 0051 47.5032 "$3,325.98"

. $665.20

27707 Incision of

fibula CH T 0050 32.4461 "$2,271.75"

. $454.35

27709 Incision of tibia &

fibula T 0050 32.4461 "$2,271.75"

. $454.35

27712 Realignment of lower

leg C

27715 Revision of lower

leg C

27720 Repair of

tibia T 0063 49.8979 "$3,493.65"

. $698.73

27722 Repair/graft of

tibia T 0064 68.1203 "$4,769.51"

. $953.91

27724 Repair/graft of

tibia C

27725 Repair of lower

leg C

27726 Repair fibula

nonunion T 0063 49.8979 "$3,493.65"

. $698.73

27727 Repair of lower

leg C

27730 Repair of tibia

epiphysis T 0050 32.4461 "$2,271.75"

. $454.35

27732 Repair of fibula

epiphysis T 0050 32.4461 "$2,271.75"

. $454.35

27734 Repair lower leg

epiphyses T 0050 32.4461 "$2,271.75"

. $454.35

27740 Repair of leg

epiphyses T 0050 32.4461 "$2,271.75"

. $454.35

27742 Repair of leg

epiphyses T 0051 47.5032 "$3,325.98"

. $665.2027745 Reinforce

tibia T 0052 88.8483 "$6,220.80"

. "$1,244.16"

27750 Treatment of tibia

fracture T 0129 1.5020 $105.16

. $21.04

27752 Treatment of tibia

fracture T 0139 18.9489 "$1,326.73"

. $265.35

27756 Treatment of tibia

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

27758 Treatment of tibia

fracture T 0063 49.8979 "$3,493.65"

. $698.73

27759 Treatment of tibia

fracture T 0064 68.1203 "$4,769.51"

. $953.91

27760 Cltx medial ankle

fx T 0129 1.5020 $105.16

. $21.04

27762 Cltx med ankle fx

w/mnpj T 0139 18.9489 "$1,326.73"

. $265.35

27766 Optx medial ankle

fx T 0063 49.8979 "$3,493.65"

. $698.73

27767 Cltx post ankle

fx T 0129 1.5020 $105.16

. $21.04

27768 Cltx post ankle fx

w/mnpj T 0129 1.5020 $105.16

. $21.04

27769 Optx post ankle

fx T 0063 49.8979 "$3,493.65"

. $698.73

27780 Treatment of fibula

fracture T 0129 1.5020 $105.16

. $21.04

27781 Treatment of fibula

fracture T 0139 18.9489 "$1,326.73"

. $265.35

27784 Treatment of fibula

fracture T 0063 49.8979 "$3,493.65"

. $698.73

27786 Treatment of ankle

fracture T 0129 1.5020 $105.16

. $21.04

27788 Treatment of anklefracture T 0129 1.5020 $105.16

. $21.04

27792 Treatment of ankle

fracture T 0063 49.8979 "$3,493.65"

. $698.73

27808 Treatment of ankle

fracture T 0129 1.5020 $105.16

. $21.04

27810 Treatment of ankle

fracture T 0129 1.5020 $105.16

. $21.04

27814 Treatment of ankle

fracture T 0063 49.8979 "$3,493.65"

. $698.73

27816 Treatment of ankle

fracture T 0129 1.5020 $105.16

. $21.04

27818 Treatment of ankle

fracture T 0138 5.0454 $353.26

. $70.66

27822 Treatment of ankle

fracture T 0063 49.8979 "$3,493.65"

. $698.73

27823 Treatment of ankle

fracture T 0064 68.1203 "$4,769.51"

. $953.91

27824 Treat lower leg

fracture T 0129 1.5020 $105.16

. $21.04

27825 Treat lower leg

fracture T 0139 18.9489 "$1,326.73"

. $265.35

27826 Treat lower leg

fracture T 0063 49.8979 "$3,493.65"

. $698.73

27827 Treat lower leg

fracture T 0064 68.1203 "$4,769.51"

. $953.91

27828 Treat lower leg

fracture T 0064 68.1203 "$4,769.51"

. $953.91

27829 Treat lower leg

joint T 0063 49.8979 "$3,493.65"

. $698.73

27830 Treat lower leg

dislocation T 0129 1.5020 $105.16

. $21.04

27831 Treat lower leg

dislocation T 0139 18.9489 "$1,326.73"

. $265.3527832 Treat lower leg

dislocation T 0063 49.8979 "$3,493.65"

. $698.73

27840 Treat ankle

dislocation T 0129 1.5020 $105.16

. $21.04

27842 Treat ankle

dislocation T 0045 15.4596 "$1,082.42" $268.44 $216.49

27846 Treat ankle

dislocation T 0063 49.8979 "$3,493.65"

. $698.73

27848 Treat ankle

dislocation T 0063 49.8979 "$3,493.65"

. $698.73

27860 Fixation of ankle

joint T 0045 15.4596 "$1,082.42" $268.44 $216.49

27870 Fusion of ankle joint

open T 0052 88.8483 "$6,220.80"

. "$1,244.16"

27871 Fusion of tibiofibular

joint T 0052 88.8483 "$6,220.80"

. "$1,244.16"

27880 Amputation of lower

leg C

27881 Amputation of lower

leg C

27882 Amputation of lower

leg C

27884 Amputation follow-up

surgery T 0049 22.0797 "$1,545.93"

. $309.19

27886 Amputation follow-up

surgery C

27888 Amputation of foot at

ankle C

27889 Amputation of foot at

ankle T 0050 32.4461 "$2,271.75"

. $454.35

27892 Decompression of

leg T 0050 32.4461 "$2,271.75"

. $454.35

27893 Decompression of

leg T 0050 32.4461 "$2,271.75"

. $454.35

27894 Decompression of

leg T 0050 32.4461 "$2,271.75"

. $454.3527899 Leg/ankle surgery

procedure T 0129 1.5020 $105.16

. $21.04

28001 Drainage of bursa of

foot T 0007 12.8082 $896.78

. $179.36

28002 Treatment of foot

infection T 0049 22.0797 "$1,545.93"

. $309.19

28003 Treatment of foot

infection T 0049 22.0797 "$1,545.93"

. $309.19

28005 Treat foot bone

lesion T 0055 22.0963 "$1,547.09" $353.25 $309.42

28008 Incision of foot

fascia T 0055 22.0963 "$1,547.09" $353.25 $309.42

28010 Incision of toe

tendon T 0055 22.0963 "$1,547.09" $353.25 $309.42

28011 Incision of toe

tendons T 0055 22.0963 "$1,547.09" $353.25 $309.42

28020 Exploration of foot

joint T 0055 22.0963 "$1,547.09" $353.25 $309.42

28022 Exploration of foot

joint T 0055 22.0963 "$1,547.09" $353.25 $309.42

28024 Exploration of toe

joint T 0055 22.0963 "$1,547.09" $353.25 $309.42

28035 Decompression of tibia

nerve T 0220 18.8921 "$1,322.75"

. $264.55

28039 Exc foot/toe tum sc 1.5

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

28041 Exc foot/toe tum dep

1.5cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

28043 Exc foot/toe tum sc < 1.5

cm T 0021 16.9957 "$1,189.97"

. $238.00

28045 Exc foot/toe tum deep

<1.5cm T 0021 16.9957 "$1,189.97"

. $238.0028046 Resect foot/toe tumor < 3

cm T 0021 16.9957 "$1,189.97"

. $238.00

28047 Resect foot/toe tumor 3

cm/> T 0022 23.2636 "$1,628.82" $350.74 $325.77

28050 Biopsy of foot joint

lining T 0055 22.0963 "$1,547.09" $353.25 $309.42

28052 Biopsy of foot joint

lining T 0055 22.0963 "$1,547.09" $353.25 $309.42

28054 Biopsy of toe joint

lining T 0055 22.0963 "$1,547.09" $353.25 $309.42

28055 Neurectomy

foot T 0220 18.8921 "$1,322.75"

. $264.55

28060 Partial removal foot

fascia T 0055 22.0963 "$1,547.09" $353.25 $309.42

28062 Removal of foot

fascia T 0055 22.0963 "$1,547.09" $353.25 $309.42

28070 Removal of foot joint

lining T 0055 22.0963 "$1,547.09" $353.25 $309.42

28072 Removal of foot joint

lining T 0055 22.0963 "$1,547.09" $353.25 $309.42

28080 Removal of foot

lesion T 0055 22.0963 "$1,547.09" $353.25 $309.42

28086 Excise foot tendon

sheath T 0055 22.0963 "$1,547.09" $353.25 $309.42

28088 Excise foot tendon

sheath T 0055 22.0963 "$1,547.09" $353.25 $309.42

28090 Removal of foot

lesion T 0055 22.0963 "$1,547.09" $353.25 $309.42

28092 Removal of toe

lesions T 0055 22.0963 "$1,547.09" $353.25 $309.42

28100 Removal of ankle/heel

lesion T 0055 22.0963 "$1,547.09" $353.25 $309.42

28102 Remove/graft foot

lesion T 0056 58.4586 "$4,093.04"

. $818.6128103 Remove/graft foot

lesion T 0056 58.4586 "$4,093.04"

. $818.61

28104 Removal of foot

lesion T 0055 22.0963 "$1,547.09" $353.25 $309.42

28106 Remove/graft foot

lesion T 0056 58.4586 "$4,093.04"

. $818.61

28107 Remove/graft foot

lesion T 0056 58.4586 "$4,093.04"

. $818.61

28108 Removal of toe

lesions T 0055 22.0963 "$1,547.09" $353.25 $309.42

28110 Part removal of

metatarsal T 0055 22.0963 "$1,547.09" $353.25 $309.42

28111 Part removal of

metatarsal T 0055 22.0963 "$1,547.09" $353.25 $309.42

28112 Part removal of

metatarsal T 0055 22.0963 "$1,547.09" $353.25 $309.42

28113 Part removal of

metatarsal T 0055 22.0963 "$1,547.09" $353.25 $309.42

28114 Removal of metatarsal

heads T 0055 22.0963 "$1,547.09" $353.25 $309.42

28116 Revision of

foot T 0055 22.0963 "$1,547.09" $353.25 $309.42

28118 Removal of heel

bone T 0055 22.0963 "$1,547.09" $353.25 $309.42

28119 Removal of heel

spur T 0055 22.0963 "$1,547.09" $353.25 $309.42

28120 Part removal of

ankle/heel T 0055 22.0963 "$1,547.09" $353.25 $309.42

28122 Partial removal of foot

bone T 0055 22.0963 "$1,547.09" $353.25 $309.42

28124 Partial removal of

toe T 0055 22.0963 "$1,547.09" $353.25 $309.4228126 Partial removal of

toe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28130 Removal of ankle

bone T 0055 22.0963 "$1,547.09" $353.25 $309.42

28140 Removal of

metatarsal T 0055 22.0963 "$1,547.09" $353.25 $309.42

28150 Removal of

toe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28153 Partial removal of

toe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28160 Partial removal of

toe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28171 Resect tarsal

tumor T 0055 22.0963 "$1,547.09" $353.25 $309.42

28173 Resect metatarsal

tumor T 0055 22.0963 "$1,547.09" $353.25 $309.42

28175 Resect phalanx of toe

tumor T 0055 22.0963 "$1,547.09" $353.25 $309.42

28190 Removal of foot foreign

body T 0020 8.2918 $580.56

. $116.12

28192 Removal of foot foreign

body T 0021 16.9957 "$1,189.97"

. $238.00

28193 Removal of foot foreign

body T 0020 8.2918 $580.56

. $116.12

28200 Repair of foot

tendon T 0055 22.0963 "$1,547.09" $353.25 $309.42

28202 Repair/graft of foot

tendon T 0055 22.0963 "$1,547.09" $353.25 $309.42

28208 Repair of foot

tendon T 0055 22.0963 "$1,547.09" $353.25 $309.42

28210 Repair/graft of foot

tendon T 0056 58.4586 "$4,093.04"

. $818.61

28220 Release of foot

tendon T 0055 22.0963 "$1,547.09" $353.25 $309.4228222 Release of foot

tendons T 0055 22.0963 "$1,547.09" $353.25 $309.42

28225 Release of foot

tendon T 0055 22.0963 "$1,547.09" $353.25 $309.42

28226 Release of foot

tendons T 0055 22.0963 "$1,547.09" $353.25 $309.42

28230 Incision of foot

tendon(s) T 0055 22.0963 "$1,547.09" $353.25 $309.42

28232 Incision of toe

tendon T 0055 22.0963 "$1,547.09" $353.25 $309.42

28234 Incision of foot

tendon T 0055 22.0963 "$1,547.09" $353.25 $309.42

28238 Revision of foot

tendon T 0056 58.4586 "$4,093.04"

. $818.61

28240 Release of big

toe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28250 Revision of foot

fascia T 0055 22.0963 "$1,547.09" $353.25 $309.42

28260 Release of midfoot

joint T 0055 22.0963 "$1,547.09" $353.25 $309.42

28261 Revision of foot

tendon T 0055 22.0963 "$1,547.09" $353.25 $309.42

28262 Revision of foot and

ankle T 0055 22.0963 "$1,547.09" $353.25 $309.42

28264 Release of midfoot

joint T 0056 58.4586 "$4,093.04"

. $818.61

28270 Release of foot

contracture T 0055 22.0963 "$1,547.09" $353.25 $309.42

28272 Release of toe joint

each T 0055 22.0963 "$1,547.09" $353.25 $309.42

28280 Fusion of

toes T 0055 22.0963 "$1,547.09" $353.25 $309.4228285 Repair of

hammertoe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28286 Repair of

hammertoe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28288 Partial removal of foot

bone T 0055 22.0963 "$1,547.09" $353.25 $309.42

28289 Repair hallux

rigidus T 0055 22.0963 "$1,547.09" $353.25 $309.42

28290 Correction of

bunion T 0057 32.7262 "$2,291.36" $475.91 $458.28

28292 Correction of

bunion T 0057 32.7262 "$2,291.36" $475.91 $458.28

28293 Correction of

bunion T 0057 32.7262 "$2,291.36" $475.91 $458.28

28294 Correction of

bunion T 0057 32.7262 "$2,291.36" $475.91 $458.28

28296 Correction of

bunion T 0057 32.7262 "$2,291.36" $475.91 $458.28

28297 Correction of

bunion T 0057 32.7262 "$2,291.36" $475.91 $458.28

28298 Correction of

bunion T 0057 32.7262 "$2,291.36" $475.91 $458.28

28299 Correction of

bunion T 0057 32.7262 "$2,291.36" $475.91 $458.28

28300 Incision of heel

bone T 0056 58.4586 "$4,093.04"

. $818.61

28302 Incision of ankle

bone T 0055 22.0963 "$1,547.09" $353.25 $309.42

28304 Incision of midfoot

bones T 0056 58.4586 "$4,093.04"

. $818.61

28305 Incise/graft midfoot

bones T 0056 58.4586 "$4,093.04"

. $818.61

28306 Incision of

metatarsal T 0055 22.0963 "$1,547.09" $353.25 $309.4228307 Incision of

metatarsal T 0055 22.0963 "$1,547.09" $353.25 $309.42

28308 Incision of

metatarsal T 0055 22.0963 "$1,547.09" $353.25 $309.42

28309 Incision of

metatarsals T 0056 58.4586 "$4,093.04"

. $818.61

28310 Revision of big

toe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28312 Revision of

toe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28313 Repair deformity of

toe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28315 Removal of sesamoid

bone T 0055 22.0963 "$1,547.09" $353.25 $309.42

28320 Repair of foot

bones T 0056 58.4586 "$4,093.04"

. $818.61

28322 Repair of

metatarsals T 0056 58.4586 "$4,093.04"

. $818.61

28340 Resect enlarged toe

tissue T 0055 22.0963 "$1,547.09" $353.25 $309.42

28341 Resect enlarged

toe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28344 Repair extra

toe(s) T 0055 22.0963 "$1,547.09" $353.25 $309.42

28345 Repair webbed

toe(s) T 0055 22.0963 "$1,547.09" $353.25 $309.42

28360 Reconstruct cleft

foot T 0056 58.4586 "$4,093.04"

. $818.61

28400 Treatment of heel

fracture T 0129 1.5020 $105.16

. $21.04

28405 Treatment of heel

fracture T 0139 18.9489 "$1,326.73"

. $265.3528406 Treatment of heel

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

28415 Treat heel

fracture T 0064 68.1203 "$4,769.51"

. $953.91

28420 Treat/graft heel

fracture T 0063 49.8979 "$3,493.65"

. $698.73

28430 Treatment of ankle

fracture T 0129 1.5020 $105.16

. $21.04

28435 Treatment of ankle

fracture T 0129 1.5020 $105.16

. $21.04

28436 Treatment of ankle

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

28445 Treat ankle

fracture T 0063 49.8979 "$3,493.65"

. $698.73

28446 Osteochondral talus

autogrft T 0056 58.4586 "$4,093.04"

. $818.61

28450 Treat midfoot fracture

each T 0129 1.5020 $105.16

. $21.04

28455 Treat midfoot fracture

each T 0129 1.5020 $105.16

. $21.04

28456 Treat midfoot

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

28465 Treat midfoot fracture

each T 0063 49.8979 "$3,493.65"

. $698.73

28470 Treat metatarsal

fracture T 0129 1.5020 $105.16

. $21.04

28475 Treat metatarsal

fracture T 0129 1.5020 $105.16

. $21.04

28476 Treat metatarsal

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

28485 Treat metatarsal

fracture T 0063 49.8979 "$3,493.65"

. $698.73

28490 Treat big toe

fracture T 0129 1.5020 $105.16

. $21.0428495 Treat big toe

fracture T 0129 1.5020 $105.16

. $21.04

28496 Treat big toe

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

28505 Treat big toe

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

28510 Treatment of toe

fracture T 0129 1.5020 $105.16

. $21.04

28515 Treatment of toe

fracture T 0129 1.5020 $105.16

. $21.04

28525 Treat toe

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

28530 Treat sesamoid bone

fracture T 0129 1.5020 $105.16

. $21.04

28531 Treat sesamoid bone

fracture T 0062 26.1202 "$1,828.83" $372.85 $365.77

28540 Treat foot

dislocation T 0129 1.5020 $105.16

. $21.04

28545 Treat foot

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

28546 Treat foot

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

28555 Repair foot

dislocation T 0063 49.8979 "$3,493.65"

. $698.73

28570 Treat foot

dislocation T 0129 1.5020 $105.16

. $21.04

28575 Treat foot

dislocation T 0139 18.9489 "$1,326.73"

. $265.35

28576 Treat foot

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

28585 Repair foot

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.7728600 Treat foot

dislocation T 0129 1.5020 $105.16

. $21.04

28605 Treat foot

dislocation T 0129 1.5020 $105.16

. $21.04

28606 Treat foot

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

28615 Repair foot

dislocation T 0063 49.8979 "$3,493.65"

. $698.73

28630 Treat toe

dislocation T 0129 1.5020 $105.16

. $21.04

28635 Treat toe

dislocation T 0045 15.4596 "$1,082.42" $268.44 $216.49

28636 Treat toe

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

28645 Repair toe

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

28660 Treat toe

dislocation T 0129 1.5020 $105.16

. $21.04

28665 Treat toe

dislocation T 0045 15.4596 "$1,082.42" $268.44 $216.49

28666 Treat toe

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

28675 Repair of toe

dislocation T 0062 26.1202 "$1,828.83" $372.85 $365.77

28705 Fusion of foot

bones T 0056 58.4586 "$4,093.04"

. $818.61

28715 Fusion of foot

bones T 0052 88.8483 "$6,220.80"

. "$1,244.16"

28725 Fusion of foot

bones T 0056 58.4586 "$4,093.04"

. $818.61

28730 Fusion of foot

bones T 0056 58.4586 "$4,093.04"

. $818.61

28735 Fusion of foot

bones T 0056 58.4586 "$4,093.04"

. $818.6128737 Revision of foot

bones T 0056 58.4586 "$4,093.04"

. $818.61

28740 Fusion of foot

bones T 0056 58.4586 "$4,093.04"

. $818.61

28750 Fusion of big toe

joint T 0056 58.4586 "$4,093.04"

. $818.61

28755 Fusion of big toe

joint T 0055 22.0963 "$1,547.09" $353.25 $309.42

28760 Fusion of big toe

joint T 0056 58.4586 "$4,093.04"

. $818.61

28800 Amputation of

midfoot C

28805 Amputation thru

metatarsal T 0055 22.0963 "$1,547.09" $353.25 $309.42

28810 Amputation toe &

metatarsal T 0055 22.0963 "$1,547.09" $353.25 $309.42

28820 Amputation of

toe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28825 Partial amputation of

toe T 0055 22.0963 "$1,547.09" $353.25 $309.42

28890 High energy eswt plantar

f T 0050 32.4461 "$2,271.75"

. $454.35

28899 Foot/toes surgery

procedure T 0129 1.5020 $105.16

. $21.04

29000 Application of body

cast S 0058 1.1255 $78.80

. $15.76

29010 Application of body

cast S 0426 2.5699 $179.93

. $35.99

29015 Application of body

cast S 0426 2.5699 $179.93

. $35.99

29020 Application of body

cast S 0058 1.1255 $78.80

. $15.76

29025 Application of bodycast S 0058 1.1255 $78.80

. $15.76

29035 Application of body

cast S 0426 2.5699 $179.93

. $35.99

29040 Application of body

cast S 0058 1.1255 $78.80

. $15.76

29044 Application of body

cast S 0426 2.5699 $179.93

. $35.99

29046 Application of body

cast S 0426 2.5699 $179.93

. $35.99

29049 Application of figure

eight S 0058 1.1255 $78.80

. $15.76

29055 Application of shoulder

cast S 0426 2.5699 $179.93

. $35.99

29058 Application of shoulder

cast S 0058 1.1255 $78.80

. $15.76

29065 Application of long arm

cast S 0426 2.5699 $179.93

. $35.99

29075 Application of forearm

cast S 0426 2.5699 $179.93

. $35.99

29085 Apply hand/wrist

cast S 0058 1.1255 $78.80

. $15.76

29086 Apply finger

cast S 0058 1.1255 $78.80

. $15.76

29105 Apply long arm

splint S 0058 1.1255 $78.80

. $15.76

29125 Apply forearm

splint S 0058 1.1255 $78.80

. $15.76

29126 Apply forearm

splint S 0058 1.1255 $78.80

. $15.76

29130 Application of finger

splint S 0058 1.1255 $78.80

. $15.76

29131 Application of finger

splint S 0058 1.1255 $78.80

. $15.7629200 Strapping of

chest S 0058 1.1255 $78.80

. $15.76

29240 Strapping of

shoulder S 0058 1.1255 $78.80

. $15.76

29260 Strapping of elbow or

wrist S 0058 1.1255 $78.80

. $15.76

29280 Strapping of hand or

finger S 0058 1.1255 $78.80

. $15.76

29305 Application of hip

cast S 0426 2.5699 $179.93

. $35.99

29325 Application of hip

casts S 0426 2.5699 $179.93

. $35.99

29345 Application of long leg

cast S 0426 2.5699 $179.93

. $35.99

29355 Application of long leg

cast S 0426 2.5699 $179.93

. $35.99

29358 Apply long leg cast

brace S 0426 2.5699 $179.93

. $35.99

29365 Application of long leg

cast S 0426 2.5699 $179.93

. $35.99

29405 Apply short leg

cast S 0426 2.5699 $179.93

. $35.99

29425 Apply short leg

cast S 0426 2.5699 $179.93

. $35.99

29435 Apply short leg

cast S 0426 2.5699 $179.93

. $35.99

29440 Addition of walker to

cast S 0058 1.1255 $78.80

. $15.76

29445 Apply rigid leg

cast S 0426 2.5699 $179.93

. $35.99

29450 Application of leg

cast S 0058 1.1255 $78.80

. $15.76

29505 Application long legsplint S 0058 1.1255 $78.80

. $15.76

29515 Application lower leg

splint S 0058 1.1255 $78.80

. $15.76

29520 Strapping of

hip S 0058 1.1255 $78.80

. $15.76

29530 Strapping of

knee S 0058 1.1255 $78.80

. $15.76

29540 Strapping of ankle and/or

ft S 0058 1.1255 $78.80

. $15.76

29550 Strapping of

toes S 0058 1.1255 $78.80

. $15.76

29580 Application of paste

boot S 0058 1.1255 $78.80

. $15.76

29581 Apply multlay comprs lwr

leg S 0058 1.1255 $78.80

. $15.76

29582 Apply multlay comprs upr

leg NI S 0058 1.1255 $78.80

. $15.76

29583 Apply multlay comprs upr

arm NI S 0058 1.1255 $78.80

. $15.76

29584 Appl multlay comprs

arm/hand NI S 0058 1.1255 $78.80

. $15.76

29590 Application of foot

splint S 0058 1.1255 $78.80

. $15.76

29700 Removal/revision of

cast S 0058 1.1255 $78.80

. $15.76

29705 Removal/revision of

cast S 0058 1.1255 $78.80

. $15.76

29710 Removal/revision of

cast S 0426 2.5699 $179.93

. $35.99

29715 Removal/revision of

cast S 0058 1.1255 $78.80

. $15.76

29720 Repair of body

cast S 0058 1.1255 $78.80

. $15.7629730 Windowing of

cast S 0058 1.1255 $78.80

. $15.76

29740 Wedging of

cast S 0058 1.1255 $78.80

. $15.76

29750 Wedging of clubfoot

cast S 0058 1.1255 $78.80

. $15.76

29799 Casting/strapping

procedure S 0058 1.1255 $78.80

. $15.76

29800 Jaw

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29804 Jaw

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29805 Shoulder arthroscopy

dx T 0041 29.7721 "$2,084.52"

. $416.91

29806 Shoulder

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29807 Shoulder

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29819 Shoulder

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29820 Shoulder

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29821 Shoulder

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29822 Shoulder

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29823 Shoulder

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29824 Shoulder

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29825 Shoulder

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29826 Shoulderarthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29827 Arthroscop rotator cuff

repr T 0042 57.0707 "$3,995.86" $804.74 $799.18

29828 Arthroscopy biceps

tenodesis T 0042 57.0707 "$3,995.86" $804.74 $799.18

29830 Elbow

arthroscopy T 0041 29.7721 "$2,084.52"

. $416.91

29834 Elbow

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29835 Elbow

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29836 Elbow

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29837 Elbow

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29838 Elbow

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29840 Wrist

arthroscopy T 0041 29.7721 "$2,084.52"

. $416.91

29843 Wrist

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29844 Wrist

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29845 Wrist

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29846 Wrist

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29847 Wrist

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29848 Wrist

endoscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29850 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.9129851 Knee

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29855 Tibial

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29856 Tibial

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29860 Hip arthroscopy

dx T 0042 57.0707 "$3,995.86" $804.74 $799.18

29861 Hip arthro w/fb

removal T 0042 57.0707 "$3,995.86" $804.74 $799.18

29862 Hip arthr0

w/debridement T 0042 57.0707 "$3,995.86" $804.74 $799.18

29863 Hip arthr0

w/synovectomy T 0042 57.0707 "$3,995.86" $804.74 $799.18

29866 Autgrft implnt knee

w/scope T 0042 57.0707 "$3,995.86" $804.74 $799.18

29867 Allgrft implnt knee

w/scope T 0042 57.0707 "$3,995.86" $804.74 $799.18

29868 Meniscal trnspl knee

w/scpe T 0042 57.0707 "$3,995.86" $804.74 $799.18

29870 Knee arthroscopy

dx T 0041 29.7721 "$2,084.52"

. $416.91

29871 Knee

arthroscopy/drainage T 0041 29.7721 "$2,084.52"

. $416.91

29873 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29874 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29875 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29876 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29877 Kneearthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29879 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29880 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29881 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29882 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29883 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29884 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29885 Knee

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29886 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29887 Knee

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29888 Knee

arthroscopy/surgery T 0052 88.8483 "$6,220.80"

. "$1,244.16"

29889 Knee

arthroscopy/surgery T 0052 88.8483 "$6,220.80"

. "$1,244.16"

29891 Ankle

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29892 Ankle

arthroscopy/surgery T 0052 88.8483 "$6,220.80"

. "$1,244.16"

29893 Scope plantar

fasciotomy T 0055 22.0963 "$1,547.09" $353.25 $309.42

29894 Ankle

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29895 Ankle

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.9129897 Ankle

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29898 Ankle

arthroscopy/surgery T 0041 29.7721 "$2,084.52"

. $416.91

29899 Ankle

arthroscopy/surgery T 0042 57.0707 "$3,995.86" $804.74 $799.18

29900 Mcp joint arthroscopy

dx T 0041 29.7721 "$2,084.52"

. $416.91

29901 Mcp joint arthroscopy

surg T 0041 29.7721 "$2,084.52"

. $416.91

29902 Mcp joint arthroscopy

surg T 0041 29.7721 "$2,084.52"

. $416.91

29904 Subtalar arthro w/fb

rmvl T 0041 29.7721 "$2,084.52"

. $416.91

29905 Subtalar arthro

w/exc T 0041 29.7721 "$2,084.52"

. $416.91

29906 Subtalar arthro

w/deb T 0041 29.7721 "$2,084.52"

. $416.91

29907 Subtalar arthro

w/fusion T 0042 57.0707 "$3,995.86" $804.74 $799.18

29914 Hip arthro

w/femoroplasty T 0042 57.0707 "$3,995.86" $804.74 $799.18

29915 Hip arthro

acetabuloplasty T 0042 57.0707 "$3,995.86" $804.74 $799.18

29916 Hip arthro w/labral

repair T 0042 57.0707 "$3,995.86" $804.74 $799.18

29999 Arthroscopy of

joint T 0041 29.7721 "$2,084.52"

. $416.91

30000 Drainage of nose

lesion T 0251 3.1150 $218.10

. $43.62

30020 Drainage of nose

lesion T 0251 3.1150 $218.10

. $43.62

30100 Intranasalbiopsy T 0252 7.4614 $522.42 $104.55 $104.49

30110 Removal of nose

polyp(s) T 0253 16.8699 "$1,181.16" $279.20 $236.24

30115 Removal of nose

polyp(s) T 0253 16.8699 "$1,181.16" $279.20 $236.24

30117 Removal of intranasal

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

30118 Removal of intranasal

lesion T 0254 24.8895 "$1,742.66"

. $348.54

30120 Revision of

nose T 0254 24.8895 "$1,742.66"

. $348.54

30124 Removal of nose

lesion T 0252 7.4614 $522.42 $104.55 $104.49

30125 Removal of nose

lesion T 0256 45.0377 "$3,153.36"

. $630.68

30130 Excise inferior

turbinate T 0253 16.8699 "$1,181.16" $279.20 $236.24

30140 Resect inferior

turbinate T 0254 24.8895 "$1,742.66"

. $348.54

30150 Partial removal of

nose T 0256 45.0377 "$3,153.36"

. $630.68

30160 Removal of

nose T 0256 45.0377 "$3,153.36"

. $630.68

30200 Injection treatment of

nose T 0252 7.4614 $522.42 $104.55 $104.49

30210 Nasal sinus

therapy T 0252 7.4614 $522.42 $104.55 $104.49

30220 Insert nasal septal

button T 0252 7.4614 $522.42 $104.55 $104.49

30300 Remove nasal foreign

body X 0340 0.6499 $45.50

. $9.10

30310 Remove nasal foreign

body T 0253 16.8699 "$1,181.16" $279.20 $236.2430320 Remove nasal foreign

body T 0253 16.8699 "$1,181.16" $279.20 $236.24

30400 Reconstruction of

nose T 0256 45.0377 "$3,153.36"

. $630.68

30410 Reconstruction of

nose T 0256 45.0377 "$3,153.36"

. $630.68

30420 Reconstruction of

nose T 0256 45.0377 "$3,153.36"

. $630.68

30430 Revision of

nose T 0254 24.8895 "$1,742.66"

. $348.54

30435 Revision of

nose T 0256 45.0377 "$3,153.36"

. $630.68

30450 Revision of

nose T 0256 45.0377 "$3,153.36"

. $630.68

30460 Revision of

nose T 0256 45.0377 "$3,153.36"

. $630.68

30462 Revision of

nose T 0256 45.0377 "$3,153.36"

. $630.68

30465 Repair nasal

stenosis T 0256 45.0377 "$3,153.36"

. $630.68

30520 Repair of nasal

septum T 0254 24.8895 "$1,742.66"

. $348.54

30540 Repair nasal

defect T 0256 45.0377 "$3,153.36"

. $630.68

30545 Repair nasal

defect T 0256 45.0377 "$3,153.36"

. $630.68

30560 Release of nasal

adhesions T 0251 3.1150 $218.10

. $43.62

30580 Repair upper jaw

fistula T 0256 45.0377 "$3,153.36"

. $630.68

30600 Repair mouth/nose

fistula T 0256 45.0377 "$3,153.36"

. $630.68

30620 Intranasalreconstruction T 0256 45.0377 "$3,153.36"

. $630.68

30630 Repair nasal septum

defect T 0254 24.8895 "$1,742.66"

. $348.54

30801 Ablate inf turbinate

superf T 0252 7.4614 $522.42 $104.55 $104.49

30802 Ablate inf turbinate

submuc T 0253 16.8699 "$1,181.16" $279.20 $236.24

30901 Control of

nosebleed T 0250 1.0709 $74.98 $24.12 $15.00

30903 Control of

nosebleed T 0250 1.0709 $74.98 $24.12 $15.00

30905 Control of

nosebleed T 0250 1.0709 $74.98 $24.12 $15.00

30906 Repeat control of

nosebleed T 0250 1.0709 $74.98 $24.12 $15.00

30915 Ligation nasal sinus

artery T 0092 26.8120 "$1,877.27"

. $375.46

30920 Ligation upper jaw

artery T 0092 26.8120 "$1,877.27"

. $375.46

30930 Ther fx nasal inf

turbinate T 0253 16.8699 "$1,181.16" $279.20 $236.24

30999 Nasal surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.00

31000 Irrigation maxillary

sinus T 0251 3.1150 $218.10

. $43.62

31002 Irrigation sphenoid

sinus T 0252 7.4614 $522.42 $104.55 $104.49

31020 Exploration maxillary

sinus T 0254 24.8895 "$1,742.66"

. $348.54

31030 Exploration maxillary

sinus T 0256 45.0377 "$3,153.36"

. $630.68

31032 Explore sinus remove

polyps T 0256 45.0377 "$3,153.36"

. $630.6831040 Exploration behind upper

jaw T 0254 24.8895 "$1,742.66"

. $348.54

31050 Exploration sphenoid

sinus T 0256 45.0377 "$3,153.36"

. $630.68

31051 Sphenoid sinus

surgery T 0256 45.0377 "$3,153.36"

. $630.68

31070 Exploration of frontal

sinus T 0254 24.8895 "$1,742.66"

. $348.54

31075 Exploration of frontal

sinus T 0256 45.0377 "$3,153.36"

. $630.68

31080 Removal of frontal

sinus T 0256 45.0377 "$3,153.36"

. $630.68

31081 Removal of frontal

sinus T 0256 45.0377 "$3,153.36"

. $630.68

31084 Removal of frontal

sinus T 0256 45.0377 "$3,153.36"

. $630.68

31085 Removal of frontal

sinus T 0256 45.0377 "$3,153.36"

. $630.68

31086 Removal of frontal

sinus T 0256 45.0377 "$3,153.36"

. $630.68

31087 Removal of frontal

sinus T 0256 45.0377 "$3,153.36"

. $630.68

31090 Exploration of

sinuses T 0256 45.0377 "$3,153.36"

. $630.68

31200 Removal of ethmoid

sinus T 0256 45.0377 "$3,153.36"

. $630.68

31201 Removal of ethmoid

sinus T 0256 45.0377 "$3,153.36"

. $630.68

31205 Removal of ethmoid

sinus T 0256 45.0377 "$3,153.36"

. $630.68

31225 Removal of upper

jaw C

31230 Removal of upper

jaw C31231 Nasal endoscopy

dx T 0072 1.8643 $130.53

. $26.11

31233 Nasal/sinus endoscopy

dx T 0072 1.8643 $130.53

. $26.11

31235 Nasal/sinus endoscopy

dx T 0074 21.2774 "$1,489.76"

. $297.96

31237 Nasal/sinus endoscopy

surg T 0074 21.2774 "$1,489.76"

. $297.96

31238 Nasal/sinus endoscopy

surg T 0074 21.2774 "$1,489.76"

. $297.96

31239 Nasal/sinus endoscopy

surg T 0075 30.3487 "$2,124.89" $444.55 $424.98

31240 Nasal/sinus endoscopy

surg T 0074 21.2774 "$1,489.76"

. $297.96

31254 Revision of ethmoid

sinus T 0075 30.3487 "$2,124.89" $444.55 $424.98

31255 Removal of ethmoid

sinus T 0075 30.3487 "$2,124.89" $444.55 $424.98

31256 Exploration maxillary

sinus T 0075 30.3487 "$2,124.89" $444.55 $424.98

31267 Endoscopy maxillary

sinus T 0075 30.3487 "$2,124.89" $444.55 $424.98

31276 Sinus endoscopy

surgical T 0075 30.3487 "$2,124.89" $444.55 $424.98

31287 Nasal/sinus endoscopy

surg T 0075 30.3487 "$2,124.89" $444.55 $424.98

31288 Nasal/sinus endoscopy

surg T 0075 30.3487 "$2,124.89" $444.55 $424.98

31290 Nasal/sinus endoscopy

surg C

31291 Nasal/sinus endoscopy

surg C

31292 Nasal/sinus endoscopy

surg T 0075 30.3487 "$2,124.89" $444.55 $424.9831293 Nasal/sinus endoscopy

surg T 0075 30.3487 "$2,124.89" $444.55 $424.98

31294 Nasal/sinus endoscopy

surg T 0075 30.3487 "$2,124.89" $444.55 $424.98

31295 Sinus endo w/balloon

dil T 0075 30.3487 "$2,124.89" $444.55 $424.98

31296 Sinus endo w/balloon

dil T 0075 30.3487 "$2,124.89" $444.55 $424.98

31297 Sinus endo w/balloon

dil T 0075 30.3487 "$2,124.89" $444.55 $424.98

31299 Sinus surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.00

31300 Removal of larynx

lesion T 0254 24.8895 "$1,742.66"

. $348.54

31320 Diagnostic incision

larynx T 0256 45.0377 "$3,153.36"

. $630.68

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

31400 Revision of

larynx T 0256 45.0377 "$3,153.36"

. $630.6831420 Removal of

epiglottis T 0256 45.0377 "$3,153.36"

. $630.68

31500 Insert emergency

airway S 0094 2.2326 $156.32 $43.83 $31.27

31502 Change of windpipe

airway S 0078 1.4089 $98.65

. $19.73

31505 Diagnostic

laryngoscopy T 0071 1.0729 $75.12

. $15.03

31510 Laryngoscopy with

biopsy T 0074 21.2774 "$1,489.76"

. $297.96

31511 Remove foreign body

larynx T 0072 1.8643 $130.53

. $26.11

31512 Removal of larynx

lesion T 0074 21.2774 "$1,489.76"

. $297.96

31513 Injection into vocal

cord T 0072 1.8643 $130.53

. $26.11

31515 Laryngoscopy for

aspiration T 0074 21.2774 "$1,489.76"

. $297.96

31520 Dx laryngoscopy

newborn T 0072 1.8643 $130.53

. $26.11

31525 Dx laryngoscopy excl

nb T 0074 21.2774 "$1,489.76"

. $297.96

31526 Dx laryngoscopy w/oper

scope T 0074 21.2774 "$1,489.76"

. $297.96

31527 Laryngoscopy for

treatment T 0075 30.3487 "$2,124.89" $444.55 $424.98

31528 Laryngoscopy and

dilation T 0074 21.2774 "$1,489.76"

. $297.96

31529 Laryngoscopy and

dilation T 0074 21.2774 "$1,489.76"

. $297.96

31530 Laryngoscopy w/fb

removal T 0074 21.2774 "$1,489.76"

. $297.96

31531 Laryngoscopy w/fb & opscope T 0074 21.2774 "$1,489.76"

. $297.96

31535 Laryngoscopy

w/biopsy T 0074 21.2774 "$1,489.76"

. $297.96

31536 Laryngoscopy w/bx & op

scope T 0074 21.2774 "$1,489.76"

. $297.96

31540 Laryngoscopy w/exc of

tumor T 0074 21.2774 "$1,489.76"

. $297.96

31541 Larynscop w/tumr exc +

scope T 0074 21.2774 "$1,489.76"

. $297.96

31545 Remove vc lesion

w/scope T 0075 30.3487 "$2,124.89" $444.55 $424.98

31546 Remove vc lesion

scope/graft T 0075 30.3487 "$2,124.89" $444.55 $424.98

31560 Laryngoscop

w/arytenoidectom T 0075 30.3487 "$2,124.89" $444.55 $424.98

31561 Larynscop remve cart +

scop T 0075 30.3487 "$2,124.89" $444.55 $424.98

31570 Laryngoscope w/vc

inj T 0074 21.2774 "$1,489.76"

. $297.96

31571 Laryngoscop w/vc inj +

scope T 0075 30.3487 "$2,124.89" $444.55 $424.98

31575 Diagnostic

laryngoscopy T 0072 1.8643 $130.53

. $26.11

31576 Laryngoscopy with

biopsy T 0074 21.2774 "$1,489.76"

. $297.96

31577 Remove foreign body

larynx T 0073 4.4119 $308.90 $67.83 $61.78

31578 Removal of larynx

lesion T 0075 30.3487 "$2,124.89" $444.55 $424.98

31579 Diagnostic

laryngoscopy T 0073 4.4119 $308.90 $67.83 $61.78

31580 Revision of

larynx T 0256 45.0377 "$3,153.36"

. $630.6831582 Revision of

larynx T 0256 45.0377 "$3,153.36"

. $630.68

31584 Treat larynx

fracture C

31587 Revision of

larynx C

31588 Revision of

larynx T 0256 45.0377 "$3,153.36"

. $630.68

31590 Reinnervate

larynx T 0256 45.0377 "$3,153.36"

. $630.68

31595 Larynx nerve

surgery T 0256 45.0377 "$3,153.36"

. $630.68

31599 Larynx surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.00

31600 Incision of

windpipe T 0254 24.8895 "$1,742.66"

. $348.54

31601 Incision of

windpipe T 0254 24.8895 "$1,742.66"

. $348.54

31603 Incision of

windpipe T 0252 7.4614 $522.42 $104.55 $104.49

31605 Incision of

windpipe T 0252 7.4614 $522.42 $104.55 $104.49

31610 Incision of

windpipe T 0254 24.8895 "$1,742.66"

. $348.54

31611 Surgery/speech

prosthesis T 0254 24.8895 "$1,742.66"

. $348.54

31612 Puncture/clear

windpipe T 0254 24.8895 "$1,742.66"

. $348.54

31613 Repair windpipe

opening T 0254 24.8895 "$1,742.66"

. $348.54

31614 Repair windpipe

opening T 0256 45.0377 "$3,153.36"

. $630.68

31615 Visualization of

windpipe T 0252 7.4614 $522.42 $104.55 $104.4931620 Endobronchial us

add-on N

31622 Dx

bronchoscope/wash T 0076 10.4689 $732.99 $189.82 $146.60

31623 Dx

bronchoscope/brush T 0076 10.4689 $732.99 $189.82 $146.60

31624 Dx

bronchoscope/lavage T 0076 10.4689 $732.99 $189.82 $146.60

31625 Bronchoscopy

w/biopsy(s) T 0076 10.4689 $732.99 $189.82 $146.60

31626 Bronchoscopy

w/markers CH T 0415 28.9051 "$2,023.82" $459.92 $404.77

31627 Navigational

bronchoscopy N

31628 Bronchoscopy/lung bx

each T 0076 10.4689 $732.99 $189.82 $146.60

31629 Bronchoscopy/needle bx

each T 0076 10.4689 $732.99 $189.82 $146.60

31630 Bronchoscopy dilate/fx

repr T 0415 28.9051 "$2,023.82" $459.92 $404.77

31631 Bronchoscopy dilate

w/stent T 0415 28.9051 "$2,023.82" $459.92 $404.77

31632 Bronchoscopy/lung bx

addl T 0076 10.4689 $732.99 $189.82 $146.60

31633 Bronchoscopy/needle bx

addl T 0076 10.4689 $732.99 $189.82 $146.60

31634 Bronch w/balloon

occlusion T 0076 10.4689 $732.99 $189.82 $146.60

31635 Bronchoscopy w/fb

removal T 0076 10.4689 $732.99 $189.82 $146.60

31636 Bronchoscopy bronch

stents T 0415 28.9051 "$2,023.82" $459.92 $404.77

31637 Bronchoscopy stent

add-on T 0076 10.4689 $732.99 $189.82 $146.6031638 Bronchoscopy revise

stent T 0415 28.9051 "$2,023.82" $459.92 $404.77

31640 Bronchoscopy w/tumor

excise T 0415 28.9051 "$2,023.82" $459.92 $404.77

31641 Bronchoscopy treat

blockage T 0415 28.9051 "$2,023.82" $459.92 $404.77

31643 Diag

bronchoscope/catheter T 0076 10.4689 $732.99 $189.82 $146.60

31645 Bronchoscopy clear

airways T 0076 10.4689 $732.99 $189.82 $146.60

31646 Bronchoscopy reclear

airway T 0076 10.4689 $732.99 $189.82 $146.60

31656 Bronchoscopy inj for

x-ray T 0076 10.4689 $732.99 $189.82 $146.60

31715 Injection for bronchus

x-ray N

31717 Bronchial brush

biopsy T 0073 4.4119 $308.90 $67.83 $61.78

31720 Clearance of

airways S 0077 0.4237 $29.67 $7.74 $5.94

31725 Clearance of

airways C

31730 Intro windpipe

wire/tube T 0073 4.4119 $308.90 $67.83 $61.78

31750 Repair of

windpipe T 0256 45.0377 "$3,153.36"

. $630.68

31755 Repair of

windpipe T 0256 45.0377 "$3,153.36"

. $630.68

31760 Repair of

windpipe C

31766 Reconstruction of

windpipe C

31770 Repair/graft of

bronchus C

31775 Reconstructbronchus C

31780 Reconstruct

windpipe C

31781 Reconstruct

windpipe C

31785 Remove windpipe

lesion T 0254 24.8895 "$1,742.66"

. $348.54

31786 Remove windpipe

lesion C

31800 Repair of windpipe

injury C

31805 Repair of windpipe

injury C

31820 Closure of windpipe

lesion T 0254 24.8895 "$1,742.66"

. $348.54

31825 Repair of windpipe

defect T 0254 24.8895 "$1,742.66"

. $348.54

31830 Revise windpipe

scar T 0254 24.8895 "$1,742.66"

. $348.54

31899 Airways surgical

procedure T 0076 10.4689 $732.99 $189.82 $146.60

32035 Thoracostomy w/rib

resection C

32036 Thoracostomy w/flap

drainage C

32095 Biopsy through chest

wall CH D

32096 Open wedge/bx lung

infiltr NI C

32097 Open wedge/bx lung

nodule NI C

32098 Open biopsy of lung

pleura NI C

32100 Exploration of

chest C

32110 Explore/repair

chest C

32120 Re-exploration of

chest C

32124 Explore chest free

adhesions C32140 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 5.5061 $385.52

. $77.11

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 9.6713 $677.15

. $135.43

32402 Open biopsy chest

lining CH D

32405 Percut bx

lung/mediastinum T 0685 9.6713 $677.15

. $135.43

32420 Puncture/clear

lung T 0070 5.5061 $385.52

. $77.11

32421 Thoracentesis for

aspiration T 0070 5.5061 $385.52

. $77.11

32422 Thoracentesis w/tube

insert T 0070 5.5061 $385.52

. $77.11

32440 Remove lung

pneumonectomy C

32442 Sleevepneumonectomy C

32445 Removal of lung

extrapleural 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 CH D

32501 Repair bronchus

add-on C

32503 Resect apical lung

tumor C

32504 Resect apical lung

tum/chest C

32505 Wedge resect of lung

initial NI C

32506 Wedge resect of lung

add-on NI C

32507 Wedge resect of lung

diag NI C

32540 Removal of lung

lesion C

32550 Insert pleural

cath T 0652 30.8430 "$2,159.50"

. $431.90

32551 Insertion of chest

tube T 0070 5.5061 $385.52

. $77.11

32552 Remove lung

catheter S 0078 1.4089 $98.65

. $19.73

32553 Ins mark thor for rt

perq X 0310 13.6332 $954.54 $325.27 $190.9132560 Treat pleurodesis

w/agent T 0070 5.5061 $385.52

. $77.11

32561 Lyse chest fibrin init

day T 0070 5.5061 $385.52

. $77.11

32562 Lyse chest fibrin subq

day T 0070 5.5061 $385.52

. $77.11

32601 Thoracoscopy

diagnostic T 0069 34.5272 "$2,417.46" $591.64 $483.50

32602 Thoracoscopy

diagnostic CH D

32603 Thoracoscopy

diagnostic CH D

32604 Thoracoscopy wbx

sac T 0069 34.5272 "$2,417.46" $591.64 $483.50

32605 Thoracoscopy

diagnostic CH D

32606 Thoracoscopy w/bx med

space T 0069 34.5272 "$2,417.46" $591.64 $483.50

32607 Thoracoscopy w/bx

infiltrate NI T 0069 34.5272 "$2,417.46" $591.64 $483.50

32608 Thoracoscopy w/bx

nodule NI T 0069 34.5272 "$2,417.46" $591.64 $483.50

32609 Thoracoscopy w/bx

pleura NI T 0069 34.5272 "$2,417.46" $591.64 $483.50

32650 Thoracoscopy

w/pleurodesis C

32651 Thoracoscopy remove

cortex C

32652 Thoracoscopy rem totl

cortex C

32653 Thoracoscopy remov

fb/fibrin C

32654 Thoracoscopy contrl

bleeding C

32655 Thoracoscopy resect

bullae C32656 Thoracoscopy

w/pleurectomy C

32657 Thoracoscopy

surgical CH D

32658 Thoracoscopy w/sac fb

remove C

32659 Thoracoscopy w/sac

drainage C

32660 Thoracoscopy

surgical CH D

32661 Thoracoscopy w/pericard

exc C

32662 Thoracoscopy w/mediast

exc C

32663 Thoracoscopy

w/lobectomy C

32664 Thoracoscopy w/ th nrv

exc C

32665 Thoracoscop w/esoph musc

exc C

32666 Thoracoscopy w/wedge

resect NI C

32667 Thoracoscopy w/w resect

addl NI C

32668 Thoracoscopy w/w resect

diag NI C

32669 Thoracoscopy remove

segment NI C

32670 Thoracoscopy

bilobectomy NI C

32671 Thoracoscopy

pneumonectomy NI C

32672 Thoracoscopy for

lvrs NI C

32673 Thoracoscopy w/thymus

resect NI C

32674 Thoracoscopy lymph node

exc NI C

32800 Repair lung

hernia C

32810 Close chest afterdrainage C

32815 Close bronchial

fistula C

32820 Reconstruct injured

chest C

32850 Donor

pneumonectomy C

32851 Lung transplant

single C

32852 Lung transplant with

bypass C

32853 Lung transplant

double C

32854 Lung transplant with

bypass C

32855 Prepare donor lung

single C

32856 Prepare donor lung

double C

32900 Removal of

rib(s) C

32905 Revise & repair chest

wall C

32906 Revise & repair chest

wall C

32940 Revision of

lung C

32960 Therapeutic

pneumothorax T 0070 5.5061 $385.52

. $77.11

32997 Total lung

lavage C

32998 Perq rf ablate tx pul

tumor T 0423 58.4890 "$4,095.17"

. $819.04

32999 Chest surgery

procedure T 0070 5.5061 $385.52

. $77.11

33010 Drainage of heart

sac T 0070 5.5061 $385.52

. $77.11

33011 Repeat drainage of heart

sac T 0070 5.5061 $385.52

. $77.11

33015 Incision of heartsac 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 Resect heart sac

lesion C

33120 Removal of heart

lesion C

33130 Removal of heart

lesion C

33140 Heart revascularize

(tmr) C

33141 Heart tmr w/other

procedure C

33202 Insert epicard eltrd

open C

33203 Insert epicard eltrd

endo C

33206 Insert heart pm

atrial T 0089 112.1218 "$7,850.32" "$1,643.98" "$1,570.07"

33207 Insert heart pm

ventricular T 0089 112.1218 "$7,850.32" "$1,643.98" "$1,570.07"

33208 Insrt heart pm atrial &

vent T 0655 137.6558 "$9,638.11"

. "$1,927.63"

33210 Insert electrd/pm cath

sngl T 0106 47.1769 "$3,303.14"

. $660.63

33211 Insert card electrodes

dual T 0106 47.1769 "$3,303.14"

. $660.63

33212 Insert pulse gen sngl

lead T 0090 94.2220 "$6,597.05" "$1,593.50" "$1,319.41"

33213 Insert pulse gen dual

leads T 0654 103.3418 "$7,235.58"

. "$1,447.12"

33214 Upgrade of pacemaker

system T 0655 137.6558 "$9,638.11"

. "$1,927.63"33215 Reposition pacing-defib

lead T 0105 21.7420 "$1,522.29"

. $304.46

33216 Insert 1 electrode

pm-defib T 0106 47.1769 "$3,303.14"

. $660.63

33217 Insert 2 electrode

pm-defib T 0106 47.1769 "$3,303.14"

. $660.63

33218 Repair lead pace-defib

one T 0105 21.7420 "$1,522.29"

. $304.46

33220 Repair lead pace-defib

dual T 0105 21.7420 "$1,522.29"

. $304.46

33221 Insert pulse gen mult

leads NI T 0654 103.3418 "$7,235.58"

. "$1,447.12"

33222 Revise pocket

pacemaker T 0136 16.7703 "$1,174.19"

. $234.84

33223 Revise pocket for

defib T 0136 16.7703 "$1,174.19"

. $234.84

33224 Insert pacing lead &

connect CH T 0655 137.6558 "$9,638.11"

. "$1,927.63"

33225 L ventric pacing lead

add-on CH Q3 0655 137.6558 "$9,638.11"

. "$1,927.63"

33226 Reposition l ventric

lead T 0105 21.7420 "$1,522.29"

. $304.46

33227 Remove&replace pm gen

singl NI T 0090 94.2220 "$6,597.05" "$1,593.50" "$1,319.41"

33228 Remv&replc pm gen dual

lead NI T 0654 103.3418 "$7,235.58"

. "$1,447.12"

33229 Remv&replc pm gen mult

leads NI T 0654 103.3418 "$7,235.58"

. "$1,447.12"

33230 Insrt pulse gen w/dual

leads NI T 0107 341.5859 "$23,916.48"

. "$4,783.30"

33231 Insrt pulse gen w/mult

leads NI T 0107 341.5859 "$23,916.48"

. "$4,783.30"

33233 Removal of pmgenerator T 0105 21.7420 "$1,522.29"

. $304.46

33234 Removal of pacemaker

system T 0105 21.7420 "$1,522.29"

. $304.46

33235 Removal pacemaker

electrode T 0105 21.7420 "$1,522.29"

. $304.46

33236 Remove

electrode/thoracotomy C

33237 Remove

electrode/thoracotomy C

33238 Remove

electrode/thoracotomy C

33240 Insrt pulse gen w/singl

lead T 0107 341.5859 "$23,916.48"

. "$4,783.30"

33241 Remove pulse

generator T 0105 21.7420 "$1,522.29"

. $304.46

33243 Remove

eltrd/thoracotomy C

33244 Remove eltrd

transven T 0105 21.7420 "$1,522.29"

. $304.46

33249 Nsert pace-defib

w/lead Q3 0108 426.1201 "$29,835.22"

. "$5,967.05"

33250 Ablate heart dysrhythm

focus C

33251 Ablate heart dysrhythm

focus C

33254 Ablate atria

lmtd C

33255 Ablate atria w/o bypass

ext C

33256 Ablate atria w/bypass

exten C

33257 Ablate atria lmtd

add-on C

33258 Ablate atria x10sv

add-on C

33259 Ablate atria w/bypass

add-on C33261 Ablate heart dysrhythm

focus C

33262 Remv&replc cvd gen sing

lead NI T 0107 341.5859 "$23,916.48"

. "$4,783.30"

33263 Remv&replc cvd gen dual

lead NI T 0107 341.5859 "$23,916.48"

. "$4,783.30"

33264 Remv&replc cvd gen mult

lead NI T 0107 341.5859 "$23,916.48"

. "$4,783.30"

33265 Ablate atria lmtd

endo C

33266 Ablate atria x10sv

endo C

33282 Implant pat-active ht

record S 0680 80.3579 "$5,626.34"

. "$1,125.27"

33284 Remove pat-active ht

record T 0020 8.2918 $580.56

. $116.12

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 C33403 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

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 C33468 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

33508 Endoscopic vein

harvest N

33510 Cabg vein

single C

33511 Cabg vein

two C

33512 Cabg vein

three C

33513 Cabg vein

four C33514 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 C33610 Repair by

enlargement C

33611 Repair double

ventricle C

33612 Repair double

ventricle C

33615 Repair modified

fontan C

33617 Repair single

ventricle C

33619 Repair single

ventricle C

33620 Apply r&l pulm art

bands C

33621 Transthor cath for

stent C

33622 Redo compl cardiac

anomaly C

33641 Repair heart septum

defect C

33645 Revision of heart

veins C

33647 Repair heart septum

defects C

33660 Repair of heart

defects C

33665 Repair of heart

defects C

33670 Repair of heart

chambers C

33675 Close mult

vsd C

33676 Close mult vsd

w/resection C

33677 Cl mult vsd w/rem pul

band C

33681 Repair heart septum

defect C

33684 Repair heart septum

defect C

33688 Repair heart septum

defect C

33690 Reinforce pulmonaryartery 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 vesselsdefect 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

33782 Nikaidoh

proc C

33783 Nikaidoh proc w/ostia

implt C

33786 Repair arterial

trunk C

33788 Revision of pulmonary

artery C

33800 Aortic

suspension C

33802 Repair vessel

defect C

33803 Repair vessel

defect C

33813 Repair septal

defect C

33814 Repair septal

defect C

33820 Revise major

vessel C

33822 Revise major

vessel C

33824 Revise major

vessel C

33840 Remove aortaconstriction C

33845 Remove aorta

constriction C

33851 Remove aorta

constriction C

33852 Repair septal

defect C

33853 Repair septal

defect C

33860 Ascending aortic

graft C

33863 Ascending aortic

graft C

33864 Ascending aortic

graft C

33870 Transverse aortic 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 pulmonaryartery C

33920 Repair pulmonary

atresia C

33922 Transect pulmonary

artery C

33924 Remove pulmonary

shunt C

33925 Rpr pul art unifocal w/o

cpb C

33926 Repr pul art unifocal

w/cpb C

33930 Removal of donor

heart/lung C

33933 Prepare donor

heart/lung C

33935 Transplantation

heart/lung C

33940 Removal of 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 ventriculardevice C

33978 Remove ventricular

device C

33979 Insert intracorporeal

device C

33980 Remove intracorporeal

device C

33981 Replace vad pump

ext C

33982 Replace vad intra w/o

bp C

33983 Replace vad intra

w/bp C

33999 Cardiac surgery

procedure T 0070 5.5061 $385.52

. $77.11

34001 Removal of artery

clot C

34051 Removal of artery

clot C

34101 Removal of artery

clot T 0088 41.0387 "$2,873.37" $655.18 $574.68

34111 Removal of arm artery

clot T 0088 41.0387 "$2,873.37" $655.18 $574.68

34151 Removal of artery

clot C

34201 Removal of artery

clot T 0088 41.0387 "$2,873.37" $655.18 $574.68

34203 Removal of leg artery

clot T 0088 41.0387 "$2,873.37" $655.18 $574.68

34401 Removal of vein

clot C

34421 Removal of vein

clot T 0088 41.0387 "$2,873.37" $655.18 $574.68

34451 Removal of vein

clot C

34471 Removal of vein

clot T 0088 41.0387 "$2,873.37" $655.18 $574.68

34490 Removal of vein

clot T 0088 41.0387 "$2,873.37" $655.18 $574.6834501 Repair valve femoral

vein T 0088 41.0387 "$2,873.37" $655.18 $574.68

34502 Reconstruct vena

cava C

34510 Transposition of vein

valve T 0088 41.0387 "$2,873.37" $655.18 $574.68

34520 Cross-over vein

graft T 0088 41.0387 "$2,873.37" $655.18 $574.68

34530 Leg vein

fusion T 0088 41.0387 "$2,873.37" $655.18 $574.68

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

34806 Aneurysm press sensor

add-on C

34808 Endovas iliac a device

addon C

34812 Xpose for endoprosth

femorl C

34813 Femoral endovas graft

add-on C

34820 Xpose for endoprosth

iliac C

34825 Endovasc extend prosth

init C

34826 Endovasc exten prosth

addl C

34830 Open aortic tube prosth

repr C

34831 Open aortoiliac prosth

repr C

34832 Open aortofemor prosth

repr C

34833 Xpose for endoprosthiliac C

34834 Xpose endoprosth

brachial C

34900 Endovasc iliac repr

w/graft C

35001 Repair defect of

artery C

35002 Repair artery rupture

neck C

35005 Repair defect of

artery C

35011 Repair defect of

artery T 0653 43.8023 "$3,066.86"

. $613.38

35013 Repair artery rupture

arm C

35021 Repair defect of

artery C

35022 Repair artery rupture

chest C

35045 Repair defect of arm

artery CH T 0093 31.1505 "$2,181.03"

. $436.21

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 C35132 Repair artery rupture

groin C

35141 Repair defect of

artery C

35142 Repair artery rupture

thigh C

35151 Repair defect of

artery C

35152 Repair artery rupture

knee C

35180 Repair blood vessel

lesion T 0093 31.1505 "$2,181.03"

. $436.21

35182 Repair blood vessel

lesion C

35184 Repair blood vessel

lesion T 0093 31.1505 "$2,181.03"

. $436.21

35188 Repair blood vessel

lesion T 0088 41.0387 "$2,873.37" $655.18 $574.68

35189 Repair blood vessel

lesion C

35190 Repair blood vessel

lesion T 0093 31.1505 "$2,181.03"

. $436.21

35201 Repair blood vessel

lesion T 0093 31.1505 "$2,181.03"

. $436.21

35206 Repair blood vessel

lesion T 0093 31.1505 "$2,181.03"

. $436.21

35207 Repair blood vessel

lesion T 0088 41.0387 "$2,873.37" $655.18 $574.68

35211 Repair blood vessel

lesion C

35216 Repair blood vessel

lesion C

35221 Repair blood vessel

lesion C

35226 Repair blood vessel

lesion T 0020 8.2918 $580.56

. $116.12

35231 Repair blood vessel

lesion T 0093 31.1505 "$2,181.03"

. $436.2135236 Repair blood vessel

lesion T 0093 31.1505 "$2,181.03"

. $436.21

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 31.1505 "$2,181.03"

. $436.21

35261 Repair blood vessel

lesion T 0653 43.8023 "$3,066.86"

. $613.38

35266 Repair blood vessel

lesion T 0653 43.8023 "$3,066.86"

. $613.38

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 43.8023 "$3,066.86"

. $613.38

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 31.1505 "$2,181.03"

. $436.21

35331 Rechanneling of

artery C35341 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

35458 Repair arterial

blockage T 0083 65.8519 "$4,610.69"

. $922.14

35460 Repair venous

blockage T 0083 65.8519 "$4,610.69"

. $922.14

35471 Repair arterial

blockage T 0083 65.8519 "$4,610.69"

. $922.14

35472 Repair arterial

blockage T 0083 65.8519 "$4,610.69"

. $922.14

35475 Repair arterial

blockage T 0083 65.8519 "$4,610.69"

. $922.14

35476 Repair venous

blockage T 0083 65.8519 "$4,610.69"

. $922.14

35500 Harvest vein for

bypass T 0103 16.3852 "$1,147.23"

. $229.45

35501 Artery bypass

graft C

35506 Artery bypassgraft 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

35523 Artery bypass

graft C

35525 Artery bypass

graft C

35526 Artery bypass

graft C

35531 Artery bypass

graft C

35533 Artery bypass

graft C

35535 Artery bypass

graft C

35536 Artery bypass

graft C

35537 Artery bypass

graft C

35538 Artery bypass

graft C

35539 Artery bypass

graft C

35540 Artery bypass

graft C

35548 Artery bypassgraft CH D

35549 Artery bypass

graft CH D

35551 Artery bypass

graft CH D

35556 Artery bypass

graft C

35558 Artery bypass

graft C

35560 Artery bypass

graft C

35563 Artery bypass

graft C

35565 Artery bypass

graft C

35566 Artery bypass

graft C

35570 Artery bypass

graft C

35571 Artery bypass

graft C

35572 Harvest femoropopliteal

vein N

35583 Vein bypass

graft C

35585 Vein bypass

graft C

35587 Vein bypass

graft C

35600 Harvest art for cabg

add-on C

35601 Artery bypass

graft C

35606 Artery bypass

graft C

35612 Artery bypass

graft C

35616 Artery bypass

graft C

35621 Artery bypass

graft C

35623 Bypass graft not

vein C

35626 Artery bypassgraft C

35631 Artery bypass

graft C

35632 Artery bypass

graft C

35633 Artery bypass

graft C

35634 Artery bypass

graft C

35636 Artery bypass

graft C

35637 Artery bypass

graft C

35638 Artery bypass

graft C

35642 Artery bypass

graft C

35645 Artery bypass

graft C

35646 Artery bypass

graft C

35647 Artery bypass

graft C

35650 Artery bypass

graft C

35651 Artery bypass

graft CH D

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 bypassgraft C

35683 Composite bypass

graft C

35685 Bypass graft

patency/patch T 0093 31.1505 "$2,181.03"

. $436.21

35686 Bypass graft/av fist

patency T 0093 31.1505 "$2,181.03"

. $436.21

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

35761 Exploration of

artery/vein T 0093 31.1505 "$2,181.03"

. $436.21

35800 Explore neck

vessels C

35820 Explore chest

vessels C

35840 Explore abdominal

vessels C

35860 Explore limb

vessels T 0093 31.1505 "$2,181.03"

. $436.21

35870 Repair vessel graft

defect C

35875 Removal of clot in

graft T 0088 41.0387 "$2,873.37" $655.18 $574.6835876 Removal of clot in

graft T 0088 41.0387 "$2,873.37" $655.18 $574.68

35879 Revise graft

w/vein T 0088 41.0387 "$2,873.37" $655.18 $574.68

35881 Revise graft

w/vein T 0088 41.0387 "$2,873.37" $655.18 $574.68

35883 Revise graft w/nonauto

graft T 0088 41.0387 "$2,873.37" $655.18 $574.68

35884 Revise graft

w/vein T 0088 41.0387 "$2,873.37" $655.18 $574.68

35901 Excision graft

neck C

35903 Excision graft

extremity T 0093 31.1505 "$2,181.03"

. $436.21

35905 Excision graft

thorax C

35907 Excision graft

abdomen C

36000 Place needle in

vein N

36002 Pseudoaneurysm injection

trt S 0267 2.1681 $151.80 $59.37 $30.36

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 N36120 Establish access to

artery N

36140 Establish access to

artery N

36147 Access av dial grft for

eval CH T 0668 9.4045 $658.47

. $131.70

36148 Access av dial grft for

proc N

36160 Establish access to

aorta N

36200 Place catheter in

aorta N

36215 Place catheter in

artery N

36216 Place catheter in

artery N

36217 Place catheter in

artery N

36218 Place catheter in

artery N

36245 Ins cath abd/l-ext art

1st N

36246 Ins cath abd/l-ext art

2nd N

36247 Ins cath abd/l-ext art

3rd N

36248 Ins cath abd/l-ext art

addl N

36251 Ins cath ren art 1st

unilat NI Q2 0279 29.7209 "$2,080.94"

. $416.19

36252 Ins cath ren art 1st

bilat NI Q2 0279 29.7209 "$2,080.94"

. $416.19

36253 Ins cath ren art 2nd+

unilat NI Q2 0279 29.7209 "$2,080.94"

. $416.19

36254 Ins cath ren art 2nd+

bilat NI Q2 0279 29.7209 "$2,080.94"

. $416.19

36260 Insertion of infusion

pump T 0623 30.3507 "$2,125.03"

. $425.01

36261 Revision of infusion

pump T 0105 21.7420 "$1,522.29"

. $304.4636262 Removal of infusion

pump T 0105 21.7420 "$1,522.29"

. $304.46

36299 Vessel injection

procedure N

36400 Bl draw < 3 yrs

fem/jugular N

36405 Bl draw < 3 yrs scalp

vein N

36406 Bl draw < 3 yrs other

vein N

36410 Non-routine bl draw > 3

yrs N

36415 Routine

venipuncture A

36416 Capillary blood

draw N

36420 Vein access cutdown < 1

yr X 0035 0.2673 $18.72

. $3.75

36425 Vein access cutdown > 1

yr X 0035 0.2673 $18.72

. $3.75

36430 Blood transfusion

service S 0110 3.4217 $239.57

. $47.92

36440 Bl push transfuse 2 yr or

< S 0110 3.4217 $239.57

. $47.92

36450 Bl exchange/transfuse

nb S 0110 3.4217 $239.57

. $47.92

36455 Bl exchange/transfuse

non-nb S 0110 3.4217 $239.57

. $47.92

36460 Transfusion service

fetal S 0110 3.4217 $239.57

. $47.92

36468 Injection(s) spider

veins T 0013 0.8768 $61.39

. $12.28

36469 Injection(s) spider

veins CH T 0015 1.4966 $104.79

. $20.96

36470 Injection therapy of

vein CH T 0015 1.4966 $104.79

. $20.9636471 Injection therapy of

veins CH T 0015 1.4966 $104.79

. $20.96

36475 Endovenous rf 1st

vein T 0091 44.2272 "$3,096.61"

. $619.33

36476 Endovenous rf vein

add-on T 0092 26.8120 "$1,877.27"

. $375.46

36478 Endovenous laser 1st

vein T 0092 26.8120 "$1,877.27"

. $375.46

36479 Endovenous laser vein

addon T 0092 26.8120 "$1,877.27"

. $375.46

36481 Insertion of catheter

vein N

36500 Insertion of catheter

vein N

36510 Insertion of catheter

vein N

36511 Apheresis

wbc S 0111 11.6629 $816.59 $189.89 $163.32

36512 Apheresis

rbc S 0111 11.6629 $816.59 $189.89 $163.32

36513 Apheresis

platelets S 0111 11.6629 $816.59 $189.89 $163.32

36514 Apheresis

plasma S 0111 11.6629 $816.59 $189.89 $163.32

36515 Apheresis

adsorp/reinfuse S 0112 35.6252 "$2,494.33"

. $498.87

36516 Apheresis

selective S 0112 35.6252 "$2,494.33"

. $498.87

36522 Photopheresis S 0112 35.6252 "$2,494.33"

. $498.87

36555 Insert non-tunnel cv

cath T 0621 11.0639 $774.65

. $154.93

36556 Insert non-tunnel cv

cath T 0621 11.0639 $774.65

. $154.9336557 Insert tunneled cv

cath T 0622 25.2672 "$1,769.11"

. $353.83

36558 Insert tunneled cv

cath T 0622 25.2672 "$1,769.11"

. $353.83

36560 Insert tunneled cv

cath T 0623 30.3507 "$2,125.03"

. $425.01

36561 Insert tunneled cv

cath T 0623 30.3507 "$2,125.03"

. $425.01

36563 Insert tunneled cv

cath T 0623 30.3507 "$2,125.03"

. $425.01

36565 Insert tunneled cv

cath T 0623 30.3507 "$2,125.03"

. $425.01

36566 Insert tunneled cv

cath T 0623 30.3507 "$2,125.03"

. $425.01

36568 Insert picc

cath T 0621 11.0639 $774.65

. $154.93

36569 Insert picc

cath T 0621 11.0639 $774.65

. $154.93

36570 Insert picvad

cath T 0622 25.2672 "$1,769.11"

. $353.83

36571 Insert picvad

cath T 0622 25.2672 "$1,769.11"

. $353.83

36575 Repair tunneled cv

cath T 0121 6.2123 $434.96

. $87.00

36576 Repair tunneled cv

cath T 0621 11.0639 $774.65

. $154.93

36578 Replace tunneled cv

cath T 0622 25.2672 "$1,769.11"

. $353.83

36580 Replace cvad

cath T 0621 11.0639 $774.65

. $154.93

36581 Replace tunneled cv

cath T 0622 25.2672 "$1,769.11"

. $353.83

36582 Replace tunneled cv

cath T 0623 30.3507 "$2,125.03"

. $425.0136583 Replace tunneled cv

cath T 0623 30.3507 "$2,125.03"

. $425.01

36584 Replace picc

cath T 0621 11.0639 $774.65

. $154.93

36585 Replace picvad

cath T 0622 25.2672 "$1,769.11"

. $353.83

36589 Removal tunneled cv

cath T 0121 6.2123 $434.96

. $87.00

36590 Removal tunneled cv

cath T 0621 11.0639 $774.65

. $154.93

36591 Draw blood off venous

device Q1 0624 0.6068 $42.49 $12.33 $8.50

36592 Collect blood from

picc Q1 0624 0.6068 $42.49 $12.33 $8.50

36593 Declot vascular

device T 0676 2.3021 $161.18

. $32.24

36595 Mech remov tunneled cv

cath T 0622 25.2672 "$1,769.11"

. $353.83

36596 Mech remov tunneled cv

cath T 0621 11.0639 $774.65

. $154.93

36597 Reposition venous

catheter T 0621 11.0639 $774.65

. $154.93

36598 Inj w/fluor eval cv

device T 0676 2.3021 $161.18

. $32.24

36600 Withdrawal of arterial

blood Q3 0035 0.2673 $18.72

. $3.75

36620 Insertion catheter

artery N

36625 Insertion catheter

artery N

36640 Insertion catheter

artery T 0623 30.3507 "$2,125.03"

. $425.01

36660 Insertion catheter

artery C36680 Insert needle bone

cavity T 0002 1.6118 $112.85

. $22.57

36800 Insertion of

cannula T 0115 37.4593 "$2,622.75"

. $524.55

36810 Insertion of

cannula T 0115 37.4593 "$2,622.75"

. $524.55

36815 Insertion of

cannula T 0115 37.4593 "$2,622.75"

. $524.55

36818 Av fuse uppr arm

cephalic T 0088 41.0387 "$2,873.37" $655.18 $574.68

36819 Av fuse uppr arm

basilic T 0088 41.0387 "$2,873.37" $655.18 $574.68

36820 Av fusion/forearm

vein T 0088 41.0387 "$2,873.37" $655.18 $574.68

36821 Av fusion direct any

site T 0088 41.0387 "$2,873.37" $655.18 $574.68

36822 Insertion of

cannula(s) C

36823 Insertion of

cannula(s) C

36825 Artery-vein

autograft T 0088 41.0387 "$2,873.37" $655.18 $574.68

36830 Artery-vein

nonautograft T 0088 41.0387 "$2,873.37" $655.18 $574.68

36831 Open thrombect av

fistula T 0088 41.0387 "$2,873.37" $655.18 $574.68

36832 Av fistula revision

open T 0088 41.0387 "$2,873.37" $655.18 $574.68

36833 Av fistula

revision T 0088 41.0387 "$2,873.37" $655.18 $574.68

36835 Artery to vein

shunt T 0115 37.4593 "$2,622.75"

. $524.55

36838 Dist revas ligation

hemo T 0088 41.0387 "$2,873.37" $655.18 $574.6836860 External cannula

declotting T 0676 2.3021 $161.18

. $32.24

36861 Cannula

declotting T 0115 37.4593 "$2,622.75"

. $524.55

36870 Percut thrombect av

fistula T 0653 43.8023 "$3,066.86"

. $613.38

37140 Revision of

circulation C

37145 Revision of

circulation C

37160 Revision of

circulation C

37180 Revision of

circulation C

37181 Splice spleen/kidney

veins C

37182 Insert hepatic shunt

(tips) C

37183 Remove hepatic shunt

(tips) T 0229 115.5014 "$8,086.95"

. "$1,617.39"

37184 Prim art mech

thrombectomy T 0088 41.0387 "$2,873.37" $655.18 $574.68

37185 Prim art m-thrombect

add-on T 0088 41.0387 "$2,873.37" $655.18 $574.68

37186 Sec art m-thrombect

add-on T 0088 41.0387 "$2,873.37" $655.18 $574.68

37187 Venous mech

thrombectomy T 0088 41.0387 "$2,873.37" $655.18 $574.68

37188 Venous m-thrombectomy

add-on T 0088 41.0387 "$2,873.37" $655.18 $574.68

37191 Ins endovas vena cava

filtr NI T 0091 44.2272 "$3,096.61"

. $619.33

37192 Redo endovas vena cava

filtr NI T 0623 30.3507 "$2,125.03"

. $425.0137193 Rem endovas vena cava

filter NI T 0623 30.3507 "$2,125.03"

. $425.01

37195 Thrombolytic therapy

stroke T 0676 2.3021 $161.18

. $32.24

37200 Transcatheter

biopsy T 0623 30.3507 "$2,125.03"

. $425.01

37201 Transcatheter therapy

infuse T 0103 16.3852 "$1,147.23"

. $229.45

37202 Transcatheter therapy

infuse T 0103 16.3852 "$1,147.23"

. $229.45

37203 Transcatheter

retrieval T 0623 30.3507 "$2,125.03"

. $425.01

37204 Transcatheter

occlusion T 0082 105.0651 "$7,356.24"

. "$1,471.25"

37205 Transcath iv stent

percut T 0229 115.5014 "$8,086.95"

. "$1,617.39"

37206 Transcath iv stent/perc

addl T 0229 115.5014 "$8,086.95"

. "$1,617.39"

37207 Transcath iv stent

open T 0229 115.5014 "$8,086.95"

. "$1,617.39"

37208 Transcath iv stent/open

addl T 0229 115.5014 "$8,086.95"

. "$1,617.39"

37209 Change iv cath at thromb

tx T 0623 30.3507 "$2,125.03"

. $425.01

37210 Embolization uterine

fibroid T 0229 115.5014 "$8,086.95"

. "$1,617.39"

37215 Transcath stent cca

w/eps C

37216 Transcath stent cca w/o

eps E

37220 Iliac

revasc T 0083 65.8519 "$4,610.69"

. $922.14

37221 Iliac revasc

w/stent CH T 0229 115.5014 "$8,086.95"

. "$1,617.39"37222 Iliac revasc

add-on T 0083 65.8519 "$4,610.69"

. $922.14

37223 Iliac revasc w/stent

add-on T 0083 65.8519 "$4,610.69"

. $922.14

37224 Fem/popl revas

w/tla T 0083 65.8519 "$4,610.69"

. $922.14

37225 Fem/popl revas

w/ather T 0229 115.5014 "$8,086.95"

. "$1,617.39"

37226 Fem/popl revasc

w/stent T 0229 115.5014 "$8,086.95"

. "$1,617.39"

37227 Fem/popl revasc stnt &

ather T 0319 203.0553 "$14,217.12" "$5,559.48" "$2,843.43"

37228 Tib/per revasc

w/tla T 0083 65.8519 "$4,610.69"

. $922.14

37229 Tib/per revasc

w/ather T 0229 115.5014 "$8,086.95"

. "$1,617.39"

37230 Tib/per revasc

w/stent T 0229 115.5014 "$8,086.95"

. "$1,617.39"

37231 Tib/per revasc stent &

ather T 0319 203.0553 "$14,217.12" "$5,559.48" "$2,843.43"

37232 Tib/per revasc

add-on T 0083 65.8519 "$4,610.69"

. $922.14

37233 Tibper revasc w/ather

add-on T 0229 115.5014 "$8,086.95"

. "$1,617.39"

37234 Revsc opn/prq tib/pero

stent T 0083 65.8519 "$4,610.69"

. $922.14

37235 Tib/per revasc stnt &

ather T 0083 65.8519 "$4,610.69"

. $922.14

37250 Iv us first vessel

add-on N

37251 Iv us each add vessel

add-on N

37500 Endoscopy ligate perf

veins T 0091 44.2272 "$3,096.61"

. $619.3337501 Vascular endoscopy

procedure T 0092 26.8120 "$1,877.27"

. $375.46

37565 Ligation of neck

vein T 0093 31.1505 "$2,181.03"

. $436.21

37600 Ligation of neck

artery T 0093 31.1505 "$2,181.03"

. $436.21

37605 Ligation of neck

artery T 0091 44.2272 "$3,096.61"

. $619.33

37606 Ligation of neck

artery T 0092 26.8120 "$1,877.27"

. $375.46

37607 Ligation of a-v

fistula T 0092 26.8120 "$1,877.27"

. $375.46

37609 Temporal artery

procedure T 0021 16.9957 "$1,189.97"

. $238.00

37615 Ligation of neck

artery T 0092 26.8120 "$1,877.27"

. $375.46

37616 Ligation of chest

artery C

37617 Ligation of abdomen

artery C

37618 Ligation of extremity

artery C

37619 Ligation of inf vena

cava NI T 0091 44.2272 "$3,096.61"

. $619.33

37620 Revision of major

vein CH D

37650 Revision of major

vein T 0092 26.8120 "$1,877.27"

. $375.46

37660 Revision of major

vein C

37700 Revise leg

vein T 0092 26.8120 "$1,877.27"

. $375.46

37718 Ligate/strip short leg

vein T 0092 26.8120 "$1,877.27"

. $375.46

37722 Ligate/strip long leg

vein T 0091 44.2272 "$3,096.61"

. $619.3337735 Removal of leg

veins/lesion T 0091 44.2272 "$3,096.61"

. $619.33

37760 Ligate leg veins

radical T 0092 26.8120 "$1,877.27"

. $375.46

37761 Ligate leg veins

open T 0092 26.8120 "$1,877.27"

. $375.46

37765 Stab phleb veins xtr

10-20 T 0092 26.8120 "$1,877.27"

. $375.46

37766 Phleb veins - extrem

20+ T 0092 26.8120 "$1,877.27"

. $375.46

37780 Revision of leg

vein T 0092 26.8120 "$1,877.27"

. $375.46

37785 Ligate/divide/excise

vein T 0092 26.8120 "$1,877.27"

. $375.46

37788 Revascularization

penis C

37790 Penile venous

occlusion T 0181 34.6069 "$2,423.04" $607.60 $484.61

37799 Vascular surgery

procedure X 0624 0.6068 $42.49 $12.33 $8.50

38100 Removal of spleen

total C

38101 Removal of spleen

partial C

38102 Removal of spleen

total C

38115 Repair of ruptured

spleen C

38120 Laparoscopy

splenectomy T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

38129 Laparoscope proc

spleen T 0130 38.9223 "$2,725.18" $659.53 $545.04

38200 Injection for spleen

x-ray N

38204 Bl donor search

management N38205 Harvest allogenic stem

cells B

38206 Harvest auto stem

cells S 0111 11.6629 $816.59 $189.89 $163.32

38207 Cryopreserve stem

cells S 0110 3.4217 $239.57

. $47.92

38208 Thaw preserved stem

cells S 0110 3.4217 $239.57

. $47.92

38209 Wash harvest stem

cells S 0110 3.4217 $239.57

. $47.92

38210 T-cell depletion of

harvest S 0393 6.9196 $484.48

. $96.90

38211 Tumor cell deplete of

harvst S 0393 6.9196 $484.48

. $96.90

38212 Rbc depletion of

harvest S 0393 6.9196 $484.48

. $96.90

38213 Platelet deplete of

harvest S 0393 6.9196 $484.48

. $96.90

38214 Volume deplete of

harvest S 0393 6.9196 $484.48

. $96.90

38215 Harvest stem cell

concentrte S 0393 6.9196 $484.48

. $96.90

38220 Bone marrow

aspiration T 0003 3.5548 $248.89

. $49.78

38221 Bone marrow

biopsy T 0003 3.5548 $248.89

. $49.78

38230 Bone marrow harvest

allogen S 0112 35.6252 "$2,494.33"

. $498.87

38232 Bone marrow harvest

autolog NI S 0112 35.6252 "$2,494.33"

. $498.87

38240 Bn marrow/stm transplt

allo S 0112 35.6252 "$2,494.33"

. $498.87

38241 Bn marrow/stm transplt

auto S 0112 35.6252 "$2,494.33"

. $498.8738242 Lymphocyte infuse

transplant S 0111 11.6629 $816.59 $189.89 $163.32

38300 Drainage lymph node

lesion T 0007 12.8082 $896.78

. $179.36

38305 Drainage lymph node

lesion T 0008 20.5510 "$1,438.90"

. $287.78

38308 Incision of lymph

channels T 0113 25.2738 "$1,769.57"

. $353.92

38380 Thoracic duct

procedure C

38381 Thoracic duct

procedure C

38382 Thoracic duct

procedure C

38500 Biopsy/removal lymph

nodes T 0113 25.2738 "$1,769.57"

. $353.92

38505 Needle biopsy lymph

nodes T 0005 8.1596 $571.30

. $114.26

38510 Biopsy/removal lymph

nodes T 0113 25.2738 "$1,769.57"

. $353.92

38520 Biopsy/removal lymph

nodes T 0113 25.2738 "$1,769.57"

. $353.92

38525 Biopsy/removal lymph

nodes T 0113 25.2738 "$1,769.57"

. $353.92

38530 Biopsy/removal lymph

nodes T 0113 25.2738 "$1,769.57"

. $353.92

38542 Explore deep node(s)

neck T 0114 51.2792 "$3,590.36"

. $718.08

38550 Removal neck/armpit

lesion T 0113 25.2738 "$1,769.57"

. $353.92

38555 Removal neck/armpit

lesion T 0113 25.2738 "$1,769.57"

. $353.92

38562 Removal pelvic lymph

nodes C38564 Removal abdomen lymph

nodes C

38570 Laparoscopy lymph node

biop T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

38571 Laparoscopy

lymphadenectomy T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

38572 Laparoscopy

lymphadenectomy T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

38589 Laparoscope proc

lymphatic T 0130 38.9223 "$2,725.18" $659.53 $545.04

38700 Removal of lymph nodes

neck T 0113 25.2738 "$1,769.57"

. $353.92

38720 Removal of lymph nodes

neck T 0113 25.2738 "$1,769.57"

. $353.92

38724 Removal of lymph nodes

neck C

38740 Remove armpit lymph

nodes T 0114 51.2792 "$3,590.36"

. $718.08

38745 Remove armpit lymph

nodes T 0114 51.2792 "$3,590.36"

. $718.08

38746 Remove thoracic lymph

nodes C

38747 Remove abdominal lymph

nodes C

38760 Remove groin lymph

nodes T 0113 25.2738 "$1,769.57"

. $353.92

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 Ra tracer id of sentinl

node Q1 0392 2.2892 $160.28 $39.07 $32.06

38794 Access thoracic lymph

duct N38900 Io map of sent lymph

node N

38999 Blood/lymph system

procedure S 0110 3.4217 $239.57

. $47.92

39000 Exploration of

chest C

39010 Exploration of

chest C

39200 Resect mediastinal

cyst C

39220 Resect mediastinal

tumor C

39400 Mediastinoscopy incl

biopsy T 0069 34.5272 "$2,417.46" $591.64 $483.50

39499 Chest

procedure C

39501 Repair diaphragm

laceration C

39503 Repair of diaphragm

hernia C

39540 Repair of diaphragm

hernia C

39541 Repair of diaphragm

hernia C

39545 Revision of

diaphragm C

39560 Resect diaphragm

simple C

39561 Resect diaphragm

complex C

39599 Diaphragm surgery

procedure C

40490 Biopsy of

lip T 0251 3.1150 $218.10

. $43.62

40500 Partial excision of

lip T 0253 16.8699 "$1,181.16" $279.20 $236.24

40510 Partial excision of

lip T 0254 24.8895 "$1,742.66"

. $348.54

40520 Partial excision of

lip T 0253 16.8699 "$1,181.16" $279.20 $236.2440525 Reconstruct lip with

flap T 0254 24.8895 "$1,742.66"

. $348.54

40527 Reconstruct lip with

flap T 0254 24.8895 "$1,742.66"

. $348.54

40530 Partial removal of

lip T 0254 24.8895 "$1,742.66"

. $348.54

40650 Repair

lip T 0252 7.4614 $522.42 $104.55 $104.49

40652 Repair

lip T 0252 7.4614 $522.42 $104.55 $104.49

40654 Repair

lip T 0252 7.4614 $522.42 $104.55 $104.49

40700 Repair cleft

lip/nasal T 0256 45.0377 "$3,153.36"

. $630.68

40701 Repair cleft

lip/nasal T 0256 45.0377 "$3,153.36"

. $630.68

40702 Repair cleft

lip/nasal T 0256 45.0377 "$3,153.36"

. $630.68

40720 Repair cleft

lip/nasal T 0256 45.0377 "$3,153.36"

. $630.68

40761 Repair cleft

lip/nasal T 0256 45.0377 "$3,153.36"

. $630.68

40799 Lip surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.00

40800 Drainage of mouth

lesion T 0006 1.4209 $99.49

. $19.90

40801 Drainage of mouth

lesion T 0252 7.4614 $522.42 $104.55 $104.49

40804 Removal foreign body

mouth X 0340 0.6499 $45.50

. $9.10

40805 Removal foreign body

mouth T 0252 7.4614 $522.42 $104.55 $104.49

40806 Incision of lipfold T 0251 3.1150 $218.10

. $43.62

40808 Biopsy of mouth

lesion T 0251 3.1150 $218.10

. $43.62

40810 Excision of mouth

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

40812 Excise/repair mouth

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

40814 Excise/repair mouth

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

40816 Excision of mouth

lesion T 0254 24.8895 "$1,742.66"

. $348.54

40818 Excise oral mucosa for

graft T 0251 3.1150 $218.10

. $43.62

40819 Excise lip or cheek

fold T 0252 7.4614 $522.42 $104.55 $104.49

40820 Treatment of mouth

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

40830 Repair mouth

laceration T 0251 3.1150 $218.10

. $43.62

40831 Repair mouth

laceration T 0252 7.4614 $522.42 $104.55 $104.49

40840 Reconstruction of

mouth T 0254 24.8895 "$1,742.66"

. $348.54

40842 Reconstruction of

mouth T 0254 24.8895 "$1,742.66"

. $348.54

40843 Reconstruction of

mouth T 0254 24.8895 "$1,742.66"

