59048 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 400, 405, 410, 411, and

414

[BPD–884–FC]

RIN 0938–AH94

Medicare Program; Revisions to

Payment Policies and Adjustments to

the Relative Value Units Under the

Physician Fee Schedule, Other Part B

Payment Policies, and Establishment

of the Clinical Psychologist Fee

Schedule for Calendar Year 1998

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Final rule with comment period.

SUMMARY: This final rule makes several

policy changes affecting Medicare Part B

payment. The changes relate to

physician services, including

geographic practice cost index changes,

clinical psychologist services, physician

supervision of diagnostic tests,

establishment of independent diagnostic

testing facilities, the methodology used

to develop reasonable compensation

equivalent limits, payment to

participating and nonparticipating

suppliers, global surgical services,

caloric vestibular testing, and clinical

consultations.

This rule also implements provisions

in the Balanced Budget Act of 1997

relating to practice expense relative

value units, screening mammography,

colorectal cancer screening, screening

pelvic examinations, and EKG

transportation. In addition, we are

finalizing the 1997 interim work relative

value units and are issuing interim work

relative value units for new and revised

codes for 1998.

DATES: Effective Date: This rule is

effective January 1, 1998. This rule is a

major rule as defined in Title 5, United

States Code, section 804(2). Pursuant to

5 U.S.C. section 801(a)(1)(A), we are

submitting a report to the Congress on

this rule on October 30, 1997.

Comment Date: We will accept

comments on interim RVUs for selected

procedure codes identified in

Addendum C. Comments will be

considered if we receive them at the

appropriate address, as provided below,

no later than 5 p.m. on December 30,

1997.

ADDRESSES: Mail written comments (1

original and 3 copies) to the following

address: Health Care Financing

Administration, Department of Health

and Human Services, Attention: BPD–

884–FC, P.O. Box 26688, Baltimore, MD

21207–0488.

If you prefer, you may deliver your

written comments (1 original and 3

copies) to one of the following

addresses:

Room 309-G, Hubert H. Humphrey

Building, 200 Independence Avenue,

SW., Washington, DC 20201, or

Room C5–09–26, 7500 Security

Boulevard, Baltimore, MD 21244–

1850.

Because of staffing and resource

limitations, we cannot accept comments

by facsimile (FAX) transmission. In

commenting, please refer to file code

BPD–884-FC. Comments received timely

will be available for public inspection as

they are received, beginning

approximately 3 weeks after publication

of the document, in Room 309-G of the

Department’s offices at 200

Independence Avenue, SW.,

Washington, DC, on Monday through

Friday of each week from 8:30 a.m. to

5 p.m. (phone: (202) 690–7890).

Copies: To order copies of the Federal

Register containing this document, send

your request to: New Orders,

Superintendent of Documents, P.O. Box

371954, Pittsburgh, PA 15250–7954.

Specify stock number 069–001–00101

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date. Credit card orders can also be

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Attention: Electronic Products, P.O. Box

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This Federal Register document is

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(no password required).

FOR FURTHER INFORMATION CONTACT: For

staff in the Center for Health Plans and

Providers, Plan and Provider Purchasing

Policy Group, Division of Practitioner

and Ambulatory Care:

Jim Menas, (410) 786–4507 (for issues

related to practice expense relative

value units).

Regina Walker-Wren, (410) 786–9160

(for issues related to the clinical

psychologist fee schedule).

William Morse, (410) 786–4520 (for

issues related to the supervision of

diagnostic tests and independent

diagnostic testing facilities).

Ward Pleines, Center for Health Plans

and Providers, Chronic Care

Purchasing Policy Group, Division of

Cost Reporting, (410) 786–4528, (for

issues related to the reasonable

compensation equivalent limit update

factor).

Anita Heygster, Center for Health Plans

and Providers, Plan and Provider

Purchasing Policy Group, Division of

Integrated Delivery Systems, (410)

786–4486 (for issues related to

participating and nonparticipating

suppliers).

Bill Larson, Office of Clinical Standards

and Quality, Coverage and Analysis

Group, (410) 786–4639 (for issues

related to screening mammography,

screening pelvic examinations, and

screening colorectal cancer

examinations).

Stanley Weintraub, Center for Health

Plans and Providers, Plan and

Provider Purchasing Policy Group,

Division of Practitioner and

Ambulatory Care, (410) 786–4498 (for

all other issues).

SUPPLEMENTARY INFORMATION: In this

final rule, we provide background on

the statutory authority for and

development of the physician fee

schedule. We also explain in detail the

process by which certain interim work

relative value units (RVUs) are reviewed

and, in some cases, revised.

Section 1848(c)(2)(B) of the Social

Security Act (the Act) provides that

adjustments in RVUs resulting from an

annual review of those RVUs may not
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59049

cause total physician fee schedule

payments to differ by more than $20

million from what they would have

been had the adjustments not been

made. Thus, the statute allows a $20

million tolerance for increasing or

reducing total expenditures under the

physician fee schedule. We have

determined that net increases because of

changes to the physician fee schedule

would have added to projected

expenditures in calendar year 1998 by

approximately $300 million. Therefore,

we are making the budget neutrality

adjustment required by changes in

payment policy and Physicians’ Current

Procedural Terminology (CPT) through

the conversion factor (CF). A CF is a

national value that converts RVUs into

payment amounts. Effective January 1,

1998, there will be one CF, as specified

by the Balanced Budget Act of 1997

(BBA 1997) (Public Law 105–33),

enacted on August 5, 1997. (Anesthesia

has a separate CF but is paid using a

different formula.) The CF is updated

annually.

We have made the adjustment to

achieve budget neutrality as we were

best able to estimate. As a result, the

total projected expenditures from the

revised fee schedule are estimated to be

the same as they would have been had

we not changed the RVUs for any

individual codes or added new codes to

the fee schedule.

Addenda to this rule provide the

following information:

Addendum A—Explanation and Use of

Addenda B Through G.

Addendum B—1998 Relative Value

Units and Related Information Used

in Determining Medicare Payments

for 1998.

Addendum C—Codes with Interim

Relative Value Units.

Addendum D—1999 Geographic

Practice Cost Indices by Medicare

Carrier and Locality.

Addendum E—1998 Geographic

Practice Cost Indices by Medicare

Carrier and Locality.

Addendum F—1999 Versus 1997

Geographic Adjustment Factor (GAF)

by 1998 Fee Schedule Area.

Addendum G—Counties Included in

1998 Localities (Alphabetically by

State and Locality Name Within

State).

The RVUs and revisions to payment

policies in this final rule apply to

physicians’ services furnished on or

after January 1, 1998.