. $348.54

40844 Reconstruction of

mouth T 0256 45.0377 "$3,153.36"

. $630.68

40845 Reconstruction of

mouth T 0256 45.0377 "$3,153.36"

. $630.68

40899 Mouth surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.0041000 Drainage of mouth

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

41005 Drainage of mouth

lesion T 0251 3.1150 $218.10

. $43.62

41006 Drainage of mouth

lesion T 0254 24.8895 "$1,742.66"

. $348.54

41007 Drainage of mouth

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

41008 Drainage of mouth

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

41009 Drainage of mouth

lesion T 0251 3.1150 $218.10

. $43.62

41010 Incision of tongue

fold T 0252 7.4614 $522.42 $104.55 $104.49

41015 Drainage of mouth

lesion T 0251 3.1150 $218.10

. $43.62

41016 Drainage of mouth

lesion T 0252 7.4614 $522.42 $104.55 $104.49

41017 Drainage of mouth

lesion T 0252 7.4614 $522.42 $104.55 $104.49

41018 Drainage of mouth

lesion T 0252 7.4614 $522.42 $104.55 $104.49

41019 Place needles h&n for

rt T 0254 24.8895 "$1,742.66"

. $348.54

41100 Biopsy of

tongue T 0252 7.4614 $522.42 $104.55 $104.49

41105 Biopsy of

tongue T 0253 16.8699 "$1,181.16" $279.20 $236.24

41108 Biopsy of floor of

mouth T 0019 4.3953 $307.74

. $61.55

41110 Excision of tongue

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

41112 Excision of tonguelesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

41113 Excision of tongue

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

41114 Excision of tongue

lesion T 0254 24.8895 "$1,742.66"

. $348.54

41115 Excision of tongue

fold T 0252 7.4614 $522.42 $104.55 $104.49

41116 Excision of mouth

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

41120 Partial removal of

tongue T 0254 24.8895 "$1,742.66"

. $348.54

41130 Partial removal of

tongue C

41135 Tongue and neck

surgery C

41140 Removal of

tongue C

41145 Tongue removal neck

surgery C

41150 Tongue mouth jaw

surgery C

41153 Tongue mouth neck

surgery C

41155 Tongue jaw & neck

surgery C

41250 Repair tongue

laceration T 0250 1.0709 $74.98 $24.12 $15.00

41251 Repair tongue

laceration T 0251 3.1150 $218.10

. $43.62

41252 Repair tongue

laceration T 0252 7.4614 $522.42 $104.55 $104.49

41500 Fixation of

tongue T 0254 24.8895 "$1,742.66"

. $348.54

41510 Tongue to lip

surgery T 0253 16.8699 "$1,181.16" $279.20 $236.24

41512 Tongue

suspension T 0252 7.4614 $522.42 $104.55 $104.4941520 Reconstruction tongue

fold T 0252 7.4614 $522.42 $104.55 $104.49

41530 Tongue base vol

reduction T 0254 24.8895 "$1,742.66"

. $348.54

41599 Tongue and mouth

surgery T 0250 1.0709 $74.98 $24.12 $15.00

41800 Drainage of gum

lesion T 0006 1.4209 $99.49

. $19.90

41805 Removal foreign body

gum T 0254 24.8895 "$1,742.66"

. $348.54

41806 Removal foreign body

jawbone T 0253 16.8699 "$1,181.16" $279.20 $236.24

41820 Excision gum each

quadrant T 0252 7.4614 $522.42 $104.55 $104.49

41821 Excision of gum

flap T 0252 7.4614 $522.42 $104.55 $104.49

41822 Excision of gum

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

41823 Excision of gum

lesion T 0254 24.8895 "$1,742.66"

. $348.54

41825 Excision of gum

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

41826 Excision of gum

lesion T 0254 24.8895 "$1,742.66"

. $348.54

41827 Excision of gum

lesion T 0254 24.8895 "$1,742.66"

. $348.54

41828 Excision of gum

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

41830 Removal of gum

tissue T 0253 16.8699 "$1,181.16" $279.20 $236.24

41850 Treatment of gum

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.2441870 Gum

graft T 0254 24.8895 "$1,742.66"

. $348.54

41872 Repair

gum T 0253 16.8699 "$1,181.16" $279.20 $236.24

41874 Repair tooth

socket T 0254 24.8895 "$1,742.66"

. $348.54

41899 Dental surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.00

42000 Drainage mouth roof

lesion T 0251 3.1150 $218.10

. $43.62

42100 Biopsy roof of

mouth T 0252 7.4614 $522.42 $104.55 $104.49

42104 Excision lesion mouth

roof T 0253 16.8699 "$1,181.16" $279.20 $236.24

42106 Excision lesion mouth

roof T 0253 16.8699 "$1,181.16" $279.20 $236.24

42107 Excision lesion mouth

roof T 0254 24.8895 "$1,742.66"

. $348.54

42120 Remove

palate/lesion T 0256 45.0377 "$3,153.36"

. $630.68

42140 Excision of

uvula T 0252 7.4614 $522.42 $104.55 $104.49

42145 Repair palate

pharynx/uvula T 0254 24.8895 "$1,742.66"

. $348.54

42160 Treatment mouth roof

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

42180 Repair

palate T 0251 3.1150 $218.10

. $43.62

42182 Repair

palate T 0256 45.0377 "$3,153.36"

. $630.68

42200 Reconstruct cleft

palate T 0256 45.0377 "$3,153.36"

. $630.68

42205 Reconstruct cleft

palate T 0256 45.0377 "$3,153.36"

. $630.6842210 Reconstruct cleft

palate T 0256 45.0377 "$3,153.36"

. $630.68

42215 Reconstruct cleft

palate T 0256 45.0377 "$3,153.36"

. $630.68

42220 Reconstruct cleft

palate T 0256 45.0377 "$3,153.36"

. $630.68

42225 Reconstruct cleft

palate T 0256 45.0377 "$3,153.36"

. $630.68

42226 Lengthening of

palate T 0256 45.0377 "$3,153.36"

. $630.68

42227 Lengthening of

palate T 0256 45.0377 "$3,153.36"

. $630.68

42235 Repair

palate T 0253 16.8699 "$1,181.16" $279.20 $236.24

42260 Repair nose to lip

fistula T 0254 24.8895 "$1,742.66"

. $348.54

42280 Preparation palate

mold T 0251 3.1150 $218.10

. $43.62

42281 Insertion palate

prosthesis T 0253 16.8699 "$1,181.16" $279.20 $236.24

42299 Palate/uvula

surgery T 0250 1.0709 $74.98 $24.12 $15.00

42300 Drainage of salivary

gland T 0253 16.8699 "$1,181.16" $279.20 $236.24

42305 Drainage of salivary

gland T 0253 16.8699 "$1,181.16" $279.20 $236.24

42310 Drainage of salivary

gland T 0251 3.1150 $218.10

. $43.62

42320 Drainage of salivary

gland T 0251 3.1150 $218.10

. $43.62

42330 Removal of salivary

stone T 0253 16.8699 "$1,181.16" $279.20 $236.2442335 Removal of salivary

stone T 0253 16.8699 "$1,181.16" $279.20 $236.24

42340 Removal of salivary

stone T 0253 16.8699 "$1,181.16" $279.20 $236.24

42400 Biopsy of salivary

gland T 0005 8.1596 $571.30

. $114.26

42405 Biopsy of salivary

gland T 0254 24.8895 "$1,742.66"

. $348.54

42408 Excision of salivary

cyst T 0253 16.8699 "$1,181.16" $279.20 $236.24

42409 Drainage of salivary

cyst T 0253 16.8699 "$1,181.16" $279.20 $236.24

42410 Excise parotid

gland/lesion T 0256 45.0377 "$3,153.36"

. $630.68

42415 Excise parotid

gland/lesion T 0256 45.0377 "$3,153.36"

. $630.68

42420 Excise parotid

gland/lesion T 0256 45.0377 "$3,153.36"

. $630.68

42425 Excise parotid

gland/lesion T 0256 45.0377 "$3,153.36"

. $630.68

42426 Excise parotid

gland/lesion C

42440 Excise submaxillary

gland T 0256 45.0377 "$3,153.36"

. $630.68

42450 Excise sublingual

gland T 0254 24.8895 "$1,742.66"

. $348.54

42500 Repair salivary

duct T 0254 24.8895 "$1,742.66"

. $348.54

42505 Repair salivary

duct T 0256 45.0377 "$3,153.36"

. $630.68

42507 Parotid duct

diversion T 0256 45.0377 "$3,153.36"

. $630.68

42508 Parotid duct

diversion T 0256 45.0377 "$3,153.36"

. $630.6842509 Parotid duct

diversion T 0256 45.0377 "$3,153.36"

. $630.68

42510 Parotid duct

diversion T 0256 45.0377 "$3,153.36"

. $630.68

42550 Injection for salivary

x-ray N

42600 Closure of salivary

fistula T 0253 16.8699 "$1,181.16" $279.20 $236.24

42650 Dilation of salivary

duct T 0252 7.4614 $522.42 $104.55 $104.49

42660 Dilation of salivary

duct T 0251 3.1150 $218.10

. $43.62

42665 Ligation of salivary

duct T 0254 24.8895 "$1,742.66"

. $348.54

42699 Salivary surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.00

42700 Drainage of tonsil

abscess T 0251 3.1150 $218.10

. $43.62

42720 Drainage of throat

abscess T 0253 16.8699 "$1,181.16" $279.20 $236.24

42725 Drainage of throat

abscess T 0256 45.0377 "$3,153.36"

. $630.68

42800 Biopsy of

throat T 0252 7.4614 $522.42 $104.55 $104.49

42802 Biopsy of

throat T 0253 16.8699 "$1,181.16" $279.20 $236.24

42804 Biopsy of upper

nose/throat T 0253 16.8699 "$1,181.16" $279.20 $236.24

42806 Biopsy of upper

nose/throat T 0254 24.8895 "$1,742.66"

. $348.54

42808 Excise pharynx

lesion T 0254 24.8895 "$1,742.66"

. $348.54

42809 Remove pharynx foreignbody X 0340 0.6499 $45.50

. $9.10

42810 Excision of neck

cyst T 0254 24.8895 "$1,742.66"

. $348.54

42815 Excision of neck

cyst T 0256 45.0377 "$3,153.36"

. $630.68

42820 Remove tonsils and

adenoids T 0254 24.8895 "$1,742.66"

. $348.54

42821 Remove tonsils and

adenoids T 0254 24.8895 "$1,742.66"

. $348.54

42825 Removal of

tonsils T 0254 24.8895 "$1,742.66"

. $348.54

42826 Removal of

tonsils T 0254 24.8895 "$1,742.66"

. $348.54

42830 Removal of

adenoids T 0254 24.8895 "$1,742.66"

. $348.54

42831 Removal of

adenoids T 0254 24.8895 "$1,742.66"

. $348.54

42835 Removal of

adenoids T 0254 24.8895 "$1,742.66"

. $348.54

42836 Removal of

adenoids T 0254 24.8895 "$1,742.66"

. $348.54

42842 Extensive surgery of

throat T 0254 24.8895 "$1,742.66"

. $348.54

42844 Extensive surgery of

throat T 0256 45.0377 "$3,153.36"

. $630.68

42845 Extensive surgery of

throat C

42860 Excision of tonsil

tags T 0254 24.8895 "$1,742.66"

. $348.54

42870 Excision of lingual

tonsil T 0254 24.8895 "$1,742.66"

. $348.54

42890 Partial removal of

pharynx T 0256 45.0377 "$3,153.36"

. $630.6842892 Revision of pharyngeal

walls T 0256 45.0377 "$3,153.36"

. $630.68

42894 Revision of pharyngeal

walls C

42900 Repair throat

wound T 0252 7.4614 $522.42 $104.55 $104.49

42950 Reconstruction of

throat T 0254 24.8895 "$1,742.66"

. $348.54

42953 Repair throat

esophagus C

42955 Surgical opening of

throat T 0254 24.8895 "$1,742.66"

. $348.54

42960 Control throat

bleeding T 0250 1.0709 $74.98 $24.12 $15.00

42961 Control throat

bleeding C

42962 Control throat

bleeding T 0256 45.0377 "$3,153.36"

. $630.68

42970 Control nose/throat

bleeding T 0250 1.0709 $74.98 $24.12 $15.00

42971 Control nose/throat

bleeding C

42972 Control nose/throat

bleeding T 0253 16.8699 "$1,181.16" $279.20 $236.24

42999 Throat surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.00

43020 Incision of

esophagus T 0252 7.4614 $522.42 $104.55 $104.49

43030 Throat muscle

surgery T 0253 16.8699 "$1,181.16" $279.20 $236.24

43045 Incision of

esophagus C

43100 Excision of esophagus

lesion C

43101 Excision of esophagus

lesion C

43107 Removal ofesophagus 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

43130 Removal of esophagus

pouch T 0256 45.0377 "$3,153.36"

. $630.68

43135 Removal of esophagus

pouch C

43200 Esophagus

endoscopy T 0141 8.4511 $591.71 $138.69 $118.35

43201 Esoph scope w/submucous

inj CH T 0419 12.6671 $886.90 $207.88 $177.38

43202 Esophagus endoscopy

biopsy T 0141 8.4511 $591.71 $138.69 $118.35

43204 Esoph scope w/sclerosis

inj T 0141 8.4511 $591.71 $138.69 $118.35

43205 Esophagus

endoscopy/ligation CH T 0419 12.6671 $886.90 $207.88 $177.38

43215 Esophagus

endoscopy CH T 0419 12.6671 $886.90 $207.88 $177.38

43216 Esophagus

endoscopy/lesion T 0422 25.9792 "$1,818.96"

. $363.8043217 Esophagus

endoscopy CH T 0419 12.6671 $886.90 $207.88 $177.38

43219 Esophagus

endoscopy T 0384 29.2172 "$2,045.67"

. $409.14

43220 Esoph endoscopy

dilation CH T 0419 12.6671 $886.90 $207.88 $177.38

43226 Esoph endoscopy

dilation CH T 0419 12.6671 $886.90 $207.88 $177.38

43227 Esoph endoscopy

repair CH T 0419 12.6671 $886.90 $207.88 $177.38

43228 Esoph endoscopy

ablation T 0422 25.9792 "$1,818.96"

. $363.80

43231 Esoph endoscopy w/us

exam CH T 0419 12.6671 $886.90 $207.88 $177.38

43232 Esoph endoscopy w/us fn

bx CH T 0419 12.6671 $886.90 $207.88 $177.38

43234 Upper gi endoscopy

exam T 0141 8.4511 $591.71 $138.69 $118.35

43235 Uppr gi endoscopy

diagnosis T 0141 8.4511 $591.71 $138.69 $118.35

43236 Uppr gi scope w/submuc

inj T 0141 8.4511 $591.71 $138.69 $118.35

43237 Endoscopic us exam

esoph CH T 0419 12.6671 $886.90 $207.88 $177.38

43238 Uppr gi endoscopy w/us fn

bx CH T 0419 12.6671 $886.90 $207.88 $177.38

43239 Upper gi endoscopy

biopsy T 0141 8.4511 $591.71 $138.69 $118.35

43240 Esoph endoscope w/drain

cyst CH T 0419 12.6671 $886.90 $207.88 $177.38

43241 Upper GI endoscopy with

tube T 0141 8.4511 $591.71 $138.69 $118.35

43242 Uppr gi endoscopy w/us fnbx CH T 0419 12.6671 $886.90 $207.88 $177.38

43243 Upper gi endoscopy &

inject T 0141 8.4511 $591.71 $138.69 $118.35

43244 Upper GI

endoscopy/ligation CH T 0419 12.6671 $886.90 $207.88 $177.38

43245 Uppr gi scope dilate

strictr CH T 0419 12.6671 $886.90 $207.88 $177.38

43246 Place gastrostomy

tube CH T 0419 12.6671 $886.90 $207.88 $177.38

43247 Operative upper GI

endoscopy T 0141 8.4511 $591.71 $138.69 $118.35

43248 Uppr gi endoscopy/guide

wire T 0141 8.4511 $591.71 $138.69 $118.35

43249 Esoph endoscopy

dilation CH T 0419 12.6671 $886.90 $207.88 $177.38

43250 Upper GI

endoscopy/tumor CH T 0419 12.6671 $886.90 $207.88 $177.38

43251 Operative upper GI

endoscopy CH T 0419 12.6671 $886.90 $207.88 $177.38

43255 Operative upper GI

endoscopy CH T 0419 12.6671 $886.90 $207.88 $177.38

43256 Uppr gi endoscopy

w/stent T 0384 29.2172 "$2,045.67"

. $409.14

43257 Uppr gi scope w/thrml

txmnt T 0422 25.9792 "$1,818.96"

. $363.80

43258 Operative upper GI

endoscopy CH T 0419 12.6671 $886.90 $207.88 $177.38

43259 Endoscopic ultrasound

exam CH T 0419 12.6671 $886.90 $207.88 $177.38

43260 Endo

cholangiopancreatograph T 0151 24.6966 "$1,729.16"

. $345.84

43261 Endo

cholangiopancreatograph T 0151 24.6966 "$1,729.16"

. $345.8443262 Endo

cholangiopancreatograph T 0151 24.6966 "$1,729.16"

. $345.84

43263 Endo

cholangiopancreatograph T 0151 24.6966 "$1,729.16"

. $345.84

43264 Endo

cholangiopancreatograph T 0151 24.6966 "$1,729.16"

. $345.84

43265 Endo

cholangiopancreatograph T 0151 24.6966 "$1,729.16"

. $345.84

43267 Endo

cholangiopancreatograph T 0151 24.6966 "$1,729.16"

. $345.84

43268 Endo

cholangiopancreatograph T 0384 29.2172 "$2,045.67"

. $409.14

43269 Endo

cholangiopancreatograph T 0384 29.2172 "$2,045.67"

. $409.14

43271 Endo

cholangiopancreatograph T 0151 24.6966 "$1,729.16"

. $345.84

43272 Endo

cholangiopancreatograph T 0151 24.6966 "$1,729.16"

. $345.84

43273 Endoscopic

pancreatoscopy T 0151 24.6966 "$1,729.16"

. $345.84

43279 Lap myotomy

heller C

43280 Laparoscopy

fundoplasty T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

43281 Lap paraesophag hern

repair CH T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

43282 Lap paraesoph her rpr

w/mesh C

43283 Lap esoph

lengthening C

43289 Laparoscope proc

esoph T 0130 38.9223 "$2,725.18" $659.53 $545.04

43300 Repair of

esophagus C43305 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

43325 Revise esophagus &

stomach C

43327 Esoph fundoplasty

lap C

43328 Esoph fundoplasty

thor C

43330 Esophagomyotomy

abdominal C

43331 Esophagomyotomy

thoracic C

43332 Transab esoph hiat hern

rpr C

43333 Transab esoph hiat hern

rpr C

43334 Transthor diaphrag hern

rpr C

43335 Transthor diaphrag hern

rpr C

43336 Thorabd diaphr hern

repair C

43337 Thorabd diaphr hern

repair C

43338 Esoph

lengthening C

43340 Fuse esophagus &

intestine C

43341 Fuse esophagus &

intestine C

43350 Surgical opening

esophagus C

43351 Surgical opening

esophagus C43352 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 T 0254 24.8895 "$1,742.66"

. $348.54

43425 Repair esophagus

opening C

43450 Dilate

esophagus T 0140 6.5866 $461.17

. $92.24

43453 Dilate

esophagus T 0140 6.5866 $461.17

. $92.24

43456 Dilate

esophagus T 0140 6.5866 $461.17

. $92.24

43458 Dilate

esophagus CH T 0419 12.6671 $886.90 $207.88 $177.38

43460 Pressure treatment

esophagus C

43496 Free jejunum flap

microvasc C

43499 Esophagus surgery

procedure T 0141 8.4511 $591.71 $138.69 $118.35

43500 Surgical opening of

stomach C

43501 Surgical repair of

stomach C

43502 Surgical repair of

stomach C43510 Surgical opening of

stomach CH T 0141 8.4511 $591.71 $138.69 $118.35

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

43647 Lap impl electrode

antrum S 0061 88.6050 "$6,203.77"

. "$1,240.76"

43648 Lap revise/remv eltrd

antrum T 0130 38.9223 "$2,725.18" $659.53 $545.04

43651 Laparoscopy vagus

nerve T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"43652 Laparoscopy vagus

nerve T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

43653 Laparoscopy

gastrostomy T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

43659 Laparoscope proc

stom T 0130 38.9223 "$2,725.18" $659.53 $545.04

43752 Nasal/orogastric

w/stent Q3 0272 1.2171 $85.22 $30.47 $17.05

43753 Tx gastro intub

w/asp X 0340 0.6499 $45.50

. $9.10

43754 Dx gastr intub w/asp

spec X 0340 0.6499 $45.50

. $9.10

43755 Dx gastr intub w/asp

specs S 0097 0.9350 $65.46

. $13.10

43756 Dx duod intub w/asp

spec X 0272 1.2171 $85.22 $30.47 $17.05

43757 Dx duod intub w/asp

specs X 0272 1.2171 $85.22 $30.47 $17.05

43760 Change gastrostomy

tube T 0676 2.3021 $161.18

. $32.24

43761 Reposition gastrostomy

tube T 0141 8.4511 $591.71 $138.69 $118.35

43770 Lap place gastr adj

device CH T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

43771 Lap revise gastr adj

device C

43772 Lap rmvl gastr adj

device C

43773 Lap replace gastr adj

device C

43774 Lap rmvl gastr adj all

parts C

43775 Lap sleeve

gastrectomy E

43800 Reconstruction of

pylorus C43810 Fusion of stomach and

bowel C

43820 Fusion of stomach and

bowel C

43825 Fusion of stomach and

bowel C

43830 Place gastrostomy

tube T 0422 25.9792 "$1,818.96"

. $363.80

43831 Place gastrostomy

tube T 0141 8.4511 $591.71 $138.69 $118.35

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

switch C

43846 Gastric bypass for

obesity C

43847 Gastric bypass incl small

i C

43848 Revision

gastroplasty C

43850 Revise stomach-bowel

fusion C

43855 Revise stomach-bowel

fusion C

43860 Revise stomach-bowel

fusion C

43865 Revise stomach-bowel

fusion C

43870 Repair stomach

opening T 0422 25.9792 "$1,818.96"

. $363.80

43880 Repair stomach-bowel

fistula C

43881 Impl/redo electrd

antrum C43882 Revise/remove electrd

antrum C

43886 Revise gastric port

open T 0137 21.4409 "$1,501.21"

. $300.25

43887 Remove gastric port

open T 0135 4.9271 $344.98

. $69.00

43888 Change gastric port

open T 0137 21.4409 "$1,501.21"

. $300.25

43999 Stomach surgery

procedure T 0141 8.4511 $591.71 $138.69 $118.35

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

44100 Biopsy of

bowel CH T 0419 12.6671 $886.90 $207.88 $177.38

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 C44127 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

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 C44158 Colectomy w/neo-rectum

pouch C

44160 Removal of

colon C

44180 Lap

enterolysis T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

44186 Lap

jejunostomy T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

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

44206 Lap part colectomy

w/stoma T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

44207 L

colectomy/coloproctostomy T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

44208 L

colectomy/coloproctostomy T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

44210 Laparo total

proctocolectomy C

44211 Lap colectomy

w/proctectomy C

44212 Laparo total

proctocolectomy C

44213 Lap mobil splenic fl

add-on T 0130 38.9223 "$2,725.18" $659.53 $545.04

44227 Lap close

enterostomy C44238 Laparoscope proc

intestine T 0130 38.9223 "$2,725.18" $659.53 $545.04

44300 Open bowel to

skin C

44310 Ileostomy/jejunostomy C

44312 Revision of

ileostomy T 0137 21.4409 "$1,501.21"

. $300.25

44314 Revision of

ileostomy C

44316 Devise bowel

pouch C

44320 Colostomy C

44322 Colostomy with

biopsies C

44340 Revision of

colostomy T 0137 21.4409 "$1,501.21"

. $300.25

44345 Revision of

colostomy C

44346 Revision of

colostomy C

44360 Small bowel

endoscopy T 0142 10.4394 $730.93 $152.78 $146.19

44361 Small bowel

endoscopy/biopsy T 0142 10.4394 $730.93 $152.78 $146.19

44363 Small bowel

endoscopy T 0142 10.4394 $730.93 $152.78 $146.19

44364 Small bowel

endoscopy CH T 0424 15.7819 "$1,104.99" $240.64 $221.00

44365 Small bowel

endoscopy CH T 0424 15.7819 "$1,104.99" $240.64 $221.00

44366 Small bowel

endoscopy CH T 0424 15.7819 "$1,104.99" $240.64 $221.00

44369 Small bowel

endoscopy CH T 0424 15.7819 "$1,104.99" $240.64 $221.00

44370 Small bowel

endoscopy/stent T 0384 29.2172 "$2,045.67"

. $409.1444372 Small bowel

endoscopy CH T 0424 15.7819 "$1,104.99" $240.64 $221.00

44373 Small bowel

endoscopy CH T 0424 15.7819 "$1,104.99" $240.64 $221.00

44376 Small bowel

endoscopy T 0142 10.4394 $730.93 $152.78 $146.19

44377 Small bowel

endoscopy/biopsy T 0142 10.4394 $730.93 $152.78 $146.19

44378 Small bowel

endoscopy CH T 0424 15.7819 "$1,104.99" $240.64 $221.00

44379 S bowel endoscope

w/stent T 0384 29.2172 "$2,045.67"

. $409.14

44380 Small bowel

endoscopy T 0142 10.4394 $730.93 $152.78 $146.19

44382 Small bowel

endoscopy T 0142 10.4394 $730.93 $152.78 $146.19

44383 Ileoscopy

w/stent T 0384 29.2172 "$2,045.67"

. $409.14

44385 Endoscopy of bowel

pouch T 0143 9.3693 $656.00 $186.06 $131.20

44386 Endoscopy bowel

pouch/biop T 0143 9.3693 $656.00 $186.06 $131.20

44388 Colonoscopy T 0143 9.3693 $656.00 $186.06 $131.20

44389 Colonoscopy with

biopsy T 0143 9.3693 $656.00 $186.06 $131.20

44390 Colonoscopy for foreign

body T 0143 9.3693 $656.00 $186.06 $131.20

44391 Colonoscopy for

bleeding T 0143 9.3693 $656.00 $186.06 $131.20

44392 Colonoscopy &

polypectomy T 0143 9.3693 $656.00 $186.06 $131.20

44393 Colonoscopy lesionremoval T 0143 9.3693 $656.00 $186.06 $131.20

44394 Colonoscopy

w/snare T 0143 9.3693 $656.00 $186.06 $131.20

44397 Colonoscopy

w/stent T 0384 29.2172 "$2,045.67"

. $409.14

44500 Intro gastrointestinal

tube T 0121 6.2123 $434.96

. $87.00

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

44701 Intraop colon lavage

add-on N

44715 Prepare donor

intestine C

44720 Prep donorintestine/venous C

44721 Prep donor

intestine/artery C

44799 Unlisted procedure

intestine T 0153 27.2798 "$1,910.02"

. $382.01

44800 Excision of bowel

pouch C

44820 Excision of mesentery

lesion C

44850 Repair of

mesentery C

44899 Bowel surgery

procedure C

44900 Drain app abscess

open C

44901 Drain app abscess

percut T 0037 15.3535 "$1,074.99" $227.40 $215.00

44950 Appendectomy T 0153 27.2798 "$1,910.02"

. $382.01

44955 Appendectomy

add-on T 0153 27.2798 "$1,910.02"

. $382.01

44960 Appendectomy C

44970 Laparoscopy

appendectomy T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

44979 Laparoscope proc

app T 0130 38.9223 "$2,725.18" $659.53 $545.04

45000 Drainage of pelvic

abscess CH T 0149 24.4382 "$1,711.07"

. $342.22

45005 Drainage of rectal

abscess CH T 0149 24.4382 "$1,711.07"

. $342.22

45020 Drainage of rectal

abscess T 0155 15.4175 "$1,079.47"

. $215.90

45100 Biopsy of

rectum T 0149 24.4382 "$1,711.07"

. $342.22

45108 Removal of anorectal

lesion T 0149 24.4382 "$1,711.07"

. $342.2245110 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

45150 Excision of rectal

stricture T 0149 24.4382 "$1,711.07"

. $342.22

45160 Excision of rectal

lesion T 0149 24.4382 "$1,711.07"

. $342.22

45171 Exc rect tum transanal

part CH T 0149 24.4382 "$1,711.07"

. $342.22

45172 Exc rect tum transanal

full T 0149 24.4382 "$1,711.07"

. $342.22

45190 Destruction rectal

tumor T 0149 24.4382 "$1,711.07"

. $342.2245300 Proctosigmoidoscopy

dx T 0146 6.2205 $435.53

. $87.11

45303 Proctosigmoidoscopy

dilate T 0147 11.0417 $773.10

. $154.62

45305 Proctosigmoidoscopy

w/bx T 0147 11.0417 $773.10

. $154.62

45307 Proctosigmoidoscopy

fb T 0428 23.9777 "$1,678.82"

. $335.77

45308 Proctosigmoidoscopy

removal T 0147 11.0417 $773.10

. $154.62

45309 Proctosigmoidoscopy

removal T 0147 11.0417 $773.10

. $154.62

45315 Proctosigmoidoscopy

removal T 0147 11.0417 $773.10

. $154.62

45317 Proctosigmoidoscopy

bleed T 0147 11.0417 $773.10

. $154.62

45320 Proctosigmoidoscopy

ablate T 0428 23.9777 "$1,678.82"

. $335.77

45321 Proctosigmoidoscopy

volvul T 0428 23.9777 "$1,678.82"

. $335.77

45327 Proctosigmoidoscopy

w/stent T 0384 29.2172 "$2,045.67"

. $409.14

45330 Diagnostic

sigmoidoscopy T 0146 6.2205 $435.53

. $87.11

45331 Sigmoidoscopy and

biopsy T 0146 6.2205 $435.53

. $87.11

45332 Sigmoidoscopy w/fb

removal T 0146 6.2205 $435.53

. $87.11

45333 Sigmoidoscopy &

polypectomy CH T 0146 6.2205 $435.53

. $87.11

45334 Sigmoidoscopy for

bleeding T 0147 11.0417 $773.10

. $154.6245335 Sigmoidoscopy w/submuc

inj T 0146 6.2205 $435.53

. $87.11

45337 Sigmoidoscopy &

decompress T 0146 6.2205 $435.53

. $87.11

45338 Sigmoidoscopy w/tumr

remove CH T 0146 6.2205 $435.53

. $87.11

45339 Sigmoidoscopy w/ablate

tumr T 0147 11.0417 $773.10

. $154.62

45340 Sig w/balloon

dilation T 0147 11.0417 $773.10

. $154.62

45341 Sigmoidoscopy

w/ultrasound CH T 0146 6.2205 $435.53

. $87.11

45342 Sigmoidoscopy w/us guide

bx T 0147 11.0417 $773.10

. $154.62

45345 Sigmoidoscopy

w/stent T 0384 29.2172 "$2,045.67"

. $409.14

45355 Surgical

colonoscopy T 0143 9.3693 $656.00 $186.06 $131.20

45378 Diagnostic

colonoscopy T 0143 9.3693 $656.00 $186.06 $131.20

45379 Colonoscopy w/fb

removal T 0143 9.3693 $656.00 $186.06 $131.20

45380 Colonoscopy and

biopsy T 0143 9.3693 $656.00 $186.06 $131.20

45381 Colonoscopy submucous

inj T 0143 9.3693 $656.00 $186.06 $131.20

45382 Colonoscopy/control

bleeding T 0143 9.3693 $656.00 $186.06 $131.20

45383 Lesion removal

colonoscopy T 0143 9.3693 $656.00 $186.06 $131.20

45384 Lesion remove

colonoscopy T 0143 9.3693 $656.00 $186.06 $131.20

45385 Lesion removal

colonoscopy T 0143 9.3693 $656.00 $186.06 $131.2045386 Colonoscopy dilate

stricture T 0143 9.3693 $656.00 $186.06 $131.20

45387 Colonoscopy

w/stent T 0384 29.2172 "$2,045.67"

. $409.14

45391 Colonoscopy w/endoscope

us T 0143 9.3693 $656.00 $186.06 $131.20

45392 Colonoscopy w/endoscopic

fnb T 0143 9.3693 $656.00 $186.06 $131.20

45395 Lap removal of

rectum C

45397 Lap remove rectum

w/pouch C

45400 Laparoscopic

proc C

45402 Lap proctopexy w/sig

resect C

45499 Laparoscope proc

rectum T 0130 38.9223 "$2,725.18" $659.53 $545.04

45500 Repair of

rectum T 0149 24.4382 "$1,711.07"

. $342.22

45505 Repair of

rectum T 0150 32.9805 "$2,309.16"

. $461.84

45520 Treatment of rectal

prolapse CH T 0015 1.4966 $104.79

. $20.96

45540 Correct rectal

prolapse C

45541 Correct rectal

prolapse T 0150 32.9805 "$2,309.16"

. $461.84

45550 Repair rectum/remove

sigmoid C

45560 Repair of

rectocele T 0150 32.9805 "$2,309.16"

. $461.84

45562 Exploration/repair of

rectum C

45563 Exploration/repair of

rectum C45800 Repair rect/bladder

fistula C

45805 Repair fistula

w/colostomy C

45820 Repair rectourethral

fistula C

45825 Repair fistula

w/colostomy C

45900 Reduction of rectal

prolapse T 0148 5.5158 $386.19

. $77.24

45905 Dilation of anal

sphincter T 0149 24.4382 "$1,711.07"

. $342.22

45910 Dilation of rectal

narrowing T 0149 24.4382 "$1,711.07"

. $342.22

45915 Remove rectal

obstruction T 0155 15.4175 "$1,079.47"

. $215.90

45990 Surg dx exam

anorectal T 0149 24.4382 "$1,711.07"

. $342.22

45999 Rectum surgery

procedure T 0148 5.5158 $386.19

. $77.24

46020 Placement of

seton T 0149 24.4382 "$1,711.07"

. $342.22

46030 Removal of rectal

marker T 0148 5.5158 $386.19

. $77.24

46040 Incision of rectal

abscess T 0149 24.4382 "$1,711.07"

. $342.22

46045 Incision of rectal

abscess T 0149 24.4382 "$1,711.07"

. $342.22

46050 Incision of anal

abscess CH T 0148 5.5158 $386.19

. $77.24

46060 Incision of rectal

abscess T 0149 24.4382 "$1,711.07"

. $342.22

46070 Incision of anal

septum T 0155 15.4175 "$1,079.47"

. $215.9046080 Incision of anal

sphincter T 0149 24.4382 "$1,711.07"

. $342.22

46083 Incise external

hemorrhoid T 0164 1.9499 $136.52

. $27.31

46200 Removal of anal

fissure T 0149 24.4382 "$1,711.07"

. $342.22

46220 Excise anal ext

tag/papilla T 0155 15.4175 "$1,079.47"

. $215.90

46221 Ligation of

hemorrhoid(s) T 0148 5.5158 $386.19

. $77.24

46230 Removal of anal

tags T 0149 24.4382 "$1,711.07"

. $342.22

46250 Remove ext hem groups

2+ T 0149 24.4382 "$1,711.07"

. $342.22

46255 Remove int/ext hem 1

group T 0149 24.4382 "$1,711.07"

. $342.22

46257 Remove in/ex hem grp &

fiss T 0149 24.4382 "$1,711.07"

. $342.22

46258 Remove in/ex hem grp

w/fistu T 0149 24.4382 "$1,711.07"

. $342.22

46260 Remove in/ex hem groups

2+ T 0149 24.4382 "$1,711.07"

. $342.22

46261 Remove in/ex hem grps &

fiss T 0149 24.4382 "$1,711.07"

. $342.22

46262 Remove in/ex hem grps

w/fist T 0149 24.4382 "$1,711.07"

. $342.22

46270 Remove anal fist

subq T 0149 24.4382 "$1,711.07"

. $342.22

46275 Remove anal fist

inter T 0149 24.4382 "$1,711.07"

. $342.22

46280 Remove anal fist

complex T 0149 24.4382 "$1,711.07"

. $342.22

46285 Remove anal fist 2

stage T 0149 24.4382 "$1,711.07"

. $342.2246288 Repair anal

fistula T 0149 24.4382 "$1,711.07"

. $342.22

46320 Removal of hemorrhoid

clot T 0149 24.4382 "$1,711.07"

. $342.22

46500 Injection into

hemorrhoid(s) CH T 0148 5.5158 $386.19

. $77.24

46505 Chemodenervation anal

musc T 0149 24.4382 "$1,711.07"

. $342.22

46600 Diagnostic

anoscopy X 0340 0.6499 $45.50

. $9.10

46604 Anoscopy and

dilation T 0147 11.0417 $773.10

. $154.62

46606 Anoscopy and

biopsy T 0146 6.2205 $435.53

. $87.11

46608 Anoscopy remove for

body CH T 0146 6.2205 $435.53

. $87.11

46610 Anoscopy remove

lesion T 0428 23.9777 "$1,678.82"

. $335.77

46611 Anoscopy T 0147 11.0417 $773.10

. $154.62

46612 Anoscopy remove

lesions T 0428 23.9777 "$1,678.82"

. $335.77

46614 Anoscopy control

bleeding T 0146 6.2205 $435.53

. $87.11

46615 Anoscopy T 0428 23.9777 "$1,678.82"

. $335.77

46700 Repair of anal

stricture T 0149 24.4382 "$1,711.07"

. $342.22

46705 Repair of anal

stricture C

46706 Repr of anal fistula

w/glue T 0150 32.9805 "$2,309.16"

. $461.84

46707 Repair anorectal fist

w/plug T 0150 32.9805 "$2,309.16"

. $461.8446710 Repr per/vag pouch sngl

proc C

46712 Repr per/vag pouch dbl

proc C

46715 Rep perf anoper

fistu C

46716 Rep perf anoper/vestib

fistu C

46730 Construction of absent

anus C

46735 Construction of absent

anus C

46740 Construction of absent

anus C

46742 Repair of imperforated

anus C

46744 Repair of cloacal

anomaly C

46746 Repair of cloacal

anomaly C

46748 Repair of cloacal

anomaly C

46750 Repair of anal

sphincter T 0150 32.9805 "$2,309.16"

. $461.84

46751 Repair of anal

sphincter C

46753 Reconstruction of

anus T 0149 24.4382 "$1,711.07"

. $342.22

46754 Removal of suture from

anus T 0149 24.4382 "$1,711.07"

. $342.22

46760 Repair of anal

sphincter T 0150 32.9805 "$2,309.16"

. $461.84

46761 Repair of anal

sphincter T 0150 32.9805 "$2,309.16"

. $461.84

46762 Implant artificial

sphincter T 0150 32.9805 "$2,309.16"

. $461.84

46900 Destruction anal

lesion(s) T 0016 2.7597 $193.22

. $38.65

46910 Destruction anallesion(s) T 0017 21.6700 "$1,517.25"

. $303.45

46916 Cryosurgery anal

lesion(s) T 0015 1.4966 $104.79

. $20.96

46917 Laser surgery anal

lesions T 0017 21.6700 "$1,517.25"

. $303.45

46922 Excision of anal

lesion(s) T 0017 21.6700 "$1,517.25"

. $303.45

46924 Destruction anal

lesion(s) T 0017 21.6700 "$1,517.25"

. $303.45

46930 Destroy internal

hemorrhoids T 0148 5.5158 $386.19

. $77.24

46940 Treatment of anal

fissure T 0149 24.4382 "$1,711.07"

. $342.22

46942 Treatment of anal

fissure T 0148 5.5158 $386.19

. $77.24

46945 Remove by ligat int hem

grp CH T 0149 24.4382 "$1,711.07"

. $342.22

46946 Remove by ligat int hem

grps CH T 0149 24.4382 "$1,711.07"

. $342.22

46947 Hemorrhoidopexy by

stapling T 0150 32.9805 "$2,309.16"

. $461.84

46999 Anus surgery

procedure T 0148 5.5158 $386.19

. $77.24

47000 Needle biopsy of

liver T 0685 9.6713 $677.15

. $135.43

47001 Needle biopsy liver

add-on N

47010 Open drainage liver

lesion C

47011 Percut drain liver

lesion T 0037 15.3535 "$1,074.99" $227.40 $215.00

47015 Inject/aspirate liver

cyst C

47100 Wedge biopsy of

liver C47120 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

47370 Laparo ablate liver tumor

rf T 0174 111.6495 "$7,817.25" "$2,055.58" "$1,563.45"47371 Laparo ablate liver

cryosurg T 0174 111.6495 "$7,817.25" "$2,055.58" "$1,563.45"

47379 Laparoscope procedure

liver T 0130 38.9223 "$2,725.18" $659.53 $545.04

47380 Open ablate liver tumor

rf C

47381 Open ablate liver tumor

cryo C

47382 Percut ablate liver

rf T 0423 58.4890 "$4,095.17"

. $819.04

47399 Liver surgery

procedure T 0004 4.5721 $320.12

. $64.03

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 29.1415 "$2,040.37"

. $408.08

47500 Injection for liver

x-rays N

47505 Injection for liver

x-rays N

47510 Insert catheter bile

duct T 0152 29.1415 "$2,040.37"

. $408.08

47511 Insert bile duct

drain T 0152 29.1415 "$2,040.37"

. $408.08

47525 Change bile duct

catheter T 0427 16.2412 "$1,137.14"

. $227.43

47530 Revise/reinsert bile

tube T 0427 16.2412 "$1,137.14"

. $227.43

47550 Bile duct endoscopyadd-on C

47552 Biliary endoscopy thru

skin T 0152 29.1415 "$2,040.37"

. $408.08

47553 Biliary endoscopy thru

skin T 0152 29.1415 "$2,040.37"

. $408.08

47554 Biliary endoscopy thru

skin T 0152 29.1415 "$2,040.37"

. $408.08

47555 Biliary endoscopy thru

skin T 0152 29.1415 "$2,040.37"

. $408.08

47556 Biliary endoscopy thru

skin CH T 0423 58.4890 "$4,095.17"

. $819.04

47560 Laparoscopy

w/cholangio T 0130 38.9223 "$2,725.18" $659.53 $545.04

47561 Laparo

w/cholangio/biopsy T 0130 38.9223 "$2,725.18" $659.53 $545.04

47562 Laparoscopic

cholecystectomy T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

47563 Laparo

cholecystectomy/graph T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

47564 Laparo

cholecystectomy/explr T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

47570 Laparo

cholecystoenterostomy C

47579 Laparoscope proc

biliary T 0130 38.9223 "$2,725.18" $659.53 $545.04

47600 Removal of

gallbladder C

47605 Removal of

gallbladder C

47610 Removal of

gallbladder C

47612 Removal of

gallbladder C47620 Removal of

gallbladder C

47630 Remove bile duct

stone T 0152 29.1415 "$2,040.37"

. $408.08

47700 Exploration of bile

ducts C

47701 Bile duct

revision C

47711 Excision of bile duct

tumor C

47712 Excision of bile duct

tumor C

47715 Excision of bile duct

cyst C

47720 Fuse gallbladder &

bowel C

47721 Fuse upper gi

structures C

47740 Fuse gallbladder &

bowel C

47741 Fuse gallbladder &

bowel C

47760 Fuse bile ducts and

bowel C

47765 Fuse liver ducts &

bowel C

47780 Fuse bile ducts and

bowel C

47785 Fuse bile ducts and

bowel C

47800 Reconstruction of bile

ducts C

47801 Placement bile duct

support C

47802 Fuse liver duct &

intestine C

47900 Suture bile duct

injury C

47999 Bile tract surgery

procedure T 0152 29.1415 "$2,040.37"

. $408.08

48000 Drainage of

abdomen C48001 Placement of drain

pancreas C

48020 Removal of pancreatic

stone C

48100 Biopsy of pancreas

open C

48102 Needle biopsy

pancreas T 0685 9.6713 $677.15

. $135.43

48105 Resect/debride

pancreas C

48120 Removal of pancreas

lesion C

48140 Partial removal of

pancreas C

48145 Partial removal of

pancreas C

48146 Pancreatectomy C

48148 Removal of pancreatic

duct C

48150 Partial removal of

pancreas C

48152 Pancreatectomy C

48153 Pancreatectomy C

48154 Pancreatectomy C

48155 Removal of

pancreas C

48160 Pancreas

removal/transplant E

48400 Injection intraop

add-on C

48500 Surgery of pancreatic

cyst C

48510 Drain pancreatic

pseudocyst C

48511 Drain pancreatic

pseudocyst T 0037 15.3535 "$1,074.99" $227.40 $215.00

48520 Fuse pancreas cyst and

bowel C48540 Fuse pancreas cyst and

bowel C

48545 Pancreatorrhaphy C

48547 Duodenal

exclusion C

48548 Fuse pancreas and

bowel C

48550 Donor

pancreatectomy E

48551 Prep donor

pancreas C

48552 Prep donor

pancreas/venous C

48554 Transpl allograft

pancreas C

48556 Removal allograft

pancreas C

48999 Pancreas surgery

procedure T 0004 4.5721 $320.12

. $64.03

49000 Exploration of

abdomen C

49002 Reopening of

abdomen C

49010 Exploration behind

abdomen C

49020 Drain abdominal

abscess C

49021 Drain abdominal

abscess T 0037 15.3535 "$1,074.99" $227.40 $215.00

49040 Drain open abdom

abscess C

49041 Drain percut abdom

abscess T 0037 15.3535 "$1,074.99" $227.40 $215.00

49060 Drain open retrop

abscess C

49061 Drain percut retroper

absc T 0037 15.3535 "$1,074.99" $227.40 $215.00

49062 Drain to peritoneal

cavity C49080 Puncture peritoneal

cavity CH D

49081 Removal of abdominal

fluid CH D

49082 Abd

paracentesis NI T 0070 5.5061 $385.52

. $77.11

49083 Abd paracentesis

w/imaging NI T 0070 5.5061 $385.52

. $77.11

49084 Peritoneal

lavage NI T 0070 5.5061 $385.52

. $77.11

49180 Biopsy abdominal

mass T 0685 9.6713 $677.15

. $135.43

49203 Exc abd tum 5 cm or

less C

49204 Exc abd tum over 5

cm C

49205 Exc abd tum over 10

cm C

49215 Excise sacral spine

tumor C

49220 Multiple surgery

abdomen C

49250 Excision of

umbilicus T 0153 27.2798 "$1,910.02"

. $382.01

49255 Removal of

omentum C

49320 Diag laparo separate

proc T 0130 38.9223 "$2,725.18" $659.53 $545.04

49321 Laparoscopy

biopsy T 0130 38.9223 "$2,725.18" $659.53 $545.04

49322 Laparoscopy

aspiration T 0130 38.9223 "$2,725.18" $659.53 $545.04

49323 Laparo drain

lymphocele T 0130 38.9223 "$2,725.18" $659.53 $545.04

49324 Lap insert tunnel ip

cath T 0130 38.9223 "$2,725.18" $659.53 $545.04

49325 Lap revision perm ip

cath T 0130 38.9223 "$2,725.18" $659.53 $545.0449326 Lap w/omentopexy

add-on T 0130 38.9223 "$2,725.18" $659.53 $545.04

49327 Lap ins device for

rt T 0130 38.9223 "$2,725.18" $659.53 $545.04

49329 Laparo proc

abdm/per/oment T 0130 38.9223 "$2,725.18" $659.53 $545.04

49400 Air injection into

abdomen N

49402 Remove foreign body

adbomen T 0153 27.2798 "$1,910.02"

. $382.01

49411 Ins mark abd/pel for rt

perq X 0310 13.6332 $954.54 $325.27 $190.91

49412 Ins device for rt guide

open C

49418 Insert tun ip cath

perc T 0652 30.8430 "$2,159.50"

. $431.90

49419 Insert tun ip cath

w/port T 0115 37.4593 "$2,622.75"

. $524.55

49421 Ins tun ip cath for dial

opn T 0652 30.8430 "$2,159.50"

. $431.90

49422 Remove tunneled ip

cath T 0105 21.7420 "$1,522.29"

. $304.46

49423 Exchange drainage

catheter T 0427 16.2412 "$1,137.14"

. $227.43

49424 Assess cyst contrast

inject N

49425 Insert abdomen-venous

drain C

49426 Revise abdomen-venous

shunt T 0153 27.2798 "$1,910.02"

. $382.01

49427 Injection abdominal

shunt N

49428 Ligation of

shunt C

49429 Removal of

shunt T 0105 21.7420 "$1,522.29"

. $304.4649435 Insert subq exten to ip

cath T 0427 16.2412 "$1,137.14"

. $227.43

49436 Embedded ip cath

exit-site T 0427 16.2412 "$1,137.14"

. $227.43

49440 Place gastrostomy tube

perc CH T 0419 12.6671 $886.90 $207.88 $177.38

49441 Place duod/jej tube

perc CH T 0419 12.6671 $886.90 $207.88 $177.38

49442 Place cecostomy tube

perc CH T 0149 24.4382 "$1,711.07"

. $342.22

49446 Change g-tube to g-j

perc CH T 0419 12.6671 $886.90 $207.88 $177.38

49450 Replace g/c tube

perc T 0121 6.2123 $434.96

. $87.00

49451 Replace duod/jej tube

perc T 0121 6.2123 $434.96

. $87.00

49452 Replace g-j tube

perc T 0121 6.2123 $434.96

. $87.00

49460 Fix g/colon tube

w/device T 0121 6.2123 $434.96

. $87.00

49465 Fluoro exam of g/colon

tube Q1 0277 2.0340 $142.41 $53.90 $28.49

49491 Rpr hern preemie

reduc T 0154 32.9294 "$2,305.58" $464.85 $461.12

49492 Rpr ing hern premie

blocked T 0154 32.9294 "$2,305.58" $464.85 $461.12

49495 Rpr ing hernia baby

reduc T 0154 32.9294 "$2,305.58" $464.85 $461.12

49496 Rpr ing hernia baby

blocked T 0154 32.9294 "$2,305.58" $464.85 $461.12

49500 Rpr ing hernia init

reduce T 0154 32.9294 "$2,305.58" $464.85 $461.1249501 Rpr ing hernia init

blocked T 0154 32.9294 "$2,305.58" $464.85 $461.12

49505 Prp i/hern init reduc >5

yr T 0154 32.9294 "$2,305.58" $464.85 $461.12

49507 Prp i/hern init block >5

yr T 0154 32.9294 "$2,305.58" $464.85 $461.12

49520 Rerepair ing hernia

reduce T 0154 32.9294 "$2,305.58" $464.85 $461.12

49521 Rerepair ing hernia

blocked T 0154 32.9294 "$2,305.58" $464.85 $461.12

49525 Repair ing hernia

sliding T 0154 32.9294 "$2,305.58" $464.85 $461.12

49540 Repair lumbar

hernia T 0154 32.9294 "$2,305.58" $464.85 $461.12

49550 Rpr rem hernia init

reduce T 0154 32.9294 "$2,305.58" $464.85 $461.12

49553 Rpr fem hernia init

blocked T 0154 32.9294 "$2,305.58" $464.85 $461.12

49555 Rerepair fem hernia

reduce T 0154 32.9294 "$2,305.58" $464.85 $461.12

49557 Rerepair fem hernia

blocked T 0154 32.9294 "$2,305.58" $464.85 $461.12

49560 Rpr ventral hern init

reduc T 0154 32.9294 "$2,305.58" $464.85 $461.12

49561 Rpr ventral hern init

block T 0154 32.9294 "$2,305.58" $464.85 $461.12

49565 Rerepair ventrl hern

reduce T 0154 32.9294 "$2,305.58" $464.85 $461.12

49566 Rerepair ventrl hern

block T 0154 32.9294 "$2,305.58" $464.85 $461.12

49568 Hernia repair

w/mesh T 0154 32.9294 "$2,305.58" $464.85 $461.12

49570 Rpr epigastric hern

reduce T 0154 32.9294 "$2,305.58" $464.85 $461.1249572 Rpr epigastric hern

blocked T 0154 32.9294 "$2,305.58" $464.85 $461.12

49580 Rpr umbil hern reduc < 5

yr T 0154 32.9294 "$2,305.58" $464.85 $461.12

49582 Rpr umbil hern block < 5

yr T 0154 32.9294 "$2,305.58" $464.85 $461.12

49585 Rpr umbil hern reduc > 5

yr T 0154 32.9294 "$2,305.58" $464.85 $461.12

49587 Rpr umbil hern block > 5

yr T 0154 32.9294 "$2,305.58" $464.85 $461.12

49590 Repair spigelian

hernia T 0154 32.9294 "$2,305.58" $464.85 $461.12

49600 Repair umbilical

lesion T 0154 32.9294 "$2,305.58" $464.85 $461.12

49605 Repair umbilical

lesion C

49606 Repair umbilical

lesion C

49610 Repair umbilical

lesion C

49611 Repair umbilical

lesion C

49650 Lap ing hernia repair

init T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

49651 Lap ing hernia repair

recur T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

49652 Lap vent/abd hernia

repair T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

49653 Lap vent/abd hern proc

comp T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

49654 Lap inc hernia

repair T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

49655 Lap inc hern repair

comp T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"49656 Lap inc hernia repair

recur T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

49657 Lap inc hern recur

comp T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

49659 Laparo proc hernia

repair T 0130 38.9223 "$2,725.18" $659.53 $545.04

49900 Repair of abdominal

wall C

49904 Omental flap

extra-abdom C

49905 Omental flap

intra-abdom C

49906 Free omental flap

microvasc C

49999 Abdomen surgery

procedure T 0153 27.2798 "$1,910.02"

. $382.01

50010 Exploration of

kidney C

50020 Renal abscess open

drain T 0162 26.2973 "$1,841.23"

. $368.25

50021 Renal abscess percut

drain T 0037 15.3535 "$1,074.99" $227.40 $215.00

50040 Drainage of

kidney C

50045 Exploration of

kidney C

50060 Removal of kidney

stone C

50065 Incision of

kidney C

50070 Incision of

kidney C

50075 Removal of kidney

stone C

50080 Removal of kidney

stone T 0429 45.7676 "$3,204.46"

. $640.90

50081 Removal of kidney

stone T 0429 45.7676 "$3,204.46"

. $640.9050100 Revise kidney blood

vessels C

50120 Exploration of

kidney C

50125 Explore and drain

kidney C

50130 Removal of kidney

stone C

50135 Exploration of

kidney C

50200 Renal biopsy

perq T 0685 9.6713 $677.15

. $135.43

50205 Renal biopsy

open C

50220 Remove kidney

open C

50225 Removal kidney open

complex C

50230 Removal kidney open

radical C

50234 Removal of kidney &

ureter C

50236 Removal of kidney &

ureter C

50240 Partial removal of

kidney C

50250 Cryoablate renal mass

open C

50280 Removal of kidney

lesion C

50290 Removal of kidney

lesion C

50300 Remove cadaver donor

kidney C

50320 Remove kidney living

donor C

50323 Prep cadaver renal

allograft C

50325 Prep donor renal

graft C

50327 Prep renal

graft/venous C50328 Prep renal

graft/arterial C

50329 Prep renal

graft/ureteral C

50340 Removal of

kidney C

50360 Transplantation of

kidney C

50365 Transplantation of

kidney C

50370 Remove transplanted

kidney C

50380 Reimplantation of

kidney C

50382 Change ureter stent

percut T 0162 26.2973 "$1,841.23"

. $368.25

50384 Remove ureter stent

percut T 0161 17.4715 "$1,223.28"

. $244.66

50385 Change stent via

transureth T 0162 26.2973 "$1,841.23"

. $368.25

50386 Remove stent via

transureth T 0160 6.7736 $474.26

. $94.86

50387 Change ext/int ureter

stent T 0427 16.2412 "$1,137.14"

. $227.43

50389 Remove renal tube

w/fluoro T 0160 6.7736 $474.26

. $94.86

50390 Drainage of kidney

lesion T 0685 9.6713 $677.15

. $135.43

50391 Instll rx agnt into rnal

tub T 0126 1.1095 $77.68 $16.21 $15.54

50392 Insert kidney

drain T 0161 17.4715 "$1,223.28"

. $244.66

50393 Insert ureteral

tube T 0162 26.2973 "$1,841.23"

. $368.25

50394 Injection for kidney

x-ray N50395 Create passage to

kidney T 0162 26.2973 "$1,841.23"

. $368.25

50396 Measure kidney

pressure T 0164 1.9499 $136.52

. $27.31

50398 Change kidney

tube T 0427 16.2412 "$1,137.14"

. $227.43

50400 Revision of

kidney/ureter C

50405 Revision of

kidney/ureter C

50500 Repair of kidney

wound C

50520 Close kidney-skin

fistula C

50525 Repair renal-abdomen

fistula C

50526 Repair renal-abdomen

fistula C

50540 Revision of horseshoe

kidney C

50541 Laparo ablate renal

cyst T 0130 38.9223 "$2,725.18" $659.53 $545.04

50542 Laparo ablate renal

mass T 0174 111.6495 "$7,817.25" "$2,055.58" "$1,563.45"

50543 Laparo partial

nephrectomy T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

50544 Laparoscopy

pyeloplasty CH T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

50545 Laparo radical

nephrectomy C

50546 Laparoscopic

nephrectomy C

50547 Laparo removal donor

kidney C

50548 Laparo remove

w/ureter C

50549 Laparoscope procrenal T 0130 38.9223 "$2,725.18" $659.53 $545.04

50551 Kidney

endoscopy T 0160 6.7736 $474.26

. $94.86

50553 Kidney

endoscopy T 0162 26.2973 "$1,841.23"

. $368.25

50555 Kidney endoscopy &

biopsy T 0160 6.7736 $474.26

. $94.86

50557 Kidney endoscopy &

treatment T 0162 26.2973 "$1,841.23"

. $368.25

50561 Kidney endoscopy &

treatment T 0162 26.2973 "$1,841.23"

. $368.25

50562 Renal scope w/tumor

resect T 0160 6.7736 $474.26

. $94.86

50570 Kidney

endoscopy T 0160 6.7736 $474.26

. $94.86

50572 Kidney

endoscopy T 0160 6.7736 $474.26

. $94.86

50574 Kidney endoscopy &

biopsy T 0160 6.7736 $474.26

. $94.86

50575 Kidney

endoscopy T 0163 37.0730 "$2,595.70"

. $519.14

50576 Kidney endoscopy &

treatment T 0161 17.4715 "$1,223.28"

. $244.66

50580 Kidney endoscopy &

treatment T 0161 17.4715 "$1,223.28"

. $244.66

50590 Fragmenting of kidney

stone T 0169 52.0882 "$3,647.01" $997.74 $729.41

50592 Perc rf ablate renal

tumor T 0423 58.4890 "$4,095.17"

. $819.04

50593 Perc cryo ablate renal

tum T 0423 58.4890 "$4,095.17"

. $819.04

50600 Exploration of

ureter C50605 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 1.1095 $77.68 $16.21 $15.54

50688 Change of ureter

tube/stent T 0427 16.2412 "$1,137.14"

. $227.43

50690 Injection for ureter

x-ray N

50700 Revision of

ureter C

50715 Release of

ureter C

50722 Release of

ureter C

50725 Release/revise

ureter C

50727 Revise

ureter T 0165 20.4158 "$1,429.43"

. $285.89

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 C50782 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

50945 Laparoscopy

ureterolithotomy T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

50947 Laparo new

ureter/bladder T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

50948 Laparo new

ureter/bladder T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

50949 Laparoscope proc

ureter T 0130 38.9223 "$2,725.18" $659.53 $545.04

50951 Endoscopy of

ureter T 0160 6.7736 $474.26

. $94.8650953 Endoscopy of

ureter T 0160 6.7736 $474.26

. $94.86

50955 Ureter endoscopy &

biopsy T 0162 26.2973 "$1,841.23"

. $368.25

50957 Ureter endoscopy &

treatment T 0162 26.2973 "$1,841.23"

. $368.25

50961 Ureter endoscopy &

treatment T 0162 26.2973 "$1,841.23"

. $368.25

50970 Ureter

endoscopy T 0160 6.7736 $474.26

. $94.86

50972 Ureter endoscopy &

catheter T 0160 6.7736 $474.26

. $94.86

50974 Ureter endoscopy &

biopsy T 0161 17.4715 "$1,223.28"

. $244.66

50976 Ureter endoscopy &

treatment T 0161 17.4715 "$1,223.28"

. $244.66

50980 Ureter endoscopy &

treatment T 0162 26.2973 "$1,841.23"

. $368.25

51020 Incise & treat

bladder T 0162 26.2973 "$1,841.23"

. $368.25

51030 Incise & treat

bladder T 0162 26.2973 "$1,841.23"

. $368.25

51040 Incise & drain

bladder T 0162 26.2973 "$1,841.23"

. $368.25

51045 Incise bladder/drain

ureter T 0160 6.7736 $474.26

. $94.86

51050 Removal of bladder

stone T 0162 26.2973 "$1,841.23"

. $368.25

51060 Removal of ureter

stone T 0163 37.0730 "$2,595.70"

. $519.14

51065 Remove ureter

calculus T 0162 26.2973 "$1,841.23"

. $368.2551080 Drainage of bladder

abscess T 0008 20.5510 "$1,438.90"

. $287.78

51100 Drain bladder by

needle T 0164 1.9499 $136.52

. $27.31

51101 Drain bladder by

trocar/cath T 0126 1.1095 $77.68 $16.21 $15.54

51102 Drain bl w/cath

insertion T 0165 20.4158 "$1,429.43"

. $285.89

51500 Removal of bladder

cyst T 0154 32.9294 "$2,305.58" $464.85 $461.12

51520 Removal of bladder

lesion T 0162 26.2973 "$1,841.23"

. $368.25

51525 Removal of bladder

lesion C

51530 Removal of bladder

lesion C

51535 Repair of ureter

lesion T 0162 26.2973 "$1,841.23"

. $368.25

51550 Partial removal of

bladder C

51555 Partial removal of

bladder C

51565 Revise bladder &

ureter(s) C

51570 Removal of

bladder C

51575 Removal of bladder &

nodes C

51580 Remove bladder/revise

tract C

51585 Removal of bladder &

nodes C

51590 Remove bladder/revise

tract C

51595 Remove bladder/revise

tract C

51596 Remove bladder/create

pouch C

51597 Removal of pelvic

structures C51600 Injection for bladder

x-ray N

51605 Preparation for bladder

xray N

51610 Injection for bladder

x-ray N

51700 Irrigation of

bladder T 0164 1.9499 $136.52

. $27.31

51701 Insert bladder

catheter X 0340 0.6499 $45.50

. $9.10

51702 Insert temp bladder

cath X 0340 0.6499 $45.50

. $9.10

51703 Insert bladder cath

complex T 0126 1.1095 $77.68 $16.21 $15.54

51705 Change of bladder

tube T 0164 1.9499 $136.52

. $27.31

51710 Change of bladder

tube T 0121 6.2123 $434.96

. $87.00

51715 Endoscopic

injection/implant T 0168 32.3061 "$2,261.94"

. $452.39

51720 Treatment of bladder

lesion T 0156 3.1886 $223.25

. $44.65

51725 Simple

cystometrogram T 0156 3.1886 $223.25

. $44.65

51726 Complex

cystometrogram T 0156 3.1886 $223.25

. $44.65

51727 Cystometrogram

w/up T 0156 3.1886 $223.25

. $44.65

51728 Cystometrogram

w/vp T 0156 3.1886 $223.25

. $44.65

51729 Cystometrogram

w/vp&up T 0156 3.1886 $223.25

. $44.65

51736 Urine flow

measurement X 0340 0.6499 $45.50

. $9.1051741 Electro-uroflowmetry

first T 0126 1.1095 $77.68 $16.21 $15.54

51784 Anal/urinary muscle

study T 0126 1.1095 $77.68 $16.21 $15.54

51785 Anal/urinary muscle

study T 0164 1.9499 $136.52

. $27.31

51792 Urinary reflex

study T 0126 1.1095 $77.68 $16.21 $15.54

51797 Intraabdominal pressure

test T 0164 1.9499 $136.52

. $27.31

51798 Us urine capacity

measure X 0340 0.6499 $45.50

. $9.10

51800 Revision of

bladder/urethra C

51820 Revision of urinary

tract C

51840 Attach

bladder/urethra C

51841 Attach

bladder/urethra C

51845 Repair bladder

neck T 0202 45.9895 "$3,220.00" $981.50 $644.00

51860 Repair of bladder

wound T 0162 26.2973 "$1,841.23"

. $368.25

51865 Repair of bladder

wound C

51880 Repair of bladder

opening T 0162 26.2973 "$1,841.23"

. $368.25

51900 Repair bladder/vagina

lesion C

51920 Close bladder-uterus

fistula C

51925 Hysterectomy/bladder

repair C

51940 Correction of bladder

defect C51960 Revision of bladder &

bowel C

51980 Construct bladder

opening C

51990 Laparo urethral

suspension T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

51992 Laparo sling

operation T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

51999 Laparoscope proc

bla T 0130 38.9223 "$2,725.18" $659.53 $545.04

52000 Cystoscopy T 0160 6.7736 $474.26

. $94.86

52001 Cystoscopy removal of

clots T 0161 17.4715 "$1,223.28"

. $244.66

52005 Cystoscopy & ureter

catheter T 0162 26.2973 "$1,841.23"

. $368.25

52007 Cystoscopy and

biopsy T 0162 26.2973 "$1,841.23"

. $368.25

52010 Cystoscopy & duct

catheter T 0160 6.7736 $474.26

. $94.86

52204 Cystoscopy

w/biopsy(s) T 0162 26.2973 "$1,841.23"

. $368.25

52214 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52224 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52234 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52235 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52240 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52250 Cystoscopy and

radiotracer T 0162 26.2973 "$1,841.23"

. $368.25

52260 Cystoscopy andtreatment T 0161 17.4715 "$1,223.28"

. $244.66

52265 Cystoscopy and

treatment T 0160 6.7736 $474.26

. $94.86

52270 Cystoscopy & revise

urethra T 0161 17.4715 "$1,223.28"

. $244.66

52275 Cystoscopy & revise

urethra T 0162 26.2973 "$1,841.23"

. $368.25

52276 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52277 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52281 Cystoscopy and

treatment T 0161 17.4715 "$1,223.28"

. $244.66

52282 Cystoscopy implant

stent T 0163 37.0730 "$2,595.70"

. $519.14

52283 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52285 Cystoscopy and

treatment T 0161 17.4715 "$1,223.28"

. $244.66

52290 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52300 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52301 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52305 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52310 Cystoscopy and

treatment T 0161 17.4715 "$1,223.28"

. $244.66

52315 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52317 Remove bladder

stone T 0162 26.2973 "$1,841.23"

. $368.2552318 Remove bladder

stone T 0162 26.2973 "$1,841.23"

. $368.25

52320 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52325 Cystoscopy stone

removal T 0162 26.2973 "$1,841.23"

. $368.25

52327 Cystoscopy inject

material T 0163 37.0730 "$2,595.70"

. $519.14

52330 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52332 Cystoscopy and

treatment T 0162 26.2973 "$1,841.23"

. $368.25

52334 Create passage to

kidney T 0162 26.2973 "$1,841.23"

. $368.25

52341 Cysto w/ureter stricture

tx T 0162 26.2973 "$1,841.23"

. $368.25

52342 Cysto w/up stricture

tx T 0162 26.2973 "$1,841.23"

. $368.25

52343 Cysto w/renal stricture

tx T 0162 26.2973 "$1,841.23"

. $368.25

52344 Cysto/uretero stricture

tx T 0162 26.2973 "$1,841.23"

. $368.25

52345 Cysto/uretero w/up

stricture T 0162 26.2973 "$1,841.23"

. $368.25

52346 Cystouretero w/renal

strict T 0162 26.2973 "$1,841.23"

. $368.25

52351 Cystouretero & or

pyeloscope T 0162 26.2973 "$1,841.23"

. $368.25

52352 Cystouretero w/stone

remove T 0162 26.2973 "$1,841.23"

. $368.25

52353 Cystouretero

w/lithotripsy T 0163 37.0730 "$2,595.70"

. $519.14

52354 Cystoureterow/biopsy T 0162 26.2973 "$1,841.23"

. $368.25

52355 Cystouretero w/excise

tumor T 0162 26.2973 "$1,841.23"

. $368.25

52400 Cystouretero w/congen

repr T 0162 26.2973 "$1,841.23"

. $368.25

52402 Cystourethro cut ejacul

duct T 0162 26.2973 "$1,841.23"

. $368.25

52450 Incision of

prostate T 0162 26.2973 "$1,841.23"

. $368.25

52500 Revision of bladder

neck T 0162 26.2973 "$1,841.23"

. $368.25

52601 Prostatectomy

(TURP) T 0163 37.0730 "$2,595.70"

. $519.14

52630 Remove prostate

regrowth T 0163 37.0730 "$2,595.70"

. $519.14

52640 Relieve bladder

contracture T 0162 26.2973 "$1,841.23"

. $368.25

52647 Laser surgery of

prostate T 0429 45.7676 "$3,204.46"

. $640.90

52648 Laser surgery of

prostate T 0429 45.7676 "$3,204.46"

. $640.90

52649 Prostate laser

enucleation T 0429 45.7676 "$3,204.46"

. $640.90

52700 Drainage of prostate

abscess T 0162 26.2973 "$1,841.23"

. $368.25

53000 Incision of

urethra T 0166 21.0031 "$1,470.55"

. $294.11

53010 Incision of

urethra T 0166 21.0031 "$1,470.55"

. $294.11

53020 Incision of

urethra T 0166 21.0031 "$1,470.55"

. $294.11

53025 Incision of

urethra T 0166 21.0031 "$1,470.55"

. $294.1153040 Drainage of urethra

abscess T 0166 21.0031 "$1,470.55"

. $294.11

53060 Drainage of urethra

abscess T 0166 21.0031 "$1,470.55"

. $294.11

53080 Drainage of urinary

leakage T 0166 21.0031 "$1,470.55"

. $294.11

53085 Drainage of urinary

leakage T 0166 21.0031 "$1,470.55"

. $294.11

53200 Biopsy of

urethra T 0166 21.0031 "$1,470.55"

. $294.11

53210 Removal of

urethra T 0168 32.3061 "$2,261.94"

. $452.39

53215 Removal of

urethra T 0166 21.0031 "$1,470.55"

. $294.11

53220 Treatment of urethra

lesion T 0168 32.3061 "$2,261.94"

. $452.39

53230 Removal of urethra

lesion T 0168 32.3061 "$2,261.94"

. $452.39

53235 Removal of urethra

lesion T 0166 21.0031 "$1,470.55"

. $294.11

53240 Surgery for urethra

pouch T 0168 32.3061 "$2,261.94"

. $452.39

53250 Removal of urethra

gland T 0166 21.0031 "$1,470.55"

. $294.11

53260 Treatment of urethra

lesion T 0166 21.0031 "$1,470.55"

. $294.11

53265 Treatment of urethra

lesion T 0166 21.0031 "$1,470.55"

. $294.11

53270 Removal of urethra

gland T 0166 21.0031 "$1,470.55"

. $294.11

53275 Repair of urethra

defect T 0166 21.0031 "$1,470.55"

. $294.11

53400 Revise urethra stage1 T 0168 32.3061 "$2,261.94"

. $452.39

53405 Revise urethra stage

2 T 0168 32.3061 "$2,261.94"

. $452.39

53410 Reconstruction of

urethra T 0168 32.3061 "$2,261.94"

. $452.39

53415 Reconstruction of

urethra C

53420 Reconstruct urethra stage

1 T 0168 32.3061 "$2,261.94"

. $452.39

53425 Reconstruct urethra stage

2 T 0168 32.3061 "$2,261.94"

. $452.39

53430 Reconstruction of

urethra T 0168 32.3061 "$2,261.94"

. $452.39

53431 Reconstruct

urethra/bladder T 0168 32.3061 "$2,261.94"

. $452.39

53440 Male sling

procedure S 0385 104.8530 "$7,341.39"

. "$1,468.28"

53442 Remove/revise male

sling T 0168 32.3061 "$2,261.94"

. $452.39

53444 Insert tandem

cuff S 0385 104.8530 "$7,341.39"

. "$1,468.28"

53445 Insert uro/ves nck

sphincter S 0386 169.3017 "$11,853.83"

. "$2,370.77"

53446 Remove uro

sphincter T 0168 32.3061 "$2,261.94"

. $452.39

53447 Remove/replace ur

sphincter S 0386 169.3017 "$11,853.83"

. "$2,370.77"

53448 Remov/replc ur sphinctr

comp C

53449 Repair uro

sphincter T 0168 32.3061 "$2,261.94"

. $452.39

53450 Revision of

urethra T 0168 32.3061 "$2,261.94"

. $452.39

53460 Revision ofurethra T 0166 21.0031 "$1,470.55"

. $294.11

53500 Urethrlys transvag w/

scope T 0168 32.3061 "$2,261.94"

. $452.39

53502 Repair of urethra

injury T 0166 21.0031 "$1,470.55"

. $294.11

53505 Repair of urethra

injury T 0168 32.3061 "$2,261.94"

. $452.39

53510 Repair of urethra

injury T 0166 21.0031 "$1,470.55"

. $294.11

53515 Repair of urethra

injury T 0168 32.3061 "$2,261.94"

. $452.39

53520 Repair of urethra

defect T 0168 32.3061 "$2,261.94"

. $452.39

53600 Dilate urethra

stricture T 0156 3.1886 $223.25

. $44.65

53601 Dilate urethra

stricture T 0126 1.1095 $77.68 $16.21 $15.54

53605 Dilate urethra

stricture T 0161 17.4715 "$1,223.28"

. $244.66

53620 Dilate urethra

stricture T 0165 20.4158 "$1,429.43"

. $285.89

53621 Dilate urethra

stricture T 0164 1.9499 $136.52

. $27.31

53660 Dilation of

urethra T 0126 1.1095 $77.68 $16.21 $15.54

53661 Dilation of

urethra T 0126 1.1095 $77.68 $16.21 $15.54

53665 Dilation of

urethra T 0166 21.0031 "$1,470.55"

. $294.11

53850 Prostatic microwave

thermotx T 0429 45.7676 "$3,204.46"

. $640.90

53852 Prostatic rf

thermotx T 0429 45.7676 "$3,204.46"

. $640.9053855 Insert prost urethral

stent T 0164 1.9499 $136.52

. $27.31

53860 Transurethral rf

treatment T 0165 20.4158 "$1,429.43"

. $285.89

53899 Urology surgery

procedure T 0126 1.1095 $77.68 $16.21 $15.54

54000 Slitting of

prepuce T 0166 21.0031 "$1,470.55"

. $294.11

54001 Slitting of

prepuce T 0166 21.0031 "$1,470.55"

. $294.11

54015 Drain penis

lesion T 0008 20.5510 "$1,438.90"

. $287.78

54050 Destruction penis

lesion(s) CH T 0015 1.4966 $104.79

. $20.96

54055 Destruction penis

lesion(s) T 0017 21.6700 "$1,517.25"

. $303.45

54056 Cryosurgery penis

lesion(s) T 0013 0.8768 $61.39

. $12.28

54057 Laser surg penis

lesion(s) T 0017 21.6700 "$1,517.25"

. $303.45

54060 Excision of penis

lesion(s) T 0017 21.6700 "$1,517.25"

. $303.45

54065 Destruction penis

lesion(s) T 0017 21.6700 "$1,517.25"

. $303.45

54100 Biopsy of

penis T 0021 16.9957 "$1,189.97"

. $238.00

54105 Biopsy of

penis T 0022 23.2636 "$1,628.82" $350.74 $325.77

54110 Treatment of penis

lesion T 0181 34.6069 "$2,423.04" $607.60 $484.61

54111 Treat penis lesion

graft T 0181 34.6069 "$2,423.04" $607.60 $484.61

54112 Treat penis lesiongraft T 0181 34.6069 "$2,423.04" $607.60 $484.61

54115 Treatment of penis

lesion T 0008 20.5510 "$1,438.90"

. $287.78

54120 Partial removal of

penis T 0181 34.6069 "$2,423.04" $607.60 $484.61

54125 Removal of

penis C

54130 Remove penis &

nodes C

54135 Remove penis &

nodes C

54150 Circumcision w/regionl

block T 0183 23.5454 "$1,648.55"

. $329.71

54160 Circumcision

neonate T 0183 23.5454 "$1,648.55"

. $329.71

54161 Circum 28 days or

older T 0183 23.5454 "$1,648.55"

. $329.71

54162 Lysis penil circumic

lesion T 0183 23.5454 "$1,648.55"

. $329.71

54163 Repair of

circumcision T 0183 23.5454 "$1,648.55"

. $329.71

54164 Frenulotomy of

penis T 0183 23.5454 "$1,648.55"

. $329.71

54200 Treatment of penis

lesion T 0164 1.9499 $136.52

. $27.31

54205 Treatment of penis

lesion T 0181 34.6069 "$2,423.04" $607.60 $484.61

54220 Treatment of penis

lesion T 0164 1.9499 $136.52

. $27.31

54230 Prepare penis

study N

54231 Dynamic

cavernosometry T 0165 20.4158 "$1,429.43"

. $285.89

54235 Penile

injection CH T 0164 1.9499 $136.52

. $27.3154240 Penis

study T 0126 1.1095 $77.68 $16.21 $15.54

54250 Penis

study T 0164 1.9499 $136.52

. $27.31

54300 Revision of

penis T 0181 34.6069 "$2,423.04" $607.60 $484.61

54304 Revision of

penis T 0181 34.6069 "$2,423.04" $607.60 $484.61

54308 Reconstruction of

urethra T 0181 34.6069 "$2,423.04" $607.60 $484.61

54312 Reconstruction of

urethra T 0181 34.6069 "$2,423.04" $607.60 $484.61

54316 Reconstruction of

urethra T 0181 34.6069 "$2,423.04" $607.60 $484.61

54318 Reconstruction of

urethra T 0181 34.6069 "$2,423.04" $607.60 $484.61

54322 Reconstruction of

urethra T 0181 34.6069 "$2,423.04" $607.60 $484.61

54324 Reconstruction of

urethra T 0181 34.6069 "$2,423.04" $607.60 $484.61

54326 Reconstruction of

urethra T 0181 34.6069 "$2,423.04" $607.60 $484.61

54328 Revise

penis/urethra T 0181 34.6069 "$2,423.04" $607.60 $484.61

54332 Revise

penis/urethra T 0181 34.6069 "$2,423.04" $607.60 $484.61

54336 Revise

penis/urethra T 0181 34.6069 "$2,423.04" $607.60 $484.61

54340 Secondary urethral

surgery T 0181 34.6069 "$2,423.04" $607.60 $484.61

54344 Secondary urethral

surgery T 0181 34.6069 "$2,423.04" $607.60 $484.61

54348 Secondary urethralsurgery T 0181 34.6069 "$2,423.04" $607.60 $484.61

54352 Reconstruct

urethra/penis T 0181 34.6069 "$2,423.04" $607.60 $484.61

54360 Penis plastic

surgery T 0181 34.6069 "$2,423.04" $607.60 $484.61

54380 Repair

penis T 0181 34.6069 "$2,423.04" $607.60 $484.61

54385 Repair

penis T 0181 34.6069 "$2,423.04" $607.60 $484.61

54390 Repair penis and

bladder C

54400 Insert semi-rigid

prosthesis S 0385 104.8530 "$7,341.39"

. "$1,468.28"

54401 Insert self-contd

prosthesis S 0386 169.3017 "$11,853.83"

. "$2,370.77"

54405 Insert multi-comp penis

pros S 0386 169.3017 "$11,853.83"

. "$2,370.77"

54406 Remove muti-comp penis

pros T 0181 34.6069 "$2,423.04" $607.60 $484.61

54408 Repair multi-comp penis

pros T 0181 34.6069 "$2,423.04" $607.60 $484.61

54410 Remove/replace penis

prosth S 0386 169.3017 "$11,853.83"

. "$2,370.77"

54411 Remov/replc penis pros

comp C

54415 Remove self-contd penis

pros T 0181 34.6069 "$2,423.04" $607.60 $484.61

54416 Remv/repl penis contain

pros S 0386 169.3017 "$11,853.83"

. "$2,370.77"

54417 Remv/replc penis pros

compl C

54420 Revision of

penis T 0181 34.6069 "$2,423.04" $607.60 $484.61

54430 Revision of

penis C54435 Revision of

penis T 0181 34.6069 "$2,423.04" $607.60 $484.61

54440 Repair of

penis T 0181 34.6069 "$2,423.04" $607.60 $484.61

54450 Preputial

stretching T 0156 3.1886 $223.25

. $44.65

54500 Biopsy of

testis T 0037 15.3535 "$1,074.99" $227.40 $215.00

54505 Biopsy of

testis T 0183 23.5454 "$1,648.55"

. $329.71

54512 Excise lesion

testis T 0183 23.5454 "$1,648.55"

. $329.71

54520 Removal of

testis T 0183 23.5454 "$1,648.55"

. $329.71

54522 Orchiectomy

partial T 0183 23.5454 "$1,648.55"

. $329.71

54530 Removal of

testis T 0154 32.9294 "$2,305.58" $464.85 $461.12

54535 Extensive testis

surgery T 0181 34.6069 "$2,423.04" $607.60 $484.61

54550 Exploration for

testis T 0154 32.9294 "$2,305.58" $464.85 $461.12

54560 Exploration for

testis T 0183 23.5454 "$1,648.55"

. $329.71

54600 Reduce testis

torsion T 0183 23.5454 "$1,648.55"

. $329.71

54620 Suspension of

testis T 0183 23.5454 "$1,648.55"

. $329.71

54640 Suspension of

testis T 0154 32.9294 "$2,305.58" $464.85 $461.12

54650 Orchiopexy

(Fowler-Stephens) CH T 0154 32.9294 "$2,305.58" $464.85 $461.12

54660 Revision oftestis T 0183 23.5454 "$1,648.55"

. $329.71

54670 Repair testis

injury T 0183 23.5454 "$1,648.55"

. $329.71

54680 Relocation of

testis(es) T 0183 23.5454 "$1,648.55"

. $329.71

54690 Laparoscopy

orchiectomy T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

54692 Laparoscopy

orchiopexy T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

54699 Laparoscope proc

testis T 0130 38.9223 "$2,725.18" $659.53 $545.04

54700 Drainage of

scrotum T 0183 23.5454 "$1,648.55"

. $329.71

54800 Biopsy of

epididymis T 0004 4.5721 $320.12

. $64.03

54830 Remove epididymis

lesion T 0183 23.5454 "$1,648.55"

. $329.71

54840 Remove epididymis

lesion T 0183 23.5454 "$1,648.55"

. $329.71

54860 Removal of

epididymis T 0183 23.5454 "$1,648.55"

. $329.71

54861 Removal of

epididymis T 0183 23.5454 "$1,648.55"

. $329.71

54865 Explore

epididymis T 0183 23.5454 "$1,648.55"

. $329.71

54900 Fusion of spermatic

ducts T 0183 23.5454 "$1,648.55"

. $329.71

54901 Fusion of spermatic

ducts T 0183 23.5454 "$1,648.55"

. $329.71

55000 Drainage of

hydrocele T 0004 4.5721 $320.12

. $64.03

55040 Removal of

hydrocele T 0154 32.9294 "$2,305.58" $464.85 $461.1255041 Removal of

hydroceles T 0154 32.9294 "$2,305.58" $464.85 $461.12

55060 Repair of

hydrocele T 0183 23.5454 "$1,648.55"

. $329.71

55100 Drainage of scrotum

abscess T 0007 12.8082 $896.78

. $179.36

55110 Explore

scrotum T 0183 23.5454 "$1,648.55"

. $329.71

55120 Removal of scrotum

lesion T 0183 23.5454 "$1,648.55"

. $329.71

55150 Removal of

scrotum T 0183 23.5454 "$1,648.55"

. $329.71

55175 Revision of

scrotum T 0183 23.5454 "$1,648.55"

. $329.71

55180 Revision of

scrotum T 0183 23.5454 "$1,648.55"

. $329.71

55200 Incision of sperm

duct T 0183 23.5454 "$1,648.55"

. $329.71

55250 Removal of sperm

duct(s) T 0183 23.5454 "$1,648.55"

. $329.71

55300 Prepare sperm duct

x-ray N

55400 Repair of sperm

duct T 0183 23.5454 "$1,648.55"

. $329.71

55450 Ligation of sperm

duct T 0183 23.5454 "$1,648.55"

. $329.71

55500 Removal of

hydrocele T 0183 23.5454 "$1,648.55"

. $329.71

55520 Removal of sperm cord

lesion T 0183 23.5454 "$1,648.55"

. $329.71

55530 Revise spermatic cord

veins T 0183 23.5454 "$1,648.55"

. $329.71

55535 Revise spermatic cord

veins T 0154 32.9294 "$2,305.58" $464.85 $461.1255540 Revise hernia & sperm

veins T 0154 32.9294 "$2,305.58" $464.85 $461.12

55550 Laparo ligate spermatic

vein T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

55559 Laparo proc spermatic

cord T 0130 38.9223 "$2,725.18" $659.53 $545.04

55600 Incise sperm duct

pouch T 0183 23.5454 "$1,648.55"

. $329.71

55605 Incise sperm duct

pouch C

55650 Remove sperm duct

pouch C

55680 Remove sperm pouch

lesion T 0183 23.5454 "$1,648.55"

. $329.71

55700 Biopsy of

prostate T 0184 13.7727 $964.31

. $192.87

55705 Biopsy of

prostate T 0184 13.7727 $964.31

. $192.87

55706 Prostate saturation

sampling T 0184 13.7727 $964.31

. $192.87

55720 Drainage of prostate

abscess T 0162 26.2973 "$1,841.23"

. $368.25

55725 Drainage of prostate

abscess T 0162 26.2973 "$1,841.23"

. $368.25

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 C55840 Extensive prostate

surgery C

55842 Extensive prostate

surgery C

55845 Extensive prostate

surgery C

55860 Surgical exposure

prostate T 0165 20.4158 "$1,429.43"

. $285.89

55862 Extensive prostate

surgery C

55865 Extensive prostate

surgery C

55866 Laparo radical

prostatectomy C

55870 Electroejaculation T 0189 3.4818 $243.78

. $48.76

55873 Cryoablate

prostate T 0674 113.8112 "$7,968.60"

. "$1,593.72"

55875 Transperi needle place

pros Q3 0163 37.0730 "$2,595.70"

. $519.14

55876 Place rt device/marker

pros X 0310 13.6332 $954.54 $325.27 $190.91

55899 Genital surgery

procedure T 0126 1.1095 $77.68 $16.21 $15.54

55920 Place needles pelvic for

rt T 0153 27.2798 "$1,910.02"

. $382.01

55970 Sex transformation m to

f E

55980 Sex transformation f to

m E

56405 I & D of

vulva/perineum T 0188 1.5841 $110.91

. $22.19

56420 Drainage of gland

abscess T 0188 1.5841 $110.91

. $22.19

56440 Surgery for vulva

lesion T 0193 20.6493 "$1,445.78"

. $289.16

56441 Lysis of labial

lesion(s) T 0193 20.6493 "$1,445.78"

. $289.1656442 Hymenotomy T 0193 20.6493 "$1,445.78"

. $289.16

56501 Destroy vulva lesions

sim T 0017 21.6700 "$1,517.25"

. $303.45

56515 Destroy vulva lesion/s

compl T 0017 21.6700 "$1,517.25"

. $303.45

56605 Biopsy of

vulva/perineum T 0189 3.4818 $243.78

. $48.76

56606 Biopsy of

vulva/perineum T 0188 1.5841 $110.91

. $22.19

56620 Partial removal of

vulva T 0193 20.6493 "$1,445.78"

. $289.16

56625 Complete removal of

vulva T 0193 20.6493 "$1,445.78"

. $289.16

56630 Extensive vulva

surgery C

56631 Extensive vulva

surgery C

56632 Extensive vulva

surgery C

56633 Extensive vulva

surgery C

56634 Extensive vulva

surgery C

56637 Extensive vulva

surgery C

56640 Extensive vulva

surgery C

56700 Partial removal of

hymen T 0193 20.6493 "$1,445.78"

. $289.16

56740 Remove vagina gland

lesion T 0193 20.6493 "$1,445.78"

. $289.16

56800 Repair of

vagina T 0193 20.6493 "$1,445.78"

. $289.16

56805 Repair

clitoris T 0193 20.6493 "$1,445.78"

. $289.1656810 Repair of

perineum T 0193 20.6493 "$1,445.78"

. $289.16

56820 Exam of vulva

w/scope T 0188 1.5841 $110.91

. $22.19

56821 Exam/biopsy of vulva

w/scope T 0188 1.5841 $110.91

. $22.19

57000 Exploration of

vagina T 0193 20.6493 "$1,445.78"

. $289.16

57010 Drainage of pelvic

abscess T 0193 20.6493 "$1,445.78"

. $289.16

57020 Drainage of pelvic

fluid T 0192 6.6979 $468.96

. $93.80

57022 I & d vaginal hematoma

pp T 0007 12.8082 $896.78

. $179.36

57023 I & d vag hematoma

non-ob T 0008 20.5510 "$1,438.90"

. $287.78

57061 Destroy vag lesions

simple T 0193 20.6493 "$1,445.78"

. $289.16

57065 Destroy vag lesions

complex T 0193 20.6493 "$1,445.78"

. $289.16

57100 Biopsy of

vagina T 0192 6.6979 $468.96

. $93.80

57105 Biopsy of

vagina T 0193 20.6493 "$1,445.78"

. $289.16

57106 Remove vagina wall

partial T 0193 20.6493 "$1,445.78"

. $289.16

57107 Remove vagina tissue

part T 0195 35.9087 "$2,514.18"

. $502.84

57109 Vaginectomy partial

w/nodes T 0195 35.9087 "$2,514.18"

. $502.84

57110 Remove vagina wall

complete C

57111 Remove vagina tissue

compl C57112 Vaginectomy w/nodes

compl C

57120 Closure of

vagina T 0195 35.9087 "$2,514.18"

. $502.84

57130 Remove vagina

lesion T 0193 20.6493 "$1,445.78"

. $289.16

57135 Remove vagina

lesion T 0193 20.6493 "$1,445.78"

. $289.16

57150 Treat vagina

infection T 0188 1.5841 $110.91

. $22.19

57155 Insert uteri

tandems/ovoids T 0192 6.6979 $468.96

. $93.80

57156 Ins vag brachytx

device T 0189 3.4818 $243.78

. $48.76

57160 Insert pessary/other

device T 0188 1.5841 $110.91

. $22.19

57170 Fitting of

diaphragm/cap T 0191 0.1337 $9.36 $1.95 $1.88

57180 Treat vaginal

bleeding T 0188 1.5841 $110.91

. $22.19

57200 Repair of

vagina T 0193 20.6493 "$1,445.78"

. $289.16

57210 Repair

vagina/perineum T 0193 20.6493 "$1,445.78"

. $289.16

57220 Revision of

urethra T 0202 45.9895 "$3,220.00" $981.50 $644.00

57230 Repair of urethral

lesion T 0195 35.9087 "$2,514.18"

. $502.84

57240 Repair bladder &

vagina T 0195 35.9087 "$2,514.18"

. $502.84

57250 Repair rectum &

vagina T 0195 35.9087 "$2,514.18"

. $502.84

57260 Repair of

vagina T 0195 35.9087 "$2,514.18"

. $502.8457265 Extensive repair of

vagina T 0202 45.9895 "$3,220.00" $981.50 $644.00

57267 Insert mesh/pelvic flr

addon T 0195 35.9087 "$2,514.18"

. $502.84

57268 Repair of bowel

bulge T 0195 35.9087 "$2,514.18"

. $502.84

57270 Repair of bowel

pouch C

57280 Suspension of

vagina C

57282 Colpopexy

extraperitoneal T 0202 45.9895 "$3,220.00" $981.50 $644.00

57283 Colpopexy

intraperitoneal T 0202 45.9895 "$3,220.00" $981.50 $644.00

57284 Repair paravag defect

open T 0202 45.9895 "$3,220.00" $981.50 $644.00

57285 Repair paravag defect

vag T 0202 45.9895 "$3,220.00" $981.50 $644.00

57287 Revise/remove sling

repair T 0195 35.9087 "$2,514.18"

. $502.84

57288 Repair bladder

defect T 0202 45.9895 "$3,220.00" $981.50 $644.00

57289 Repair bladder &

vagina T 0195 35.9087 "$2,514.18"

. $502.84

57291 Construction of

vagina T 0195 35.9087 "$2,514.18"

. $502.84

57292 Construct vagina with

graft T 0195 35.9087 "$2,514.18"

. $502.84

57295 Revise vag graft via

vagina T 0193 20.6493 "$1,445.78"

. $289.16

57296 Revise vag graft open

abd C

57300 Repair rectum-vagina

fistula T 0195 35.9087 "$2,514.18"

. $502.8457305 Repair rectum-vagina

fistula C

57307 Fistula repair &

colostomy C

57308 Fistula repair

transperine C

57310 Repair urethrovaginal

lesion T 0202 45.9895 "$3,220.00" $981.50 $644.00

57311 Repair urethrovaginal

lesion C

57320 Repair bladder-vagina

lesion T 0195 35.9087 "$2,514.18"

. $502.84

57330 Repair bladder-vagina

lesion T 0195 35.9087 "$2,514.18"

. $502.84

57335 Repair

vagina T 0195 35.9087 "$2,514.18"

. $502.84

57400 Dilation of

vagina T 0193 20.6493 "$1,445.78"

. $289.16

57410 Pelvic

examination T 0193 20.6493 "$1,445.78"

. $289.16

57415 Remove vaginal foreign

body T 0193 20.6493 "$1,445.78"

. $289.16

57420 Exam of vagina

w/scope T 0189 3.4818 $243.78

. $48.76

57421 Exam/biopsy of vag

w/scope T 0189 3.4818 $243.78

. $48.76

57423 Repair paravag defect

lap T 0202 45.9895 "$3,220.00" $981.50 $644.00

57425 Laparoscopy surg

colpopexy CH T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

57426 Revise prosth vag graft

lap T 0193 20.6493 "$1,445.78"

. $289.16

57452 Exam of cervix

w/scope T 0188 1.5841 $110.91

. $22.19

57454 Bx/curett of cervixw/scope T 0189 3.4818 $243.78

. $48.76

57455 Biopsy of cervix

w/scope T 0189 3.4818 $243.78

. $48.76

57456 Endocerv curettage

w/scope T 0189 3.4818 $243.78

. $48.76

57460 Bx of cervix w/scope

leep T 0193 20.6493 "$1,445.78"

. $289.16

57461 Conz of cervix w/scope

leep T 0193 20.6493 "$1,445.78"

. $289.16

57500 Biopsy of

cervix T 0192 6.6979 $468.96

. $93.80

57505 Endocervical

curettage T 0192 6.6979 $468.96

. $93.80

57510 Cauterization of

cervix T 0193 20.6493 "$1,445.78"

. $289.16

57511 Cryocautery of

cervix T 0188 1.5841 $110.91

. $22.19

57513 Laser surgery of

cervix T 0193 20.6493 "$1,445.78"

. $289.16

57520 Conization of

cervix T 0193 20.6493 "$1,445.78"

. $289.16

57522 Conization of

cervix T 0193 20.6493 "$1,445.78"

. $289.16

57530 Removal of

cervix T 0195 35.9087 "$2,514.18"

. $502.84

57531 Removal of cervix

radical C

57540 Removal of residual

cervix C

57545 Remove cervix/repair

pelvis C

57550 Removal of residual

cervix T 0195 35.9087 "$2,514.18"

. $502.84

57555 Remove cervix/repair

vagina T 0195 35.9087 "$2,514.18"

. $502.8457556 Remove cervix repair

bowel T 0202 45.9895 "$3,220.00" $981.50 $644.00

57558 D&c of cervical

stump T 0193 20.6493 "$1,445.78"

. $289.16

57700 Revision of

cervix T 0193 20.6493 "$1,445.78"

. $289.16

57720 Revision of

cervix T 0193 20.6493 "$1,445.78"

. $289.16

57800 Dilation of cervical

canal T 0193 20.6493 "$1,445.78"

. $289.16

58100 Biopsy of uterus

lining T 0188 1.5841 $110.91

. $22.19

58110 Bx done w/colposcopy

add-on N

58120 Dilation and

curettage T 0193 20.6493 "$1,445.78"

. $289.16

58140 Myomectomy abdom

method C

58145 Myomectomy vag

method T 0195 35.9087 "$2,514.18"

. $502.84

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 C58260 Vaginal

hysterectomy T 0195 35.9087 "$2,514.18"

. $502.84

58262 Vag hyst including

t/o T 0195 35.9087 "$2,514.18"

. $502.84

58263 Vag hyst w/t/o & vag

repair T 0195 35.9087 "$2,514.18"

. $502.84

58267 Vag hyst w/urinary

repair C

58270 Vag hyst w/enterocele

repair T 0195 35.9087 "$2,514.18"

. $502.84

58275 Hysterectomy/revise

vagina C

58280 Hysterectomy/revise

vagina C

58285 Extensive

hysterectomy C

58290 Vag hyst

complex T 0202 45.9895 "$3,220.00" $981.50 $644.00

58291 Vag hyst incl t/o

complex T 0202 45.9895 "$3,220.00" $981.50 $644.00

58292 Vag hyst t/o & repair

compl T 0202 45.9895 "$3,220.00" $981.50 $644.00

58293 Vag hyst w/uro repair

compl C

58294 Vag hyst w/enterocele

compl T 0202 45.9895 "$3,220.00" $981.50 $644.00

58300 Insert intrauterine

device E

58301 Remove intrauterine

device T 0188 1.5841 $110.91

. $22.19

58321 Artificial

insemination T 0189 3.4818 $243.78

. $48.76

58322 Artificial

insemination T 0189 3.4818 $243.78

. $48.76

58323 Sperm

washing T 0189 3.4818 $243.78

. $48.7658340 Catheter for

hysterography N

58345 Reopen fallopian

tube T 0193 20.6493 "$1,445.78"

. $289.16

58346 Insert heyman uteri

capsule T 0193 20.6493 "$1,445.78"

. $289.16

58350 Reopen fallopian

tube T 0195 35.9087 "$2,514.18"

. $502.84

58353 Endometr ablate

thermal T 0195 35.9087 "$2,514.18"

. $502.84

58356 Endometrial

cryoablation T 0202 45.9895 "$3,220.00" $981.50 $644.00

58400 Suspension of

uterus C

58410 Suspension of

uterus C

58520 Repair of ruptured

uterus C

58540 Revision of

uterus C

58541 Lsh uterus 250 g or

less T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

58542 Lsh w/t/o ut 250 g or

less T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

58543 Lsh uterus above 250

g T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

58544 Lsh w/t/o uterus above 250

g T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

58545 Laparoscopic

myomectomy T 0130 38.9223 "$2,725.18" $659.53 $545.04

58546 Laparo-myomectomy

complex T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58548 Lap radical

hyst C

58550 Laparo-asst vag

hysterectomy T 0132 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"58552 Laparo-vag hyst incl

t/o T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58553 Laparo-vag hyst

complex T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58554 Laparo-vag hyst w/t/o

compl T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58555 Hysteroscopy dx sep

proc T 0190 23.0098 "$1,611.05" $424.28 $322.21

58558 Hysteroscopy

biopsy T 0190 23.0098 "$1,611.05" $424.28 $322.21

58559 Hysteroscopy

lysis T 0190 23.0098 "$1,611.05" $424.28 $322.21

58560 Hysteroscopy resect

septum T 0387 38.3457 "$2,684.81" $655.55 $536.97

58561 Hysteroscopy remove

myoma T 0387 38.3457 "$2,684.81" $655.55 $536.97

58562 Hysteroscopy remove

fb T 0190 23.0098 "$1,611.05" $424.28 $322.21

58563 Hysteroscopy

ablation T 0387 38.3457 "$2,684.81" $655.55 $536.97

58565 Hysteroscopy

sterilization T 0202 45.9895 "$3,220.00" $981.50 $644.00

58570 Tlh uterus 250 g or

less T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58571 Tlh w/t/o 250 g or

less T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58572 Tlh uterus over 250

g T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58573 Tlh w/t/o uterus over 250

g T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58578 Laparo proc

uterus T 0130 38.9223 "$2,725.18" $659.53 $545.0458579 Hysteroscope

procedure T 0190 23.0098 "$1,611.05" $424.28 $322.21

58600 Division of fallopian

tube T 0195 35.9087 "$2,514.18"

. $502.84

58605 Division of fallopian

tube C

58611 Ligate oviduct(s)

add-on C

58615 Occlude fallopian

tube(s) T 0193 20.6493 "$1,445.78"

. $289.16

58660 Laparoscopy

lysis T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58661 Laparoscopy remove

adnexa T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58662 Laparoscopy excise

lesions T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58670 Laparoscopy tubal

cautery T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58671 Laparoscopy tubal

block T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58672 Laparoscopy

fimbrioplasty T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58673 Laparoscopy

salpingostomy T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

58679 Laparo proc

oviduct-ovary T 0130 38.9223 "$2,725.18" $659.53 $545.04

58700 Removal of fallopian

tube C

58720 Removal of

ovary/tube(s) C

58740 Adhesiolysis tube

ovary C

58750 Repair

oviduct C

58752 Revise ovarian

tube(s) C58760 Fimbrioplasty C

58770 Create new tubal

opening T 0195 35.9087 "$2,514.18"

. $502.84

58800 Drainage of ovarian

cyst(s) T 0193 20.6493 "$1,445.78"

. $289.16

58805 Drainage of ovarian

cyst(s) T 0195 35.9087 "$2,514.18"

. $502.84

58820 Drain ovary abscess

open T 0195 35.9087 "$2,514.18"

. $502.84

58822 Drain ovary abscess

percut C

58823 Drain pelvic abscess

percut T 0193 20.6493 "$1,445.78"

. $289.16

58825 Transposition

ovary(s) C

58900 Biopsy of

ovary(s) T 0193 20.6493 "$1,445.78"

. $289.16

58920 Partial removal of

ovary(s) T 0195 35.9087 "$2,514.18"

. $502.84

58925 Removal of ovarian

cyst(s) T 0195 35.9087 "$2,514.18"

. $502.84

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 gynmal C

58958 Resect recur gyn mal

w/lym C

58960 Exploration of

abdomen C

58970 Retrieval of

oocyte T 0189 3.4818 $243.78

. $48.76

58974 Transfer of

embryo T 0189 3.4818 $243.78

. $48.76

58976 Transfer of

embryo T 0189 3.4818 $243.78

. $48.76

58999 Genital surgery

procedure T 0191 0.1337 $9.36 $1.95 $1.88

59000 Amniocentesis

diagnostic T 0189 3.4818 $243.78

. $48.76

59001 Amniocentesis

therapeutic T 0192 6.6979 $468.96

. $93.80

59012 Fetal cord puncture

prenatal T 0189 3.4818 $243.78

. $48.76

59015 Chorion

biopsy T 0189 3.4818 $243.78

. $48.76

59020 Fetal contract stress

test T 0188 1.5841 $110.91

. $22.19

59025 Fetal non-stress

test T 0188 1.5841 $110.91

. $22.19

59030 Fetal scalp blood

sample T 0189 3.4818 $243.78

. $48.76

59050 Fetal monitor

w/report M

59051 Fetal monitor/interpret

only B

59070 Transabdom amnioinfus

w/us T 0188 1.5841 $110.91

. $22.19

59072 Umbilical cord occlud

w/us T 0189 3.4818 $243.78

. $48.7659074 Fetal fluid drainage

w/us T 0189 3.4818 $243.78

. $48.76

59076 Fetal shunt placement

w/us T 0189 3.4818 $243.78

. $48.76

59100 Remove uterus

lesion T 0195 35.9087 "$2,514.18"

. $502.84

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 47.9394 "$3,356.53" "$1,001.89" $671.31

59151 Treat ectopic

pregnancy T 0131 47.9394 "$3,356.53" "$1,001.89" $671.31

59160 D & c after

delivery T 0193 20.6493 "$1,445.78"

. $289.16

59200 Insert cervical

dilator T 0188 1.5841 $110.91

. $22.19

59300 Episiotomy or vaginal

repair T 0193 20.6493 "$1,445.78"

. $289.16

59320 Revision of

cervix T 0193 20.6493 "$1,445.78"

. $289.16

59325 Revision of

cervix C

59350 Repair of

uterus C

59400 Obstetrical

care B

59409 Obstetrical

care T 0193 20.6493 "$1,445.78"

. $289.1659410 Obstetrical

care B

59412 Antepartum

manipulation T 0193 20.6493 "$1,445.78"

. $289.16

59414 Deliver

placenta T 0193 20.6493 "$1,445.78"

. $289.16

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

cesarean C

59610 Vbac

delivery B

59612 Vbac delivery

only T 0193 20.6493 "$1,445.78"

. $289.16

59614 Vbac care after

delivery B

59618 Attempted vbac

delivery B

59620 Attempted vbac delivery

only C

59622 Attempted vbac after

care B

59812 Treatment of

miscarriage T 0193 20.6493 "$1,445.78"

. $289.16

59820 Care of

miscarriage T 0193 20.6493 "$1,445.78"

. $289.16

59821 Treatment of

miscarriage T 0193 20.6493 "$1,445.78"

. $289.16

59830 Treat uterus

infection C59840 Abortion T 0193 20.6493 "$1,445.78"

. $289.16

59841 Abortion T 0193 20.6493 "$1,445.78"

. $289.16

59850 Abortion C

59851 Abortion C

59852 Abortion C

59855 Abortion C

59856 Abortion C

59857 Abortion C

59866 Abortion

(mpr) T 0189 3.4818 $243.78

. $48.76

59870 Evacuate mole of

uterus T 0193 20.6493 "$1,445.78"

. $289.16

59871 Remove cerclage

suture T 0193 20.6493 "$1,445.78"

. $289.16

59897 Fetal invas px

w/us T 0191 0.1337 $9.36 $1.95 $1.88

59898 Laparo proc ob

care/deliver T 0130 38.9223 "$2,725.18" $659.53 $545.04

59899 Maternity care

procedure T 0191 0.1337 $9.36 $1.95 $1.88

60000 Drain thyroid/tongue

cyst T 0252 7.4614 $522.42 $104.55 $104.49

60100 Biopsy of

thyroid T 0004 4.5721 $320.12

. $64.03

60200 Remove thyroid

lesion T 0114 51.2792 "$3,590.36"

. $718.08

60210 Partial thyroid

excision T 0114 51.2792 "$3,590.36"

. $718.08

60212 Partial thyroidexcision T 0114 51.2792 "$3,590.36"

. $718.08

60220 Partial removal of

thyroid T 0114 51.2792 "$3,590.36"

. $718.08

60225 Partial removal of

thyroid T 0114 51.2792 "$3,590.36"

. $718.08

60240 Removal of

thyroid T 0114 51.2792 "$3,590.36"

. $718.08

60252 Removal of

thyroid T 0256 45.0377 "$3,153.36"

. $630.68

60254 Extensive thyroid

surgery C

60260 Repeat thyroid

surgery T 0256 45.0377 "$3,153.36"

. $630.68

60270 Removal of

thyroid C

60271 Removal of

thyroid T 0256 45.0377 "$3,153.36"

. $630.68

60280 Remove thyroid duct

lesion T 0114 51.2792 "$3,590.36"

. $718.08

60281 Remove thyroid duct

lesion T 0114 51.2792 "$3,590.36"

. $718.08

60300 Aspir/inj thyroid

cyst T 0004 4.5721 $320.12

. $64.03

60500 Explore parathyroid

glands T 0256 45.0377 "$3,153.36"

. $630.68

60502 Re-explore

parathyroids T 0256 45.0377 "$3,153.36"

. $630.68

60505 Explore parathyroid

glands C

60512 Autotransplant

parathyroid T 0022 23.2636 "$1,628.82" $350.74 $325.77

60520 Removal of thymus

gland T 0256 45.0377 "$3,153.36"

. $630.68

60521 Removal of thymus

gland C60522 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 38.9223 "$2,725.18" $659.53 $545.04

60699 Endocrine surgery

procedure T 0114 51.2792 "$3,590.36"

. $718.08

61000 Remove cranial cavity

fluid T 0207 7.4537 $521.88

. $104.38

61001 Remove cranial cavity

fluid T 0207 7.4537 $521.88

. $104.38

61020 Remove brain cavity

fluid T 0207 7.4537 $521.88

. $104.38

61026 Injection into brain

canal T 0207 7.4537 $521.88

. $104.38

61050 Remove brain canal

fluid T 0207 7.4537 $521.88

. $104.38

61055 Injection into brain

canal T 0207 7.4537 $521.88

. $104.38

61070 Brain canal shunt

procedure T 0121 6.2123 $434.96

. $87.00

61105 Twist drill

hole C

61107 Drill skull for

implantation C

61108 Drill skull for

drainage C61120 Burr hole for

puncture C

61140 Pierce skull for

biopsy C

61150 Pierce skull for

drainage C

61151 Pierce skull for

drainage C

61154 Pierce skull & remove

clot C

61156 Pierce skull for

drainage C

61210 Pierce skull implant

device C

61215 Insert brain-fluid

device T 0224 41.5547 "$2,909.49"

. $581.90

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 C61330 Decompress eye

socket T 0256 45.0377 "$3,153.36"

. $630.68

61332 Explore/biopsy eye

socket C

61333 Explore orbit/remove

lesion C

61334 Explore orbit/remove

object T 0256 45.0377 "$3,153.36"

. $630.68

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 C61518 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 C61546 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

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 C61585 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 C61613 Remove aneurysm

sinus C

61615 Resect/excise lesion

skull C

61616 Resect/excise lesion

skull C

61618 Repair

dura C

61619 Repair

dura C

61623 Endovasc tempory vessel

occl T 0082 105.0651 "$7,356.24"

. "$1,471.25"

61624 Transcath occlusion

cns C

61626 Transcath occlusion

non-cns T 0082 105.0651 "$7,356.24"

. "$1,471.25"

61630 Intracranial

angioplasty C

61635 Intracran angioplsty

w/stent C

61640 Dilate ic vasospasm

init E

61641 Dilate ic vasospasm

add-on E

61642 Dilate ic vasospasm

add-on E

61680 Intracranial 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 C61700 Brain aneurysm repr

simple C

61702 Inner skull vessel

surgery C

61703 Clamp neck

artery C

61705 Revise circulation to

head C

61708 Revise circulation to

head C

61710 Revise circulation to

head C

61711 Fusion of skull

arteries C

61720 Incise skull/brain

surgery T 0221 36.1290 "$2,529.61"

. $505.93

61735 Incise skull/brain

surgery C

61750 Incise skull/brain

biopsy C

61751 Brain biopsy w/ct/mr

guide C

61760 Implant brain

electrodes C

61770 Incise skull for

treatment T 0221 36.1290 "$2,529.61"

. $505.93

61781 Scan proc cranial

intra N

61782 Scan proc cranial

extra N

61783 Scan proc

spinal N

61790 Treat trigeminal

nerve T 0220 18.8921 "$1,322.75"

. $264.55

61791 Treat trigeminal

tract T 0203 12.7996 $896.18

. $179.24

61796 Srs cranial lesion

simple B

61797 Srs cran les simple

addl B

61798 Srs cranial lesioncomplex B

61799 Srs cran les complex

addl B

61800 Apply srs headframe

add-on B

61850 Implant

neuroelectrodes C

61860 Implant

neuroelectrodes C

61863 Implant

neuroelectrode C

61864 Implant neuroelectrde

addl C

61867 Implant

neuroelectrode C

61868 Implant neuroelectrde

addl C

61870 Implant

neuroelectrodes C

61875 Implant

neuroelectrodes C

61880 Revise/remove

neuroelectrode T 0687 20.7198 "$1,450.72" $385.30 $290.15

61885 Insrt/redo neurostim 1

array S 0039 216.9330 "$15,188.78"

. "$3,037.76"

61886 Implant neurostim

arrays S 0315 285.5893 "$19,995.82"

. "$3,999.17"

61888 Revise/remove

neuroreceiver T 0688 31.1002 "$2,177.51" $768.94 $435.51

62000 Treat skull

fracture T 0254 24.8895 "$1,742.66"

. $348.54

62005 Treat skull

fracture C

62010 Treatment of head

injury C

62100 Repair brain fluid

leakage C62115 Reduction of skull

defect C

62116 Reduction of skull

defect C

62117 Reduction of skull

defect C

62120 Repair skull cavity

lesion C

62121 Incise skull

repair C

62140 Repair of skull

defect C

62141 Repair of skull

defect C

62142 Remove skull

plate/flap C

62143 Replace skull

plate/flap C

62145 Repair of skull &

brain C

62146 Repair of skull with

graft C

62147 Repair of skull with

graft C

62148 Retr bone flap to fix

skull C

62160 Neuroendoscopy

add-on N

62161 Dissect brain

w/scope C

62162 Remove colloid cyst

w/scope C

62163 Zneuroendoscopy 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 C62194 Replace/irrigate

catheter T 0207 7.4537 $521.88

. $104.38

62200 Establish brain cavity

shunt C

62201 Brain cavity shunt

w/scope C

62220 Establish brain cavity

shunt C

62223 Establish brain cavity

shunt C

62225 Replace/irrigate

catheter T 0427 16.2412 "$1,137.14"

. $227.43

62230 Replace/revise brain

shunt T 0224 41.5547 "$2,909.49"

. $581.90

62252 Csf shunt

reprogram S 0691 2.3930 $167.55

. $33.51

62256 Remove brain cavity

shunt C

62258 Replace brain cavity

shunt C

62263 Epidural lysis mult

sessions CH T 0203 12.7996 $896.18

. $179.24

62264 Epidural lysis on single

day T 0203 12.7996 $896.18

. $179.24

62267 Interdiscal perq aspir

dx T 0004 4.5721 $320.12

. $64.03

62268 Drain spinal cord

cyst T 0207 7.4537 $521.88

. $104.38

62269 Needle biopsy spinal

cord T 0685 9.6713 $677.15

. $135.43

62270 Spinal fluid tap

diagnostic T 0206 3.8754 $271.34

. $54.27

62272 Drain cerebro spinal

fluid T 0206 3.8754 $271.34

. $54.27

62273 Inject epidural

patch T 0207 7.4537 $521.88

. $104.3862280 Treat spinal cord

lesion T 0207 7.4537 $521.88

. $104.38

62281 Treat spinal cord

lesion CH T 0203 12.7996 $896.18

. $179.24

62282 Treat spinal canal

lesion CH T 0203 12.7996 $896.18

. $179.24

62284 Injection for

myelogram N

62287 Percutaneous

diskectomy T 0221 36.1290 "$2,529.61"

. $505.93

62290 Inject for spine disk

x-ray N

62291 Inject for spine disk

x-ray N

62292 Injection into disk

lesion T 0207 7.4537 $521.88

. $104.38

62294 Injection into spinal

artery T 0207 7.4537 $521.88

. $104.38

62310 Inject spine

c/t T 0207 7.4537 $521.88

. $104.38

62311 Inject spine l/s

(cd) T 0207 7.4537 $521.88

. $104.38

62318 Inject spine w/cath

c/t T 0207 7.4537 $521.88

. $104.38

62319 Inject spine w/cath l/s

(cd) T 0203 12.7996 $896.18

. $179.24

62350 Implant spinal canal

cath T 0224 41.5547 "$2,909.49"

. $581.90

62351 Implant spinal canal

cath T 0208 50.7343 "$3,552.21"

. $710.45

62355 Remove spinal canal

catheter T 0203 12.7996 $896.18

. $179.24

62360 Insert spine infusion

device T 0224 41.5547 "$2,909.49"

. $581.9062361 Implant spine infusion

pump T 0227 192.7379 "$13,494.74"

. "$2,698.95"

62362 Implant spine infusion

pump T 0227 192.7379 "$13,494.74"

. "$2,698.95"

62365 Remove spine infusion

device T 0221 36.1290 "$2,529.61"

. $505.93

62367 Analyze spine infus

pump S 0691 2.3930 $167.55

. $33.51

62368 Analyze sp inf pump

w/reprog S 0691 2.3930 $167.55

. $33.51

62369 Anal sp inf pmp

w/reprg&fill NI S 0691 2.3930 $167.55

. $33.51

62370 Anl sp inf pmp

w/mdreprg&fil NI S 0691 2.3930 $167.55

. $33.51

63001 Removal of spinal

lamina T 0208 50.7343 "$3,552.21"

. $710.45

63003 Removal of spinal

lamina T 0208 50.7343 "$3,552.21"

. $710.45

63005 Removal of spinal

lamina T 0208 50.7343 "$3,552.21"

. $710.45

63011 Removal of spinal

lamina T 0208 50.7343 "$3,552.21"

. $710.45

63012 Removal of spinal

lamina T 0208 50.7343 "$3,552.21"

. $710.45

63015 Removal of spinal

lamina T 0208 50.7343 "$3,552.21"

. $710.45

63016 Removal of spinal

lamina T 0208 50.7343 "$3,552.21"

. $710.45

63017 Removal of spinal

lamina T 0208 50.7343 "$3,552.21"

. $710.45

63020 Neck spine disk

surgery T 0208 50.7343 "$3,552.21"

. $710.45

63030 Low back disk

surgery T 0208 50.7343 "$3,552.21"

. $710.4563035 Spinal disk surgery

add-on T 0208 50.7343 "$3,552.21"

. $710.45

63040 Laminotomy single

cervical T 0208 50.7343 "$3,552.21"

. $710.45

63042 Laminotomy single

lumbar T 0208 50.7343 "$3,552.21"

. $710.45

63043 Laminotomy addl

cervical C

63044 Laminotomy addl

lumbar C

63045 Removal of spinal

lamina T 0208 50.7343 "$3,552.21"

. $710.45

63046 Removal of spinal

lamina T 0208 50.7343 "$3,552.21"

. $710.45

63047 Removal of spinal

lamina T 0208 50.7343 "$3,552.21"

. $710.45

63048 Remove spinal lamina

add-on T 0208 50.7343 "$3,552.21"

. $710.45

63050 Cervical

laminoplasty C

63051 C-laminoplasty

w/graft/plate C

63055 Decompress spinal

cord T 0208 50.7343 "$3,552.21"

. $710.45

63056 Decompress spinal

cord T 0208 50.7343 "$3,552.21"

. $710.45

63057 Decompress spine cord

add-on T 0208 50.7343 "$3,552.21"

. $710.45

63064 Decompress spinal

cord T 0208 50.7343 "$3,552.21"

. $710.45

63066 Decompress spine cord

add-on T 0208 50.7343 "$3,552.21"

. $710.45

63075 Neck spine disk

surgery T 0208 50.7343 "$3,552.21"

. $710.4563076 Neck spine disk

surgery T 0208 50.7343 "$3,552.21"

. $710.45

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 C63191 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 C63277 Biopsy/excise spinal

tumor C

63278 Biopsy/excise spinal

tumor C

63280 Biopsy/excise spinal

tumor C

63281 Biopsy/excise spinal

tumor C

63282 Biopsy/excise spinal

tumor C

63283 Biopsy/excise spinal

tumor C

63285 Biopsy/excise spinal

tumor C

63286 Biopsy/excise spinal

tumor C

63287 Biopsy/excise spinal

tumor C

63290 Biopsy/excise spinal

tumor C

63295 Repair of laminectomy

defect C

63300 Removal of vertebral

body C

63301 Removal of vertebral

body C

63302 Removal of vertebral

body C

63303 Removal of vertebral

body C

63304 Removal of vertebral

body C

63305 Removal of vertebral

body C

63306 Removal of vertebral

body C

63307 Removal of vertebral

body C

63308 Remove vertebral body

add-on C

63600 Remove spinal cord

lesion T 0220 18.8921 "$1,322.75"

. $264.55

63610 Stimulation of spinal

cord T 0220 18.8921 "$1,322.75"

. $264.5563615 Remove lesion of spinal

cord T 0220 18.8921 "$1,322.75"

. $264.55

63620 Srs spinal

lesion B

63621 Srs spinal lesion

addl B

63650 Implant

neuroelectrodes S 0040 63.3729 "$4,437.12"

. $887.43

63655 Implant

neuroelectrodes S 0061 88.6050 "$6,203.77"

. "$1,240.76"

63661 Remove spine eltrd perq

aray T 0687 20.7198 "$1,450.72" $385.30 $290.15

63662 Remove spine eltrd

plate T 0687 20.7198 "$1,450.72" $385.30 $290.15

63663 Revise spine eltrd perq

aray CH S 0040 63.3729 "$4,437.12"

. $887.43

63664 Revise spine eltrd

plate CH S 0040 63.3729 "$4,437.12"

. $887.43

63685 Insrt/redo spine n

generator S 0039 216.9330 "$15,188.78"

. "$3,037.76"

63688 Revise/remove

neuroreceiver T 0688 31.1002 "$2,177.51" $768.94 $435.51

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 spinalshunt C

63741 Install spinal

shunt T 0224 41.5547 "$2,909.49"

. $581.90

63744 Revision of spinal

shunt T 0224 41.5547 "$2,909.49"

. $581.90

63746 Removal of spinal

shunt T 0203 12.7996 $896.18

. $179.24

64400 N block inj

trigeminal T 0204 2.6055 $182.43

. $36.49

64402 N block inj

facial T 0204 2.6055 $182.43

. $36.49

64405 N block inj

occipital T 0206 3.8754 $271.34

. $54.27

64408 N block inj

vagus CH T 0204 2.6055 $182.43

. $36.49

64410 N block inj

phrenic CH T 0204 2.6055 $182.43

. $36.49

64412 N block inj spinal

accessor CH T 0206 3.8754 $271.34

. $54.27

64413 N block inj cervical

plexus T 0206 3.8754 $271.34

. $54.27

64415 N block inj brachial

plexus T 0206 3.8754 $271.34

. $54.27

64416 N block cont infuse b

plex T 0207 7.4537 $521.88

. $104.38

64417 N block inj

axillary T 0206 3.8754 $271.34

. $54.27

64418 N block inj

suprascapular T 0206 3.8754 $271.34

. $54.27

64420 N block inj intercost

sng T 0206 3.8754 $271.34

. $54.27

64421 N block inj intercost

mlt T 0207 7.4537 $521.88

. $104.3864425 N block inj

ilio-ing/hypogi T 0206 3.8754 $271.34

. $54.27

64430 N block inj

pudendal T 0207 7.4537 $521.88

. $104.38

64435 N block inj

paracervical T 0206 3.8754 $271.34

. $54.27

64445 N block inj sciatic

sng T 0207 7.4537 $521.88

. $104.38

64446 N blk inj sciatic cont

inf T 0207 7.4537 $521.88

. $104.38

64447 N block inj fem

single T 0206 3.8754 $271.34

. $54.27

64448 N block inj fem cont

inf T 0207 7.4537 $521.88

. $104.38

64449 N block inj lumbar

plexus T 0207 7.4537 $521.88

. $104.38

64450 N block other

peripheral T 0206 3.8754 $271.34

. $54.27

64455 N block inj plantar

digit T 0204 2.6055 $182.43

. $36.49

64479 Inj foramen epidural

c/t T 0207 7.4537 $521.88

. $104.38

64480 Inj foramen epidural

add-on T 0206 3.8754 $271.34

. $54.27

64483 Inj foramen epidural

l/s T 0207 7.4537 $521.88

. $104.38

64484 Inj foramen epidural

add-on T 0206 3.8754 $271.34

. $54.27

64490 Inj paravert f jnt c/t 1

lev T 0207 7.4537 $521.88

. $104.38

64491 Inj paravert f jnt c/t 2

lev T 0204 2.6055 $182.43

. $36.49

64492 Inj paravert f jnt c/t 3

lev T 0204 2.6055 $182.43

. $36.4964493 Inj paravert f jnt l/s 1

lev T 0207 7.4537 $521.88

. $104.38

64494 Inj paravert f jnt l/s 2

lev T 0204 2.6055 $182.43

. $36.49

64495 Inj paravert f jnt l/s 3

lev T 0204 2.6055 $182.43

. $36.49

64505 N block spenopalatine

gangl T 0204 2.6055 $182.43

. $36.49

64508 N block carotid sinus

s/p T 0204 2.6055 $182.43

. $36.49

64510 N block stellate

ganglion T 0207 7.4537 $521.88

. $104.38

64517 N block inj hypogas

plxs T 0207 7.4537 $521.88

. $104.38

64520 N block

lumbar/thoracic T 0207 7.4537 $521.88

. $104.38

64530 N block inj celiac

pelus T 0207 7.4537 $521.88

. $104.38

64550 Apply

neurostimulator A

64553 Implant

neuroelectrodes S 0040 63.3729 "$4,437.12"

. $887.43

64555 Implant

neuroelectrodes S 0040 63.3729 "$4,437.12"

. $887.43

64560 Implant

neuroelectrodes CH D

64561 Implant

neuroelectrodes S 0040 63.3729 "$4,437.12"

. $887.43

64565 Implant

neuroelectrodes S 0040 63.3729 "$4,437.12"

. $887.43

64566 Neuroeltrd stim post

tibial T 0204 2.6055 $182.43

. $36.4964568 Inc for vagus n elect

impl S 0318 346.4693 "$24,258.39" "$9,121.76" "$4,851.68"

64569 Revise/repl vagus n

eltrd T 0687 20.7198 "$1,450.72" $385.30 $290.15

64570 Remove vagus n

eltrd T 0221 36.1290 "$2,529.61"

. $505.93

64575 Implant

neuroelectrodes S 0061 88.6050 "$6,203.77"

. "$1,240.76"

64577 Implant

neuroelectrodes CH D

64580 Implant

neuroelectrodes S 0061 88.6050 "$6,203.77"

. "$1,240.76"

64581 Implant

neuroelectrodes S 0061 88.6050 "$6,203.77"

. "$1,240.76"

64585 Revise/remove

neuroelectrode T 0687 20.7198 "$1,450.72" $385.30 $290.15

64590 Insrt/redo pn/gastr

stimul S 0039 216.9330 "$15,188.78"

. "$3,037.76"

64595 Revise/rmv pn/gastr

stimul T 0688 31.1002 "$2,177.51" $768.94 $435.51

64600 Injection treatment of

nerve T 0203 12.7996 $896.18

. $179.24

64605 Injection treatment of

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64610 Injection treatment of

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64611 Chemodenerv saliv

glands T 0204 2.6055 $182.43

. $36.49

64612 Destroy nerve face

muscle T 0204 2.6055 $182.43

. $36.49

64613 Destroy nerve neck

muscle T 0206 3.8754 $271.34

. $54.27

64614 Destroy nerve extrem

musc T 0206 3.8754 $271.34

. $54.2764620 Injection treatment of

nerve CH T 0203 12.7996 $896.18

. $179.24

64622 Destr paravertebrl nerve

l/s CH D

64623 Destr paravertebral n

add-on CH D

64626 Destr paravertebrl nerve

c/t CH D

64627 Destr paravertebral n

add-on CH D

64630 Injection treatment of

nerve T 0207 7.4537 $521.88

. $104.38

64632 N block inj common

digit T 0204 2.6055 $182.43

. $36.49

64633 Destroy cerv/thor facet

jnt NI T 0207 7.4537 $521.88

. $104.38

64634 Destroy c/th facet jnt

addl NI T 0204 2.6055 $182.43

. $36.49

64635 Destroy lumb/sac facet

jnt NI T 0203 12.7996 $896.18

. $179.24

64636 Destroy l/s facet jnt

addl NI T 0207 7.4537 $521.88

. $104.38

64640 Injection treatment of

nerve T 0207 7.4537 $521.88

. $104.38

64650 Chemodenerv eccrine

glands T 0204 2.6055 $182.43

. $36.49

64653 Chemodenerv eccrine

glands T 0204 2.6055 $182.43

. $36.49

64680 Injection treatment of

nerve CH T 0203 12.7996 $896.18

. $179.24

64681 Injection treatment of

nerve T 0203 12.7996 $896.18

. $179.24

64702 Revise finger/toe

nerve T 0220 18.8921 "$1,322.75"

. $264.5564704 Revise hand/foot

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64708 Revise arm/leg

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64712 Revision of sciatic

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64713 Revision of arm

nerve(s) T 0220 18.8921 "$1,322.75"

. $264.55

64714 Revise low back

nerve(s) T 0220 18.8921 "$1,322.75"

. $264.55

64716 Revision of cranial

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64718 Revise ulnar nerve at

elbow T 0220 18.8921 "$1,322.75"

. $264.55

64719 Revise ulnar nerve at

wrist T 0220 18.8921 "$1,322.75"

. $264.55

64721 Carpal tunnel

surgery T 0220 18.8921 "$1,322.75"

. $264.55

64722 Relieve pressure on

nerve(s) T 0220 18.8921 "$1,322.75"

. $264.55

64726 Release foot/toe

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64727 Internal nerve

revision T 0220 18.8921 "$1,322.75"

. $264.55

64732 Incision of brow

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64734 Incision of cheek

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64736 Incision of chin

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64738 Incision of jaw

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64740 Incision of tongue

nerve T 0220 18.8921 "$1,322.75"

. $264.5564742 Incision of facial

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64744 Incise nerve back of

head T 0220 18.8921 "$1,322.75"

. $264.55

64746 Incise diaphragm

nerve T 0220 18.8921 "$1,322.75"

. $264.55

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 18.8921 "$1,322.75"

. $264.55

64763 Incise hip/thigh

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64766 Incise hip/thigh

nerve T 0221 36.1290 "$2,529.61"

. $505.93

64771 Sever cranial

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64772 Incision of spinal

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64774 Remove skin nerve

lesion T 0220 18.8921 "$1,322.75"

. $264.55

64776 Remove digit nerve

lesion T 0220 18.8921 "$1,322.75"

. $264.55

64778 Digit nerve surgery

add-on T 0220 18.8921 "$1,322.75"

. $264.55

64782 Remove limb nerve

lesion T 0220 18.8921 "$1,322.75"

. $264.55

64783 Limb nerve surgery

add-on T 0220 18.8921 "$1,322.75"

. $264.55

64784 Remove nerve

lesion T 0220 18.8921 "$1,322.75"

. $264.5564786 Remove sciatic nerve

lesion T 0221 36.1290 "$2,529.61"

. $505.93

64787 Implant nerve

end T 0220 18.8921 "$1,322.75"

. $264.55

64788 Remove skin nerve

lesion T 0220 18.8921 "$1,322.75"

. $264.55

64790 Removal of nerve

lesion T 0220 18.8921 "$1,322.75"

. $264.55

64792 Removal of nerve

lesion T 0221 36.1290 "$2,529.61"

. $505.93

64795 Biopsy of

nerve T 0220 18.8921 "$1,322.75"

. $264.55

64802 Remove sympathetic

nerves T 0220 18.8921 "$1,322.75"

. $264.55

64804 Remove sympathetic

nerves T 0220 18.8921 "$1,322.75"

. $264.55

64809 Remove sympathetic

nerves C

64818 Remove sympathetic

nerves C

64820 Remove sympathetic

nerves T 0220 18.8921 "$1,322.75"

. $264.55

64821 Remove sympathetic

nerves T 0054 28.8625 "$2,020.84"

. $404.17

64822 Remove sympathetic

nerves T 0054 28.8625 "$2,020.84"

. $404.17

64823 Remove sympathetic

nerves T 0054 28.8625 "$2,020.84"

. $404.17

64831 Repair of digit

nerve T 0221 36.1290 "$2,529.61"

. $505.93

64832 Repair nerve

add-on T 0221 36.1290 "$2,529.61"

. $505.93

64834 Repair of hand or foot

nerve T 0221 36.1290 "$2,529.61"

. $505.9364835 Repair of hand or foot

nerve T 0221 36.1290 "$2,529.61"

. $505.93

64836 Repair of hand or foot

nerve T 0221 36.1290 "$2,529.61"

. $505.93

64837 Repair nerve

add-on T 0221 36.1290 "$2,529.61"

. $505.93

64840 Repair of leg

nerve T 0221 36.1290 "$2,529.61"

. $505.93

64856 Repair/transpose

nerve T 0221 36.1290 "$2,529.61"

. $505.93

64857 Repair arm/leg

nerve T 0221 36.1290 "$2,529.61"

. $505.93

64858 Repair sciatic

nerve T 0221 36.1290 "$2,529.61"

. $505.93

64859 Nerve

surgery T 0221 36.1290 "$2,529.61"

. $505.93

64861 Repair of arm

nerves T 0221 36.1290 "$2,529.61"

. $505.93

64862 Repair of low back

nerves T 0221 36.1290 "$2,529.61"

. $505.93

64864 Repair of facial

nerve T 0221 36.1290 "$2,529.61"

. $505.93

64865 Repair of facial

nerve T 0221 36.1290 "$2,529.61"

. $505.93

64866 Fusion of facial/other

nerve C

64868 Fusion of facial/other

nerve C

64870 Fusion of facial/other

nerve T 0221 36.1290 "$2,529.61"

. $505.93

64872 Subsequent repair of

nerve T 0221 36.1290 "$2,529.61"

. $505.93

64874 Repair & revise nerve

add-on T 0221 36.1290 "$2,529.61"

. $505.9364876 Repair nerve/shorten

bone T 0221 36.1290 "$2,529.61"

. $505.93

64885 Nerve graft head or

neck T 0221 36.1290 "$2,529.61"

. $505.93

64886 Nerve graft head or

neck T 0221 36.1290 "$2,529.61"

. $505.93

64890 Nerve graft hand or

foot T 0221 36.1290 "$2,529.61"

. $505.93

64891 Nerve graft hand or

foot T 0221 36.1290 "$2,529.61"

. $505.93

64892 Nerve graft arm or

leg T 0221 36.1290 "$2,529.61"

. $505.93

64893 Nerve graft arm or

leg T 0221 36.1290 "$2,529.61"

. $505.93

64895 Nerve graft hand or

foot T 0221 36.1290 "$2,529.61"

. $505.93

64896 Nerve graft hand or

foot T 0221 36.1290 "$2,529.61"

. $505.93

64897 Nerve graft arm or

leg T 0221 36.1290 "$2,529.61"

. $505.93

64898 Nerve graft arm or

leg T 0221 36.1290 "$2,529.61"

. $505.93

64901 Nerve graft

add-on T 0221 36.1290 "$2,529.61"

. $505.93

64902 Nerve graft

add-on T 0221 36.1290 "$2,529.61"

. $505.93

64905 Nerve pedicle

transfer T 0221 36.1290 "$2,529.61"

. $505.93

64907 Nerve pedicle

transfer T 0221 36.1290 "$2,529.61"

. $505.93

64910 Nerve repair

w/allograft T 0221 36.1290 "$2,529.61"

. $505.93

64911 Neurorraphy w/veinautograft T 0221 36.1290 "$2,529.61"

. $505.93

64999 Nervous system

surgery T 0204 2.6055 $182.43

. $36.49

65091 Revise

eye T 0242 40.4039 "$2,828.92" $597.36 $565.79

65093 Revise eye with

implant T 0242 40.4039 "$2,828.92" $597.36 $565.79

65101 Removal of

eye T 0242 40.4039 "$2,828.92" $597.36 $565.79

65103 Remove eye/insert

implant T 0242 40.4039 "$2,828.92" $597.36 $565.79

65105 Remove eye/attach

implant T 0242 40.4039 "$2,828.92" $597.36 $565.79

65110 Removal of

eye T 0242 40.4039 "$2,828.92" $597.36 $565.79

65112 Remove eye/revise

socket T 0242 40.4039 "$2,828.92" $597.36 $565.79

65114 Remove eye/revise

socket T 0242 40.4039 "$2,828.92" $597.36 $565.79

65125 Revise ocular

implant T 0241 27.3416 "$1,914.35" $383.45 $382.87

65130 Insert ocular

implant T 0241 27.3416 "$1,914.35" $383.45 $382.87

65135 Insert ocular

implant T 0241 27.3416 "$1,914.35" $383.45 $382.87

65140 Attach ocular

implant T 0242 40.4039 "$2,828.92" $597.36 $565.79

65150 Revise ocular

implant T 0241 27.3416 "$1,914.35" $383.45 $382.87

65155 Reinsert ocular

implant T 0242 40.4039 "$2,828.92" $597.36 $565.79

65175 Removal of ocular

implant T 0240 19.7786 "$1,384.82" $296.20 $276.9765205 Remove foreign body from

eye S 0698 1.0589 $74.14

. $14.83

65210 Remove foreign body from

eye S 0698 1.0589 $74.14

. $14.83

65220 Remove foreign body from

eye S 0698 1.0589 $74.14

. $14.83

65222 Remove foreign body from

eye S 0698 1.0589 $74.14

. $14.83

65235 Remove foreign body from

eye T 0233 16.6214 "$1,163.76"

. $232.76

65260 Remove foreign body from

eye T 0235 4.8135 $337.02

. $67.41

65265 Remove foreign body from

eye T 0237 21.5368 "$1,507.92"

. $301.59

65270 Repair of eye

wound T 0240 19.7786 "$1,384.82" $296.20 $276.97

65272 Repair of eye

wound T 0234 23.2851 "$1,630.33" $347.90 $326.07

65273 Repair of eye

wound C

65275 Repair of eye

wound T 0234 23.2851 "$1,630.33" $347.90 $326.07

65280 Repair of eye

wound T 0237 21.5368 "$1,507.92"

. $301.59

65285 Repair of eye

wound T 0672 41.0159 "$2,871.77"

. $574.36

65286 Repair of eye

wound T 0255 7.2190 $505.45 $101.81 $101.09

65290 Repair of eye socket

wound T 0243 24.8671 "$1,741.09" $411.91 $348.22

65400 Removal of eye

lesion T 0233 16.6214 "$1,163.76"

. $232.76

65410 Biopsy of

cornea T 0233 16.6214 "$1,163.76"

. $232.7665420 Removal of eye

lesion T 0233 16.6214 "$1,163.76"

. $232.76

65426 Removal of eye

lesion T 0234 23.2851 "$1,630.33" $347.90 $326.07

65430 Corneal

smear S 0698 1.0589 $74.14

. $14.83

65435 Curette/treat

cornea T 0239 7.6566 $536.08

. $107.22

65436 Curette/treat

cornea T 0233 16.6214 "$1,163.76"

. $232.76

65450 Treatment of corneal

lesion S 0231 2.0294 $142.09

. $28.42

65600 Revision of

cornea T 0240 19.7786 "$1,384.82" $296.20 $276.97

65710 Corneal

transplant T 0244 37.8979 "$2,653.46" $794.94 $530.70

65730 Corneal

transplant T 0244 37.8979 "$2,653.46" $794.94 $530.70

65750 Corneal

transplant T 0244 37.8979 "$2,653.46" $794.94 $530.70

65755 Corneal

transplant T 0244 37.8979 "$2,653.46" $794.94 $530.70

65756 Corneal trnspl

endothelial T 0244 37.8979 "$2,653.46" $794.94 $530.70

65757 Prep corneal endo

allograft N

65760 Revision of

cornea E

65765 Revision of

cornea E

65767 Corneal tissue

transplant E

65770 Revise cornea with

implant T 0293 117.1298 "$8,200.96"

. "$1,640.20"65771 Radial

keratotomy E

65772 Correction of

astigmatism T 0233 16.6214 "$1,163.76"

. $232.76

65775 Correction of

astigmatism T 0233 16.6214 "$1,163.76"

. $232.76

65778 Cover eye

w/membrane CH Q2 0233 16.6214 "$1,163.76"

. $232.76

65779 Cover eye w/membrane

suture CH T 0233 16.6214 "$1,163.76"

. $232.76

65780 Ocular reconst

transplant T 0244 37.8979 "$2,653.46" $794.94 $530.70

65781 Ocular reconst

transplant T 0244 37.8979 "$2,653.46" $794.94 $530.70

65782 Ocular reconst

transplant T 0244 37.8979 "$2,653.46" $794.94 $530.70

65800 Drainage of

eye T 0255 7.2190 $505.45 $101.81 $101.09

65805 Drainage of

eye CH T 0234 23.2851 "$1,630.33" $347.90 $326.07

65810 Drainage of

eye T 0234 23.2851 "$1,630.33" $347.90 $326.07

65815 Drainage of

eye T 0234 23.2851 "$1,630.33" $347.90 $326.07

65820 Relieve inner eye

pressure T 0234 23.2851 "$1,630.33" $347.90 $326.07

65850 Incision of

eye T 0234 23.2851 "$1,630.33" $347.90 $326.07

65855 Laser surgery of

eye T 0247 5.4120 $378.93 $102.28 $75.79

65860 Incise inner eye

adhesions T 0247 5.4120 $378.93 $102.28 $75.79

65865 Incise inner eye

adhesions T 0233 16.6214 "$1,163.76"

. $232.7665870 Incise inner eye

adhesions T 0234 23.2851 "$1,630.33" $347.90 $326.07

65875 Incise inner eye

adhesions T 0234 23.2851 "$1,630.33" $347.90 $326.07

65880 Incise inner eye

adhesions T 0233 16.6214 "$1,163.76"

. $232.76

65900 Remove eye

lesion T 0232 2.8247 $197.77 $42.27 $39.56

65920 Remove implant of

eye T 0234 23.2851 "$1,630.33" $347.90 $326.07

65930 Remove blood clot from

eye T 0234 23.2851 "$1,630.33" $347.90 $326.07

66020 Injection treatment of

eye T 0233 16.6214 "$1,163.76"

. $232.76

66030 Injection treatment of

eye T 0233 16.6214 "$1,163.76"

. $232.76

66130 Remove eye

lesion T 0234 23.2851 "$1,630.33" $347.90 $326.07

66150 Glaucoma

surgery T 0234 23.2851 "$1,630.33" $347.90 $326.07

66155 Glaucoma

surgery T 0234 23.2851 "$1,630.33" $347.90 $326.07

66160 Glaucoma

surgery T 0234 23.2851 "$1,630.33" $347.90 $326.07

66165 Glaucoma

surgery T 0234 23.2851 "$1,630.33" $347.90 $326.07

66170 Glaucoma

surgery T 0234 23.2851 "$1,630.33" $347.90 $326.07

66172 Incision of

eye T 0234 23.2851 "$1,630.33" $347.90 $326.07

66174 Translum dil eye

canal T 0673 41.5778 "$2,911.11" $634.95 $582.23

66175 Trnslum dil eye canalw/stnt T 0673 41.5778 "$2,911.11" $634.95 $582.23

66180 Implant eye

shunt T 0673 41.5778 "$2,911.11" $634.95 $582.23

66185 Revise eye

shunt T 0234 23.2851 "$1,630.33" $347.90 $326.07

66220 Repair eye

lesion T 0672 41.0159 "$2,871.77"

. $574.36

66225 Repair/graft eye

lesion T 0673 41.5778 "$2,911.11" $634.95 $582.23

66250 Follow-up surgery of

eye T 0233 16.6214 "$1,163.76"

. $232.76

66500 Incision of

iris T 0232 2.8247 $197.77 $42.27 $39.56

66505 Incision of

iris T 0255 7.2190 $505.45 $101.81 $101.09

66600 Remove iris and

lesion T 0234 23.2851 "$1,630.33" $347.90 $326.07

66605 Removal of

iris T 0234 23.2851 "$1,630.33" $347.90 $326.07

66625 Removal of

iris T 0255 7.2190 $505.45 $101.81 $101.09

66630 Removal of

iris T 0234 23.2851 "$1,630.33" $347.90 $326.07

66635 Removal of

iris T 0234 23.2851 "$1,630.33" $347.90 $326.07

66680 Repair iris & ciliary

body T 0234 23.2851 "$1,630.33" $347.90 $326.07

66682 Repair iris & ciliary

body T 0234 23.2851 "$1,630.33" $347.90 $326.07

66700 Destruction ciliary

body T 0233 16.6214 "$1,163.76"

. $232.76

66710 Ciliary transsleral

therapy T 0233 16.6214 "$1,163.76"

. $232.7666711 Ciliary endoscopic

ablation CH T 0234 23.2851 "$1,630.33" $347.90 $326.07

66720 Destruction ciliary

body T 0233 16.6214 "$1,163.76"

. $232.76

66740 Destruction ciliary

body T 0234 23.2851 "$1,630.33" $347.90 $326.07

66761 Revision of

iris T 0247 5.4120 $378.93 $102.28 $75.79

66762 Revision of

iris T 0247 5.4120 $378.93 $102.28 $75.79

66770 Removal of inner eye

lesion T 0247 5.4120 $378.93 $102.28 $75.79

66820 Incision secondary

cataract T 0255 7.2190 $505.45 $101.81 $101.09

66821 After cataract laser

surgery T 0247 5.4120 $378.93 $102.28 $75.79

66825 Reposition intraocular

lens T 0234 23.2851 "$1,630.33" $347.90 $326.07

66830 Removal of lens

lesion T 0255 7.2190 $505.45 $101.81 $101.09

66840 Removal of lens

material CH T 0233 16.6214 "$1,163.76"

. $232.76

66850 Removal of lens

material T 0249 30.9855 "$2,169.48" $516.99 $433.90

66852 Removal of lens

material T 0249 30.9855 "$2,169.48" $516.99 $433.90

66920 Extraction of

lens T 0249 30.9855 "$2,169.48" $516.99 $433.90

66930 Extraction of

lens T 0249 30.9855 "$2,169.48" $516.99 $433.90

66940 Extraction of

lens CH T 0255 7.2190 $505.45 $101.81 $101.09

66982 Cataract surgerycomplex T 0246 23.8810 "$1,672.05" $490.37 $334.41

66983 Cataract surg w/iol 1

stage T 0246 23.8810 "$1,672.05" $490.37 $334.41

66984 Cataract surg w/iol 1

stage T 0246 23.8810 "$1,672.05" $490.37 $334.41

66985 Insert lens

prosthesis T 0246 23.8810 "$1,672.05" $490.37 $334.41

66986 Exchange lens

prosthesis T 0246 23.8810 "$1,672.05" $490.37 $334.41

66990 Ophthalmic endoscope

add-on N

66999 Eye surgery

procedure T 0232 2.8247 $197.77 $42.27 $39.56

67005 Partial removal of eye

fluid T 0237 21.5368 "$1,507.92"

. $301.59

67010 Partial removal of eye

fluid T 0672 41.0159 "$2,871.77"

. $574.36

67015 Release of eye

fluid T 0672 41.0159 "$2,871.77"

. $574.36

67025 Replace eye

fluid T 0672 41.0159 "$2,871.77"

. $574.36

67027 Implant eye drug

system T 0672 41.0159 "$2,871.77"

. $574.36

67028 Injection eye

drug T 0238 3.1036 $217.30

. $43.46

67030 Incise inner eye

strands T 0237 21.5368 "$1,507.92"

. $301.59

67031 Laser surgery eye

strands T 0247 5.4120 $378.93 $102.28 $75.79

67036 Removal of inner eye

fluid T 0672 41.0159 "$2,871.77"

. $574.36

67039 Laser treatment of

retina T 0672 41.0159 "$2,871.77"

. $574.3667040 Laser treatment of

retina T 0672 41.0159 "$2,871.77"

. $574.36

67041 Vit for macular

pucker T 0672 41.0159 "$2,871.77"

. $574.36

67042 Vit for macular

hole T 0672 41.0159 "$2,871.77"

. $574.36

67043 Vit for membrane

dissect T 0672 41.0159 "$2,871.77"

. $574.36

67101 Repair detached

retina T 0237 21.5368 "$1,507.92"

. $301.59

67105 Repair detached

retina T 0247 5.4120 $378.93 $102.28 $75.79

67107 Repair detached

retina T 0672 41.0159 "$2,871.77"

. $574.36

67108 Repair detached

retina T 0672 41.0159 "$2,871.77"

. $574.36

67110 Repair detached

retina T 0237 21.5368 "$1,507.92"

. $301.59

67112 Rerepair detached

retina T 0672 41.0159 "$2,871.77"

. $574.36

67113 Repair retinal detach

cplx T 0672 41.0159 "$2,871.77"

. $574.36

67115 Release encircling

material T 0237 21.5368 "$1,507.92"

. $301.59

67120 Remove eye implant

material T 0237 21.5368 "$1,507.92"

. $301.59

67121 Remove eye implant

material T 0672 41.0159 "$2,871.77"

. $574.36

67141 Treatment of

retina T 0235 4.8135 $337.02

. $67.41

67145 Treatment of

retina T 0247 5.4120 $378.93 $102.28 $75.79

67208 Treatment of retinal

lesion T 0235 4.8135 $337.02

. $67.4167210 Treatment of retinal

lesion T 0247 5.4120 $378.93 $102.28 $75.79

67218 Treatment of retinal

lesion T 0237 21.5368 "$1,507.92"

. $301.59

67220 Treatment of choroid

lesion T 0235 4.8135 $337.02

. $67.41

67221 Ocular photodynamic

ther T 0235 4.8135 $337.02

. $67.41

67225 Eye photodynamic ther

add-on T 0235 4.8135 $337.02

. $67.41

67227 Treatment of retinal

lesion T 0237 21.5368 "$1,507.92"

. $301.59

67228 Treatment of retinal

lesion T 0247 5.4120 $378.93 $102.28 $75.79

67229 Tr retinal les preterm

inf T 0247 5.4120 $378.93 $102.28 $75.79

67250 Reinforce eye

wall T 0240 19.7786 "$1,384.82" $296.20 $276.97

67255 Reinforce/graft eye

wall T 0237 21.5368 "$1,507.92"

. $301.59

67299 Eye surgery

procedure T 0235 4.8135 $337.02

. $67.41

67311 Revise eye

muscle T 0243 24.8671 "$1,741.09" $411.91 $348.22

67312 Revise two eye

muscles T 0243 24.8671 "$1,741.09" $411.91 $348.22

67314 Revise eye

muscle T 0243 24.8671 "$1,741.09" $411.91 $348.22

67316 Revise two eye

muscles T 0243 24.8671 "$1,741.09" $411.91 $348.22

67318 Revise eye

muscle(s) T 0243 24.8671 "$1,741.09" $411.91 $348.2267320 Revise eye muscle(s)

add-on T 0243 24.8671 "$1,741.09" $411.91 $348.22

67331 Eye surgery follow-up

add-on T 0243 24.8671 "$1,741.09" $411.91 $348.22

67332 Rerevise eye muscles

add-on T 0243 24.8671 "$1,741.09" $411.91 $348.22

67334 Revise eye muscle

w/suture T 0243 24.8671 "$1,741.09" $411.91 $348.22

67335 Eye suture during

surgery T 0243 24.8671 "$1,741.09" $411.91 $348.22

67340 Revise eye muscle

add-on T 0243 24.8671 "$1,741.09" $411.91 $348.22

67343 Release eye

tissue T 0243 24.8671 "$1,741.09" $411.91 $348.22

67345 Destroy nerve of eye

muscle T 0238 3.1036 $217.30

. $43.46

67346 Biopsy eye

muscle T 0699 15.4248 "$1,079.98"

. $216.00

67399 Eye muscle surgery

procedure T 0243 24.8671 "$1,741.09" $411.91 $348.22

67400 Explore/biopsy eye

socket T 0240 19.7786 "$1,384.82" $296.20 $276.97

67405 Explore/drain eye

socket T 0241 27.3416 "$1,914.35" $383.45 $382.87

67412 Explore/treat eye

socket T 0240 19.7786 "$1,384.82" $296.20 $276.97

67413 Explore/treat eye

socket T 0241 27.3416 "$1,914.35" $383.45 $382.87

67414 Explr/decompress eye

socket T 0242 40.4039 "$2,828.92" $597.36 $565.79

67415 Aspiration orbital

contents T 0240 19.7786 "$1,384.82" $296.20 $276.97

67420 Explore/treat eye

socket T 0242 40.4039 "$2,828.92" $597.36 $565.7967430 Explore/treat eye

socket T 0242 40.4039 "$2,828.92" $597.36 $565.79

67440 Explore/drain eye

socket T 0242 40.4039 "$2,828.92" $597.36 $565.79

67445 Explr/decompress eye

socket T 0242 40.4039 "$2,828.92" $597.36 $565.79

67450 Explore/biopsy eye

socket T 0242 40.4039 "$2,828.92" $597.36 $565.79

67500 Inject/treat eye

socket S 0231 2.0294 $142.09

. $28.42

67505 Inject/treat eye

socket T 0238 3.1036 $217.30

. $43.46

67515 Inject/treat eye

socket T 0238 3.1036 $217.30

. $43.46

67550 Insert eye socket

implant T 0242 40.4039 "$2,828.92" $597.36 $565.79

67560 Revise eye socket

implant T 0241 27.3416 "$1,914.35" $383.45 $382.87

67570 Decompress optic

nerve T 0242 40.4039 "$2,828.92" $597.36 $565.79

67599 Orbit surgery

procedure T 0238 3.1036 $217.30

. $43.46

67700 Drainage of eyelid

abscess T 0238 3.1036 $217.30

. $43.46

67710 Incision of

eyelid T 0239 7.6566 $536.08

. $107.22

67715 Incision of eyelid

fold T 0240 19.7786 "$1,384.82" $296.20 $276.97

67800 Remove eyelid

lesion T 0238 3.1036 $217.30

. $43.46

67801 Remove eyelid

lesions T 0239 7.6566 $536.08

. $107.2267805 Remove eyelid

lesions T 0238 3.1036 $217.30

. $43.46

67808 Remove eyelid

lesion(s) T 0240 19.7786 "$1,384.82" $296.20 $276.97

67810 Biopsy of

eyelid T 0238 3.1036 $217.30

. $43.46

67820 Revise

eyelashes S 0698 1.0589 $74.14

. $14.83

67825 Revise

eyelashes T 0238 3.1036 $217.30

. $43.46

67830 Revise

eyelashes T 0239 7.6566 $536.08

. $107.22

67835 Revise

eyelashes T 0240 19.7786 "$1,384.82" $296.20 $276.97

67840 Remove eyelid

lesion T 0239 7.6566 $536.08

. $107.22

67850 Treat eyelid

lesion T 0239 7.6566 $536.08

. $107.22

67875 Closure of eyelid by

suture T 0239 7.6566 $536.08

. $107.22

67880 Revision of

eyelid T 0233 16.6214 "$1,163.76"

. $232.76

67882 Revision of

eyelid T 0240 19.7786 "$1,384.82" $296.20 $276.97

67900 Repair brow

defect T 0241 27.3416 "$1,914.35" $383.45 $382.87

67901 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67902 Repair eyelid

defect T 0241 27.3416 "$1,914.35" $383.45 $382.87

67903 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67904 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.9767906 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67908 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67909 Revise eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67911 Revise eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67912 Correction eyelid

w/implant T 0240 19.7786 "$1,384.82" $296.20 $276.97

67914 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67915 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67916 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67917 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67921 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67922 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67923 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67924 Repair eyelid

defect T 0240 19.7786 "$1,384.82" $296.20 $276.97

67930 Repair eyelid

wound T 0240 19.7786 "$1,384.82" $296.20 $276.97

67935 Repair eyelid

wound T 0240 19.7786 "$1,384.82" $296.20 $276.97

67938 Remove eyelid foreign

body S 0231 2.0294 $142.09

. $28.4267950 Revision of

eyelid T 0240 19.7786 "$1,384.82" $296.20 $276.97

67961 Revision of

eyelid T 0240 19.7786 "$1,384.82" $296.20 $276.97

67966 Revision of

eyelid T 0240 19.7786 "$1,384.82" $296.20 $276.97

67971 Reconstruction of

eyelid T 0240 19.7786 "$1,384.82" $296.20 $276.97

67973 Reconstruction of

eyelid T 0241 27.3416 "$1,914.35" $383.45 $382.87

67974 Reconstruction of

eyelid T 0240 19.7786 "$1,384.82" $296.20 $276.97

67975 Reconstruction of

eyelid T 0240 19.7786 "$1,384.82" $296.20 $276.97

67999 Revision of

eyelid T 0238 3.1036 $217.30

. $43.46

68020 Incise/drain eyelid

lining T 0238 3.1036 $217.30

. $43.46

68040 Treatment of eyelid

lesions S 0698 1.0589 $74.14

. $14.83

68100 Biopsy of eyelid

lining CH T 0239 7.6566 $536.08

. $107.22

68110 Remove eyelid lining

lesion T 0699 15.4248 "$1,079.98"

. $216.00

68115 Remove eyelid lining

lesion T 0240 19.7786 "$1,384.82" $296.20 $276.97

68130 Remove eyelid lining

lesion T 0233 16.6214 "$1,163.76"

. $232.76

68135 Remove eyelid lining

lesion T 0239 7.6566 $536.08

. $107.22

68200 Treat eyelid by

injection CH S 0230 0.6424 $44.98

. $9.00

68320 Revise/graft eyelid

lining T 0241 27.3416 "$1,914.35" $383.45 $382.8768325 Revise/graft eyelid

lining T 0241 27.3416 "$1,914.35" $383.45 $382.87

68326 Revise/graft eyelid

lining T 0240 19.7786 "$1,384.82" $296.20 $276.97

68328 Revise/graft eyelid

lining T 0241 27.3416 "$1,914.35" $383.45 $382.87

68330 Revise eyelid

lining T 0234 23.2851 "$1,630.33" $347.90 $326.07

68335 Revise/graft eyelid

lining T 0241 27.3416 "$1,914.35" $383.45 $382.87

68340 Separate eyelid

adhesions T 0240 19.7786 "$1,384.82" $296.20 $276.97

68360 Revise eyelid

lining T 0234 23.2851 "$1,630.33" $347.90 $326.07

68362 Revise eyelid

lining T 0234 23.2851 "$1,630.33" $347.90 $326.07

68371 Harvest eye tissue

alograft CH T 0234 23.2851 "$1,630.33" $347.90 $326.07

68399 Eyelid lining

surgery T 0238 3.1036 $217.30

. $43.46

68400 Incise/drain tear

gland T 0238 3.1036 $217.30

. $43.46

68420 Incise/drain tear

sac T 0240 19.7786 "$1,384.82" $296.20 $276.97

68440 Incise tear duct

opening T 0238 3.1036 $217.30

. $43.46

68500 Removal of tear

gland T 0241 27.3416 "$1,914.35" $383.45 $382.87

68505 Partial removal tear

gland T 0241 27.3416 "$1,914.35" $383.45 $382.87

68510 Biopsy of tear

gland T 0240 19.7786 "$1,384.82" $296.20 $276.9768520 Removal of tear

sac T 0241 27.3416 "$1,914.35" $383.45 $382.87

68525 Biopsy of tear

sac T 0240 19.7786 "$1,384.82" $296.20 $276.97

68530 Clearance of tear

duct T 0238 3.1036 $217.30

. $43.46

68540 Remove tear gland

lesion T 0240 19.7786 "$1,384.82" $296.20 $276.97

68550 Remove tear gland

lesion T 0241 27.3416 "$1,914.35" $383.45 $382.87

68700 Repair tear

ducts T 0240 19.7786 "$1,384.82" $296.20 $276.97

68705 Revise tear duct

opening T 0238 3.1036 $217.30

. $43.46

68720 Create tear sac

drain T 0241 27.3416 "$1,914.35" $383.45 $382.87

68745 Create tear duct

drain T 0241 27.3416 "$1,914.35" $383.45 $382.87

68750 Create tear duct

drain T 0241 27.3416 "$1,914.35" $383.45 $382.87

68760 Close tear duct

opening T 0238 3.1036 $217.30

. $43.46

68761 Close tear duct

opening T 0238 3.1036 $217.30

. $43.46

68770 Close tear system

fistula T 0241 27.3416 "$1,914.35" $383.45 $382.87

68801 Dilate tear duct

opening S 0698 1.0589 $74.14

. $14.83

68810 Probe nasolacrimal

duct T 0238 3.1036 $217.30

. $43.46

68811 Probe nasolacrimal

duct T 0240 19.7786 "$1,384.82" $296.20 $276.97

68815 Probe nasolacrimal

duct T 0240 19.7786 "$1,384.82" $296.20 $276.9768816 Probe nl duct

w/balloon T 0240 19.7786 "$1,384.82" $296.20 $276.97

68840 Explore/irrigate tear

ducts S 0231 2.0294 $142.09

. $28.42

68850 Injection for tear sac

x-ray N

68899 Tear duct system

surgery T 0238 3.1036 $217.30

. $43.46

69000 Drain external ear

lesion T 0006 1.4209 $99.49

. $19.90

69005 Drain external ear

lesion T 0008 20.5510 "$1,438.90"

. $287.78

69020 Drain outer ear canal

lesion T 0006 1.4209 $99.49

. $19.90

69090 Pierce

earlobes E

69100 Biopsy of external

ear T 0251 3.1150 $218.10

. $43.62

69105 Biopsy of external ear

canal T 0253 16.8699 "$1,181.16" $279.20 $236.24

69110 Remove external ear

partial T 0021 16.9957 "$1,189.97"

. $238.00

69120 Removal of external

ear T 0254 24.8895 "$1,742.66"

. $348.54

69140 Remove ear canal

lesion(s) T 0254 24.8895 "$1,742.66"

. $348.54

69145 Remove ear canal

lesion(s) T 0021 16.9957 "$1,189.97"

. $238.00

69150 Extensive ear canal

surgery T 0252 7.4614 $522.42 $104.55 $104.49

69155 Extensive ear/neck

surgery C

69200 Clear outer ear

canal X 0340 0.6499 $45.50

. $9.1069205 Clear outer ear

canal T 0022 23.2636 "$1,628.82" $350.74 $325.77

69210 Remove impacted ear

wax X 0340 0.6499 $45.50

. $9.10

69220 Clean out mastoid

cavity T 0013 0.8768 $61.39

. $12.28

69222 Clean out mastoid

cavity T 0253 16.8699 "$1,181.16" $279.20 $236.24

69300 Revise external

ear T 0254 24.8895 "$1,742.66"

. $348.54

69310 Rebuild outer ear

canal T 0256 45.0377 "$3,153.36"

. $630.68

69320 Rebuild outer ear

canal T 0256 45.0377 "$3,153.36"

. $630.68

69399 Outer ear surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.00

69400 Inflate middle ear

canal T 0251 3.1150 $218.10

. $43.62

69401 Inflate middle ear

canal T 0251 3.1150 $218.10

. $43.62

69405 Catheterize middle ear

canal T 0252 7.4614 $522.42 $104.55 $104.49

69420 Incision of

eardrum T 0251 3.1150 $218.10

. $43.62

69421 Incision of

eardrum T 0253 16.8699 "$1,181.16" $279.20 $236.24

69424 Remove ventilating

tube T 0253 16.8699 "$1,181.16" $279.20 $236.24

69433 Create eardrum

opening T 0252 7.4614 $522.42 $104.55 $104.49

69436 Create eardrum

opening T 0253 16.8699 "$1,181.16" $279.20 $236.24

69440 Exploration of middleear T 0254 24.8895 "$1,742.66"

. $348.54

69450 Eardrum

revision T 0256 45.0377 "$3,153.36"

. $630.68

69501 Mastoidectomy T 0256 45.0377 "$3,153.36"

. $630.68

69502 Mastoidectomy T 0254 24.8895 "$1,742.66"

. $348.54

69505 Remove mastoid

structures T 0256 45.0377 "$3,153.36"

. $630.68

69511 Extensive mastoid

surgery T 0256 45.0377 "$3,153.36"

. $630.68

69530 Extensive mastoid

surgery T 0256 45.0377 "$3,153.36"

. $630.68

69535 Remove part of temporal

bone C

69540 Remove ear

lesion T 0253 16.8699 "$1,181.16" $279.20 $236.24

69550 Remove ear

lesion T 0256 45.0377 "$3,153.36"

. $630.68

69552 Remove ear

lesion T 0256 45.0377 "$3,153.36"

. $630.68

69554 Remove ear

lesion C

69601 Mastoid surgery

revision T 0256 45.0377 "$3,153.36"

. $630.68

69602 Mastoid surgery

revision T 0256 45.0377 "$3,153.36"

. $630.68

69603 Mastoid surgery

revision T 0256 45.0377 "$3,153.36"

. $630.68

69604 Mastoid surgery

revision T 0256 45.0377 "$3,153.36"

. $630.68

69605 Mastoid surgery

revision T 0256 45.0377 "$3,153.36"

. $630.68

69610 Repair of

eardrum T 0254 24.8895 "$1,742.66"

. $348.5469620 Repair of

eardrum T 0254 24.8895 "$1,742.66"

. $348.54

69631 Repair eardrum

structures T 0256 45.0377 "$3,153.36"

. $630.68

69632 Rebuild eardrum

structures T 0256 45.0377 "$3,153.36"

. $630.68

69633 Rebuild eardrum

structures T 0256 45.0377 "$3,153.36"

. $630.68

69635 Repair eardrum

structures T 0256 45.0377 "$3,153.36"

. $630.68

69636 Rebuild eardrum

structures T 0256 45.0377 "$3,153.36"

. $630.68

69637 Rebuild eardrum

structures T 0256 45.0377 "$3,153.36"

. $630.68

69641 Revise middle ear &

mastoid T 0256 45.0377 "$3,153.36"

. $630.68

69642 Revise middle ear &

mastoid T 0256 45.0377 "$3,153.36"

. $630.68

69643 Revise middle ear &

mastoid T 0256 45.0377 "$3,153.36"

. $630.68

69644 Revise middle ear &

mastoid T 0256 45.0377 "$3,153.36"

. $630.68

69645 Revise middle ear &

mastoid T 0256 45.0377 "$3,153.36"

. $630.68

69646 Revise middle ear &

mastoid T 0256 45.0377 "$3,153.36"

. $630.68

69650 Release middle ear

bone T 0254 24.8895 "$1,742.66"

. $348.54

69660 Revise middle ear

bone T 0256 45.0377 "$3,153.36"

. $630.68

69661 Revise middle ear

bone T 0256 45.0377 "$3,153.36"

. $630.68

69662 Revise middle earbone T 0256 45.0377 "$3,153.36"

. $630.68

69666 Repair middle ear

structures T 0256 45.0377 "$3,153.36"

. $630.68

69667 Repair middle ear

structures T 0256 45.0377 "$3,153.36"

. $630.68

69670 Remove mastoid air

cells T 0256 45.0377 "$3,153.36"

. $630.68

69676 Remove middle ear

nerve T 0256 45.0377 "$3,153.36"

. $630.68

69700 Close mastoid

fistula T 0256 45.0377 "$3,153.36"

. $630.68

69710 Implant/replace hearing

aid E

69711 Remove/repair hearing

aid T 0256 45.0377 "$3,153.36"

. $630.68

69714 Implant temple bone

w/stimul T 0425 132.5319 "$9,279.35"

. "$1,855.87"

69715 Temple bne implnt

w/stimulat T 0425 132.5319 "$9,279.35"

. "$1,855.87"

69717 Temple bone implant

revision T 0425 132.5319 "$9,279.35"

. "$1,855.87"

69718 Revise temple bone

implant T 0425 132.5319 "$9,279.35"

. "$1,855.87"

69720 Release facial

nerve T 0256 45.0377 "$3,153.36"

. $630.68

69725 Release facial

nerve T 0256 45.0377 "$3,153.36"

. $630.68

69740 Repair facial

nerve T 0256 45.0377 "$3,153.36"

. $630.68

69745 Repair facial

nerve T 0256 45.0377 "$3,153.36"

. $630.68

69799 Middle ear surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.0069801 Incise inner

ear T 0253 16.8699 "$1,181.16" $279.20 $236.24

69802 Incise inner

ear CH D

69805 Explore inner

ear T 0256 45.0377 "$3,153.36"

. $630.68

69806 Explore inner

ear T 0256 45.0377 "$3,153.36"

. $630.68

69820 Establish inner ear

window T 0256 45.0377 "$3,153.36"

. $630.68

69840 Revise inner ear

window T 0256 45.0377 "$3,153.36"

. $630.68

69905 Remove inner

ear T 0256 45.0377 "$3,153.36"

. $630.68

69910 Remove inner ear &

mastoid T 0256 45.0377 "$3,153.36"

. $630.68

69915 Incise inner ear

nerve T 0256 45.0377 "$3,153.36"

. $630.68

69930 Implant cochlear

device T 0259 412.7299 "$28,897.70" "$7,948.75" "$5,779.54"

69949 Inner ear surgery

procedure T 0250 1.0709 $74.98 $24.12 $15.00

69950 Incise inner ear

nerve C

69955 Release facial

nerve T 0256 45.0377 "$3,153.36"

. $630.68

69960 Release inner ear

canal T 0256 45.0377 "$3,153.36"

. $630.68

69970 Remove inner ear

lesion T 0256 45.0377 "$3,153.36"

. $630.68

69979 Temporal bone

surgery T 0250 1.0709 $74.98 $24.12 $15.00

69990 Microsurgery

add-on N

70010 Contrast x-ray ofbrain Q2 0274 7.0678 $494.86

. $98.98

70015 Contrast x-ray of

brain Q2 0274 7.0678 $494.86

. $98.98

70030 X-ray eye for foreign

body X 0260 0.6409 $44.87

. $8.98

70100 X-ray exam of

jaw X 0260 0.6409 $44.87

. $8.98

70110 X-ray exam of

jaw X 0260 0.6409 $44.87

. $8.98

70120 X-ray exam of

mastoids X 0260 0.6409 $44.87

. $8.98

70130 X-ray exam of

mastoids X 0260 0.6409 $44.87

. $8.98

70134 X-ray exam of middle

ear X 0261 1.0790 $75.55

. $15.11

70140 X-ray exam of facial

bones X 0260 0.6409 $44.87

. $8.98

70150 X-ray exam of facial

bones X 0260 0.6409 $44.87

. $8.98

70160 X-ray exam of nasal

bones X 0260 0.6409 $44.87

. $8.98

70170 X-ray exam of tear

duct Q2 0263 3.3643 $235.55

. $47.11

70190 X-ray exam of eye

sockets X 0260 0.6409 $44.87

. $8.98

70200 X-ray exam of eye

sockets X 0260 0.6409 $44.87

. $8.98

70210 X-ray exam of

sinuses X 0260 0.6409 $44.87

. $8.98

70220 X-ray exam of

sinuses X 0260 0.6409 $44.87

. $8.98

70240 X-ray exam pituitary

saddle X 0260 0.6409 $44.87

. $8.9870250 X-ray exam of

skull X 0260 0.6409 $44.87

. $8.98

70260 X-ray exam of

skull X 0261 1.0790 $75.55

. $15.11

70300 X-ray exam of

teeth X 0262 0.4640 $32.49

. $6.50

70310 X-ray exam of

teeth X 0262 0.4640 $32.49

. $6.50

70320 Full mouth x-ray of

teeth X 0262 0.4640 $32.49

. $6.50

70328 X-ray exam of jaw

joint X 0260 0.6409 $44.87

. $8.98

70330 X-ray exam of jaw

joints X 0260 0.6409 $44.87

. $8.98

70332 X-ray exam of jaw

joint Q2 0275 4.0104 $280.79 $68.90 $56.16

70336 Magnetic image jaw

joint Q3 0336 4.8381 $338.74 $133.48 $67.75

70350 X-ray head for

orthodontia X 0260 0.6409 $44.87

. $8.98

70355 Panoramic x-ray of

jaws X 0262 0.4640 $32.49

. $6.50

70360 X-ray exam of

neck X 0260 0.6409 $44.87

. $8.98

70370 Throat x-ray &

fluoroscopy X 0272 1.2171 $85.22 $30.47 $17.05

70371 Speech evaluation

complex X 0272 1.2171 $85.22 $30.47 $17.05

70373 Contrast x-ray of

larynx Q2 0263 3.3643 $235.55

. $47.11

70380 X-ray exam of salivary

gland X 0260 0.6409 $44.87

. $8.98

70390 X-ray exam of salivaryduct Q2 0263 3.3643 $235.55

. $47.11

70450 Ct head/brain w/o

dye Q3 0332 2.7436 $192.10 $74.27 $38.42

70460 Ct head/brain

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.12

70470 Ct head/brain w/o &

w/dye Q3 0333 4.7767 $334.45 $116.13 $66.89

70480 Ct orbit/ear/fossa w/o

dye Q3 0332 2.7436 $192.10 $74.27 $38.42

70481 Ct orbit/ear/fossa

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.12

70482 Ct orbit/ear/fossa

w/o&w/dye Q3 0333 4.7767 $334.45 $116.13 $66.89

70486 Ct maxillofacial w/o

dye Q3 0332 2.7436 $192.10 $74.27 $38.42

70487 Ct maxillofacial

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.12

70488 Ct maxillofacial w/o &

w/dye Q3 0333 4.7767 $334.45 $116.13 $66.89

70490 Ct soft tissue neck w/o

dye Q3 0332 2.7436 $192.10 $74.27 $38.42

70491 Ct soft tissue neck

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.12

70492 Ct sft tsue nck w/o &

w/dye Q3 0333 4.7767 $334.45 $116.13 $66.89

70496 Ct angiography

head Q3 0662 4.8375 $338.70 $114.37 $67.74

70498 Ct angiography

neck Q3 0662 4.8375 $338.70 $114.37 $67.74

70540 Mri orbit/face/neck w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

70542 Mri orbit/face/neck

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.3070543 Mri orbt/fac/nck w/o &

w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

70544 Mr angiography head w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

70545 Mr angiography head

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.30

70546 Mr angiograph head

w/o&w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

70547 Mr angiography neck w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

70548 Mr angiography neck

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.30

70549 Mr angiograph neck

w/o&w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

70551 Mri brain w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

70552 Mri brain

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.30

70553 Mri brain w/o &

w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

70554 Fmri brain by

tech Q3 0336 4.8381 $338.74 $133.48 $67.75

70555 Fmri brain by

phys/psych S 0336 4.8381 $338.74 $133.48 $67.75

70557 Mri brain w/o

dye S 0336 4.8381 $338.74 $133.48 $67.75

70558 Mri brain

w/dye S 0284 6.2343 $436.50 $146.69 $87.30

70559 Mri brain w/o &

w/dye S 0337 7.6347 $534.55 $197.64 $106.91

71010 Chest

x-ray Q3 0260 0.6409 $44.87

. $8.98

71015 Chestx-ray Q3 0260 0.6409 $44.87

. $8.98

71020 Chest

x-ray Q3 0260 0.6409 $44.87

. $8.98

71021 Chest

x-ray X 0260 0.6409 $44.87

. $8.98

71022 Chest

x-ray X 0260 0.6409 $44.87

. $8.98

71023 Chest x-ray and

fluoroscopy X 0272 1.2171 $85.22 $30.47 $17.05

71030 Chest

x-ray X 0260 0.6409 $44.87

. $8.98

71034 Chest x-ray and

fluoroscopy X 0272 1.2171 $85.22 $30.47 $17.05

71035 Chest

x-ray X 0260 0.6409 $44.87

. $8.98

71040 Contrast x-ray of

bronchi Q2 0263 3.3643 $235.55

. $47.11

71060 Contrast x-ray of

bronchi Q2 0263 3.3643 $235.55

. $47.11

71090 X-ray & pacemaker

insertion CH D

71100 X-ray exam of

ribs X 0260 0.6409 $44.87

. $8.98

71101 X-ray exam of

ribs/chest X 0260 0.6409 $44.87

. $8.98

71110 X-ray exam of

ribs X 0260 0.6409 $44.87

. $8.98

71111 X-ray exam of

ribs/chest X 0261 1.0790 $75.55

. $15.11

71120 X-ray exam of

breastbone X 0260 0.6409 $44.87

. $8.98

71130 X-ray exam of

breastbone X 0260 0.6409 $44.87

. $8.9871250 Ct thorax w/o

dye Q3 0332 2.7436 $192.10 $74.27 $38.42

71260 Ct thorax

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.12

71270 Ct thorax w/o &

w/dye Q3 0333 4.7767 $334.45 $116.13 $66.89

71275 Ct angiography

chest Q3 0662 4.8375 $338.70 $114.37 $67.74

71550 Mri chest w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

71551 Mri chest

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.30

71552 Mri chest w/o &

w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

71555 Mri angio chest w or w/o

dye B

72010 X-ray exam of

spine X 0261 1.0790 $75.55

. $15.11

72020 X-ray exam of

spine X 0260 0.6409 $44.87

. $8.98

72040 X-ray exam of neck

spine X 0260 0.6409 $44.87

. $8.98

72050 X-ray exam of neck

spine X 0261 1.0790 $75.55

. $15.11

72052 X-ray exam of neck

spine X 0261 1.0790 $75.55

. $15.11

72069 X-ray exam of trunk

spine X 0260 0.6409 $44.87

. $8.98

72070 X-ray exam of thoracic

spine X 0260 0.6409 $44.87

. $8.98

72072 X-ray exam of thoracic

spine X 0260 0.6409 $44.87

. $8.98

72074 X-ray exam of thoracic

spine X 0260 0.6409 $44.87

. $8.9872080 X-ray exam of trunk

spine X 0260 0.6409 $44.87

. $8.98

72090 X-ray exam of trunk

spine X 0261 1.0790 $75.55

. $15.11

72100 X-ray exam of lower

spine X 0260 0.6409 $44.87

. $8.98

72110 X-ray exam of lower

spine X 0261 1.0790 $75.55

. $15.11

72114 X-ray exam of lower

spine X 0261 1.0790 $75.55

. $15.11

72120 X-ray exam of lower

spine X 0260 0.6409 $44.87

. $8.98

72125 Ct neck spine w/o

dye Q3 0332 2.7436 $192.10 $74.27 $38.42

72126 Ct neck spine

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.12

72127 Ct neck spine w/o &

w/dye Q3 0333 4.7767 $334.45 $116.13 $66.89

72128 Ct chest spine w/o

dye Q3 0332 2.7436 $192.10 $74.27 $38.42

72129 Ct chest spine

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.12

72130 Ct chest spine w/o &

w/dye Q3 0333 4.7767 $334.45 $116.13 $66.89

72131 Ct lumbar spine w/o

dye Q3 0332 2.7436 $192.10 $74.27 $38.42

72132 Ct lumbar spine

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.12

72133 Ct lumbar spine w/o &

w/dye Q3 0333 4.7767 $334.45 $116.13 $66.89

72141 Mri neck spine w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.7572142 Mri neck spine

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.30

72146 Mri chest spine w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

72147 Mri chest spine

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.30

72148 Mri lumbar spine w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

72149 Mri lumbar spine

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.30

72156 Mri neck spine w/o &

w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

72157 Mri chest spine w/o &

w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

72158 Mri lumbar spine w/o &

w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

72159 Mr angio spine

w/o&w/dye B

72170 X-ray exam of

pelvis X 0260 0.6409 $44.87

. $8.98

72190 X-ray exam of

pelvis X 0260 0.6409 $44.87

. $8.98

72191 Ct angiograph pelv

w/o&w/dye Q3 0662 4.8375 $338.70 $114.37 $67.74

72192 Ct pelvis w/o

dye Q3 0332 2.7436 $192.10 $74.27 $38.42

72193 Ct pelvis

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.12

72194 Ct pelvis w/o &

w/dye Q3 0333 4.7767 $334.45 $116.13 $66.89

72195 Mri pelvis w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

72196 Mri pelvis

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.3072197 Mri pelvis w/o &

w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

72198 Mr angio pelvis w/o &

w/dye B

72200 X-ray exam sacroiliac

joints X 0260 0.6409 $44.87

. $8.98

72202 X-ray exam sacroiliac

joints X 0260 0.6409 $44.87

. $8.98

72220 X-ray exam of

tailbone X 0260 0.6409 $44.87

. $8.98

72240 Contrast x-ray of neck

spine Q2 0274 7.0678 $494.86

. $98.98

72255 Contrast x-ray thorax

spine Q2 0274 7.0678 $494.86

. $98.98

72265 Contrast x-ray lower

spine Q2 0274 7.0678 $494.86

. $98.98

72270 Contrast x-ray

spine Q2 0274 7.0678 $494.86

. $98.98

72275 Epidurography N

72285 X-ray c/t spine

disk Q2 0388 22.7689 "$1,594.19"

. $318.84

72291 Perq verte/sacroplsty

fluor N

72292 Perq verte/sacroplsty

ct N

72295 X-ray of lower spine

disk Q2 0388 22.7689 "$1,594.19"