To assist readers in referencing

sections contained in this preamble, we

are providing the following table of

contents. Some of the issues discussed

in this preamble affect the payment

policies but do not require changes to

the regulations in the Code of Federal

Regulations. Information on the

regulation’s impact appears throughout

the preamble and not exclusively in

section VIII.

Table of Contents

I. Background

A. Legislative History

B. Published Changes to the Fee Schedule

C. Components of the Fee Schedule

Payment Amounts

D. Summary of the Development of the

Relative Value Units

1. Work Relative Value Units

2. Practice Expense and Malpractice

Expense Relative Value Units

II. Specific Proposals for Calendar Year 1998

A. Resource-Based Practice Expense

Relative Value Units

1. Phased-In Implementation

2. Adjustment for Practice Expense

Relative Value Units for 1998

3. Additional Provisions

B. Geographic Practice Cost Index Changes

1. Work Geographic Practice Cost Indices

2. Practice Expense Geographic Practice

Cost Indices

a. Employee Wage Indices

b. Rent Indices

c. Medical Equipment, Supplies, and

Miscellaneous Expenses

3. Malpractice Geographic Practice Cost

Indices

C. Fee Schedule for Clinical Psychologist

Services

1. Background

2. Legislative Changes

3. Physician Payment Reform

4. Related Federal Register Document

5. Policy Pertaining to Clinical

Psychologist Services

6. Rationale and Alternatives Considered

D. Diagnostic Tests

1. Ordering of Diagnostic Tests

2. Supervision of Diagnostic Tests

3. Independent Diagnostic Testing Facility

E. Reasonable Compensation Equivalent

Limit Update Factor

1. Background

2. Change in the Methodology Used to

Develop Reasonable Compensation

Equivalent Limits

F. Payment to Participating and

Nonparticipating Suppliers

G. Increase in Work Relative Value Units

for Global Surgical Services to Account

for the 1997 Increases for Work Relative

Value Units in Evaluation and

Management Services

H. Caloric Vestibular Testing

I. Clinical Consultations

J. Actual Charges

III. Implementation of the Balanced Budget

Act of 1997

A. Changes in Practice Expense Relative

Value Units for 1998

B. Coverage of Screening Mammography

and Related Payment Changes

C. Colorectal Cancer Screening

1. Coverage Determination in Screening

Barium Enemas

2. Provisions of the Final Rule

3. Frequency Limits and Conditions of

Coverage

4. Payment Limits

5. Screening Colonoscopy in an

Ambulatory Surgical Center

D. Coverage of Screening Pelvic

Examination (Including a Clinical Breast

Examination) and Related Payment

Changes

E. Reinstatement of the Payment for

Transportation of EKG Equipment

F. Waiver of Proposed Rulemaking for

Provisions in the Balanced Budget Act of

1997

IV. Refinement of Relative Value Units for

Calendar Year 1998 and Responses to

Public Comments on Interim Relative

Value Units for 1997

A. Summary of Issues Discussed Related to

the Adjustment of Relative Value Units

B. Process for Establishing Work Relative

Value Units for the 1998 Fee Schedule

1. Work Relative Value Unit Refinements

of Interim and Related Relative Value

Units (Includes Table 1—Work Relative

Value Unit Refinements of 1997 Interim

and Related Relative Value Units)

2. Establishment of Interim Work Relative

Value Units for New and Revised

Physicians’ Current Procedural

Terminology Codes and New HCFA

Common Procedure Coding System

Codes for 1998

a. Methodology (Includes Table 2—

American Medical Association Specialty

Society Relative Value Update

Committee and Health Care Professionals

Advisory Committee Recommendations

and HCFA’s Decisions for New and

Revised 1998 CPT Codes)

b. Discussion of Codes for Which the RUC

Recommendations Were Not Accepted

C. Other Changes to the 1998 Physician Fee

Schedule and Clarification of CPT

Definitions

V. Provisions of the Final Rule

VI. Collection of Information Requirements

VII. Waiver of Proposed Rulemaking and

Response to Comments

VIII. Regulatory Impact Analysis

A. Regulatory Flexibility Act

B. Geographic Practice Cost Index Changes

C. Fee Schedule for Clinical Psychologist

Services

D. Diagnostic Tests

E. Reasonable Compensation Equivalent

Limit Update Factor

F. Payment to Participating and

Nonparticipating Suppliers

G. Increase in Work Relative Value Units

for Global Surgical Services to Account

for the 1997 Increases for Work Relative

Value Units in Evaluation and

Management Services

H. Caloric Vestibular Testing

I. Clinical Consultations

J. Changes in Practice Expense Relative

Value Units for 1998

K. Coverage of Screening Mammography

and Related Payment Changes

L. Colorectal Cancer Screening

M. Coverage of Screening Pelvic

Examination (Including a Clinical Breast

Examination) and Related Payment

Changes

N. Reinstatement of the Payment for

Transportation of EKG Equipment
59050 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

O. Elimination of the Separate BudgetNeutrality Adjuster for the Work Relative

Value Units

P. Effect of Changes Resulting from

Adjustments to the Relative Value Units

Q. Net Impact of Relative Value Unit

Changes on Medicare Specialties

1. Impact Estimation Methodology

2. Overall Fee Schedule Impact

3. Specialty Level Effect (Includes Table

3— Impact on Medicare Payments by

Specialty Due to Changes in Relative

Value Units)

R. Five-Year Impacts of Benefit Changes

(Includes Table 4—Projected Budget

Impact of New Benefits)

S. Rural Hospital Impact Statement

Addendum A—Explanation and Use of

Addenda B Through G.

Addendum B—1998 Relative Value Units

and Related Information Used in

Determining Medicare Payments for

1998.

Addendum C—Codes with Interim Relative

Value Units.

Addendum D—1999 Geographic Practice

Cost Indices by Medicare Carrier and

Locality.

Addendum E—1998 Geographic Practice

Cost Indices by Medicare Carrier and

Locality.

Addendum F—1999 Versus 1997 Geographic

Adjustment Factor (GAF) by 1998 Fee

Schedule Area.

Addendum G—Counties Included in 1998

Localities (Alphabetically by State and

Locality Name Within State).

In addition, because of the many

organizations and terms to which we refer by

acronym in this final rule, we are listing

these acronyms and their corresponding

terms in alphabetical order below:

AMA—American Medical Association.

BBA—1997 Balanced Budget Act of 1997

CF—Conversion factor.

CFR—Code of Federal Regulations.

CPI—Consumer Price Index.

CPI–U—Consumer Price Index for All Urban

Consumers.

CPT—[Physicians’] Current Procedural

Terminology [4th Edition, 1997,

copyrighted by the American Medical

Association].

CT—Computerized axial tomography.