. $318.84

73000 X-ray exam of collar

bone X 0260 0.6409 $44.87

. $8.98

73010 X-ray exam of shoulder

blade X 0260 0.6409 $44.87

. $8.98

73020 X-ray exam of

shoulder X 0260 0.6409 $44.87

. $8.98

73030 X-ray exam ofshoulder X 0260 0.6409 $44.87

. $8.98

73040 Contrast x-ray of

shoulder Q2 0275 4.0104 $280.79 $68.90 $56.16

73050 X-ray exam of

shoulders X 0260 0.6409 $44.87

. $8.98

73060 X-ray exam of

humerus X 0260 0.6409 $44.87

. $8.98

73070 X-ray exam of

elbow X 0260 0.6409 $44.87

. $8.98

73080 X-ray exam of

elbow X 0260 0.6409 $44.87

. $8.98

73085 Contrast x-ray of

elbow Q2 0275 4.0104 $280.79 $68.90 $56.16

73090 X-ray exam of

forearm X 0260 0.6409 $44.87

. $8.98

73092 X-ray exam of arm

infant X 0260 0.6409 $44.87

. $8.98

73100 X-ray exam of

wrist X 0260 0.6409 $44.87

. $8.98

73110 X-ray exam of

wrist X 0260 0.6409 $44.87

. $8.98

73115 Contrast x-ray of

wrist Q2 0275 4.0104 $280.79 $68.90 $56.16

73120 X-ray exam of

hand X 0260 0.6409 $44.87

. $8.98

73130 X-ray exam of

hand X 0260 0.6409 $44.87

. $8.98

73140 X-ray exam of

finger(s) X 0260 0.6409 $44.87

. $8.98

73200 Ct upper extremity w/o

dye Q3 0332 2.7436 $192.10 $74.27 $38.42

73201 Ct upper extremity

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.1273202 Ct uppr extremity

w/o&w/dye Q3 0333 4.7767 $334.45 $116.13 $66.89

73206 Ct angio upr extrm

w/o&w/dye Q3 0662 4.8375 $338.70 $114.37 $67.74

73218 Mri upper extremity w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

73219 Mri upper extremity

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.30

73220 Mri uppr extremity

w/o&w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

73221 Mri joint upr extrem w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

73222 Mri joint upr extrem

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.30

73223 Mri joint upr extr

w/o&w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

73225 Mr angio upr extr

w/o&w/dye B

73500 X-ray exam of

hip X 0260 0.6409 $44.87

. $8.98

73510 X-ray exam of

hip X 0260 0.6409 $44.87

. $8.98

73520 X-ray exam of

hips X 0260 0.6409 $44.87

. $8.98

73525 Contrast x-ray of

hip Q2 0275 4.0104 $280.79 $68.90 $56.16

73530 X-ray exam of

hip N

73540 X-ray exam of pelvis &

hips X 0260 0.6409 $44.87

. $8.98

73542 X-ray exam sacroiliac

joint CH D

73550 X-ray exam of

thigh X 0260 0.6409 $44.87

. $8.9873560 X-ray exam of knee 1 or

2 X 0260 0.6409 $44.87

. $8.98

73562 X-ray exam of knee

3 X 0260 0.6409 $44.87

. $8.98

73564 X-ray exam knee 4 or

more X 0260 0.6409 $44.87

. $8.98

73565 X-ray exam of

knees X 0260 0.6409 $44.87

. $8.98

73580 Contrast x-ray of knee

joint Q2 0275 4.0104 $280.79 $68.90 $56.16

73590 X-ray exam of lower

leg X 0260 0.6409 $44.87

. $8.98

73592 X-ray exam of leg

infant X 0260 0.6409 $44.87

. $8.98

73600 X-ray exam of

ankle X 0260 0.6409 $44.87

. $8.98

73610 X-ray exam of

ankle X 0260 0.6409 $44.87

. $8.98

73615 Contrast x-ray of

ankle Q2 0275 4.0104 $280.79 $68.90 $56.16

73620 X-ray exam of

foot X 0260 0.6409 $44.87

. $8.98

73630 X-ray exam of

foot X 0260 0.6409 $44.87

. $8.98

73650 X-ray exam of

heel X 0260 0.6409 $44.87

. $8.98

73660 X-ray exam of

toe(s) X 0260 0.6409 $44.87

. $8.98

73700 Ct lower extremity w/o

dye Q3 0332 2.7436 $192.10 $74.27 $38.42

73701 Ct lower extremity

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.12

73702 Ct lwr extremity

w/o&w/dye Q3 0333 4.7767 $334.45 $116.13 $66.8973706 Ct angio lwr extr

w/o&w/dye Q3 0662 4.8375 $338.70 $114.37 $67.74

73718 Mri lower extremity w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

73719 Mri lower extremity

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.30

73720 Mri lwr extremity

w/o&w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

73721 Mri jnt of lwr extre w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

73722 Mri joint of lwr extr

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.30

73723 Mri joint lwr extr

w/o&w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

73725 Mr ang lwr ext w or w/o

dye B

74000 X-ray exam of

abdomen X 0260 0.6409 $44.87

. $8.98

74010 X-ray exam of

abdomen X 0260 0.6409 $44.87

. $8.98

74020 X-ray exam of

abdomen X 0260 0.6409 $44.87

. $8.98

74022 X-ray exam series

abdomen X 0261 1.0790 $75.55

. $15.11

74150 Ct abdomen w/o

dye Q3 0332 2.7436 $192.10 $74.27 $38.42

74160 Ct abdomen

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.12

74170 Ct abdomen w/o &

w/dye Q3 0333 4.7767 $334.45 $116.13 $66.89

74174 Ct angio abd&pelv

w/o&w/dye NI S 0334 8.2987 $581.04 $187.25 $116.21

74175 Ct angio abdom w/o &w/dye Q3 0662 4.8375 $338.70 $114.37 $67.74

74176 Ct abd &

pelvis CH Q3 0331 5.7930 $405.60 $156.82 $81.12

74177 Ct abd & pelv

w/contrast CH Q3 0334 8.2987 $581.04 $187.25 $116.21

74178 Ct abd & pelv 1/>

regns CH Q3 0334 8.2987 $581.04 $187.25 $116.21

74181 Mri abdomen w/o

dye Q3 0336 4.8381 $338.74 $133.48 $67.75

74182 Mri abdomen

w/dye Q3 0284 6.2343 $436.50 $146.69 $87.30

74183 Mri abdomen w/o &

w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

74185 Mri angio abdom w orw/o

dye B

74190 X-ray exam of

peritoneum Q2 0263 3.3643 $235.55

. $47.11

74210 Contrst x-ray exam of

throat S 0276 1.2186 $85.32 $33.87 $17.07

74220 Contrast x-ray

esophagus S 0276 1.2186 $85.32 $33.87 $17.07

74230 Cine/vid x-ray

throat/esoph S 0276 1.2186 $85.32 $33.87 $17.07

74235 Remove esophagus

obstruction N

74240 X-ray exam upper gi

tract S 0276 1.2186 $85.32 $33.87 $17.07

74241 X-ray exam upper gi

tract S 0276 1.2186 $85.32 $33.87 $17.07

74245 X-ray exam upper gi

tract S 0277 2.0340 $142.41 $53.90 $28.49

74246 Contrst x-ray uppr gi

tract S 0276 1.2186 $85.32 $33.87 $17.0774247 Contrst x-ray uppr gi

tract S 0276 1.2186 $85.32 $33.87 $17.07

74249 Contrst x-ray uppr gi

tract S 0277 2.0340 $142.41 $53.90 $28.49

74250 X-ray exam of small

bowel S 0276 1.2186 $85.32 $33.87 $17.07

74251 X-ray exam of small

bowel S 0277 2.0340 $142.41 $53.90 $28.49

74260 X-ray exam of small

bowel S 0276 1.2186 $85.32 $33.87 $17.07

74261 Ct colonography

dx Q3 0332 2.7436 $192.10 $74.27 $38.42

74262 Ct colonography dx

w/dye Q3 0283 4.2929 $300.57 $96.62 $60.12

74263 Ct colonography

screening E

74270 Contrast x-ray exam of

colon S 0276 1.2186 $85.32 $33.87 $17.07

74280 Contrast x-ray exam of

colon S 0277 2.0340 $142.41 $53.90 $28.49

74283 Contrast x-ray exam of

colon S 0276 1.2186 $85.32 $33.87 $17.07

74290 Contrast x-ray

gallbladder S 0276 1.2186 $85.32 $33.87 $17.07

74291 Contrast x-rays

gallbladder S 0276 1.2186 $85.32 $33.87 $17.07

74300 X-ray bile

ducts/pancreas N

74301 X-rays at surgery

add-on N

74305 X-ray bile

ducts/pancreas Q2 0263 3.3643 $235.55

. $47.11

74320 Contrast x-ray of bile

ducts Q2 0317 5.7208 $400.55

. $80.1174327 X-ray bile stone

removal N

74328 X-ray bile duct

endoscopy N

74329 X-ray for pancreas

endoscopy N

74330 X-ray bile/panc

endoscopy N

74340 X-ray guide for GI

tube N

74355 X-ray guide intestinal

tube N

74360 X-ray guide gi

dilation N

74363 X-ray bile duct

dilation N

74400 Contrst x-ray urinary

tract S 0278 2.6196 $183.41 $58.44 $36.69

74410 Contrst x-ray urinary

tract S 0278 2.6196 $183.41 $58.44 $36.69

74415 Contrst x-ray urinary

tract S 0278 2.6196 $183.41 $58.44 $36.69

74420 Contrst x-ray urinary

tract S 0278 2.6196 $183.41 $58.44 $36.69

74425 Contrst x-ray urinary

tract Q2 0278 2.6196 $183.41 $58.44 $36.69

74430 Contrast x-ray

bladder Q2 0278 2.6196 $183.41 $58.44 $36.69

74440 X-ray male genital

tract Q2 0278 2.6196 $183.41 $58.44 $36.69

74445 X-ray exam of

penis Q2 0278 2.6196 $183.41 $58.44 $36.69

74450 X-ray

urethra/bladder Q2 0278 2.6196 $183.41 $58.44 $36.69

74455 X-ray

urethra/bladder Q2 0278 2.6196 $183.41 $58.44 $36.69

74470 X-ray exam of kidney

lesion Q2 0263 3.3643 $235.55

. $47.1174475 X-ray control cath

insert Q2 0161 17.4715 "$1,223.28"

. $244.66

74480 X-ray control cath

insert Q2 0161 17.4715 "$1,223.28"

. $244.66

74485 X-ray guide gu

dilation Q2 0161 17.4715 "$1,223.28"

. $244.66

74710 X-ray measurement of

pelvis X 0261 1.0790 $75.55

. $15.11

74740 X-ray female genital

tract Q2 0263 3.3643 $235.55

. $47.11

74742 X-ray fallopian

tube N

74775 X-ray exam of

perineum S 0278 2.6196 $183.41 $58.44 $36.69

75557 Cardiac mri for

morph Q3 0336 4.8381 $338.74 $133.48 $67.75

75559 Cardiac mri w/stress

img Q3 0336 4.8381 $338.74 $133.48 $67.75

75561 Cardiac mri for morph

w/dye Q3 0337 7.6347 $534.55 $197.64 $106.91

75563 Card mri w/stress img &

dye Q3 0337 7.6347 $534.55 $197.64 $106.91

75565 Card mri veloc flow

mapping N

75571 Ct hrt w/o dye w/ca

test X 0340 0.6499 $45.50

. $9.10

75572 Ct hrt w/3d

image S 0383 3.7417 $261.98

. $52.40

75573 Ct hrt w/3d image

congen S 0383 3.7417 $261.98

. $52.40

75574 Ct angio hrt w/3d

image S 0383 3.7417 $261.98

. $52.40

75600 Contrast x-ray exam of

aorta Q2 0279 29.7209 "$2,080.94"

. $416.1975605 Contrast x-ray exam of

aorta Q2 0279 29.7209 "$2,080.94"

. $416.19

75625 Contrast x-ray exam of

aorta Q2 0279 29.7209 "$2,080.94"

. $416.19

75630 X-ray aorta leg

arteries Q2 0279 29.7209 "$2,080.94"

. $416.19

75635 Ct angio abdominal

arteries Q2 0662 4.8375 $338.70 $114.37 $67.74

75650 Artery x-rays head &

neck Q2 0280 49.6878 "$3,478.94"

. $695.79

75658 Artery x-rays

arm Q2 0279 29.7209 "$2,080.94"

. $416.19

75660 Artery x-rays head &

neck Q2 0280 49.6878 "$3,478.94"

. $695.79

75662 Artery x-rays head &

neck Q2 0280 49.6878 "$3,478.94"

. $695.79

75665 Artery x-rays head &

neck Q2 0279 29.7209 "$2,080.94"

. $416.19

75671 Artery x-rays head &

neck Q2 0280 49.6878 "$3,478.94"

. $695.79

75676 Artery x-rays

neck Q2 0279 29.7209 "$2,080.94"

. $416.19

75680 Artery x-rays

neck Q2 0279 29.7209 "$2,080.94"

. $416.19

75685 Artery x-rays

spine Q2 0279 29.7209 "$2,080.94"

. $416.19

75705 Artery x-rays

spine Q2 0279 29.7209 "$2,080.94"

. $416.19

75710 Artery x-rays

arm/leg Q2 0279 29.7209 "$2,080.94"

. $416.19

75716 Artery x-rays

arms/legs Q2 0279 29.7209 "$2,080.94"

. $416.1975722 Artery x-rays

kidney CH D

75724 Artery x-rays

kidneys CH D

75726 Artery x-rays

abdomen Q2 0279 29.7209 "$2,080.94"

. $416.19

75731 Artery x-rays adrenal

gland Q2 0279 29.7209 "$2,080.94"

. $416.19

75733 Artery x-rays

adrenals Q2 0279 29.7209 "$2,080.94"

. $416.19

75736 Artery x-rays

pelvis Q2 0279 29.7209 "$2,080.94"

. $416.19

75741 Artery x-rays

lung Q2 0279 29.7209 "$2,080.94"

. $416.19

75743 Artery x-rays

lungs Q2 0279 29.7209 "$2,080.94"

. $416.19

75746 Artery x-rays

lung Q2 0668 9.4045 $658.47

. $131.70

75756 Artery x-rays

chest Q2 0668 9.4045 $658.47

. $131.70

75774 Artery x-ray each

vessel N

75791 Av dialysis shunt

imaging CH Q2 0668 9.4045 $658.47

. $131.70

75801 Lymph vessel x-ray

arm/leg Q2 0317 5.7208 $400.55

. $80.11

75803 Lymph vessel x-ray

arms/legs Q2 0317 5.7208 $400.55

. $80.11

75805 Lymph vessel x-ray

trunk Q2 0317 5.7208 $400.55

. $80.11

75807 Lymph vessel x-ray

trunk Q2 0317 5.7208 $400.55

. $80.11

75809 Nonvascular shunt

x-ray Q2 0261 1.0790 $75.55

. $15.11

75810 Vein x-rayspleen/liver Q2 0279 29.7209 "$2,080.94"

. $416.19

75820 Vein x-ray

arm/leg Q2 0668 9.4045 $658.47

. $131.70

75822 Vein x-ray

arms/legs Q2 0668 9.4045 $658.47

. $131.70

75825 Vein x-ray

trunk Q2 0279 29.7209 "$2,080.94"

. $416.19

75827 Vein x-ray

chest Q2 0668 9.4045 $658.47

. $131.70

75831 Vein x-ray

kidney Q2 0279 29.7209 "$2,080.94"

. $416.19

75833 Vein x-ray

kidneys Q2 0279 29.7209 "$2,080.94"

. $416.19

75840 Vein x-ray adrenal

gland Q2 0279 29.7209 "$2,080.94"

. $416.19

75842 Vein x-ray adrenal

glands Q2 0279 29.7209 "$2,080.94"

. $416.19

75860 Vein x-ray

neck Q2 0668 9.4045 $658.47

. $131.70

75870 Vein x-ray

skull Q2 0668 9.4045 $658.47

. $131.70

75872 Vein x-ray

skull Q2 0668 9.4045 $658.47

. $131.70

75880 Vein x-ray eye

socket Q2 0668 9.4045 $658.47

. $131.70

75885 Vein x-ray

liver Q2 0279 29.7209 "$2,080.94"

. $416.19

75887 Vein x-ray

liver Q2 0668 9.4045 $658.47

. $131.70

75889 Vein x-ray

liver Q2 0279 29.7209 "$2,080.94"

. $416.19

75891 Vein x-ray

liver Q2 0279 29.7209 "$2,080.94"

. $416.1975893 Venous sampling by

catheter Q2 0279 29.7209 "$2,080.94"

. $416.19

75894 X-rays transcath

therapy N

75896 X-rays transcath

therapy N

75898 Follow-up

angiography Q1 0261 1.0790 $75.55

. $15.11

75900 Intravascular cath

exchange C

75901 Remove cva device

obstruct N

75902 Remove cva lumen

obstruct N

75940 X-ray placement vein

filter CH D

75945 Intravascular

us Q2 0267 2.1681 $151.80 $59.37 $30.36

75946 Intravascular us

add-on N

75952 Endovasc repair abdom

aorta C

75953 Abdom aneurysm endovas

rpr C

75954 Iliac aneurysm endovas

rpr C

75956 Xray endovasc thor ao

repr C

75957 Xray endovasc thor ao

repr C

75958 Xray place prox ext thor

ao C

75959 Xray place dist ext thor

ao C

75960 Transcath iv stent

rs&i N

75961 Retrieval broken

catheter N

75962 Repair arterial

blockage Q2 0083 65.8519 "$4,610.69"

. $922.14

75964 Repair artery blockageeach N

75966 Repair arterial

blockage Q2 0083 65.8519 "$4,610.69"

. $922.14

75968 Repair artery blockage

each N

75970 Vascular

biopsy N

75978 Repair venous

blockage Q2 0093 31.1505 "$2,181.03"

. $436.21

75980 Contrast xray exam bile

duct N

75982 Contrast xray exam bile

duct N

75984 Xray control catheter

change N

75989 Abscess drainage under

x-ray N

76000 Fluoroscope

examination Q1 0272 1.2171 $85.22 $30.47 $17.05

76001 Fluoroscope exam

extensive N

76010 X-ray nose to

rectum X 0260 0.6409 $44.87

. $8.98

76080 X-ray exam of

fistula Q2 0263 3.3643 $235.55

. $47.11

76098 X-ray exam breast

specimen Q2 0317 5.7208 $400.55

. $80.11

76100 X-ray exam of body

section X 0261 1.0790 $75.55

. $15.11

76101 Complex body section

x-ray X 0263 3.3643 $235.55

. $47.11

76102 Complex body section

x-rays X 0263 3.3643 $235.55

. $47.11

76120 Cine/video

x-rays X 0272 1.2171 $85.22 $30.47 $17.05

76125 Cine/video x-rays

add-on N76140 X-ray

consultation E

76376 3d render w/o

postprocess N

76377 3d rendering

w/postprocess N

76380 CAT scan follow-up

study S 0282 1.5251 $106.78 $35.57 $21.36

76390 Mr

spectroscopy E

76496 Fluoroscopic

procedure X 0272 1.2171 $85.22 $30.47 $17.05

76497 Ct

procedure S 0282 1.5251 $106.78 $35.57 $21.36

76498 Mri

procedure S 0336 4.8381 $338.74 $133.48 $67.75

76499 Radiographic

procedure X 0260 0.6409 $44.87

. $8.98

76506 Echo exam of

head S 0265 0.8990 $62.94 $22.26 $12.59

76510 Ophth us b & quant

a T 0232 2.8247 $197.77 $42.27 $39.56

76511 Ophth us quant a

only S 0266 1.3781 $96.49 $37.23 $19.30

76512 Ophth us b w/non-quant

a S 0266 1.3781 $96.49 $37.23 $19.30

76513 Echo exam of eye water

bath S 0266 1.3781 $96.49 $37.23 $19.30

76514 Echo exam of eye

thickness X 0035 0.2673 $18.72

. $3.75

76516 Echo exam of

eye S 0265 0.8990 $62.94 $22.26 $12.59

76519 Echo exam of

eye S 0266 1.3781 $96.49 $37.23 $19.3076529 Echo exam of

eye S 0265 0.8990 $62.94 $22.26 $12.59

76536 Us exam of head and

neck S 0266 1.3781 $96.49 $37.23 $19.30

76604 Us exam

chest Q3 0265 0.8990 $62.94 $22.26 $12.59

76645 Us exam

breast(s) S 0265 0.8990 $62.94 $22.26 $12.59

76700 Us exam abdom

complete Q3 0266 1.3781 $96.49 $37.23 $19.30

76705 Echo exam of

abdomen Q3 0266 1.3781 $96.49 $37.23 $19.30

76770 Us exam abdo back wall

comp Q3 0266 1.3781 $96.49 $37.23 $19.30

76775 Us exam abdo back wall

lim Q3 0266 1.3781 $96.49 $37.23 $19.30

76776 Us exam k transpl

w/doppler Q3 0266 1.3781 $96.49 $37.23 $19.30

76800 Us exam spinal

canal S 0266 1.3781 $96.49 $37.23 $19.30

76801 Ob us < 14 wks single

fetus S 0266 1.3781 $96.49 $37.23 $19.30

76802 Ob us < 14 wks addl

fetus S 0265 0.8990 $62.94 $22.26 $12.59

76805 Ob us >/= 14 wks sngl

fetus S 0266 1.3781 $96.49 $37.23 $19.30

76810 Ob us >/= 14 wks addl

fetus S 0266 1.3781 $96.49 $37.23 $19.30

76811 Ob us detailed sngl

fetus S 0267 2.1681 $151.80 $59.37 $30.36

76812 Ob us detailed addl

fetus S 0265 0.8990 $62.94 $22.26 $12.5976813 Ob us nuchal meas 1

gest S 0265 0.8990 $62.94 $22.26 $12.59

76814 Ob us nuchal meas

add-on S 0265 0.8990 $62.94 $22.26 $12.59

76815 Ob us limited

fetus(s) S 0265 0.8990 $62.94 $22.26 $12.59

76816 Ob us follow-up per

fetus S 0265 0.8990 $62.94 $22.26 $12.59

76817 Transvaginal us

obstetric S 0265 0.8990 $62.94 $22.26 $12.59

76818 Fetal biophys profile

w/nst S 0266 1.3781 $96.49 $37.23 $19.30

76819 Fetal biophys profil w/o

nst S 0266 1.3781 $96.49 $37.23 $19.30

76820 Umbilical artery

echo S 0265 0.8990 $62.94 $22.26 $12.59

76821 Middle cerebral artery

echo S 0265 0.8990 $62.94 $22.26 $12.59

76825 Echo exam of fetal

heart CH S 0697 3.1615 $221.36

. $44.28

76826 Echo exam of fetal

heart CH S 0697 3.1615 $221.36

. $44.28

76827 Echo exam of fetal

heart S 0265 0.8990 $62.94 $22.26 $12.59

76828 Echo exam of fetal

heart S 0265 0.8990 $62.94 $22.26 $12.59

76830 Transvaginal us

non-ob S 0266 1.3781 $96.49 $37.23 $19.30

76831 Echo exam

uterus Q3 0267 2.1681 $151.80 $59.37 $30.36

76856 Us exam pelvic

complete Q3 0266 1.3781 $96.49 $37.23 $19.30

76857 Us exam pelvic

limited Q3 0265 0.8990 $62.94 $22.26 $12.5976870 Us exam

scrotum Q3 0266 1.3781 $96.49 $37.23 $19.30

76872 Us

transrectal S 0266 1.3781 $96.49 $37.23 $19.30

76873 Echograp trans r pros

study S 0266 1.3781 $96.49 $37.23 $19.30

76881 Us xtr non-vasc

complete S 0266 1.3781 $96.49 $37.23 $19.30

76882 Us xtr non-vasc

lmtd S 0265 0.8990 $62.94 $22.26 $12.59

76885 Us exam infant hips

dynamic S 0265 0.8990 $62.94 $22.26 $12.59

76886 Us exam infant hips

static S 0265 0.8990 $62.94 $22.26 $12.59

76930 Echo guide

cardiocentesis N

76932 Echo guide for heart

biopsy N

76936 Echo guide for artery

repair S 0096 1.5248 $106.76 $36.86 $21.36

76937 Us guide vascular

access N

76940 Us guide tissue

ablation N

76941 Echo guide for

transfusion N

76942 Echo guide for

biopsy N

76945 Echo guide villus

sampling N

76946 Echo guide for

amniocentesis N

76948 Echo guide ova

aspiration N

76950 Echo guidance

radiotherapy N76965 Echo guidance

radiotherapy N

76970 Ultrasound exam

follow-up S 0265 0.8990 $62.94 $22.26 $12.59

76975 GI endoscopic

ultrasound Q2 0267 2.1681 $151.80 $59.37 $30.36

76977 Us bone density

measure X 0340 0.6499 $45.50 $0.00 $0.00

76998 Us guide

intraop N

76999 Echo examination

procedure S 0265 0.8990 $62.94 $22.26 $12.59

77001 Fluoroguide for vein

device N

77002 Needle localization by

xray N

77003 Fluoroguide for spine

inject N

77011 Ct scan for

localization N

77012 Ct scan for needle

biopsy N

77013 Ct guide for tissue

ablation N

77014 Ct scan for therapy

guide N

77021 Mr guidance for needle

place N

77022 Mri for tissue

ablation N

77031 Stereotact guide for brst

bx N

77032 Guidance for needle

breast N

77051 Computer dx mammogram

add-on A

77052 Comp screen mammogram

add-on A

77053 X-ray of mammaryduct Q2 0263 3.3643 $235.55

. $47.11

77054 X-ray of mammary

ducts Q2 0263 3.3643 $235.55

. $47.11

77055 Mammogram one

breast A

77056 Mammogram both

breasts A

77057 Mammogram

screening A

77058 Mri one

breast B

77059 Mri both

breasts B

77071 X-ray stress

view X 0260 0.6409 $44.87

. $8.98

77072 X-rays for bone

age X 0260 0.6409 $44.87

. $8.98

77073 X-rays bone length

studies X 0260 0.6409 $44.87

. $8.98

77074 X-rays bone survey

limited X 0261 1.0790 $75.55

. $15.11

77075 X-rays bone survey

complete X 0261 1.0790 $75.55

. $15.11

77076 X-rays bone survey

infant X 0261 1.0790 $75.55

. $15.11

77077 Joint survey single

view X 0260 0.6409 $44.87

. $8.98

77078 Ct bone density

axial S 0288 1.0218 $71.54 $0.00 $0.00

77079 Ct bone density

peripheral CH D

77080 Dxa bone density

axial S 0288 1.0218 $71.54 $0.00 $0.00

77081 Dxa bone

density/peripheral S 0665 0.4865 $34.06 $0.00 $0.0077082 Dxa bone density vert

fx X 0260 0.6409 $44.87

. $8.98

77083 Radiographic

absorptiometry CH D

77084 Magnetic image bone

marrow S 0336 4.8381 $338.74 $133.48 $67.75

77261 Radiation therapy

planning B

77262 Radiation therapy

planning B

77263 Radiation therapy

planning B

77280 Set radiation therapy

field X 0304 1.5329 $107.33 $34.63 $21.47

77285 Set radiation therapy

field X 0305 3.7681 $263.83 $88.76 $52.77

77290 Set radiation therapy

field X 0305 3.7681 $263.83 $88.76 $52.77

77295 Set radiation therapy

field X 0310 13.6332 $954.54 $325.27 $190.91

77299 Radiation therapy

planning X 0304 1.5329 $107.33 $34.63 $21.47

77300 Radiation therapy dose

plan X 0304 1.5329 $107.33 $34.63 $21.47

77301 Radiotherapy dose plan

imrt X 0310 13.6332 $954.54 $325.27 $190.91

77305 Teletx isodose plan

simple X 0304 1.5329 $107.33 $34.63 $21.47

77310 Teletx isodose plan

intermed X 0304 1.5329 $107.33 $34.63 $21.47

77315 Teletx isodose plan

complex X 0305 3.7681 $263.83 $88.76 $52.77

77321 Special teletx port

plan X 0305 3.7681 $263.83 $88.76 $52.77

77326 Brachytx isodose calcsimp X 0304 1.5329 $107.33 $34.63 $21.47

77327 Brachytx isodose calc

interm X 0305 3.7681 $263.83 $88.76 $52.77

77328 Brachytx isodose plan

compl X 0305 3.7681 $263.83 $88.76 $52.77

77331 Special radiation

dosimetry X 0304 1.5329 $107.33 $34.63 $21.47

77332 Radiation treatment

aid(s) X 0303 2.8573 $200.06 $66.95 $40.02

77333 Radiation treatment

aid(s) X 0303 2.8573 $200.06 $66.95 $40.02

77334 Radiation treatment

aid(s) X 0303 2.8573 $200.06 $66.95 $40.02

77336 Radiation physics

consult X 0304 1.5329 $107.33 $34.63 $21.47

77338 Design mlc device for

imrt CH X 0305 3.7681 $263.83 $88.76 $52.77

77370 Radiation physics

consult X 0304 1.5329 $107.33 $34.63 $21.47

77371 Srs

multisource S 0127 106.5454 "$7,459.88"

. "$1,491.98"

77372 Srs linear

based B

77373 Sbrt

delivery B

77399 External radiation

dosimetry X 0304 1.5329 $107.33 $34.63 $21.47

77401 Radiation treatment

delivery S 0300 1.4252 $99.79

. $19.96

77402 Radiation treatment

delivery S 0300 1.4252 $99.79

. $19.96

77403 Radiation treatment

delivery S 0300 1.4252 $99.79

. $19.96

77404 Radiation treatmentdelivery S 0300 1.4252 $99.79

. $19.96

77406 Radiation treatment

delivery S 0300 1.4252 $99.79

. $19.96

77407 Radiation treatment

delivery S 0300 1.4252 $99.79

. $19.96

77408 Radiation treatment

delivery CH S 0301 2.4149 $169.08

. $33.82

77409 Radiation treatment

delivery CH S 0301 2.4149 $169.08

. $33.82

77411 Radiation treatment

delivery S 0301 2.4149 $169.08

. $33.82

77412 Radiation treatment

delivery S 0301 2.4149 $169.08

. $33.82

77413 Radiation treatment

delivery S 0301 2.4149 $169.08

. $33.82

77414 Radiation treatment

delivery S 0301 2.4149 $169.08

. $33.82

77416 Radiation treatment

delivery S 0301 2.4149 $169.08

. $33.82

77417 Radiology port

film(s) N

77418 Radiation tx delivery

imrt S 0412 6.5452 $458.27

. $91.66

77421 Stereoscopic x-ray

guidance N

77422 Neutron beam tx

simple S 0301 2.4149 $169.08

. $33.82

77423 Neutron beam tx

complex S 0301 2.4149 $169.08

. $33.82

77424 Io rad tx delivery by

x-ray NI N

77425 Io rad tx deliver by

elctrns NI N

77427 Radiation tx management

x5 B77431 Radiation therapy

management B

77432 Stereotactic radiation

trmt B

77435 Sbrt

management N

77469 Io radiation tx

management NI N

77470 Special radiation

treatment S 0299 5.6386 $394.79

. $78.96

77499 Radiation therapy

management B

77520 Proton trmt simple w/o

comp S 0664 16.9101 "$1,183.98"

. $236.80

77522 Proton trmt simple

w/comp S 0664 16.9101 "$1,183.98"

. $236.80

77523 Proton trmt

intermediate S 0667 22.1209 "$1,548.82"

. $309.77

77525 Proton treatment

complex S 0667 22.1209 "$1,548.82"

. $309.77

77600 Hyperthermia

treatment S 0299 5.6386 $394.79

. $78.96

77605 Hyperthermia

treatment S 0299 5.6386 $394.79

. $78.96

77610 Hyperthermia

treatment S 0299 5.6386 $394.79

. $78.96

77615 Hyperthermia

treatment S 0299 5.6386 $394.79

. $78.96

77620 Hyperthermia

treatment S 0299 5.6386 $394.79

. $78.96

77750 Infuse radioactive

materials S 0301 2.4149 $169.08

. $33.82

77761 Apply intrcav radiat

simple S 0312 5.4044 $378.39

. $75.68

77762 Apply intrcav radiat

interm S 0312 5.4044 $378.39

. $75.6877763 Apply intrcav radiat

compl S 0312 5.4044 $378.39

. $75.68

77776 Apply interstit radiat

simpl S 0312 5.4044 $378.39

. $75.68

77777 Apply interstit radiat

inter S 0312 5.4044 $378.39

. $75.68

77778 Apply interstit radiat

compl Q3 0651 11.9274 $835.11

. $167.03

77785 Hdr brachytx 1

channel S 0313 9.9687 $697.97 $263.92 $139.60

77786 Hdr brachytx 2-12

channel S 0313 9.9687 $697.97 $263.92 $139.60

77787 Hdr brachytx over 12

chan S 0313 9.9687 $697.97 $263.92 $139.60

77789 Apply surface

radiation S 0300 1.4252 $99.79

. $19.96

77790 Radiation

handling N

77799 Radium/radioisotope

therapy S 0312 5.4044 $378.39

. $75.68

78000 Thyroid single

uptake S 0389 1.5569 $109.01 $26.88 $21.81

78001 Thyroid multiple

uptakes S 0389 1.5569 $109.01 $26.88 $21.81

78003 Thyroid

suppress/stimul S 0389 1.5569 $109.01 $26.88 $21.81

78006 Thyroid imaging with

uptake S 0391 3.1610 $221.32 $65.46 $44.27

78007 Thyroid image mult

uptakes S 0391 3.1610 $221.32 $65.46 $44.27

78010 Thyroid

imaging S 0390 1.8944 $132.64 $47.64 $26.53

78011 Thyroid imaging withflow S 0390 1.8944 $132.64 $47.64 $26.53

78015 Thyroid met

imaging S 0406 4.0053 $280.44 $85.08 $56.09

78016 Thyroid met

imaging/studies S 0406 4.0053 $280.44 $85.08 $56.09

78018 Thyroid met imaging

body S 0406 4.0053 $280.44 $85.08 $56.09

78020 Thyroid met

uptake N

78070 Parathyroid nuclear

imaging S 0391 3.1610 $221.32 $65.46 $44.27

78075 Adrenal nuclear

imaging S 0408 13.6750 $957.47

. $191.50

78099 Endocrine nuclear

procedure S 0390 1.8944 $132.64 $47.64 $26.53

78102 Bone marrow imaging

ltd S 0400 3.6580 $256.12 $90.92 $51.23

78103 Bone marrow imaging

mult S 0400 3.6580 $256.12 $90.92 $51.23

78104 Bone marrow imaging

body S 0400 3.6580 $256.12 $90.92 $51.23

78110 Plasma volume

single S 0393 6.9196 $484.48

. $96.90

78111 Plasma volume

multiple S 0393 6.9196 $484.48

. $96.90

78120 Red cell mass

single S 0393 6.9196 $484.48

. $96.90

78121 Red cell mass

multiple S 0393 6.9196 $484.48

. $96.90

78122 Blood

volume S 0393 6.9196 $484.48

. $96.90

78130 Red cell survival

study S 0393 6.9196 $484.48

. $96.9078135 Red cell survival

kinetics S 0393 6.9196 $484.48

. $96.90

78140 Red cell

sequestration S 0393 6.9196 $484.48

. $96.90

78185 Spleen

imaging S 0400 3.6580 $256.12 $90.92 $51.23

78190 Platelet survival

kinetics S 0392 2.2892 $160.28 $39.07 $32.06

78191 Platelet

survival S 0392 2.2892 $160.28 $39.07 $32.06

78195 Lymph system

imaging S 0400 3.6580 $256.12 $90.92 $51.23

78199 Blood/lymph nuclear

exam S 0400 3.6580 $256.12 $90.92 $51.23

78201 Liver

imaging S 0394 4.1909 $293.43 $90.78 $58.69

78202 Liver imaging with

flow S 0394 4.1909 $293.43 $90.78 $58.69

78205 Liver imaging

(3D) S 0394 4.1909 $293.43 $90.78 $58.69

78206 Liver image (3d) with

flow S 0394 4.1909 $293.43 $90.78 $58.69

78215 Liver and spleen

imaging S 0394 4.1909 $293.43 $90.78 $58.69

78216 Liver & spleen

image/flow S 0394 4.1909 $293.43 $90.78 $58.69

78220 Liver function

study CH D

78223 Hepatobiliary

imaging CH D

78226 Hepatobiliary system

imaging NI S 0394 4.1909 $293.43 $90.78 $58.69

78227 Hepatobil syst image

w/drug NI S 0394 4.1909 $293.43 $90.78 $58.6978230 Salivary gland

imaging S 0395 3.4841 $243.94 $87.01 $48.79

78231 Serial salivary

imaging S 0395 3.4841 $243.94 $87.01 $48.79

78232 Salivary gland function

exam S 0395 3.4841 $243.94 $87.01 $48.79

78258 Esophageal motility

study S 0395 3.4841 $243.94 $87.01 $48.79

78261 Gastric mucosa

imaging S 0395 3.4841 $243.94 $87.01 $48.79

78262 Gastroesophageal reflux

exam S 0395 3.4841 $243.94 $87.01 $48.79

78264 Gastric emptying

study S 0395 3.4841 $243.94 $87.01 $48.79

78267 Breath tst attain/anal

c-14 A

78268 Breath test analysis

c-14 A

78270 Vit B-12 absorption

exam S 0392 2.2892 $160.28 $39.07 $32.06

78271 Vit b-12 absrp exam int

fac S 0392 2.2892 $160.28 $39.07 $32.06

78272 Vit b-12 absorp

combined S 0392 2.2892 $160.28 $39.07 $32.06

78278 Acute GI blood loss

imaging S 0395 3.4841 $243.94 $87.01 $48.79

78282 GI protein loss

exam S 0395 3.4841 $243.94 $87.01 $48.79

78290 Meckels divert

exam S 0395 3.4841 $243.94 $87.01 $48.79

78291 Leveen/shunt patency

exam S 0395 3.4841 $243.94 $87.01 $48.79

78299 GI nuclear

procedure S 0395 3.4841 $243.94 $87.01 $48.7978300 Bone imaging limited

area S 0396 3.5304 $247.18 $94.20 $49.44

78305 Bone imaging multiple

areas S 0396 3.5304 $247.18 $94.20 $49.44

78306 Bone imaging whole

body S 0396 3.5304 $247.18 $94.20 $49.44

78315 Bone imaging 3

phase S 0396 3.5304 $247.18 $94.20 $49.44

78320 Bone imaging

(3D) S 0396 3.5304 $247.18 $94.20 $49.44

78350 Bone mineral single

photon E

78351 Bone mineral dual

photon E

78399 Musculoskeletal nuclear

exam S 0396 3.5304 $247.18 $94.20 $49.44

78414 Non-imaging heart

function S 0398 4.2548 $297.90 $93.33 $59.58

78428 Cardiac shunt

imaging S 0398 4.2548 $297.90 $93.33 $59.58

78445 Vascular flow

imaging S 0397 2.0980 $146.89 $33.94 $29.38

78451 Ht muscle image spect

sing S 0377 9.6018 $672.28

. $134.46

78452 Ht muscle image spect

mult S 0377 9.6018 $672.28

. $134.46

78453 Ht muscle image planar

sing S 0377 9.6018 $672.28

. $134.46

78454 Ht musc image planar

mult S 0377 9.6018 $672.28

. $134.46

78456 Acute venous thrombus

image S 0397 2.0980 $146.89 $33.94 $29.38

78457 Venous thrombosis

imaging S 0397 2.0980 $146.89 $33.94 $29.3878458 Ven thrombosis images

bilat S 0397 2.0980 $146.89 $33.94 $29.38

78459 Heart muscle imaging

(PET) CH S 0308 14.8260 "$1,038.06"

. $207.62

78466 Heart infarct

image S 0398 4.2548 $297.90 $93.33 $59.58

78468 Heart infarct image

(ef) S 0398 4.2548 $297.90 $93.33 $59.58

78469 Heart infarct image

(3D) S 0398 4.2548 $297.90 $93.33 $59.58

78472 Gated heart planar

single S 0398 4.2548 $297.90 $93.33 $59.58

78473 Gated heart

multiple S 0398 4.2548 $297.90 $93.33 $59.58

78481 Heart first pass

single S 0398 4.2548 $297.90 $93.33 $59.58

78483 Heart first pass

multiple S 0398 4.2548 $297.90 $93.33 $59.58

78491 Heart image (pet)

single CH S 0308 14.8260 "$1,038.06"

. $207.62

78492 Heart image (pet)

multiple CH S 0308 14.8260 "$1,038.06"

. $207.62

78494 Heart image

spect S 0398 4.2548 $297.90 $93.33 $59.58

78496 Heart first pass

add-on N

78499 Cardiovascular nuclear

exam S 0398 4.2548 $297.90 $93.33 $59.58

78579 Lung ventilation

imaging NI S 0401 2.8915 $202.45 $71.16 $40.49

78580 Lung perfusion

imaging S 0401 2.8915 $202.45 $71.16 $40.49

78582 Lung ventilat&perfus

imaging NI S 0378 4.5192 $316.42 $126.56 $63.2978584 Lung V/Q image single

breath CH D

78585 Lung V/Q

imaging CH D

78586 Aerosol lung image

single CH D

78587 Aerosol lung image

multiple CH D

78588 Perfusion lung

image CH D

78591 Vent image 1 breath 1

proj CH D

78593 Vent image 1 proj

gas CH D

78594 Vent image mult proj

gas CH D

78596 Lung differential

function CH D

78597 Lung perfusion

differential NI S 0401 2.8915 $202.45 $71.16 $40.49

78598 Lung perf&ventilat

diferentl NI S 0378 4.5192 $316.42 $126.56 $63.29

78599 Respiratory nuclear

exam S 0401 2.8915 $202.45 $71.16 $40.49

78600 Brain image < 4

views S 0403 3.4408 $240.91 $72.42 $48.19

78601 Brain image w/flow < 4

views S 0402 8.6793 $607.69

. $121.54

78605 Brain image 4+

views S 0403 3.4408 $240.91 $72.42 $48.19

78606 Brain image w/flow 4 +

views S 0402 8.6793 $607.69

. $121.54

78607 Brain imaging

(3D) S 0402 8.6793 $607.69

. $121.54

78608 Brain imaging

(PET) S 0308 14.8260 "$1,038.06"

. $207.62

78609 Brain imaging

(PET) E78610 Brain flow imaging

only S 0403 3.4408 $240.91 $72.42 $48.19

78630 Cerebrospinal fluid

scan S 0402 8.6793 $607.69

. $121.54

78635 CSF

ventriculography S 0402 8.6793 $607.69

. $121.54

78645 CSF shunt

evaluation S 0403 3.4408 $240.91 $72.42 $48.19

78647 Cerebrospinal fluid

scan S 0402 8.6793 $607.69

. $121.54

78650 CSF leakage

imaging S 0402 8.6793 $607.69

. $121.54

78660 Nuclear exam of tear

flow S 0403 3.4408 $240.91 $72.42 $48.19

78699 Nervous system nuclear

exam S 0403 3.4408 $240.91 $72.42 $48.19

78700 Kidney imaging

morphol S 0404 4.5536 $318.82 $81.52 $63.77

78701 Kidney imaging with

flow S 0404 4.5536 $318.82 $81.52 $63.77

78707 K flow/funct image w/o

drug S 0404 4.5536 $318.82 $81.52 $63.77

78708 K flow/funct image

w/drug S 0404 4.5536 $318.82 $81.52 $63.77

78709 K flow/funct image

multiple S 0404 4.5536 $318.82 $81.52 $63.77

78710 Kidney imaging

(3D) S 0404 4.5536 $318.82 $81.52 $63.77

78725 Kidney function

study S 0392 2.2892 $160.28 $39.07 $32.06

78730 Urinary bladder

retention S 0389 1.5569 $109.01 $26.88 $21.81

78740 Ureteral refluxstudy S 0404 4.5536 $318.82 $81.52 $63.77

78761 Testicular imaging

w/flow S 0404 4.5536 $318.82 $81.52 $63.77

78799 Genitourinary nuclear

exam S 0404 4.5536 $318.82 $81.52 $63.77

78800 Tumor imaging limited

area S 0406 4.0053 $280.44 $85.08 $56.09

78801 Tumor imaging mult

areas S 0414 7.0664 $494.76

. $98.96

78802 Tumor imaging whole

body S 0414 7.0664 $494.76

. $98.96

78803 Tumor imaging

(3D) S 0414 7.0664 $494.76

. $98.96

78804 Tumor imaging whole

body S 0408 13.6750 $957.47

. $191.50

78805 Abscess imaging ltd

area S 0414 7.0664 $494.76

. $98.96

78806 Abscess imaging whole

body S 0414 7.0664 $494.76

. $98.96

78807 Nuclear

localization/abscess S 0414 7.0664 $494.76

. $98.96

78808 Iv inj ra drug dx

study Q1 0392 2.2892 $160.28 $39.07 $32.06

78811 Pet image ltd

area S 0308 14.8260 "$1,038.06"

. $207.62

78812 Pet image

skull-thigh S 0308 14.8260 "$1,038.06"

. $207.62

78813 Pet image full

body S 0308 14.8260 "$1,038.06"

. $207.62

78814 Pet image w/ct

lmtd S 0308 14.8260 "$1,038.06"

. $207.62

78815 Pet image w/ct

skull-thigh S 0308 14.8260 "$1,038.06"

. $207.6278816 Pet image w/ct full

body S 0308 14.8260 "$1,038.06"

. $207.62

78999 Nuclear diagnostic

exam S 0389 1.5569 $109.01 $26.88 $21.81

79005 Nuclear rx oral

admin S 0407 3.2941 $230.64 $78.13 $46.13

79101 Nuclear rx iv

admin S 0407 3.2941 $230.64 $78.13 $46.13

79200 Nuclear rx intracav

admin S 0413 4.0373 $282.68

. $56.54

79300 Nuclr rx interstit

colloid S 0407 3.2941 $230.64 $78.13 $46.13

79403 Hematopoietic nuclear

tx S 0413 4.0373 $282.68

. $56.54

79440 Nuclear rx

intra-articular S 0413 4.0373 $282.68

. $56.54

79445 Nuclear rx

intra-arterial S 0407 3.2941 $230.64 $78.13 $46.13

79999 Nuclear medicine

therapy S 0407 3.2941 $230.64 $78.13 $46.13

80047 Metabolic panel ionized

ca A

80048 Metabolic panel total

ca 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 hepatitispanel A

80076 Hepatic function

panel A

80100 Drug screen

qualitate/multi E

80101 Drug screen

single E

80102 Drug

confirmation A

80103 Drug analysis tissue

prep N

80104 Drug scrn 1+ class

nonchromo E

80150 Assay of

amikacin A

80152 Assay of

amitriptyline A

80154 Assay of

benzodiazepines A

80156 Assay carbamazepine

total A

80157 Assay carbamazepine

free A

80158 Assay of

cyclosporine A

80160 Assay of

desipramine A

80162 Assay of

digoxin A

80164 Assay dipropylacetic

acid A

80166 Assay of

doxepin A

80168 Assay of

ethosuximide A

80170 Assay of

gentamicin A

80172 Assay of

gold A80173 Assay of

haloperidol A

80174 Assay of

imipramine A

80176 Assay of

lidocaine A

80178 Assay of

lithium A

80182 Assay of

nortriptyline A

80184 Assay of

phenobarbital A

80185 Assay of phenytoin

total A

80186 Assay of phenytoin

free A

80188 Assay of

primidone A

80190 Assay of

procainamide A

80192 Assay of

procainamide A

80194 Assay of

quinidine A

80195 Assay of

sirolimus A

80196 Assay of

salicylate A

80197 Assay of

tacrolimus A

80198 Assay of

theophylline A

80200 Assay of

tobramycin A

80201 Assay of

topiramate A

80202 Assay of

vancomycin A

80299 Quantitative assay

drug A80400 Acth stimulation

panel A

80402 Acth stimulation

panel A

80406 Acth stimulation

panel A

80408 Aldosterone suppression

eval A

80410 Calcitonin stimul

panel A

80412 CRH stimulation

panel A

80414 Testosterone

response A

80415 Estradiol response

panel A

80416 Renin stimulation

panel A

80417 Renin stimulation

panel A

80418 Pituitary evaluation

panel A

80420 Dexamethasone

panel A

80422 Glucagon tolerance

panel A

80424 Glucagon tolerance

panel A

80426 Gonadotropin hormone

panel A

80428 Growth hormone

panel A

80430 Growth hormone

panel A

80432 Insulin suppression

panel A

80434 Insulin tolerance

panel A

80435 Insulin tolerance

panel A

80436 Metyrapone

panel A

80438 TRH stimulation

panel A80439 TRH stimulation

panel A

80440 TRH stimulation

panel A

80500 Lab pathology

consultation CH X 0342 0.1601 $11.21

. $2.25

80502 Lab pathology

consultation X 0342 0.1601 $11.21

. $2.25

81000 Urinalysis nonauto

w/scope A

81001 Urinalysis auto

w/scope A

81002 Urinalysis nonauto w/o

scope A

81003 Urinalysis auto w/o

scope A

81005 Urinalysis A

81007 Urine screen for

bacteria A

81015 Microscopic exam of

urine A

81020 Urinalysis glass

test A

81025 Urine pregnancy

test A

81050 Urinalysis volume

measure A

81099 Urinalysis test

procedure A

81200 Aspa

gene NI B

81205 Bckdhb

gene NI B

81206 Bcr/abl1 gene major

bp NI B

81207 Bcr/abl1 gene minor

bp NI B

81208 Bcr/abl1 gene other

bp NI B

81209 Blm

gene NI B

81210 Brafgene NI B

81211 Brca1&2 seq & com

dup/del NI B

81212 Brca1&2 185&5385&6174

var NI B

81213 Brca1&2 uncom dup/del

var NI B

81214 Brca1 full seq & com

dup/del NI B

81215 Brca1 gene known fam

variant NI B

81216 Brca2 gene full

sequence NI B

81217 Brca2 gene known fam

variant NI B

81220 Cftr gene com

variants NI B

81221 Cftr gene known fam

variants NI B

81222 Cftr gene dup/delet

variants NI B

81223 Cftr gene full

sequence NI B

81224 Cftr gene intron poly

t NI B

81225 Cyp2c19 gene com

variants NI B

81226 Cyp2d6 gene com

variants NI B

81227 Cyp2c9 gene com

variants NI B

81228 Cytogen micrarray copy

nmbr NI B

81229 Cytogen m array copy

no&snp NI B

81240 F2

gene NI B

81241 F5

gene NI B

81242 Fancc

gene NI B

81243 Fmr1 gene

detection NI B81244 Fmr1 gene

characterization NI B

81245 Flt3

gene NI B

81250 G6pc

gene NI B

81251 Gba

gene NI B

81255 Hexa

gene NI B

81256 Hfe

gene NI B

81257 Hba1/hba2

gene NI B

81260 Ikbkap

gene NI B

81261 Igh gene rearrange amp

meth NI B

81262 Igh gene rearrang dir

probe NI B

81263 Igh vari regional

mutation NI B

81264 Igk rearrangeabn clonal

pop NI B

81265 Str markers specimen

anal NI B

81266 Str markers spec anal

addl NI B

81267 Chimerism anal no cell

selec NI B

81268 Chimerism anal w/cell

select NI B

81270 Jak2

gene NI B

81275 Kras

gene NI B

81280 Long qt synd gene full

seq NI B

81281 Long qt synd known fam

var NI B

81282 Long qt syn gene dup/dlt

var NI B

81290 Mcoln1

gene NI B81291 Mthfr

gene NI B

81292 Mlh1 gene full

seq NI B

81293 Mlh1 gene known

variants NI B

81294 Mlh1 gene dup/delete

variant NI B

81295 Msh2 gene full

seq NI B

81296 Msh2 gene known

variants NI B

81297 Msh2 gene dup/delete

variant NI B

81298 Msh6 gene full

seq NI B

81299 Msh6 gene known

variants NI B

81300 Msh6 gene dup/delete

variant NI B

81301 Microsatellite

instability NI B

81302 Mecp2 gene full

seq NI B

81303 Mecp2 gene known

variant NI B

81304 Mecp2 gene dup/delet

variant NI B

81310 Npm1

gene NI B

81315 Pml/raralpha com

breakpoints NI B

81316 Pml/raralpha 1

breakpoint NI B

81317 Pms2 gene full seq

analysis NI B

81318 Pms2 known familial

variants NI B

81319 Pms2 gene dup/delet

variants NI B

81330 Smpd1 gene common

variants NI B81331 Snrpn/ube3a

gene NI B

81332 Serpina1

gene NI B

81340 Trb@ gene rearrange

amplify NI B

81341 Trb@ gene rearrange

dirprobe NI B

81342 Trg gene rearrangement

anal NI B

81350 Ugt1a1

gene NI B

81355 Vkorc1

gene NI B

81370 Hla i & ii typing

lr NI B

81371 Hla i & ii type verify

lr NI B

81372 Hla i typing complete

lr NI B

81373 Hla i typing 1 locus

lr NI B

81374 Hla i typing 1 antigen

lr NI B

81375 Hla ii typing ag equiv

lr NI B

81376 Hla ii typing 1 locus

lr NI B

81377 Hla ii type 1 ag equiv

lr NI B

81378 Hla i & ii typing

hr NI B

81379 Hla i typing complete

hr NI B

81380 Hla i typing 1 locus

hr NI B

81381 Hla i typing 1 allele

hr NI B

81382 Hla ii typing 1 loc

hr NI B

81383 Hla ii typing 1 allele

hr NI B

81400 Mopath procedure level

1 NI B81401 Mopath procedure level

2 NI B

81402 Mopath procedure level

3 NI B

81403 Mopath procedure level

4 NI B

81404 Mopath procedure level

5 NI B

81405 Mopath procedure level

6 NI B

81406 Mopath procedure level

7 NI B

81407 Mopath procedure level

8 NI B

81408 Mopath procedure level

9 NI B

82000 Assay of blood

acetaldehyde A

82003 Assay of

acetaminophen A

82009 Test for

acetone/ketones A

82010 Acetone

assay A

82013 Acetylcholinesterase

assay A

82016 Acylcarnitines

qual A

82017 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 Microalbuminsemiquant A

82045 Albumin ischemia

modified A

82055 Assay of

ethanol A

82075 Assay of breath

ethanol A

82085 Assay of

aldolase A

82088 Assay of

aldosterone A

82101 Assay of urine

alkaloids A

82103 Alpha-1-antitrypsin

total A

82104 Alpha-1-antitrypsin

pheno A

82105 Alpha-fetoprotein

serum A

82106 Alpha-fetoprotein

amniotic A

82107 Alpha-fetoprotein

l3 A

82108 Assay of

aluminum A

82120 Amines vaginal fluid

qual A

82127 Amino acid single

qual A

82128 Amino acids mult

qual A

82131 Amino acids single

quant A

82135 Assay aminolevulinic

acid A

82136 Amino acids quant

2-5 A

82139 Amino acids quan 6 or

more A

82140 Assay of

ammonia A

82143 Amniotic fluid

scan A82145 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 bloodfeces A

82271 Occult blood other

sources A

82272 Occult bld feces 1-3

tests A

82274 Assay test for blood

fecal A

82286 Assay of

bradykinin A

82300 Assay of

cadmium A

82306 Vitamin d 25

hydroxy A

82308 Assay of

calcitonin A

82310 Assay of

calcium A

82330 Assay of

calcium A

82331 Calcium infusion

test A

82340 Assay of calcium in

urine A

82355 Calculus analysis

qual A

82360 Calculus assay

quant A

82365 Calculus

spectroscopy A

82370 X-ray assay

calculus A

82373 Assay c-d transfer

measure A

82374 Assay blood carbon

dioxide A

82375 Assay carboxyhb

quant A

82376 Assay carboxyhb

qual A

82378 Carcinoembryonic

antigen A

82379 Assay of

carnitine A82380 Assay of

carotene A

82382 Assay urine

catecholamines A

82383 Assay blood

catecholamines A

82384 Assay three

catecholamines A

82387 Assay of

cathepsin-d A

82390 Assay of

ceruloplasmin A

82397 Chemiluminescent

assay A

82415 Assay of

chloramphenicol A

82435 Assay of blood

chloride A

82436 Assay of urine

chloride A

82438 Assay other fluid

chlorides A

82441 Test for

chlorohydrocarbons A

82465 Assay bld/serum

cholesterol A

82480 Assay serum

cholinesterase A

82482 Assay rbc

cholinesterase A

82485 Assay chondroitin

sulfate A

82486 Gas/liquid

chromatography A

82487 Paper

chromatography A82488 Paper

chromatography A

82489 Thin layer

chromatography A

82491 Chromotography quant

sing A

82492 Chromotography quant

mult A

82495 Assay of

chromium A

82507 Assay of

citrate A

82520 Assay of

cocaine A

82523 Collagen

crosslinks A

82525 Assay of

copper A

82528 Assay of

corticosterone A

82530 Cortisol

free A

82533 Total

cortisol A

82540 Assay of

creatine A

82541 Column chromotography

qual A

82542 Column chromotography

quant A

82543 Column

chromotograph/isotope A

82544 Column

chromotograph/isotope A

82550 Assay of ck

(cpk) A

82552 Assay of cpk in

blood A

82553 Creatine mb

fraction A

82554 Creatineisoforms 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

82610 Cystatin

c A

82615 Test for urine

cystines A

82626 Dehydroepiandrosterone A

82627 Dehydroepiandrosterone A

82633 Desoxycorticosterone A

82634 Deoxycortisol A

82638 Assay of dibucaine

number A

82646 Assay of

dihydrocodeinone A

82649 Assay of

dihydromorphinone A

82651 Assay of

dihydrotestosterone A

82652 Vit d 1

25-dihydroxy A

82654 Assay ofdimethadione 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 A82731 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

transferase A

82776 Galactose transferase

test A

82784 Assay iga/igd/igg/igm

each A

82785 Assay of

ige A

82787 Igg 1 2 3 or 4

each A

82800 Blood

pH A

82803 Blood gases any

combination A

82805 Blood gases w/o2

saturation A

82810 Blood gases o2 sat

only A

82820 Hemoglobin-oxygen

affinity A

82930 Gastric analy w/ph ea

spec A

82938 Gastrin

test A

82941 Assay ofgastrin A

82943 Assay of

glucagon A

82945 Glucose other

fluid A

82946 Glucagon tolerance

test A

82947 Assay glucose blood

quant A

82948 Reagent strip/blood

glucose A

82950 Glucose

test A

82951 Glucose tolerance test

(GTT) A

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 A83001 Gonadotropin

(FSH) A

83002 Gonadotropin

(LH) A

83003 Assay growth hormone

(hgh) A

83008 Assay of

guanosine A

83009 H pylori (c-13)

blood A

83010 Assay of haptoglobin

quant A

83012 Assay of

haptoglobins A

83013 H pylori (c-13)

breath A

83014 H pylori drug

admin A

83015 Heavy metal

screen A

83018 Quantitative screen

metals A

83020 Hemoglobin

electrophoresis A

83021 Hemoglobin

chromotography A

83026 Hemoglobin copper

sulfate A

83030 Fetal hemoglobin

chemical A

83033 Fetal hemoglobin assay

qual A

83036 Glycosylated hemoglobin

test A

83037 Glycosylated hb home

device A

83045 Blood methemoglobin

test A

83050 Blood methemoglobin

assay A

83051 Assay of plasma

hemoglobin A83055 Blood sulfhemoglobin

test A

83060 Blood sulfhemoglobin

assay A

83065 Assay of hemoglobin

heat A

83068 Hemoglobin stability

screen A

83069 Assay of urine

hemoglobin A

83070 Assay of hemosiderin

qual A

83071 Assay of hemosiderin

quant A

83080 Assay of b

hexosaminidase A

83088 Assay of

histamine A

83090 Assay of

homocystine 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

hydroxyproline A

83516 Immunoassay

nonantibody A

83518 Immunoassay

dipstick A

83519 Rianonantibody A

83520 Immunoassay quant nos

nonab A

83525 Assay of

insulin A

83527 Assay of

insulin A

83528 Assay of intrinsic

factor A

83540 Assay of

iron A

83550 Iron binding

test A

83570 Assay of idh

enzyme A

83582 Assay of ketogenic

steroids A

83586 Assay 17-

ketosteroids A

83593 Fractionation

ketosteroids A

83605 Assay of lactic

acid A

83615 Lactate (LD) (LDH)

enzyme 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

83634 Assay of urine for

lactose A

83655 Assay of

lead A

83661 L/s ratio fetal

lung A

83662 Foam stability fetallung A

83663 Fluoro polarize fetal

lung A

83664 Lamellar bdy fetal

lung A

83670 Assay of lap

enzyme A

83690 Assay of

lipase A

83695 Assay of

lipoprotein(a) A

83698 Assay lipoprotein

pla2 A

83700 Lipopro bld

electrophoretic A

83701 Lipoprotein bld hr

fraction A

83704 Lipoprotein bld by

nmr A

83718 Assay of

lipoprotein A

83719 Assay of blood

lipoprotein A

83721 Assay of blood

lipoprotein A

83727 Assay of lrh

hormone 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 ofmercury A

83835 Assay of

metanephrines A

83840 Assay of

methadone A

83857 Assay of

methemalbumin A

83858 Assay of

methsuximide A

83861 Microfluid analy

tears A

83864 Mucopolysaccharides A

83866 Mucopolysaccharides

screen A

83872 Assay synovial fluid

mucin A

83873 Assay of csf

protein A

83874 Assay of

myoglobin A

83876 Assay

myeloperoxidase A

83880 Natriuretic

peptide A

83883 Assay nephelometry not

spec A

83885 Assay of

nickel A

83887 Assay of

nicotine A

83890 Molecule

isolate A

83891 Molecule isolate

nucleic A

83892 Molecular

diagnostics A

83893 Molecule

dot/slot/blot A

83894 Molecule gelelectrophor A

83896 Molecular

diagnostics A

83897 Molecule nucleic

transfer A

83898 Molecule nucleic ampli

each A

83900 Molecule nucleic ampli 2

seq A

83901 Molecule nucleic ampli

addon A

83902 Molecular

diagnostics A

83903 Molecule mutation

scan A

83904 Molecule mutation

identify A

83905 Molecule mutation

identify A

83906 Molecule mutation

identify A

83907 Lyse cells for nucleic

ext A

83908 Nucleic acid signal

ampli A

83909 Nucleic acid high

resolute A

83912 Genetic

examination A

83913 Molecular rna

stabilization A

83914 Mutation ident

ola/sbce/aspe A

83915 Assay of

nucleotidase A

83916 Oligoclonal

bands A

83918 Organic acids total

quant A83919 Organic acids qual

each A

83921 Organic acid single

quant A

83925 Assay of

opiates A

83930 Assay of blood

osmolality A

83935 Assay of urine

osmolality A

83937 Assay of

osteocalcin A

83945 Assay of

oxalate A

83950 Oncoprotein

her-2/neu A

83951 Oncoprotein

dcp A

83970 Assay of

parathormone A

83986 Assay ph body fluid

nos A

83987 Exhaled breath

condensate A

83992 Assay for

phencyclidine A

83993 Assay for calprotectin

fecal A

84022 Assay of

phenothiazine A

84030 Assay of blood

pku A

84035 Assay of

phenylketones A

84060 Assay acid

phosphatase A

84061 Phosphatase forensic

exam A

84066 Assay prostate

phosphatase A84075 Assay alkaline

phosphatase A

84078 Assay alkaline

phosphatase A

84080 Assay alkaline

phosphatases A

84081 Amniotic fluid enzyme

test A

84085 Assay of rbc pg6d

enzyme A

84087 Assay phosphohexose

enzymes A

84100 Assay of

phosphorus A

84105 Assay of urine

phosphorus A

84106 Test for

porphobilinogen A

84110 Assay of

porphobilinogen A

84112 Placenta alpha micro ig

c/v A

84119 Test urine for

porphyrins A

84120 Assay of urine

porphyrins A

84126 Assay of feces

porphyrins A

84127 Assay of feces

porphyrins A

84132 Assay of serum

potassium A

84133 Assay of urine

potassium A

84134 Assay of

prealbumin A

84135 Assay of

pregnanediol A

84138 Assay of

pregnanetriol A84140 Assay of

pregnenolone A

84143 Assay of

17-hydroxypregneno A

84144 Assay of

progesterone A

84145 Procalcitonin

(pct) A

84146 Assay of

prolactin A

84150 Assay of

prostaglandin A

84152 Assay of psa

complexed A

84153 Assay of psa

total A

84154 Assay of psa

free A

84155 Assay of protein

serum A

84156 Assay of protein

urine A

84157 Assay of protein

other A

84160 Assay of protein any

source A

84163 Pappa

serum A

84165 Protein e-phoresis

serum A

84166 Protein

e-phoresis/urine/csf A

84181 Western blot

test A

84182 Protein western blot

test A

84202 Assay RBC

protoporphyrin A

84203 Test RBCprotoporphyrin 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

receptor A

84244 Assay of

renin A

84252 Assay of vitamin

b-2 A

84255 Assay of

selenium A

84260 Assay of

serotonin A

84270 Assay of sex hormone

globul A

84275 Assay of sialic

acid A

84285 Assay of

silica A

84295 Assay of serum

sodium A

84300 Assay of urine

sodium A

84302 Assay of sweat

sodium A

84305 Assay of

somatomedin A

84307 Assay ofsomatostatin A

84311 Spectrophotometry A

84315 Body fluid specific

gravity A

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

testosterone A

84425 Assay of vitamin

b-1 A

84430 Assay of

thiocyanate A

84431 Thromboxane

urine A

84432 Assay of

thyroglobulin A

84436 Assay of total

thyroxine A

84437 Assay of neonatal

thyroxine A

84439 Assay of free

thyroxine A

84442 Assay of thyroid

activity A

84443 Assay thyroid stim

hormone A

84445 Assay of

tsi A84446 Assay of vitamin

e A

84449 Assay of

transcortin A

84450 Transferase (AST)

(SGOT) A

84460 Alanine amino (ALT)

(SGPT) A

84466 Assay of

transferrin A

84478 Assay of

triglycerides A

84479 Assay of thyroid (t3 or

t4) A

84480 Assay triiodothyronine

(t3) A

84481 Free assay

(FT-3) A

84482 T3

reverse A

84484 Assay of troponin

quant A

84485 Assay duodenal fluid

trypsin A

84488 Test feces for

trypsin A

84490 Assay of feces for

trypsin A

84510 Assay of

tyrosine A

84512 Assay of troponin

qual A

84520 Assay of urea

nitrogen A

84525 Urea nitrogen

semi-quant A

84540 Assay of

urine/urea-n A

84545 Urea-N clearance

test A

84550 Assay of blood/uricacid A

84560 Assay of urine/uric

acid A

84577 Assay of

feces/urobilinogen A

84578 Test urine

urobilinogen A

84580 Assay of urine

urobilinogen A

84583 Assay of urine

urobilinogen A

84585 Assay of urine

vma A

84586 Assay of

vip A

84588 Assay of

vasopressin 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

test A

84703 Chorionic gonadotropin

assay A

84704 Hcg free betachain

test A

84830 Ovulation

tests A

84999 Clinical chemistry

test A85002 Bleeding time

test A

85004 Automated diff wbc

count A

85007 Bl smear w/diff wbc

count A

85008 Bl smear w/o diff wbc

count A

85009 Manual diff wbc count

b-coat A

85013 Spun

microhematocrit A

85014 Hematocrit A

85018 Hemoglobin A

85025 Complete cbc w/auto diff

wbc A

85027 Complete cbc

automated A

85032 Manual cell count

each A

85041 Automated rbc

count A

85044 Manual reticulocyte

count A

85045 Automated reticulocyte

count A

85046 Reticyte/hgb

concentrate A

85048 Automated leukocyte

count A

85049 Automated platelet

count A

85055 Reticulated platelet

assay A

85060 Blood smear

interpretation B

85097 Bone marrow

interpretation X 0343 0.5259 $36.82 $10.84 $7.37

85130 Chromogenic substrateassay A

85170 Blood clot

retraction A

85175 Blood clot lysis

time A

85210 Blood clot factor II

test A

85220 Blood clot factor V

test A

85230 Blood clot factor VII

test A

85240 Blood clot factor VIII

test A

85244 Blood clot factor VIII

test A

85245 Blood clot factor VIII

test A

85246 Blood clot factor VIII

test A

85247 Blood clot factor VIII

test A

85250 Blood clot factor IX

test 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

test A

85291 Blood clot factor XIII

test A

85292 Blood clot factor

assay A

85293 Blood clot factor

assay A

85300 Antithrombin III

test A

85301 Antithrombin III

test A

85302 Blood clot inhibitor

antigen A

85303 Blood clot inhibitortest A

85305 Blood clot inhibitor

assay A

85306 Blood clot inhibitor

test A

85307 Assay activated protein

c A

85335 Factor inhibitor

test A

85337 Thrombomodulin A

85345 Coagulation

time A

85347 Coagulation

time A

85348 Coagulation

time A

85360 Euglobulin

lysis A

85362 Fibrin degradation

products A

85366 Fibrinogen

test 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

blood N

85397 Clotting funct

activity A

85400 Fibrinolytic

plasmin A

85410 Fibrinolyticantiplasmin A

85415 Fibrinolytic

plasminogen A

85420 Fibrinolytic

plasminogen A

85421 Fibrinolytic

plasminogen A

85441 Heinz bodies

direct A

85445 Heinz bodies

induced A

85460 Hemoglobin

fetal A

85461 Hemoglobin

fetal A

85475 Hemolysin A

85520 Heparin

assay A

85525 Heparin

neutralization A

85530 Heparin-protamine

tolerance A

85536 Iron stain peripheral

blood A

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 Phospholipid pltlt

neutraliz A85598 Hexagnal phosph pltlt

neutrl A

85610 Prothrombin

time A

85611 Prothrombin

test A

85612 Viper venom prothrombin

time A

85613 Russell viper venom

diluted A

85635 Reptilase

test A

85651 Rbc sed rate

nonautomated A

85652 Rbc sed rate

automated A

85660 RBC sickle cell

test A

85670 Thrombin time

plasma A

85675 Thrombin time

titer A

85705 Thromboplastin

inhibition A

85730 Thromboplastin time

partial A

85732 Thromboplastin time

partial A

85810 Blood viscosity

examination A

85999 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

identification A86022 Platelet

antibodies A

86023 Immunoglobulin

assay A

86038 Antinuclear

antibodies A

86039 Antinuclear antibodies

(ANA) A

86060 Antistreptolysin o

titer A

86063 Antistreptolysin o

screen A

86077 Physician blood bank

service CH X 0342 0.1601 $11.21

. $2.25

86078 Physician blood bank

service X 0343 0.5259 $36.82 $10.84 $7.37

86079 Physician blood bank

service CH X 0342 0.1601 $11.21

. $2.25

86140 C-reactive

protein A

86141 C-reactive protein

hs A

86146 Glycoprotein

antibody A

86147 Cardiolipin

antibody A

86148 Phospholipid

antibody A

86155 Chemotaxis

assay A

86156 Cold agglutinin

screen A

86157 Cold agglutinin

titer A

86160 Complement

antigen A

86161 Complement/function

activity A

86162 Complement total

(ch50) A

86171 Complement fixation

each A86185 Counterimmunoelectrophoresis A

86200 Ccp

antibody A

86215 Deoxyribonuclease

antibody A

86225 DNA

antibody A

86226 Dna antibody single

strand A

86235 Nuclear antigen

antibody A

86243 Fc

receptor A

86255 Fluorescent antibody

screen A

86256 Fluorescent antibody

titer A

86277 Growth hormone

antibody A

86280 Hemagglutination

inhibition A

86294 Immunoassay tumor

qual A

86300 Immunoassay tumor ca

15-3 A

86301 Immunoassay tumor ca

19-9 A

86304 Immunoassay tumor ca

125 A

86305 Human epididymis protein

4 A

86308 Heterophile

antibodies A

86309 Heterophile

antibodies A

86310 Heterophile

antibodies A

86316 Immunoassay tumor

other A

86317 Immunoassay infectious

agent A

86318 Immunoassay infectious

agent A86320 Serum

immunoelectrophoresis A

86325 Other

immunoelectrophoresis A

86327 Immunoelectrophoresis

assay A

86329 Immunodiffusion A

86331 Immunodiffusion

ouchterlony A

86332 Immune complex

assay A

86334 Immunofix e-phoresis

serum A

86335 Immunfix

e-phorsis/urine/csf A

86336 Inhibin

A A

86337 Insulin

antibodies A

86340 Intrinsic factor

antibody A

86341 Islet cell

antibody A

86343 Leukocyte histamine

release A

86344 Leukocyte

phagocytosis A

86352 Cell function assay

w/stim A

86353 Lymphocyte

transformation A

86355 B cells total

count A

86356 Mononuclear cell

antigen A

86357 Nk cells total

count A

86359 T cells total

count A86360 T cell absolute

count/ratio A

86361 T cell absolute

count A

86367 Stem cells total

count A

86376 Microsomal

antibody A

86378 Migration inhibitory

factor A

86382 Neutralization test

viral A

86384 Nitroblue tetrazolium

dye A

86386 Nuclear matrix protein

22 NI A

86403 Particle agglutination

test A

86406 Particle agglutination

test A

86430 Rheumatoid factor

test A

86431 Rheumatoid factor

quant A

86480 Tb test cell immun

measure A

86481 Tb ag response t-cell

susp A

86485 Skin test

candida X 0341 0.0806 $5.64 $2.09 $1.13

86486 Skin test nos

antigen X 0341 0.0806 $5.64 $2.09 $1.13

86490 Coccidioidomycosis skin

test X 0341 0.0806 $5.64 $2.09 $1.13

86510 Histoplasmosis skin

test X 0341 0.0806 $5.64 $2.09 $1.13

86580 TB intradermal

test X 0341 0.0806 $5.64 $2.09 $1.13

86590 Streptokinase

antibody A86592 Syphilis test non-trep

qual A

86593 Syphilis test non-trep

quant A

86602 Antinomyces

antibody A

86603 Adenovirus

antibody A

86606 Aspergillus

antibody A

86609 Bacterium

antibody A

86611 Bartonella

antibody A

86612 Blastomyces

antibody A

86615 Bordetella

antibody A

86617 Lyme disease

antibody A

86618 Lyme disease

antibody A

86619 Borrelia

antibody A

86622 Brucella

antibody A

86625 Campylobacter

antibody A

86628 Candida

antibody A

86631 Chlamydia

antibody A

86632 Chlamydia igm

antibody A

86635 Coccidioides

antibody A

86638 Q fever

antibody A

86641 Cryptococcus

antibody A

86644 CMV

antibody A

86645 Cmv antibody

igm A86648 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 A86696 Herpes simplex type

2 A

86698 Histoplasma A

86701 HIV-1 A

86702 HIV-2 A

86703 Hiv-1/hiv-2 single

result 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 A86744 Nocardia

antibody A

86747 Parvovirus

antibody A

86750 Malaria

antibody A

86753 Protozoa antibody

nos A

86756 Respiratory virus

antibody A

86757 Rickettsia

antibody A

86759 Rotavirus

antibody A

86762 Rubella

antibody A

86765 Rubeola

antibody A

86768 Salmonella

antibody A

86771 Shigella

antibody A

86774 Tetanus

antibody A

86777 Toxoplasma

antibody A

86778 Toxoplasma antibody

igm A

86780 Treponema

pallidum A

86784 Trichinella

antibody A

86787 Varicella-zoster

antibody A

86788 West nile virus ab

igm A

86789 West nile virus

antibody A

86790 Virus antibody

nos A

86793 Yersinia

antibody A

86800 Thyroglobulin

antibody A86803 Hepatitis c ab

test A

86804 Hep c ab test

confirm A

86805 Lymphocytotoxicity

assay A

86806 Lymphocytotoxicity

assay A

86807 Cytotoxic antibody

screening A

86808 Cytotoxic antibody

screening A

86812 Hla typing a b or

c A

86813 Hla typing a b or

c A

86816 Hla typing

dr/dq A

86817 Hla typing

dr/dq A

86821 Lymphocyte culture

mixed A

86822 Lymphocyte culture

primed A

86825 Hla x-math

non-cytotoxic A

86826 Hla x-match noncytotoxc

addl A

86849 Immunology

procedure A

86850 RBC antibody

screen X 0345 0.2135 $14.95

. $2.99

86860 RBC antibody

elution X 0346 0.3538 $24.77

. $4.96

86870 RBC antibody

identification X 0346 0.3538 $24.77

. $4.96

86880 Coombs test

direct X 0409 0.1101 $7.71 $2.17 $1.55

86885 Coombs test indirect

qual X 0409 0.1101 $7.71 $2.17 $1.5586886 Coombs test indirect

titer X 0409 0.1101 $7.71 $2.17 $1.55

86890 Autologous blood

process X 0347 0.6730 $47.12

. $9.43

86891 Autologous blood op

salvage X 0345 0.2135 $14.95

. $2.99

86900 Blood typing

abo X 0409 0.1101 $7.71 $2.17 $1.55

86901 Blood typing rh

(d) X 0409 0.1101 $7.71 $2.17 $1.55

86902 Blood type antigen donor

ea X 0345 0.2135 $14.95

. $2.99

86904 Blood typing patient

serum X 0345 0.2135 $14.95

. $2.99

86905 Blood typing rbc

antigens X 0345 0.2135 $14.95

. $2.99

86906 Blood typing rh

phenotype X 0345 0.2135 $14.95

. $2.99

86910 Blood typing paternity

test E

86911 Blood typing antigen

system E

86920 Compatibility test

spin X 0345 0.2135 $14.95

. $2.99

86921 Compatibility test

incubate X 0345 0.2135 $14.95

. $2.99

86922 Compatibility test

antiglob X 0346 0.3538 $24.77

. $4.96

86923 Compatibility test

electric X 0345 0.2135 $14.95

. $2.99

86927 Plasma fresh

frozen X 0345 0.2135 $14.95

. $2.99

86930 Frozen blood

prep X 0347 0.6730 $47.12

. $9.4386931 Frozen blood

thaw X 0347 0.6730 $47.12

. $9.43

86932 Frozen blood

freeze/thaw X 0347 0.6730 $47.12

. $9.43

86940 Hemolysins/agglutinins

auto A

86941 Hemolysins/agglutinins A

86945 Blood

product/irradiation X 0345 0.2135 $14.95

. $2.99

86950 Leukacyte

transfusion X 0345 0.2135 $14.95

. $2.99

86960 Vol reduction of

blood/prod X 0345 0.2135 $14.95

. $2.99

86965 Pooling blood

platelets X 0346 0.3538 $24.77

. $4.96

86970 RBC

pretreatment X 0345 0.2135 $14.95

. $2.99

86971 RBC

pretreatment X 0345 0.2135 $14.95

. $2.99

86972 RBC

pretreatment X 0345 0.2135 $14.95

. $2.99

86975 Rbc pretreatment

serum X 0346 0.3538 $24.77

. $4.96

86976 Rbc pretreatment

serum X 0345 0.2135 $14.95

. $2.99

86977 Rbc pretreatment

serum X 0347 0.6730 $47.12

. $9.43

86978 Rbc pretreatment

serum X 0346 0.3538 $24.77

. $4.96

86985 Split blood or

products X 0345 0.2135 $14.95

. $2.99

86999 Transfusion

procedure X 0345 0.2135 $14.95

. $2.9987001 Small animal

inoculation A

87003 Small animal

inoculation A

87015 Specimen

concentration A

87040 Blood culture for

bacteria A

87045 Feces culture

bacteria A

87046 Stool cultr bacteria

each A

87070 Culture bacteria

other A

87071 Culture bacteri aerobic

othr A

87073 Culture bacteria

anaerobic A

87075 Cultr bacteria except

blood A

87076 Culture anaerobe ident

each A

87077 Culture aerobic

identify A

87081 Culture screen

only A

87084 Culture of specimen by

kit A

87086 Urine culture/colony

count A

87088 Urine bacteria

culture A

87101 Skin fungi

culture A

87102 Fungus isolation

culture A

87103 Blood fungus

culture A

87106 Fungi identification

yeast A

87107 Fungi identification

mold A87109 Mycoplasma A

87110 Chlamydia

culture A

87116 Mycobacteria

culture A

87118 Mycobacteric

identification A

87140 Culture type

immunofluoresc A

87143 Culture typing

glc/hplc A

87147 Culture type

immunologic A

87149 Dna/rna direct

probe A

87150 Dna/rna amplified

probe A

87152 Culture type pulse field

gel A

87153 Dna/rna

sequencing A

87158 Culture typing added

method A

87164 Dark field

examination A

87166 Dark field

examination A

87168 Macroscopic exam

arthropod A

87169 Macroscopic exam

parasite A

87172 Pinworm

exam A

87176 Tissue homogenization

cultr A

87177 Ova and parasites

smears A

87181 Microbe susceptible

diffuse A87184 Microbe susceptible

disk A

87185 Microbe susceptible

enzyme A

87186 Microbe susceptible

mic A

87187 Microbe susceptible

mlc A

87188 Microbe suscept

macrobroth A

87190 Microbe suscept

mycobacteri A

87197 Bactericidal level

serum A

87205 Smear gram

stain A

87206 Smear fluorescent/acid

stai A

87207 Smear special

stain A

87209 Smear complex

stain A

87210 Smear wet mount

saline/ink A

87220 Tissue exam for

fungi A

87230 Assay toxin or

antitoxin A

87250 Virus inoculate

eggs/animal A

87252 Virus inoculation

tissue A

87253 Virus inoculate tissue

addl A

87254 Virus inoculation shell

via A

87255 Genet virus isolate

hsv A

87260 Adenovirus ag

if A

87265 Pertussis ag

if A

87267 Enterovirus antibodydfa A

87269 Giardia ag

if A

87270 Chlamydia trachomatis ag

if A

87271 Cytomegalovirus

dfa A

87272 Cryptosporidium ag

if A

87273 Herpes simplex 2 ag

if A

87274 Herpes simplex 1 ag

if A

87275 Influenza b ag

if A

87276 Influenza a ag

if A

87277 Legionella micdadei ag

if A

87278 Legion pneumophilia ag

if A

87279 Parainfluenza ag

if A

87280 Respiratory syncytial ag

if A

87281 Pneumocystis carinii ag

if A

87283 Rubeola ag

if A

87285 Treponema pallidum ag

if A

87290 Varicella zoster ag

if A

87299 Antibody detection nos

if A

87300 Ag detection polyval

if A

87301 Adenovirus ag

eia A

87305 Aspergillus ag

eia A

87320 Chylmd trach ag

eia A

87324 Clostridium ageia A

87327 Cryptococcus neoform ag

eia A

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

eia A

87337 Entamoeb hist group ag

eia A

87338 Hpylori stool

eia A

87339 H pylori ag

eia A

87340 Hepatitis b surface ag

eia A

87341 Hepatitis b surface ag

eia A

87350 Hepatitis be ag

eia A

87380 Hepatitis delta ag

eia A

87385 Histoplasma capsul ag

eia A

87389 Hiv-1 ag w/hiv-1 & hiv-2

ab NI 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 ageia A

87449 Ag detect nos eia

mult A

87450 Ag detect nos eia

single A

87451 Ag detect polyval eia

mult A

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

probe A

87486 Chylmd pneum dna amp

probe A

87487 Chylmd pneum dna

quant A

87490 Chylmd trach dna dir

probe A

87491 Chylmd trach dna amp

probe A

87492 Chylmd trach dna

quant A

87493 C diff amplified

probe A

87495 Cytomeg dna dir

probe A

87496 Cytomeg dna amp

probe A

87497 Cytomeg dnaquant A

87498 Enterovirus dna amp

probe A

87500 Vanomycin dna amp

probe A

87501 Influenza dna amp prob

1+ A

87502 Influenza dna amp

probe A

87503 Influenza dna amp prob

addl A

87510 Gardner vag dna dir

probe A

87511 Gardner vag dna amp

probe A

87512 Gardner vag dna

quant A

87515 Hepatitis b dna dir

probe A

87516 Hepatitis b dna amp

probe A

87517 Hepatitis b dna

quant A

87520 Hepatitis c rna dir

probe A

87521 Hepatitis c rna amp

probe A

87522 Hepatitis c rna

quant A

87525 Hepatitis g dna dir

probe A

87526 Hepatitis g dna amp

probe A

87527 Hepatitis g dna

quant A

87528 Hsv dna dir

probe A

87529 Hsv dna amp

probe A

87530 Hsv dna

quant A

87531 Hhv-6 dna dir

probe A

87532 Hhv-6 dna ampprobe 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

prob A

87541 Legion pneumo dna amp

prob A

87542 Legion pneumo dna

quant A

87550 Mycobacteria dna dir

probe A

87551 Mycobacteria dna amp

probe A

87552 Mycobacteria dna

quant A

87555 M.tuberculo dna dir

probe A

87556 M.tuberculo dna amp

probe A

87557 M.tuberculo dna

quant A

87560 M.avium-intra dna dir

prob A

87561 M.avium-intra dna amp

prob A

87562 M.avium-intra dna

quant A

87580 M.pneumon dna dir

probe A

87581 M.pneumon dna amp

probe A

87582 M.pneumon dnaquant A

87590 N.gonorrhoeae dna dir

prob A

87591 N.gonorrhoeae dna amp

prob A

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

probe A

87797 Detect agent nos dna

dir A

87798 Detect agent nos dna

amp A

87799 Detect agent nos dna

quant A

87800 Detect agnt mult dna

direc A

87801 Detect agnt mult dna

ampli A

87802 Strep b assay

w/optic A

87803 Clostridium toxin a

w/optic A

87804 Influenza assay

w/optic A

87807 Rsv assayw/optic A

87808 Trichomonas assay

w/optic A

87809 Adenovirus assay

w/optic A

87810 Chylmd trach assay

w/optic A

87850 N. gonorrhoeae assay

w/optic A

87880 Strep a assay

w/optic A

87899 Agent nos assay

w/optic A

87900 Phenotype infect agent

drug A

87901 Genotype dna hiv reverse

t A

87902 Genotype dna hepatitis

c A

87903 Phenotype dna hiv

w/culture A

87904 Phenotype dna hiv w/clt

add A

87905 Sialidase enzyme

assay A

87906 Genotype dna hiv reverse

t A

87999 Microbiology

procedure A

88000 Autopsy (necropsy)

gross E

88005 Autopsy (necropsy)

gross E

88007 Autopsy (necropsy)

gross E

88012 Autopsy (necropsy)

gross E

88014 Autopsy (necropsy)

gross E

88016 Autopsy (necropsy)

gross E

88020 Autopsy (necropsy)

complete E

88025 Autopsy (necropsy)complete E

88027 Autopsy (necropsy)

complete E

88028 Autopsy (necropsy)

complete E

88029 Autopsy (necropsy)

complete E

88036 Limited

autopsy E

88037 Limited

autopsy E

88040 Forensic autopsy

(necropsy) E

88045 Coroners autopsy

(necropsy) E

88099 Necropsy (autopsy)

procedure E

88104 Cytopath fl nongyn

smears X 0433 0.2434 $17.04 $5.06 $3.41

88106 Cytopath fl nongyn

filter X 0433 0.2434 $17.04 $5.06 $3.41

88107 Cytopath fl nongyn

sm/fltr CH D

88108 Cytopath concentrate

tech X 0433 0.2434 $17.04 $5.06 $3.41

88112 Cytopath cell enhance

tech X 0343 0.5259 $36.82 $10.84 $7.37

88120 Cytp urne 3-5 probes ea

spec X 0344 0.8180 $57.27 $15.56 $11.46

88121 Cytp urine 3-5 probes

cmptr X 0344 0.8180 $57.27 $15.56 $11.46

88125 Forensic

cytopathology X 0433 0.2434 $17.04 $5.06 $3.41

88130 Sex chromatin

identification A

88140 Sex chromatin

identification A

88141 Cytopath c/vinterpret N

88142 Cytopath c/v thin

layer A

88143 Cytopath c/v thin layer

redo A

88147 Cytopath c/v

automated A

88148 Cytopath c/v auto

rescreen A

88150 Cytopath c/v

manual A

88152 Cytopath c/v auto

redo A

88153 Cytopath c/v

redo A

88154 Cytopath c/v

select A

88155 Cytopath c/v index

add-on A

88160 Cytopath smear other

source X 0433 0.2434 $17.04 $5.06 $3.41

88161 Cytopath smear other

source X 0433 0.2434 $17.04 $5.06 $3.41

88162 Cytopath smear other

source X 0343 0.5259 $36.82 $10.84 $7.37

88164 Cytopath tbs c/v

manual A

88165 Cytopath tbs c/v

redo A

88166 Cytopath tbs c/v auto

redo A

88167 Cytopath tbs c/v

select A

88172 Cytp dx eval fna 1st ea

site X 0433 0.2434 $17.04 $5.06 $3.41

88173 Cytopath eval fna

report X 0343 0.5259 $36.82 $10.84 $7.37

88174 Cytopath c/v auto in

fluid A

88175 Cytopath c/v auto fluid

redo A88177 Cytp fna eval ea

addl X 0342 0.1601 $11.21

. $2.25

88182 Cell marker

study X 0343 0.5259 $36.82 $10.84 $7.37

88184 Flowcytometry/ tc 1

marker X 0433 0.2434 $17.04 $5.06 $3.41

88185 Flowcytometry/tc

add-on X 0433 0.2434 $17.04 $5.06 $3.41

88187 Flowcytometry/read

2-8 X 0342 0.1601 $11.21

. $2.25

88188 Flowcytometry/read

9-15 X 0343 0.5259 $36.82 $10.84 $7.37

88189 Flowcytometry/read 16 &

> X 0343 0.5259 $36.82 $10.84 $7.37

88199 Cytopathology

procedure X 0342 0.1601 $11.21

. $2.25

88230 Tissue culture

lymphocyte A

88233 Tissue culture

skin/biopsy A

88235 Tissue culture

placenta A

88237 Tissue culture bone

marrow A

88239 Tissue culture

tumor A

88240 Cell

cryopreserve/storage A

88241 Frozen cell

preparation A

88245 Chromosome analysis

20-25 A

88248 Chromosome analysis

50-100 A

88249 Chromosome analysis

100 A88261 Chromosome analysis

5 A

88262 Chromosome analysis

15-20 A

88263 Chromosome analysis

45 A

88264 Chromosome analysis

20-25 A

88267 Chromosome analys

placenta A

88269 Chromosome analys

amniotic A

88271 Cytogenetics dna

probe A

88272 Cytogenetics

3-5 A

88273 Cytogenetics

10-30 A

88274 Cytogenetics

25-99 A

88275 Cytogenetics

100-300 A

88280 Chromosome karyotype

study A

88283 Chromosome banding

study A

88285 Chromosome count

additional A

88289 Chromosome study

additional A

88291 Cyto/molecular

report M

88299 Cytogenetic

study X 0342 0.1601 $11.21

. $2.25

88300 Surgical path

gross CH X 0342 0.1601 $11.21

. $2.25

88302 Tissue exam by

pathologist X 0433 0.2434 $17.04 $5.06 $3.41

88304 Tissue exam by

pathologist X 0343 0.5259 $36.82 $10.84 $7.37

88305 Tissue exam by

pathologist X 0343 0.5259 $36.82 $10.84 $7.3788307 Tissue exam by

pathologist X 0344 0.8180 $57.27 $15.56 $11.46

88309 Tissue exam by

pathologist X 0344 0.8180 $57.27 $15.56 $11.46

88311 Decalcify

tissue X 0342 0.1601 $11.21

. $2.25

88312 Special stains group

1 X 0433 0.2434 $17.04 $5.06 $3.41

88313 Special stains group

2 X 0433 0.2434 $17.04 $5.06 $3.41

88314 Histochemical stains

add-on X 0433 0.2434 $17.04 $5.06 $3.41

88318 Chemical

histochemistry CH D

88319 Enzyme

histochemistry CH X 0433 0.2434 $17.04 $5.06 $3.41

88321 Microslide

consultation X 0433 0.2434 $17.04 $5.06 $3.41

88323 Microslide

consultation X 0343 0.5259 $36.82 $10.84 $7.37

88325 Comprehensive review of

data X 0344 0.8180 $57.27 $15.56 $11.46

88329 Path consult

introp X 0433 0.2434 $17.04 $5.06 $3.41

88331 Path consult intraop 1

bloc X 0343 0.5259 $36.82 $10.84 $7.37

88332 Path consult intraop

addl CH X 0342 0.1601 $11.21

. $2.25

88333 Intraop cyto path consult

1 X 0433 0.2434 $17.04 $5.06 $3.41

88334 Intraop cyto path consult

2 X 0433 0.2434 $17.04 $5.06 $3.4188342 Immunohistochemistry X 0343 0.5259 $36.82 $10.84 $7.37

88346 Immunofluorescent

study X 0343 0.5259 $36.82 $10.84 $7.37

88347 Immunofluorescent

study X 0343 0.5259 $36.82 $10.84 $7.37

88348 Electron

microscopy X 0661 2.3496 $164.51

. $32.91

88349 Scanning electron

microscopy X 0661 2.3496 $164.51

. $32.91

88355 Analysis skeletal

muscle X 0343 0.5259 $36.82 $10.84 $7.37

88356 Analysis

nerve X 0344 0.8180 $57.27 $15.56 $11.46

88358 Analysis

tumor X 0343 0.5259 $36.82 $10.84 $7.37

88360 Tumor

immunohistochem/manual X 0343 0.5259 $36.82 $10.84 $7.37

88361 Tumor

immunohistochem/comput X 0344 0.8180 $57.27 $15.56 $11.46

88362 Nerve teasing

preparations X 0344 0.8180 $57.27 $15.56 $11.46

88363 Xm archive tissue molec

anal X 0342 0.1601 $11.21

. $2.25

88365 Insitu hybridization

(fish) X 0344 0.8180 $57.27 $15.56 $11.46

88367 Insitu hybridization

auto X 0343 0.5259 $36.82 $10.84 $7.37

88368 Insitu hybridization

manual X 0344 0.8180 $57.27 $15.56 $11.46

88371 Protein western blot

tissue A

88372 Protein analysis

w/probe A

88380 Microdissectionlaser N

88381 Microdissection

manual N

88384 Eval molecular probes

11-50 X 0433 0.2434 $17.04 $5.06 $3.41

88385 Eval molecul probes

51-250 X 0343 0.5259 $36.82 $10.84 $7.37

88386 Eval molecul probes

251-500 X 0344 0.8180 $57.27 $15.56 $11.46

88387 Tiss exam molecular

study N

88388 Tiss ex molecul study

add-on N

88399 Surgical pathology

procedure X 0342 0.1601 $11.21

. $2.25

88720 Bilirubin total

transcut A

88738 Hgb quant

transcutaneous A

88740 Transcutaneous

carboxyhb A

88741 Transcutaneous

methb A

88749 In vivo lab

service A

89049 Chct for mal

hyperthermia X 0342 0.1601 $11.21

. $2.25

89050 Body fluid cell

count A

89051 Body fluid cell

count A

89055 Leukocyte assessment

fecal A

89060 Exam synovial fluid

crystals A

89125 Specimen fat

stain A

89160 Exam feces for meat

fibers A

89190 Nasal smear foreosinophils A

89220 Sputum specimen

collection X 0433 0.2434 $17.04 $5.06 $3.41

89230 Collect sweat for

test X 0343 0.5259 $36.82 $10.84 $7.37

89240 Pathology lab

procedure X 0342 0.1601 $11.21

. $2.25

89250 Cultr oocyte/embryo <4

days X 0344 0.8180 $57.27 $15.56 $11.46

89251 Cultr oocyte/embryo <4

days X 0344 0.8180 $57.27 $15.56 $11.46

89253 Embryo

hatching X 0344 0.8180 $57.27 $15.56 $11.46

89254 Oocyte

identification X 0344 0.8180 $57.27 $15.56 $11.46

89255 Prepare embryo for

transfer X 0344 0.8180 $57.27 $15.56 $11.46

89257 Sperm

identification X 0343 0.5259 $36.82 $10.84 $7.37

89258 Cryopreservation

embryo(s) X 0344 0.8180 $57.27 $15.56 $11.46

89259 Cryopreservation

sperm CH X 0433 0.2434 $17.04 $5.06 $3.41

89260 Sperm isolation

simple X 0343 0.5259 $36.82 $10.84 $7.37

89261 Sperm isolation

complex X 0343 0.5259 $36.82 $10.84 $7.37

89264 Identify sperm

tissue X 0344 0.8180 $57.27 $15.56 $11.46

89268 Insemination of

oocytes X 0344 0.8180 $57.27 $15.56 $11.46

89272 Extended culture of

oocytes X 0344 0.8180 $57.27 $15.56 $11.4689280 Assist oocyte

fertilization X 0344 0.8180 $57.27 $15.56 $11.46

89281 Assist oocyte

fertilization X 0344 0.8180 $57.27 $15.56 $11.46

89290 Biopsy oocyte polar

body X 0344 0.8180 $57.27 $15.56 $11.46

89291 Biopsy oocyte polar

body X 0344 0.8180 $57.27 $15.56 $11.46

89300 Semen analysis

w/huhner A

89310 Semen analysis

w/count A

89320 Semen anal

vol/count/mot A

89321 Semen anal sperm

detection A

89322 Semen anal strict

criteria A

89325 Sperm antibody

test A

89329 Sperm evaluation

test A

89330 Evaluation cervical

mucus A

89331 Retrograde ejaculation

anal A

89335 Cryopreserve testicular

tiss X 0344 0.8180 $57.27 $15.56 $11.46

89342 Storage/year

embryo(s) X 0344 0.8180 $57.27 $15.56 $11.46

89343 Storage/year

sperm/semen X 0344 0.8180 $57.27 $15.56 $11.46

89344 Storage/year reprod

tissue X 0344 0.8180 $57.27 $15.56 $11.46

89346 Storage/year

oocyte(s) X 0344 0.8180 $57.27 $15.56 $11.46

89352 Thawing cryopresrvedembryo X 0344 0.8180 $57.27 $15.56 $11.46

89353 Thawing cryopresrved

sperm X 0344 0.8180 $57.27 $15.56 $11.46

89354 Thaw cryoprsvrd reprod

tiss X 0344 0.8180 $57.27 $15.56 $11.46

89356 Thawing cryopresrved

oocyte X 0344 0.8180 $57.27 $15.56 $11.46

89398 Unlisted reprod med lab

proc X 0342 0.1601 $11.21

. $2.25

90281 Human ig

im E

90283 Human ig

iv E

90284 Human ig

sc E

90287 Botulinum

antitoxin E

90288 Botulism ig

iv E

90291 Cmv ig

iv E

90296 Diphtheria

antitoxin E

90371 Hep b ig

im K 1630 $113.50

. $22.70

90375 Rabies ig

im/sc K 9133 $185.74

. $37.15

90376 Rabies ig heat

treated K 9134 $177.81

. $35.57

90378 Rsv mab im

50mg K 9003 "$1,158.85"

. $231.77

90384 Rh ig full-dose

im E

90385 Rh ig minidose

im N

90386 Rh ig

iv E

90389 Tetanus igim E

90393 Vaccina ig

im E

90396 Varicella-zoster ig

im K 9135 $94.28

. $18.86

90399 Immune

globulin E

90460 Im admin 1st/only

component B

90461 Im admin each addl

component B

90471 Immunization

admin CH S 0437 0.4972 $34.81

. $6.97

90472 Immunization admin each

add S 0436 0.3545 $24.82

. $4.97

90473 Immune admin

oral/nasal S 0436 0.3545 $24.82

. $4.97

90474 Immune admin oral/nasal

addl S 0436 0.3545 $24.82

. $4.97

90476 Adenovirus vaccine type

4 CH N

90477 Adenovirus vaccine type

7 E

90581 Anthrax vaccine sc or

im E

90585 Bcg vaccine

percut K 9137 $112.23

. $22.45

90586 Bcg vaccine

intravesical B

90632 Hep a vaccine adult

im N

90633 Hep a vacc ped/adol 2

dose N

90634 Hep a vacc ped/adol 3

dose N

90636 Hep a/hep b vacc adult

im N

90644 Meningoccl hib vac 4 dose

im E90645 Hib vaccine hboc

im N

90646 Hib vaccine prp-d

im N

90647 Hib vaccine prp-omp

im N

90648 Hib vaccine prp-t

im N

90649 Hpv vaccine 4 valent

im M

90650 Hpv vaccine 2 valent

im M

90654 Flu vaccine no preserv

id L

90655 Flu vaccine no preserv

6-35m L

90656 Flu vaccine no preserv 3 &

> L

90657 Flu vaccine 3 yrs

im L

90658 Flu vaccine 3 yrs & >

im E

90660 Flu vaccine

nasal L

90661 Flu vacc cell cult prsv

free E

90662 Flu vacc prsv free inc

antig L

90664 Flu vacc pandemic

intranasal E

90665 Lyme disease vaccine

im N

90666 Flu vac pandem prsrv free

im E

90667 Flu vac pandemic adjuvant

im E

90668 Flu vac pandemic splt

im E

90669 Pneumococcal vacc 7 val

im L

90670 Pneumococcal vacc 13 val

im L

90675 Rabies vaccine

im K 9139 $205.48

. $41.1090676 Rabies vaccine

id K 9140 $139.69

. $27.94

90680 Rotovirus vacc 3 dose

oral CH N

90681 Rotavirus vacc 2 dose

oral K 1239 $106.60

. $21.32

90690 Typhoid vaccine

oral N

90691 Typhoid vaccine

im N

90692 Typhoid vaccine h-p

sc/id N

90693 Typhoid vaccine akd

sc B

90696 Dtap-ipv vacc 4-6 yr

im N

90698 Dtap-hib-ip vaccine

im N

90700 Dtap vaccine < 7 yrs

im N

90701 Dtp vaccine

im N

90702 Dt vaccine < 7

im N

90703 Tetanus vaccine

im N

90704 Mumps vaccine

sc N

90705 Measles vaccine

sc N

90706 Rubella vaccine

sc N

90707 Mmr vaccine

sc N

90708 Measles-rubella vaccine

sc N

90710 Mmrv vaccine

sc N

90712 Oral poliovirus

vaccine N

90713 Poliovirus ipv

sc/im N90714 Td vaccine no prsrv >/= 7

im N

90715 Tdap vaccine >7

im N

90716 Chicken pox vaccine

sc M

90717 Yellow fever vaccine

sc N

90718 Td vaccine > 7

im N

90719 Diphtheria vaccine

im N

90720 Dtp/hib vaccine

im N

90721 Dtap/hib vaccine

im N

90723 Dtap-hep b-ipv vaccine

im E

90725 Cholera vaccine

injectable E

90727 Plague vaccine

im E

90732 Pneumococcal

vaccine L

90733 Meningococcal vaccine

sc K 9143 $110.75

. $22.15

90734 Meningococcal vaccine

im K 9145 $92.92

. $18.59

90735 Encephalitis vaccine

sc K 9144 $100.15

. $20.03

90736 Zoster vacc

sc M

90738 Inactivated je vacc

im M

90740 Hepb vacc ill pat 3 dose

im F

90743 Hep b vacc adol 2 dose

im F

90744 Hepb vacc ped/adol 3 dose

im F

90746 Hep b vaccine adult

im F90747 Hepb vacc ill pat 4 dose

im F

90748 Hep b/hib vaccine

im E

90749 Vaccine

toxoid N

90801 Psy dx

interview Q3 0323 1.5910 $111.40

. $22.28

90802 Intac psy dx

interview Q3 0323 1.5910 $111.40

. $22.28

90804 Psytx office 20-30

min Q3 0322 1.1395 $79.78

. $15.96

90805 Psytx off 20-30 min

w/e&m Q3 0322 1.1395 $79.78

. $15.96

90806 Psytx off 45-50

min Q3 0323 1.5910 $111.40

. $22.28

90807 Psytx off 45-50 min

w/e&m Q3 0323 1.5910 $111.40

. $22.28

90808 Psytx office 75-80

min Q3 0323 1.5910 $111.40

. $22.28

90809 Psytx off 75-80

w/e&m Q3 0323 1.5910 $111.40

. $22.28

90810 Intac psytx off 20-30

min Q3 0322 1.1395 $79.78

. $15.96

90811 Intac psytx 20-30

w/e&m Q3 0322 1.1395 $79.78

. $15.96

90812 Intac psytx off 45-50

min Q3 0323 1.5910 $111.40

. $22.28

90813 Intac psytx 45-50 min

w/e&m Q3 0323 1.5910 $111.40

. $22.28

90814 Intac psytx off 75-80

min Q3 0323 1.5910 $111.40

. $22.28

90815 Intac psytx 75-80

w/e&m Q3 0323 1.5910 $111.40

. $22.28

90816 Psytx hosp 20-30min P

90817 Psytx hosp 20-30 min

w/e&m P

90818 Psytx hosp 45-50

min P

90819 Psytx hosp 45-50 min

w/e&m P

90821 Psytx hosp 75-80

min P

90822 Psytx hosp 75-80 min

w/e&m P

90823 Intac psytx hosp 20-30

min P

90824 Intac psytx hsp 20-30

w/e&m P

90826 Intac psytx hosp 45-50

min P

90827 Intac psytx hsp 45-50

w/e&m P

90828 Intac psytx hosp 75-80

min P

90829 Intac psytx hsp 75-80

w/e&m P

90845 Psychoanalysis Q3 0323 1.5910 $111.40

. $22.28

90846 Family psytx w/o

patient Q3 0324 1.8190 $127.36

. $25.48

90847 Family psytx

w/patient Q3 0324 1.8190 $127.36

. $25.48

90849 Multiple family group

psytx Q3 0325 0.8088 $56.63 $11.70 $11.33

90853 Group

psychotherapy Q3 0325 0.8088 $56.63 $11.70 $11.33

90857 Intac group

psytx Q3 0325 0.8088 $56.63 $11.70 $11.33

90862 Medication

management Q3 0605 1.0311 $72.19

. $14.44

90865 Narcosynthesis Q3 0323 1.5910 $111.40

. $22.28

90867 Tcranial magn stim txplan S 0218 1.2025 $84.19

. $16.84

90868 Tcranial magn stim tx

deli S 0218 1.2025 $84.19

. $16.84

90869 Tcran magn stim

redetemine NI S 0218 1.2025 $84.19

. $16.84

90870 Electroconvulsive

therapy S 0320 5.9715 $418.10

. $83.62

90875 Psychophysiological

therapy E

90876 Psychophysiological

therapy E

90880 Hypnotherapy Q3 0323 1.5910 $111.40

. $22.28

90882 Environmental

manipulation E

90885 Psy evaluation of

records N

90887 Consultation with

family N

90889 Preparation of

report N

90899 Psychiatric

service/therapy Q3 0322 1.1395 $79.78

. $15.96

90901 Biofeedback train any

meth A

90911 Biofeedback

peri/uro/rectal T 0126 1.1095 $77.68 $16.21 $15.54

90935 Hemodialysis one

evaluation S 0170 6.2419 $437.03

. $87.41

90937 Hemodialysis repeated

eval B

90940 Hemodialysis access

study N

90945 Dialysis one

evaluation V 0608 2.5237 $176.70

. $35.34

90947 Dialysis repeated

eval B

90951 Esrd serv 4 visits p mo<2 M

90952 Esrd serv 2-3 vsts p mo

<2 M

90953 Esrd serv 1 visit p mo

<2 M

90954 Esrd serv 4 vsts p mo

2-11 M

90955 Esrd srv 2-3 vsts p mo

2-11 M

90956 Esrd srv 1 visit p mo

2-11 M

90957 Esrd srv 4 vsts p mo

12-19 M

90958 Esrd srv 2-3 vsts p mo

12-19 M

90959 Esrd serv 1 vst p mo

12-19 M

90960 Esrd srv 4 visits p mo

20+ M

90961 Esrd srv 2-3 vsts p mo

20+ M

90962 Esrd serv 1 visit p mo

20+ M

90963 Esrd home pt serv p mo

<2 M

90964 Esrd home pt serv p mo

2-11 M

90965 Esrd home pt serv p mo

12-19 M

90966 Esrd home pt serv p mo

20+ M

90967 Esrd home pt serv p day

<2 M

90968 Esrd home pt srv p day

2-11 M

90969 Esrd home pt srv p day

12-19 M

90970 Esrd home pt serv p day

20+ M

90989 Dialysis training

complete B

90993 Dialysis training

incompl B

90997 Hemoperfusion B90999 Dialysis

procedure B

91010 Esophagus motility

study X 0361 4.0827 $285.85 $83.23 $57.17

91013 Esophgl motil

w/stim/perfus X 0361 4.0827 $285.85 $83.23 $57.17

91020 Gastric motility

studies X 0361 4.0827 $285.85 $83.23 $57.17

91022 Duodenal motility

study X 0361 4.0827 $285.85 $83.23 $57.17

91030 Acid perfusion of

esophagus X 0361 4.0827 $285.85 $83.23 $57.17

91034 Gastroesophageal reflux

test X 0361 4.0827 $285.85 $83.23 $57.17

91035 G-esoph reflx tst

w/electrod X 0361 4.0827 $285.85 $83.23 $57.17

91037 Esoph imped function

test X 0360 1.7152 $120.09 $33.87 $24.02

91038 Esoph imped funct test >

1h X 0361 4.0827 $285.85 $83.23 $57.17

91040 Esoph balloon distension

tst X 0360 1.7152 $120.09 $33.87 $24.02

91065 Breath hydrogen

test X 0360 1.7152 $120.09 $33.87 $24.02

91110 Gi tract capsule

endoscopy T 0142 10.4394 $730.93 $152.78 $146.19

91111 Esophageal capsule

endoscopy CH T 0419 12.6671 $886.90 $207.88 $177.38

91117 Colon motility 6 hr

study T 0156 3.1886 $223.25

. $44.65

91120 Rectal sensation

test T 0126 1.1095 $77.68 $16.21 $15.54

91122 Anal pressurerecord T 0156 3.1886 $223.25

. $44.65

91132 Electrogastrography X 0360 1.7152 $120.09 $33.87 $24.02

91133 Electrogastrography

w/test X 0360 1.7152 $120.09 $33.87 $24.02

91299 Gastroenterology

procedure X 0360 1.7152 $120.09 $33.87 $24.02

92002 Eye exam new

patient V 0606 1.3588 $95.14

. $19.03

92004 Eye exam new

patient V 0606 1.3588 $95.14

. $19.03

92012 Eye exam established

pat V 0605 1.0311 $72.19

. $14.44

92014 Eye exam &

treatment V 0605 1.0311 $72.19

. $14.44

92015 Refraction E

92018 New eye exam &

treatment T 0699 15.4248 "$1,079.98"

. $216.00

92019 Eye exam &

treatment T 0699 15.4248 "$1,079.98"

. $216.00

92020 Special eye

evaluation S 0230 0.6424 $44.98

. $9.00

92025 Corneal

topography CH S 0230 0.6424 $44.98

. $9.00

92060 Special eye

evaluation CH S 0230 0.6424 $44.98

. $9.00

92065 Orthoptic/pleoptic

training CH S 0230 0.6424 $44.98

. $9.00

92070 Fitting of contact

lens CH D

92071 Contact lens fitting for

tx NI N

92072 Fit contac lens for

managmnt NI N92081 Visual field

examination(s) S 0230 0.6424 $44.98

. $9.00

92082 Visual field

examination(s) CH S 0230 0.6424 $44.98

. $9.00

92083 Visual field

examination(s) S 0698 1.0589 $74.14

. $14.83

92100 Serial tonometry

exam(s) N

92120 Tonography & eye

evaluation CH D

92130 Water provocation

tonography CH D

92132 Cmptr ophth dx img ant

segmt S 0230 0.6424 $44.98

. $9.00

92133 Cmptr ophth img optic

nerve S 0230 0.6424 $44.98

. $9.00

92134 Cptr ophth dx img post

segmt S 0230 0.6424 $44.98

. $9.00

92136 Ophthalmic

biometry S 0698 1.0589 $74.14

. $14.83

92140 Glaucoma provocative

tests S 0230 0.6424 $44.98

. $9.00

92225 Special eye exam

initial S 0230 0.6424 $44.98

. $9.00

92226 Special eye exam

subsequent CH S 0230 0.6424 $44.98

. $9.00

92227 Remote dx retinal

imaging X 0035 0.2673 $18.72

. $3.75

92228 Remote retinal imaging

mgmt X 0035 0.2673 $18.72

. $3.75

92230 Eye exam with

photos CH S 0698 1.0589 $74.14

. $14.83

92235 Eye exam with

photos S 0231 2.0294 $142.09

. $28.4292240 Icg

angiography S 0231 2.0294 $142.09

. $28.42

92250 Eye exam with

photos CH S 0230 0.6424 $44.98

. $9.00

92260 Ophthalmoscopy/dynamometry S 0230 0.6424 $44.98

. $9.00

92265 Eye muscle

evaluation CH S 0230 0.6424 $44.98

. $9.00

92270 Electro-oculography S 0230 0.6424 $44.98

. $9.00

92275 Electroretinography S 0231 2.0294 $142.09

. $28.42

92283 Color vision

examination S 0230 0.6424 $44.98

. $9.00

92284 Dark adaptation eye

exam CH S 0230 0.6424 $44.98

. $9.00

92285 Eye

photography CH S 0230 0.6424 $44.98

. $9.00

92286 Internal eye

photography CH S 0698 1.0589 $74.14

. $14.83

92287 Internal eye

photography CH S 0698 1.0589 $74.14

. $14.83

92310 Contact lens

fitting E

92311 Contact lens

fitting S 0698 1.0589 $74.14

. $14.83

92312 Contact lens

fitting CH S 0230 0.6424 $44.98

. $9.00

92313 Contact lens

fitting CH S 0698 1.0589 $74.14

. $14.83

92314 Prescription of contact

lens E

92315 Prescription of contact

lens CH S 0698 1.0589 $74.14

. $14.83

92316 Prescription of contact

lens S 0698 1.0589 $74.14

. $14.8392317 Prescription of contact

lens S 0230 0.6424 $44.98

. $9.00

92325 Modification of contact

lens CH S 0698 1.0589 $74.14

. $14.83

92326 Replacement of contact

lens CH S 0230 0.6424 $44.98

. $9.00

92340 Fitting of

spectacles E

92341 Fitting of

spectacles E

92342 Fitting of

spectacles E

92352 Special spectacles

fitting S 0698 1.0589 $74.14

. $14.83

92353 Special spectacles

fitting CH S 0698 1.0589 $74.14

. $14.83

92354 Special spectacles

fitting S 0230 0.6424 $44.98

. $9.00

92355 Special spectacles

fitting S 0230 0.6424 $44.98

. $9.00

92358 Eye prosthesis

service S 0230 0.6424 $44.98

. $9.00

92370 Repair & adjust

spectacles E

92371 Repair & adjust

spectacles CH S 0698 1.0589 $74.14

. $14.83

92499 Eye service or

procedure S 0230 0.6424 $44.98

. $9.00

92502 Ear and throat

examination T 0251 3.1150 $218.10

. $43.62

92504 Ear microscopy

examination N

92506 Speech/hearing

evaluation A

92507 Speech/hearingtherapy A

92508 Speech/hearing

therapy A

92511 Nasopharyngoscopy T 0071 1.0729 $75.12

. $15.03

92512 Nasal function

studies X 0363 0.9638 $67.48 $17.10 $13.50

92516 Facial nerve function

test CH X 0363 0.9638 $67.48 $17.10 $13.50

92520 Laryngeal function

studies X 0660 1.8189 $127.35 $27.10 $25.47

92526 Oral function

therapy A

92531 Spontaneous nystagmus

study N

92532 Positional nystagmus

test N

92533 Caloric vestibular

test N

92534 Optokinetic nystagmus

test N

92540 Basic vestibular

evaluation X 0660 1.8189 $127.35 $27.10 $25.47

92541 Spontaneous nystagmus

test X 0363 0.9638 $67.48 $17.10 $13.50

92542 Positional nystagmus

test X 0363 0.9638 $67.48 $17.10 $13.50

92543 Caloric vestibular

test X 0660 1.8189 $127.35 $27.10 $25.47

92544 Optokinetic nystagmus

test X 0363 0.9638 $67.48 $17.10 $13.50

92545 Oscillating tracking

test X 0363 0.9638 $67.48 $17.10 $13.50

92546 Sinusoidal rotational

test X 0660 1.8189 $127.35 $27.10 $25.47

92547 Supplemental electrical

test N92548 Posturography X 0660 1.8189 $127.35 $27.10 $25.47

92550 Tympanometry & reflex

thresh X 0364 0.4911 $34.38 $7.06 $6.88

92551 Pure tone hearing test

air E

92552 Pure tone audiometry

air X 0364 0.4911 $34.38 $7.06 $6.88

92553 Audiometry air &

bone X 0365 1.2175 $85.24 $18.05 $17.05

92555 Speech threshold

audiometry X 0364 0.4911 $34.38 $7.06 $6.88

92556 Speech audiometry

complete X 0364 0.4911 $34.38 $7.06 $6.88

92557 Comprehensive hearing

test X 0365 1.2175 $85.24 $18.05 $17.05

92558 Evoked auditory test

qual NI E

92559 Group audiometric

testing E

92560 Bekesy audiometry

screen E

92561 Bekesy audiometry

diagnosis CH X 0365 1.2175 $85.24 $18.05 $17.05

92562 Loudness balance

test X 0364 0.4911 $34.38 $7.06 $6.88

92563 Tone decay hearing

test X 0364 0.4911 $34.38 $7.06 $6.88

92564 Sisi hearing

test X 0364 0.4911 $34.38 $7.06 $6.88

92565 Stenger test pure

tone X 0364 0.4911 $34.38 $7.06 $6.88

92567 Tympanometry X 0364 0.4911 $34.38 $7.06 $6.88

92568 Acoustic refl threshold

tst X 0364 0.4911 $34.38 $7.06 $6.8892570 Acoustic immitance

testing CH X 0365 1.2175 $85.24 $18.05 $17.05

92571 Filtered speech hearing

test X 0364 0.4911 $34.38 $7.06 $6.88

92572 Staggered spondaic word

test X 0366 1.6864 $118.07 $23.65 $23.62

92575 Sensorineural acuity

test X 0364 0.4911 $34.38 $7.06 $6.88

92576 Synthetic sentence

test X 0364 0.4911 $34.38 $7.06 $6.88

92577 Stenger test

speech X 0366 1.6864 $118.07 $23.65 $23.62

92579 Visual audiometry

(vra) X 0365 1.2175 $85.24 $18.05 $17.05

92582 Conditioning play

audiometry X 0365 1.2175 $85.24 $18.05 $17.05

92583 Select picture

audiometry X 0364 0.4911 $34.38 $7.06 $6.88

92584 Electrocochleography S 0216 2.6488 $185.46

. $37.10

92585 Auditor evoke potent

compre S 0216 2.6488 $185.46

. $37.10

92586 Auditor evoke potent

limit S 0218 1.2025 $84.19

. $16.84

92587 Evoked auditory test

limited X 0363 0.9638 $67.48 $17.10 $13.50

92588 Evoked auditory tst

complete X 0363 0.9638 $67.48 $17.10 $13.50

92590 Hearing aid exam one

ear E

92591 Hearing aid exam both

ears E

92592 Hearing aid check one

ear E

92593 Hearing aid check both

ears E92594 Electro hearng aid test

one E

92595 Electro hearng aid tst

both E

92596 Ear protector

evaluation X 0364 0.4911 $34.38 $7.06 $6.88

92597 Oral speech device

eval A

92601 Cochlear implt f/up exam <

7 X 0366 1.6864 $118.07 $23.65 $23.62

92602 Reprogram cochlear implt <

7 X 0366 1.6864 $118.07 $23.65 $23.62

92603 Cochlear implt f/up exam 7

> X 0366 1.6864 $118.07 $23.65 $23.62

92604 Reprogram cochlear implt 7

> X 0366 1.6864 $118.07 $23.65 $23.62

92605 Ex for nonspeech device

rx A

92606 Non-speech device

service A

92607 Ex for speech device rx

1hr A

92608 Ex for speech device rx

addl A

92609 Use of speech device

service A

92610 Evaluate swallowing

function A

92611 Motion

fluoroscopy/swallow A

92612 Endoscopy swallow tst

(fees) A

92613 Endoscopy swallow tst

(fees) B

92614 Laryngoscopic sensory

test A

92615 Eval laryngoscopy sense

tst E

92616 Fees w/laryngeal sense

test A92617 Interprt fees/laryngeal

test E

92618 Ex for nonspeech dev rx

add NI A

92620 Auditory function 60

min X 0365 1.2175 $85.24 $18.05 $17.05

92621 Auditory function + 15

min N

92625 Tinnitus

assessment X 0365 1.2175 $85.24 $18.05 $17.05

92626 Eval aud rehab

status X 0366 1.6864 $118.07 $23.65 $23.62

92627 Eval aud status rehab

add-on N

92630 Aud rehab pre-ling hear

loss E

92633 Aud rehab postling hear

loss E

92640 Aud brainstem implt

programg X 0365 1.2175 $85.24 $18.05 $17.05

92700 Ent

procedure/service X 0364 0.4911 $34.38 $7.06 $6.88

92950 Heart/lung resuscitation

cpr S 0094 2.2326 $156.32 $43.83 $31.27

92953 Temporary external

pacing Q3 0094 2.2326 $156.32 $43.83 $31.27

92960 Cardioversion electric

ext S 0679 5.3254 $372.86 $95.30 $74.58

92961 Cardioversion electric

int S 0679 5.3254 $372.86 $95.30 $74.58

92970 Cardioassist

internal C

92971 Cardioassist

external C

92973 Percut coronary

thrombectomy T 0088 41.0387 "$2,873.37" $655.18 $574.68

92974 Cath place cardiobrachytx T 0103 16.3852 "$1,147.23"

. $229.45

92975 Dissolve clot heart

vessel C

92977 Dissolve clot heart

vessel T 0676 2.3021 $161.18

. $32.24

92978 Intravasc us heart

add-on N

92979 Intravasc us heart

add-on N

92980 Insert intracoronary

stent T 0104 81.1503 "$5,681.82"

. "$1,136.37"

92981 Insert intracoronary

stent T 0104 81.1503 "$5,681.82"

. "$1,136.37"

92982 Coronary artery

dilation T 0083 65.8519 "$4,610.69"

. $922.14

92984 Coronary artery

dilation T 0083 65.8519 "$4,610.69"

. $922.14

92986 Revision of aortic

valve T 0083 65.8519 "$4,610.69"

. $922.14

92987 Revision of mitral

valve T 0083 65.8519 "$4,610.69"

. $922.14

92990 Revision of pulmonary

valve T 0083 65.8519 "$4,610.69"

. $922.14

92992 Revision of heart

chamber C

92993 Revision of heart

chamber C

92995 Coronary

atherectomy T 0082 105.0651 "$7,356.24"

. "$1,471.25"

92996 Coronary atherectomy

add-on T 0082 105.0651 "$7,356.24"

. "$1,471.25"

92997 Pul art balloon repr

percut T 0083 65.8519 "$4,610.69"

. $922.14

92998 Pul art balloon repr

percut T 0083 65.8519 "$4,610.69"

. $922.1493000 Electrocardiogram

complete M

93005 Electrocardiogram

tracing S 0099 0.3817 $26.73

. $5.35

93010 Electrocardiogram

report B

93015 Cardiovascular stress

test B

93016 Cardiovascular stress

test B

93017 Cardiovascular stress

test X 0100 2.5439 $178.11 $41.37 $35.63

93018 Cardiovascular stress

test B

93024 Cardiac drug stress

test X 0100 2.5439 $178.11 $41.37 $35.63

93025 Microvolt t-wave

assess X 0100 2.5439 $178.11 $41.37 $35.63

93040 Rhythm ECG with

report B

93041 Rhythm ecg

tracing X 0035 0.2673 $18.72

. $3.75

93042 Rhythm ecg

report B

93224 Ecg monit/reprt up to 48

hrs M

93225 Ecg monit/reprt up to 48

hrs S 0097 0.9350 $65.46

. $13.10

93226 Ecg monit/reprt up to 48

hrs S 0097 0.9350 $65.46

. $13.10

93227 Ecg monit/reprt up to 48

hrs M

93228 Remote 30 day ecg

rev/report M

93229 Remote 30 day ecg tech

supp S 0209 11.3569 $795.16 $268.73 $159.04

93268 ECG

record/review M93270 Remote 30 day ecg

rev/report S 0097 0.9350 $65.46

. $13.10

93271 Ecg/monitoring and

analysis S 0692 1.5944 $111.63

. $22.33

93272 Ecg/review interpret

only M

93278 ECG/signal-averaged X 0035 0.2673 $18.72

. $3.75

93279 Pm device progr eval

sngl S 0690 0.4928 $34.50

. $6.90

93280 Pm device progr eval

dual S 0690 0.4928 $34.50

. $6.90

93281 Pm device progr eval

multi S 0690 0.4928 $34.50

. $6.90

93282 Icd device prog eval 1

sngl S 0690 0.4928 $34.50

. $6.90

93283 Icd device progr eval

dual S 0690 0.4928 $34.50

. $6.90

93284 Icd device progr eval

mult S 0690 0.4928 $34.50

. $6.90

93285 Ilr device eval

progr S 0690 0.4928 $34.50

. $6.90

93286 Pre-op pm device

eval N

93287 Pre-op icd device

eval N

93288 Pm device eval in

person S 0690 0.4928 $34.50

. $6.90

93289 Icd device

interrogate S 0690 0.4928 $34.50

. $6.90

93290 Icm device

eval X 0035 0.2673 $18.72

. $3.75

93291 Ilr device

interrogate S 0690 0.4928 $34.50

. $6.90

93292 Wcd device

interrogate S 0690 0.4928 $34.50

. $6.9093293 Pm phone r-strip device

eval S 0690 0.4928 $34.50

. $6.90

93294 Pm device interrogate

remote M

93295 Icd device interrogat

remote M

93296 Pm/icd remote tech

serv S 0690 0.4928 $34.50

. $6.90

93297 Icm device interrogat

remote M

93298 Ilr device interrogat

remote M

93299 Icm/ilr remote tech

serv CH S 0690 0.4928 $34.50

. $6.90

93303 Echo

transthoracic S 0270 8.2952 $580.80 $133.61 $116.16

93304 Echo

transthoracic S 0269 5.6156 $393.18

. $78.64

93306 Tte w/doppler

complete S 0269 5.6156 $393.18

. $78.64

93307 Tte w/o doppler

complete S 0269 5.6156 $393.18

. $78.64

93308 Tte f-up or

lmtd S 0697 3.1615 $221.36

. $44.28

93312 Echo

transesophageal S 0270 8.2952 $580.80 $133.61 $116.16

93313 Echo

transesophageal S 0269 5.6156 $393.18

. $78.64

93314 Echo

transesophageal N

93315 Echo

transesophageal CH S 0269 5.6156 $393.18

. $78.64

93316 Echo

transesophageal S 0270 8.2952 $580.80 $133.61 $116.1693317 Echo

transesophageal N

93318 Echo transesophageal

intraop S 0270 8.2952 $580.80 $133.61 $116.16

93320 Doppler echo exam

heart N

93321 Doppler echo exam

heart N

93325 Doppler color flow

add-on N

93350 Stress tte

only S 0269 5.6156 $393.18

. $78.64

93351 Stress tte

complete S 0270 8.2952 $580.80 $133.61 $116.16

93352 Admin ecg contrast

agent M

93451 Right heart

cath T 0080 38.8523 "$2,720.28" $836.90 $544.06

93452 Left hrt cath

w/ventrclgrphy T 0080 38.8523 "$2,720.28" $836.90 $544.06

93453 R&l hrt cath

w/ventriclgrphy T 0080 38.8523 "$2,720.28" $836.90 $544.06

93454 Coronary artery angio

s&i T 0080 38.8523 "$2,720.28" $836.90 $544.06

93455 Coronary art/grft angio

s&i T 0080 38.8523 "$2,720.28" $836.90 $544.06

93456 R hrt coronary artery

angio T 0080 38.8523 "$2,720.28" $836.90 $544.06

93457 R hrt art/grft

angio T 0080 38.8523 "$2,720.28" $836.90 $544.06

93458 L hrt artery/ventricle

angio T 0080 38.8523 "$2,720.28" $836.90 $544.06

93459 L hrt art/grft

angio T 0080 38.8523 "$2,720.28" $836.90 $544.06

93460 R&l hrt art/ventricle

angio T 0080 38.8523 "$2,720.28" $836.90 $544.0693461 R&l hrt art/ventricle

angio T 0080 38.8523 "$2,720.28" $836.90 $544.06

93462 L hrt cath trnsptl

puncture T 0080 38.8523 "$2,720.28" $836.90 $544.06

93463 Drug admin & hemodynmic

meas N

93464 Exercise w/hemodynamic

meas N

93503 Insert/place heart

catheter T 0103 16.3852 "$1,147.23"

. $229.45

93505 Biopsy of heart

lining T 0103 16.3852 "$1,147.23"

. $229.45

93530 Rt heart cath

congenital T 0080 38.8523 "$2,720.28" $836.90 $544.06

93531 R & l heart cath

congenital T 0080 38.8523 "$2,720.28" $836.90 $544.06

93532 R & l heart cath

congenital T 0080 38.8523 "$2,720.28" $836.90 $544.06

93533 R & l heart cath

congenital T 0080 38.8523 "$2,720.28" $836.90 $544.06

93561 Cardiac output

measurement N

93562 Card output measure

subsq N

93563 Inject congenital card

cath N

93564 Inject hrt congntl

art/grft N

93565 Inject l ventr/atrial

angio N

93566 Inject r ventr/atrial

angio N

93567 Inject suprvlv

aortography N

93568 Inject pulm art hrt

cath N93571 Heart flow reserve

measure N

93572 Heart flow reserve

measure N

93580 Transcath closure of

asd T 0434 171.3141 "$11,994.73"

. "$2,398.95"

93581 Transcath closure of

vsd T 0434 171.3141 "$11,994.73"

. "$2,398.95"

93600 Bundle of His

recording S 0084 9.9330 $695.47

. $139.10

93602 Intra-atrial

recording S 0084 9.9330 $695.47

. $139.10

93603 Right ventricular

recording S 0084 9.9330 $695.47

. $139.10

93609 Map tachycardia

add-on N

93610 Intra-atrial

pacing S 0084 9.9330 $695.47

. $139.10

93612 Intraventricular

pacing S 0084 9.9330 $695.47

. $139.10

93613 Electrophys map 3d

add-on N

93615 Esophageal

recording S 0084 9.9330 $695.47

. $139.10

93616 Esophageal

recording S 0084 9.9330 $695.47

. $139.10

93618 Heart rhythm

pacing S 0084 9.9330 $695.47

. $139.10

93619 Electrophysiology

evaluation Q3 0085 53.2719 "$3,729.89"

. $745.98

93620 Electrophysiology

evaluation Q3 0085 53.2719 "$3,729.89"

. $745.98

93621 Electrophysiology

evaluation N

93622 Electrophysiology

evaluation N93623 Stimulation pacing

heart N

93624 Electrophysiologic

study T 0085 53.2719 "$3,729.89"

. $745.98

93631 Heart pacing

mapping N

93640 Evaluation heart

device N

93641 Electrophysiology

evaluation N

93642 Electrophysiology

evaluation S 0084 9.9330 $695.47

. $139.10

93650 Ablate heart dysrhythm

focus Q3 0085 53.2719 "$3,729.89"

. $745.98

93651 Ablate heart dysrhythm

focus Q3 0086 121.8174 "$8,529.17"

. "$1,705.84"

93652 Ablate heart dysrhythm

focus Q3 0086 121.8174 "$8,529.17"

. "$1,705.84"

93660 Tilt table

evaluation S 0101 4.2669 $298.75 $100.24 $59.75

93662 Intracardiac ecg

(ice) N

93668 Peripheral vascular

rehab E

93701 Bioimpedance cv

analysis S 0099 0.3817 $26.73

. $5.35

93720 Total body

plethysmography CH D

93721 Plethysmography

tracing CH D

93722 Plethysmography

report CH D

93724 Analyze pacemaker

system S 0690 0.4928 $34.50

. $6.90

93740 Temperature gradient

studies CH X 0367 0.7420 $51.95 $13.76 $10.39

93745 Set-up

cardiovert-defibrill S 0690 0.4928 $34.50

. $6.9093750 Interrogation vad in

person S 0692 1.5944 $111.63

. $22.33

93770 Measure venous

pressure N

93784 Ambulatory BP

monitoring E

93786 Ambulatory BP

recording S 0097 0.9350 $65.46

. $13.10

93788 Ambulatory BP

analysis S 0097 0.9350 $65.46

. $13.10

93790 Review/report BP

recording M

93797 Cardiac

rehab S 0095 0.9930 $69.53

. $13.91

93798 Cardiac

rehab/monitor S 0095 0.9930 $69.53

. $13.91

93799 Cardiovascular

procedure S 0097 0.9350 $65.46

. $13.10

93875 Extracranial

study CH D

93880 Extracranial

study S 0267 2.1681 $151.80 $59.37 $30.36

93882 Extracranial

study S 0267 2.1681 $151.80 $59.37 $30.36

93886 Intracranial

study S 0267 2.1681 $151.80 $59.37 $30.36

93888 Intracranial

study S 0265 0.8990 $62.94 $22.26 $12.59

93890 Tcd vasoreactivity

study S 0266 1.3781 $96.49 $37.23 $19.30

93892 Tcd emboli detect w/o

inj S 0266 1.3781 $96.49 $37.23 $19.30

93893 Tcd emboli detect

w/inj S 0266 1.3781 $96.49 $37.23 $19.3093922 Upr/l xtremity art 2

levels S 0097 0.9350 $65.46

. $13.10

93923 Upr/lxtr art stdy 3+

lvls S 0096 1.5248 $106.76 $36.86 $21.36

93924 Lwr xtr vasc stdy

bilat S 0096 1.5248 $106.76 $36.86 $21.36

93925 Lower extremity

study S 0267 2.1681 $151.80 $59.37 $30.36

93926 Lower extremity

study S 0266 1.3781 $96.49 $37.23 $19.30

93930 Upper extremity

study S 0267 2.1681 $151.80 $59.37 $30.36

93931 Upper extremity

study S 0266 1.3781 $96.49 $37.23 $19.30

93965 Extremity

study S 0096 1.5248 $106.76 $36.86 $21.36

93970 Extremity

study S 0267 2.1681 $151.80 $59.37 $30.36

93971 Extremity

study S 0266 1.3781 $96.49 $37.23 $19.30

93975 Vascular

study S 0267 2.1681 $151.80 $59.37 $30.36

93976 Vascular

study S 0267 2.1681 $151.80 $59.37 $30.36

93978 Vascular

study S 0267 2.1681 $151.80 $59.37 $30.36

93979 Vascular

study S 0266 1.3781 $96.49 $37.23 $19.30

93980 Penile vascular

study S 0267 2.1681 $151.80 $59.37 $30.36

93981 Penile vascular

study S 0267 2.1681 $151.80 $59.37 $30.36

93982 Aneurysm pressure sens

study S 0097 0.9350 $65.46

. $13.1093990 Doppler flow

testing S 0266 1.3781 $96.49 $37.23 $19.30

93998 Noninvas vasc dx study

proc NI X 0035 0.2673 $18.72

. $3.75

94002 Vent mgmt inpat init

day Q3 0079 3.1979 $223.90

. $44.78

94003 Vent mgmt inpat subq

day Q3 0079 3.1979 $223.90

. $44.78

94004 Vent mgmt nf per

day B

94005 Home vent mgmt

supervision M

94010 Breathing capacity

test CH X 0367 0.7420 $51.95 $13.76 $10.39

94011 Spirometry up to 2 yrs

old CH X 0367 0.7420 $51.95 $13.76 $10.39

94012 Spirmtry w/brnchdil inf-2

yr CH X 0367 0.7420 $51.95 $13.76 $10.39

94013 Meas lung vol thru 2

yrs X 0369 2.6868 $188.12 $38.23 $37.63

94014 Patient recorded

spirometry X 0367 0.7420 $51.95 $13.76 $10.39

94015 Patient recorded

spirometry X 0367 0.7420 $51.95 $13.76 $10.39

94016 Review patient

spirometry A

94060 Evaluation of

wheezing S 0078 1.4089 $98.65

. $19.73

94070 Evaluation of

wheezing X 0369 2.6868 $188.12 $38.23 $37.63

94150 Vital capacity

test X 0367 0.7420 $51.95 $13.76 $10.39

94200 Lung function test

(MBC/MVV) X 0367 0.7420 $51.95 $13.76 $10.3994240 Residual lung

capacity CH D

94250 Expired gas

collection X 0367 0.7420 $51.95 $13.76 $10.39

94260 Thoracic gas

volume CH D

94350 Lung nitrogen washout

curve CH D

94360 Measure airflow

resistance CH D

94370 Breath airway closing

volume CH D

94375 Respiratory flow volume

loop CH X 0367 0.7420 $51.95 $13.76 $10.39

94400 CO2 breathing response

curve X 0367 0.7420 $51.95 $13.76 $10.39

94450 Hypoxia response

curve X 0368 0.8906 $62.36 $20.93 $12.48

94452 Hast

w/report X 0368 0.8906 $62.36 $20.93 $12.48

94453 Hast w/oxygen

titrate CH X 0367 0.7420 $51.95 $13.76 $10.39

94610 Surfactant admin thru

tube S 0077 0.4237 $29.67 $7.74 $5.94

94620 Pulmonary stress

test/simple X 0368 0.8906 $62.36 $20.93 $12.48

94621 Pulm stress

test/complex X 0369 2.6868 $188.12 $38.23 $37.63

94640 Airway inhalation

treatment S 0077 0.4237 $29.67 $7.74 $5.94

94642 Aerosol inhalation

treatment S 0078 1.4089 $98.65

. $19.73

94644 Cbt 1st

hour X 0340 0.6499 $45.50

. $9.1094645 Cbt each addl

hour X 0340 0.6499 $45.50

. $9.10

94660 Pos airway pressure

cpap Q3 0078 1.4089 $98.65

. $19.73

94662 Neg press ventilation

cnp Q3 0079 3.1979 $223.90

. $44.78

94664 Evaluate pt use of

inhaler S 0077 0.4237 $29.67 $7.74 $5.94

94667 Chest wall

manipulation S 0077 0.4237 $29.67 $7.74 $5.94

94668 Chest wall

manipulation S 0077 0.4237 $29.67 $7.74 $5.94

94680 Exhaled air analysis

o2 X 0368 0.8906 $62.36 $20.93 $12.48

94681 Exhaled air analysis

o2/co2 CH X 0369 2.6868 $188.12 $38.23 $37.63

94690 Exhaled air

analysis X 0367 0.7420 $51.95 $13.76 $10.39

94720 Monoxide diffusing

capacity CH D

94725 Membrane diffusion

capacity CH D

94726 Pulm funct tst

plethysmograp NI X 0367 0.7420 $51.95 $13.76 $10.39

94727 Pulm function test by

gas NI X 0367 0.7420 $51.95 $13.76 $10.39

94728 Pulm funct test

oscillometry NI X 0367 0.7420 $51.95 $13.76 $10.39

94729 C02/membane diffuse

capacity NI X 0368 0.8906 $62.36 $20.93 $12.48

94750 Pulmonary compliance

study X 0367 0.7420 $51.95 $13.76 $10.39

94760 Measure blood oxygen

level N

94761 Measure blood oxygenlevel N

94762 Measure blood oxygen

level Q3 0097 0.9350 $65.46

. $13.10

94770 Exhaled carbon dioxide

test X 0368 0.8906 $62.36 $20.93 $12.48

94772 Breath recording

infant X 0369 2.6868 $188.12 $38.23 $37.63

94774 Ped home apnea rec

compl B

94775 Ped home apnea rec

hk-up S 0097 0.9350 $65.46

. $13.10

94776 Ped home apnea rec

downld S 0097 0.9350 $65.46

. $13.10

94777 Ped home apnea rec

report B

94780 Car seat/bed test 60

min NI X 0340 0.6499 $45.50

. $9.10

94781 Car seat/bed test + 30

min NI X 0340 0.6499 $45.50

. $9.10

94799 Pulmonary

service/procedure X 0367 0.7420 $51.95 $13.76 $10.39

95004 Percut allergy skin

tests X 0381 0.4426 $30.99

. $6.20

95010 Percut allergy titrate

test X 0381 0.4426 $30.99

. $6.20

95012 Exhaled nitric oxide

meas X 0367 0.7420 $51.95 $13.76 $10.39

95015 Id allergy

titrate-drug/bug X 0381 0.4426 $30.99

. $6.20

95024 Id allergy test

drug/bug X 0381 0.4426 $30.99

. $6.20

95027 Id allergy

titrate-airborne X 0381 0.4426 $30.99

. $6.20

95028 Id allergy test-delayed

type X 0381 0.4426 $30.99

. $6.2095044 Allergy patch

tests X 0381 0.4426 $30.99

. $6.20

95052 Photo patch

test X 0381 0.4426 $30.99

. $6.20

95056 Photosensitivity

tests X 0370 1.1369 $79.60

. $15.92

95060 Eye allergy

tests X 0370 1.1369 $79.60

. $15.92

95065 Nose allergy

test X 0381 0.4426 $30.99

. $6.20

95070 Bronchial allergy

tests X 0369 2.6868 $188.12 $38.23 $37.63

95071 Bronchial allergy

tests CH X 0368 0.8906 $62.36 $20.93 $12.48

95075 Ingestion challenge

test X 0361 4.0827 $285.85 $83.23 $57.17

95115 Immunotherapy one

injection S 0436 0.3545 $24.82

. $4.97

95117 Immunotherapy

injections S 0436 0.3545 $24.82

. $4.97

95120 Immunotherapy one

injection E

95125 Immunotherapy many

antigens E

95130 Immunotherapy insect

venom E

95131 Immunotherapy insect

venoms E

95132 Immunotherapy insect

venoms E

95133 Immunotherapy insect

venoms E

95134 Immunotherapy insect

venoms E

95144 Antigen therapy

services S 0437 0.4972 $34.81

. $6.9795145 Antigen therapy

services S 0437 0.4972 $34.81

. $6.97

95146 Antigen therapy

services S 0438 1.0388 $72.73

. $14.55

95147 Antigen therapy

services S 0438 1.0388 $72.73

. $14.55

95148 Antigen therapy

services S 0437 0.4972 $34.81

. $6.97

95149 Antigen therapy

services S 0437 0.4972 $34.81

. $6.97

95165 Antigen therapy

services S 0436 0.3545 $24.82

. $4.97

95170 Antigen therapy

services S 0437 0.4972 $34.81

. $6.97

95180 Rapid

desensitization X 0370 1.1369 $79.60

. $15.92

95199 Allergy immunology

services X 0381 0.4426 $30.99

. $6.20

95250 Glucose monitoring

cont V 0607 1.8647 $130.56

. $26.12

95251 Gluc monitor cont phys

i&r B

95800 Slp stdy

unattended S 0213 2.4298 $170.12 $53.58 $34.03

95801 Slp stdy unatnd

w/anal S 0213 2.4298 $170.12 $53.58 $34.03

95803 Actigraphy

testing S 0218 1.2025 $84.19

. $16.84

95805 Multiple sleep latency

test S 0209 11.3569 $795.16 $268.73 $159.04

95806 Sleep study unatt&resp

efft S 0213 2.4298 $170.12 $53.58 $34.03

95807 Sleep study

attended S 0209 11.3569 $795.16 $268.73 $159.0495808 Polysomnography

1-3 S 0209 11.3569 $795.16 $268.73 $159.04

95810 Polysomnography 4 or

more S 0209 11.3569 $795.16 $268.73 $159.04

95811 Polysomnography

w/cpap S 0209 11.3569 $795.16 $268.73 $159.04

95812 Eeg 41-60

minutes S 0213 2.4298 $170.12 $53.58 $34.03

95813 Eeg over 1

hour S 0213 2.4298 $170.12 $53.58 $34.03

95816 Eeg awake and

drowsy S 0213 2.4298 $170.12 $53.58 $34.03

95819 Eeg awake and

asleep S 0213 2.4298 $170.12 $53.58 $34.03

95822 Eeg coma or sleep

only S 0213 2.4298 $170.12 $53.58 $34.03

95824 Eeg cerebral death

only S 0216 2.6488 $185.46

. $37.10

95827 Eeg all night

recording S 0213 2.4298 $170.12 $53.58 $34.03

95829 Surgery

electrocorticogram N

95830 Insert electrodes for

EEG B

95831 Limb muscle testing

manual A

95832 Hand muscle testing

manual A

95833 Body muscle testing

manual A

95834 Body muscle testing

manual A

95851 Range of motion

measurements A

95852 Range of motionmeasurements A

95857 Cholinesterase

challenge S 0218 1.2025 $84.19

. $16.84

95860 Muscle test one

limb S 0218 1.2025 $84.19

. $16.84

95861 Muscle test 2

limbs S 0218 1.2025 $84.19

. $16.84

95863 Muscle test 3

limbs S 0218 1.2025 $84.19

. $16.84

95864 Muscle test 4

limbs S 0218 1.2025 $84.19

. $16.84

95865 Muscle test

larynx S 0218 1.2025 $84.19

. $16.84

95866 Muscle test

hemidiaphragm S 0218 1.2025 $84.19

. $16.84

95867 Muscle test cran nerv

unilat S 0218 1.2025 $84.19

. $16.84

95868 Muscle test cran nerve

bilat S 0218 1.2025 $84.19

. $16.84

95869 Muscle test thor

paraspinal S 0215 0.6335 $44.36

. $8.88

95870 Muscle test

nonparaspinal S 0215 0.6335 $44.36

. $8.88

95872 Muscle test one

fiber S 0218 1.2025 $84.19

. $16.84

95873 Guide nerv destr elec

stim N

95874 Guide nerv destr needle

emg N

95875 Limb exercise

test S 0218 1.2025 $84.19

. $16.84

95885 Musc tst done w/nerv tst

lim NI S 0218 1.2025 $84.19

. $16.84

95886 Musc test done w/n testcomp NI S 0218 1.2025 $84.19

. $16.84

95887 Musc tst done w/n tst

nonext NI S 0215 0.6335 $44.36

. $8.88

95900 Motor nerve conduction

test S 0215 0.6335 $44.36

. $8.88

95903 Motor nerve conduction

test S 0215 0.6335 $44.36

. $8.88

95904 Sense nerve conduction

test S 0215 0.6335 $44.36

. $8.88

95905 Motor/sens nrve conduct

test S 0215 0.6335 $44.36

. $8.88

95920 Intraop nerve test

add-on N

95921 Autonomic nerv function

test S 0218 1.2025 $84.19

. $16.84

95922 Autonomic nerv function

test S 0218 1.2025 $84.19

. $16.84

95923 Autonomic nerv function

test S 0218 1.2025 $84.19

. $16.84

95925 Somatosensory

testing S 0216 2.6488 $185.46

. $37.10

95926 Somatosensory

testing S 0216 2.6488 $185.46

. $37.10

95927 Somatosensory

testing S 0216 2.6488 $185.46

. $37.10

95928 C motor evoked uppr

limbs S 0218 1.2025 $84.19

. $16.84

95929 C motor evoked lwr

limbs S 0218 1.2025 $84.19

. $16.84

95930 Visual evoked potential

test S 0216 2.6488 $185.46

. $37.10

95933 Blink reflex

test S 0215 0.6335 $44.36

. $8.8895934 H-reflex

test S 0215 0.6335 $44.36

. $8.88

95936 H-reflex

test S 0215 0.6335 $44.36

. $8.88

95937 Neuromuscular junction

test S 0218 1.2025 $84.19

. $16.84

95938 Somatosensory

testing NI S 0216 2.6488 $185.46

. $37.10

95939 C motor evoked upr&lwr

limbs NI S 0218 1.2025 $84.19

. $16.84

95950 Ambulatory eeg

monitoring S 0209 11.3569 $795.16 $268.73 $159.04

95951 EEG

monitoring/videorecord S 0209 11.3569 $795.16 $268.73 $159.04

95953 EEG

monitoring/computer S 0209 11.3569 $795.16 $268.73 $159.04

95954 EEG monitoring/giving

drugs S 0218 1.2025 $84.19

. $16.84

95955 EEG during

surgery N

95956 Eeg monitor technol

attended S 0209 11.3569 $795.16 $268.73 $159.04

95957 EEG digital

analysis N

95958 EEG monitoring/function

test S 0213 2.4298 $170.12 $53.58 $34.03

95961 Electrode stimulation

brain S 0216 2.6488 $185.46

. $37.10

95962 Electrode stim brain

add-on S 0216 2.6488 $185.46

. $37.10

95965 Meg

spontaneous CH S 0066 35.9961 "$2,520.30"

. $504.06

95966 Meg evoked

single S 0065 12.8903 $902.53

. $180.5195967 Meg evoked each

addl S 0065 12.8903 $902.53

. $180.51

95970 Analyze neurostim no

prog S 0218 1.2025 $84.19

. $16.84

95971 Analyze neurostim

simple S 0692 1.5944 $111.63

. $22.33

95972 Analyze neurostim

complex S 0692 1.5944 $111.63

. $22.33

95973 Analyze neurostim

complex CH S 0218 1.2025 $84.19

. $16.84

95974 Cranial neurostim

complex S 0692 1.5944 $111.63

. $22.33

95975 Cranial neurostim

complex CH S 0218 1.2025 $84.19

. $16.84

95978 Analyze neurostim

brain/1h S 0692 1.5944 $111.63

. $22.33

95979 Analyz neurostim brain

addon S 0692 1.5944 $111.63

. $22.33

95980 Io anal gast n-stim

init N

95981 Io anal gast n-stim

subsq S 0218 1.2025 $84.19

. $16.84

95982 Io ga n-stim subsq

w/reprog S 0692 1.5944 $111.63

. $22.33

95990 Spin/brain pump refil &

main S 0439 1.8098 $126.71

. $25.35

95991 Spin/brain pump refil &

main S 0439 1.8098 $126.71

. $25.35

95992 Canalith repositioning

proc A

95999 Neurological

procedure S 0215 0.6335 $44.36

. $8.88

96000 Motion analysis

video/3d S 0216 2.6488 $185.46

. $37.1096001 Motion test w/ft press

meas S 0216 2.6488 $185.46

. $37.10

96002 Dynamic surface

emg S 0218 1.2025 $84.19

. $16.84

96003 Dynamic fine wire

emg S 0218 1.2025 $84.19

. $16.84

96004 Phys review of motion

tests B

96020 Functional brain

mapping N

96040 Genetic counseling 30

min B

96101 Psycho testing by

psych/phys Q3 0382 2.5717 $180.06

. $36.02

96102 Psycho testing by

technician CH Q3 0373 1.3842 $96.92

. $19.39

96103 Psycho testing admin by

comp Q3 0373 1.3842 $96.92

. $19.39

96105 Assessment of

aphasia A

96110 Developmental

screen CH E

96111 Developmental test

extend Q3 0373 1.3842 $96.92

. $19.39

96116 Neurobehavioral status

exam Q3 0382 2.5717 $180.06

. $36.02

96118 Neuropsych tst by

psych/phys Q3 0382 2.5717 $180.06

. $36.02

96119 Neuropsych testing by

tec Q3 0382 2.5717 $180.06

. $36.02

96120 Neuropsych tst admin

w/comp Q3 0382 2.5717 $180.06

. $36.02

96125 Cognitive test by hc

pro A

96150 Assess hlth/behave

init Q3 0432 0.5154 $36.09

. $7.2296151 Assess hlth/behave

subseq Q3 0432 0.5154 $36.09

. $7.22

96152 Intervene hlth/behave

indiv Q3 0432 0.5154 $36.09

. $7.22

96153 Intervene hlth/behave

group Q3 0432 0.5154 $36.09

. $7.22

96154 Interv hlth/behav fam

w/pt Q3 0432 0.5154 $36.09

. $7.22

96155 Interv hlth/behav fam no

pt E

96360 Hydration iv infusion

init S 0438 1.0388 $72.73

. $14.55

96361 Hydrate iv infusion

add-on S 0436 0.3545 $24.82

. $4.97

96365 Ther/proph/diag iv inf

init S 0439 1.8098 $126.71

. $25.35

96366 Ther/proph/diag iv inf

addon CH S 0437 0.4972 $34.81

. $6.97

96367 Tx/proph/dg addl seq iv

inf S 0437 0.4972 $34.81

. $6.97

96368 Ther/diag concurrent

inf N

96369 Sc ther infusion up to 1

hr S 0439 1.8098 $126.71

. $25.35

96370 Sc ther infusion addl

hr S 0437 0.4972 $34.81

. $6.97

96371 Sc ther infusion reset

pump CH S 0437 0.4972 $34.81

. $6.97

96372 Ther/proph/diag inj

sc/im CH S 0437 0.4972 $34.81

. $6.97

96373 Ther/proph/diag inj

ia S 0437 0.4972 $34.81

. $6.97

96374 Ther/proph/diag inj iv

push S 0437 0.4972 $34.81

. $6.9796375 Tx/pro/dx inj new drug

addon S 0437 0.4972 $34.81

. $6.97

96376 Tx/pro/dx inj same drug

adon N

96379 Ther/prop/diag inj/inf

proc S 0436 0.3545 $24.82

. $4.97

96401 Chemo anti-neopl

sq/im S 0437 0.4972 $34.81

. $6.97

96402 Chemo hormon antineopl

sq/im S 0437 0.4972 $34.81

. $6.97

96405 Chemo intralesional up to

7 S 0437 0.4972 $34.81

. $6.97

96406 Chemo intralesional over

7 S 0439 1.8098 $126.71

. $25.35

96409 Chemo iv push sngl

drug S 0439 1.8098 $126.71

. $25.35

96411 Chemo iv push addl

drug S 0438 1.0388 $72.73

. $14.55

96413 Chemo iv infusion 1

hr S 0440 2.9679 $207.80

. $41.56

96415 Chemo iv infusion addl

hr S 0437 0.4972 $34.81

. $6.97

96416 Chemo prolong infuse

w/pump S 0440 2.9679 $207.80

. $41.56

96417 Chemo iv infus each addl

seq S 0438 1.0388 $72.73

. $14.55

96420 Chemo ia push

tecnique S 0438 1.0388 $72.73

. $14.55

96422 Chemo ia infusion up to 1

hr S 0440 2.9679 $207.80

. $41.56

96423 Chemo ia infuse each addl

hr S 0438 1.0388 $72.73

. $14.55

96425 Chemotherapy infusion

method S 0440 2.9679 $207.80

. $41.5696440 Chemotherapy

intracavitary S 0439 1.8098 $126.71

. $25.35

96446 Chemotx admn prtl

cavity S 0439 1.8098 $126.71

. $25.35

96450 Chemotherapy into

cns S 0440 2.9679 $207.80

. $41.56

96521 Refill/maint portable

pump S 0439 1.8098 $126.71

. $25.35

96522 Refill/maint pump/resvr

syst S 0439 1.8098 $126.71

. $25.35

96523 Irrig drug delivery

device Q1 0624 0.6068 $42.49 $12.33 $8.50

96542 Chemotherapy

injection S 0438 1.0388 $72.73

. $14.55

96549 Chemotherapy

unspecified S 0436 0.3545 $24.82

. $4.97

96567 Photodynamic tx

skin T 0015 1.4966 $104.79

. $20.96

96570 Photodynmc tx 30 min

add-on T 0015 1.4966 $104.79

. $20.96

96571 Photodynamic tx addl 15

min T 0015 1.4966 $104.79

. $20.96

96900 Ultraviolet light

therapy S 0001 0.5043 $35.31

. $7.07

96902 Trichogram N

96904 Whole body

photography N

96910 Photochemotherapy with

UV-B S 0001 0.5043 $35.31

. $7.07

96912 Photochemotherapy with

UV-A S 0001 0.5043 $35.31

. $7.07

96913 Photochemotherapy uv-a or

b S 0683 3.0368 $212.62

. $42.5396920 Laser tx skin < 250 sq

cm T 0015 1.4966 $104.79

. $20.96

96921 Laser tx skin 250-500 sq

cm T 0015 1.4966 $104.79

. $20.96

96922 Laser tx skin > 500 sq

cm T 0015 1.4966 $104.79

. $20.96

96999 Dermatological

procedure T 0012 0.3878 $27.15

. $5.43

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

therapy A

97014 Electric stimulation

therapy E

97016 Vasopneumatic device

therapy A

97018 Paraffin bath

therapy A

97022 Whirlpool

therapy A

97024 Diathermy eg

microwave A

97026 Infrared

therapy A

97028 Ultraviolet

therapy A

97032 Electricalstimulation A

97033 Electric current

therapy A

97034 Contrast bath

therapy A

97035 Ultrasound

therapy A

97036 Hydrotherapy A

97039 Physical therapy

treatment A

97110 Therapeutic

exercises A

97112 Neuromuscular

reeducation A

97113 Aquatic

therapy/exercises A

97116 Gait training

therapy A

97124 Massage

therapy A

97139 Physical medicine

procedure A

97140 Manual

therapy A

97150 Group therapeutic

procedures A

97530 Therapeutic

activities A

97532 Cognitive skills

development A

97533 Sensory

integration A

97535 Self care mngment

training A

97537 Community/work

reintegration A

97542 Wheelchair mngment

training A

97545 Workhardening A

97546 Work hardening

add-on A

97597 Rmvl devital tis 20

cm/< T 0015 1.4966 $104.79

. $20.96

97598 Rmvl devital tis addl 20

cm< T 0015 1.4966 $104.79

. $20.96

97602 Wound(s) care

non-selective T 0013 0.8768 $61.39

. $12.28

97605 Neg press wound tx < 50

cm T 0013 0.8768 $61.39

. $12.28

97606 Neg press wound tx > 50

cm T 0015 1.4966 $104.79

. $20.96

97750 Physical performance

test A

97755 Assistive technology

assess A

97760 Orthotic mgmt and

training A

97761 Prosthetic

training A

97762 C/o for orthotic/prosth

use A

97799 Physical medicine

procedure A

97802 Medical nutrition indiv

in A

97803 Med nutrition indiv

subseq A

97804 Medical nutrition

group A

97810 Acupunct w/o stimul 15

min E

97811 Acupunct w/o stimul addl

15m E

97813 Acupunct w/stimul 15

min E

97814 Acupunct w/stimul addl

15m E

98925 Osteopathic

manipulation S 0060 0.3428 $24.00

. $4.8098926 Osteopathic

manipulation S 0060 0.3428 $24.00

. $4.80

98927 Osteopathic

manipulation S 0060 0.3428 $24.00

. $4.80

98928 Osteopathic

manipulation S 0060 0.3428 $24.00

. $4.80

98929 Osteopathic

manipulation S 0060 0.3428 $24.00

. $4.80

98940 Chiropractic

manipulation S 0060 0.3428 $24.00

. $4.80

98941 Chiropractic

manipulation S 0060 0.3428 $24.00

. $4.80

98942 Chiropractic

manipulation S 0060 0.3428 $24.00

. $4.80

98943 Chiropractic

manipulation E

98960 Self-mgmt educ & train 1

pt E

98961 Self-mgmt educ/train 2-4

pt E

98962 Self-mgmt educ/train 5-8

pt E

98966 Hc pro phone call 5-10

min E

98967 Hc pro phone call 11-20

min E

98968 Hc pro phone call 21-30

min E

98969 Online service by hc

pro E

99000 Specimen

handling E

99001 Specimen

handling E

99002 Device

handling B

99024 Postop follow-up

visit B99026 In-hospital on call

service E

99027 Out-of-hosp on call

service E

99050 Medical services after

hrs B

99051 Med serv

eve/wkend/holiday B

99053 Med serv 10pm-8am 24 hr

fac B

99056 Med service out of

office B

99058 Office emergency

care B

99060 Out of office emerg med

serv B

99070 Special

supplies B

99071 Patient education

materials B

99075 Medical

testimony E

99078 Group health

education N

99080 Special reports or

forms B

99082 Unusual physician

travel B

99090 Computer data

analysis B

99091 Collect/review data from

pt N

99100 Special anesthesia

service B

99116 Anesthesia with

hypothermia B

99135 Special anesthesia

procedure B

99140 Emergency

anesthesia B

99143 Mod cs by same phys < 5

yrs N99144 Mod cs by same phys 5 yrs

+ N

99145 Mod cs by same phys

add-on N

99148 Mod cs diff phys < 5

yrs N

99149 Mod cs diff phys 5 yrs

+ N

99150 Mod cs diff phys

add-on N

99170 Anogenital exam

child T 0191 0.1337 $9.36 $1.95 $1.88

99172 Ocular function

screen E

99173 Visual acuity

screen E

99174 Ocular

photoscreening E

99175 Induction of

vomiting N

99183 Hyperbaric oxygen

therapy B

99190 Special pump

services C

99191 Special pump

services C

99192 Special pump

services C

99195 Phlebotomy X 0624 0.6068 $42.49 $12.33 $8.50

99199 Special

service/proc/report B

99201 Office/outpatient visit

new V 0604 0.7689 $53.84

. $10.77

99202 Office/outpatient visit

new V 0605 1.0311 $72.19

. $14.44

99203 Office/outpatient visit

new V 0606 1.3588 $95.14

. $19.03

99204 Office/outpatient visit

new V 0607 1.8647 $130.56

. $26.1299205 Office/outpatient visit

new Q3 0608 2.5237 $176.70

. $35.34

99211 Office/outpatient visit

est V 0604 0.7689 $53.84

. $10.77

99212 Office/outpatient visit

est V 0605 1.0311 $72.19

. $14.44

99213 Office/outpatient visit

est V 0605 1.0311 $72.19

. $14.44

99214 Office/outpatient visit

est V 0606 1.3588 $95.14

. $19.03

99215 Office/outpatient visit

est Q3 0607 1.8647 $130.56

. $26.12

99217 Observation care

discharge B

99218 Initial observation

care B

99219 Initial observation

care B

99220 Initial observation

care B

99221 Initial hospital

care B

99222 Initial hospital

care B

99223 Initial hospital

care B

99224 Subsequent observation

care B

99225 Subsequent observation

care B

99226 Subsequent observation

care B

99231 Subsequent hospital

care B

99232 Subsequent hospital

care B

99233 Subsequent hospital

care B

99234 Observ/hosp same

date B99235 Observ/hosp same

date B

99236 Observ/hosp same

date B

99238 Hospital discharge

day B

99239 Hospital discharge

day B

99241 Office

consultation E

99242 Office

consultation E

99243 Office

consultation E

99244 Office

consultation E

99245 Office

consultation E

99251 Inpatient

consultation E

99252 Inpatient

consultation E

99253 Inpatient

consultation E

99254 Inpatient

consultation E

99255 Inpatient

consultation E

99281 Emergency dept

visit V 0609 0.7181 $50.28 $12.04 $10.06

99282 Emergency dept

visit V 0613 1.2356 $86.51 $20.79 $17.31

99283 Emergency dept

visit V 0614 1.9447 $136.16 $33.59 $27.24

99284 Emergency deptvisit Q3 0615 3.1277 $218.99 $47.70 $43.80

99285 Emergency dept

visit Q3 0616 4.6152 $323.14 $71.44 $64.63

99288 Direct advanced life

support B

99291 Critical care first

hour Q3 0617 6.6453 $465.28 $104.95 $93.06

99292 Critical care addl 30

min N

99304 Nursing facility care

init B

99305 Nursing facility care

init B

99306 Nursing facility care

init B

99307 Nursing fac care

subseq B

99308 Nursing fac care

subseq B

99309 Nursing fac care

subseq B

99310 Nursing fac care

subseq B

99315 Nursing fac discharge

day B

99316 Nursing fac discharge

day B

99318 Annual nursing fac

assessmnt B

99324 Domicil/r-home visit new

pat B

99325 Domicil/r-home visit new

pat B

99326 Domicil/r-home visit new

pat B

99327 Domicil/r-home visit new

pat B

99328 Domicil/r-home visit new

pat B

99334 Domicil/r-home visit est

pat B

99335 Domicil/r-home visit estpat B

99336 Domicil/r-home visit est

pat B

99337 Domicil/r-home visit est

pat B

99339 Domicil/r-home care

supervis B

99340 Domicil/r-home care

supervis B

99341 Home visit new

patient B

99342 Home visit new

patient B

99343 Home visit new

patient B

99344 Home visit new

patient B

99345 Home visit new

patient B

99347 Home visit est

patient B

99348 Home visit est

patient B

99349 Home visit est

patient B

99350 Home visit est

patient B

99354 Prolonged service

office N

99355 Prolonged service

office N

99356 Prolonged service

inpatient C

99357 Prolonged service

inpatient C

99358 Prolong service w/o

contact N

99359 Prolong serv w/o contact

add N

99360 Physician standby

services B

99363 Anticoag mgmt

init B

99364 Anticoag mgmtsubseq B

99366 Team conf w/pat by hc

pro N

99367 Team conf w/o pat by

phys N

99368 Team conf w/o pat by hc

pro N

99374 Home health care

supervision B

99375 Home health care

supervision E

99377 Hospice care

supervision B

99378 Hospice care

supervision E

99379 Nursing fac care

supervision B

99380 Nursing fac care

supervision B

99381 Init pm e/m new pat

inf E

99382 Init pm e/m new pat 1-4

yrs E

99383 Prev visit new age

5-11 E

99384 Prev visit new age

12-17 E

99385 Prev visit new age

18-39 E

99386 Prev visit new age

40-64 E

99387 Init pm e/m new pat 65+

yrs E

99391 Per pm reeval est pat

inf E

99392 Prev visit est age

1-4 E

99393 Prev visit est age

5-11 E

99394 Prev visit est age12-17 E

99395 Prev visit est age

18-39 E

99396 Prev visit est age

40-64 E

99397 Per pm reeval est pat 65+

yr E

99401 Preventive counseling

indiv E

99402 Preventive counseling

indiv E

99403 Preventive counseling

indiv E

99404 Preventive counseling

indiv E

99406 Behav chng smoking 3-10

min X 0031 0.2988 $20.92

. $4.19

99407 Behav chng smoking > 10

min X 0031 0.2988 $20.92

. $4.19

99408 Audit/dast 15-30

min E

99409 Audit/dast over 30

min E

99411 Preventive counseling

group E

99412 Preventive counseling

group E

99420 Health risk assessment

test E

99429 Unlisted preventive

service E

99441 Phone e/m by phys 5-10

min E

99442 Phone e/m by phys 11-20

min E

99443 Phone e/m by phys 21-30

min E

99444 Online e/m by

phys E

99450 Basic life disability

exam E

99455 Work related disability

exam B99456 Disability

examination B

99460 Init nb em per day

hosp V 0605 1.0311 $72.19

. $14.44

99461 Init nb em per day

non-fac M

99462 Sbsq nb em per day

hosp C

99463 Same day nb

discharge V 0605 1.0311 $72.19

. $14.44

99464 Attendance at

delivery N

99465 Nb

resuscitation S 0094 2.2326 $156.32 $43.83 $31.27

99466 Ped crit care

transport N

99467 Ped crit care transport

addl N

99468 Neonate crit care

initial C

99469 Neonate crit care

subsq C

99471 Ped critical care

initial C

99472 Ped critical care

subsq C

99475 Ped crit care age 2-5

init C

99476 Ped crit care age 2-5

subsq C

99477 Init day hosp neonate

care C

99478 Ic lbw inf < 1500 gm

subsq C

99479 Ic lbw inf 1500-2500 g

subsq C

99480 Ic inf pbw 2501-5000 g

subsq C

99499 Unlisted e&m

service B

99500 Home visitprenatal E

99501 Home visit

postnatal E

99502 Home visit nb

care E

99503 Home visit resp

therapy E

99504 Home visit mech

ventilator E

99505 Home visit stoma

care E

99506 Home visit im

injection E

99507 Home visit cath

maintain E

99509 Home visit day life

activity E

99510 Home visit sing/m/fam

couns E

99511 Home visit fecal/enema

mgmt E

99512 Home visit for

hemodialysis E

99600 Home visit

nos E

99601 Home infusion/visit 2

hrs E

99602 Home infusion each addtl

hr E

99605 Mtms by pharm np 15

min E

99606 Mtms by pharm est 15

min E

99607 Mtms by pharm addl 15

min E

0001F Heart failure

composite E

0005F Osteoarthritis

composite E

0012F Cap bacterial

assess E

0014F Comp preop assess cat

surg E0015F Melan follow-up

complete E

0019T Extracorp shock wv tx ms

nos A

0030T Antiprothrombin

antibody A

0042T Ct perfusion w/contrast

cbf N

0048T Implant ventricular

device C

0050T Removal circulation

assist C

0051T Implant total heart

system C

0052T Replace component heart

syst C

0053T Replace component heart

syst C

0054T Bone surgery using

computer N

0055T Bone surgery using

computer N

0058T Cryopreservation ovary

tiss X 0344 0.8180 $57.27 $15.56 $11.46

0059T Cryopreservation

oocyte X 0344 0.8180 $57.27 $15.56 $11.46

0071T U/s leiomyomata ablate

<200 S 0067 48.1833 "$3,373.60"

. $674.72

0072T U/s leiomyomata ablate

>200 S 0067 48.1833 "$3,373.60"

. $674.72

0073T Delivery comp

imrt S 0412 6.5452 $458.27

. $91.66

0075T Perq stent/chest vert

art C

0076T S&i stent/chest vert

art C

0078T Endovasc aort repr

w/device C

0079T Endovasc visc extnsn

repr C

0080T Endovasc aort repr rads&i C

0081T Endovasc visc extnsn

s&i C

0085T Breath test heart

reject E

0092T Artific disc

addl C

0095T Artific diskectomy

addl C

0098T Rev artific disc

addl C

0099T Implant corneal

ring CH T 0234 23.2851 "$1,630.33" $347.90 $326.07

0100T Prosth retina

receive&gen T 0672 41.0159 "$2,871.77"

. $574.36

0101T Extracorp shockwv tx hi

enrg T 0050 32.4461 "$2,271.75"

. $454.35

0102T Extracorp shockwv tx

anesth T 0050 32.4461 "$2,271.75"

. $454.35

0103T Holotranscobalamin A

0106T Touch quant sensory

test X 0341 0.0806 $5.64 $2.09 $1.13

0107T Vibrate quant sensory

test X 0341 0.0806 $5.64 $2.09 $1.13

0108T Cool quant sensory

test X 0341 0.0806 $5.64 $2.09 $1.13

0109T Heat quant sensory

test X 0341 0.0806 $5.64 $2.09 $1.13

0110T Nos quant sensory

test X 0341 0.0806 $5.64 $2.09 $1.13

0111T Rbc membranes fatty

acids A

0123T Scleral

fistulization T 0234 23.2851 "$1,630.33" $347.90 $326.07

0124T Conjunctival drug

placement T 0232 2.8247 $197.77 $42.27 $39.560126T Chd risk imt

study Q1 0340 0.6499 $45.50

. $9.10

0141T Perq islet

transplant CH D

0142T Open islet

transplant CH D

0143T Laparoscopic islet

transplnt CH D

0155T Lap impl gast curve

electrd CH D

0156T Lap remv gast curve

electrd CH D

0157T Open impl gast curve

electrd CH D

0158T Open remv gast curve

electrd CH D

0159T Cad breast

mri N

0163T Lumb artif diskectomy

addl C

0164T Remove lumb artif disc

addl C

0165T Revise lumb artif disc

addl C

0166T Tcath vsd close w/o

bypass CH D

0167T Tcath vsd close

w/bypass CH D

0168T Rhinophototx light app

bilat CH D

0169T Place stereo cath

brain C

0171T Lumbar spine proces

distract T 0052 88.8483 "$6,220.80"

. "$1,244.16"

0172T Lumbar spine process

addl T 0052 88.8483 "$6,220.80"

. "$1,244.16"

0173T Iop monit io

pressure N

0174T Cad cxr with

interp N0175T Cad cxr

remote N

0178T 64 lead ecg

w/i&r B

0179T 64 lead ecg

w/tracing X 0100 2.5439 $178.11 $41.37 $35.63

0180T 64 lead ecg w/i&r

only B

0181T Corneal

hysteresis S 0230 0.6424 $44.98

. $9.00

0182T Hdr elect

brachytherapy S 0313 9.9687 $697.97 $263.92 $139.60

0183T Wound

ultrasound T 0015 1.4966 $104.79

. $20.96

0184T Exc rectal tumor

endoscopic CH T 0149 24.4382 "$1,711.07"

. $342.22

0185T Comptr probability

analysis N

0186T Suprachoroidal drug

delivery T 0237 21.5368 "$1,507.92"

. $301.59

0188T Videoconf crit care 74

min M

0189T Videoconf crit care addl

30 M

0190T Place intraoc radiation

src T 0237 21.5368 "$1,507.92"

. $301.59

0191T Insert ant segment drain

int T 0673 41.5778 "$2,911.11" $634.95 $582.23

0192T Insert ant segment drain

ext T 0673 41.5778 "$2,911.11" $634.95 $582.23

0195T Arthrod presac

interbody C

0196T Arthrod presac interbody

eac C

0197T Intrafraction track

motion N

0198T Ocular blood flow

measure CH S 0698 1.0589 $74.14

. $14.830199T Physiologic tremor

record S 0215 0.6335 $44.36

. $8.88

0200T Perq sacral augmt unilat

inj CH T 0050 32.4461 "$2,271.75"

. $454.35

0201T Perq sacral augmt bilat

inj T 0050 32.4461 "$2,271.75"

. $454.35

0202T Post vert arthrplst 1

lumbar C

0205T Inirs each vessel

add-on N

0206T Remote algorithm analys

ecg Q1 0340 0.6499 $45.50

. $9.10

0207T Clear eyelid gland

w/heat S 0230 0.6424 $44.98

. $9.00

0208T Audiometry air

only X 0035 0.2673 $18.72

. $3.75

0209T Audiometry air &

bone X 0035 0.2673 $18.72

. $3.75

0210T Speech audiometry

threshold X 0035 0.2673 $18.72

. $3.75

0211T Speech audiom thresh &

recog X 0035 0.2673 $18.72

. $3.75

0212T Compre audiometry

evaluation CH X 0365 1.2175 $85.24 $18.05 $17.05

0213T Njx paravert w/us

cer/thor T 0207 7.4537 $521.88

. $104.38

0214T Njx paravert w/us

cer/thor T 0204 2.6055 $182.43

. $36.49

0215T Njx paravert w/us

cer/thor T 0204 2.6055 $182.43

. $36.49

0216T Njx paravert w/us

lumb/sac T 0207 7.4537 $521.88

. $104.38

0217T Njx paravert w/us

lumb/sac T 0204 2.6055 $182.43

. $36.490218T Njx paravert w/us

lumb/sac T 0204 2.6055 $182.43

. $36.49

0219T Plmt post facet implt

cerv C

0220T Plmt post facet implt

thor C

0221T Plmt post facet implt

lumb T 0050 32.4461 "$2,271.75"

. $454.35

0222T Plmt post facet implt

addl T 0050 32.4461 "$2,271.75"

. $454.35

0223T Acoustic ecg

w/i&r S 0099 0.3817 $26.73

. $5.35

0224T Acoustic ecg 1+

analysis S 0690 0.4928 $34.50

. $6.90

0225T Acoustic ecg analy &

reprog S 0690 0.4928 $34.50

. $6.90

0226T Anoscopy hra w/spec

collect X 0340 0.6499 $45.50

. $9.10

0227T Anoscopy hra

w/biopsy T 0146 6.2205 $435.53

. $87.11

0228T Njx tfrml eprl w/us

cer/thor T 0207 7.4537 $521.88

. $104.38

0229T Njx tfrml eprl w/us

cer/thor T 0206 3.8754 $271.34

. $54.27

0230T Njx tfrml eprl w/us

lumb/sac T 0207 7.4537 $521.88

. $104.38

0231T Njx tfrml eprl w/us

lumb/sac T 0206 3.8754 $271.34

. $54.27

0232T Njx platelet

plasma X 0340 0.6499 $45.50

. $9.10

0233T Skin glycation

spectroscopy A

0234T Trluml perip athrc renal

art T 0082 105.0651 "$7,356.24"

. "$1,471.25"0235T Trluml perip athrc

visceral C

0236T Trluml perip athrc abd

aorta T 0082 105.0651 "$7,356.24"

. "$1,471.25"

0237T Trluml perip athrc

brchiocph T 0082 105.0651 "$7,356.24"

. "$1,471.25"

0238T Trluml perip athrc iliac

art T 0082 105.0651 "$7,356.24"

. "$1,471.25"

0239T Bioimpedance

spectroscopy CH S 0097 0.9350 $65.46

. $13.10

0240T Esoph motility 3d

topography X 0361 4.0827 $285.85 $83.23 $57.17

0241T Esoph motility

w/stim/perf X 0361 4.0827 $285.85 $83.23 $57.17

0242T Gi tract transit & pres

meas X 0361 4.0827 $285.85 $83.23 $57.17

0243T Intm msr bronchodil

wheeze S 0078 1.4089 $98.65

. $19.73

0244T Cont msr bronchodil

wheeze X 0369 2.6868 $188.12 $38.23 $37.63

0245T Open tx rib fx 1-2

ribs T 0062 26.1202 "$1,828.83" $372.85 $365.77

0246T Opn tx rib fx 3-4

ribs T 0062 26.1202 "$1,828.83" $372.85 $365.77

0247T Opn tx rib fx 5-6

ribs T 0062 26.1202 "$1,828.83" $372.85 $365.77

0248T Open tx rib fx 7/>

ribs T 0062 26.1202 "$1,828.83" $372.85 $365.77

0249T Ligation hemorrhoid

w/us T 0155 15.4175 "$1,079.47"

. $215.90

0250T Insert bronchial

valve T 0415 28.9051 "$2,023.82" $459.92 $404.77

0251T Remov bronchialvalve T 0076 10.4689 $732.99 $189.82 $146.60

0252T Remov bronch valve

addl T 0076 10.4689 $732.99 $189.82 $146.60

0253T Insert aqueous drain

device CH T 0673 41.5778 "$2,911.11" $634.95 $582.23

0254T Evasc rpr iliac art

bifur C

0255T Evasc rpr iliac art bifr

s&i C

0256T Evasc aortic hrt

valve C

0257T Opn tthrc aortic hrt

valve C

0258T Aortic hrt valv w/o card

byp C

0259T Aortic hrt valve w/card

byp C

0260T Hypthrm bdy neonate

28d/< N

0261T Hypthrm head neonate

28d/< N

0262T Impltj pulm vlv evasc

appr C

0263T Im B1 mrw cel ther

cmpl S 0112 35.6252 "$2,494.33"

. $498.87

0264T Im B1 mrw cel ther xcl

hrvst S 0112 35.6252 "$2,494.33"

. $498.87

0265T Im B1 mrw cel ther hrvst

onl S 0112 35.6252 "$2,494.33"

. $498.87

0266T Implt/rpl crtd sns dev

total C

0267T Implt/rpl crtd sns dev

lead T 0687 20.7198 "$1,450.72" $385.30 $290.15

0268T Implt/rpl crtd sns dev

gen S 0039 216.9330 "$15,188.78"

. "$3,037.76"

0269T Rev/remvl crtd sns dev

total T 0221 36.1290 "$2,529.61"

. $505.93

0270T Rev/remvl crtd sns devlead T 0687 20.7198 "$1,450.72" $385.30 $290.15

0271T Rev/remvl crtd sns dev

gen T 0688 31.1002 "$2,177.51" $768.94 $435.51

0272T Interrogate crtd sns

dev S 0218 1.2025 $84.19

. $16.84

0273T Interrogate crtd sns

w/pgrmg S 0218 1.2025 $84.19

. $16.84

0274T Perq lamot/lam

crv/thrc T 0208 50.7343 "$3,552.21"

. $710.45

0275T Perq lamot/lam

lumbar T 0208 50.7343 "$3,552.21"

. $710.45

0276T Bronch thermoplasty 1

lobe NI T 0415 28.9051 "$2,023.82" $459.92 $404.77

0277T Bronch thermoplasty

lobes NI T 0415 28.9051 "$2,023.82" $459.92 $404.77

0278T Tempr NI S 0215 0.6335 $44.36

. $8.88

0279T Ctc

test NI X 0342 0.1601 $11.21

. $2.25

0280T Ctc test w/i &

r NI X 0342 0.1601 $11.21

. $2.25

0281T Laa closure

w/implant NI C

0282T Periph field stimul

trial NI S 0040 63.3729 "$4,437.12"

. $887.43

0283T Periph field stimul

perm NI S 0318 346.4693 "$24,258.39" "$9,121.76" "$4,851.68"