FDA—Food and Drug Administration.

GAF—Geographic adjustment factor.

GPCI—Geographic practice cost index.

HCFA—Health Care Financing

Administration.

HCPCS—HCFA Common Procedure Coding

System.

HHS—[Department of] Health and Human

Services.

HUD—[Department of] Housing and Urban

Development.

IDTF—Independent Diagnostic Testing

Facility.

IPL—Independent Physiological Laboratory.

MEI—Medicare Economic Index.

MRI—Magnetic resonance imaging.

OBRA—Omnibus Budget Reconciliation Act.

PC—Professional component.

RUC—[AMA’s Specialty Society] Relative

[Value] Update Committee.

RVU—Relative value unit.

TC—Technical component.

I. Background

A. Legislative History

Since January 1, 1992, Medicare has

paid for physician services under

section 1848 of the Social Security Act

(the Act), ‘‘Payment for Physicians’

Services.’’ This section contains three

major elements: (1) A fee schedule for

the payment of physician services; (2) a

method to control the rates of increase

in Medicare expenditures for

physicians’ services; and (3) limits on

the amounts that nonparticipating

physicians can charge beneficiaries. The

Act requires that payments under the

fee schedule be based on national

uniform relative value units (RVUs)

based on the resources used in

furnishing a service. Section 1848(c) of

the Act requires that national RVUs be

established for physician work, practice

expense, and malpractice expense.

Section 1848(c)(2)(B)(ii)(II) of the Act

provides that adjustments in RVUs

because of changes resulting from a

review of those RVUs may not cause

total physician fee schedule payments

to differ by more than $20 million from

what they would have been had the

adjustments not been made. As noted

above, if this tolerance is exceeded, we

must make an adjustment to the

conversion factor (CF) to preserve

budget neutrality.

Section 1848(e)(1)(C) of the Act

requires us to review and, if necessary,

adjust the geographic practice cost

indices (GPCIs) at least every 3 years.

This section also requires us to phase in

the adjustment over 2 years and

implement only one-half of any

adjustment if more than 1 year has

elapsed since the last GPCI revision.

The GPCIs were first implemented in

1992 and were reviewed and revised in

1995. Thus, we are required to complete

the second GPCI review and implement

only one-half of any adjustment by 1998

and one-half in 1999.

The Act requires that payments vary

among fee schedule areas according to

geographic indices. In general, the fee

schedule areas that existed under the

prior reasonable charge system were

retained under the fee schedule. A

detailed discussion of fee schedule areas

can be found in the June 5, 1991

proposed rule (56 FR 25832) and in the

November 25, 1991 final rule (56 FR

59514). We are required by section

1848(e)(1)(A) of the Act to develop

separate indices to measure relative cost

differences among fee schedule areas

compared to the national average for

each of the three fee schedule

components. While requiring that the

practice expense GPCIs and malpractice

GPCIs reflect the full relative cost

differences, the Act requires that the

work indices reflect only one-quarter of

the relative cost differences compared to

the national average.

B. Published Changes to the Fee

Schedule

In the June 18, 1997 proposed rule (62

FR 33159), we listed all of the final rules

published through November 22, 1996

relating to the updates to the RVUs and

revisions to payment policies under the

physician fee schedule. In the June 1997

proposed rule (62 FR 33158), we

discussed several policy options

affecting Medicare payment for

physicians’ services including resourcebased practice expense RVUs,

geographic practice cost index changes,

clinical psychologist services,

supervision of diagnostic tests,

establishment of independent diagnostic

testing facilities, the methodology used

to develop reasonable compensation

equivalent limits, payment to

participating and nonparticipating

suppliers, global surgical services,

caloric vestibular testing, clinical

consultations, and payments based on

actual charges.

This final rule affects the regulations

set forth at part 400, which consists of

an introduction and definitions; part

405, which consists of regulations on

Federal health insurance for the aged

and disabled; part 410, which consists

of regulations pertaining to

supplementary medical insurance

benefits (Part B); part 411, which

consists of regulations pertaining to

exclusions from Medicare and

limitations on Medicare payment; and

part 414, which consists of regulations

pertaining to the payment for Part B

medical and other health services. It

also discusses changes to work RVUs

affecting payment of physician services.

The information in this final rule

updates information in the June 18,

1997 proposed rule (62 FR 33158).

C. Components of the Fee Schedule

Payment Amounts

Under the formula set forth in section

1848(b)(1) of the Act, the payment

amount for each service paid for under

the physician fee schedule is the

product of three factors: (1) A nationally

uniform relative value for the service;

(2) a geographic adjustment factor (GAF)

for each physician fee schedule area;

and (3) a nationally uniform CF for the

service. The CF converts the relative

values into payment amounts.

For each physician fee schedule

service, there are three relative values:

(1) An RVU for physician work; (2) an

RVU for practice expense; and (3) an

RVU for malpractice expense. For each
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59051

of these components of the fee schedule

there is a GPCI for each fee schedule

area. The GPCIs reflect the relative costs

of practice expenses, malpractice

insurance, and physician work in an

area compared to the national average

for each component.

The general formula for calculating

the Medicare fee schedule amount for a

given service in a given fee schedule

area can be expressed as:

Payment=[(RVUwork×work

adjuster×GPCIwork)+(RVUpractice

expense×GPCIpractice expense)+

(RVUmalpractice×GPCImalpractice)×CF]

The CF for calendar year 1998 appears

in Addendum A. The RVUs for calendar

year 1998 are in Addendum B. The

GPCIs for calendar year 1998 are in

Addendum E.

Section 1848(e) of the Act requires the

Secretary to develop GAFs for all

physician fee schedule areas. The total

GAF for a fee schedule area is equal to

a weighted average of the individual

GPCIs for each of the three components

of the service. Thus, the GPCIs reflect

the relative costs of practice expenses,

malpractice insurance, and physician

work in an area compared to the

national average. In accordance with the

law, however, the GAF for the

physician’s work reflects one-quarter of

the relative cost of physician’s work

compared to the national average.

D. Summary of the Development of the

Relative Value Units

1. Work Relative Value Units

Approximately 7,500 codes represent

services included in the physician fee

schedule. The work RVUs established

for the implementation of the fee

schedule in January 1992 were

developed with extensive input from

the physician community. The original

work RVUs for most codes were

developed by a research team at the

Harvard School of Public Health in a

cooperative agreement with us. In

constructing the vignettes for the

original RVUs, Harvard worked with

panels of expert physicians and

obtained input from physicians from

numerous specialties.