0284T Periph field stimul

revise NI T 0687 20.7198 "$1,450.72" $385.30 $290.15

0285T Periph field stimul

analys NI S 0218 1.2025 $84.19

. $16.84

0286T Near ifr spectrsc of

wounds NI N

0287T Near ifr guide of vascsite NI N

0288T Anoscopy w/rf

delivery NI T 0148 5.5158 $386.19

. $77.24

0289T Laser inc for pkp/lkp

donor NI N

0290T Laser inc for pkp/lkp

recip NI N

0291T Iv oct for proc init

vessel NI N

0292T Iv oct for proc addl

vessel NI N

0293T Ins lt atrl press

monitor NI C

0294T Ins lt atrl press mont

addon NI C

0295T Ext ecg

complete NI M

0296T Ext ecg

recording NI S 0097 0.9350 $65.46

. $13.10

0297T Ext ecg scan

w/report NI S 0097 0.9350 $65.46

. $13.10

0298T Ext ecg review and

interp NI M

0299T Esw wound healing init

wound NI X 0340 0.6499 $45.50

. $9.10

0300T Esw wound healing addl

wound NI X 0340 0.6499 $45.50

. $9.10

0301T Mw therapy for breast

tumor NI S 0065 12.8903 $902.53

. $180.51

0500F Initial prenatal care

visit E

0501F Prenatal flow

sheet E

0502F Subsequent prenatal

care E

0503F Postpartum care

visit E

0505F Hemodialysis plan

docd CH E

0507F Periton dialysis plandocd CH E

0509F Urine incon plan

docd M

0513F Elev bp plan of care

docd M

0514F Care plan hgb docd esa

pt CH E

0516F Anemia plan of care

docd E

0517F Glaucoma plan of care

docd M

0518F Fall plan of care

docd M

0519F Pland chemo docd b/4

txmnt E

0520F Rad dos limts b/4 3d

rad M

0521F Plan of care 4 pain

docd M

0525F Initial visit for

episode E

0526F Subs visit for

episode M

0528F Rcmnd flw-up 10 yrs

docd E

0529F Intrvl 3+yrs pts clnscp

docd M

0535F Dyspnea mngmnt plan

docd E

0540F Gluco mngmnt plan

docd M

0545F Follow up care plan mdd

docd E

0550F Cytopath report nongyn

spcmn NI E

0551F Cytopath report non routine

NI E

0555F Symptom mgmnt plan care

docd NI E

0556F Plan care lipid control docd

NI M

0557F Plan caremng angnl

symptdocd NI M0575F HIV rna plan care

docd M

1000F Tobacco use

assessed E

1002F Assess anginal

symptom/level CH E

1003F Level of activity

assess E

1004F Clin symp vol ovrld

assess E

1005F Asthma symptoms

evaluate CH E

1006F Osteoarthritis

assess M

1007F Anti-inflm/anlgsc otc

assess M

1008F Gi/renal risk

assess E

1010F Severity angina by

actvty NI M

1011F Angina present

NI M

1012F Angina absent

NI M

1015F Copd symptoms

assess E

1018F Assess dyspnea not

present E

1019F Assess dyspnea

present E

1022F Pneumo imm status

assess E

1026F Co-morbid condition

assess E

1030F Influenza imm status

assess E

1031F Smoking & 2nd hand assessed

NI M

1032F Smoker/exposed 2nd hnd

smoke NI M

1033F Tobacco nonsmoker nor

2ndhnd NI M

1034F Current tobacco

smoker E1035F Smokeless tobacco

user E

1036F Tobacco

non-user M

1038F Persistent

asthma M

1039F Intermittent

asthma M

1040F Dsm-iv info mdd

docd M

1050F History of mole

changes E

1052F Type location activity

asses NI M

1055F Visual funct status

assess E

1060F Doc perm/cont/parox atr

fib E

1061F Doc lack perm+cont+parox

fib E

1065F Ischm stroke symp lt3

hrsb/4 E

1066F Ischm stroke symp ge3

hrsb/4 E

1070F Alarm symp

assessed-absent E

1071F Alarm symp assessed-1+

prsnt E

1090F Pres/absn urine incon

assess M

1091F Urine incon

characterized M

1100F Ptfalls assess-docd

ge2+/yr M

1101F Pt falls assess-docd

le1/yr M

1110F Pt lft inpt fac w/in 60

days M

1111F Dschrg med/current med

merge M

1116F Auric/peri pain

assessed M1118F GERD symps assessed 12

month E

1119F Init eval for

condition M

1121F Subs eval for

condition M

1123F Acp discuss/dscn mkr

docd M

1124F Acp discuss-no dscnmkr

docd M

1125F Amnt pain noted pain

prsnt M

1126F Amnt pain noted none

prsnt M

1127F New episode for condition

E

1128F Subs episode for condition

E

1130F Bk pain + fxn

assessed M

1134F Epsd bk pain for =< 6

wks E

1135F Epsd bk pain for > 6

wks E

1136F Epsd bk pain for <= 12

wks E

1137F Epsd bk pain for > 12

wks E

1150F Doc pt rsk death w/in

1yr E

1151F Doc no pt rsk death w/in

1yr E

1152F Doc advncd dis comfort

1st E

1153F Doc advncd dis cmfrt not

1st E

1157F Advnc care plan in

rcrd E

1158F Advnc care plan tlk

docd M

1159F Med list docd in

rcrd E

1160F Rvw meds by rx/dr in

rcrd E1170F Fxnl status

assessed M

1175F Function stat assessed

rvwd NI M

1180F Thromboemb risk

assessed E

1181F Neuropsychia sympts assessed

NI M

1182F Neuropsychi sympt

1+present NI E

1183F Neuropsychiatric symp

absent NI E

1200F Seizure type& frequ

docd CH M

1205F EPI etiol synd rvwd and

docd CH M

1220F Pt screened for

depression CH M

1400F Prkns diag

rviewed CH M

1450F Symptoms improved/consist

NI E

1451F Sympt show clin import drop

NI E

1460F Qual card diag prior 12 mons

NI M

1461F No qual card diag

prior12mon NI M

1490F Dem severity classified

mild NI M

1491F Dem severity classified

mod NI M

1493F Dem severity class

severe NI M

1494F Cognit assessed and reviewed

NI M

2000F Blood pressure

measure M

2001F Weight

record E

2002F Clin sign vol ovrld

assess E2004F Initial exam involved

joints E

2010F Vital signs

recorded M

2014F Mental status

assess M

2015F Asthma impairment assessed

NI M

2016F Asthma risk assessed

NI M

2018F Hydration status

assess E

2019F Dilated macul exam

done M

2020F Dilated fundus eval

done E

2021F Dilat macul+ exam

done M

2022F Dil retina exam interp

rev M

2024F 7 field photo interp doc

rev M

2026F Eye image valid to dx

rev M

2027F Optic nerve head eval

done M

2028F Foot exam

performed M

2029F Complete phys skin exam

done E

2030F H2o stat docd

normal E

2031F H2o stat docd

dehydrated E

2035F Tymp memb motion

examd M

2040F Bk pn xm on init visit

date M

2044F Doc mntl tst b/4 bk

trxmnt E

2050F Wound char size etc

docd E

2060F Pt talk eval hlthwkr re

mdd E3006F Cxr doc

rev E

3008F Body mass index

docd E

3011F Lipid panel doc

rev E

3014F Screen mammo doc

rev M

3015F Cerv cancer screen

docd E

3016F Pt scrnd unhlthy OH

use M

3017F Colorectal ca screen doc

rev M

3018F Pre-prxd rsk et al

docd E

3019F Lvef assess planpost dschrge

NI E

3020F Lvf

assess CH E

3021F Lvef mod/sever deprs

syst M

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

copd M

3028F O2 saturation doc

rev M

3035F O2 saturation<=88%

/pao<=55 E

3037F O2 saturation> 88%

/pao>55 E

3038F Pulm fx w/in 12 mon b/4

surg M

3040F Fev<40% predicted

value E

3042F Fev>=40% predicted

value E

3044F Hg a1c level lt

7.0% M3045F Hg a1c level

7.0-9.0% M

3046F Hemoglobin a1c level >

9.0% M

3048F Ldl-c <100

mg/dl M

3049F Ldl-c 100-129

mg/dl M

3050F Ldl-c >= 130

mg/dl M

3055F Lvef less than/equal to

35% NI E

3056F Lvef greater than

35% NI E

3060F Pos microalbuminuria

rev M

3061F Neg microalbuminuria

rev M

3062F Pos macroalbuminuria

rev M

3066F Nephropathy doc

tx M

3072F Low risk for

retinopathy M

3073F Pre-surg eye measures

docd E

3074F Syst bp lt 130 mm

hg M

3075F Syst bp ge 130 - 139mm

hg M

3077F Syst bp >= 140 mm

hg M

3078F Diast bp < 80 mm

hg M

3079F Diast bp 80-89 mm

hg M

3080F Diast bp >= 90 mm

hg M

3082F Kt/v

<1.2 CH E

3083F Kt/v > 1.2

<1.7 CH E

3084F Kt/v ge

1.7 CH E3085F Suicide risk

assessed M

3088F Mdd

mild E

3089F Mdd

moderate E

3090F Mdd severe w/o

psych E

3091F Mdd severe

w/psych E

3092F Mdd in

remission M

3093F Doc new diag 1st/addl

mdd E

3095F Central dexa results

docd M

3096F Central dexa

ordered M

3100F Image test ref carot

diam M

3110F Pres/absn hmrhg/lesion

docd M

3111F Ct/mri brain done w/in

24hrs M

3112F Ct/mri brain done >24

hrs M

3115F Quant results activity +symp

NI E

3117F Hf assessment tool completed

NI E

3118F Ny heart assoc class docd

NI E

3119F No eval activity clin symp

NI E

3120F 12-lead ecg

performed M

3125F Esoph bx rprt w/dyspl

info NI M

3130F Upper gi endoscopy

performed E

3132F Doc ref upper gi

endoscopy E

3140F Upper gi endo shows

barrtts E3141F Upper gi endo not

barrtts E

3142F Barium swallow test

ordered E

3150F Forceps esoph biopsy

done E

3155F Cytogen test marrow b/4

tx M

3160F Doc fe+ stores b/4 epo

thx M

3170F Flow cyto done b/4

tx M

3200F Barium swallow test not

req E

3210F Grp a strep test

performed M

3215F Pt immunity to hep a

docd M

3216F Pt immunity to hep b

docd M

3218F Rna tstng hep c docd

done M

3220F Hep c quant rna tstng

docd M

3230F Note hring tst w/in 6

mon E

3250F Nonprim loc anat bx site

tum M

3260F Pt cat/pn cat/hist grd

docd M

3265F Rna tstng hepc vir

ord/docd M

3266F Hepc gn tstng docd

b/4txmnt M

3267F path rprt w/ pt pn cat et

al NI M

3268F Psa/t/glsc docd b/4

txmnt E

3269F Bone scn b/4 txmnt/aftr

Dx M

3270F No bone scn b/4

txmnt/aftrDx M

3271F Low risk prostatecancer M

3272F Med risk prostate

cancer M

3273F High risk prostate

cancer M

3274F Prost Cncr rsk not

lw/md/hgh M

3278F Serum lvls CA/iPTH/lpd

ord CH E

3279F Hgb lvl >/= 13

g/dl CH E

3280F Hgb lvl 11-12.9

g/dL CH E

3281F Hgb lvl < 11

g/dl CH E

3284F Iop down >15% of pre-svc

lvl M

3285F IOP down <15% of pre-svc

lvl M

3288F Fall risk assessment

docd M

3290F Pt=D(Rh)- and

unsensitized E

3291F Pt=d(rh)+ or

sensitized E

3292F Hiv tstng

asked/docd/revwd E

3293F Abo rh blood typing

docd E

3294F Grp b strep screening

docd E

3300F AJCC stage docd b/4

thxpy M

3301F Cancer stage docd

metast M

3315F Er+ or pr+ breast

cancer M

3316F ER- or PR- breast

cancer M

3317F Path rpt malig cancer

docd E

3318F Path rpt malig cancer

docd E3319F X-ray/ct/ultrsnd et al

ord M

3320F No xray/ct/ et al

ordd M

3321F AJCC cncr 0/IA melan

docd M

3322F Melanoma>ajcc stage 0 or

ia M

3323F Clin node stgng docdb/4

surg M

3324F Mri ct scan ord rvwd

rqstd E

3325F Preop asses 4 cataract

surg E

3328F Prfrmnc docd 2 wks b/4

surg M

3330F Imaging study ordered

(bkp) E

3331F Bk imaging tst not

ordered E

3340F Mammo assess inc xray

docd M

3341F Mammo assess negative

docd M

3342F Mammo assess bengn

docd M

3343F Mammo probably bengn

docd M

3344F Mammo assess susp

docd M

3345F Mammo assess hghlymalig

doc M

3350F Mammo bx proven malig

docd M

3351F Neg scrn dep symp by

deptool E

3352F No sig dep symp by dep

tool E

3353F Mild-mod dep symp by

deptool E

3354F Clin sig dep sym by dep

tool E

3370F AJCC brst cncr stage 0

docd M3372F Ajcc brst cncr stage 1

docd M

3374F Ajcc brst cncr stage 1

docd M

3376F AJCC brstcncr stage 2

docd M

3378F AJCC brstcncr stage 3

docd M

3380F AJCC brstcncr stage 4

docd M

3382F AJCC cln cncr stage 0

docd M

3384F AJCC cln cncr stage 1

docd M

3386F AJCC cln cncr stage 2

docd M

3388F AJCC cln cncr stage 3

docd M

3390F AJCC cln cncr stage 4

docd M

3394F Quant her2 ihc eval brst

cx NI M

3395F Quant nonher2 ihc brst

cx NI M

3450F Dyspnea scrnd no-mild

dysp E

3451F Dyspnea scrnd mod-high

dysp E

3452F Dyspnea not

screened E

3455F TB scrng done-interpd

6mon M

3470F Ra disease activity

low M

3471F Ra disease activity

mod M

3472F Ra disease activity

high M

3475F Disease progn RA poor

docd M

3476F Disease progn RA good

docd M

3490F History aids-defining

cond M3491F HIV unsure baby of

HIV+moms E

3492F History cd4+ cell count

<350 M

3493F No hist cd4+ cell

count<350 M

3494F CD4+cell count

<200cells/mm3 M

3495F Cd4+cell cnt 200-499

cells M

3496F Cd4+ cell count + 500

cells M

3497F CD4+ cell percentage

<15% E

3498F Cd4+ cell >=15%

(hiv) E

3500F Cd4+cell cnt/% docd as

done M

3502F HIV rna vrl ld <lmts

quantif M

3503F HIV rna vrl ldnot<lmts

quntf M

3510F Doc tb scrng-rslts

interpd CH M

3511F Chlmyd/gonrh tsts docd

done M

3512F Syph scrng docd as

done M

3513F Hep B scrng docd as

done E

3514F Hep C scrng docd as

done E

3515F Pt has docd immun to hep

C E

3517F Hbv assess&results intrp

1yr NI M

3520F Cdifficile testing

performe NI E

3550F Low rsk

thromboembolism E

3551F Intrmed rsk

thromboembolism E3552F Hgh risk for

thromboembolism E

3555F Pt inr measurement

performed E

3570F Rprt bone scint xref w

xray M

3572F Pt consid poss risk

fx E

3573F Pt not consid poss risk

fx E

3650F Eeg ordered rvwd

reqstd E

3700F Psych disorders

assessed CH M

3720F Cognit impairment

assessed CH M

3725F Screen depression

performed NI M

3750F Ptnotrcvngsteroid>/=10mg/day NI M

4000F Tobacco use txmnt

counseling NI M

4001F Tobacco use txmnt

pharmacol M

4002F Statin therapy

rx CH D

4003F Pt ed write/oral pts w/

hf CH E

4004F Pt tobacco screen rcvd

tlk M

4005F Pharm thx for op

rxd M

4006F Beta-blocker therapy

rx CH D

4008F Beta-blocker therapy

rxd/tkn NI M

4009F Ace/arb inhibitor therapy

rx CH D

4010F ACE/ARB therapy

rxd/taken NI M

4011F Oral antiplatelet therapyrx CH E

4012F Warfarin therapy

rx M

4013F Statin therapy/currently

tkn NI M

4014F Written discharge instr

prvd E

4015F Persist asthma medicine

ctrl CH E

4016F Anti-inflm/anlgsc agent

rx E

4017F Gi prophylaxis for nsaid

rx E

4018F Therapy exercise joint

rx E

4019F Doc recpt counsl vit

d/calc+ E

4025F Inhaled bronchodilator

rx M

4030F Oxygen therapy

rx E

4033F Pulmonary rehab

rec E

4035F Influenza imm

rec CH M

4037F Influenza imm

order/admin M

4040F Pneumoc

vac/admin/rcvd M

4041F Doc order

cefazolin/cefurox M

4042F Doc antibio not

given M

4043F Doc order given stop

antibio M

4044F Doc order given vte

prophylx M

4045F Empiric antibiotic

rx M

4046F Doc antibio given b/4

surg M

4047F Doc antibio given b/4surg M

4048F Doc antibio given b/4

surg M

4049F Doc order given stop

antibio M

4050F Ht care plan

doc CH E

4051F Referred for an AV

fistula CH E

4052F Hemodialysis via AV

fistula E

4053F Hemodialysis via AV

graft E

4054F Hemodialysis via

catheter E

4055F Pt rcvng periton

dialysis E

4056F Approp oral rehyd

recommd E

4058F Ped gastro ed given

caregvr E

4060F Psych svcs

provided E

4062F Pt referral psych

docd E

4063F Antidepres rxthxpy not

rxd E

4064F Antidepressant

rx E

4065F Antipsychotic

rx E

4066F ECT

provided E

4067F Pt referral for ect

docd E

4069F Vte prophylaxis

rcvd NI E

4070F Dvt prophylx recvd day

2 M

4073F Oral antiplat thx rx

dischrg CH E

4075F Anticoag thx rx at

dischrg M

4077F Doc t-pa adminconsidered E

4079F Doc rehab svcs

considered CH E

4084F Aspirin recvd w/in 24

hrs M

4086F Aspirin/clopidogrel

rxd NI M

4090F Pt rcvng epo

thxpy M

4095F Pt not rcvng epo

thxpy M

4100F Biphos thxpy vein

ord/recvd M

4110F Int mam art used for

cabg M

4115F Beta blckr admin w/in 24

hrs M

4120F Antibiot

rxd/given M

4124F Antibiot not

rxd/given M

4130F Topical prep rx

aoe M

4131F Syst antimicrobial thx

rx M

4132F No syst antimicrobial thx

rx M

4133F Antihist/decong

rx/recom E

4134F No antihist/decong

rx/recom E

4135F Systemic corticosteroids

rx E

4136F Syst corticosteroids not

rx E

4140F Inhaled corticosteroids

rxd NI M

4142F Corticoster sparng txmnt

rxd NI M

4144F Alt long-term cntrl med

rxd NI M

4145F 2+ anti-hyprtnsv agents tkn

NI M4148F Hep A vac injxn

admin/recvd M

4149F Hep B vac injxn

admin/recvd M

4150F Pt recvng antivir txmnt

hepc M

4151F Pt not recvng antiv hep

c M

4153F Combo pegintf/rib

rx M

4155F Hep A vac series prev

recvd E

4157F Hep B vac series prev

recvd E

4158F Pt edu re alcoh drnkng

done M

4159F Contrcp talk b/4 antiv

txmnt M

4163F Pt couns 4 txmnt opt

prost E

4164F Adjv hrmnl thxpy

rxd M

4165F 3d-crt/imrt

received M

4167F Hd bed tilted 1st day

vent E

4168F Pt care icu&vent w/in

24hrs E

4169F No pt care ICU/vent in

24hrs E

4171F Pt rcvng esa

thxpy M

4172F Pt not rcvng esa

thxpy M

4174F Couns potent glauc

impct E

4175F Vis of >= 20/40 w/in 90

days M

4176F Talk re uv light

pt/crgvr E

4177F Talk pt/crgvr re areds

prev M

4178F Antid glbln rcvd w/in26wks E

4179F Tamoxifen/AI

prescribed M

4180F Adjv thxpyrxd/rcvd colon

ca M

4181F Conformal radn thxpy

rcvd E

4182F No conformal radn

thxpy E

4185F Continuous ppi or h2ra

rcvd E

4186F No cont ppi or h2ra

rcvd E

4187F Anti rheum

drugthxpyrxd/gvn M

4188F Approp ACE/ARB tstng

done E

4189F Approp digoxin tstng

done E

4190F Approp diuretic tstng

done E

4191F Approp anticonvuls

tstng E

4192F Pt not rcvng glucoco

thxpy M

4193F Pt rcvng<10mg daily

predniso M

4194F Pt rcvng>10mg daily

predniso M

4195F Pt rcvng anti-rheum thxpy

RA M

4196F Ptnot rcvng anti-rhm

thxpyRA M

4200F External beam to prost

only M

4201F Extrnl beam other than

prost M

4210F Ace/arb thxpy for

mos/> E

4220F Digoxin thxpy for 6

mos/> E

4221F Diuretic thxpy for 6

mos/> E4230F Anticonv thxpy for 6

mos/> E

4240F Instr xrcz 4bk pn >12

weeks E

4242F Sprvsd xrcz bk pn >12

weeks E

4245F Pt instr nrml

lifest M

4248F Pt instr no bd rest 4

days/> M

4250F Wrmng 4 surg

normothermia M

4255F Anesth 60 min/> as

docd M

4256F Anesthe <60 min as

docd M

4260F Wound srfc culturetech

used CH M

4261F Tech other than surfc

cultr CH M

4265F Wet-dry dressings rx

recmd CH M

4266F No wet-dry drssings rx

recmd CH M

4267F Comprssion thxpy

prescribed M

4268F Pt ed re comp thxpy

rcvd E

4269F Appropos mthd offloading

Rxd E

4270F Pt rcvng anti r-viral

thxpy M

4271F Pt rcvng anti r-viral

thxpy M

4274F Flu immuno admind

rcvd CH E

4275F Hep b vac inj

admin/rcvd CH D

4276F Potent antivir thxpy

Rxd M

4279F PCP prophylaxis

Rxd E

4280F PCP prophylax Rxd 3mon low% M

4290F Pt scrned for inj drug

use M

4293F Pt scrnd hgh-risk sex

behav M

4300F Pt rcvng warf

thxpy E

4301F Pt not rcvng warf

thxpy E

4305F Pt ed re ft care inspct

rcvd E

4306F Pt tlk psych & Rx opd

addic E

4320F Pt talk psychsoc&rx oh

dpnd CH M

4322F Crgvr prov w/ ed addl

rsrcs NI M

4324F Pt queried prkns

complic E

4325F Med txmnt options rvwd

w/pt CH M

4326F Pt asked re symp auto

dysfxn E

4328F Pt asked re sleep

disturb CH M

4330F Cnslng epi spec sfty

issues CH M

4340F Cnslng chldbrng women

epi CH M

4350F Cnslng provided symp mngmnt

NI E

4400F Rehab thxpy options

w/pt CH M

4450F Self-care ed provided to pt

NI E

4470F Icd counseling provided

NI E

4480F Pt rcvng ace/arb

b-blockertx NI E

4481F Pt rcvng ace/arb

blker<3mons NI E

4500F Ref to outpt card rehab

prog NI M4510F Prev cardrehab

qualcardevent NI M

4525F Neuropsychia interven order

NI M

4526F Neuropsychia interven

rcvd NI M

5005F Pt counsld on exam for

moles E

5010F Macul result to phy mng

dm M

5015F Doc fx & test/txmnt for

op M

5020F Txmnts 2 main Dr by 1

mon E

5050F Plan 2 main dr by 1

month M

5060F Fndngs mammo 2pt w/in 3

days E

5062F Mammo result com to pt 5

day E

5100F Rsk fx ref w/n 24 hrs

xray E

5200F Eval appros surg thxpy

epi E

5250F Asthma discharge plan

presnt NI E

6005F Care level rationale

doc E

6010F Dysphag test done b/4

eating M

6015F Dysphag test done b/4

eating M

6020F Npo (nothing-mouth)

ordered M

6030F Max sterile barriers

follwd M

6040F Appro rad ds dvcs techs

docd E

6045F Radxps in end rprt4fluro

pxd M

6070F Pt asked/cnsld aed

effects CH M

6080F Pt/caregiver queriedfalls E

6090F Pt/caregiver counsel

safety CH M

6100F Verify pt site pxd docd

NI E

6101F Safety counseling dementia

NI M

6102F Safety counseling dem order

NI M

6110F Counsel prov driving risks

NI M

6150F Pt notrcvng1st antitnf

txmnt NI M

7010F Pt info into recall

system M

7020F Mammo assess cat in

dbase E

7025F Pt infosys alarm 4 nxt

mammo M

A0021 Outside state ambulance

serv E

A0080 Noninterest escort in non

er E

A0090 Interest escort in non

er E

A0100 Nonemergency transport

taxi E

A0110 Nonemergency transport

bus E

A0120 Noner transport

mini-bus E

A0130 Noner transport wheelch

van E

A0140 Nonemergency transport

air E

A0160 Noner transport case

worker E

A0170 Transport parking

fees/tolls E

A0180 Noner transport lodgng

recip E

A0190 Noner transport meals

recip E

A0200 Noner transport lodgngescrt E

A0210 Noner transport meals

escort E

A0225 Neonatal emergency

transport E

A0380 Basic life support

mileage E

A0382 Basic support routine

suppls A

A0384 Bls defibrillation

supplies A

A0390 Advanced life support

mileag E

A0392 Als defibrillation

supplies A

A0394 Als IV drug therapy

supplies A

A0396 Als esophageal intub

suppls A

A0398 Als routine disposble

suppls A

A0420 Ambulance waiting 1/2

hr A

A0422 Ambulance 02 life

sustaining A

A0424 Extra ambulance

attendant A

A0425 Ground

mileage A

A0426 Als

1 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 AA0434 Specialty care

transport A

A0435 Fixed wing air

mileage A

A0436 Rotary wing air

mileage A

A0888 Noncovered ambulance

mileage E

A0998 Ambulance

response/treatment E

A0999 Unlisted ambulance

service A

A4206 1 CC sterile

syringe&needle E

A4207 2 CC sterile

syringe&needle E

A4208 3 CC sterile

syringe&needle E

A4209 5+ CC sterile

syringe&needle E

A4210 Nonneedle injection

device E

A4211 Supp for self-adm

injections E

A4212 Non coring needle or

stylet B

A4213 20+ CC syringe

only E

A4215 Sterile

needle E

A4216 "Sterile water/saline, 10

ml" A

A4217 "Sterile water/saline, 500

ml" A

A4218 Sterile saline or

water N

A4220 Infusion pump refill

kit N

A4221 Maint drug infus cath per

wk YA4222 Infusion supplies with

pump Y

A4223 Infusion supplies w/o

pump E

A4230 Infus insulin pump non

needl N

A4231 Infusion insulin pump

needle N

A4232 Syringe w/needle insulin

3cc E

A4233 Alkalin batt for glucose

mon Y

A4234 J-cell batt for glucose

mon Y

A4235 Lithium batt for glucose

mon Y

A4236 Silvr oxide batt glucose

mon Y

A4244 Alcohol or peroxide per

pint E

A4245 Alcohol wipes per

box E

A4246 Betadine/phisohex

solution E

A4247 Betadine/iodine

swabs/wipes E

A4248 Chlorhexidine

antisept N

A4250 Urine reagent

strips/tablets E

A4252 Blood ketone test or

strip E

A4253 Blood glucose/reagent

strips Y

A4255 Glucose monitor

platforms Y

A4256 Calibrator

solution/chips Y

A4257 Replace Lensshield

Cartridge Y

A4258 Lancet device

each YA4259 Lancets per

box Y

A4261 Cervical cap

contraceptive E

A4262 Temporary tear duct

plug N

A4263 Permanent tear duct

plug N

A4264 Intratubal occlusion

device E

A4265 Paraffin Y

A4266 Diaphragm E

A4267 Male

condom E

A4268 Female

condom E

A4269 Spermicide E

A4270 Disposable endoscope

sheath N

A4280 Brst prsths adhsv

attchmnt A

A4281 Replacement breastpump

tube E

A4282 Replacement breastpump

adpt E

A4283 Replacement breastpump

cap E

A4284 Replcmnt breast pump

shield E

A4285 Replcmnt breast pump

bottle E

A4286 Replcmnt breastpump lok

ring E

A4290 Sacral nerve stim test

lead B

A4300 Cath impl vasc access

portal N

A4301 Implantable access syst

perc N

A4305 Drug delivery system >=50

ML NA4306 Drug delivery system <=50

ml N

A4310 Insert tray w/o

bag/cath A

A4311 Catheter w/o bag 2-way

latex A

A4312 Cath w/o bag 2-way

silicone A

A4313 Catheter w/bag

3-way A

A4314 Cath w/drainage 2-way

latex A

A4315 Cath w/drainage 2-way

silcne A

A4316 Cath w/drainage

3-way A

A4320 Irrigation

tray A

A4321 Cath therapeutic irrig

agent A

A4322 Irrigation

syringe A

A4326 Male external

catheter A

A4327 Fem urinary collect dev

cup A

A4328 Fem urinary collect

pouch A

A4330 Stool collection

pouch A

A4331 Extension drainage

tubing A

A4332 Lube sterile

packet A

A4333 Urinary cath anchor

device A

A4334 Urinary cath leg

strap A

A4335 Incontinence

supply A

A4336 Urethral

insert A

A4338 Indwelling catheter

latex AA4340 Indwelling catheter

special A

A4344 Cath indw foley 2 way

silicn A

A4346 Cath indw foley 3

way A

A4349 Disposable male external

cat A

A4351 Straight tip urine

catheter A

A4352 Coude tip urinary

catheter A

A4353 Intermittent urinary

cath A

A4354 Cath insertion tray

w/bag A

A4355 Bladder irrigation

tubing A

A4356 Ext ureth clmp or compr

dvc A

A4357 Bedside drainage

bag A

A4358 Urinary leg or abdomen

bag A

A4360 Disposable ext urethral

dev A

A4361 Ostomy face

plate A

A4362 Solid skin

barrier A

A4363 "Ostomy clamp,

replacement" A

A4364 "Adhesive, liquid or

equal" A

A4366 Ostomy

vent A

A4367 Ostomy

belt A

A4368 Ostomy

filter A

A4369 Skin barrier liquid per

oz A

A4371 Skin barrier powder peroz A

A4372 Skin barrier solid 4x4

equiv A

A4373 Skin barrier with

flange A

A4375 Drainable plastic pch w

fcpl A

A4376 Drainable rubber pch w

fcplt A

A4377 Drainable plstic pch w/o

fp A

A4378 Drainable rubber pch w/o

fp A

A4379 Urinary plastic pouch w

fcpl A

A4380 Urinary rubber pouch w

fcplt A

A4381 Urinary plastic pouch w/o

fp A

A4382 Urinary hvy plstc pch w/o

fp A

A4383 Urinary rubber pouch w/o

fp A

A4384 Ostomy faceplt/silicone

ring A

A4385 Ost skn barrier sld ext

wear A

A4387 Ost clsd pouch w att st

barr A

A4388 Drainable pch w ex wear

barr A

A4389 Drainable pch w st wear

barr A

A4390 Drainable pch ex wear

convex A

A4391 Urinary pouch w ex wear

barr A

A4392 Urinary pouch w st wear

barr A

A4393 Urine pch w ex wear bar

conv A

A4394 Ostomy pouch liq

deodorant A

A4395 Ostomy pouch soliddeodorant A

A4396 Peristomal hernia supprt

blt A

A4397 Irrigation supply

sleeve A

A4398 Ostomy irrigation

bag A

A4399 Ostomy irrig cone/cath w

brs A

A4400 Ostomy irrigation

set A

A4402 Lubricant per

ounce A

A4404 Ostomy ring

each A

A4405 Nonpectin based ostomy

paste A

A4406 Pectin based ostomy

paste A

A4407 "Ext wear ost skn barr

<=4sq""" A

A4408 "Ext wear ost skn barr

>4sq""" A

A4409 Ost skn barr convex <=4 sq

i A

A4410 Ost skn barr extnd >4

sq A

A4411 Ost skn barr extnd

=4sq A

A4412 Ost pouch drain high

output A

A4413 2 pc drainable ost

pouch A

A4414 Ost sknbar w/o conv<=4 sq

in A

A4415 Ost skn barr w/o conv >4

sqi A

A4416 Ost pch clsd w

barrier/filtr A

A4417 Ost pch w

bar/bltinconv/fltr A

A4418 Ost pch clsd w/o bar w

filtr AA4419 Ost pch for bar w

flange/flt A

A4420 Ost pch clsd for bar w lk

fl A

A4421 Ostomy supply

misc E

A4422 Ost pouch absorbent

material A

A4423 Ost pch for bar w lk

fl/fltr A

A4424 Ost pch drain w bar &

filter A

A4425 Ost pch drain for barrier

fl A

A4426 Ost pch drain 2 piece

system A

A4427 Ost pch drain/barr lk

flng/f A

A4428 Urine ost pouch w

faucet/tap A

A4429 Urine ost pouch w

bltinconv A

A4430 Ost urine pch w b/bltin

conv A

A4431 Ost pch urine w

barrier/tapv A

A4432 Os pch urine w

bar/fange/tap A

A4433 Urine ost pch bar w lock

fln A

A4434 Ost pch urine w lock

flng/ft A

A4450 Non-waterproof

tape A

A4452 Waterproof

tape A

A4455 Adhesive remover per

ounce A

A4456 "Adhesive remover,

wipes" A

A4458 Reusable enema

bag EA4461 Surgicl dress hold

non-reuse A

A4463 Surgical dress holder

reuse A

A4465 Non-elastic extremity

binder N

A4466 Elastic

garment/covering E

A4470 Gravlee jet

washer N

A4480 Vabra

aspirator N

A4481 Tracheostoma

filter A

A4483 Moisture

exchanger A

A4490 Above knee surgical

stocking E

A4495 Thigh length surg

stocking E

A4500 Below knee surgical

stocking E

A4510 Full length surg

stocking E

A4520 Incontinence garment

anytype E

A4550 Surgical

trays B

A4554 Disposable

underpads E

A4556 "Electrodes,

pair" Y

A4557 "Lead wires,

pair" Y

A4558 Conductive gel or

paste Y

A4559 Coupling gel or

paste Y

A4561 "Pessary rubber, any

type" N

A4562 "Pessary, non rubber,any

type" N

A4565 Slings NA4566 Should

sling/vest/abrestrain E

A4570 Splint E

A4575 Hyperbaric o2 chamber

disps E

A4580 Cast supplies

(plaster) E

A4590 Special casting

material E

A4595 TENS suppl 2 lead per

month Y

A4600 "Sleeve, inter limb comp

dev" Y

A4601 "Lith ion batt, non-pros use

" Y

A4604 Tubing with heating

element Y

A4605 Trach suction cath close

sys Y

A4606 Oxygen probe used w

oximeter A

A4608 Transtracheal oxygen

cath Y

A4611 Heavy duty

battery Y

A4612 Battery

cables Y

A4613 Battery

charger Y

A4614 Hand-held PEFR

meter Y

A4615 Cannula

nasal Y

A4616 Tubing (oxygen) per

foot Y

A4617 Mouth

piece Y

A4618 Breathing

circuits Y

A4619 Face

tent Y

A4620 Variable concentrationmask Y

A4623 Tracheostomy inner

cannula A

A4624 Tracheal suction

tube Y

A4625 Trach care kit for new

trach A

A4626 Tracheostomy cleaning

brush A

A4627 Spacer

bag/reservoir E

A4628 Oropharyngeal suction

cath Y

A4629 Tracheostomy care

kit A

A4630 Repl bat t.e.n.s. own by

pt Y

A4633 Uvl replacement

bulb Y

A4634 Replacement bulb th

lightbox A

A4635 Underarm crutch

pad Y

A4636 Handgrip for cane

etc Y

A4637 Repl tip

cane/crutch/walker Y

A4638 Repl batt pulse gen

sys Y

A4639 Infrared ht sys replcmnt

pad Y

A4640 Alternating pressure

pad Y

A4641 Radiopharm dx agent

noc N

A4642 In111

satumomab N

A4648 Implantable tissue

marker N

A4649 Surgical

supplies N

A4650 Implant radiation

dosimeter NA4651 Calibrated microcap

tube A

A4652 Microcapillary tube

sealant A

A4653 PD catheter anchor

belt A

A4657 Syringe w/wo

needle N

A4660 Sphyg/bp app w cuff and

stet N

A4663 Dialysis blood pressure

cuff N

A4670 "Automatic bp monitor,

dial" E

A4671 Disposable cycler

set B

A4672 "Drainage ext line,

dialysis" B

A4673 Ext line w easy lock

connect B

A4674 "Chem/antisept solution,

8oz" B

A4680 "Activated carbon filter,

ea" N

A4690 "Dialyzer,

each" N

A4706 Bicarbonate conc sol per

gal N

A4707 Bicarbonate conc pow per

pac N

A4708 Acetate conc sol per

gallon N

A4709 Acid conc sol per

gallon N

A4714 Treated water per

gallon N

A4719 """Y set""

tubing" N

A4720 Dialysat sol fld vol >

249cc N

A4721 Dialysat sol fld vol >

999cc N

A4722 Dialys sol fld vol >

1999cc NA4723 Dialys sol fld vol >

2999cc N

A4724 Dialys sol fld vol >

3999cc N

A4725 Dialys sol fld vol >

4999cc N

A4726 Dialys sol fld vol >

5999cc N

A4728 "Dialysate solution,

non-dex" B

A4730 "Fistula cannulation set,

ea" N

A4736 "Topical anesthetic, per

gram" N

A4737 Inj anesthetic per 10

ml N

A4740 Shunt

accessory N

A4750 Art or venous blood

tubing N

A4755 Comb art/venous blood

tubing N

A4760 "Dialysate sol test kit,

each" N

A4765 Dialysate conc pow per

pack N

A4766 Dialysate conc sol add 10

ml N

A4770 Blood collection

tube/vacuum N

A4771 Serum clotting time

tube N

A4772 Blood glucose test

strips N

A4773 Occult blood test

strips N

A4774 Ammonia test

strips N

A4802 Protamine sulfate per 50

mg N

A4860 Disposable catheter

tips N

A4870 Plumb/elec wk hm hemoequip N

A4890 Repair/maint cont hemo

equip N

A4911 Drain

bag/bottle N

A4913 Misc dialysis supplies

noc N

A4918 Venous pressure

clamp N

A4927 Non-sterile

gloves N

A4928 Surgical

mask N

A4929 "Tourniquet for dialysis,

ea" N

A4930 "Sterile, gloves per

pair" N

A4931 Reusable oral

thermometer N

A4932 Reusable rectal

thermometer E

A5051 Pouch clsd w barr

attached A

A5052 Clsd ostomy pouch w/o

barr A

A5053 Clsd ostomy pouch

faceplate A

A5054 Clsd ostomy pouch

w/flange A

A5055 Stoma

cap A

A5056 1 pc ost pouch w

filter NI A

A5057 1 pc ost pou w built-in

conv NI A

A5061 Pouch drainable w barrier

at A

A5062 Drnble ostomy pouch w/o

barr A

A5063 Drain ostomy pouch

w/flange A

A5071 Urinary pouch

w/barrier AA5072 Urinary pouch w/o

barrier A

A5073 Urinary pouch on barr

w/flng A

A5081 Continent stoma

plug A

A5082 Continent stoma

catheter A

A5083 Stoma absorptive

cover A

A5093 Ostomy accessory convex

inse A

A5102 Bedside drain btl w/wo

tube A

A5105 Urinary

suspensory A

A5112 Urinary leg

bag A

A5113 Latex leg

strap A

A5114 Foam/fabric leg

strap A

A5120 "Skin barrier, wipe or

swab" A

A5121 Solid skin barrier

6x6 A

A5122 Solid skin barrier

8x8 A

A5126 Disk/foam pad +oradhesive A

A5131 Appliance

cleaner A

A5200 Percutaneous catheter

anchor A

A5500 Diab shoe for density

insert Y

A5501 Diabetic custom molded

shoe Y

A5503 Diabetic shoe

w/roller/rockr Y

A5504 Diabetic shoe with

wedge Y

A5505 Diab shoe w/metatarsalbar Y

A5506 Diabetic shoe w/off set

heel Y

A5507 Modification diabetic

shoe Y

A5508 Diabetic deluxe

shoe Y

A5510 Compression form shoe

insert E

A5512 Multi den insert direct

form Y

A5513 Multi den insert custom

mold Y

A6000 Wound warming wound

cover E

A6010 Collagen based wound

filler A

A6011 Collagen gel/paste wound

fil A

A6021 Collagen dressing <=16 sq

in A

A6022 Collagen drsg>16<=48 sq

in A

A6023 Collagen dressing >48 sq

in A

A6024 Collagen dsg wound

filler A

A6025 "Silicone gel sheet,

each" E

A6154 Wound pouch

each A

A6196 Alginate dressing <=16 sq

in A

A6197 Alginate drsg >16 <=48 sq

in A

A6198 alginate dressing > 48 sq

in A

A6199 Alginate drsg wound

filler A

A6203 Composite drsg <= 16 sq

in A

A6204 Composite drsg >16<=48 sq

in A

A6205 Composite drsg > 48 sqin A

A6206 Contact layer <= 16 sq

in A

A6207 Contact layer >16<= 48 sq

in A

A6208 Contact layer > 48 sq

in A

A6209 Foam drsg <=16 sq in w/o

bdr A

A6210 Foam drg >16<=48 sq in w/o

b A

A6211 Foam drg > 48 sq in w/o

brdr A

A6212 Foam drg <=16 sq in

w/border A

A6213 Foam drg >16<=48 sq in

w/bdr A

A6214 Foam drg > 48 sq in

w/border A

A6215 Foam dressing wound

filler A

A6216 Non-sterile gauze<=16 sq

in A

A6217 Non-sterile gauze>16<=48

sq A

A6218 Non-sterile gauze > 48 sq

in A

A6219 Gauze <= 16 sq in

w/border A

A6220 Gauze >16 <=48 sq in

w/bordr A

A6221 Gauze > 48 sq in

w/border A

A6222 Gauze <=16 in no w/sal w/o

b A

A6223 Gauze >16<=48 no w/sal w/o

b A

A6224 Gauze > 48 in no w/sal w/o

b A

A6228 Gauze <= 16 sq in

water/sal A

A6229 Gauze >16<=48 sq in

watr/sal A

A6230 Gauze > 48 sq inwater/salne A

A6231 Hydrogel dsg<=16 sq

in A

A6232 Hydrogel dsg>16<=48 sq

in A

A6233 Hydrogel dressing >48 sq

in A

A6234 Hydrocolld drg <=16 w/o

bdr A

A6235 Hydrocolld drg >16<=48 w/o

b A

A6236 Hydrocolld drg > 48 in w/o

b A

A6237 Hydrocolld drg <=16 in

w/bdr A

A6238 Hydrocolld drg >16<=48

w/bdr A

A6239 Hydrocolld drg > 48 in

w/bdr A

A6240 Hydrocolld drg filler

paste A

A6241 Hydrocolloid drg filler

dry A

A6242 Hydrogel drg <=16 in w/o

bdr A

A6243 Hydrogel drg >16<=48 w/o

bdr A

A6244 Hydrogel drg >48 in w/o

bdr A

A6245 Hydrogel drg <= 16 in

w/bdr A

A6246 Hydrogel drg >16<=48 in

w/b A

A6247 Hydrogel drg > 48 sq in

w/b A

A6248 Hydrogel drsg gel

filler A

A6250 Skin seal protect

moisturizr A

A6251 Absorpt drg <=16 sq in w/o

b A

A6252 Absorpt drg >16 <=48 w/o

bdr AA6253 Absorpt drg > 48 sq in w/o

b A

A6254 Absorpt drg <=16 sq in

w/bdr A

A6255 Absorpt drg >16<=48 in

w/bdr A

A6256 Absorpt drg > 48 sq in

w/bdr A

A6257 Transparent film <= 16 sq

in A

A6258 Transparent film >16<=48

in A

A6259 Transparent film > 48 sq

in A

A6260 Wound cleanser any

type/size A

A6261 Wound filler gel/paste

/oz A

A6262 Wound filler dry form /

gram A

A6266 Impreg gauze no

h20/sal/yard A

A6402 Sterile gauze <= 16 sq

in A

A6403 Sterile gauze>16 <= 48 sq

in A

A6404 Sterile gauze > 48 sq

in A

A6407 "Packing strips,

non-impreg" A

A6410 Sterile eye

pad A

A6411 Non-sterile eye

pad A

A6412 Occlusive eye

patch A

A6413 "Adhesive bandage,

first-aid" E

A6441 "Pad band w>=3""

<5""/yd" A

A6442 "Conform band n/s

w<3""/yd" A

A6443 "Conform band n/sw>=3""<5""/yd" A

A6444 "Conform band n/s

w>=5""/yd" A

A6445 "Conform band s w

<3""/yd" A

A6446 "Conform band s w>=3""

<5""/yd" A

A6447 "Conform band s w

>=5""/yd" A

A6448 "Lt compres band

<3""/yd" A

A6449 "Lt compres band >=3""

<5""/yd" A

A6450 "Lt compres band

>=5""/yd" A

A6451 "Mod compres band

w>=3""<5""/yd" A

A6452 "High compres band

w>=3""<5""yd" A

A6453 "Self-adher band w

<3""/yd" A

A6454 "Self-adher band w>=3""

<5""/yd" A

A6455 "Self-adher band

>=5""/yd" A

A6456 "Zinc paste band w

>=3""<5""/yd" A

A6457 Tubular

dressing A

A6501 Compres burngarment

bodysuit A

A6502 Compres burngarment

chinstrp A

A6503 Compres burngarment

facehood A

A6504 Cmprsburngarment

glove-wrist A

A6505 Cmprsburngarment

glove-elbow A

A6506 Cmprsburngrmntglove-axilla A

A6507 Cmprs burngarment

foot-knee A

A6508 Cmprs burngarment

foot-thigh A

A6509 Compres burn garment

jacket A

A6510 Compres burn garment

leotard A

A6511 Compres burn garment

panty A

A6512 "Compres burn garment,

noc" A

A6513 Compress burn mask

face/neck B

A6530 Compression stocking

BK18-30 E

A6531 Compression stocking

BK30-40 A

A6532 Compression stocking

BK40-50 A

A6533 Gc stocking thighlngth

18-30 E

A6534 Gc stocking thighlngth

30-40 E

A6535 Gc stocking thighlngth

40-50 E

A6536 Gc stocking full lngth

18-30 E

A6537 Gc stocking full lngth

30-40 E

A6538 Gc stocking full lngth

40-50 E

A6539 Gc stocking waistlngth

18-30 E

A6540 Gc stocking waistlngth

30-40 E

A6541 Gc stocking waistlngth

40-50 E

A6544 Gc stocking garter

belt E

A6545 Grad comp non-elastic

BK AA6549 G compression

stocking E

A6550 Neg pres wound ther drsg

set Y

A7000 Disposable canister for

pump Y

A7001 Nondisposable pump

canister Y

A7002 Tubing used w suction

pump Y

A7003 Nebulizer administration

set Y

A7004 Disposable nebulizer sml

vol Y

A7005 Nondisposable nebulizer

set Y

A7006 Filtered nebulizer admin

set Y

A7007 Lg vol nebulizer

disposable Y

A7008 Disposable nebulizer

prefill Y

A7009 Nebulizer reservoir

bottle Y

A7010 Disposable corrugated

tubing Y

A7011 Nondispos corrugated

tubing Y

A7012 Nebulizer water collec

devic Y

A7013 Disposable compressor

filter Y

A7014 Compressor nondispos

filter Y

A7015 Aerosol mask used w

nebulize Y

A7016 Nebulizer dome &

mouthpiece Y

A7017 Nebulizer not used w

oxygen Y

A7018 Water distilled

w/nebulizer Y

A7020 "Interface, cough stim

device" YA7025 Replace chest compress

vest Y

A7026 Replace chst cmprss sys

hose Y

A7027 Combination oral/nasal

mask Y

A7028 Repl oral cushion combo

mask Y

A7029 Repl nasal pillow comb

mask Y

A7030 CPAP full face

mask Y

A7031 Replacement facemask

interfa Y

A7032 Replacement nasal

cushion 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

pap" Y

A7040 One way chest drain

valve A

A7041 Water seal drain

container A

A7042 Implanted pleural

catheter N

A7043 Vacuum

drainagebottle/tubing A

A7044 PAP oral

interface Y

A7045 Repl exhalation port for

PAP Y

A7046 "Repl water chamber, PAPdev" Y

A7501 Tracheostoma valve w

diaphra A

A7502 Replacement

diaphragm/fplate A

A7503 HMES filter holder or

cap A

A7504 Tracheostoma HMES

filter A

A7505 HMES or trach valve

housing A

A7506 HMES/trachvalve

adhesivedisk A

A7507 Integrated filter &

holder A

A7508 Housing & Integrated

Adhesiv A

A7509 Heat & moisture exchange

sys A

A7520 Trach/laryn tube

non-cuffed A

A7521 Trach/laryn tube

cuffed A

A7522 Trach/laryn tube

stainless A

A7523 Tracheostomy shower

protect A

A7524 Tracheostoma

stent/stud/bttn A

A7525 Tracheostomy

mask A

A7526 Tracheostomy tube

collar A

A7527 Trach/laryn tube

plug/stop A

A8000 Soft protect helmet

prefab Y

A8001 Hard protect helmet

prefab Y

A8002 Soft protect helmet

custom Y

A8003 Hard protect helmetcustom Y

A8004 "Repl soft interface,

helmet" Y

A9150 Misc/exper non-prescript

dru B

A9152 Single vitamin

nos E

A9153 Multi-vitamin

nos E

A9155 Artificial

saliva B

A9180 "Lice treatment,

topical" E

A9270 Non-covered item or

service E

A9272 Disposable mech wound

suct NI E

A9273 Hot/cold

h2obot/cap/col/wrap Y

A9274 Ext amb insulin delivery

sys E

A9275 Disp home glucose monitor

E

A9276 "Disposable sensor, CGM

sys" E

A9277 "External transmitter,

CGM" E

A9278 "External receiver, CGM

sys" E

A9279 Monitoring

feature/deviceNOC E

A9280 "Alert device,

noc" E

A9281 Reaching/grabbing

device E

A9282 Wig any

type E

A9283 Foot press off load supp

dev E

A9284 Non-electronic

spirometer N

A9300 Exercise

equipment EA9500 Tc99m

sestamibi N

A9501 Technetium TC-99m

teboroxime N

A9502 Tc99m

tetrofosmin N

A9503 Tc99m

medronate N

A9504 Tc99m

apcitide N

A9505 TL201

thallium N

A9507 In111

capromab N

A9508 "I131 iodobenguate,

dx" N

A9509 Iodine I-123 sod iodide

mil N

A9510 Tc99m

disofenin N

A9512 Tc99m

pertechnetate N

A9516 Iodine I-123 sod iodide

mic N

A9517 "I131 iodide cap,

rx" K 1064 $17.26

. $3.46

A9521 Tc99m

exametazime N

A9524 "I131 serum albumin,

dx" N

A9526 Nitrogen N-13

ammonia N

A9527 Iodine I-125 sodium

iodide U 2632 0.2404 $16.83

. $3.37

A9528 "Iodine I-131 iodide cap,

dx" N

A9529 "I131 iodide sol,

dx" N

A9530 "I131 iodide sol,

rx" K 1150 $10.49

. $2.10A9531 I131 max

100uCi N

A9532 "I125 serum albumin,

dx" N

A9536 Tc99m

depreotide N

A9537 Tc99m

mebrofenin N

A9538 Tc99m

pyrophosphate N

A9539 Tc99m

pentetate N

A9540 Tc99m

MAA N

A9541 Tc99m sulfur

colloid N

A9542 "In111 ibritumomab,

dx" N

A9543 "Y90 ibritumomab,

rx" K 1643 "$36,100.41"

. "$7,220.09"

A9544 "I131 tositumomab,

dx" N

A9545 "I131 tositumomab,

rx" K 1645 "$29,618.96"

. "$5,923.80"

A9546 Co57/58 N

A9547 In111

oxyquinoline N

A9548 In111

pentetate N

A9550 Tc99m

gluceptate N

A9551 Tc99m

succimer N

A9552 F18

fdg N

A9553 Cr51

chromate N

A9554 "I125 iothalamate,

dx" N

A9555 Rb82 rubidiumN

A9556 Ga67

gallium N

A9557 Tc99m

bicisate N

A9558 Xe133 xenon

10mci N

A9559 Co57

cyano N

A9560 Tc99m labeled

rbc N

A9561 Tc99m

oxidronate N

A9562 Tc99m

mertiatide N

A9563 P32 Na

phosphate K 1675 $126.14

. $25.23

A9564 P32 chromic

phosphate K 1676 $579.98

. $116.00

A9566 Tc99m

fanolesomab N

A9567 Technetium TC-99m

aerosol N

A9568 Technetium tc99m

arcitumomab N

A9569 Technetium TC-99m auto

WBC N

A9570 Indium In-111 auto

WBC N

A9571 Indium IN-111 auto

platelet N

A9572 Indium In-111

pentetreotide N

A9576 Inj prohance

multipack N

A9577 Inj

multihance N

A9578 Inj multihance

multipack N

A9579 "Gad-base MR contrast NOS,1ml

" NA9580 Sodium fluoride

F-18 N

A9581 Gadoxetate disodium

inj N

A9582 Iodine I-123

iobenguane CH N

A9583 Gadofosveset trisodium

inj CH N

A9584 Iodine i-123

ioflupane NI G 9406 "$1,908.00" $0.00 $0.00

A9585 Gadobutrol

injection NI N

A9600 Sr89

strontium K 0701 $954.77

. $190.96

A9604 Sm 153

lexidronam K 1295 "$7,592.00"

. "$1,518.40"

A9698 Non-rad contrast

materialNOC N

A9699 Radiopharm rx agent

noc N

A9700 Echocardiography

Contrast B

A9900 Supply/accessory/service Y

A9901 Delivery/set

up/dispensing A

A9999 "DME supply or accessory,

nos" Y

B4034 Enter feed supkit syr by

day Y

B4035 Enteral feed supp pump per

d Y

B4036 Enteral feed sup kit grav

by Y

B4081 Enteral ng tubing w/

stylet Y

B4082 Enteral ng tubing w/o

stylet Y

B4083 Enteral stomach tubelevine Y

B4087 "Gastro/jejuno tube,

std" A

B4088 "Gastro/jejuno tube,

low-pro" A

B4100 Food thickener

oral E

B4102 EF adult fluids and

electro Y

B4103 EF ped fluid and

electrolyte Y

B4104 Additive for enteral

formula E

B4149 EF blenderized

foods Y

B4150 EF complet w/intact

nutrient Y

B4152 EF calorie

dense>/=1.5Kcal Y

B4153 EF hydrolyzed/amino

acids Y

B4154 EF spec metabolic

noninherit Y

B4155 EF

incomplete/modular Y

B4157 EF special metabolic

inherit Y

B4158 EF ped complete intact

nut Y

B4159 EF ped complete soy

based Y

B4160 EF ped caloric

dense>/=0.7kc Y

B4161 EF ped hydrolyzed/amino

acid Y

B4162 EF ped specmetabolic

inherit Y

B4164 Parenteral 50% dextrose

solu Y

B4168 Parenteral sol amino acid

3. YB4172 Parenteral sol amino acid

5. Y

B4176 Parenteral sol amino acid

7- Y

B4178 Parenteral sol amino acid

> Y

B4180 Parenteral sol carb >

50% Y

B4185 Parenteral sol 10 gm

lipids B

B4189 Parenteral sol amino acid

& Y

B4193 Parenteral sol 52-73 gm

prot Y

B4197 Parenteral sol 74-100 gm

pro Y

B4199 Parenteral sol > 100gm

prote Y

B4216 Parenteral nutrition

additiv Y

B4220 Parenteral supply kit

premix Y

B4222 Parenteral supply kit

homemi Y

B4224 Parenteral administration

ki Y

B5000 Parenteral sol

renal-amirosy Y

B5100 Parenteral sol

hepatic-fream Y

B5200 Parenteral sol stres-brnch

c Y

B9000 Enter infusion pump w/o

alrm Y

B9002 Enteral infusion pump w/

ala Y

B9004 Parenteral infus pump

portab Y

B9006 Parenteral infus pump

statio Y

B9998 Enteral supp not otherwise

c Y

B9999 Parenteral supp not othrwsc Y

C1300 HYPERBARIC

Oxygen S 0659 1.4941 $104.61

. $20.93

C1713 "Anchor/screw

bn/bn,tis/bn" N

C1714 "Cath, trans atherectomy,

dir" N

C1715 Brachytherapy

needle N

C1716 "Brachytx, non-str,

Gold-198" U 1716 0.5004 $35.04

. $7.01

C1717 "Brachytx, non-str,HDR

Ir-192" U 1717 3.3224 $232.62

. $46.53

C1719 "Brachytx, NS,

Non-HDRIr-192" U 1719 0.4544 $31.82

. $6.37

C1721 "AICD, dual

chamber" N

C1722 "AICD, single

chamber" N

C1724 "Cath, trans

atherec,rotation" N

C1725 "Cath, translumin

non-laser" N

C1726 "Cath, bal dil,

non-vascular" N

C1727 "Cath, bal tis dis,

non-vas" N

C1728 "Cath, brachytx seed

adm" N

C1729 "Cath,

drainage" N

C1730 "Cath, EP, 19 or few

elect" N

C1731 "Cath, EP, 20 or more

elec" N

C1732 "Cath, EP, diag/abl,

3D/vect" N

C1733 "Cath, EP, othr than

cool-tip" NC1749 "Endo, colon, retro

imaging" H 1749

C1750 "Cath,

hemodialysis,long-term" N

C1751 "Cath, inf,

per/cent/midline" N

C1752 "Cath,hemodialysis,short-term" N

C1753 "Cath, intravas

ultrasound" N

C1754 "Catheter,

intradiscal" N

C1755 "Catheter,

intraspinal" N

C1756 "Cath, pacing,

transesoph" N

C1757 "Cath,

thrombectomy/embolect" N

C1758 "Catheter,

ureteral" N

C1759 "Cath, intra

echocardiography" N

C1760 "Closure dev,

vasc" N

C1762 "Conn tiss, human(inc

fascia)" N

C1763 "Conn tiss,

non-human" N

C1764 "Event recorder,

cardiac" N

C1765 Adhesion

barrier N

C1766 "Intro/sheath,strble,non-peel" N

C1767 "Generator, neuro

non-recharg" N

C1768 "Graft,

vascular" NC1769 Guide

wire N

C1770 "Imaging coil, MR,

insertable" N

C1771 "Rep dev, urinary,

w/sling" N

C1772 "Infusion pump,

programmable" N

C1773 "Ret dev,

insertable" N

C1776 Joint device

(implantable) N

C1777 "Lead, AICD, endo single

coil" N

C1778 "Lead,

neurostimulator" N

C1779 "Lead, pmkr, transvenous

VDD" N

C1780 "Lens, intraocular (new

tech)" N

C1781 Mesh

(implantable) N

C1782 Morcellator N

C1783 "Ocular imp, aqueous drain

de" N

C1784 "Ocular dev, intraop, det

ret" N

C1785 "Pmkr, dual,

rate-resp" N

C1786 "Pmkr, single,

rate-resp" N

C1787 "Patient progr,

neurostim" N

C1788 "Port, indwelling,

imp" N

C1789 "Prosthesis, breast,

imp" N

C1813 "Prosthesis, penile,

inflatab" NC1814 "Retinal tamp, silicone

oil" N

C1815 "Pros, urinary sph,

imp" N

C1816 "Receiver/transmitter,

neuro" N

C1817 Septal defect imp

sys N

C1818 Integrated

keratoprosthesis N

C1819 Tissue

localization-excision N

C1820 Generator neuro rechg bat

sy N

C1821 Interspinous

implant N

C1830 Power bone marrow bx

needle H 1830

C1840 Telescopic intraocular

lens H 1840

C1874 "Stent, coated/cov w/del

sys" N

C1875 "Stent, coated/cov w/o del

sy" N

C1876 "Stent, non-coa/non-cov

w/del" N

C1877 "Stent, non-coat/cov w/o

del" N

C1878 Matrl for vocal

cord N

C1879 "Tissue marker,

implantable" N

C1880 Vena cava

filter N

C1881 Dialysis access

system N

C1882 "AICD, other than

sing/dual" N

C1883 "Adapt/ext, pacing/neuro

lead" N

C1884 Embolization Protect

syst NC1885 "Cath, translumin angio

laser" N

C1886 "Catheter,

ablation" NI H 1886

C1887 "Catheter,

guiding" N

C1888 Endovas non-cardiac abl

cath N

C1891 "Infusion pump,non-prog,

perm" N

C1892 "Intro/sheath,fixed,peel-away" N

C1893 "Intro/sheath,

fixed,non-peel" N

C1894 "Intro/sheath,

non-laser" N

C1895 "Lead, AICD, endo dual

coil" N

C1896 "Lead, AICD, non

sing/dual" N

C1897 "Lead, neurostim test

kit" N

C1898 "Lead, pmkr, other than

trans" N

C1899 "Lead, pmkr/AICD

combination" N

C1900 "Lead, coronary

venous" N

C2614 "Probe, perc lumb

disc" N

C2615 "Sealant, pulmonary,

liquid" N

C2616 "Brachytx,

non-str,Yttrium-90" U 2616 224.7054 "$15,732.97"

. "$3,146.60"

C2617 "Stent, non-cor, tem w/o

del" N

C2618 "Probe,

cryoablation" N

C2619 "Pmkr, dual, non

rate-resp" NC2620 "Pmkr, single, non

rate-resp" N

C2621 "Pmkr, other than

sing/dual" N

C2622 "Prosthesis, penile,

non-inf" N

C2625 "Stent, non-cor, tem w/del

sy" N

C2626 "Infusion pump,

non-prog,temp" N

C2627 "Cath,

suprapubic/cystoscopic" N

C2628 "Catheter,

occlusion" N

C2629 "Intro/sheath,

laser" N

C2630 "Cath, EP,

cool-tip" N

C2631 "Rep dev, urinary, w/o

sling" N

C2634 "Brachytx, non-str, HA,

I-125" U 2634 0.8944 $62.62

. $12.53

C2635 "Brachytx, non-str, HA,

P-103" U 2635 0.3855 $26.99

. $5.40

C2636 "Brachy linear,

non-str,P-103" U 2636 0.5294 $37.07

. $7.42

C2637 "Brachy,non-str,Ytterbium-169" B

C2638 "Brachytx, stranded,

I-125" U 2638 0.6498 $45.50

. $9.10

C2639 "Brachytx,

non-stranded,I-125" U 2639 0.5078 $35.55

. $7.11

C2640 "Brachytx, stranded,

P-103" U 2640 1.1433 $80.05

. $16.01

C2641 "Brachytx,

non-stranded,P-103" U 2641 0.9180 $64.27

. $12.86

C2642 "Brachytx, stranded,

C-131" U 2642 1.7379 $121.68

. $24.34C2643 "Brachytx,

non-stranded,C-131" U 2643 1.1044 $77.33

. $15.47

C2698 "Brachytx, stranded,

NOS" U 2698 0.6498 $45.50

. $9.10

C2699 "Brachytx, non-stranded,

NOS" U 2699 0.3855 $26.99

. $5.40

C8900 "MRA w/cont,

abd" Q3 0284 6.2343 $436.50 $146.69 $87.30

C8901 "MRA w/o cont,

abd" Q3 0336 4.8381 $338.74 $133.48 $67.75

C8902 "MRA w/o fol w/cont,

abd" Q3 0337 7.6347 $534.55 $197.64 $106.91

C8903 "MRI w/cont, breast,

uni" Q3 0284 6.2343 $436.50 $146.69 $87.30

C8904 "MRI w/o cont, breast,

uni" Q3 0336 4.8381 $338.74 $133.48 $67.75

C8905 "MRI w/o fol w/cont, brst,

un" Q3 0337 7.6347 $534.55 $197.64 $106.91

C8906 "MRI w/cont, breast,

bi" Q3 0284 6.2343 $436.50 $146.69 $87.30

C8907 "MRI w/o cont, breast,

bi" Q3 0336 4.8381 $338.74 $133.48 $67.75

C8908 "MRI w/o fol w/cont,

breast," Q3 0337 7.6347 $534.55 $197.64 $106.91

C8909 "MRA w/cont,

chest" Q3 0284 6.2343 $436.50 $146.69 $87.30

C8910 "MRA w/o cont,

chest" Q3 0336 4.8381 $338.74 $133.48 $67.75

C8911 "MRA w/o fol w/cont,

chest" Q3 0337 7.6347 $534.55 $197.64 $106.91

C8912 "MRA w/cont, lwr

ext" Q3 0284 6.2343 $436.50 $146.69 $87.30

C8913 "MRA w/o cont, lwrext" Q3 0336 4.8381 $338.74 $133.48 $67.75

C8914 "MRA w/o fol w/cont, lwr

ext" Q3 0337 7.6347 $534.55 $197.64 $106.91

C8918 "MRA w/cont,

pelvis" Q3 0284 6.2343 $436.50 $146.69 $87.30

C8919 "MRA w/o cont,

pelvis" Q3 0336 4.8381 $338.74 $133.48 $67.75

C8920 "MRA w/o fol w/cont,

pelvis" Q3 0337 7.6347 $534.55 $197.64 $106.91

C8921 "TTE w or w/o fol w/cont,

com" S 0128 7.9593 $557.28 $166.16 $111.46

C8922 "TTE w or w/o fol w/cont,

f/u" S 0128 7.9593 $557.28 $166.16 $111.46

C8923 "2D TTE w or w/o fol

w/con,co" S 0128 7.9593 $557.28 $166.16 $111.46

C8924 "2D TTE w or w/o fol

w/con,fu" S 0128 7.9593 $557.28 $166.16 $111.46

C8925 "2D TEE w or w/o fol

w/con,in" S 0128 7.9593 $557.28 $166.16 $111.46

C8926 "TEE w or w/o fol

w/cont,cong" S 0128 7.9593 $557.28 $166.16 $111.46

C8927 "TEE w or w/o fol w/cont,

mon" S 0128 7.9593 $557.28 $166.16 $111.46

C8928 "TTE w or w/o fol

w/con,stres" S 0128 7.9593 $557.28 $166.16 $111.46

C8929 "TTE w or wo fol

wcon,Doppler" S 0128 7.9593 $557.28 $166.16 $111.46

C8930 "TTE w or w/o contr, cont

ECG" S 0128 7.9593 $557.28 $166.16 $111.46

C8931 "MRA, w/dye, spinal

canal" Q3 0284 6.2343 $436.50 $146.69 $87.30

C8932 "MRA, w/o dye, spinal canal

" Q3 0336 4.8381 $338.74 $133.48 $67.75C8933 "MRA, w/o&w/dye, spinal

canal" Q3 0337 7.6347 $534.55 $197.64 $106.91

C8934 "MRA, w/dye, upper

extremity" Q3 0284 6.2343 $436.50 $146.69 $87.30

C8935 "MRA, w/o dye, upper

extr" Q3 0336 4.8381 $338.74 $133.48 $67.75

C8936 "MRA, w/o&w/dye, upper

extr" Q3 0337 7.6347 $534.55 $197.64 $106.91

C8957 "Prolonged IV inf, req

pump" S 0440 2.9679 $207.80

. $41.56

C9113 "Inj pantoprazole sodium,

via" N

C9121 "Injection,

argatroban" K 9121 $20.16

. $4.04

C9248 "Inj, clevidipine

butyrate" K 9248 $2.66

. $0.54

C9250 Artiss fibrin

sealant CH K 9250 $129.72

. $25.95

C9254 "Injection,

lacosamide" K 9254 $0.15

. $0.03

C9257 Bevacizumab

injection K 1281 $1.50

. $0.30

C9270 Gammaplex

IVIG CH D

C9272 "Inj,

denosumab" CH D

C9274 Crotalidae Poly Immune

Fab CH D

C9275 Hexaminolevulinate

HCl G 9275 $623.28 $0.00 $0.00

C9276 Cabazitaxel

injection CH D

C9277 "Lumizyme, 1

mg" CH D

C9279 "Injection,ibuprofen" G 9279 $1.62

. $0.32

C9280 "Injection, eribulin

mesylate" CH D

C9281 "Injection,

pegloticase" CH D

C9282 "Inj, ceftaroline

fosamil" CH D

C9283 "Injection,

acetaminophen" CH D

C9284 "Injection,

ipilimumab" CH D

C9285 "Patch,

lidocaine/tetracaine" G 9285 $13.57

. $2.67

C9286 "Injection,

belatacept" G 9286 $3.91

. $0.77

C9287 "Inj, brentuximab

vedotin" NI G 9287 $95.40

. $18.72

C9352 "Neuragen nerve guide, per

cm" N

C9353 "Neurawrap nerve

protector,cm" N

C9354 "Veritas collagen matrix,

cm2" N

C9355 "Neuromatrix nerve cuff,

cm" N

C9356 "TenoGlide tendon prot,

cm2" N

C9358 "SurgiMend,

fetal" K 9358 $10.91

. $2.19

C9359 "Implnt,bon void

filler-putty" N

C9360 "SurgiMend,

neonatal" CH K 9360 $11.23

. $2.25

C9361 NeuroMend nerve

wrap CH N

C9362 "Implnt,bon voidfiller-strip" CH N

C9363 Integra Meshed Bil Wound

Mat CH K 9363 $20.60

. $4.12

C9364 "Porcine implant,

Permacol" CH N

C9365 Oasis Ultra Tri-Layer

Matrix CH D

C9366 EpiFix wound

cover NI G 9366 $177.77

. $34.89

C9367 Endoform Dermal

Template G 9367 $4.35

. $0.86

C9399 Unclassified drugs or

biolog A

C9406 "Dx I-123 ioflupane, per

dose" CH D

C9716 Radiofrequency energy to

anu T 0150 32.9805 "$2,309.16"

. $461.84

C9724 EPS gast cardia

plic T 0422 25.9792 "$1,818.96"

. $363.80

C9725 Place endorectal

app T 0148 5.5158 $386.19

. $77.24

C9726 Rxt breast appl

place/remov T 0028 25.5066 "$1,785.87"