The RVUs for radiology services are

based on the American College of

Radiology relative value scale, which

we integrated into the overall physician

fee schedule. The RVUs for anesthesia

services are based on RVUs from a

uniform relative value guide. We

established a separate CF for anesthesia

services while we continue to recognize

time as a factor in determining payment

for these services. As a result, there is

a separate payment system for

anesthesia services.

Proposed RVUs for services were

published in a proposed rule in the

Federal Register on June 5, 1991 (56 FR

25792). We responded to the comments

in the November 25, 1991 final rule.

Since many of the RVUs were published

for the first time in the final rule, we

considered the RVUs to be interim

during the first year of the fee schedule

and gave the public 120 days to

comment on all work RVUs. In response

to the final rule, we received comments

on approximately 1,000 services. We

responded to those comments and listed

the new RVUs in the November 25, 1992

notice for the 1993 fee schedule for

physicians’ services. We considered

these RVUs to be final and did not

request comments on them.

The November 25, 1992 notice (57 FR

55914) also discussed the process used

to establish work RVUs for codes that

were new or revised in 1993. The RVUs

for these codes, which were listed in

Addendum C of the November 25, 1992

notice, were considered interim in 1993

and open to comment through January

26, 1993.

We responded to comments received

on RVUs listed in Addendum C of the

November 25, 1992 notice (57 FR 56152)

in the December 2, 1993 final rule (58

FR 63647) for the 1994 physician fee

schedule. The December 2, 1993 final

rule discussed the process used to

establish RVUs for codes that were new

or revised for 1994. The RVUs for these

codes, which are listed in Addendum C

of the December 2, 1993 final rule (58

FR 63842), were considered interim in

1994 and open to comment through

January 31, 1994. We proposed RVUs

for some non-Medicare and carrierpriced codes in our June 24, 1994

proposed rule (59 FR 32760). Codes

listed in Table 1 of the June 1994

proposed rule were open to comment.

These comments, in addition to

comments on RVUs published as

interim in the December 2, 1993 final

rule were addressed in the December 8,

1994 final rule (59 FR 63432). In

addition, the December 8, 1994 final

rule discussed the process used to

establish RVUs for codes that were new

or revised for 1995. Interim RVUs for

new or revised procedure codes were

open to comment. Comments were also

accepted on all RVUs considered under

the 5-year refinement process. The

December 8, 1995 final rule (60 FR

63124) addressed comments on RVUs

published as interim in the December 8,

1994 final rule. In addition, the

December 8, 1995 final rule discussed

the process used to establish RVUs for

codes that were new or revised for 1996.

The November 22, 1996 final rule (61

FR 59490) addressed all comments

received in response to our May 3, 1996

proposed notice (61 FR 19992) on the 5-

year review of work RVUs, finalized the

1996 interim work RVUs, and issued

interim RVUs for new and revised

procedure codes for 1997.

2. Practice Expense and Malpractice

Expense Relative Value Units

Section 1848(c)(2)(C) of the Act

required that the practice expense and

malpractice expense RVUs equal the

product of the base allowed charges and

the practice expense and malpractice

percentages for the service. Base

allowed charges are defined as the

national average allowed charges for the

service furnished during 1991, as

estimated using the most recent data

available. For most services, we used

1989 charge data ‘‘aged’’ to reflect the

1991 payment rules, since those were

the most recent data available for the

1992 fee schedule.

Section 121 of the Social Security Act

Amendments of 1994 (Pub. L. 103–432),

enacted on October 31, 1994, and

amended by the BBA 1997, requires us

to develop a methodology for a

resource-based system for determining

practice expense RVUs for each

physician service. In developing the

methodology, we considered the staff,

equipment, and supplies used in

providing medical and surgical services

in various settings. The legislation

required the new payment methodology

to be phased in over 4 years, effective

for services furnished in 1999.

II. Specific Proposals for Calendar Year

1998

In response to the publication of the

June 1997 proposed rule, we received

approximately 8,600 comments. We

received comments from individual

physicians, health care workers, and

professional associations and societies.

The majority of the comments addressed

the proposals related to resource-based

practice expense RVUs, supervision of

diagnostic tests, and payments based on

actual charges.

The proposed rule discussed policies

that affect the number of RVUs on

which payment for certain services

would be based. Certain changes

implemented through this final rule are

subject to the $20 million limitation on

annual adjustments contained in section

1848(c)(2)(B) of the Act.

After reviewing the comments and

determining the policies we will

implement, we have estimated the costs

and savings of these policies and added

those costs and savings to the estimated

costs associated with any other changes

in RVUs for 1998. We discuss in detail

the effects of these changes in the
59052 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

Regulatory Impact Analysis (section

VIII).

For the convenience of the reader, the

headings for the policy issues in section

II correspond to the headings used in

the June 1997 proposed rule (62 FR

33158). More detailed background

information for each issue can be found

in the June 1997 proposed rule.

A. Resource-Based Practice Expense

Relative Value Units

Section 121 of the Social Security Act

Amendments of 1994 (Public Law 103–

432), enacted on October 31, 1994,

requires us to develop a methodology

for a resource-based system for

determining practice expense RVUs for

each physician service. The June 1997

proposed rule (62 FR 33160), contained

the proposed resource-based practice

expense RVUs. We received a

substantial number of comments on our

proposal, both favorable and

unfavorable.

Before the close of the comment

period on August 18, 1997, the Balanced

Budget Act (BBA) of 1997 (Pub. L. 105–

33) was enacted on August 5, 1997. The

BBA 1997 delayed implementation of

the resource-based practice expense

system until 1999. The BBA 1997

contained additional requirements.

1. Phased-in Implementation

Instead of paying for all services

entirely under a resource-based practice

expense system in 1999, the system will

be implemented over a 4-year period.

The practice expense RVUs for 1999

will be based on the product of 75

percent of the previous year’s practice

expense RVUs (1998) and 25 percent of

the resource-based practice expense

RVUs. For the year 2000, the

percentages will be 50 percent of the

charge-based practice expense RVUs

and 50 percent of the resource-based

practice expense RVUs. For 2001, the

percentages will be 25 percent of the

charge-based practice expense RVUs

and 75 percent of the resource-based

practice expense RVUs. For subsequent

years, the RVUs will be based totally on

resource-based practice expense RVUs.

2. Adjustment for Practice Expense

Relative Value Units for 1998

Section 4505 of the BBA 1997

specifies the manner in which practice

expense RVUs in 1998 are adjusted.

Section 4505 of the BBA 1997 enacted

a provision that would in 1998

redistribute practice expense RVUs in

the direction of the resource-based

RVUs that are to be implemented in

1999. The 1998 practice expense RVUs

for certain services are reduced to 110

percent of their work RVUs for the

service, and the monies are used to raise

the practice expense RVUs for office

visit procedures. (Section 4505 of the

BBA 1997 also gives us the authority to

adjust this percentage if the aggregate

amount of reductions exceeds $390

million. Since the application of the 110

percent results in reductions of

approximately $330 million, no further

adjustment is necessary.) A detailed

discussion of this provisions is

discussed in section III,

‘‘Implementation of the Balanced

Budget Act of 1997.’’