. $357.18

C9727 Insert palate

implants T 0252 7.4614 $522.42 $104.55 $104.49

C9728 "Place device/marker, non

pro" X 0310 13.6332 $954.54 $325.27 $190.91

C9730 "Bronchial thermo, 1

lobe" CH D

C9731 "Bronchial thermo, >1

lobe" CH D

C9732 Insert ocular telescope

pros NI T 0234 23.2851 "$1,630.33" $347.90 $326.07

C9800 Dermal filler inj

px/suppl T 0135 4.9271 $344.98

. $69.00C9898 Inpnt stay radiolabeled

item N

C9899 "Inpt implant pros dev,no

cov" A

D0120 Periodic oral

evaluation E

D0140 Limit oral eval problm

focus E

D0145 "Oral evaluation, pt <

3yrs" E

D0150 Comprehensve oral

evaluation S 0330 8.2687 $578.94

. $115.79

D0160 Extensv oral eval prob

focus E

D0170 "Re-eval,est pt,problem

focus" E

D0180 Comp periodontal

evaluation E

D0210 Intraor complete film

series E

D0220 Intraoral periapical first

f E

D0230 Intraoral periapical ea

add E

D0240 Intraoral occlusal

film S 0330 8.2687 $578.94

. $115.79

D0250 Extraoral first

film S 0330 8.2687 $578.94

. $115.79

D0260 Extraoral ea additional

film S 0330 8.2687 $578.94

. $115.79

D0270 Dental bitewing single

film S 0330 8.2687 $578.94

. $115.79

D0272 Dental bitewings two

films S 0330 8.2687 $578.94

. $115.79

D0273 Bitewings - three

films E

D0274 Dental bitewings four

films S 0330 8.2687 $578.94

. $115.79

D0277 Vert bitewings-sev to

eight S 0330 8.2687 $578.94

. $115.79D0290 Dental film skull/facial

bon E

D0310 Dental

saliography E

D0320 Dental tmj arthrogram incl

i E

D0321 Dental other tmj

films E

D0322 Dental tomographic

survey E

D0330 Dental panoramic

film E

D0340 Dental cephalometric

film E

D0350 Oral/facial photo

images E

D0360 Cone beam

ct E

D0362 "Cone beam, two

dimensional" E

D0363 "Cone beam, three

dimensional" E

D0415 Collection of

microorganisms E

D0416 Viral

culture B

D0417 Collect & prep saliva

sample E

D0418 Analysis of saliva

sample E

D0421 Gen tst suscept oral

disease B

D0425 Caries susceptibility

test E

D0431 Diag tst detect mucos

abnorm B

D0460 Pulp vitality

test S 0330 8.2687 $578.94

. $115.79

D0470 Diagnostic

casts ED0472 "Gross exam, prep &

report" B

D0473 "Micro exam, prep &

report" B

D0474 Micro w exam of surg

margins B

D0475 Decalcification

procedure B

D0476 Spec stains for

microorganis B

D0477 Spec stains not for

microorg B

D0478 Immunohistochemical

stains B

D0479 Tissue in-situ

hybridization B

D0480 Cytopath smear prep &

report B

D0481 Electron microscopy

diagnost B

D0482 Direct

immunofluorescence B

D0483 Indirect

immunofluorescence B

D0484 Consult slides prep

elsewher B

D0485 Consult inc prep of

slides B

D0486 Access of transep cytol

samp E

D0502 Other oral pathology

procedu B

D0999 Unspecified diagnostic

proce B

D1110 Dental prophylaxis

adult E

D1120 Dental prophylaxis

child E

D1203 Topical app fluoride

child E

D1204 Topical app fluorideadult E

D1206 Topical fluoride

varnish E

D1310 Nutri counsel-control

caries E

D1320 Tobacco

counseling E

D1330 Oral hygiene

instruction E

D1351 Dental sealant per

tooth E

D1352 "Prev resin rest, perm

tooth" E

D1510 Space maintainer fxd

unilat S 0330 8.2687 $578.94

. $115.79

D1515 Fixed bilat space

maintainer S 0330 8.2687 $578.94

. $115.79

D1520 Remove unilat space

maintain S 0330 8.2687 $578.94

. $115.79

D1525 Remove bilat space

maintain S 0330 8.2687 $578.94

. $115.79

D1550 Recement space

maintainer S 0330 8.2687 $578.94

. $115.79

D1555 Remove fix space

maintainer E

D2140 Amalgam one surface

permanen E

D2150 Amalgam two surfaces

permane E

D2160 Amalgam three surfaces

perma E

D2161 Amalgam 4 or > surfaces

perm E

D2330 Resin one

surface-anterior E

D2331 Resin two

surfaces-anterior E

D2332 Resin three

surfaces-anterio ED2335 Resin 4/> surf or w incis

an E

D2390 Ant resin-based cmpst

crown E

D2391 Post 1 srfc resinbased

cmpst E

D2392 Post 2 srfc resinbased

cmpst E

D2393 Post 3 srfc resinbased

cmpst E

D2394 Post >=4srfc resinbase

cmpst E

D2410 Dental gold foil one

surface E

D2420 Dental gold foil two

surface E

D2430 Dental gold foil three

surfa E

D2510 Dental inlay metalic 1

surf E

D2520 Dental inlay metallic 2

surf E

D2530 Dental inlay metl 3/more

sur E

D2542 Dental onlay metallic 2

surf E

D2543 Dental onlay metallic 3

surf E

D2544 Dental onlay metl 4/more

sur E

D2610 Inlay porcelain/ceramic 1

su E

D2620 Inlay porcelain/ceramic 2

su E

D2630 Dental onlay porc 3/more

sur E

D2642 Dental onlay porcelin 2

surf E

D2643 Dental onlay porcelin 3

surf E

D2644 Dental onlay porc 4/more

sur E

D2650 Inlay composite/resin onesu E

D2651 Inlay composite/resin two

su E

D2652 Dental inlay resin 3/mre

sur E

D2662 Dental onlay resin 2

surface E

D2663 Dental onlay resin 3

surface E

D2664 Dental onlay resin 4/mre

sur E

D2710 Crown resin-based

indirect E

D2712 Crown 3/4 resin-based

compos E

D2720 Crown resin w/ high noble

me E

D2721 Crown resin w/ base

metal E

D2722 Crown resin w/ noble

metal E

D2740 Crown porcelain/ceramic

subs E

D2750 Crown porcelain w/ h noble

m E

D2751 Crown porcelain fused base

m E

D2752 Crown porcelain w/ noble

met E

D2780 Crown 3/4 cast hi noble

met E

D2781 Crown 3/4 cast base

metal E

D2782 Crown 3/4 cast noble

metal E

D2783 Crown 3/4

porcelain/ceramic E

D2790 Crown full cast high noble

m E

D2791 Crown full cast base

metal E

D2792 Crown full cast noble

metal ED2794 Crown-titanium E

D2799 Provisional

crown E

D2910 Recement inlay onlay or

part E

D2915 Recement cast or prefab

post E

D2920 Dental recement

crown E

D2930 Prefab stnlss steel crwn

pri E

D2931 Prefab stnlss steel crown

pe E

D2932 Prefabricated resin

crown E

D2933 Prefab stainless steel

crown E

D2934 Prefab steel crown

primary E

D2940 Protective

restoration E

D2950 Core build-up incl any

pins E

D2951 Tooth pin

retention E

D2952 Post and core cast +

crown E

D2953 Each addtnl cast

post E

D2954 Prefab post/core +

crown E

D2955 Post

removal E

D2957 Each addtnl prefab

post E

D2960 Laminate labial

veneer E

D2961 Lab labial veneer

resin E

D2962 Lab labial veneer

porcelain E

D2970 Temp crown (fractured

tooth) ED2971 Add proc construct new

crown E

D2975 Coping E

D2980 Crown

repair E

D2999 Dental unspec restorative

pr S 0330 8.2687 $578.94

. $115.79

D3110 Pulp cap

direct E

D3120 Pulp cap

indirect E

D3220 Therapeutic

pulpotomy E

D3221 Gross pulpal

debridement E

D3222 Part pulp for

apexogenesis E

D3230 Pulpal therapy anterior

prim E

D3240 Pulpal therapy posterior

pri E

D3310 "End thxpy, anterior

tooth" E

D3320 "End thxpy, bicuspid

tooth" E

D3330 "End thxpy,

molar" E

D3331 Non-surg tx root canal

obs E

D3332 Incomplete endodontic

tx E

D3333 Internal root

repair E

D3346 Retreat root canal

anterior E

D3347 Retreat root canal

bicuspid E

D3348 Retreat root canal

molar E

D3351 Apexification/recalc

initial ED3352 Apexification/recalc

interim E

D3353 Apexification/recalc

final E

D3354 Pulpal regeneration

E

D3410 Apicoect/perirad surg

anter E

D3421 Root surgery

bicuspid E

D3425 Root surgery

molar E

D3426 Root surgery ea add

root E

D3430 Retrograde

filling E

D3450 Root

amputation E

D3460 Endodontic endosseous

implan S 0330 8.2687 $578.94

. $115.79

D3470 Intentional

replantation E

D3910 Isolation- tooth w rubb

dam E

D3920 Tooth

splitting E

D3950 Canal prep/fitting of

dowel E

D3999 Endodontic

procedure S 0330 8.2687 $578.94

. $115.79

D4210 Gingivectomy/plasty per

quad E

D4211 Gingivectomy/plasty per

toot E

D4230 Ana crown exp 4 or> per

quad E

D4231 Ana crown exp 1-3 per

quad E

D4240 Gingival flap proc w/

planin E

D4241 Gngvl flap w rootplan 1-3

th ED4245 Apically positioned

flap E

D4249 Crown lengthen hard

tissue E

D4260 Osseous surgery per

quadrant S 0330 8.2687 $578.94

. $115.79

D4261 Osseous

surgl-3teethperquad E

D4263 Bone replce graft first

site S 0330 8.2687 $578.94

. $115.79

D4264 Bone replce graft each

add S 0330 8.2687 $578.94

. $115.79

D4265 Bio mtrls to aid soft/os

reg E

D4266 Guided tiss regen

resorble E

D4267 Guided tiss regen

nonresorb E

D4268 Surgical revision

procedure S 0330 8.2687 $578.94

. $115.79

D4270 Pedicle soft tissue graft

pr S 0330 8.2687 $578.94

. $115.79

D4271 Free soft tissue graft

proc S 0330 8.2687 $578.94

. $115.79

D4273 Subepithelial tissue

graft S 0330 8.2687 $578.94

. $115.79

D4274 Distal/proximal wedge

proc E

D4275 Soft tissue

allograft E

D4276 Con tissue w dble ped

graft E

D4320 Provision splnt

intracoronal E

D4321 Provisional splint

extracoro E

D4341 Periodontal scaling &

root ED4342 Periodontal scaling

1-3teeth E

D4355 Full mouth

debridement S 0330 8.2687 $578.94

. $115.79

D4381 Localized delivery

antimicro S 0330 8.2687 $578.94

. $115.79

D4910 Periodontal maint

procedures E

D4920 Unscheduled dressing

change E

D4999 Unspecified periodontal

proc E

D5110 Dentures complete

maxillary E

D5120 Dentures complete

mandible E

D5130 Dentures immediat

maxillary E

D5140 Dentures immediat

mandible E

D5211 Dentures maxill part

resin E

D5212 Dentures mand part

resin E

D5213 Dentures maxill part

metal E

D5214 Dentures mandibl part

metal E

D5225 Maxillary part denture

flex E

D5226 Mandibular part denture

flex E

D5281 Removable partial

denture E

D5410 Dentures adjust cmplt

maxil E

D5411 Dentures adjust cmplt

mand E

D5421 Dentures adjust part

maxill E

D5422 Dentures adjust part

mandbl ED5510 Dentur repr broken compl

bas E

D5520 Replace denture teeth

complt E

D5610 Dentures repair resin

base E

D5620 Rep part denture cast

frame E

D5630 Rep partial denture

clasp E

D5640 Replace part denture

teeth E

D5650 Add tooth to partial

denture E

D5660 Add clasp to partial

denture E

D5670 Replc tth&acrlc on mtl

frmwk E

D5671 Replc tth&acrlc

mandibular E

D5710 Dentures rebase cmplt

maxil E

D5711 Dentures rebase cmplt

mand E

D5720 Dentures rebase part

maxill E

D5721 Dentures rebase part

mandbl E

D5730 Denture reln cmplt maxil

ch E

D5731 Denture reln cmplt mand

chr E

D5740 Denture reln part maxil

chr E

D5741 Denture reln part mand

chr E

D5750 Denture reln cmplt max

lab E

D5751 Denture reln cmplt mand

lab E

D5760 Denture reln part maxil

lab E

D5761 Denture reln part mand

lab ED5810 Denture interm cmplt

maxill E

D5811 Denture interm cmplt

mandbl E

D5820 Denture interm part

maxill E

D5821 Denture interm part

mandbl E

D5850 Denture tiss conditn

maxill E

D5851 Denture tiss condtin

mandbl E

D5860 Overdenture

complete E

D5861 Overdenture

partial E

D5862 Precision

attachment E

D5867 Replacement of precision

att E

D5875 Prosthesis

modification E

D5899 Removable prosthodontic

proc E

D5911 Facial moulage

sectional S 0330 8.2687 $578.94

. $115.79

D5912 Facial moulage

complete S 0330 8.2687 $578.94

. $115.79

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 ED5924 Cranial

prosthesis E

D5925 Facial augmentation

implant E

D5926 Replacement nasal

prosthesis E

D5927 Auricular

replacement E

D5928 Orbital

replacement E

D5929 Facial

replacement E

D5931 Surgical

obturator E

D5932 Postsurgical

obturator E

D5933 Refitting of

obturator E

D5934 Mandibular flange

prosthesis E

D5935 Mandibular denture

prosth E

D5936 Temp obturator

prosthesis E

D5937 Trismus

appliance E

D5951 Feeding

aid E

D5952 Pediatric speech

aid E

D5953 Adult speech

aid E

D5954 Superimposed

prosthesis E

D5955 Palatal lift

prosthesis E

D5958 Intraoral con def inter

plt E

D5959 Intraoral con def mod

palat E

D5960 Modify speech aid

prosthesis ED5982 Surgical

stent E

D5983 Radiation

applicator S 0330 8.2687 $578.94

. $115.79

D5984 Radiation

shield S 0330 8.2687 $578.94

. $115.79

D5985 Radiation cone

locator S 0330 8.2687 $578.94

. $115.79

D5986 Fluoride

applicator E

D5987 Commissure

splint S 0330 8.2687 $578.94

. $115.79

D5988 Surgical

splint E

D5991 Topical medicament

carrier E

D5992 Adjust max prost appliance

E

D5993 Main/clean max prosthesis

E

D5999 Maxillofacial

prosthesis E

D6010 Odontics endosteal

implant E

D6012 Endosteal

implant E

D6040 Odontics eposteal

implant E

D6050 Odontics transosteal

implnt E

D6053 Implnt/abtmnt spprt remv

dnt E

D6054 Implnt/abtmnt spprt

remvprtl E

D6055 Implant connecting

bar E

D6056 Prefabricated

abutment E

D6057 Custom

abutment E

D6058 Abutment supported

crown ED6059 Abutment supported mtl

crown E

D6060 Abutment supported mtl

crown E

D6061 Abutment supported mtl

crown E

D6062 Abutment supported mtl

crown E

D6063 Abutment supported mtl

crown E

D6064 Abutment supported mtl

crown E

D6065 Implant supported

crown E

D6066 Implant supported mtl

crown E

D6067 Implant supported mtl

crown E

D6068 Abutment supported

retainer E

D6069 Abutment supported

retainer E

D6070 Abutment supported

retainer E

D6071 Abutment supported

retainer E

D6072 Abutment supported

retainer E

D6073 Abutment supported

retainer E

D6074 Abutment supported

retainer E

D6075 Implant supported

retainer E

D6076 Implant supported

retainer E

D6077 Implant supported

retainer E

D6078 Implnt/abut suprtd fixd

dent E

D6079 Implnt/abut suprtd fixd

dent E

D6080 Implant

maintenance ED6090 Repair

implant E

D6091 Repl semi/precision

attach E

D6092 Recement supp

crown E

D6093 Recement supp part

denture E

D6094 Abut support crown

titanium E

D6095 Odontics repr

abutment E

D6100 Removal of

implant E

D6190 Radio/surgical implant

index E

D6194 Abut support retainer

titani E

D6199 Implant

procedure E

D6205 Pontic-indirect resin

based E

D6210 Prosthodont high noble

metal E

D6211 Bridge base metal

cast E

D6212 Bridge noble metal

cast E

D6214 Pontic

titanium E

D6240 Bridge porcelain high

noble E

D6241 Bridge porcelain base

metal E

D6242 Bridge porcelain nobel

metal E

D6245 Bridge

porcelain/ceramic E

D6250 Bridge resin w/high

noble E

D6251 Bridge resin base

metal ED6252 Bridge resin w/noble

metal E

D6253 Provisional

pontic E

D6254 Interim pontic

E

D6545 Dental retainr cast

metl E

D6548 Porcelain/ceramic

retainer E

D6600 Porcelain/ceramic inlay

2srf E

D6601 Porc/ceram inlay >= 3

surfac E

D6602 Cst hgh nble mtl inlay 2

srf E

D6603 Cst hgh nble mtl inlay

>=3sr E

D6604 Cst bse mtl inlay 2

surfaces E

D6605 Cst bse mtl inlay >= 3

surfa E

D6606 Cast noble metal inlay 2

sur E

D6607 Cst noble mtl inlay >=3

surf E

D6608 Onlay porc/crmc 2

surfaces E

D6609 Onlay porc/crmc >=3

surfaces E

D6610 Onlay cst hgh nbl mtl 2

srfc E

D6611 Onlay cst hgh nbl mtl

>=3srf E

D6612 Onlay cst base mtl 2

surface E

D6613 Onlay cst base mtl >=3

surfa E

D6614 Onlay cst nbl mtl 2

surfaces E

D6615 Onlay cst nbl mtl >=3

surfac E

D6624 Inlay

titanium ED6634 Onlay

titanium E

D6710 Crown-indirect resin

based E

D6720 Retain crown resin w hi

nble E

D6721 Crown resin w/base

metal E

D6722 Crown resin w/noble

metal E

D6740 Crown

porcelain/ceramic E

D6750 Crown porcelain high

noble E

D6751 Crown porcelain base

metal E

D6752 Crown porcelain noble

metal E

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/ceramic E

D6790 Crown full high noble

metal E

D6791 Crown full base metal

cast E

D6792 Crown full noble metal

cast E

D6793 Provisional retainer

crown E

D6794 Crown

titanium E

D6795 Interim retainer crown

E

D6920 Dental connector

bar S 0330 8.2687 $578.94

. $115.79

D6930 Dental recement

bridge ED6940 Stress

breaker E

D6950 Precision

attachment E

D6970 Post & core plus

retainer E

D6972 Prefab post & core plus

reta E

D6973 Core build up for

retainer E

D6975 Coping

metal E

D6976 Each addtnl cast

post E

D6977 Each addtl prefab

post E

D6980 Bridge

repair E

D6985 Pediatric partial denture

fx E

D6999 Fixed prosthodontic

proc E

D7111 Extraction coronal

remnants S 0330 8.2687 $578.94

. $115.79

D7140 Extraction erupted

tooth/exr S 0330 8.2687 $578.94

. $115.79

D7210 Rem imp tooth w mucoper

flp S 0330 8.2687 $578.94

. $115.79

D7220 Impact tooth remov soft

tiss S 0330 8.2687 $578.94

. $115.79

D7230 Impact tooth remov part

bony S 0330 8.2687 $578.94

. $115.79

D7240 Impact tooth remov comp

bony S 0330 8.2687 $578.94

. $115.79

D7241 Impact tooth rem bony

w/comp S 0330 8.2687 $578.94

. $115.79

D7250 Tooth root

removal S 0330 8.2687 $578.94

. $115.79

D7251 Coronectomy ED7260 Oral antral fistula

closure S 0330 8.2687 $578.94

. $115.79

D7261 Primary closure sinus

perf S 0330 8.2687 $578.94

. $115.79

D7270 Tooth

reimplantation E

D7272 Tooth

transplantation E

D7280 Exposure impact tooth

orthod E

D7282 Mobilize erupted/malpos

toot E

D7283 Place device impacted

tooth B

D7285 Biopsy of oral tissue

hard E

D7286 Biopsy of oral tissue

soft E

D7287 Exfoliative cytolog

collect E

D7288 Brush

biopsy B

D7290 Repositioning of

teeth E

D7291 Transseptal

fiberotomy S 0330 8.2687 $578.94

. $115.79

D7292 Screw retained

plate E

D7293 Temp anchorage dev w

flap E

D7294 Temp anchorage dev w/o

flap E

D7295 "Bone harvest,auto graft proc

" E

D7310 Alveoplasty w/

extraction E

D7311 Alveoloplasty w/extract

1-3 E

D7320 Alveoplasty w/o

extraction ED7321 Alveoloplasty not

w/extracts B

D7340 Vestibuloplasty ridge

extens E

D7350 Vestibuloplasty exten

graft E

D7410 Rad exc lesion up to 1.25

cm E

D7411 Excision benign

lesion>1.25c E

D7412 Excision benign lesion

compl E

D7413 Excision malig

lesion<=1.25c E

D7414 Excision malig

lesion>1.25cm E

D7415 Excision malig les

complicat E

D7440 Malig tumor exc to 1.25

cm E

D7441 Malig tumor > 1.25

cm E

D7450 Rem odontogen cyst to

1.25cm E

D7451 Rem odontogen cyst > 1.25

cm E

D7460 Rem nonodonto cyst to

1.25cm E

D7461 Rem nonodonto cyst > 1.25

cm E

D7465 Lesion

destruction E

D7471 Rem exostosis any

site E

D7472 Removal of torus

palatinus E

D7473 Remove torus

mandibularis E

D7485 Surg reduct

osseoustuberosit ED7490 Maxilla or mandible

resectio E

D7510 I&d absc intraoral soft

tiss E

D7511 Incision/drain abscess

intra B

D7520 I&d abscess

extraoral E

D7521 Incision/drain abscess

extra B

D7530 Removal fb skin/areolar

tiss E

D7540 Removal of fb

reaction E

D7550 Removal of sloughed off

bone E

D7560 Maxillary

sinusotomy E

D7610 Maxilla open reduct

simple E

D7620 Clsd reduct simpl maxilla

fx E

D7630 Open red simpl mandible

fx E

D7640 Clsd red simpl mandible

fx E

D7650 Open red simp malar/zygom

fx E

D7660 Clsd red simp malar/zygom

fx E

D7670 Closd rductn splint

alveolus E

D7671 Alveolus open

reduction E

D7680 Reduct simple facial bone

fx E

D7710 Maxilla open reduct

compound E

D7720 Clsd reduct compd maxilla

fx E

D7730 Open reduct compd mandble

fx E

D7740 Clsd reduct compd mandble

fx ED7750 Open red comp malar/zygma

fx E

D7760 Clsd red comp malar/zygma

fx E

D7770 Open reduc compd alveolus

fx E

D7771 Alveolus clsd reduc stblz

te E

D7780 Reduct compnd facial bone

fx E

D7810 Tmj open

reduct-dislocation E

D7820 Closed tmp

manipulation E

D7830 Tmj manipulation under

anest E

D7840 Removal of tmj

condyle E

D7850 Tmj

meniscectomy E

D7852 Tmj repair of joint

disc E

D7854 Tmj excisn of joint

membrane E

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

adhesn ED7874 Tmj arthroscopy disc

reposit E

D7875 Tmj arthroscopy

synovectomy E

D7876 Tmj arthroscopy

discectomy E

D7877 Tmj arthroscopy

debridement E

D7880 Occlusal orthotic

appliance E

D7899 Tmj unspecified

therapy E

D7910 Dent sutur recent wnd to

5cm E

D7911 Dental suture wound to 5

cm E

D7912 Suture complicate wnd > 5

cm E

D7920 Dental skin

graft E

D7940 Reshaping bone

orthognathic S 0330 8.2687 $578.94

. $115.79

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

total E

D7947 Reconstruct maxilla

segment E

D7948 Reconstruct midface no

graft E

D7949 Reconstruct midface

w/graft E

D7950 Mandible

graft E

D7951 Sinus aug w bone/bone

sup ED7953 Bone replacement

graft E

D7955 Repair maxillofacial

defects E

D7960 Frenulectomy/frenectomy E

D7963 Frenuloplasty E

D7970 Excision hyperplastic

tissue E

D7971 Excision pericoronal

gingiva E

D7972 Surg redct fibrous

tuberosit E

D7980 Sialolithotomy E

D7981 Excision of salivary

gland E

D7982 Sialodochoplasty E

D7983 Closure of salivary

fistula E

D7990 Emergency

tracheotomy E

D7991 Dental

coronoidectomy E

D7995 Synthetic graft facial

bones E

D7996 Implant mandible for

augment E

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

transition E

D8030 Limited dental tx

adolescent E

D8040 Limited dental txadult E

D8050 Intercep dental tx

primary E

D8060 Intercep dental tx

transitn E

D8070 Compre dental tx

transition E

D8080 Compre dental tx

adolescent E

D8090 Compre dental tx

adult E

D8210 Orthodontic rem appliance

tx E

D8220 Fixed appliance therapy

habt E

D8660 Preorthodontic tx

visit E

D8670 Periodic orthodontc tx

visit E

D8680 Orthodontic

retention E

D8690 Orthodontic

treatment E

D8691 Repair ortho

appliance E

D8692 Replacement

retainer E

D8693 Rebond/cement/repair

retain E

D8999 Orthodontic

procedure E

D9110 Tx dental pain minor

proc N

D9120 Fix partial denture

section E

D9210 Dent anesthesia w/o

surgery E

D9211 Regional block

anesthesia E

D9212 Trigeminal block

anesthesia E

D9215 Local

anesthesia E

D9220 Generalanesthesia E

D9221 General anesthesia ea ad

15m E

D9230 Analgesia N

D9241 Intravenous

sedation E

D9242 IV sedation ea ad 30

m E

D9248 Sedation

(non-iv) N

D9310 Dental

consultation E

D9410 Dental house

call E

D9420 Hospital/ASC

call E

D9430 Office visit during

hours E

D9440 Office visit after

hours E

D9450 Case presentation tx

plan E

D9610 Dent therapeutic drug

inject E

D9612 Thera par drugs 2 or >

admin E

D9630 Other

drugs/medicaments S 0330 8.2687 $578.94

. $115.79

D9910 Dent appl desensitizing

med E

D9911 Appl desensitizing

resin E

D9920 Behavior

management E

D9930 Treatment of

complications S 0330 8.2687 $578.94

. $115.79

D9940 Dental occlusal

guard S 0330 8.2687 $578.94

. $115.79

D9941 Fabrication athletic

guard ED9942 Repair/reline occlusal

guard E

D9950 Occlusion

analysis S 0330 8.2687 $578.94

. $115.79

D9951 Limited occlusal

adjustment S 0330 8.2687 $578.94

. $115.79

D9952 Complete occlusal

adjustment S 0330 8.2687 $578.94

. $115.79

D9970 Enamel

microabrasion E

D9971 Odontoplasty 1-2

teeth E

D9972 Extrnl bleaching per

arch E

D9973 Extrnl bleaching per

tooth E

D9974 Intrnl bleaching per

tooth E

D9999 Adjunctive

procedure E

E0100 Cane adjust/fixed with

tip Y

E0105 Cane adjust/fixed quad/3

pro Y

E0110 Crutch forearm

pair Y

E0111 Crutch forearm

each Y

E0112 Crutch underarm pair

wood Y

E0113 Crutch underarm each

wood Y

E0114 Crutch underarm pair no

wood Y

E0116 Crutch underarm each no

wood Y

E0117 Underarm springassist

crutch Y

E0118 Crutch

substitute E

E0130 Walker rigid adjust/fixed

ht YE0135 Walker folding

adjust/fixed Y

E0140 Walker w trunk

support Y

E0141 Rigid wheeled walker

adj/fix Y

E0143 Walker folding wheeled w/o

s Y

E0144 Enclosed walker w rear

seat Y

E0147 Walker variable wheel

resist Y

E0148 Heavyduty walker no

wheels Y

E0149 Heavy duty wheeled

walker Y

E0153 Forearm crutch platform

atta Y

E0154 Walker platform

attachment Y

E0155 "Walker wheel

attachment,pair" Y

E0156 Walker seat

attachment Y

E0157 Walker crutch

attachment Y

E0158 Walker leg extenders set

of4 Y

E0159 Brake for wheeled

walker Y

E0160 Sitz type bath or

equipment Y

E0161 Sitz bath/equipment

w/faucet Y

E0162 Sitz bath

chair Y

E0163 Commode chair with fixed

arm Y

E0165 Commode chair with

detacharm Y

E0167 Commode chair pail or

pan YE0168 Heavyduty/wide commode

chair Y

E0170 Commode chair

electric Y

E0171 Commode chair

non-electric Y

E0172 Seat lift mechanism

toilet E

E0175 Commode chair foot

rest Y

E0181 Press pad alternating w/

pum Y

E0182 "Replace pump, alt press

pad" Y

E0184 Dry pressure

mattress Y

E0185 Gel pressure mattress

pad Y

E0186 Air pressure

mattress Y

E0187 Water pressure

mattress Y

E0188 Synthetic sheepskin

pad Y

E0189 Lambswool sheepskin

pad Y

E0190 Positioning

cushion E

E0191 Protector heel or

elbow Y

E0193 Powered air flotation

bed Y

E0194 Air fluidized

bed Y

E0196 Gel pressure

mattress Y

E0197 Air pressure pad for

mattres Y

E0198 Water pressure pad for

mattr Y

E0199 Dry pressure pad for

mattres Y

E0200 Heat lamp without

stand YE0202 Phototherapy light w/

photom Y

E0203 Therapeutic lightbox

tabletp E

E0205 Heat lamp with

stand Y

E0210 Electric heat pad

standard Y

E0215 Electric heat pad

moist Y

E0217 Water circ heat pad w

pump Y

E0218 Water circ cold pad w

pump Y

E0221 Infrared heating pad

system Y

E0225 Hydrocollator

unit Y

E0231 Wound warming

device E

E0232 Warming card for

NWT E

E0235 Paraffin bath unit

portable Y

E0236 Pump for water circulating

p Y

E0239 Hydrocollator unit

portable Y

E0240 Bath/shower

chair E

E0241 Bath tub wall

rail E

E0242 Bath tub rail

floor E

E0243 Toilet

rail E

E0244 Toilet seat

raised E

E0245 Tub stool or

bench E

E0246 Transfer tub rail

attachment E

E0247 Trans bench w/wo comm

open EE0248 HDtrans bench w/wo comm

open E

E0249 Pad water circulating heat

u Y

E0250 Hosp bed fixed ht w/

mattres Y

E0251 Hosp bed fixd ht w/o

mattres Y

E0255 Hospital bed var ht w/

mattr Y

E0256 Hospital bed var ht w/o

matt Y

E0260 Hosp bed semi-electr w/

matt Y

E0261 Hosp bed semi-electr w/o

mat Y

E0265 Hosp bed total electr w/

mat Y

E0266 Hosp bed total elec w/o

matt Y

E0270 Hospital bed institutional

t E

E0271 Mattress

innerspring Y

E0272 Mattress foam

rubber Y

E0273 Bed

board E

E0274 Over-bed

table E

E0275 Bed pan

standard Y

E0276 Bed pan

fracture Y

E0277 Powered pres-redu air

mattrs Y

E0280 Bed

cradle Y

E0290 Hosp bed fx ht w/o rails

w/m Y

E0291 Hosp bed fx ht w/o rail

w/o Y

E0292 Hosp bed var ht w/o railw/o Y

E0293 Hosp bed var ht w/o rail

w/ Y

E0294 Hosp bed semi-elect w/

mattr Y

E0295 Hosp bed semi-elect w/o

matt Y

E0296 Hosp bed total elect w/

matt Y

E0297 Hosp bed total elect w/o

mat Y

E0300 Enclosed ped crib hosp

grade Y

E0301 "HD hosp bed, 350-600

lbs" Y

E0302 Ex hd hosp bed > 600

lbs Y

E0303 Hosp bed hvy dty xtra

wide Y

E0304 Hosp bed xtra hvy dty x

wide Y

E0305 Rails bed side half

length Y

E0310 Rails bed side full

length Y

E0315 Bed accessory

brd/tbl/supprt E

E0316 Bed safety

enclosure Y

E0325 Urinal male

jug-type Y

E0326 Urinal female

jug-type Y

E0328 "Ped hospital bed,

manual" Y

E0329 Ped hospital bed

semi/elect Y

E0350 Control unit bowel

system E

E0352 Disposable pack w/bowel

syst E

E0370 Air elevator for

heel EE0371 Nonpower mattress

overlay Y

E0372 Powered air mattress

overlay Y

E0373 Nonpowered pressure

mattress Y

E0424 Stationary compressed gas

02 Y

E0425 Gas system stationary

compre E

E0430 Oxygen system gas

portable E

E0431 Portable gaseous

02 Y

E0433 Portable liquid oxygen

sys Y

E0434 Portable liquid

02 Y

E0435 Oxygen system liquid

portabl E

E0439 Stationary liquid

02 Y

E0440 Oxygen system liquid

station E

E0441 "Stationary O2 contents,

gas" Y

E0442 "Stationary O2 contents,

liq" Y

E0443 "Portable 02 contents,

gas" Y

E0444 "Portable 02 contents,

liquid" Y

E0445 Oximeter

non-invasive N

E0446 "Topical Ox Deliver sys,

nos" E

E0450 Vol control vent invasiv

int Y

E0455 Oxygen tent excl croup/ped

t Y

E0457 Chest

shell Y

E0459 Chest

wrap YE0460 Neg press vent

portabl/statn Y

E0461 Vol control vent noninv

int Y

E0462 Rocking bed w/ or w/o side

r Y

E0463 Press supp vent invasive

int Y

E0464 Press supp vent noninv

int Y

E0470 RAD w/o backup non-inv

intfc Y

E0471 RAD w/backup non inv

intrfc Y

E0472 RAD w backup invasive

intrfc Y

E0480 Percussor elect/pneum home

m Y

E0481 Intrpulmnry percuss vent

sys E

E0482 Cough stimulating

device Y

E0483 Chest compression gen

system Y

E0484 Non-elec oscillatory pep

dvc Y

E0485 Oral device/appliance

prefab Y

E0486 Oral device/appliance

cusfab Y

E0487 Electronic spirometer

N

E0500 Ippb all

types Y

E0550 Humidif extens supple w

ippb Y

E0555 Humidifier for use w/

regula Y

E0560 Humidifier supplemental w/

i Y

E0561 Humidifier nonheated w

PAP Y

E0562 Humidifier heated used wPAP Y

E0565 Compressor air power

source Y

E0570 Nebulizer with

compression Y

E0571 Aerosol compressor for

svneb CH D

E0572 Aerosol compressor adjust

pr Y

E0574 Ultrasonic generator w

svneb Y

E0575 Nebulizer

ultrasonic Y

E0580 Nebulizer for use w/

regulat Y

E0585 Nebulizer w/ compressor &

he Y

E0600 Suction pump portab hom

modl Y

E0601 Cont airway pressure

device Y

E0602 Manual breast

pump Y

E0603 Electric breast

pump N

E0604 Hosp grade elec breast

pump A

E0605 Vaporizer room

type Y

E0606 Drainage board

postural Y

E0607 Blood glucose monitor

home Y

E0610 Pacemaker monitr

audible/vis Y

E0615 Pacemaker monitr

digital/vis Y

E0616 Cardiac event

recorder N

E0617 Automatic ext

defibrillator YE0618 Apnea

monitor Y

E0619 Apnea monitor w

recorder Y

E0620 Cap bld skin piercing

laser Y

E0621 Patient lift sling or

seat Y

E0625 Patient lift bathroom or

toi E

E0627 Seat lift incorp

lift-chair Y

E0628 Seat lift for pt

furn-electr Y

E0629 Seat lift for pt

furn-non-el Y

E0630 Patient lift

hydraulic Y

E0635 Patient lift

electric Y

E0636 PT support & positioning

sys Y

E0637 Combination sit to stand

sys E

E0638 Standing frame

sys E

E0639 Moveable patient lift

system E

E0640 Fixed patient lift

system E

E0641 Multi-position stnd fram

sys E

E0642 Dynamic standing

frame E

E0650 Pneuma compresor

non-segment Y

E0651 Pneum compressor

segmental Y

E0652 Pneum compres w/cal

pressure Y

E0655 Pneumatic appliance half

arm YE0656 Segmental pneumatic

trunk Y

E0657 Segmental pneumatic

chest Y

E0660 Pneumatic appliance full

leg Y

E0665 Pneumatic appliance full

arm Y

E0666 Pneumatic appliance half

leg Y

E0667 Seg pneumatic appl full

leg Y

E0668 Seg pneumatic appl full

arm Y

E0669 Seg pneumatic appli half

leg Y

E0671 Pressure pneum appl full

leg Y

E0672 Pressure pneum appl full

arm Y

E0673 Pressure pneum appl half

leg Y

E0675 Pneumatic compression

device Y

E0676 Inter limb compress dev

NOS Y

E0691 Uvl pnl 2 sq ft or

less Y

E0692 Uvl sys panel 4

ft Y

E0693 Uvl sys panel 6

ft Y

E0694 Uvl md cabinet sys 6

ft Y

E0700 Safety

equipment E

E0705 Transfer

device B

E0710 Restraints any

type E

E0720 Tens two

lead Y

E0730 Tens four

lead YE0731 Conductive garment for

tens/ Y

E0740 Incontinence treatment

systm Y

E0744 Neuromuscular stim for

scoli Y

E0745 Neuromuscular stim for

shock Y

E0746 Electromyograph

biofeedback N

E0747 Elec osteogen stim not

spine Y

E0748 Elec osteogen stim

spinal Y

E0749 Elec osteogen stim

implanted N

E0755 Electronic salivary reflex

s E

E0760 Osteogen ultrasound

stimltor Y

E0761 Nontherm electromgntc

device E

E0762 Trans elec jt stim dev

sys B

E0764 Functional

neuromuscularstim Y

E0765 Nerve stimulator for tx

n&v Y

E0769 Electric wound treatment

dev B

E0770 Functional electric stim

NOS Y

E0776 Iv

pole Y

E0779 Amb infusion pump

mechanical Y

E0780 Mech amb infusion pump

<8hrs Y

E0781 External ambulatory infus

pu Y

E0782 Non-programble infusion

pump N

E0783 Programmable infusionpump N

E0784 Ext amb infusn pump

insulin Y

E0785 Replacement impl pump

cathet N

E0786 Implantable pump

replacement N

E0791 Parenteral infusion pump

sta Y

E0830 Ambulatory traction

device N

E0840 Tract frame attach

headboard Y

E0849 Cervical pneum trac

equip Y

E0850 Traction stand free

standing Y

E0855 Cervical traction

equipment Y

E0856 Cervic collar w air

bladder Y

E0860 Tract equip cervical

tract Y

E0870 Tract frame attach

footboard Y

E0880 Trac stand free stand

extrem Y

E0890 Traction frame attach

pelvic Y

E0900 Trac stand free stand

pelvic Y

E0910 Trapeze bar attached to

bed Y

E0911 HD trapeze bar attach to

bed Y

E0912 HD trapeze bar free

standing Y

E0920 Fracture frame attached to

b Y

E0930 Fracture frame free

standing Y

E0935 Cont pas motion exercise

dev YE0936 "CPM device, other than

knee" E

E0940 Trapeze bar free

standing Y

E0941 Gravity assisted traction

de Y

E0942 Cervical head

harness/halter Y

E0944 Pelvic

belt/harness/boot Y

E0945 Belt/harness

extremity Y

E0946 Fracture frame dual w

cross Y

E0947 Fracture frame attachmnts

pe Y

E0948 Fracture frame attachmnts

ce Y

E0950 Tray Y

E0951 Loop

heel Y

E0952 "Toe loop/holder,

each" Y

E0955 Cushioned

headrest Y

E0956 W/c lateral trunk/hip

suppor Y

E0957 W/c medial thigh

support Y

E0958 Whlchr att- conv 1 arm

drive Y

E0959 Amputee

adapter B

E0960 W/c shoulder

harness/straps Y

E0961 Wheelchair brake

extension B

E0966 Wheelchair head rest

extensi B

E0967 Manual wc hand rim w

project Y

E0968 Wheelchair commodeseat Y

E0969 Wheelchair narrowing

device Y

E0970 Wheelchair no. 2

footplates E

E0971 Wheelchair anti-tipping

devi B

E0973 W/Ch access det adj

armrest B

E0974 W/Ch access

anti-rollback B

E0978 "W/C acc,saf belt pelv

strap" B

E0980 Wheelchair safety

vest Y

E0981 "Seat upholstery,

replacement" Y

E0982 "Back upholstery,

replacement" Y

E0983 Add pwr

joystick Y

E0984 Add pwr

tiller Y

E0985 W/c seat lift

mechanism Y

E0986 Man w/c push-rim pow

assist Y

E0988 Lever-activated wheel

drive NI Y

E0990 Wheelchair elevating leg

res B

E0992 Wheelchair solid seat

insert B

E0994 Wheelchair arm

rest Y

E0995 Wheelchair calf

rest B

E1002 Pwr seat

tilt Y

E1003 Pwr seat

recline Y

E1004 Pwr seat reclinemech 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

adjustm Y

E1014 Reclining back add ped

w/c Y

E1015 Shock absorber for man

w/c Y

E1016 Shock absorber for power

w/c Y

E1017 HD shck absrbr for hd man

wc Y

E1018 HD shck absrber for hd

powwc Y

E1020 Residual limb support

system Y

E1028 W/c manual

swingaway Y

E1029 W/c vent tray

fixed Y

E1030 W/c vent tray

gimbaled Y

E1031 Rollabout chair with

casters Y

E1035 Patient transfer system

<300 Y

E1036 Patient transfer system

>300 Y

E1037 "Transport chair, ped

size" Y

E1038 Transport chair pt

wt<=300lb Y

E1039 Transport chair pt wt>300lb Y

E1050 Whelchr fxd full length

arms Y

E1060 Wheelchair detachable

arms Y

E1070 Wheelchair detachable foot

r Y

E1083 Hemi-wheelchair fixed

arms Y

E1084 Hemi-wheelchair detachable

a Y

E1085 Hemi-wheelchair fixed

arms E

E1086 Hemi-wheelchair detachable

a E

E1087 Wheelchair lightwt fixed

arm Y

E1088 Wheelchair lightweight det

a Y

E1089 Wheelchair lightwt fixed

arm E

E1090 Wheelchair lightweight det

a E

E1092 Wheelchair wide w/ leg

rests Y

E1093 Wheelchair wide w/ foot

rest Y

E1100 Whchr s-recl fxd arm leg

res Y

E1110 Wheelchair semi-recl

detach Y

E1130 Whlchr stand fxd arm ft

rest E

E1140 Wheelchair standard detach

a E

E1150 Wheelchair standard w/ leg

r Y

E1160 Wheelchair fixed

arms Y

E1161 Manual adult wc w

tiltinspac Y

E1170 Whlchr ampu fxd arm leg

rest Y

E1171 Wheelchair amputee w/o legr Y

E1172 Wheelchair amputee detach

ar Y

E1180 Wheelchair amputee w/ foot

r Y

E1190 Wheelchair amputee w/ leg

re Y

E1195 Wheelchair amputee heavy

dut Y

E1200 Wheelchair amputee fixed

arm Y

E1220 Whlchr special

size/constrc Y

E1221 Wheelchair spec size w

foot Y

E1222 Wheelchair spec size w/

leg Y

E1223 Wheelchair spec size w

foot Y

E1224 Wheelchair spec size w/

leg Y

E1225 Manual semi-reclining

back Y

E1226 Manual fully reclining

back B

E1227 Wheelchair spec sz spec ht

a Y

E1228 Wheelchair spec sz spec ht

b Y

E1229 Pediatric wheelchair

NOS Y

E1230 Power operated

vehicle Y

E1231 Rigid ped w/c

tilt-in-space Y

E1232 Folding ped wc

tilt-in-space Y

E1233 Rig ped wc tltnspc w/o

seat Y

E1234 Fld ped wc tltnspc w/o

seat Y

E1235 Rigid ped wcadjustable Y

E1236 Folding ped wc

adjustable Y

E1237 Rgd ped wc adjstabl w/o

seat Y

E1238 Fld ped wc adjstabl w/o

seat Y

E1239 Ped power wheelchair

NOS Y

E1240 Whchr litwt det arm leg

rest Y

E1250 Wheelchair lightwt fixed

arm E

E1260 Wheelchair lightwt foot

rest E

E1270 Wheelchair lightweight leg

r Y

E1280 Whchr h-duty det arm leg

res Y

E1285 Wheelchair heavy duty

fixed E

E1290 Wheelchair hvy duty detach

a E

E1295 Wheelchair heavy duty

fixed Y

E1296 Wheelchair special seat

heig Y

E1297 Wheelchair special seat

dept Y

E1298 Wheelchair spec seat

depth/w Y

E1300 Whirlpool

portable E

E1310 Whirlpool

non-portable Y

E1353 Oxygen supplies

regulator Y

E1354 "Wheeled cart, port

cyl/conc" Y

E1355 Oxygen supplies

stand/rack Y

E1356 "Batt pack/cart, port

conc" YE1357 "Battery charger, port

conc" Y

E1358 "DC power adapter, port

conc" Y

E1372 Oxy suppl heater for

nebuliz Y

E1390 Oxygen

concentrator Y

E1391 "Oxygen concentrator,

dual" Y

E1392 Portable oxygen

concentrator Y

E1399 Durable medical equipment

mi Y

E1405 O2/water vapor enrich

w/heat Y

E1406 O2/water vapor enrich w/o

he Y

E1500 Centrifuge A

E1510 Kidney dialysate delivry

sys A

E1520 Heparin infusion

pump A

E1530 Replacement air bubble

detec A

E1540 Replacement pressure

alarm A

E1550 Bath conductivity

meter A

E1560 Replace blood leak

detector A

E1570 Adjustable chair for esrd

pt A

E1575 Transducer protect/fld

bar A

E1580 Unipuncture control

system A

E1590 Hemodialysis

machine A

E1592 Auto interm peritoneal

dialy A

E1594 Cycler dialysismachine A

E1600 Deli/install chrg hemo

equip A

E1610 Reverse osmosis h2o puri

sys A

E1615 Deionizer H2O puri

system A

E1620 Replacement blood

pump A

E1625 Water softening

system A

E1630 Reciprocating peritoneal

dia A

E1632 Wearable artificial

kidney A

E1634 Peritoneal dialysis

clamp B

E1635 Compact travel

hemodialyzer A

E1636 Sorbent cartridges per

10 A

E1637 "Hemostats for dialysis,

each" A

E1639 Dialysis

scale A

E1699 Dialysis equipment

noc A

E1700 Jaw motion rehab

system Y

E1701 Repl cushions for jaw

motion Y

E1702 Repl measr scales jaw

motion Y

E1800 Adjust elbow ext/flex

device Y

E1801 SPS elbow

device Y

E1802 Adjst forearm pro/sup

device Y

E1805 Adjust wrist ext/flex

device Y

E1806 SPS wrist

device YE1810 Adjust knee ext/flex

device Y

E1811 SPS knee

device Y

E1812 Knee ext/flex w act res

ctrl Y

E1815 Adjust ankle ext/flex

device Y

E1816 SPS ankle

device Y

E1818 SPS forearm

device Y

E1820 Soft interface

material Y

E1821 Replacement interface

SPSD Y

E1825 Adjust finger ext/flex

devc Y

E1830 Adjust toe ext/flex

device Y

E1831 Static str toe dev

ext/flex Y

E1840 Adj shoulder ext/flex

device Y

E1841 Static str shldr dev rom

adj Y

E1902 AAC non-electronic

board Y

E2000 Gastric suction pump hme

mdl Y

E2100 Bld glucose monitor w

voice Y

E2101 Bld glucose monitor w

lance Y

E2120 Pulse gen sys tx endolymp

fl Y

E2201 "Man w/ch acc seat

w>=20""<24""" Y

E2202 Seat width 24-27

in Y

E2203 Frame depth less than 22

in Y

E2204 Frame depth 22 to 25

in YE2205 "Manual wc accessory,

handrim" Y

E2206 Complete wheel lock

assembly Y

E2207 Crutch and cane

holder Y

E2208 Cylinder tank

carrier Y

E2209 Arm trough

each Y

E2210 Wheelchair

bearings 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

tire Y

E2217 Foam filled caster tire

each Y

E2218 Foam propulsion tire

each Y

E2219 Foam caster tire any size

ea Y

E2220 Solid propulsion tire

each Y

E2221 Solid caster tire

each Y

E2222 Solid caster integrated

whl Y

E2224 Propulsion whl excludes

tire Y

E2225 Caster wheel excludes

tire Y

E2226 Caster fork replacement

only Y

E2227 Gear reduction drive

wheel YE2228 "Mwc acc, wheelchair

brake" Y

E2230 Manual standing

system E

E2231 Solid seat support

base Y

E2291 Planar back for ped size

wc Y

E2292 Planar seat for ped size

wc Y

E2293 Contour back for ped size

wc Y

E2294 Contour seat for ped size

wc Y

E2295 Ped dynamic seating

frame Y

E2300 Pwr seat elevation

sys Y

E2301 Pwr

standing Y

E2310 Electro connect btw

control Y

E2311 Electro connect btw 2

sys Y

E2312 Mini-prop remote

joystick Y

E2313 "PWC harness, expand

control" Y

E2321 Hand interface

joystick Y

E2322 Mult mech

switches Y

E2323 Special joystick

handle Y

E2324 Chin cup

interface Y

E2325 Sip and puff

interface Y

E2326 Breath tube

kit Y

E2327 Head control interface

mech Y

E2328 Head/extremity control

inter YE2329 Head control

nonproportional Y

E2330 Head control proximity

switc Y

E2331 Attendant

control Y

E2340 W/c wdth 20-23 in seat

frame Y

E2341 W/c wdth 24-27 in seat

frame Y

E2342 W/c dpth 20-21 in seat

frame Y

E2343 W/c dpth 22-25 in seat

frame Y

E2351 Electronic SGD

interface Y

E2358 Gr 34 nonsealed

leadacid NI Y

E2359 Gr34 sealed leadacid

battery NI Y

E2360 22nf nonsealed

leadacid Y

E2361 22nf sealed leadacid

battery Y

E2362 Gr24 nonsealed

leadacid Y

E2363 Gr24 sealed leadacid

battery Y

E2364 U1nonsealed leadacid

battery Y

E2365 U1 sealed leadacid

battery Y

E2366 "Battery charger, single

mode" Y

E2367 "Battery charger, dual

mode" Y

E2368 Power wc motor

replacement Y

E2369 Pwr wc gear box

replacement Y

E2370 Pwr wc motor/gear box

combo YE2371 Gr27 sealed leadacid

battery Y

E2372 Gr27 non-sealed

leadacid Y

E2373 Hand/chin ctrl spec

joystick Y

E2374 Hand/chin ctrl std

joystick Y

E2375 Non-expandable

controller Y

E2376 "Expandable controller,

repl" Y

E2377 "Expandable controller,

initl" Y

E2381 Pneum drive wheel

tire Y

E2382 "Tube, pneum wheel drive

tire" Y

E2383 "Insert, pneum wheel drive

" Y

E2384 Pneumatic caster

tire Y

E2385 "Tube, pneumatic caster

tire" Y

E2386 Foam filled drive wheel

tire Y

E2387 Foam filled caster

tire Y

E2388 Foam drive wheel

tire Y

E2389 Foam caster

tire Y

E2390 Solid drive wheel

tire Y

E2391 Solid caster

tire Y

E2392 "Solid caster tire,

integrate" Y

E2394 Drive wheel excludes

tire Y

E2395 Caster wheel excludes

tire Y

E2396 Caster

fork YE2397 "Pwc acc, lith-based

battery" Y

E2402 Neg press wound therapy

pump Y

E2500 SGD digitized pre-rec

<=8min Y

E2502 SGD prerec msg >8min

<=20min Y

E2504 SGD prerec msg>20min

<=40min Y

E2506 SGD prerec msg > 40

min Y

E2508 SGD spelling phys

contact Y

E2510 SGD w multi methods

msg/accs Y

E2511 SGD sftwre prgrm for

PC/PDA Y

E2512 "SGD accessory, mounting

sys" Y

E2599 SGD accessory

noc Y

E2601 Gen w/c cushion wdth < 22

in Y

E2602 Gen w/c cushion wdth >=22

in Y

E2603 Skin protect wc cus wd

<22in Y

E2604 Skin protect wc cus

wd>=22in Y

E2605 Position wc cush wdth <22

in Y

E2606 Position wc cush wdth>=22

in Y

E2607 Skin pro/pos wc cus wd

<22in Y

E2608 Skin pro/pos wc cus

wd>=22in Y

E2609 Custom fabricate w/c

cushion Y

E2610 Powered w/c

cushion B

E2611 Gen use back cush wdth

<22in YE2612 Gen use back cush

wdth>=22in Y

E2613 Position back cush wd

<22in Y

E2614 Position back cush

wd>=22in Y

E2615 Pos back post/lat wdth

<22in Y

E2616 Pos back post/lat

wdth>=22in Y

E2617 Custom fab w/c back

cushion Y

E2619 Replace cover w/c seat

cush Y

E2620 WC planar back cush wd

<22in Y

E2621 WC planar back cush

wd>=22in Y

E2622 Adj skin pro w/c cus

wd<22in Y

E2623 Adj skin pro wc cus

wd>=22in Y

E2624 Adj skin pro/pos

cus<22in Y

E2625 Adj skin pro/pos wc

cus>=22 Y

E2626 Seo mobile arm sup att to

wc NI Y

E2627 Arm supp att to wc rancho

ty NI Y

E2628 Mobile arm supports

reclinin NI Y

E2629 Friction dampening arm

supp NI Y

E2630 Monosuspension arm/hand

supp NI Y

E2631 Elevat proximal arm

support NI Y

E2632 Offset/lat rocker arm

w/ela NI Y

E2633 Mobile arm support

supinator NI Y

E8000 Posterior gaittrainer E

E8001 Upright gait

trainer E

E8002 Anterior gait

trainer E

G0008 Admin influenza virus

vac S 0350 0.3545 $24.82 $0.00 $0.00

G0009 Admin pneumococcal

vaccine S 0350 0.3545 $24.82 $0.00 $0.00

G0010 Admin hepatitis b

vaccine CH S 0437 0.4972 $34.81 $0.00 $0.00

G0027 Semen

analysis A

G0101 CA screen;pelvic/breast

exam V 0604 0.7689 $53.84 $0.00 $0.00

G0102 Prostate ca screening;

dre N

G0103 PSA screening

A

G0104 CA screen;flexi

sigmoidscope S 0159 5.3772 $376.49 $0.00 $0.00

G0105 Colorectal scrn; hi risk

ind T 0158 8.3164 $582.28 $0.00 $0.00

G0106 Colon CA screen;barium

enema S 0157 2.7510 $192.61

. $38.53

G0108 Diab manage trn per

indiv A

G0109 Diab manage trn

ind/group A

G0117 Glaucoma scrn hgh risk

direc S 0698 1.0589 $74.14

. $14.83

G0118 Glaucoma scrn hgh risk

direc S 0230 0.6424 $44.98

. $9.00

G0120 Colon ca scrn; barium

enema S 0157 2.7510 $192.61

. $38.53

G0121 Colon ca scrn not hi rsk

ind T 0158 8.3164 $582.28 $0.00 $0.00G0122 Colon ca scrn; barium

enema E

G0123 Screen cerv/vag thin

layer A

G0124 Screen c/v thin layer by

MD B

G0127 Trim

nail(s) T 0012 0.3878 $27.15

. $5.43

G0128 CORF skilled nursing

service B

G0129 Partial hosp prog

service P

G0130 Single energy x-ray

study X 0260 0.6409 $44.87 $0.00 $0.00

G0141 "Scr c/v cyto,autosys and

md" B

G0143 "Scr c/v

cyto,thinlayer,rescr" A

G0144 "Scr c/v

cyto,thinlayer,rescr" A

G0145 "Scr c/v

cyto,thinlayer,rescr" A

G0147 "Scr c/v cyto, automated

sys" A

G0148 "Scr c/v cyto, autosys,

rescr" A

G0151 "HHCP-serv of pt,ea 15

min" B

G0152 "HHCP-serv of ot,ea 15

min" B

G0153 "HHCP-svs of s/l path,ea

15mn" B

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

G0157 HHC PT assistant ea 15

BG0158 HHC OT assistant ea

15 B

G0159 HHC PT maint ea 15

min B

G0160 HHC Occup Therapy ea

15 B

G0161 HHC SLP ea 15

min B

G0162 "HHC RN E&M plan svs, 15

min" B

G0163 HHC LPN/RN obs/asses ea

15 B

G0164 HHC lis nurse train ea

15 B

G0166 "Extrnl counterpulse, per

tx" T 0678 1.3360 $93.54

. $18.71

G0168 Wound closure by

adhesive B

G0173 Linear acc stereo radsur

com S 0067 48.1833 "$3,373.60"

. $674.72

G0175 "OPPS Service,sched team

conf" V 0607 1.8647 $130.56

. $26.12

G0176 OPPS/PHP;activity

therapy P

G0177 OPPS/PHP; train & educ

serv N

G0179 MD recertification HHA

PT M

G0180 MD certification HHA

patient M

G0181 Home health care

supervision M

G0182 Hospice care

supervision M

G0186 "Dstry eye lesn,fdr vssl

tech" T 0235 4.8135 $337.02

. $67.41

G0202 Screeningmammographydigital A

G0204 Diagnosticmammographydigital AG0206 Diagnosticmammographydigital A

G0219 PET img wholbod melano

nonco E

G0235 PET not otherwise

specified E

G0237 Therapeutic procd strg

endur S 0077 0.4237 $29.67 $7.74 $5.94

G0238 "Oth resp proc,

indiv" S 0077 0.4237 $29.67 $7.74 $5.94

G0239 "Oth resp proc,

group" S 0077 0.4237 $29.67 $7.74 $5.94

G0245 Initial foot exam pt

lops V 0604 0.7689 $53.84

. $10.77

G0246 Followup eval of foot pt

lop V 0605 1.0311 $72.19

. $14.44

G0247 Routine footcare pt w

lops T 0013 0.8768 $61.39

. $12.28

G0248 Demonstrate use home inr

mon V 0607 1.8647 $130.56

. $26.12

G0249 Provide INR test

mater/equip V 0607 1.8647 $130.56

. $26.12

G0250 MD INR test revie inter

mgmt M

G0251 Linear acc based stero

radio S 0065 12.8903 $902.53

. $180.51

G0252 PET imaging initial

dx E

G0255 Current percep threshold

tst E

G0257 Unsched dialysis ESRD pt

hos S 0170 6.2419 $437.03

. $87.41

G0259 Inject for sacroiliac

joint N

G0260 Inj for sacroiliac jt

anesth T 0207 7.4537 $521.88

. $104.38

G0268 Removal of impacted waxmd N

G0269 Occlusive device in vein

art N

G0270 MNT subs tx for change

dx A

G0271 Group MNT 2 or more 30

mins A

G0275 "Renal angio, cardiac

cath" N

G0278 "Iliac art angio,cardiac

cath" N

G0281 Elec stim unattend for

press A

G0282 Elect stim wound care not

pd E

G0283 Elec stim other than

wound A

G0288 "Recon, CTA for surg

plan" N

G0289 "Arthro, loose body +

chondro" N

G0290 "Drug-eluting stents,

single" T 0656 105.6644 "$7,398.20"

. "$1,479.64"

G0291 "Drug-eluting stents,each

add" T 0656 105.6644 "$7,398.20"

. "$1,479.64"

G0293 "Non-cov surg proc,clin

trial" X 0340 0.6499 $45.50

. $9.10

G0294 "Non-cov proc, clinical

trial" X 0340 0.6499 $45.50

. $9.10

G0295 Electromagnetic therapy

onc E

G0302 Pre-op service LVRS

complete S 0209 11.3569 $795.16 $268.73 $159.04

G0303 Pre-op service LVRS

10-15dos S 0209 11.3569 $795.16 $268.73 $159.04

G0304 Pre-op service LVRS 1-9

dos S 0213 2.4298 $170.12 $53.58 $34.03

G0305 Post op service LVRS min

6 S 0213 2.4298 $170.12 $53.58 $34.03G0306 CBC/diffwbc w/o

platelet A

G0307 CBC without

platelet A

G0328 Fecal blood scrn

immunoassay A

G0329 Electromagntic tx for

ulcers A

G0333 Dispense fee initial 30

day M

G0337 Hospice evaluation

preelecti B

G0339 "Robot lin-radsurg com,

first" S 0067 48.1833 "$3,373.60"

. $674.72

G0340 Robt lin-radsurg fractx

2-5 S 0066 35.9961 "$2,520.30"

. $504.06

G0341 Percutaneous islet

celltrans C

G0342 Laparoscopy islet cell

trans C

G0343 Laparotomy islet cell

transp C

G0364 Bone marrow aspirate

&biopsy X 0340 0.6499 $45.50

. $9.10

G0365 Vessel mapping hemo

access S 0267 2.1681 $151.80 $59.37 $30.36

G0372 MD service required for

PMD M

G0378 Hospital observation per hr

N

G0379 Direct refer hospital

observ Q3 0604 0.7689 $53.84

. $10.77

G0380 Lev 1 hosp type B ED

visit V 0626 0.5627 $39.40

. $7.88

G0381 Lev 2 hosp type B ED

visit V 0627 0.7972 $55.82

. $11.17

G0382 Lev 3 hosp type B ED

visit V 0628 1.3178 $92.27

. $18.46G0383 Lev 4 hosp type B ED

visit V 0629 1.9503 $136.55

. $27.31

G0384 Lev 5 hosp type B ED

visit Q3 0630 3.7639 $263.53

. $52.71

G0389 Ultrasound exam AAA

screen S 0266 1.3781 $96.49 $0.00 $0.00

G0390 Trauma Respons w/hosp

criti S 0618 11.2658 $788.79

. $157.76

G0396 Alcohol/subs interv

15-30mn S 0432 0.5154 $36.09

. $7.22

G0397 Alcohol/subs interv >30

min CH S 0322 1.1395 $79.78

. $15.96

G0398 Home sleep test/type 2

Porta S 0213 2.4298 $170.12 $53.58 $34.03

G0399 Home sleep test/type 3

Porta S 0213 2.4298 $170.12 $53.58 $34.03

G0400 Home sleep test/type 4

Porta S 0213 2.4298 $170.12 $53.58 $34.03

G0402 Initial preventive

exam V 0606 1.3588 $95.14 $0.00 $0.00

G0403 EKG for initial prevent

exam M

G0404 EKG tracing for initial prev

S 0099 0.3817 $26.73

. $5.35

G0405 EKG interpret & report preve

B

G0406 Inpt/tele follow up

15 CH B

G0407 Inpt/tele follow up

25 CH B

G0408 Inpt/tele follow up

35 CH B

G0409 CORF related serv 15 mins

ea M

G0410 Grp psych partial hosp

45-50 PG0411 Inter active grp psych

parti P

G0412 Open tx iliac spine

uni/bil C

G0413 Pelvic ring fracture

uni/bil T 0050 32.4461 "$2,271.75"

. $454.35

G0414 Pelvic ring fx treat int

fix C

G0415 Open tx post pelvic

fxcture C

G0416 Sat biopsy prostate 1-20

spc X 0661 2.3496 $164.51

. $32.91

G0417 Sat biopsy prostate

21-40 CH S 1505 $350.00

. $70.00

G0418 Sat biopsy prostate

41-60 CH S 1506 $450.00

. $90.00

G0419 Sat biopsy prostate:

>60 CH S 1508 $650.00

. $130.00

G0420 Ed svc CKD ind per

session A

G0421 Ed svc CKD grp per

session A

G0422 Intens cardiac rehab

w/exerc S 0095 0.9930 $69.53

. $13.91

G0423 Intens cardiac rehab no

exer S 0095 0.9930 $69.53

. $13.91

G0424 Pulmonary rehab w

exer S 0102 0.5346 $37.43

. $7.49

G0425 Inpt/ED

teleconsult30 CH B

G0426 Inpt/ED

teleconsult50 CH B

G0427 Inpt/ED

teleconsult70 CH B

G0428 Collagen Meniscus

Implant E

G0429 Dermal fillerinjection(s) B

G0431 Drug screen multiple

class A

G0432 EIA HIV-1/HIV-2

screen A

G0433 ELISA HIV-1/HIV-2

screen A

G0434 Drug screen multi drug

class A

G0435 Oral HIV-1/HIV-2

screen A

G0436 Tobacco-use counsel 3-10

min X 0031 0.2988 $20.92 $0.00 $0.00

G0437 Tobacco-use

counsel>10min X 0031 0.2988 $20.92 $0.00 $0.00

G0438 "PPPS, initial

visit" A

G0439 "PPPS, subseq

visit" A

G0440 Skin/dermal subs init

25or< CH D

G0441 Skin/dermal subs each

additi CH D

G0448 Place perm pacing

cardiovert NI B

G0451 Devlopment test

interpt&rep NI S 0432 0.5154 $36.09

. $7.22

G0908 HgB > 12

g/dL NI M

G0909 HbG not

doc NI M

G0910 HgB < 12

g/dL NI M

G0911 Assess activity

symptoms NI M

G0912 No Assess activity

symptoms NI M

G0913 Improve visual

funct NI M

G0914 survey not

complete NI MG0915 No improve visual

funct NI M

G0916 Satisfy with

care NI M

G0917 Satisfy survey not

complete NI M

G0918 No satisfy with

care NI M

G0919 Flu immunize not

avail NI M

G0920 type loc act

doc NI M

G0921 doc pt reas no

assess NI M

G0922 type loc act not

doc NI M

G3001 "Admin + supply,

tositumomab" S 0442 21.9850 "$1,539.30"

. $307.86

G8126 Pt treat

w/antidepress12wks M

G8127 Pt not treat

w/antidepres12w M

G8128 Pt inelig for antidepres

med M

G8395 LVEF>=40% doc normal or

mild M

G8396 LVEF not

performed M

G8397 Dil macula/fundus exam/w

doc M

G8398 Dil macular/fundus not

perfo M

G8399 Pt w/DXA document or

order M

G8400 Pt w/DXA no document or

orde M

G8401 Pt inelig osteo screen

measu M

G8404 Low extemity neur exam

docum M

G8405 Low extemity neur not

perfor MG8406 Pt inelig lower extrem

neuro M

G8410 Eval on foot

documented M

G8415 Eval on foot not

performed M

G8416 Pt inelig footwear

evaluatio M

G8417 Calc BMI abv up param

f/u M

G8418 Calc BMI blw low param

f/u M

G8419 Calc BMI out nrm param

nof/u M

G8420 Calc BMI norm

parameters M

G8421 BMI not

calculated M

G8422 Pt inelig BMI

calculation M

G8427 Doc cur meds by

prov M

G8428 Cur meds not document

M

G8430 Pt inelig med

check M

G8431 Pos clin depres scrn f/u

doc M

G8432 Clin depression screen not

d M

G8433 Pt inelig; scrn clin

dep M

G8440 Pain assess f/u pln

document CH D

G8441 No document of pain

assess CH D

G8442 Pt inelig pain

assessment M

G8447 Pt vis doc use EHR cer

ATCB M

G8448 Pt vis doc w/PQRI qual EHR

M

G8450 Beta-bloc rx pt w/abnlvef M

G8451 Pt w/abn lvef inelig

b-bloc M

G8452 Pt w/abn lvef b-bloc no

rx M

G8458 Pt inelig geno no antvir

tx M

G8459 Doc pt rec antivir

treat M

G8460 Pt inelig RNA no antvir

tx M

G8461 Pt rec antivir treat hep

c M

G8462 Pt inelig couns no antvir

tx M

G8463 Pt rec antiviral treat

doc M

G8464 Pt inelig; lo to no dter

rsk M

G8465 High risk recurrence pro

ca M

G8468 ACE/ARB rx pt w/abn

lvef M

G8469 Pt w/abn lvef inelig

ACE/ARB M

G8470 Pt w/ normal

lvef M

G8471 LVEF not

performed/doc M

G8472 ACE/ARB no rx pt w/abn

lvef M

G8473 ACE/ARB thxpy

rx'd M

G8474 ACE/ARB not rx'd; doc

reas M

G8475 ACE/ARB thxpy not

rx'd M

G8476 BP sys <130 and dias

<80 M

G8477 BP sys>=130 and/or dias

>=80 M

G8478 BP not

performed/doc MG8482 Flu immunize

order/admin M

G8483 Flu imm no ord/admin doc

rea M

G8484 Flu immunize no

order/admin M

G8485 "Report, Diabetes

measures" M

G8486 "Report, Prev Care

Measures" M

G8487 Report CKD

Measures M

G8489 CAD measures

grp M

G8490 RA measures

grp M

G8491 HIV/AIDS measures

grp M

G8492 Periop Care measures

grp M

G8493 Back pain measures

grp M

G8494 DM meas qual act

perform M

G8495 CKD meas qual act

perform M

G8496 Prev Care MG qual act

perfrm M

G8497 CABG meas qual act

perform M

G8498 CAD meas qual act

perform M

G8499 RA meas qual act

perform M

G8500 HIV meas qual act

perform M

G8501 Perio meas qual act

perform M

G8502 Back Pain MG qual act

perfrm M

G8506 Pt rec

ACE/ARB MG8508 Pt inelig; pain asses no

f/u CH D

G8509 Pos pain assess no f/u

doc M

G8510 Pt inelig neg scrn

depres M

G8511 Clin depres scrn no f/u

doc M

G8524 Patch closure conv

CEA M

G8525 No patch closure

CEA M

G8526 No patch closure conv

CEA M

G8530 Auto AV fistula

recd M

G8531 Pt inelig; auto AV

fistula M

G8532 No auto AV fistula; no

reas M

G8534 Doc elder mal scrn f/u

plan CH D

G8535 Pt inelig no eld mal

scrn M

G8536 No doc elder mal

scrn M

G8537 Pt inelig eldmal scrn no

f/u CH D

G8538 Eld mal scrn no f/u

pln CH D

G8539 Doc funct and care

plan M

G8540 Pt inelig funct

assess M

G8541 No doc cur funct

assess M

G8542 Doc funct no

deficiencies M

G8543 Cur funct asses; no care

pln M

G8544 CABG measures

grp M

G8545 HepC measures

grp MG8546 CAP measures

grp M

G8547 IVD measures

grp M

G8548 HF measures

grp M

G8549 HepC MG qual act

perform M

G8550 CAP MG qual act

perform M

G8551 HF MG qual act

perform M

G8552 IVD MG qual act

perform M

G8553 1 Rx via qualified eRx

sys M

G8556 Ref to doc otolog

eval M

G8557 Pt inelig ref otolog

eval M

G8558 No ref to doc otolog

eval M

G8559 Pt ref doc oto

eval M

G8560 Pt hx act drain prev 90

days M

G8561 Pt inelig for ref oto

eval M

G8562 Pt no hx act drain 90

d M

G8563 Pt no ref oto reas no

spec M

G8564 Pt ref oto

eval M

G8565 Ver doc hear

loss M

G8566 Pt inelig ref oto

eval M

G8567 Pt no doc hear

loss M

G8568 Pt no ref otolo no

spec M

G8569 Prol intubation

req MG8570 No prol intub

req M

G8571 Ster wd ifx 30 d

postop M

G8572 No ster wd

ifx M

G8573 Stk

CABG M

G8574 No strk

CABG M

G8575 Postop ren

fail M

G8576 No postop ren

fail M

G8577 Reop req bld grft

oth M

G8578 No reop req bld grft

oth M

G8579 Antplt med

disch M

G8580 Antplt med

contraind M

G8581 no antplt med

disch M

G8582 Bblock

disch M

G8583 Bblock

contraind M

G8584 No bblock

disch M

G8585 Antilipid treat

disch M

G8586 Antlip disch

contra M

G8587 No antlipid treat

disch M

G8588 Sys BP

<140 M

G8589 Sys BP >=

140 M

G8590 Dia BP <

90 M

G8591 Dia BP >=

90 MG8592 No BP

measure M

G8593 Lipid pn

results M

G8594 No lipid prof

perf M

G8595 Ldl <

100 M

G8596 No LDL

perf M

G8597 Ldl >=

100 M

G8598 Asp therp

used M

G8599 No asp therp

used M

G8600 tPA initi w/in 3

hrs M

G8601 No elig tPA init w/in 3

hrs M

G8602 No tPA init w/in 3

hrs M

G8603 Spok lang comp

score M

G8604 No high score spok

lang M

G8605 No spok lang comp

score M

G8606 Attention

score M

G8607 No high score

attention M

G8608 No attention

score M

G8609 Memory

score M

G8610 No high score

memory M

G8611 No memory

score M

G8612 Moto speech

score M

G8613 No high score moto speech

MG8614 No moto speech

score M

G8615 Reading

score M

G8616 No high score

reading M

G8617 No reading

score M

G8618 Spok lang exp

score M

G8619 No high score spok lang

exp M

G8620 No spok lang exp

score M

G8621 Writing

score M

G8622 No high score

writing M

G8623 No writing

score M

G8624 Swallowing

score M

G8625 No high score

swallowing M

G8626 No swallowing

score M

G8627 Surg proc w/in 30

days M

G8628 No surg proc w/in 30

days M

G8629 Doc antibio order b/4

surg M

G8630 Doc antibio given b/4

surg M

G8631 Pt no elg 4 order antbi

give M

G8632 Doc no antibi order b/4

surg M

G8633 Pharm ther osteo

rx M

G8634 Pt no elg phar ther

osteo M

G8635 No pharm ther osteo

rx MG8636 Flu immun admin/prev

rec CH D

G8637 Pt no elg receiv flu

immun CH D

G8638 Flu immun no admin/prev

rec CH D

G8639 Flu immun admin or prev

rec CH D

G8640 Pt no elg rec flu

immun CH D

G8641 Flu immun not admin/pre

rec CH D

G8642 Hrdshp rural w/o

internet M

G8643 Hrdshp w/o suff pharm

w/eRx M

G8644 EP no prescribe

priv M

G8645 Asthma measures

grp M

G8646 Asthma MG qual act

perform M

G8647 Fun stat score knee >=

0 M

G8648 Fun stat score knee <

0 M

G8649 Fun stat score knee pt

noelg M

G8650 Fun stat score knee not

done M

G8651 Fun stat score hip >=

0 M

G8652 Fun stat score hip <

0 M

G8653 Fun stat score hip pt no

elg M

G8654 Fun stat score hip not

done M

G8655 Fun stat score LE >=

0 M

G8656 Fun stat score LE <

0 M

G8657 Fun stat score LE pt no

elg MG8658 Fun stat score LE not

done M

G8659 Fun stat score LS >=

0 M

G8660 Fun stat score LS <

0 M

G8661 Fun stat score LS pt no

elg M

G8662 Fun stat score LS not

done M

G8663 Fun stat score shdl

>=0 M

G8664 Fun stat score shdl <

0 M

G8665 Fun stat score shdl pt no

el M

G8666 Fun stat score shdl not

done M

G8667 Fun stat score UE

>=0 M

G8668 Fun stat score UE <

0 M

G8669 Fun stat score UE pt no

elg M

G8670 Fun stat score UE not

done M

G8671 Fun stat score neck/TS

>=0 M

G8672 Fun stat score neck/TS <

0 M

G8673 Fun stat scor nek/TS pt no

e M

G8674 Fun stat scor nek/TS not

don M

G8675 BP Syst >= 140

mmHg CH D

G8676 BP Diast >= 90

mmHg CH D

G8677 BP Syst < 130

mmHg CH D

G8678 BP Syst >=130 - 139

mmHg CH D

G8679 BP Diast < 80

mmHg CH DG8680 BP Diast 80-89

mmHg CH D

G8681 Pt hosp

w/HF CH D

G8682 LVG test

perf M

G8683 Pt not elig for LVF

test M

G8684 Pt not hosp

w/HF CH D

G8685 LVF test not

perf M

G8686 Toba smkr curr or 2 hand

exp CH D

G8687 No tob smkr cur no 2 hnd

exp CH D

G8688 Smkls tob cur; no 2 hnd

exp CH D

G8689 Toba use not

assess CH D

G8690 Curr toba smkr or 2 hand

exp CH D

G8691 No cur tob smkr no 2 hnd

exp CH D

G8692 Curr smkls tob; no 2 hnd

exp CH D

G8693 Tobacco no

assess CH D

G8694 Lvef

<40% NI M

G8695 Lvef

>=40% NI M

G8696 Antithromb thx

presc NI M

G8697 Antithromb no presc doc

reas NI M

G8698 Antithromb no presc no

reas NI M

G8699 Rehab ordered

disch NI M

G8700 Rehab not indicated

disch NI M

G8701 Rehab not

ordered NI MG8702 Antiobiotics 4 hr prior

surg NI M

G8703 Antibiotics not prior

surg NI M

G8704 ECG

performed NI M

G8705 Med reas no

ECG NI M

G8706 Pt reas no

ECG NI M

G8707 ECG not

performed NI M

G8708 Antibiotic not

pres NI M

G8709 Med reas antibiotic

pres NI M

G8710 Pt pres

antibiotic NI M

G8711 Pres

antibiotic NI M

G8712 Not pres

antibiotic NI M

G8713 SpKt/V great 1.2

Kt/V NI M

G8714 Hemodialysis 3 times

week NI M

G8715 Hemodialysis not 3 times

wk NI M

G8716 Pt reas not great

1.2Kt/V NI M

G8717 Less 1.2

Kt/V NI M

G8718 Great 1.7 Kt/V per

week NI M

G8720 Less 1.7 Kt/V per

week NI M

G8721 "Pt, pn, hist grade

doc" NI M

G8722 "Med reas pt, pn, not

doc" NI MG8723 Spec sit not prim

tumor NI M

G8724 "Pt, pn, hist grade not

doc" NI M

G8725 Lipid profile perf

doc NI M

G8726 Doc reas no lipid

profile NI M

G8727 "Hemo, perit, or kidney

trans" NI M

G8728 Lipid profile not

perf NI M

G8730 Pain doc pos and

plan NI M

G8731 Pain neg no

plan NI M

G8732 No doc of

pain NI M

G8733 Doc pos elder mal scrn

plan NI M

G8734 Doc neg elder mal no

plan NI M

G8735 Eld mal scrn pos no

plan NI M

G8736 LDL-C

<100mg/dL NI M

G8737 LDL-C

>=100mg/dL NI M

G8738 Lvef <

40% NI M

G8739 Lvef >=

40% NI M

G8740 LVEF not

perfrmd NI M

G8741 Not tx spoken

lang NI M

G8742 Not tx

attention NI M

G8743 Not tx

memory NI M

G8744 Not tx motor

speech NI MG8745 Not tx

reading NI M

G8746 Not tx spoken lang

express NI M

G8747 Not tx

writing NI M

G8748 Not tx

swallowing NI M

G8749 Signs of melanoma

absent NI M

G8750 Signs of melanoma

present NI M

G8751 Smkg status not

assess NI M

G8752 Sys BP less

140 NI M

G8753 Sys BP > or =

140 NI M

G8754 Dias BP less

90 NI M

G8755 Dias BP > or =

90 NI M

G8756 No BP measure

doc NI M

G8757 COPD MG qual act

perform NI M

G8758 IBD MG qual act

perform NI M

G8759 OSA MG qual act

perform NI M

G8760 Epilepsy MG qual act

perform NI M

G8761 Dementia MG qual act

perform NI M

G8762 PD MG qual act

perform NI M

G8763 Hyperten MG qual act

perform NI M

G8764 Car Prev MG qual act

perform NI M

G8765 Cataract MG qual act

perform NI M

G8767 Lipid panel res doc

rev NI MG8768 Doc med reas no lipid

profle NI M

G8769 Lipid profile not

perform NI M

G8770 Urine protein test doc

rev NI M

G8771 Doc dx CKD (not stage

5) NI M

G8772 Doc med reas no urine

protn NI M

G8773 No urine protein

test NI M

G8774 Serum creatinine doc

rev NI M

G8775 Doc med reas no serum

crtn NI M

G8776 No serum creatinine

test NI M

G8777 Diabetes

screen NI M

G8778 Doc med reas no diabete

scrn NI M

G8779 No diabetes

screen NI M

G8780 Counsel diet phys

activity NI M

G8781 Doc med reas no counsel

diet NI M

G8782 No counsel diet phys

act NI M

G8783 BP scrn perf rec

interval NI M

G8784 Pt no elig for BP

assess NI M

G8785 BP scrn no perf at

interval NI M

G8786 Severity of angina

assess NI M

G8787 Angina

present NI M

G8788 Angina

absent NI M

G8789 Severity angina not

assess NI MG8790 Systolic

<130mmHg NI M

G8791 Systolic

130-139mmHg NI M

G8792 Systolic

>=140mmHg NI M

G8793 Diastolic

<80mmHg NI M

G8794 Diastolic

80-89mmHg NI M

G8795 Diastolic

>=90mmHg NI M

G8796 BP not

doc NI M

G8797 Specimen site not

esophagus NI M

G8798 Specimen site not

prostate NI M

G8799 Anticoag

ordered NI M

G8800 Doc reas anticoag not

order NI M

G8801 Anticoag not

ordered NI M

G8802 Pregnancy test

order NI M

G8803 Doc reas no pregnancy

test NI M

G8805 Pregnancy test not

order NI M

G8806 Transab or transvag

US NI M

G8807 Doc reas no

US NI M

G8808 No transab or transvag

US NI M

G8809 Rh-immunoglobulin

order NI M

G8810 Doc reas no

Rh-immuno NI MG8811 No Rh-immunoglobulin

order NI M

G8812 "Pt not elig CTA, duplex,

MRA" NI M

G8813 "CTA, duplex, MRA

performed" NI M

G8814 "No CTA, duplex,

MRA" NI M

G8815 Doc reas no statin

therapy NI M

G8816 Statin med pres at

disch NI M

G8817 Doc reas no statin med

disch NI M

G8818 Pt disch to home by

day#7 NI M

G8819 Aneurysm <= 5.5

cm NI M

G8820 Aneurysm 5.6-6.0 cm

NI M

G8821 Aneurysm not

infarenal NI M

G8822 Male aneurysms

>6cm NI M

G8823 Female aneurysm

>6cm NI M

G8824 Female aneurysm 5.6-6.0

cm NI M

G8825 Pt not disch to home

day#7 NI M

G8826 Pt disch home day #2

EVAR NI M

G8827 Aneurysm ó 5.5cm for

women NI M

G8828 Aneurysm <= 5.5cm for

men NI M

G8829 Aneurysm 5.6-6.0 cm for

men NI M

G8830 Aneurysm >6cm for men

NI M

G8831 Aneurysm >-6cm for

women NI M

G8832 Aneurysm 5.6-6.0women NI M

G8833 Pt not disch home day#2

EVAR NI M

G8834 Pt disch home day #2

CEA NI M

G8835 Asymptom no

trans NI M

G8836 Stroke or TIA <120 days

CEA NI M

G8837 Stroke or TIA >120 days

CEA NI M

G8838 Not disch home by day

#2 NI M

G8839 Sleep apnea

assess NI M

G8840 Doc reas no sleep

apnea NI M

G8841 No sleep apnea

assess NI M

G8842 AHI or RDI initial

dx NI M

G8843 Doc reas no AHI or

RDI NI M

G8844 No AHI or RDI initial

dx NI M

G8845 Pos Airway Press

prescribed NI M

G8846 Mod or severe

OSA NI M

G8847 Pos Air Press not

prescribed NI M

G8848 Mild

OSA NI M

G8849 Doc reas no Pos Air

Press NI M

G8850 No PAP

prescribed NI M

G8851 Adhere Pos Air Press

therapy NI M

G8852 Pos Air Press

prescribe NI MG8853 Pos Air Press not

prescribe NI M

G8854 Reas no adhere Pos Air

Pres NI M

G8855 Pos Air Press adhere no

perf NI M

G8856 Ref for oto

eval NI M

G8857 No elig ref for oto

eval NI M

G8858 Not ref for oto

eval NI M

G8859 Corticosteroids 10mg 60

days NI M

G8860 Corticosteroid 10 mg 60

days NI M

G8861 DXA ordered for

osteo NI M

G8862 No corticostrd 10mg 60

days NI M

G8863 No assess bone

loss NI M

G8864 Pneumococcal vaccine

admin NI M

G8865 Doc med reas no

pneumococcal NI M

G8866 Doc pt reas no

pneumococcal NI M

G8867 No pneumococcal

admin NI M

G8868 1st course

antiTNF NI M

G8869 Doc immun hep B 1st

antiTNF NI M

G8870 HepB admin 1st

antiTNF NI M

G8871 No 1st

antiTNF NI M

G8872 Intraop image confirm

excise NI M

G8873 Specimen not intraop

image NI MG8874 Tissue not image

intraop NI M

G8875 Breast cancer dx min

invsive NI M

G8876 Doc reas no min inv

dx NI M

G8877 No brst cncr dx min

invasive NI M

G8878 Sent lymph node

biopsy NI M

G8879 Node neg inv brst

cncr NI M

G8880 Doc reas no lymph node

biop NI M

G8881 Brst cncr stage >

T1N0M0 NI M

G8882 No sent lymph node

biopsy NI M

G8883 "Rev, comm, track, doc

biopsy" NI M

G8884 Doc reas biopsy not

review NI M

G8885 "No rev, comm, track

biopsy" NI M

G8886 BP under

control NI M

G8887 Doc med reas BP not

control NI M

G8888 BP not under

control NI M

G8889 No doc

BP NI M

G8890 LDL-C under

control NI M

G8891 Doc med reas no LDL-C

contrl NI M

G8892 Doc med reas no LDL-C

test NI M

G8893 LDL-C not under

control NI M

G8894 LDL-C not

performed NI M

G8895 Anticoag

prescribe NI MG8896 Doc med reas no

anticoag NI M

G8897 Anticoag not

prescribe NI M

G8898 COPD Measures

Group NI M

G8899 Inflammatory Bowel Dis

MG NI M

G8900 Obstructive Sleep Apnea

MG NI M

G8901 Epilepsy Measures

Group NI M

G8902 Dementia Measures

Group NI M

G8903 Parkinson?s Disease

MG NI M

G8904 Hypertension

MG NI M

G8905 Cardiovascular Prevention

MG NI M

G8906 Cataract Measures

Group NI M

G9001 "MCCD, initial

rate" B

G9002 "MCCD,maintenance

rate" B

G9003 "MCCD, risk adj hi,

initial" B

G9004 "MCCD, risk adj lo,

initial" B

G9005 "MCCD, risk adj,

maintenance" B

G9006 "MCCD, Home

monitoring" B

G9007 "MCCD, sch team

conf" B

G9008 "Mccd,phys coor-care

ovrsght" B

G9009 "MCCD, risk adj, level

3" B

G9010 "MCCD, risk adj, level4" B

G9011 "MCCD, risk adj, level

5" B

G9012 Other Specified Case

Mgmt B

G9013 ESRD demo bundle level

I E

G9014 ESRD demo bundle-level

II E

G9016 Demo-smoking cessation

coun E

G9017 Amantadine HCL 100mg

oral A

G9018 "Zanamivir,inhalation pwd

10m" A

G9019 Oseltamivir phosphate

75mg A

G9020 Rimantadine HCL 100mg

oral A

G9033 Amantadine HCL oral

brand A

G9034 "Zanamivir, inh pwdr,

brand" A

G9035 "Oseltamivir phosp,

brand" A

G9036 "Rimantadine HCL,

brand" A

G9041 Low vision rehab

occupationa CH D

G9042 Low vision rehab

orient/mobi CH D

G9043 Low vision lowvision

therapi CH D

G9044 Low vision rehabilate

teache CH D

G9050 Oncology work-up

evaluation E

G9051 Oncology tx

decision-mgmt E

G9052 Onc surveillance for

disease E

G9053 Onc expectant managementpt E

G9054 Onc supervision

palliative E

G9055 Onc visit unspecified

NOS E

G9056 Onc prac mgmt adheres

guide E

G9057 Onc pract mgmt differs

trial E

G9058 Onc prac mgmt disagree

w/gui E

G9059 Onc prac mgmt pt opt

alterna E

G9060 Onc prac mgmt dif pt

comorb E

G9061 Onc prac cond noadd by

guide E

G9062 Onc prac guide differs

nos E

G9063 Onc dx nsclc stgI no

progres M

G9064 Onc dx nsclc stg2 no

progres M

G9065 Onc dx nsclc stg3A no

progre M

G9066 Onc dx nsclc stg3B-4

metasta M

G9067 Onc dx nsclc dx unknown

nos M

G9068 Onc dx sclc/nsclc

limited M

G9069 Onc dx sclc/nsclc ext at

dx M

G9070 Onc dx sclc/nsclc ext

unknwn M

G9071 "Onc dx brst stg1-2B

HR,nopro" M

G9072 Onc dx brst stg1-2

noprogres M

G9073 "Onc dx brst stg3-HR, no

pro" M

G9074 Onc dx brst

stg3-noprogress MG9075 Onc dx brst metastic/

recur M

G9077 Onc dx prostate T1no

progres M

G9078 Onc dx prostate T2no

progres M

G9079 Onc dx prostate

T3b-T4noprog M

G9080 Onc dx prostate w/rise

PSA M

G9083 Onc dx prostate unknwn

nos M

G9084 "Onc dx colon t1-3,n1-2,no

pr" M

G9085 "Onc dx colon T4, N0 w/o

prog" M

G9086 Onc dx colon T1-4 no dx

prog M

G9087 Onc dx colon metas evid

dx M

G9088 Onc dx colon metas noevid

dx M

G9089 Onc dx colon extent

unknown M

G9090 Onc dx rectal T1-2 no

progr M

G9091 Onc dx rectal T3 N0 no

prog M

G9092 "Onc dx rectal

T1-3,N1-2noprg" M

G9093 "Onc dx rectal T4,N,M0 no

prg" M

G9094 Onc dx rectal M1 w/mets

prog M

G9095 Onc dx rectal extent

unknwn M

G9096 Onc dx esophag T1-T3

noprog M

G9097 Onc dx esophageal T4 no

prog M

G9098 Onc dx esophageal mets

recur M

G9099 Onc dx esophagealunknown M

G9100 Onc dx gastric no

recurrence M

G9101 Onc dx gastric p

R1-R2noprog M

G9102 Onc dx gastric

unresectable M

G9103 Onc dx gastric

recurrent M

G9104 Onc dx gastric unknown

NOS M

G9105 Onc dx pancreatc p R0 res

no M

G9106 Onc dx pancreatc p R1/R2

no M

G9107 Onc dx pancreatic

unresectab M

G9108 Onc dx pancreatic unknwn

NOS M

G9109 Onc dx head/neck T1-T2no

prg M

G9110 Onc dx head/neck T3-4

noprog M

G9111 Onc dx head/neck M1 mets

rec M

G9112 Onc dx head/neck ext

unknown M

G9113 Onc dx ovarian stg1A-B no

pr M

G9114 Onc dx ovarian stg1A-B or

2 M

G9115 Onc dx ovarian stg3/4

noprog M

G9116 Onc dx ovarian

recurrence M

G9117 Onc dx ovarian unknown

NOS M

G9123 Onc dx CML chronic

phase M

G9124 Onc dx CML acceler

phase M

G9125 Onc dx CML blast

phase MG9126 Onc dx CML

remission M

G9128 Onc dx multi myeloma stage

I M

G9129 Onc dx mult myeloma stg2

hig M

G9130 Onc dx multi myeloma

unknown M

G9131 Onc dx brst unknown

NOS M

G9132 Onc dx prostate mets no

cast M

G9133 Onc dx prostate clinical

met M

G9134 Onc NHLstg 1-2 no relap

no M

G9135 Onc dx NHL stg 3-4 not

relap M

G9136 Onc dx NHL trans to lg

Bcell M

G9137 Onc dx NHL

relapse/refractor M

G9138 Onc dx NHL stg

unknown M

G9139 Onc dx CML dx status

unknown M

G9140 Frontier extended stay

demo A

G9141 "Influenza A H1N1,admin w

cou" S 0350 0.3545 $24.82 $0.00 $0.00

G9142 "Influenza A H1N1,

vaccine" E

G9143 Warfarin respon genetic

test A

G9147 Outpt IV insulin tx any

mea E

G9156 Evaluation for

wheelchair NI M

J0120 Tetracyclin

injection N

J0129 Abatacept

injection K 9230 $20.72

. $4.15J0130 Abciximab

injection K 1605 $548.95

. $109.79

J0131 Acetaminophen

injection NI G 9283 $0.11

. $0.03

J0132 Acetylcysteine

injection K 1272 $2.74

. $0.55

J0133 Acyclovir

injection N

J0135 Adalimumab

injection K 1083 $410.95

. $82.19

J0150 Injection adenosine 6

MG N

J0152 Adenosine

injection K 0917 $94.42

. $18.89

J0171 Adrenalin epinephrine

inject N

J0180 Agalsidase beta

injection K 9208 $138.53

. $27.71

J0190 Inj biperiden lactate/5

mg E

J0200 Alatrofloxacin

mesylate N

J0205 Alglucerase

injection K 0900 $41.24

. $8.25

J0207 Amifostine K 7000 $315.94

. $63.19

J0210 Methyldopate hcl

injection K 2210 $39.16

. $7.84

J0215 Alefacept K 1633 $38.72

. $7.75

J0220 Alglucosidase alfa

injection K 9234 $155.84

. $31.17

J0221 Lumizyme

injection NI G 1413 $148.30

. $29.10

J0256 Alpha 1 proteinase

inhibitor K 0901 $3.83

. $0.77J0257 Glassia

injection NI K 1415 $3.81

. $0.77

J0270 Alprostadil for

injection B

J0275 Alprostadil urethral

suppos B

J0278 Amikacin sulfate

injection N

J0280 Aminophyllin 250 MG

inj N

J0282 Amiodarone

HCl N

J0285 Amphotericin

B N

J0287 Amphotericin b lipid

complex K 9024 $8.42

. $1.69

J0288 Ampho b cholesteryl

sulfate K 0735 $14.56

. $2.92

J0289 Amphotericin b liposome

inj K 0736 $14.25

. $2.85

J0290 Ampicillin 500 MG

inj N

J0295 Ampicillin sodium per 1.5

gm N

J0300 Amobarbital 125 MG

inj CH K 1341 $113.08

. $22.62

J0330 Succinycholine chloride

inj N

J0348 Anidulafungin

injection K 1349 $1.20

. $0.24

J0350 Injection anistreplase 30

u E

J0360 Hydralazine hcl

injection N

J0364 Apomorphine

hydrochloride CH K 1360 $5.12

. $1.03

J0365 "Aprotonin, 10,000

kiu" N

J0380 Inj metaraminolbitartrate N

J0390 Chloroquine

injection N

J0395 Arbutamine hcl

injection E

J0400 Aripiprazole

injection N

J0456 Azithromycin N

J0461 Atropine sulfate

injection N

J0470 Dimecaprol

injection N

J0475 Baclofen 10 MG

injection K 9032 $187.46

. $37.50

J0476 Baclofen intrathecal

trial K 1631 $76.39

. $15.28

J0480 Basiliximab K 1683 "$2,190.58"

. $438.12

J0490 Belimumab

injection NI G 1353 $38.61

. $7.58

J0500 Dicyclomine

injection N

J0515 Inj benztropine

mesylate CH N

J0520 Bethanechol chloride

inject N

J0558 PenG benzathine/procaine

inj N

J0561 Penicillin g benzathine

inj N

J0583 Bivalirudin K 3041 $2.71

. $0.55

J0585 "Injection,onabotulinumtoxinA" K 0902 $5.38

. $1.08

J0586 AbobotulinumtoxinA K 1289 $7.29

. $1.46

J0587 "Inj,

rimabotulinumtoxinB" K 9018 $10.78

. $2.16

J0588 Incobotulinumtoxin

a NI G 9278 $5.53

. $1.08J0592 Buprenorphine

hydrochloride N

J0594 Busulfan

injection K 1178 $18.72

. $3.75

J0595 Butorphanol tartrate 1

mg N

J0597 "C-1 esterase,

berinert" G 9269 $30.23

. $5.94

J0598 "C-1 esterase,

cinryze" CH K 9251 $43.37

. $8.68

J0600 Edetate calcium disodium

inj K 1274 $189.47

. $37.90

J0610 Calcium gluconate

injection N

J0620 Calcium glycer & lact/10

ML N

J0630 Calcitonin salmon

injection CH N

J0636 Inj calcitriol per 0.1

mcg N

J0637 Caspofungin

acetate K 9019 $13.32

. $2.67

J0638 Canakinumab

injection G 1311 $88.97

. $17.46

J0640 Leucovorin calcium

injection N

J0641 Levoleucovorin

injection CH K 1236 $1.58

. $0.32

J0670 Inj mepivacaine HCL/10

ml N

J0690 Cefazolin sodium

injection N

J0692 Cefepime HCl for

injection N

J0694 Cefoxitin sodium

injection N

J0696 Ceftriaxone sodium

injection NJ0697 Sterile cefuroxime

injection N

J0698 Cefotaxime sodium

injection N

J0702 Betamethasone acet&sod

phosp N

J0706 Caffeine citrate

injection N

J0710 Cephapirin sodium

injection N

J0712 Ceftaroline fosamil

inj NI G 9282 $0.74

. $0.14

J0713 Inj ceftazidime per 500

mg N

J0715 Ceftizoxime sodium / 500

MG N

J0718 Certolizumab pegol

inj CH K 9249 $4.12

. $0.83

J0720 Chloramphenicol sodium

injec N

J0725 Chorionic

gonadotropin/1000u N

J0735 Clonidine

hydrochloride CH N

J0740 Cidofovir

injection K 9033 $742.66

. $148.54

J0743 Cilastatin sodium

injection N

J0744 Ciprofloxacin

iv N

J0745 Inj codeine phosphate /30

MG N

J0760 Colchicine

injection N

J0770 Colistimethate sodium

inj N

J0775 "Collagenase, clost hist

inj" G 1340 $37.51

. $7.36

J0780 Prochlorperazine

injection NJ0795 Corticorelin ovine

triflutal K 1684 $5.58

. $1.12

J0800 Corticotropin

injection K 1280 "$2,516.22"

. $503.25

J0833 Cosyntropin injection

NOS K 0835 $99.76

. $19.96

J0834 Cosyntropin cortrosyn

inj CH N

J0840 Crotalidae poly immune

fab NI G 9274 "$2,111.36"

. $414.31

J0850 Cytomegalovirus imm IV

/vial K 0903 $947.86

. $189.58

J0878 Daptomycin

injection K 9124 $0.48

. $0.10

J0881 "Darbepoetin alfa,

non-esrd" K 1685 $3.14

. $0.63

J0882 "Darbepoetin alfa, esrd

use" A

J0885 "Epoetin alfa,

non-esrd" K 1686 $9.70

. $1.94

J0886 Epoetin alfa 1000 units

ESRD A

J0894 Decitabine

injection K 9231 $31.94

. $6.39

J0895 Deferoxamine mesylate

inj N

J0897 Denosumab

injection NI G 9272 $14.47

. $2.84

J0900 Testosterone enanthate

inj N

J0945 Brompheniramine maleate

inj CH N

J1000 Depo-estradiol cypionate

inj N

J1020 Methylprednisolone 20 MG

inj N

J1030 Methylprednisolone 40 MGinj N

J1040 Methylprednisolone 80 MG

inj N

J1051 Medroxyprogesterone

inj N

J1055 Medrxyprogester acetate

inj E

J1056 MA/EC

contraceptiveinjection E

J1060 Testosterone cypionate 1

ML N

J1070 Testosterone cypionat 100

MG N

J1080 Testosterone cypionat 200

MG N

J1094 Inj dexamethasone

acetate N

J1100 Dexamethasone sodium

phos N

J1110 Inj dihydroergotamine

mesylt N

J1120 Acetazolamid sodium

injectio N

J1160 Digoxin

injection N

J1162 Digoxin immune fab

(ovine) K 1687 $626.71

. $125.35

J1165 Phenytoin sodium

injection N

J1170 Hydromorphone

injection N

J1180 Dyphylline

injection N

J1190 Dexrazoxane HCl

injection K 0726 $207.92

. $41.59

J1200 Diphenhydramine hcl

injectio N

J1205 Chlorothiazide sodium

inj K 0747 $269.86

. $53.98

J1212 Dimethyl sulfoxide 50% 50

ML K 1221 $94.38

. $18.88J1230 Methadone

injection N

J1240 Dimenhydrinate

injection N

J1245 Dipyridamole

injection N

J1250 Inj dobutamine HCL/250

mg N

J1260 Dolasetron

mesylate N

J1265 Dopamine

injection N

J1267 Doripenem

injection N

J1270 "Injection,

doxercalciferol" N

J1290 Ecallantide

injection G 9263 $289.07

. $56.73

J1300 Eculizumab

injection K 9236 $186.37

. $37.28

J1320 Amitriptyline

injection N

J1324 Enfuvirtide

injection CH K 1361 $0.51

. $0.11

J1325 Epoprostenol

injection N

J1327 Eptifibatide

injection K 1607 $22.02

. $4.41

J1330 Ergonovine maleate

injection N

J1335 Ertapenem

injection N

J1364 Erythro lactobionate /500

MG N

J1380 Estradiol valerate 10 MG

inj N

J1410 Inj estrogen conjugate 25

MG K 9038 $103.54

. $20.71

J1430 Ethanolamine oleate 100

mg K 1688 $294.28

. $58.86J1435 Injection estrone per 1

MG E

J1436 Etidronate disodium

inj N

J1438 Etanercept

injection K 1608 $204.31

. $40.87

J1440 Filgrastim 300 mcg

injection K 0728 $246.80

. $49.36

J1441 Filgrastim 480 mcg

injection K 7049 $390.07

. $78.02

J1450 Fluconazole N

J1451 "Fomepizole, 15

mg" K 1689 $6.91

. $1.39

J1452 Intraocular Fomivirsen

na E

J1453 Fosaprepitant

injection K 9242 $1.69

. $0.34

J1455 Foscarnet sodium

injection CH K 1359 $14.37

. $2.88

J1457 Gallium nitrate

injection CH N

J1458 Galsulfase

injection K 9224 $341.40

. $68.28

J1459 Inj IVIG privigen 500

mg K 1214 $34.42

. $6.89

J1460 Gamma globulin 1 CC

inj K 3043 $20.62

. $4.13

J1557 Gammaplex

injection NI G 9270 $37.29

. $7.32

J1559 Hizentra

injection K 1312 $7.15

. $1.43

J1560 Gamma globulin > 10 CC

inj K 0933 $206.16

. $41.24J1561 Gamunex/gamunex

c K 0948 $36.78

. $7.36

J1562 "Vivaglobin,

inj" K 1275 $12.48

. $2.50

J1566 "Immune globulin,

powder" K 2731 $30.46

. $6.10

J1568 Octagam

injection K 0943 $55.80

. $11.16

J1569 Gammagard liquid

injection K 0944 $37.08

. $7.42

J1570 Ganciclovir sodium

injection CH K 1343 $66.58

. $13.32

J1571 Hepagam b im

injection K 0946 $52.11

. $10.43

J1572 Flebogamma

injection G 0947 $35.15

. $6.90

J1573 "Hepagam b intravenous,

inj" K 1138 $52.11

. $10.43

J1580 Garamycin gentamicin

inj N

J1590 Gatifloxacin

injection N

J1595 Injection glatiramer

acetate K 1015 $109.30

. $21.86

J1599 "Ivig non-lyophilized,

NOS" N

J1600 Gold sodium thiomaleate

inj N

J1610 Glucagon hydrochloride/1

MG K 9042 $101.30

. $20.26

J1620 Gonadorelin hydroch/ 100

mcg CH K 1344 $167.25

. $33.45

J1626 Granisetron hcl

injection N

J1630 Haloperidol

injection NJ1631 Haloperidol decanoate

inj N

J1640 "Hemin, 1

mg" K 1690 $10.41

. $2.09

J1642 Inj heparin sodium per 10

u CH K 1362 $0.18

. $0.04

J1644 Inj heparin sodium per

1000u CH K 1373 $0.27

. $0.06

J1645 Dalteparin

sodium N

J1650 Inj enoxaparin

sodium N

J1652 Fondaparinux

sodium N

J1655 Tinzaparin sodium

injection N

J1670 Tetanus immune globulin

inj K 1670 $245.02

. $49.01

J1675 Histrelin

acetate B

J1680 Human fibrinogen conc

inj CH K 1290 $71.57

. $14.32

J1700 Hydrocortisone acetate

inj N

J1710 Hydrocortisone sodium ph

inj N

J1720 Hydrocortisone sodium succ

i N

J1725 Hydroxyprogesterone

caproate NI K 1354 $2.52

. $0.51

J1730 Diazoxide

injection CH N

J1740 Ibandronate sodium

injection K 9229 $148.02

. $29.61

J1742 Ibutilide fumarate

injection K 9044 $133.80

. $26.76

J1743 Idursulfase

injection K 9232 $446.44

. $89.29J1745 Infliximab

injection K 7043 $62.01

. $12.41

J1750 Inj iron

dextran K 1237 $11.53

. $2.31

J1756 Iron sucrose

injection K 9046 $0.32

. $0.07

J1786 Imuglucerase

injection K 1327 $41.20

. $8.24

J1790 Droperidol

injection N

J1800 Propranolol

injection N

J1810 Droperidol/fentanyl

inj E

J1815 Insulin

injection N

J1817 Insulin for insulin pump

use N

J1826 Interferon Beta-1A

inj E

J1830 Interferon beta-1b / .25

MG K 0910 $211.59

. $42.32

J1835 Itraconazole

injection CH K 1355 $372.55

. $74.51

J1840 Kanamycin sulfate 500 MG

inj N

J1850 Kanamycin sulfate 75 MG

inj N

J1885 Ketorolac tromethamine

inj N

J1890 Cephalothin sodium

injection N

J1930 Lanreotide

injection K 9237 $30.98

. $6.20

J1931 Laronidase

injection K 9209 $26.33

. $5.27

J1940 Furosemide

injection NJ1945 Lepirudin K 1693 $346.19

. $69.24

J1950 Leuprolide acetate /3.75

MG K 0800 $590.71

. $118.15

J1953 Levetiracetam

injection N

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 $34.48

. $6.90

J2060 Lorazepam

injection N

J2150 Mannitol

injection N

J2170 Mecasermin

injection K 1308 $25.65

. $5.13

J2175 Meperidine hydrochl /100

MG N

J2180 Meperidine/promethazine

inj N

J2185 Meropenem N

J2210 Methylergonovin maleate

inj N

J2248 Micafungin sodium

injection K 9227 $0.98

. $0.20

J2250 Inj midazolam

hydrochloride N

J2260 Inj milrinone lactate / 5MG N

J2265 Minocycline

hydrochloride NI E

J2270 Morphine sulfate

injection N

J2271 Morphine so4 injection

100mg N

J2275 Morphine sulfate

injection N

J2278 Ziconotide

injection K 1694 $6.48

. $1.30

J2280 "Inj, moxifloxacin 100

mg" N

J2300 Inj nalbuphine

hydrochloride N

J2310 Inj naloxone

hydrochloride N

J2315 "Naltrexone, depot

form" K 0759 $2.78

. $0.56

J2320 Nandrolone decanoate 50

MG CH N

J2323 Natalizumab

injection K 9126 $10.32

. $2.07

J2325 Nesiritide

injection K 1695 $46.36

. $9.28

J2353 "Octreotide injection,

depot" K 1207 $117.11

. $23.43

J2354 "Octreotide inj,

non-depot" N

J2355 Oprelvekin

injection K 7011 $239.90

. $47.98

J2357 Omalizumab

injection K 9300 $21.34

. $4.27

J2358 Olanzapine long-acting

inj K 1331 $2.70

. $0.54

J2360 Orphenadrine

injection NJ2370 Phenylephrine hcl

injection N

J2400 Chloroprocaine hcl

injection N

J2405 Ondansetron hcl

injection N

J2410 Oxymorphone hcl

injection N

J2425 Palifermin

injection K 1696 $11.45

. $2.29

J2426 Paliperidone palmitate

inj CH K 9255 $6.56

. $1.32

J2430 Pamidronate disodium /30

MG N

J2440 Papaverin hcl

injection N

J2460 Oxytetracycline

injection E

J2469 Palonosetron

hcl K 9210 $18.83

. $3.77

J2501 Paricalcitol N

J2503 Pegaptanib sodium

injection K 1697 "$1,001.34"

. $200.27

J2504 "Pegademase bovine, 25

iu" K 1739 $248.56

. $49.72

J2505 "Injection, pegfilgrastim

6mg" K 9119 "$2,676.49"

. $535.30

J2507 Pegloticase

injection NI G 9281 $301.75

. $59.22

J2510 Penicillin g procaine

inj CH N

J2513 Pentastarch 10%

solution K 1222 $13.23

. $2.65

J2515 Pentobarbital sodium

inj N

J2540 Penicillin g potassium

inj NJ2543 Piperacillin/tazobactam N

J2545 Pentamidine non-comp

unit B

J2550 Promethazine hcl

injection N

J2560 Phenobarbital sodium

inj N

J2562 Plerixafor

injection CH K 9252 $275.80

. $55.16

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

MG N

J2690 Procainamide hcl

injection N

J2700 Oxacillin sodium

injeciton K 1347 $2.51

. $0.51

J2710 Neostigmine methylslfte

inj N

J2720 Inj protamine sulfate/10

MG N

J2724 Protein c

concentrate K 1139 $12.90

. $2.58

J2725 Inj protirelin per 250

mcg CH K 1357 $27.03

. $5.41

J2730 Pralidoxime chloride

inj K 1023 $88.51

. $17.71

J2760 Phentolaine mesylate

inj CH K 1358 $53.76

. $10.76

J2765 Metoclopramide hcl

injection NJ2770 Quinupristin/dalfopristin K 2770 $171.48

. $34.30

J2778 Ranibizumab

injection K 9233 $395.53

. $79.11

J2780 Ranitidine hydrochloride

inj N

J2783 Rasburicase K 0738 $188.98

. $37.80

J2785 Regadenoson

injection K 9244 $51.22

. $10.25

J2788 Rho d immune globulin 50

mcg K 9023 $21.52

. $4.31

J2790 Rho d immune globulin

inj K 0884 $82.14

. $16.43

J2791 Rhophylac

injection K 0945 $5.09

. $1.02

J2792 "Rho(D) immune globulin h,

sd" K 1609 $17.21

. $3.45

J2793 Rilonacept

injection K 1291 $23.64

. $4.73

J2794 "Risperidone, long

acting" K 9125 $5.07

. $1.02

J2795 Ropivacaine HCl

injection N

J2796 Romiplostim

injection K 9245 $45.87

. $9.18

J2800 Methocarbamol

injection N

J2805 Sincalide

injection CH N

J2810 Inj theophylline per 40

MG N

J2820 Sargramostim

injection K 0731 $24.22

. $4.85

J2850 Inj secretin synthetic

human K 1700 $26.98

. $5.40J2910 Aurothioglucose

injeciton N

J2916 Na ferric gluconate

complex N

J2920 Methylprednisolone

injection N

J2930 Methylprednisolone

injection N

J2940 Somatrem

injection CH E

J2941 Somatropin

injection K 7034 $61.81

. $12.37

J2950 Promazine hcl

injection N

J2993 Reteplase

injection K 9005 "$1,623.59"