3. Additional Provisions

Several additional provisions relating

to the development of resource-based

practice expense RVUs will be

published in the Federal Register in the

spring of 1998. These provisions will be

discussed in a notice of intent to

regulate that is being published

elsewhere in this issue of the Federal

Register.

We are not adopting the resourcebased practice expense system proposal

published in the June 1997 proposed

rule. However, we will publish a new

proposed rule in the spring of 1998 with

a new set of resource-based practice

expense RVUs.

B. Geographic Practice Cost Index

Changes

The Act requires that payments vary

among fee schedule areas to the extent

that resource costs vary as measured by

the GPCIs. As stated earlier, section

1848(e)(1)(C) of the Act requires us to

review and, if necessary, adjust the

GPCIs at least every 3 years. This

section of the Act also requires us to

phase in the adjustment over 2 years

and implement only one-half of any

adjustment in the first year if more than

1 year has elapsed since the last GPCI

revision. The GPCIs were first

implemented in 1992, and the first

review and revision was implemented

in 1995. (A detailed discussion of the

development of the GPCIs and

references to obtaining studies on the

development of the GPCIs can be found

in the June 1997 proposed rule (62 FR

33172.)

The 1998 through 2000 GPCIs

represent the second GPCI update. The

1999 GPCIs (Addendum D) are the fully

revised GPCIs. The 1998 GPCIs

(Addendum E) represent the one-half

transition GPCIs. Addendum F shows

the estimated effects on area payments

of the fully revised 1999 GPCIs. The

payment effects in 1998 will be about

one-half of these amounts.

The same data sources and

methodology used for the 1995 through

1997 GPCIs were used for the 1998

through 2000 GPCIs with a few very

minor modifications. No acceptable

additional data sources were found.

1. Work Geographic Practice Cost

Indices

The work GPCIs are based on the

decennial census. The 1992 through

1994 work GPCIs were based on 1980

census data, because 1990 census data

were not yet available. The work GPCIs

were revised in 1995 with new data

from the 1990 census. New census data

will not be available again until after the

2000 census. We searched for other data

that would enable us to update the work

GPCIs between the decennial census. No

acceptable data sources were found.

Therefore, we are making no changes

in the work GPCIs, other than the

generally negligible changes resulting

from using 1994, rather than 1992,

RVUs in mapping counties to localities

for this GPCI update. We believe it is

preferable to make no changes rather

than making inaccurate changes based

on unacceptable data. We believe that

this is a particularly reasonable position

given the generally small magnitude of

the changes in payments resulting from

the changes in the work GPCIs from the

1980 to the 1990 census data.

2. Practice Expense Geographic Practice

Cost Indices

a. Employee Wage Indices. As with

the work GPCIs, the employee wage

portion of the practice expense GPCIs is

based on decennial census data. Like

the work GPCIs, the employee wage

indices are not being changed during

this GPCI update.

b. Rent Indices. The office rental

indices are again based on HUD

residential rent data. The revised rental

indices are based on 1996 HUD data as

opposed to 1994 HUD data used in the

1995 through 1997 GPCIs.

c. Medical Equipment, Supplies, and

Miscellaneous Expenses. As with the

1992 through 1994 and 1995 through

1997 GPCIs, this component was given

a national value of 1.000, indicating no

measurable difference among areas in

costs. (For previously published Federal

Register documents that discuss these

issues, see section I.B. of this final rule,

‘‘Published Changes to the Fee

Schedule.’’)

3. Malpractice Geographic Practice Cost

Indices

Again, malpractice premium data

were collected for a mature ‘‘claims

made’’ policy with $1 million to $3

million limits of coverage, with

adjustments made for mandatory patient

compensation funds. The proposed

malpractice indices were based on 1992
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59053

through 1994 premium data, the latest

years available when this study was

being conducted in 1995 through 1996,

compared to the 1990 through 1992 data

used in the current 1995 through 1997

indices.

Fee schedule areas are described by

carrier and locality number with a short

geographic description such as

‘‘Atlanta.’’ We received numerous

inquiries about the geographic areas that

comprise our fee schedule areas.

Addendum G lists alphabetically by

State and fee schedule area the counties

included in each fee schedule area.

Comment: The majority of

commenters expressed concern about

the continued use of proxy data,

especially the HUD residential rent data,

rather than commercial rent data, in the

GPCIs. They suggested we collect actual

data on physician earnings and

expenses.

Response: In both the 1995 and this

GPCI revision we conducted an

extensive search for alternative data

sources as well as for more recent data.

The search led us to conclude that the

current GPCI proxies are still the best

available data to measure practice cost

differences among areas. As stated in all

previous proposed and final rules on the

GPCIs, the actual earnings of physicians

were not used to adjust geographical

differences in fees because these fees

are, in large part, the determinants of

the earnings. That is, the use of actual

physician earnings would be ‘‘circular.’’

As also discussed in all previous

proposed and final rules on the GPCIs,

no acceptable sources of commercial

rent data were found.

We believe the current GPCI data

sources are an accurate reflection of area

practice cost differences. We believe

physician earnings will vary among

areas as do the earnings of other highly

educated professionals, and commercial

rents will vary among areas as do

residential rents. The employee wage

portion of the GPCIs is based on census

data on the actual earnings of the type

of employees found in physicians’

offices. The malpractice index is based

on actual malpractice premiums. The

current GPCI data sources reflect costs

across the country and are updated on

a regular basis. Any data collection of

actual physician costs of sufficient

breadth to cover all counties and be

updated on a regular basis would be

massive and extremely costly. We are

unconvinced that such an effort would

produce a result so significantly at

variance with the present GPCIs as to

justify the resources required to collect

the data.

Comment: Commenters stated that

there should be no geographic payment

differences under the physician fee

schedule. They believe that in a national

program with the same Medicare Part B

premium everywhere, that equivalent

services should have equivalent

payment regardless of geographic area.

Response: Section 1848(e)(1)(A) of the

Act requires that payments vary among

areas as resource costs vary as reflected

by the GPCIs.

Comment: One commenter stated that

the GPCIs did not accurately reflect area

cost differences because uniform GPCI

component cost share weights were

used. The commenter stated that use of

the same cost shares everywhere fails to

recognize that component weights might

vary among areas, specialties, and

services depending upon factors such as

case mix, availability of other health

care resources, and individual practice

styles.