. $324.72

J2995 Inj streptokinase /250000

IU K 1226 $19.78

. $3.96

J2997 Alteplase

recombinant K 7048 $42.24

. $8.45

J3000 Streptomycin

injection N

J3010 Fentanyl citrate

injeciton N

J3030 Sumatriptan succinate / 6

MG CH K 1374 $76.71

. $15.35

J3070 Pentazocine

injection N

J3095 Telavancin

injection G 9258 $2.10

. $0.42

J3101 Tenecteplase

injection K 9002 $57.15

. $11.43

J3105 Terbutaline sulfate

inj N

J3110 Teriparatide

injection B

J3120 Testosterone enanthate

inj N

J3130 Testosterone enanthateinj N

J3140 Testosterone suspension

inj N

J3150 Testosteron propionate

inj N

J3230 Chlorpromazine hcl

injection N

J3240 Thyrotropin

injection K 9108 "$1,032.25"

. $206.45

J3243 Tigecycline

injection K 9228 $1.30

. $0.26

J3246 Tirofiban

HCl K 7041 $8.92

. $1.79

J3250 Trimethobenzamide hcl

inj N

J3260 Tobramycin sulfate

injection N

J3262 Tocilizumab

injection G 9264 $3.47

. $0.68

J3265 Injection torsemide 10

mg/ml N

J3280 Thiethylperazine maleate

inj N

J3285 Treprostinil

injection K 1701 $60.08

. $12.02

J3300 Triamcinolone A inj

PRS-free K 1253 $3.41

. $0.69

J3301 Triamcinolone acet inj

NOS N

J3302 Triamcinolone diacetate

inj N

J3303 Triamcinolone hexacetonl

inj N

J3305 Inj trimetrexate

glucoronate CH E

J3310 Perphenazine

injeciton K 1304 $19.54

. $3.91

J3315 Triptorelin

pamoate K 9122 $176.18

. $35.24J3320 Spectinomycn di-hcl

inj E

J3350 Urea

injection K 1306 $72.00

. $14.40

J3355 "Urofollitropin, 75

iu" K 1741 $65.66

. $13.14

J3357 Ustekinumab

injection G 9261 $117.56

. $23.07

J3360 Diazepam

injection N

J3364 Urokinase 5000 IU

injection N

J3365 "Urokinase 250,000 IU

inj" K 7036 $449.09

. $89.82

J3370 Vancomycin hcl

injection N

J3385 Velaglucerase

alfa G 9271 $349.51

. $68.59

J3396 Verteporfin

injection K 1203 $9.76

. $1.96

J3400 Triflupromazine hcl

inj E

J3410 Hydroxyzine hcl

injection N

J3411 Thiamine hcl 100

mg N

J3415 Pyridoxine hcl 100

mg N

J3420 Vitamin b12

injection N

J3430 Vitamin k phytonadione

inj N

J3465 "Injection,

voriconazole" K 1052 $6.07

. $1.22

J3470 Hyaluronidase

injection N

J3471 "Ovine, up to 999 USP

units" NJ3472 "Ovine, 1000 USP

units" N

J3473 Hyaluronidase

recombinant N

J3475 Inj magnesium

sulfate N

J3480 Inj potassium

chloride N

J3485 Zidovudine N

J3486 Ziprasidone

mesylate N

J3487 Zoledronic

acid K 9115 $220.30

. $44.06

J3488 Reclast

injection K 0951 $218.44

. $43.69

J3490 Drugs unclassified

injection N

J3520 Edetate disodium per 150

mg E

J3530 Nasal vaccine

inhalation N

J3535 Metered dose inhaler

drug E

J3570 Laetrile amygdalin vit

B17 E

J3590 Unclassified

biologics N

J7030 Normal saline solution

infus N

J7040 Normal saline solution

infus N

J7042 5% dextrose/normal

saline N

J7050 Normal saline solution

infus N

J7060 5%

dextrose/water N

J7070 D5w

infusion N

J7100 Dextran 40

infusion NJ7110 Dextran 75

infusion N

J7120 Ringers lactate

infusion N

J7130 Hypertonic saline

solution CH D

J7131 Hypertonic saline

sol NI N

J7180 Factor XIII anti-hem

factor NI G 1416 $8.44

. $1.66

J7183 Wilate

injection NI G 1352 $0.87

. $0.17

J7184 Wilate

injection CH D

J7185 Xyntha

inj K 1268 $1.07

. $0.22

J7186 Antihemophilic viii/vwf

comp K 1213 $0.90

. $0.18

J7187 "Humate-P,

inj" K 1704 $0.88

. $0.18

J7189 Factor

viia K 1705 $1.52

. $0.31

J7190 Factor

viii K 0925 $0.85

. $0.17

J7191 Factor VIII

(porcine) K 1279 $9.12

. $1.83

J7192 Factor viii recombinant

NOS K 0927 $1.09

. $0.22

J7193 Factor IX

non-recombinant K 0931 $0.89

. $0.18

J7194 Factor ix

complex K 0928 $0.91

. $0.19

J7195 Factor IX

recombinant K 0932 $1.14

. $0.23

J7196 Antithrombinrecombinant K 1332 $101.40

. $20.28

J7197 Antithrombin iii

injection K 1263 $2.71

. $0.55

J7198 Anti-inhibitor K 0929 $1.60

. $0.32

J7199 Hemophilia clot factor

noc B

J7300 Intraut copper

contraceptive E

J7302 Levonorgestrel iu

contracept E

J7303 Contraceptive vaginal

ring E

J7304 Contraceptive hormone

patch E

J7306 Levonorgestrel implant

sys E

J7307 Etonogestrel implant

system E

J7308 Aminolevulinic acid hcl

top K 7308 $147.80

. $29.56

J7309 "Methyl aminolevulinate,

top" K 1338 $74.52

. $14.91

J7310 Ganciclovir long act

implant K 0913 "$16,640.00"

. "$3,328.00"

J7311 Fluocinolone acetonide

implt K 9225 "$18,980.00"

. "$3,796.00"

J7312 Dexamethasone intra

implant CH K 9256 $192.26

. $38.46

J7321 Hyalgan/supartz inj per

dose K 0873 $88.00

. $17.60

J7323 Euflexxa inj per

dose K 0875 $146.10

. $29.22

J7324 Orthovisc inj per

dose K 0877 $166.14

. $33.23

J7325 Synvisc or

Synvisc-One K 0874 $11.93

. $2.39J7326 Gel-one NI K 1417 "$1,014.00"

. $202.80

J7330 Cultured chondrocytes

implnt B

J7335 Capsaicin 8%

patch G 9268 $25.55

. $5.02

J7500 Azathioprine oral

50mg N

J7501 Azathioprine

parenteral K 0887 $122.53

. $24.51

J7502 Cyclosporine oral 100

mg N

J7504 Lymphocyte immune

globulin K 0890 $556.51

. $111.31

J7505 Monoclonal

antibodies K 7038 "$1,111.59"

. $222.32

J7506 Prednisone

oral N

J7507 Tacrolimus oral per 1

MG N

J7509 Methylprednisolone

oral N

J7510 Prednisolone oral per 5

mg N

J7511 Antithymocyte globuln

rabbit K 9104 $432.20

. $86.44

J7513 "Daclizumab,

parenteral" K 1612 $516.41

. $103.29

J7515 Cyclosporine oral 25

mg N

J7516 Cyclosporin parenteral

250mg N

J7517 Mycophenolate mofetil

oral N

J7518 Mycophenolic

acid N

J7520 "Sirolimus,

oral" N

J7525 Tacrolimusinjection K 9006 $136.86

. $27.38

J7599 Immunosuppressive drug

noc N

J7604 Acetylcysteine comp

unit M

J7605 Arformoterol non-comp

unit M

J7606 "Formoterol fumarate,

inh" M

J7607 Levalbuterol comp

con M

J7608 Acetylcysteine non-comp

unit M

J7609 Albuterol comp

unit M

J7610 Albuterol comp

con M

J7611 Albuterol non-comp

con M

J7612 Levalbuterol non-comp

con M

J7613 Albuterol non-comp

unit M

J7614 Levalbuterol non-comp

unit M

J7615 Levalbuterol comp

unit M

J7620 Albuterol ipratrop

non-comp M

J7622 Beclomethasone comp unit

M

J7624 Betamethasone comp

unit M

J7626 Budesonide non-comp unit

M

J7627 Budesonide comp unit

M

J7628 Bitolterol mesylate comp con

M

J7629 Bitolterol mesylate comp unt

M

J7631 Cromolyn sodium noncomp

unit MJ7632 Cromolyn sodium comp

unit M

J7633 Budesonide non-comp

con M

J7634 Budesonide comp

con M

J7635 Atropine comp con

M

J7636 Atropine comp unit

M

J7637 Dexamethasone comp con

M

J7638 Dexamethasone comp unit

M

J7639 Dornase alfa non-comp

unit M

J7640 Formoterol comp unit

E

J7641 Flunisolide comp unit

M

J7642 Glycopyrrolate comp con

M

J7643 Glycopyrrolate comp unit

M

J7644 Ipratropium bromide non-comp

M

J7645 Ipratropium bromide

comp M

J7647 Isoetharine comp

con M

J7648 Isoetharine non-comp con

M

J7649 Isoetharine non-comp unit

M

J7650 Isoetharine comp

unit M

J7657 Isoproterenol comp

con M

J7658 Isoproterenol non-comp con

M

J7659 Isoproterenol non-comp unit

M

J7660 Isoproterenol comp

unit MJ7665 Mannitol for

inhaler NI M

J7667 Metaproterenol comp

con M

J7668 Metaproterenol non-comp con

M

J7669 Metaproterenol non-comp unit

M

J7670 Metaproterenol comp

unit M

J7674 "Methacholine chloride,

neb" N

J7676 Pentamidine comp unit

dose M

J7680 Terbutaline sulf comp con

M

J7681 Terbutaline sulf comp unit

M

J7682 Tobramycin non-comp unit

M

J7683 Triamcinolone comp con

M

J7684 Triamcinolone comp unit

M

J7685 Tobramycin comp

unit M

J7686 "Treprostinil, non-comp

unit" M

J7699 Inhalation solution for

DME M

J7799 Non-inhalation drug for

DME N

J8498 Antiemetic rectal/supp

NOS B

J8499 Oral prescrip drug non

chemo E

J8501 Oral

aprepitant K 0868 $6.06

. $1.22

J8510 Oral

busulfan K 1307 $3.77

. $0.76

J8515 "Cabergoline, oral

0.25mg" E

J8520 "Capecitabine, oral, 150mg" K 7042 $7.32

. $1.47

J8521 "Capecitabine, oral, 500

mg" K 0934 $24.63

. $4.93

J8530 Cyclophosphamide oral 25

MG N

J8540 Oral

dexamethasone N

J8560 Etoposide oral 50

MG K 0802 $37.54

. $7.51

J8561 Oral

everolimus NI K 1418 $5.68

. $1.14

J8562 Oral fludarabine

phosphate G 1339 $77.93

. $15.30

J8565 Gefitinib

oral E

J8597 Antiemetic drug oral

NOS N

J8600 Melphalan oral 2

MG N

J8610 Methotrexate oral 2.5

MG N

J8650 Nabilone

oral CH E

J8700 Temozolomide K 1086 $9.48

. $1.90

J8705 Topotecan

oral CH K 1238 $77.92

. $15.59

J8999 Oral prescription drug

chemo B

J9000 Doxorubicin hcl

injection N

J9001 Doxorubicin hcl liposome

inj K 7046 $525.35

. $105.07

J9010 Alemtuzumab

injection K 9110 $575.18

. $115.04

J9015 Aldesleukin

injection K 0807 $969.60

. $193.92J9017 Arsenic trioxide

injection K 9012 $40.10

. $8.02

J9020 Asparaginase

injection K 0814 $62.08

. $12.42

J9025 Azacitidine

injection K 1709 $5.15

. $1.03

J9027 Clofarabine

injection K 1710 $119.68

. $23.94

J9031 Bcg live intravesical

vac K 0809 $117.34

. $23.47

J9033 Bendamustine

injection K 9243 $18.47

. $3.70

J9035 Bevacizumab

injection K 9214 $59.98

. $12.00

J9040 Bleomycin sulfate

injection N

J9041 Bortezomib

injection K 9207 $40.67

. $8.14

J9043 Cabazitaxel

injection NI G 9276 $135.57

. $26.61

J9045 Carboplatin

injection N

J9050 Carmustine

injection K 0812 $172.53

. $34.51

J9055 Cetuximab

injection K 9215 $49.53

. $9.91

J9060 Cisplatin 10 MG

injection N

J9065 Inj cladribine per 1

MG K 0858 $23.94

. $4.79

J9070 Cyclophosphamide 100 MG

inj CH K 1408 $13.43

. $2.69

J9098 Cytarabine liposome

inj K 1166 $503.48

. $100.70

J9100 Cytarabine hcl 100 MGinj N

J9120 Dactinomycin

injection K 0752 $567.28

. $113.46

J9130 Dacarbazine 100 mg

inj N

J9150 Daunorubicin

injection K 0820 $15.60

. $3.12

J9151 Daunorubicin citrate

inj K 0821 $56.58

. $11.32

J9155 Degarelix

injection CH K 1296 $2.71

. $0.55

J9160 Denileukin diftitox

inj K 1084 "$1,603.01"

. $320.61

J9165 Diethylstilbestrol

injection CH E

J9171 Docetaxel

injection K 0823 $15.75

. $3.15

J9175 Elliotts b solution per

ml N

J9178 "Inj, epirubicin hcl, 2

mg" K 1167 $1.87

. $0.38

J9179 Eribulin mesylate

injection NI G 1426 $90.06

. $17.68

J9181 Etoposide

injection N

J9185 Fludarabine phosphate

inj K 0842 $101.84

. $20.37

J9190 Fluorouracil

injection N

J9200 Floxuridine

injection K 0827 $60.82

. $12.17

J9201 Gemcitabine hcl

injection K 0828 $89.64

. $17.93

J9202 Goserelin acetate

implant K 0810 $186.43

. $37.29J9206 Irinotecan

injection K 0830 $6.42

. $1.29

J9207 Ixabepilone

injection K 9240 $63.47

. $12.70

J9208 Ifosfamide

injection K 0831 $32.03

. $6.41

J9209 Mesna

injection N

J9211 Idarubicin hcl

injection K 0832 $58.32

. $11.67

J9212 Interferon alfacon-1

inj CH N

J9213 Interferon alfa-2a

inj N

J9214 Interferon alfa-2b

inj K 0836 $16.82

. $3.37

J9215 Interferon alfa-n3

inj K 0865 $31.20

. $6.24

J9216 Interferon gamma 1-b

inj K 0838 $582.59

. $116.52

J9217 Leuprolide acetate

suspnsion K 9217 $216.90

. $43.38

J9218 Leuprolide acetate

injeciton K 0861 $4.42

. $0.89

J9219 Leuprolide acetate

implant K 7051 "$4,728.88"

. $945.78

J9225 Vantas

implant K 1711 "$3,816.98"

. $763.40

J9226 Supprelin LA

implant K 1142 "$15,418.48"

. "$3,083.70"

J9228 Ipilimumab

injection NI G 9284 $127.20

. $24.96

J9230 Mechlorethamine hcl

inj K 0751 $154.88

. $30.98

J9245 Inj melphalan hydrochl 50MG K 0840 "$1,512.71"

. $302.55

J9250 Methotrexate sodium

inj N

J9260 Methotrexate sodium

inj N

J9261 Nelarabine injection

K 0825 $113.99

. $22.80

J9263 Oxaliplatin K 1738 $9.96

. $2.00

J9264 Paclitaxel protein

bound K 1712 $9.33

. $1.87

J9265 Paclitaxel

injection CH N

J9266 Pegaspargase injection

K 0843 "$2,675.40"

. $535.08

J9268 Pentostatin

injection K 0844 "$1,084.10"

. $216.82

J9270 Plicamycin (mithramycin)

inj N

J9280 Mitomycin 5 MG

inj K 1232 $19.55

. $3.91

J9293 Mitoxantrone hydrochl / 5

MG K 0864 $37.36

. $7.48

J9300 Gemtuzumab ozogamicin

inj K 9004 "$2,690.84"

. $538.17

J9302 Ofatumumab

injection G 9260 $45.41

. $8.91

J9303 Panitumumab

injection K 9235 $85.59

. $17.12

J9305 Pemetrexed

injection K 9213 $52.76

. $10.56

J9307 Pralatrexate

injection G 9259 $165.63

. $32.50

J9310 Rituximab

injection K 0849 $615.22

. $123.05J9315 Romidepsin

injection G 9265 $224.79

. $44.11

J9320 Streptozocin

injection K 0850 $265.69

. $53.14

J9328 Temozolomide

injection CH K 9253 $4.75

. $0.95

J9330 Temsirolimus

injection K 1168 $50.57

. $10.12

J9340 Thiotepa

injection K 0851 $131.18

. $26.24

J9351 Topotecan

injection K 1350 $9.85

. $1.97

J9355 Trastuzumab

injection K 1613 $71.08

. $14.22

J9357 Valrubicin

injection K 1235 $959.07

. $191.82

J9360 Vinblastine sulfate

inj N

J9370 Vincristine sulfate 1 MG

inj N

J9390 Vinorelbine tartrate

inj CH K 1412 $17.45

. $3.49

J9395 "Injection,

Fulvestrant" K 9120 $83.63

. $16.73

J9600 Porfimer sodium

injection K 0856 "$19,348.11"

. "$3,869.63"

J9999 Chemotherapy

drug N

K0001 Standard

wheelchair Y

K0002 Stnd hemi (low seat)

whlchr Y

K0003 Lightweight

wheelchair Y

K0004 High strength ltwt

whlchr YK0005 Ultralightweight

wheelchair Y

K0006 Heavy duty

wheelchair Y

K0007 Extra heavy duty

wheelchair Y

K0009 Other manual

wheelchair/base Y

K0010 Stnd wt frame power

whlchr Y

K0011 Stnd wt pwr whlchr w

control Y

K0012 Ltwt portbl power

whlchr Y

K0014 Other power whlchr

base Y

K0015 Detach non-adjus hght

armrst Y

K0017 Detach adjust armrest

base Y

K0018 Detach adjust armrst

upper Y

K0019 Arm pad

each Y

K0020 Fixed adjust armrest

pair Y

K0037 High mount flip-up

footrest Y

K0038 Leg strap

each Y

K0039 Leg strap h style

each Y

K0040 Adjustable angle

footplate Y

K0041 Large size footplate

each Y

K0042 Standard size footplate

each Y

K0043 Ftrst lower extension

tube Y

K0044 Ftrst upper hanger

bracket Y

K0045 Footrest complete

assembly YK0046 Elevat legrst low

extension Y

K0047 Elevat legrst up hangr

brack Y

K0050 Ratchet

assembly Y

K0051 Cam relese assem

ftrst/lgrst Y

K0052 Swingaway detach

footrest Y

K0053 Elevate footrest

articulate Y

K0056 Seat ht <17 or >=21 ltwt

wc Y

K0065 Spoke

protectors Y

K0069 Rear whl complete solid

tire Y

K0070 Rear whl compl pneum

tire Y

K0071 Front castr compl pneum

tire Y

K0072 Frnt cstr cmpl sem-pneum

tir Y

K0073 Caster pin lock

each Y

K0077 Front caster assem

complete Y

K0098 Drive belt power

wheelchair Y

K0105 Iv

hanger Y

K0108 W/c component-accessory

NOS Y

K0195 Elevating whlchair leg

rests Y

K0455 Pump uninterrupted

infusion Y

K0462 Temporary replacement

eqpmnt Y

K0552 Supply/ext inf pump syr

type Y

K0601 Repl batt silver oxide 1.5v Y

K0602 Repl batt silver oxide 3 v

Y

K0603 Repl batt alkaline 1.5

v Y

K0604 Repl batt lithium 3.6

v Y

K0605 Repl batt lithium 4.5

v Y

K0606 AED garment w elec

analysis Y

K0607 Repl batt for

AED Y

K0608 Repl garment for

AED Y

K0609 Repl electrode for

AED Y

K0669 Seat/back cus no dmepdac

ver Y

K0672 Removable soft interface

LE A

K0730 Ctrl dose inh drug deliv

sys Y

K0733 12-24hr sealed lead

acid Y

K0738 Portable gas oxygen

system Y

K0739 Repair/svc DME non-oxygen

eq Y

K0740 Repair/svc oxygen

equipment E

K0741 Portable gaseous oxygen

sys Y

K0742 Portable gaseous oxygen

Y

K0743 Portable home suction

pump Y

K0744 Absorp drg <= 16 suc

pump A

K0745 Absorp drg >16<=48 suc

pump A

K0746 Absorp drg >48 suc

pump A

K0800 POV group 1 std up to300lbs Y

K0801 POV group 1 hd 301-450

lbs Y

K0802 POV group 1 vhd 451-600

lbs Y

K0806 POV group 2 std up to

300lbs Y

K0807 POV group 2 hd 301-450

lbs Y

K0808 POV group 2 vhd 451-600

lbs Y

K0812 Power operated vehicle

NOC Y

K0813 PWC gp 1 std port

seat/back Y

K0814 PWC gp 1 std port cap

chair Y

K0815 PWC gp 1 std

seat/back Y

K0816 PWC gp 1 std cap

chair Y

K0820 PWC gp 2 std port

seat/back Y

K0821 PWC gp 2 std port cap

chair Y

K0822 PWC gp 2 std

seat/back Y

K0823 PWC gp 2 std cap

chair Y

K0824 PWC gp 2 hd

seat/back Y

K0825 PWC gp 2 hd cap

chair Y

K0826 PWC gp 2 vhd

seat/back Y

K0827 PWC gp vhd cap

chair Y

K0828 PWC gp 2 xtra hd

seat/back Y

K0829 PWC gp 2 xtra hd cap

chair Y

K0830 PWC gp2 std seat elevate

s/b Y

K0831 PWC gp2 std seat elevatecap Y

K0835 PWC gp2 std sing pow opt

s/b Y

K0836 PWC gp2 std sing pow opt

cap Y

K0837 PWC gp 2 hd sing pow opt

s/b Y

K0838 PWC gp 2 hd sing pow opt

cap Y

K0839 PWC gp2 vhd sing pow opt

s/b Y

K0840 PWC gp2 xhd sing pow opt

s/b Y

K0841 PWC gp2 std mult pow opt

s/b Y

K0842 PWC gp2 std mult pow opt

cap Y

K0843 PWC gp2 hd mult pow opt

s/b Y

K0848 PWC gp 3 std

seat/back Y

K0849 PWC gp 3 std cap

chair Y

K0850 PWC gp 3 hd

seat/back Y

K0851 PWC gp 3 hd cap

chair Y

K0852 PWC gp 3 vhd

seat/back Y

K0853 PWC gp 3 vhd cap

chair Y

K0854 PWC gp 3 xhd

seat/back Y

K0855 PWC gp 3 xhd cap

chair Y

K0856 PWC gp3 std sing pow opt

s/b Y

K0857 PWC gp3 std sing pow opt

cap Y

K0858 PWC gp3 hd sing pow opt

s/b Y

K0859 PWC gp3 hd sing pow opt

cap Y

K0860 PWC gp3 vhd sing pow opts/b Y

K0861 PWC gp3 std mult pow opt

s/b Y

K0862 PWC gp3 hd mult pow opt

s/b Y

K0863 PWC gp3 vhd mult pow opt

s/b Y

K0864 PWC gp3 xhd mult pow opt

s/b Y

K0868 PWC gp 4 std

seat/back Y

K0869 PWC gp 4 std cap

chair Y

K0870 PWC gp 4 hd

seat/back Y

K0871 PWC gp 4 vhd

seat/back Y

K0877 PWC gp4 std sing pow opt

s/b Y

K0878 PWC gp4 std sing pow opt

cap Y

K0879 PWC gp4 hd sing pow opt

s/b Y

K0880 PWC gp4 vhd sing pow opt

s/b Y

K0884 PWC gp4 std mult pow opt

s/b Y

K0885 PWC gp4 std mult pow opt

cap Y

K0886 PWC gp4 hd mult pow

s/b Y

K0890 PWC gp5 ped sing pow opt

s/b Y

K0891 PWC gp5 ped mult pow opt

s/b Y

K0898 Power wheelchair

NOC Y

K0899 Pow mobil dev no

dmepdac Y

L0112 Cranial cervical

orthosis A

L0113 Cranial cervical

torticollis AL0120 Cerv flexible

non-adjustable A

L0130 Flex thermoplastic collar

mo A

L0140 Cervical semi-rigid

adjustab A

L0150 Cerv semi-rig adj molded

chn A

L0160 Cerv semi-rig wire

occ/mand A

L0170 Cervical collar molded to

pt A

L0172 Cerv col thermplas foam 2

pi A

L0174 Cerv col foam 2 piece w

thor A

L0180 Cer post col occ/man sup

adj A

L0190 Cerv collar supp adj cerv

ba A

L0200 Cerv col supp adj bar &

thor A

L0220 Thor rib belt custom

fabrica A

L0430 Dewall posture

protector A

L0450 TLSO flex prefab

thoracic A

L0452 tlso flex custom fab

thoraci A

L0454 TLSO flex prefab

sacrococ-T9 A

L0456 TLSO flex

prefab A

L0458 TLSO 2Mod symphis-xipho

pre A

L0460 TLSO2Mod symphysis-stern

pre A

L0462 TLSO 3Mod sacro-scap

pre A

L0464 TLSO 4Mod sacro-scap

pre A

L0466 TLSO rigid frame pre softap A

L0468 TLSO rigid frame prefab

pelv A

L0470 TLSO rigid frame pre

subclav A

L0472 TLSO rigid frame hyperex

pre A

L0480 TLSO rigid plastic custom

fa A

L0482 TLSO rigid lined custom

fab A

L0484 TLSO rigid plastic cust

fab A

L0486 TLSO rigidlined cust fab

two A

L0488 TLSO rigid lined pre one

pie A

L0490 TLSO rigid plastic pre

one A

L0491 TLSO 2 piece rigid

shell A

L0492 TLSO 3 piece rigid

shell A

L0621 SIO flex pelvisacral

prefab A

L0622 SIO flex pelvisacral

custom A

L0623 SIO panel

prefab A

L0624 SIO panel

custom A

L0625 LO flexibl L1-below L5

pre A

L0626 LO sag stays/panels

pre-fab A

L0627 LO sagitt rigid panel

prefab A

L0628 LO flex w/o rigid stays

pre A

L0629 LSO flex w/rigid stays

cust A

L0630 LSO post rigid panel

pre A

L0631 LSO sag-coro rigid framepre A

L0632 LSO sag rigid frame

cust A

L0633 LSO flexion control

prefab A

L0634 LSO flexion control

custom A

L0635 LSO sagit rigid panel

prefab A

L0636 LSO sagittal rigid panel

cus A

L0637 LSO sag-coronal panel

prefab A

L0638 LSO sag-coronal panel

custom A

L0639 LSO s/c shell/panel

prefab A

L0640 LSO s/c shell/panel

custom A

L0700 Ctlso a-p-l control

molded A

L0710 Ctlso a-p-l control w/

inter A

L0810 Halo cervical into jckt

vest A

L0820 Halo cervical into body

jack A

L0830 Halo cerv into milwaukee

typ A

L0859 MRI compatible

system A

L0861 Halo repl

liner/interface A

L0970 Tlso corset

front A

L0972 Lso corset

front A

L0974 Tlso full

corset A

L0976 Lso full

corset A

L0978 Axillary crutch

extension AL0980 Peroneal straps

pair A

L0982 Stocking supp grips set of

f A

L0984 Protective body sock

each A

L0999 Add to spinal orthosis

NOS A

L1000 Ctlso milwauke initial

model A

L1001 CTLSO infant

immobilizer A

L1005 Tension based scoliosis

orth A

L1010 Ctlso axilla

sling A

L1020 Kyphosis

pad A

L1025 Kyphosis pad

floating A

L1030 Lumbar bolster

pad A

L1040 Lumbar or lumbar rib

pad A

L1050 Sternal

pad A

L1060 Thoracic

pad A

L1070 Trapezius

sling A

L1080 Outrigger A

L1085 Outrigger bil w/ vert

extens A

L1090 Lumbar

sling A

L1100 Ring flange

plastic/leather A

L1110 Ring flange plas/leather

mol A

L1120 Covers for upright

each A

L1200 Furnsh initial orthosisonly A

L1210 Lateral thoracic

extension A

L1220 Anterior thoracic

extension A

L1230 Milwaukee type

superstructur A

L1240 Lumbar derotation

pad A

L1250 Anterior asis

pad A

L1260 Anterior thoracic

derotation A

L1270 Abdominal

pad A

L1280 Rib gusset (elastic)

each A

L1290 Lateral trochanteric

pad A

L1300 Body jacket mold to

patient A

L1310 Post-operative body

jacket A

L1499 Spinal orthosis

NOS A

L1500 Thkao mobility

frame CH D

L1510 Thkao standing

frame CH D

L1520 Thkao swivel

walker CH D

L1600 Abduct hip flex frejka w

cvr A

L1610 Abduct hip flex frejka

covr A

L1620 Abduct hip flex pavlik

harne A

L1630 Abduct control hip

semi-flex A

L1640 Pelv band/spread bar thigh

c A

L1650 HO abduction hip

adjustable AL1652 HO bi thighcuffs w sprdr

bar A

L1660 HO abduction static

plastic A

L1680 Pelvic & hip control thigh

c A

L1685 Post-op hip abduct custom

fa A

L1686 HO post-op hip

abduction A

L1690 Combination bilateral

HO A

L1700 Leg perthes orth toronto

typ A

L1710 Legg perthes orth

newington A

L1720 Legg perthes orthosis

trilat A

L1730 Legg perthes orth scottish

r A

L1755 Legg perthes patten bottom

t A

L1810 Ko elastic with

joints A

L1820 Ko elas w/ condyle pads &

jo A

L1830 Ko immobilizer canvas

longit A

L1831 Knee orth pos locking

joint A

L1832 KO adj jnt pos rigid

support A

L1834 Ko w/0 joint rigid molded

to A

L1836 Rigid KO wo

joints A

L1840 Ko derot ant cruciate

custom A

L1843 KO single upright custom

fit A

L1844 Ko w/adj jt rot cntrl

molded A

L1845 Ko w/ adj flex/ext rotat

cus AL1846 Ko w adj flex/ext rotat

mold A

L1847 KO adjustable w air

chambers A

L1850 Ko swedish

type A

L1860 Ko supracondylar socket

mold A

L1900 Afo sprng wir drsflx calf

bd A

L1902 Afo ankle

gauntlet A

L1904 Afo molded ankle

gauntlet A

L1906 Afo multiligamentus ankle

su A

L1907 AFO supramalleolar

custom A

L1910 Afo sing bar clasp attach

sh A

L1920 Afo sing upright w/ adjust

s A

L1930 Afo

plastic A

L1932 Afo rig ant tib prefab

TCF/= A

L1940 Afo molded to patient

plasti A

L1945 Afo molded plas rig ant

tib A

L1950 Afo spiral molded to pt

plas A

L1951 AFO spiral

prefabricated A

L1960 Afo pos solid ank plastic

mo A

L1970 Afo plastic molded w/ankle

j A

L1971 "AFO w/ankle joint,

prefab" A

L1980 Afo sing solid stirrup

calf A

L1990 Afo doub solid stirrup

calf AL2000 Kafo sing fre stirr

thi/calf A

L2005 KAFO sng/dbl mechanical

act A

L2010 Kafo sng solid stirrup w/o

j A

L2020 Kafo dbl solid stirrup

band/ A

L2030 Kafo dbl solid stirrup w/o

j A

L2034 KAFO pla sin up w/wo k/a

cus A

L2035 KAFO plastic pediatric

size A

L2036 Kafo plas doub free knee

mol A

L2037 Kafo plas sing free knee

mol A

L2038 Kafo w/o joint multi-axis

an A

L2040 Hkafo torsion bil rot

straps A

L2050 Hkafo torsion cable hip

pelv A

L2060 Hkafo torsion ball bearing

j A

L2070 Hkafo torsion unilat rot

str A

L2080 Hkafo unilat torsion

cable A

L2090 Hkafo unilat torsion ball

br A

L2106 Afo tib fx cast plaster

mold A

L2108 Afo tib fx cast molded to

pt A

L2112 Afo tibial fracture

soft A

L2114 Afo tib fx

semi-rigid A

L2116 Afo tibial fracture

rigid A

L2126 Kafo fem fx cast

thermoplas AL2128 Kafo fem fx cast molded to

p A

L2132 Kafo femoral fx cast

soft A

L2134 Kafo fem fx cast

semi-rigid A

L2136 Kafo femoral fx cast

rigid A

L2180 Plas shoe insert w ank

joint A

L2182 Drop lock

knee A

L2184 Limited motion knee

joint A

L2186 Adj motion knee jnt lerman

t A

L2188 Quadrilateral

brim A

L2190 Waist

belt A

L2192 Pelvic band & belt thigh

fla A

L2200 Limited ankle motion ea

jnt A

L2210 Dorsiflexion assist each

joi A

L2220 Dorsi & plantar flex

ass/res A

L2230 Split flat caliper stirr &

p A

L2232 "Rocker bottom, contact

AFO" A

L2240 Round caliper and plate

atta A

L2250 Foot plate molded stirrup

at A

L2260 Reinforced solid

stirrup A

L2265 Long tongue

stirrup A

L2270 Varus/valgus strap

padded/li A

L2275 Plastic mod low ext

pad/line AL2280 Molded inner

boot A

L2300 Abduction bar jointed

adjust A

L2310 Abduction

bar-straight A

L2320 Non-molded

lacer A

L2330 Lacer molded to patient

mode A

L2335 Anterior swing

band A

L2340 Pre-tibial shell molded to

p A

L2350 Prosthetic type socket

molde A

L2360 Extended steel

shank A

L2370 Patten

bottom A

L2375 Torsion ank & half solid

sti A

L2380 Torsion straight knee

joint A

L2385 Straight knee joint heavy

du A

L2387 Add LE poly knee custom

KAFO A

L2390 Offset knee joint

each A

L2395 Offset knee joint heavy

duty A

L2397 Suspension sleeve lower

ext A

L2405 Knee joint drop lock ea

jnt A

L2415 Knee joint cam lock each

joi A

L2425 Knee disc/dial lock/adj

flex A

L2430 Knee jnt ratchet lock ea

jnt A

L2492 Knee lift loop drop lockrin A

L2500 Thi/glut/ischia wgt

bearing A

L2510 Th/wght bear quad-lat brim

m A

L2520 Th/wght bear quad-lat brim

c A

L2525 Th/wght bear nar m-l brim

mo A

L2526 Th/wght bear nar m-l brim

cu A

L2530 Thigh/wght bear lacer

non-mo A

L2540 Thigh/wght bear lacer

molded A

L2550 Thigh/wght bear high roll

cu A

L2570 Hip clevis type 2 posit

jnt A

L2580 Pelvic control pelvic

sling A

L2600 Hip clevis/thrust bearing

fr A

L2610 Hip clevis/thrust bearing

lo A

L2620 Pelvic control hip heavy

dut A

L2622 Hip joint adjustable

flexion A

L2624 Hip adj flex ext abduct

cont A

L2627 Plastic mold recipro hip &

c A

L2628 Metal frame recipro hip &

ca A

L2630 Pelvic control band & belt

u A

L2640 Pelvic control band & belt

b A

L2650 Pelv & thor control

gluteal A

L2660 Thoracic control thoracic

ba A

L2670 Thorac cont paraspinaluprig A

L2680 Thorac cont lat support

upri A

L2750 Plating chrome/nickel pr

bar A

L2755 Carbon graphite

lamination A

L2760 Extension per extension

per A

L2768 Ortho sidebar

disconnect A

L2780 Non-corrosive

finish A

L2785 Drop lock retainer

each A

L2795 Knee control full

kneecap A

L2800 Knee cap medial or lateral

p A

L2810 Knee control condylar

pad A

L2820 Soft interface below knee

se A

L2830 Soft interface above knee

se A

L2840 Tibial length sock fx or

equ A

L2850 Femoral lgth sock fx or

equa A

L2861 Torsion mechanism

knee/ankle E

L2999 Lower extremity orthosis

NOS A

L3000 Ft insert ucb berkeley

shell A

L3001 Foot insert remov molded

spe A

L3002 Foot insert plastazote or

eq A

L3003 Foot insert silicone gel

eac A

L3010 Foot longitudinal arch

suppo A

L3020 Foot longitud/metatarsalsup A

L3030 Foot arch support remov

prem A

L3031 Foot lamin/prepreg

composite A

L3040 Ft arch suprt premold

longit A

L3050 Foot arch supp premold

metat A

L3060 Foot arch supp

longitud/meta A

L3070 Arch suprt att to sho

longit A

L3080 Arch supp att to shoe

metata A

L3090 Arch supp att to shoe

long/m A

L3100 Hallus-valgus nght dynamic

s A

L3140 Abduction rotation bar

shoe A

L3150 Abduct rotation bar w/o

shoe A

L3160 Shoe styled positioning

dev A

L3170 Foot plastic heel

stabilizer A

L3201 Oxford w supinat/pronat

inf A

L3202 Oxford w/ supinat/pronator

c A

L3203 Oxford w/

supinator/pronator A

L3204 Hightop w/ supp/pronator

inf A

L3206 Hightop w/ supp/pronator

chi A

L3207 Hightop w/ supp/pronator

jun A

L3208 Surgical boot each

infant A

L3209 Surgical boot each

child AL3211 Surgical boot each

junior A

L3212 Benesch boot pair

infant A

L3213 Benesch boot pair

child A

L3214 Benesch boot pair

junior A

L3215 Orthopedic ftwear ladies

oxf E

L3216 Orthoped ladies shoes dpth

i E

L3217 Ladies shoes hightop depth

i E

L3219 Orthopedic mens shoes

oxford E

L3221 Orthopedic mens shoes dpth

i E

L3222 Mens shoes hightop depth

inl E

L3224 Woman's shoe oxford

brace A

L3225 Man's shoe oxford

brace A

L3230 Custom shoes depth

inlay A

L3250 Custom mold shoe remov

prost A

L3251 Shoe molded to pt silicone

s A

L3252 Shoe molded plastazote

cust A

L3253 Shoe molded plastazote

cust A

L3254 Orth foot non-stndard

size/w A

L3255 Orth foot non-standard

size/ A

L3257 Orth foot add charge split

s A

L3260 Ambulatory surgical boot

eac E

L3265 Plastazote sandal

each AL3300 Sho lift taper to

metatarsal A

L3310 Shoe lift elev heel/sole

neo A

L3320 Shoe lift elev heel/sole

cor A

L3330 Lifts elevation metal

extens A

L3332 Shoe lifts tapered to

one-ha A

L3334 Shoe lifts elevation heel

/i A

L3340 Shoe wedge

sach A

L3350 Shoe heel

wedge A

L3360 Shoe sole wedge outside

sole A

L3370 Shoe sole wedge between

sole A

L3380 Shoe clubfoot

wedge A

L3390 Shoe outflare

wedge A

L3400 Shoe metatarsal bar wedge

ro A

L3410 Shoe metatarsal bar

between A

L3420 Full sole/heel wedge

btween A

L3430 Sho heel count plast

reinfor A

L3440 Heel leather

reinforced A

L3450 Shoe heel sach cushion

type A

L3455 Shoe heel new leather

standa A

L3460 Shoe heel new rubber

standar A

L3465 Shoe heel thomas with

wedge A

L3470 Shoe heel thomas extend to

b AL3480 Shoe heel pad & depress

for A

L3485 Shoe heel pad removable

for A

L3500 Ortho shoe add leather

insol A

L3510 Orthopedic shoe add rub

insl A

L3520 O shoe add felt w leath

insl A

L3530 Ortho shoe add half

sole A

L3540 Ortho shoe add full

sole A

L3550 O shoe add standard toe

tap A

L3560 O shoe add horseshoe toe

tap A

L3570 O shoe add instep

extension A

L3580 O shoe add instep velcro

clo A

L3590 O shoe convert to sof

counte A

L3595 Ortho shoe add march

bar A

L3600 Trans shoe calip plate

exist A

L3610 Trans shoe caliper plate

new A

L3620 Trans shoe solid stirrup

exi A

L3630 Trans shoe solid stirrup

new A

L3640 Shoe dennis browne splint

bo A

L3649 Orthopedic shoe modifica

NOS A

L3650 Shlder fig 8 abduct

restrain A

L3660 Abduct restrainer

canvas&web A

L3670 Acromio/clavicular

canvas&we AL3671 SO cap design w/o jnts

CF A

L3674 SO airplane w/wo joint

CF A

L3675 Canvas vest

SO A

L3677 SO hard plastic

stabilizer A

L3702 EO w/o joints

CF A

L3710 Elbow elastic with metal

joi A

L3720 Forearm/arm cuffs free

motio A

L3730 Forearm/arm cuffs ext/flex

a A

L3740 Cuffs adj lock w/ active

con A

L3760 "EO withjoint,

Prefabricated" A

L3762 Rigid EO wo

joints A

L3763 EWHO rigid w/o jnts

CF A

L3764 EWHO w/joint(s)

CF A

L3765 EWHFO rigid w/o jnts

CF A

L3766 EWHFO w/joint(s)

CF A

L3806 WHFO w/joint(s) custom

fab A

L3807 "WHFO,no joint,

prefabricated" A

L3808 "WHFO, rigid w/o

joints" A

L3891 Torsion mechanism

wrist/elbo E

L3900 Hinge extension/flex

wrist/f A

L3901 Hinge ext/flex wrist

finger AL3904 Whfo electric custom

fitted A

L3905 WHO w/nontorsion jnt(s)

CF A

L3906 WHO w/o joints

CF A

L3908 Wrist cock-up

non-molded A

L3912 Flex glove w/elastic

finger A

L3913 HFO w/o joints

CF A

L3915 WHO w nontor jnt(s)

prefab A

L3917 Prefab metacarpl fx

orthosis A

L3919 HO w/o joints

CF A

L3921 HFO w/joint(s)

CF A

L3923 HFO w/o joints

PF A

L3925 FO pip/dip with

joint/spring A

L3927 FO pip/dip w/o

joint/spring A

L3929 "HFO nontorsion joint,

prefab" A

L3931 WHFO nontorsion joint

prefab A

L3933 FO w/o joints

CF A

L3935 FO nontorsion joint

CF A

L3956 Add joint upper ext

orthosis A

L3960 Sewho airplan desig abdu

pos A

L3961 SEWHO cap design w/o jnts

CF A

L3962 Sewho erbs palsey design

abd A

L3964 Seo mobile arm sup att towc CH D

L3965 Arm supp att to wc rancho

ty CH D

L3966 Mobile arm supports

reclinin CH D

L3967 SEWHO airplane w/o jnts

CF A

L3968 Friction dampening arm

supp CH D

L3969 Monosuspension arm/hand

supp CH D

L3970 Elevat proximal arm

support CH D

L3971 SEWHO cap design w/jnt(s)

CF A

L3972 Offset/lat rocker arm w/

ela CH D

L3973 SEWHO airplane w/jnt(s)

CF A

L3974 Mobile arm support

supinator CH D

L3975 SEWHFO cap design w/o jnt

CF A

L3976 SEWHFO airplane w/o jnts

CF A

L3977 SEWHFO cap desgn w/jnt(s)

CF A

L3978 SEWHFO airplane w/jnt(s)

CF A

L3980 Upp ext fx orthosis

humeral A

L3982 Upper ext fx orthosis

rad/ul A

L3984 Upper ext fx orthosis

wrist A

L3995 Sock fracture or equal

each A

L3999 Upper limb orthosis

NOS A

L4000 Repl girdle milwaukee

orth A

L4002 "Replace strap, any

orthosis" AL4010 Replace trilateral socket

br A

L4020 Replace quadlat socket

brim A

L4030 Replace socket brim cust

fit A

L4040 Replace molded thigh

lacer A

L4045 Replace non-molded thigh

lac A

L4050 Replace molded calf

lacer A

L4055 Replace non-molded calf

lace A

L4060 Replace high roll

cuff A

L4070 Replace prox & dist

upright A

L4080 Repl met band kafo-afo

prox A

L4090 Repl met band kafo-afo

calf/ A

L4100 Repl leath cuff kafo prox

th A

L4110 Repl leath cuff kafo-afo

cal A

L4130 Replace pretibial

shell A

L4205 Ortho dvc repair per 15

min A

L4210 Orth dev repair/repl minor

p A

L4350 Ankle control orthosi

prefab A

L4360 Pneumati walking boot

prefab A

L4370 Pneumatic full leg

splint A

L4380 Pneumatic knee

splint CH D

L4386 Non-pneum walk boot

prefab A

L4392 Replace AFO soft

interface AL4394 Replace foot drop

spint A

L4396 Static

AFO A

L4398 Foot drop splint

recumbent A

L4631 "Afo, walk boot type, cus

fab" A

L5000 Sho insert w arch toe

filler A

L5010 Mold socket ank hgt w/ toe

f A

L5020 Tibial tubercle hgt w/ toe

f A

L5050 Ank symes mold sckt sach

ft A

L5060 Symes met fr leath socket

ar A

L5100 Molded socket shin sach

foot A

L5105 Plast socket jts/thgh

lacer A

L5150 Mold sckt ext knee shin

sach A

L5160 Mold socket bent knee shin

s A

L5200 Kne sing axis fric shin

sach A

L5210 No knee/ankle joints w/ ft

b A

L5220 No knee joint with artic

ali A

L5230 Fem focal defic constant

fri A

L5250 Hip canad sing axi cons

fric A

L5270 Tilt table locking hip

sing A

L5280 Hemipelvect canad sing

axis A

L5301 BK mold socket SACH ft

endo A

L5311 "Knee disart, SACH ft,

endo" CH DL5312 "Knee disart, SACH ft,

endo" NI A

L5321 AK open end

SACH A

L5331 Hip disart canadian SACH

ft A

L5341 Hemipelvectomy canadian

SACH A

L5400 Postop dress & 1 cast chg

bk A

L5410 Postop dsg bk ea add cast

ch A

L5420 Postop dsg & 1 cast chg

ak/d A

L5430 Postop dsg ak ea add cast

ch A

L5450 Postop app non-wgt bear

dsg A

L5460 Postop app non-wgt bear

dsg A

L5500 Init bk ptb plaster

direct A

L5505 Init ak ischal plstr

direct A

L5510 Prep BK ptb plaster

molded A

L5520 Perp BK ptb thermopls

direct A

L5530 Prep BK ptb thermopls

molded A

L5535 Prep BK ptb open end

socket A

L5540 Prep BK ptb laminated

socket A

L5560 Prep AK ischial plast

molded A

L5570 Prep AK ischial direct

form A

L5580 Prep AK ischial thermo

mold A

L5585 Prep AK ischial open

end A

L5590 Prep AK ischial

laminated AL5595 Hip disartic sach

thermopls A

L5600 Hip disart sach laminat

mold A

L5610 Above knee

hydracadence A

L5611 Ak 4 bar link w/fric

swing A

L5613 Ak 4 bar ling w/hydraul

swig A

L5614 4-bar link above knee

w/swng A

L5616 Ak univ multiplex sys

frict A

L5617 AK/BK self-aligning unit

ea A

L5618 Test socket

symes A

L5620 Test socket below

knee A

L5622 Test socket knee

disarticula A

L5624 Test socket above

knee A

L5626 Test socket hip

disarticulat A

L5628 Test socket

hemipelvectomy A

L5629 Below knee acrylic

socket A

L5630 Syme typ expandabl wall

sckt A

L5631 Ak/knee disartic acrylic

soc A

L5632 Symes type ptb brim design

s A

L5634 Symes type poster opening

so A

L5636 Symes type medial opening

so A

L5637 Below knee total

contact AL5638 Below knee leather

socket A

L5639 Below knee wood

socket A

L5640 Knee disarticulat leather

so A

L5642 Above knee leather

socket A

L5643 Hip flex inner socket ext

fr A

L5644 Above knee wood

socket A

L5645 Bk flex inner socket ext

fra A

L5646 Below knee cushion

socket A

L5647 Below knee suction

socket A

L5648 Above knee cushion

socket A

L5649 Isch containmt/narrow m-l

so A

L5650 Tot contact ak/knee disart

s A

L5651 Ak flex inner socket ext

fra A

L5652 Suction susp ak/knee

disart A

L5653 Knee disart expand wall

sock A

L5654 Socket insert

symes A

L5655 Socket insert below

knee A

L5656 Socket insert knee

articulat A

L5658 Socket insert above

knee A

L5661 Multi-durometer

symes A

L5665 Multi-durometer below

knee A

L5666 Below knee cuff

suspension AL5668 Socket insert w/o lock

lower A

L5670 Bk molded supracondylar

susp A

L5671 BK/AK locking

mechanism A

L5672 Bk removable medial brim

sus A

L5673 Socket insert w lock

mech A

L5676 Bk knee joints single axis

p A

L5677 Bk knee joints polycentric

p A

L5678 Bk joint covers

pair A

L5679 Socket insert w/o lock

mech A

L5680 Bk thigh lacer

non-molded A

L5681 Intl custm cong/latyp

insert A

L5682 Bk thigh lacer glut/ischia

m A

L5683 Initial custom socket

insert A

L5684 Bk fork

strap A

L5685 Below knee sus/seal

sleeve A

L5686 Bk back

check A

L5688 Bk waist belt

webbing A

L5690 Bk waist belt padded and

lin A

L5692 Ak pelvic control belt

light A

L5694 Ak pelvic control belt

pad/l A

L5695 Ak sleeve susp

neoprene/equa A

L5696 Ak/knee disartic pelvicjoin A

L5697 Ak/knee disartic pelvic

band A

L5698 Ak/knee disartic silesian

ba A

L5699 Shoulder

harness A

L5700 Replace socket below

knee A

L5701 Replace socket above

knee A

L5702 Replace socket

hip A

L5703 Symes ankle w/o (SACH)

foot A

L5704 Custom shape cover

BK A

L5705 Custom shape cover

AK A

L5706 Custom shape cvr knee

disart A

L5707 Custom shape cvr hip

disart A

L5710 Kne-shin exo sng axi mnl

loc A

L5711 Knee-shin exo mnl lock

ultra A

L5712 Knee-shin exo frict swg &

st A

L5714 Knee-shin exo variable

frict A

L5716 Knee-shin exo mech stance

ph A

L5718 Knee-shin exo frct swg &

sta A

L5722 Knee-shin pneum swg frct

exo A

L5724 Knee-shin exo fluid swing

ph A

L5726 Knee-shin ext jnts fld swg

e A

L5728 Knee-shin fluid swg &

stance A

L5780 Knee-shin pneum/hydrapneum A

L5781 Lower limb pros vacuum

pump A

L5782 HD low limb pros vacuum

pump A

L5785 Exoskeletal bk ultralt

mater A

L5790 Exoskeletal ak ultra-light

m A

L5795 Exoskel hip ultra-light

mate A

L5810 Endoskel knee-shin mnl

lock A

L5811 Endo knee-shin mnl lck

ultra A

L5812 Endo knee-shin frct swg &

st A

L5814 Endo knee-shin hydral swg

ph A

L5816 Endo knee-shin polyc mch

sta A

L5818 Endo knee-shin frct swg &

st A

L5822 Endo knee-shin pneum swg

frc A

L5824 Endo knee-shin fluid swing

p A

L5826 Miniature knee

joint A

L5828 Endo knee-shin fluid

swg/sta A

L5830 Endo knee-shin pneum/swg

pha A

L5840 Multi-axial knee/shin

system A

L5845 Knee-shin sys stance

flexion A

L5848 Knee-shin sys hydraul

stance A

L5850 Endo ak/hip knee extens

assi A

L5855 Mech hip extension

assist A

L5856 Elec knee-shinswing/stance A

L5857 Elec knee-shin swing

only A

L5858 Stance phase

only A

L5910 Endo below knee alignable

sy A

L5920 Endo ak/hip alignable

system A

L5925 Above knee manual

lock A

L5930 High activity knee

frame A

L5940 Endo bk ultra-light

material A

L5950 Endo ak ultra-light

material A

L5960 Endo hip ultra-light

materia A

L5961 "Endo poly hip,

pneu/hyd/rot" A

L5962 Below knee flex cover

system A

L5964 Above knee flex cover

system A

L5966 Hip flexible cover

system A

L5968 Multiaxial ankle w

dorsiflex A

L5970 Foot external keel sach

foot A

L5971 "SACH foot,

replacement" A

L5972 Flexible keel

foot A

L5973 Ank-foot sys dors-plant

flex A

L5974 Foot single axis

ankle/foot A

L5975 Combo ankle/foot

prosthesis A

L5976 Energy storingfoot A

L5978 Ft prosth multiaxial

ankl/ft A

L5979 Multi-axial ankle/ft

prosth A

L5980 Flex foot

system A

L5981 Flex-walk sys low ext

prosth A

L5982 Exoskeletal axial rotation

u A

L5984 Endoskeletal axial

rotation A

L5985 Lwr ext dynamic prosth

pylon A

L5986 Multi-axial rotation

unit A

L5987 Shank ft w vert load

pylon A

L5988 Vertical shock reducing

pylo A

L5990 User adjustable heel

height A

L5999 Lowr extremity prosthes

NOS A

L6000 Part hand thumb

rem A

L6010 Part hand

little/ring A

L6020 Part hand no

fingers A

L6025 Part hand disart

myoelectric A

L6050 Wrst MLd sck flx hng tri

pad A

L6055 Wrst mold sock w/exp

interfa A

L6100 Elb mold sock flex hinge

pad A

L6110 Elbow mold sock suspension

t A

L6120 Elbow mold doub splt soc

ste AL6130 Elbow stump activated lock

h A

L6200 Elbow mold outsid lock

hinge A

L6205 Elbow molded w/ expand

inter A

L6250 Elbow inter loc elbow

forarm A

L6300 Shlder disart int lock

elbow A

L6310 Shoulder passive restor

comp A

L6320 Shoulder passive restor

cap A

L6350 Thoracic intern lock

elbow A

L6360 Thoracic passive restor

comp A

L6370 Thoracic passive restor

cap A

L6380 Postop dsg cast chg

wrst/elb A

L6382 Postop dsg cast chg elb

dis/ A

L6384 Postop dsg cast chg

shlder/t A

L6386 Postop ea cast chg &

realign A

L6388 Postop applicat rigid dsg

on A

L6400 Below elbow prosth tiss

shap A

L6450 Elb disart prosth tiss

shap A

L6500 Above elbow prosth tiss

shap A

L6550 Shldr disar prosth tiss

shap A

L6570 Scap thorac prosth tiss

shap A

L6580 Wrist/elbow bowden cable

mol A

L6582 Wrist/elbow bowden cbl dir

f AL6584 Elbow fair lead cable

molded A

L6586 Elbow fair lead cable dir

fo A

L6588 Shdr fair lead cable

molded A

L6590 Shdr fair lead cable

direct A

L6600 Polycentric hinge

pair A

L6605 Single pivot hinge

pair A

L6610 Flexible metal hinge

pair A

L6611 "Additional switch, ext

power" A

L6615 Disconnect locking wrist

uni A

L6616 Disconnect insert locking

wr A

L6620 Flexion/extension wrist

unit A

L6621 Flex/ext wrist w/wo

friction A

L6623 Spring-ass rot wrst w/

latch A

L6624 Flex/ext/rotation wrist

unit A

L6625 Rotation wrst w/ cable

lock A

L6628 Quick disconn hook adapter

o A

L6629 Lamination collar w/

couplin A

L6630 Stainless steel any

wrist A

L6632 Latex suspension sleeve

each A

L6635 Lift assist for

elbow A

L6637 Nudge control elbow

lock A

L6638 Elec lock on manual pw

elbow AL6640 Shoulder abduction joint

pai A

L6641 Excursion amplifier pulley

t A

L6642 Excursion amplifier lever

ty A

L6645 Shoulder flexion-abduction

j A

L6646 Multipo locking shoulder

jnt A

L6647 Shoulder lock

actuator A

L6648 Ext pwrd shlder

lock/unlock A

L6650 Shoulder universal

joint A

L6655 Standard control cable

extra A

L6660 Heavy duty control

cable A

L6665 Teflon or equal cable

lining A

L6670 Hook to hand cable

adapter A

L6672 Harness chest/shlder

saddle A

L6675 Harness figure of 8 sing

con A

L6676 Harness figure of 8 dual

con A

L6677 UE triple control

harness A

L6680 Test sock wrist disart/bel

e A

L6682 Test sock elbw

disart/above A

L6684 Test socket shldr

disart/tho A

L6686 Suction

socket A

L6687 Frame typ socket bel

elbow/w AL6688 Frame typ sock above

elb/dis A

L6689 Frame typ socket shoulder

di A

L6690 Frame typ sock

interscap-tho A

L6691 Removable insert

each A

L6692 Silicone gel insert or

equal A

L6693 Lockingelbow forearm

cntrbal A

L6694 Elbow socket ins use

w/lock A

L6695 Elbow socket ins use w/o

lck A

L6696 Cus elbo skt in for

con/atyp A

L6697 Cus elbo skt in not

con/atyp A

L6698 Below/above elbow lock

mech A

L6703 "Term dev, passive hand mitt

" A

L6704 "Term dev, sport/rec/work

att" A

L6706 Term dev mech hook vol

open A

L6707 Term dev mech hook vol

close A

L6708 Term dev mech hand vol

open A

L6709 Term dev mech hand vol

close A

L6711 "Ped term dev, hook, vol

open" A

L6712 "Ped term dev, hook, vol

clos" A

L6713 "Ped term dev, hand, vol

open" A

L6714 "Ped term dev, hand, vol

clos" A

L6715 "Term device, multi art

digit" NI AL6721 "Hook/hand, hvy dty, vol

open" A

L6722 "Hook/hand, hvy dty, vol

clos" A

L6805 Term dev modifier wrist

unit A

L6810 Term dev precision pinch

dev A

L6880 Elec hand ind art

digits NI A

L6881 Term dev auto grasp

feature A

L6882 Microprocessor control

uplmb A

L6883 Replc sockt below e/w

disa A

L6884 Replc sockt above elbow

disa A

L6885 Replc sockt shldr

dis/interc A

L6890 Prefab glove for term

device A

L6895 Custom glove for term

device A

L6900 Hand restorat thumb/1

finger A

L6905 Hand restoration multiple

fi A

L6910 Hand restoration no

fingers A

L6915 Hand restoration replacmnt

g A

L6920 Wrist disarticul switch

ctrl A

L6925 Wrist disart myoelectronic

c A

L6930 Below elbow switch

control A

L6935 Below elbow myoelectronic

ct A

L6940 Elbow disarticulation

switch A

L6945 Elbow disart myoelectronic

c AL6950 Above elbow switch

control A

L6955 Above elbow myoelectronic

ct A

L6960 Shldr disartic switch

contro A

L6965 Shldr disartic

myoelectronic A

L6970 Interscapular-thor switch

ct A

L6975 Interscap-thor

myoelectronic A

L7007 Adult electric

hand A

L7008 Pediatric electric

hand A

L7009 Adult electric

hook A

L7040 Prehensile

actuator A

L7045 Pediatric electric

hook A

L7170 Electronic elbow hosmer

swit A

L7180 Electronic elbow

sequential A

L7181 Electronic elbo

simultaneous A

L7185 Electron elbow adolescent

sw A

L7186 Electron elbow child

switch A

L7190 Elbow adolescent

myoelectron A

L7191 Elbow child myoelectronic

ct A

L7260 Electron wrist rotator

otto A

L7261 Electron wrist rotator

utah A

L7266 Servo control steeper orequ CH D

L7272 Analogue control unb or

equa CH D

L7274 Proportional ctl 12 volt

uta CH D

L7360 Six volt bat otto bock/eq

ea A

L7362 Battery chrgr six volt

otto A

L7364 Twelve volt battery

utah/equ A

L7366 Battery chrgr 12 volt

utah/e A

L7367 Replacemnt lithium

ionbatter A

L7368 Lithium ion battery

charger A

L7400 "Add UE prost be/wd,

ultlite" A

L7401 Add UE prost a/e ultlite

mat A

L7402 Add UE prost s/d ultlite

mat A

L7403 Add UE prost b/e

acrylic A

L7404 Add UE prost a/e

acrylic A

L7405 Add UE prost s/d

acrylic A

L7499 Upper extremity prosthes

NOS A

L7500 Prosthetic dvc repair

hourly CH D

L7510 Prosthetic device repair

rep A

L7520 Repair prosthesis per 15

min A

L7600 Prosthetic donning

sleeve E

L7900 Male vacuum erection

system A

L8000 Mastectomy

bra A

L8001 Breast prosthesis bra &form A

L8002 Brst prsth bra & bilat

form A

L8010 Mastectomy

sleeve A

L8015 Ext breastprosthesis

garment A

L8020 Mastectomy

form A

L8030 Breast prosthes w/o

adhesive A

L8031 Breast prosthesis w

adhesive A

L8032 Reusable nipple

prosthesis A

L8035 Custom breast

prosthesis A

L8039 Breast prosthesis

NOS A

L8040 Nasal

prosthesis A

L8041 Midfacial

prosthesis A

L8042 Orbital

prosthesis A

L8043 Upper facial

prosthesis A

L8044 Hemi-facial

prosthesis A

L8045 Auricular

prosthesis A

L8046 Partial facial

prosthesis A

L8047 Nasal septal

prosthesis A

L8048 Unspec maxillofacial

prosth A

L8049 Repair maxillofacial

prosth A

L8300 Truss single w/ standard

pad A

L8310 Truss double w/ standard

pad A

L8320 Truss addition to std padwa A

L8330 Truss add to std pad

scrotal A

L8400 Sheath below

knee A

L8410 Sheath above

knee A

L8415 Sheath upper

limb A

L8417 Pros sheath/sock w gel

cushn A

L8420 Prosthetic sock multi ply

BK A

L8430 Prosthetic sock multi ply

AK A

L8435 Pros sock multi ply upper

lm A

L8440 Shrinker below

knee A

L8460 Shrinker above

knee A

L8465 Shrinker upper

limb A

L8470 Pros sock single ply

BK A

L8480 Pros sock single ply

AK A

L8485 Pros sock single ply upper

l A

L8499 Unlisted misc prosthetic

ser A

L8500 Artificial

larynx A

L8501 Tracheostomy speaking

valve A

L8505 "Artificial larynx,

accessory" A

L8507 Trach-esoph voice pros pt

in A

L8509 Trach-esoph voice pros md

in A

L8510 Voice

amplifier A

L8511 Indwelling trachinsert A

L8512 Gel cap for trach voice

pros A

L8513 Trach pros cleaning

device A

L8514 Repl trach puncture

dilator A

L8515 Gel cap app device for

trach A

L8600 Implant breast

silicone/eq N

L8603 Collagen imp urinary 2.5

ml N

L8604 Dextranomer/hyaluronic

acid N

L8606 Synthetic implnt urinary

1ml N

L8609 Artificial

cornea N

L8610 Ocular

implant N

L8612 Aqueous shunt

prosthesis N

L8613 Ossicular

implant N

L8614 Cochlear

device N

L8615 Coch implant headset

replace A

L8616 Coch implant microphone

repl A

L8617 Coch implant trans coil

repl A

L8618 Coch implant tran cable

repl A

L8619 Coch imp ext proc/contr

rplc A

L8621 Repl zinc air

battery A

L8622 Repl alkaline

battery A

L8623 "Lith ion batt

CID,non-earlvl" AL8624 "Lith ion batt CID, ear

level" A

L8627 CID ext speech process

repl A

L8628 CID ext controller

repl A

L8629 CID transmit coil and

cable A

L8630 Metacarpophalangeal

implant N

L8631 MCP joint repl 2 pc or

more N

L8641 Metatarsal joint

implant N

L8642 Hallux

implant N

L8658 Interphalangeal joint

spacer N

L8659 Interphalangeal joint

repl N

L8670 "Vascular graft,

synthetic" N

L8680 Implt neurostim elctr

each N

L8681 Pt prgrm for implt

neurostim A

L8682 Implt neurostim radiofq

rec N

L8683 Radiofq trsmtr for implt

neu A

L8684 Radiof trsmtr implt scrl

neu A

L8685 Implt nrostm pls gen sng

rec N

L8686 Implt nrostm pls gen sng

non N

L8687 Implt nrostm pls gen dua

rec N

L8688 Implt nrostm pls gen dua

non N

L8689 External recharg sys

intern A

L8690 "Aud osseo dev, int/ext

comp" NL8691 Osseointegrated snd proc

rpl A

L8692 Non-osseointegrated snd

proc E

L8693 "Aud osseo dev,

abutment" A

L8695 External recharg sys

extern A

L8699 Prosthetic implant

NOS N

L9900 O&P

supply/accessory/service N

M0064 Visit for drug

monitoring Q3 0607 1.8647 $130.56

. $26.12

M0075 Cellular

therapy E

M0076 Prolotherapy E

M0100 Intragastric

hypothermia E

M0300 IV

chelationtherapy E

M0301 Fabric wrapping of

aneurysm E

P2028 Cephalin floculation

test A

P2029 Congo red blood

test A

P2031 Hair

analysis E

P2033 Blood thymol

turbidity A

P2038 Blood

mucoprotein A

P3000 Screen pap by tech w md

supv A

P3001 Screening pap smear by

phys B

P7001 Culture bacterial

urine EP9010 Whole blood for

transfusion R 0950 2.7245 $190.76

. $38.16

P9011 Blood split

unit R 0967 1.6761 $117.35

. $23.47

P9012 Cryoprecipitate each

unit R 0952 1.1823 $82.78

. $16.56

P9016 RBC leukocytes

reduced R 0954 2.8408 $198.90

. $39.78

P9017 Plasma 1 donor frz w/in 8

hr R 9508 1.1408 $79.87

. $15.98

P9019 "Platelets, each

unit" R 0957 1.2822 $89.77

. $17.96

P9020 Plaelet rich plasma

unit R 0958 2.0257 $141.83

. $28.37

P9021 Red blood cells

unit R 0959 2.1303 $149.16

. $29.84

P9022 Washed red blood cells

unit R 0960 4.1045 $287.38

. $57.48

P9023 "Frozen plasma, pooled,

sd" R 0949 0.9547 $66.84

. $13.37

P9031 Platelets leukocytes

reduced R 1013 1.8720 $131.07

. $26.22

P9032 "Platelets,

irradiated" R 9500 1.8342 $128.42

. $25.69

P9033 Platelets leukoreduced

irrad R 0968 1.9996 $140.00

. $28.00

P9034 "Platelets,

pheresis" R 9507 6.3148 $442.14

. $88.43

P9035 Platelet pheres

leukoreduced R 9501 7.6960 $538.84

. $107.77

P9036 Platelet pheresis

irradiated R 9502 7.9257 $554.93

. $110.99

P9037 Plate pheres leukoredu

irrad R 1019 9.8804 $691.79

. $138.36P9038 RBC

irradiated R 9505 2.8419 $198.98

. $39.80

P9039 RBC

deglycerolized R 9504 3.4084 $238.64

. $47.73

P9040 RBC leukoreduced

irradiated R 0969 3.7309 $261.22

. $52.25

P9041 "Albumin (human),5%,

50ml" K 0961 $21.32

. $4.27

P9043 "Plasma protein

fract,5%,50ml" R 0956 0.2574 $18.02

. $3.61

P9044 Cryoprecipitatereducedplasma R 1009 1.0622 $74.37

. $14.88

P9045 "Albumin (human), 5%, 250

ml" K 0963 $61.94

. $12.39

P9046 "Albumin (human), 25%, 20

ml" K 0964 $26.84

. $5.37

P9047 "Albumin (human), 25%,

50ml" K 0965 $68.03

. $13.61

P9048 "Plasmaprotein

fract,5%,250ml" R 0966 1.0362 $72.55

. $14.51

P9050 "Granulocytes, pheresis

unit" R 9506 19.1478 "$1,340.65"

. $268.13

P9051 "Blood, l/r,

cmv-neg" R 1010 2.6930 $188.55

. $37.71

P9052 "Platelets, hla-m, l/r,

unit" R 1011 11.4695 $803.05

. $160.61

P9053 "Plt, pher, l/r cmv-neg,

irr" R 1020 8.7936 $615.69

. $123.14

P9054 "Blood, l/r,

froz/degly/wash" R 1016 1.4989 $104.95

. $20.99

P9055 "Plt, aph/pher, l/r,

cmv-neg" R 1017 5.4802 $383.70

. $76.74

P9056 "Blood, l/r,irradiated" R 1018 2.0966 $146.80

. $29.36

P9057 "RBC, frz/deg/wsh, l/r,

irrad" R 1021 6.4103 $448.82

. $89.77

P9058 "RBC, l/r, cmv-neg,

irrad" R 1022 4.3700 $305.97

. $61.20

P9059 "Plasma, frz between

8-24hour" R 0955 1.0400 $72.82

. $14.57

P9060 Fr frz plasma donor

retested R 9503 1.1562 $80.95

. $16.19

P9603 One-way allow prorated

miles A

P9604 One-way allow prorated

trip A

P9612 Catheterize for urine

spec A

P9615 Urine specimen collect

mult N

Q0035 Cardiokymography X 0100 2.5439 $178.11 $41.37 $35.63

Q0081 Infusion ther other than

che B

Q0083 Chemo by other than

infusion B

Q0084 Chemotherapy by

infusion B

Q0085 Chemo by both infusion and

o B

Q0091 Obtaining screen pap

smear T 0191 0.1337 $9.36 $0.00 $0.00

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 AQ0115 Post-coital mucous

exam A

Q0138 "Ferumoxytol,

non-esrd" CH K 1297 $0.65

. $0.13

Q0139 "Ferumoxytol, esrd

use" A

Q0144 "Azithromycin dihydrate,

oral" E

Q0162 Ondansetron

oral NI N

Q0163 Diphenhydramine HCl

50mg N

Q0164 Prochlorperazine maleate

5mg N

Q0165 Prochlorperazine

maleate10mg N

Q0166 Granisetron hcl 1 mg

oral N

Q0167 Dronabinol 2.5mg

oral N

Q0168 Dronabinol 5mg

oral N

Q0169 Promethazine HCl 12.5mg

oral N

Q0170 Promethazine HCl 25 mg

oral N

Q0171 Chlorpromazine HCl 10mg

oral N

Q0172 Chlorpromazine HCl 25mg

oral N

Q0173 Trimethobenzamide HCl

250mg N

Q0174 Thiethylperazine

maleate10mg E

Q0175 Perphenazine 4mg

oral N

Q0176 Perphenazine 8mg

oral N

Q0177 Hydroxyzine pamoate

25mg N

Q0178 Hydroxyzine pamoate

50mg NQ0179 Ondansetron hcl 8 mg

oral CH D

Q0180 Dolasetron mesylate

oral N

Q0181 Unspecified oral

anti-emetic E

Q0478 "Power adapter, combo

vad" A

Q0479 "Power module combo vad,

rep" A

Q0480 "Driver pneumatic vad,

rep" A

Q0481 "Microprcsr cu elec vad,

rep" A

Q0482 "Microprcsr cu combo vad,

rep" A

Q0483 "Monitor elec vad,

rep" A

Q0484 Monitor elec or comb vad

rep A

Q0485 "Monitor cable elec vad,

rep" A

Q0486 Mon cable elec/pneum vad

rep A

Q0487 "Leads any type vad, rep

only" A

Q0488 "Pwr pack base elec vad,

rep" A

Q0489 "Pwr pck base combo vad,

rep" A

Q0490 "Emr pwr source elec vad,

rep" A

Q0491 Emr pwr source combo vad

rep A

Q0492 "Emr pwr cbl elec vad,

rep" A

Q0493 "Emr pwr cbl combo vad,

rep" A

Q0494 "Emr hd pmp elec/combo,

rep" A

Q0495 "Charger elec/combo vad,

rep" A

Q0496 "Battery elec/combo vad,rep" A

Q0497 "Bat clps elec/comb vad,

rep" A

Q0498 "Holster elec/combo vad,

rep" A

Q0499 Belt/vest elec/combo vad

rep A

Q0500 "Filters elec/combo vad,

rep" A

Q0501 "Shwr cov elec/combo vad,

rep" A

Q0502 "Mobility cart pneum vad,

rep" A

Q0503 Battery pneum vad

replacemnt A

Q0504 "Pwr adpt pneum vad, rep

veh" A

Q0505 Miscl supply/accessory

vad A

Q0506 Lith-ion batt elec/pneum

VAD A

Q0510 Dispens fee

immunosupressive B

Q0511 "Sup fee

antiem,antica,immuno" B

Q0512 Px sup fee anti-can sub

pres B

Q0513 Disp fee inhal drugs/30

days B

Q0514 Disp fee inhal drugs/90

days B

Q0515 Sermorelin acetate

injection K 3050 $1.77

. $0.36

Q1004 Ntiol category

4 E

Q1005 Ntiol category

5 E

Q2004 Bladder calculi irrig

sol N

Q2009 Fosphenytoin inj

PE N

Q2017 "Teniposide, 50mg" K 7035 $316.31

. $63.27

Q2026 Radiesse

injection B

Q2027 Sculptra

injection B

Q2035 "Afluria vacc, 3 yrs & >,

im" L

Q2036 "Flulaval vacc, 3 yrs & >,

im" L

Q2037 "Fluvirin vacc, 3 yrs & >,

im" L

Q2038 "Fluzone vacc, 3 yrs & >,

im" L

Q2039 "NOS flu vacc, 3 yrs & >,

im" L

Q2040 Incobotulinumtoxin

A CH D

Q2041 Wilate

injection CH D

Q2042 Hydroxyprogesterone

caproate CH D

Q2043 Sipuleucel-T auto

CD54+ G 9273 "$32,860.00"

. "$6,448.00"

Q2044 Belimumab

injection CH D

Q3001 Brachytherapy

Radioelements B

Q3014 Telehealth facility

fee A

Q3025 IM inj interferon beta

1-a K 9022 $238.30

. $47.66

Q3026 Subc inj interferon

beta-1a E

Q3031 Collagen skin

test N

Q4001 Cast sup body cast

plaster B

Q4002 Cast sup body cast

fiberglas B

Q4003 Cast sup shoulder castplstr B

Q4004 Cast sup shoulder cast

fbrgl B

Q4005 Cast sup long arm adult

plst B

Q4006 Cast sup long arm adult

fbrg B

Q4007 Cast sup long arm ped

plster B

Q4008 Cast sup long arm ped

fbrgls B

Q4009 Cast sup sht arm adult

plstr B

Q4010 Cast sup sht arm adult

fbrgl B

Q4011 Cast sup sht arm ped

plaster B

Q4012 Cast sup sht arm ped

fbrglas B

Q4013 Cast sup gauntlet

plaster B

Q4014 Cast sup gauntlet

fiberglass B

Q4015 Cast sup gauntlet ped

plster B

Q4016 Cast sup gauntlet ped

fbrgls B

Q4017 Cast sup lng arm splint

plst B

Q4018 Cast sup lng arm splint

fbrg B

Q4019 Cast sup lng arm splnt ped

p B

Q4020 Cast sup lng arm splnt ped

f B

Q4021 Cast sup sht arm splint

plst B

Q4022 Cast sup sht arm splint

fbrg B

Q4023 Cast sup sht arm splnt ped

p B

Q4024 Cast sup sht arm splnt ped

f B

Q4025 Cast sup hip spicaplaster B

Q4026 Cast sup hip spica

fiberglas B

Q4027 Cast sup hip spica ped

plstr B

Q4028 Cast sup hip spica ped

fbrgl B

Q4029 Cast sup long leg

plaster B

Q4030 Cast sup long leg

fiberglass B

Q4031 Cast sup lng leg ped

plaster B

Q4032 Cast sup lng leg ped

fbrgls B

Q4033 Cast sup lng leg cylinder

pl B

Q4034 Cast sup lng leg cylinder

fb B

Q4035 Cast sup lngleg cylndr ped

p B

Q4036 Cast sup lngleg cylndr ped

f B

Q4037 Cast sup shrt leg

plaster B

Q4038 Cast sup shrt leg

fiberglass B

Q4039 Cast sup shrt leg ped

plster B

Q4040 Cast sup shrt leg ped

fbrgls B

Q4041 Cast sup lng leg splnt

plstr B

Q4042 Cast sup lng leg splnt

fbrgl B

Q4043 Cast sup lng leg splnt ped

p B

Q4044 Cast sup lng leg splnt ped

f B

Q4045 Cast sup sht leg splnt

plstr B

Q4046 Cast sup sht leg splnt

fbrgl B

Q4047 Cast sup sht leg splnt pedp B

Q4048 Cast sup sht leg splnt ped

f B

Q4049 "Finger splint,

static" B

Q4050 Cast supplies

unlisted B

Q4051 Splint supplies

misc B

Q4074 Iloprost non-comp unit

dose Y

Q4081 "Epoetin alfa, 100 units ESRD

" A

Q4082 Drug/bio NOC part B drug

CAP B

Q4100 "Skin substitute,

NOS" N

Q4101 Apligraf K 1240 $35.88

. $7.18

Q4102 Oasis wound

matrix K 1241 $5.74

. $1.15

Q4103 Oasis burn

matrix K 1242 $5.74

. $1.15

Q4104 Integra

BMWD K 1243 $16.26

. $3.26

Q4105 Integra

DRT K 1244 $9.62

. $1.93

Q4106 Dermagraft K 1245 $40.51

. $8.11

Q4107 Graftjacket K 1246 $94.95

. $18.99

Q4108 Integra

matrix K 1247 $21.73

. $4.35

Q4110 Primatrix K 1248 $31.42

. $6.29

Q4111 Gammagraft K 1252 $6.78

. $1.36

Q4112 Cymetra

injectable K 1249 $332.25

. $66.45

Q4113 Graftjacketxpress K 1250 $332.25

. $66.45

Q4114 Integra flowable wound

matri K 1251 "$1,019.89"

. $203.98

Q4115 Alloskin K 1287 $8.26

. $1.66

Q4116 Alloderm K 1270 $31.72

. $6.35

Q4117 Hyalomatrix E

Q4118 Matristem

micromatrix K 1342 $2.94

. $0.59

Q4119 Matristem wound

matrix K 1351 $4.52

. $0.91

Q4120 Matristem burn

matrix E

Q4121 Theraskin K 1345 $32.84

. $6.57

Q4122 Dermacell NI K 1419 $31.52

. $6.31

Q4123 Alloskin NI E

Q4124 Oasis tri-layer wound

matrix NI G 9365 $10.39

. $2.04

Q4125 Arthroflex NI E

Q4126 Memoderm NI E

Q4127 Talymed NI E

Q4128 Flexhd or allopatch

hd NI E

Q4129 Unite

biomatrix NI E

Q4130 Strattice

TM NI N

Q5001 Hospice in patient

home B

Q5002 Hospice in assisted

living B

Q5003 Hospice in LT/non-skilledNF B

Q5004 Hospice in

SNF B

Q5005 "Hospice, inpatient

hospital" B

Q5006 Hospice in hospice

facility B

Q5007 Hospice in

LTCH B

Q5008 Hospice in inpatient

psych B

Q5009 "Hospice care,

NOS" B

Q5010 Hospice home care in

hospice B

Q9951 "LOCM >= 400 mg/ml

iodine,1ml" N

Q9953 "Inj Fe-based MR

contrast,1ml" N

Q9954 "Oral MR contrast, 100

ml" N

Q9955 "Inj perflexane lip micros,ml

" N

Q9956 "Inj octafluoropropane

mic,ml" N

Q9957 "Inj perflutren lip

micros,ml" N

Q9958 "HOCM <=149 mg/ml iodine,

1ml" N

Q9959 "HOCM 150-199mg/ml

iodine,1ml" N

Q9960 "HOCM 200-249mg/ml

iodine,1ml" N

Q9961 "HOCM 250-299mg/ml

iodine,1ml" N

Q9962 "HOCM 300-349mg/ml

iodine,1ml" N

Q9963 "HOCM 350-399mg/ml

iodine,1ml" NQ9964 "HOCM>= 400mg/ml iodine,

1ml" N

Q9965 "LOCM 100-199mg/ml

iodine,1ml" N

Q9966 "LOCM 200-299mg/ml

iodine,1ml" N

Q9967 "LOCM 300-399mg/ml

iodine,1ml" N

Q9968 Visualization

adjunct CH N

R0070 Transport portable

x-ray B

R0075 Transport port x-ray

multipl B

R0076 Transport portable

EKG B

V2020 Vision svcs frames

purchases A

V2025 Eyeglasses delux

frames E

V2100 Lens spher single plano

4.00 A

V2101 Single visn sphere

4.12-7.00 A

V2102 Singl visn sphere

7.12-20.00 A

V2103 Spherocylindr

4.00d/12-2.00d A

V2104 Spherocylindr

4.00d/2.12-4d A

V2105 Spherocylinder

4.00d/4.25-6d A

V2106 Spherocylinder

4.00d/>6.00d A

V2107 Spherocylinder

4.25d/12-2d A

V2108 Spherocylinder

4.25d/2.12-4d AV2109 Spherocylinder

4.25d/4.25-6d A

V2110 Spherocylinder 4.25d/over

6d A

V2111 Spherocylindr

7.25d/.25-2.25 A

V2112 Spherocylindr

7.25d/2.25-4d A

V2113 Spherocylindr

7.25d/4.25-6d A

V2114 Spherocylinder over

12.00d A

V2115 Lens lenticular

bifocal A

V2118 Lens aniseikonic

single A

V2121 "Lenticular lens,

single" A

V2199 Lens single vision not oth

c A

V2200 Lens spher bifoc plano

4.00d A

V2201 Lens sphere bifocal

4.12-7.0 A

V2202 Lens sphere bifocal

7.12-20. A

V2203 Lens sphcyl bifocal

4.00d/.1 A

V2204 Lens sphcy bifocal

4.00d/2.1 A

V2205 Lens sphcy bifocal

4.00d/4.2 A

V2206 Lens sphcy bifocal

4.00d/ove A

V2207 Lens sphcy bifocal

4.25-7d/. A

V2208 Lens sphcy bifocal

4.25-7/2. A

V2209 Lens sphcy bifocal

4.25-7/4. A

V2210 Lens sphcy bifocal

4.25-7/ov AV2211 Lens sphcy bifo

7.25-12/.25- A

V2212 Lens sphcyl bifo

7.25-12/2.2 A

V2213 Lens sphcyl bifo

7.25-12/4.2 A

V2214 Lens sphcyl bifocal over

12. A

V2215 Lens lenticular

bifocal A

V2218 Lens aniseikonic

bifocal A

V2219 Lens bifocal seg width

over A

V2220 Lens bifocal add over

3.25d A

V2221 "Lenticular lens,

bifocal" A

V2299 Lens bifocal

speciality A

V2300 Lens sphere trifocal

4.00d A

V2301 Lens sphere trifocal

4.12-7. A

V2302 Lens sphere trifocal

7.12-20 A

V2303 Lens sphcy trifocal

4.0/.12- A

V2304 Lens sphcy trifocal

4.0/2.25 A

V2305 Lens sphcy trifocal

4.0/4.25 A

V2306 Lens sphcyl trifocal

4.00/>6 A

V2307 Lens sphcy trifocal

4.25-7/. A

V2308 Lens sphc trifocal

4.25-7/2. A

V2309 Lens sphc trifocal

4.25-7/4. A

V2310 Lens sphc trifocal

4.25-7/>6 AV2311 Lens sphc trifo

7.25-12/.25- A

V2312 Lens sphc trifo

7.25-12/2.25 A

V2313 Lens sphc trifo

7.25-12/4.25 A

V2314 Lens sphcyl trifocal over

12 A

V2315 Lens lenticular

trifocal A

V2318 Lens aniseikonic

trifocal A

V2319 Lens trifocal seg width >

28 A

V2320 Lens trifocal add over

3.25d A

V2321 "Lenticular lens,

trifocal" A

V2399 Lens trifocal

speciality A

V2410 Lens variab asphericity

sing A

V2430 Lens variable asphericity

bi A

V2499 Variable asphericity

lens A

V2500 Contact lens pmma

spherical A

V2501 Cntct lens

pmma-toric/prism A

V2502 Contact lens pmma

bifocal A

V2503 Cntct lens pmma color

vision A

V2510 Cntct gas permeable

sphericl A

V2511 Cntct toric prism

ballast A

V2512 Cntct lens gas permbl

bifocl A

V2513 Contact lens extendedwear A

V2520 Contact lens

hydrophilic A

V2521 Cntct lens hydrophilic

toric A

V2522 Cntct lens hydrophil

bifocl A

V2523 Cntct lens hydrophil

extend A

V2530 Contact lens gas

impermeable A

V2531 Contact lens gas

permeable A

V2599 Contact lens/es other

type A

V2600 Hand held low vision

aids A

V2610 Single lens spectacle

mount A

V2615 Telescop/othr compound

lens A

V2623 Plastic eye prosth

custom A

V2624 Polishing artifical

eye A

V2625 Enlargemnt of eye

prosthesis A

V2626 Reduction of eye

prosthesis A

V2627 Scleral cover

shell A

V2628 Fabrication &

fitting A

V2629 Prosthetic eye other

type A

V2630 Anter chamber intraocul

lens N

V2631 Iris support intraoclr

lens N

V2632 Post chmbr intraocular

lens N

V2700 Balance

lens AV2702 Deluxe lens

feature E

V2710 Glass/plastic slab off

prism A

V2715 Prism

lens/es A

V2718 Fresnell prism press-on

lens A

V2730 Special base

curve A

V2744 Tint photochromatic

lens/es A

V2745 "Tint, any

color/solid/grad" A

V2750 Anti-reflective

coating A

V2755 UV

lens/es A

V2756 Eye glass

case E

V2760 Scratch resistant

coating A

V2761 Mirror

coating B

V2762 "Polarization, any

lens" A

V2770 Occluder

lens/es A

V2780 Oversize

lens/es A

V2781 Progressive lens per

lens B

V2782 "Lens, 1.54-1.65

p/1.60-1.79g" A

V2783 "Lens, >= 1.66 p/>=1.80

g" A

V2784 Lens polycarb or

equal A

V2785 Corneal tissue

processing F

V2786 Occupational multifocal

lens AV2787 Astigmatism-correct

function E

V2788 Presbyopia-correct

function E

V2790 Amniotic

membrane N

V2797 Vis item/svc in other

code A

V2799 Miscellaneous vision

service A

V5008 Hearing

screening E

V5010 Assessment for hearing

aid E

V5011 Hearing aid

fitting/checking E

V5014 Hearing aid

repair/modifying E

V5020 Conformity

evaluation E

V5030 Body-worn hearing aid

air E

V5040 Body-worn hearing aid

bone E

V5050 Hearing aid monaural in

ear E

V5060 Behind ear hearing

aid E

V5070 Glasses air

conduction E

V5080 Glasses bone

conduction E

V5090 Hearing aid dispensing

fee E

V5095 Implant mid ear hearing

pros E

V5100 Body-worn bilat hearing

aid E

V5110 Hearing aid dispensing

fee E

V5120 Body-worn binaur hearing

aid E

V5130 In ear binaural hearingaid E

V5140 Behind ear binaur hearing

ai E

V5150 Glasses binaural hearing

aid E

V5160 Dispensing fee

binaural E

V5170 Within ear cros hearing

aid E

V5180 Behind ear cros hearing

aid E

V5190 Glasses cros hearing

aid E

V5200 Cros hearing aid dispens

fee E

V5210 In ear bicros hearing

aid E

V5220 Behind ear bicros hearing

ai E

V5230 Glasses bicros hearing

aid E

V5240 Dispensing fee

bicros E

V5241 "Dispensing fee,

monaural" E

V5242 "Hearing aid, monaural,

cic" E

V5243 "Hearing aid, monaural,

itc" E

V5244 "Hearing aid, prog, mon,

cic" E

V5245 "Hearing aid, prog, mon,

itc" E

V5246 "Hearing aid, prog, mon,

ite" E

V5247 "Hearing aid, prog, mon,

bte" E

V5248 "Hearing aid, binaural,

cic" E

V5249 "Hearing aid, binaural,

itc" E

V5250 "Hearing aid, prog, bin,

cic" E

V5251 "Hearing aid, prog, bin,itc" E

V5252 "Hearing aid, prog, bin,

ite" E

V5253 "Hearing aid, prog, bin,

bte" E

V5254 "Hearing id, digit, mon,

cic" E

V5255 "Hearing aid, digit, mon,

itc" E

V5256 "Hearing aid, digit, mon,

ite" E

V5257 "Hearing aid, digit, mon,

bte" E

V5258 "Hearing aid, digit, bin,

cic" E

V5259 "Hearing aid, digit, bin,

itc" E

V5260 "Hearing aid, digit, bin,

ite" E

V5261 "Hearing aid, digit, bin,

bte" E

V5262 "Hearing aid, disp,

monaural" E

V5263 "Hearing aid, disp,

binaural" E

V5264 Ear

mold/insert E

V5265 "Ear mold/insert,

disp" E

V5266 Battery for hearing

device E

V5267 Hearing aid

supply/accessory E

V5268 ALD Telephone

Amplifier E

V5269 "Alerting device, any

type" E

V5270 "ALD, TV amplifier, any

type" E

V5271 "ALD, TV caption

decoder" E

V5272 Tdd EV5273 ALD for cochlear

implant E

V5274 ALD

unspecified E

V5275 Ear

impression E

V5298 Hearing aid

noc E

V5299 Hearing

service B

V5336 Repair communication

device E

V5362 Speech

screening E

V5363 Language

screening E

V5364 Dysphagia

screening E