Response: We agree that different

specialties and individual practitioners

utilize resources differently and may

have expenses in different proportions

from the component weights used in the

GPCIs as discussed in the June 1997

proposed rule at 62 FR 33172. The

physician fee schedule was established

in 1992 specifically to eliminate the

large unjustifiable payment differences

that existed among services, specialties,

and geographic areas by establishing a

uniform national payment system.

Payments under the physician fee

schedule are based on uniform national

RVUs for a service and a national dollar

conversion factor and can vary only as

area resource costs vary as demonstrated

by the GPCIs. The law prohibits any

specialty payment differential. The

RVUs for a service represent the typical

service. The GPCI component weights

represent the average practice expense

component weights across all physician

specialties and are intended to reflect

average costs across all services and

specialties in an area and not to reflect

exactly the costs of each individual

practitioner. Thus, physician fee

schedule payments are designed by law

to reflect the resources involved with

provision of the typical service across

all specialties and physicians in an area.

It would not be in keeping with the

intent of the law nor would it be

practical or desirable in a national

program to attempt to recognize

individual practice patterns.

Comment: One commenter stated that

contrary to the GPCIs, which show that

costs tend to be higher in urban areas,

rural physicians may actually have

higher costs than urban or suburban

physicians. The commenter attributed

this to such factors as higher shipping

costs, higher equipment maintenance

costs, higher continuing education

costs, and less efficient use of medical

equipment.

Response: While we have heard this

argument since the inception of the

physician fee schedule, we have no data

demonstrating that physicians in rural

areas have higher costs of practice than

physicians in urban or suburban areas.

Physician work, rents, employee wages,

and malpractice insurance represent

about 86 percent of physician costs as

reflected in the GPCIs. Our data show

that wages, both physician wages as

reflected by wages of other highly

educated professionals and the wages of

medical and clerical personnel in

physicians’ offices, and rents are higher

in urban and suburban areas than in

rural areas. While malpractice

premiums are the same statewide in

many States, in those States where

premiums do vary geographically they

are higher in urban areas. The types of

expenses mentioned as higher in rural

areas, continuing education, higher

shipping costs, higher equipment

maintenance costs, and less efficient use

of equipment, represent only a very

small portion of physician practice

costs.

Comment: One commenter

recommended that changes in

malpractice GPCIs reflect actual changes

in costs from year to year.

Response: We interpret this comment

to mean that the malpractice GPCIs

should reflect actual changes in

malpractice premiums from the prior

year. That is, the 1998 malpractice

GPCIs should reflect actual changes in

malpractice premiums from 1997 to

1998, and the malpractice GPCIs should

be changed each year to reflect annual

premium changes. The law requires that

we review and revise the GPCIs at least

every 3 years. This revision involves

substantial data collection and analysis

and must be published in a proposed

rule. For example, the last GPCI revision

was in 1995, meaning that the next

revision is required in 1998. This

requires publication of the proposed

changes in the Federal Register in early

1997 to allow for public comment. To

meet this timeframe, data collection

begins in 1995 to allow time for data

analysis and drafting of the proposed

rule. Therefore, given the time frame for

the process to utilize updated data, this

is the most current data that could be

used. Thus, the revised malpractice

GPCIs are based on 1992 through 1994

malpractice premium data, the most

recent data available at the time the

revision process was begun in 1995. As

discussed in the proposed rule, we use

a 3-year average rather than the most

recent single year of malpractice data to

smooth the annual volatility of
59054 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

malpractice premiums and present a

more accurate indication of malpractice

premium trends over time. We do not

plan to revise the GPCIs more frequently

than every 3 years as required by law.

Result of evaluation of comments: The

GPCIs proposed on June 18, 1997 will

be effective beginning in 1998.

C. Fee Schedule for Clinical

Psychologist Services

1. Background

Until 1997, the fee schedule for

clinical psychologist services was a

locality-based fee schedule developed

by the individual Medicare carriers. The

Medicare carriers established the

locality-based fee schedule in 1988 after

section 4077(b) of the Omnibus Budget

Reconciliation Act of 1987 (OBRA 1987)

(Public Law 100–203), enacted on

December 22, 1987, first provided for

direct payment for clinical psychologist

services furnished in a community

mental health center. Section

4077(b)(3)(D) of OBRA 1987 amended

section 1833(a)(1) of the Act by

providing that payment for clinical

psychologist services be based at 80

percent of the lower of the actual charge

or a fee schedule.

The Act provides that the Secretary

determine the fee schedule. As a result,

we furnished guidance to all Medicare

Part B carriers to establish the initial,

that is, baseline, clinical psychologist

fee schedule as follows:

• Set the fee schedule for therapeutic

services at 80 percent of the adjusted

prevailing charge for participating

psychiatrists in a locality; and

• Set the fee schedule for diagnostic

services at 90 percent of the adjusted

prevailing charge for participating

psychologists in a locality.

We also advised the Medicare Part B

carriers to update the clinical

psychologist fee schedule in subsequent

years by the annual change in the

Consumer Price Index for All Urban

Consumers (CPI–U). We adopted the

CPI–U to update the clinical

psychologist fee schedule because it was

the economic index used for updating

most other nonphysician practitioner

charges at that time.

Since that time, there have been two

significant changes to the fee schedule

for clinical psychologist services. First,

effective January 1, 1992, we

implemented the policy to base

payment for psychological testing

services furnished by clinical

psychologists on the amounts in the

physician fee schedule. Second,

effective January 1, 1997, we linked the

fee schedule for clinical psychologist

services to the physician fee schedule in

the same manner as for most other

health care practitioner services. We

describe these changes in more detail in

the sections that follow.

2. Legislative Changes

Although section 4077(b) of OBRA

1987 provided for clinical psychologist

services as separately payable under

Medicare Part B under a fee schedule,

direct payment was limited to services

furnished in community mental health

centers. Subsequent amendments to the

law expanded the scope of the benefit.

These amendments were discussed in a

related Federal Register document

described in section II.C.4. below.

3. Physician Payment Reform

As noted in section I.A., since January

1, 1992, Medicare Part B has paid for

physician services based on a fee

schedule. Until 1992, physician services

had been paid on the basis of a

reasonable charge system. This system

led to significant payment variations

among types of services, physician

specialties, and localities. Section 6102

of OBRA 1989 added a new section

1848 to the Act, ‘‘Payment for

Physicians’’ Services,’’ which replaced

the reasonable charge system with a fee

schedule that reflected the resources

required to perform a given service.

Although this legislation linked the

payment methodology for most

practitioner services to the physician fee

schedule, it did not address payment for

clinical psychologist services.

Nevertheless, because amounts

established under the physician fee

schedule for psychological testing were

heavily based on combined charge data

for psychiatrists and psychologists, we

wished to ensure that clinical

psychologists would receive 100 percent

of the physician fee schedule amount

for those services. Therefore, effective

January 1, 1992, fee schedule amounts

for psychological testing services

furnished by clinical psychologists are

set at 100 percent of the physician fee

schedule. However, before 1997, no

change was made to the clinical

psychologist fee schedule for

therapeutic and other diagnostic

services.

4. Related Federal Register Document

We discussed several aspects of

payment for clinical psychologist

services in a proposed rule published in

the Federal Register on December 29,

1993 (Medicare Coverage and Payment

for Clinical Psychologist, Other

Psychologist, and Clinical Social

Worker Services (BPD–706–P)) (58 FR

68829). That document addressed issues

such as coinsurance, the outpatient

mental health treatment limitation in

section 1833(c) of the Act, and

assignment of claims. In the December

1993 proposed rule, we indicated that

we would address the calculation of the

clinical psychologist fee schedule

amounts set forth under section

1833(a)(1)(L) of the Act in a separate

proposed rule (58 FR 68837). Below, we

discuss establishing the fee schedule for

clinical psychologist services as referred

to in the December 1993 proposed rule.

5. Policy Pertaining to Clinical

Psychologist Services

There are two types of services billed

directly to Medicare Part B by clinical

psychologists: diagnostic services and

therapeutic services. Medicare direct

payment for services furnished by

clinical psychologists became effective

July 1, 1988. From 1988 through 1996,

Medicare Part B payment to clinical

psychologists for therapeutic services

was subject to a locality-based fee

schedule calculated by each Medicare

carrier. In 1988, the Medicare carriers

developed the clinical psychologist fee

schedule on the basis of a HCFA

analysis of charging practices of

psychologists and psychiatrists. Because

no Medicare charge data for therapeutic

services furnished by clinical

psychologists existed at that time, we

compared psychologist and psychiatrist

charges from other payor sources as a

gap-filling measure for Medicare pricing

purposes. The resulting clinical

psychologist fee schedule amounts for

therapeutic services, as shown in

section II.C.1. above, were set at 80

percent of the adjusted prevailing

charge for similar services of Medicareparticipating psychiatrists in the

locality. (The ‘‘adjusted prevailing

charge’’ for physicians means the

locality prevailing charge that is

calculated by applying the Medicare

Economic Index (MEI) to the base year

prevailing charge. In this way, Medicare

reasonable charges for physician

services are increased above the base

year rates only to the extent determined

to be justified by appropriate economic

data.)

Initially, the fee schedule amounts for

diagnostic services furnished by clinical

psychologists were set at 90 percent of

the Medicare prevailing charge for

independently practicing psychologists

in a locality. In contrast to therapeutic

services, Medicare charge data had

existed for diagnostic testing because

psychological testing furnished by

independent psychologists under a

physician’s order had been covered as

‘‘other diagnostic tests’’ under section

1861(s)(3) of the Act.
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59055

The amounts established under the

physician fee schedule for diagnostic

psychological testing were largely based

on blended charge data for both

psychologists and physicians.

Furthermore, because psychologists are

the predominant suppliers of

psychological testing services, the

physician fee schedule amounts for

those services were based in large part

on psychologist charge data. In the

November 25, 1991 final rule that

established the physician fee schedule,

we stated (56 FR 59507) that diagnostic

tests furnished by clinical psychologists

would be paid under the physician fee

schedule. Since January 1, 1992,

amounts for diagnostic psychological

testing services furnished by

psychologists are equivalent to the

amounts established under the

physician fee schedule authorized by

section 1848 of the Act. (Diagnostic

psychological testing services are listed

in the Physicians’ Current Procedural

Terminology (CPT) ’97 as CPT codes

96100 through 96117.)

A variety of health care practitioners

under Medicare have payment levels

that are tied, by law, to the physician fee

schedule. These practitioners include

nurse practitioners, nurse midwives,

and physician assistants. We believe

that it is also appropriate to establish a

clinical psychologist fee schedule that is

linked to the physician fee schedule.

The implementation of 24 new billing

codes for psychotherapy services

effective January 1, 1997 required us to

establish relative values under the

physician fee schedule for each code.

We established the clinical psychologist

fee schedule value for all services at 100

percent of the physician fee schedule

amount for the corresponding service.

Consequently, this rule sets forth the fee

schedule for covered clinical

psychologist services at 100 percent of

the physician fee schedule amount for

the corresponding service. The rationale

for this payment level appears in section

II.C.6. below. Although this payment

policy was implemented January 1,

1997, we are including it in this final

rule in order to codify in regulations the

methodology for the clinical

psychologist fee schedule.

6. Rationale and Alternatives

Considered

As noted in section II.C.1., we

recommended in 1988 that Medicare

carriers set clinical psychologist fee

schedule amounts for therapeutic

services at 80 percent of the MEIadjusted prevailing charge for

psychiatrists. That level had been

primarily based on the fee differential

found in a review of psychologist and

psychiatrist fees from 1985 through

1988.

Effective January 1, 1992, physicians’

services are paid under a resource-based

fee schedule rather than a reasonable

charge methodology. The physician fee

schedule establishes payment amounts

for all physician services as defined in

section 1848(j)(3) of the Act. One effect

of the physician fee schedule is that

payment for physician services is now

standardized. We believe that the

clinical psychologist fee schedule

amounts for therapeutic services should

be tied to the physician fee schedule.

As noted earlier, effective for services

furnished on or after January 1, 1992,

payment for diagnostic psychological

tests furnished by clinical psychologists

is based on the physician fee schedule.

The clinical psychologist fee schedule

for therapeutic services, which was in

use until January 1, 1997, was not

resource-based but was derived from the

initial linkage between psychologist and

psychiatrist prevailing charges.

However, with the implementation of

the physician fee schedule, prevailing

charges no longer apply for physician

services. Furthermore, because the

prevailing charge was based on actual

charging patterns, it frequently resulted

in large differences in charges from one

area to another. With implementation of

the physician fee schedule, the GAF

used to adjust the RVUs for physician

services has changed the geographic

distribution of fees. The purpose of the

GAF is to recognize only justifiable

differences in the cost of operating a

medical practice in different areas.

Finally, once the clinical psychologist

fee schedule is linked directly to the

physician fee schedule, the annual

physician update factor used to update

fees for clinical psychologist services

will be the same as the index used to

update fees for physicians and other

health care practitioners. The following

table illustrates that, for the years

between 1989 through 1991 (during

which the prevailing charge system

applied), the CPI–U update factor

exceeded the congressionally imposed

limits on the MEI that was used to

adjust Medicare prevailing charges for

nonprimary care physician services:

Annual increase

1989

(percent)

1990

(percent)

1991

(percent)

CPI–U ................ 4.0 5.2 4.7

MEI (for other

than primary

care) ............... 1.0 2.0 0.0

Using a hypothetical prevailing

charge of $100 for psychiatrists in 1988,

we illustrate the relationship of the

clinical psychologist fee schedule to

psychiatrist prevailing charges in 1991

in the following table:

1989 1990 1991

Psychiatrists (1988 prevailing charge = $100):

MEI update factor .............................................................................................................................. 1.01 1.02 1.00

Updated prevailing charge ................................................................................................................ $101.01 $103.02 $103.02

Clinical Psychologists (1988 fee = $80):

CPI–U update factor ......................................................................................................................... 1.04 1.052 1.047

Updated fee ....................................................................................................................................... $83.20 $87.53 $91.64

Psychologist/Psychiatrist (1988 = 80%) ................................................................................................... 82.4% 85.0% 89.0%

By 1991, the combined effect of using

the CPI–U to update the clinical

psychologist fee schedule and the MEI

to update psychiatrist prevailing charges

resulted in a clinical psychologist fee

schedule that was equivalent to 89

percent of the psychiatrist prevailing

charge. Additionally, implementation of

the physician fee schedule resulted in

slight payment decreases for

psychiatrist services in 1992. In 1993

and 1994, moreover, the physician fee

schedule amounts for nonsurgical

services other than primary care

services were increased by 0.8 percent

and 5.3 percent, respectively. By

comparison, during the first 3 years that

the physician fee schedule was in effect,

clinical psychologist fee schedule

amounts increased by 4.7 percent, 3.1

percent, and 3.0 percent, respectively,

for 1992, 1993, and 1994, because

clinical psychologist fee schedule

amounts were adjusted by a different

economic index, the Consumer Price

Index (CPI). Consequently, through

1994, clinical psychologist fee schedule

increases outpaced those for physicians

furnishing nonsurgical services other

than primary care as well as those for
59056 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

other nonphysician practitioners whose

payments are tied to the physician fee

schedule.

The combined effect of all these

factors is that the clinical psychologist

fee schedule no longer reflected the

original fee differentials between

psychologists and psychiatrists that had

been found in the health care

marketplace and factored into the initial

clinical psychologist fee schedule. As a

result, the clinical psychologist fee

schedule was marked by disparities

with the physician fee schedule for

similar services as well as by wide

geographic variations that reflected

historical charging patterns in different

areas.

We had previously considered setting

the clinical psychologist fee schedule at

the level established under the

physician fee schedule for similar

services. However, at that time, the CPT

descriptors for individual

psychotherapy services (CPT codes

90841 through 90844) included the term

‘‘* * * [with] continuing medical

diagnostic evaluation, and drug

management, when indicated.’’ These

are medical aspects of a

psychotherapeutic service that are

outside the scope of clinical

psychologist licensure. Therefore, we

were concerned that it would be

inappropriate to set the clinical

psychologist fee schedule amounts at

the same level as the physician fee

schedule when clinical psychologists

were unable to perform the full service

described in the codes.

During 1996, as part of the statutorily

mandated 5-year refinement of the

RVUs for the physician fee schedule, the

American Medical Association’s

(AMA’s) Specialty Society Relative

Value Scale Update Committee (RUC)

recommended increases for a number of

psychotherapy codes. (The RUC, which

is comprised of representatives of

various medical specialty societies, the

AMA, the American Osteopathic

Association, and the CPT Editorial

Panel, makes recommendations to us

concerning the assignment of RVUs to

new and revised CPT codes.) As a

prelude to accepting the RUC

recommendations, we examined the

coding of psychiatry services. We

concluded that the CPT code descriptors

for individual psychotherapy needed to

be changed to define the service more

clearly, recognize the variations in work

associated with different types of

psychotherapy as well as the settings in

which the types of psychotherapy are

furnished, and assign face-to-face time

values for the service. As a result,

effective January 1, 1997, CPT codes

90842, 90843, 90844, and 90855 for

individual psychotherapy are no longer

recognized for Medicare purposes.

These codes have been replaced by 24

alphanumeric codes that include 12

codes for therapy furnished in the office

and other outpatient settings and 12

codes for therapy furnished in inpatient

hospital, partial hospital, or residential

care settings. These two categories were

further broken down into the types of

psychotherapy services. A full listing

and discussion of these codes was

included in the final rule (Medicare

Program; Revisions to Payment Policies

and Five-Year Review of and

Adjustments to the Relative Value Units

Under the Physician Fee Schedule for

Calendar Year 1997 (BPD–852–FC)),

published November 22, 1996. (See 61

FR 59521 through 59523.)

One of the effects of the coding

system changes for psychiatric services

is that now there are codes for reporting

psychotherapy both with and without

medical evaluation and management

services. Under Medicare, clinical

psychologists may bill for individual

psychotherapy without medical

evaluation and management services.

Consequently, when clinical

psychologists bill for individual

psychotherapy without medical

evaluation and management, those

services are equivalent to individual

psychotherapy without medical

evaluation and management services

when furnished by a physician. As a

result, we believe that it is both

reasonable and equitable to pay clinical

psychologists the same amount as

physicians for equivalent services.

Alternatively, we considered retaining

the previous clinical psychologist fee

schedule for therapeutic services. We

also considered setting the clinical

psychologist fee schedule at a level

other than 100 percent of the physician

fee schedule. However, we rejected

these options because the resulting fee

schedule amounts would have

essentially continued to be derived from

physician prevailing charges, which are

no longer relevant under the physician

fee schedule and would only serve to

perpetuate geographic variations in

charges that are a residual effect of the

reasonable charge payment system.

We received a few comments on the

clinical psychologist fee schedule from

five separate major professional

associations and federations at the

national and State level.

Comment: One commenter urged us

to develop an equitable payment

methodology for clinical social workers

that takes into account the practitioner’s

investment in education and training,

office expenses, and malpractice costs

instead of a methodology that is based

on a percentage of what is paid to

another nonphysician provider. The

commenter noted that payment for

clinical social worker services seems to

be the only instance under the Medicare

statute when one G48 nonphysician’s

payment rate is tied to that of another

nonphysician provider.

Response: The Medicare statute

requires that payment be made to

clinical social workers at 80 percent of

the lesser of the actual charge for the

services or 75 percent of the amount

determined for payment for clinical

psychologist services. Under the

circumstances, it would be

inappropriate to develop an alternative

payment amount for clinical social

worker services.

Comment: Several commenters stated

that they are pleased that we have

addressed the problem of the clinical

psychologist fee schedule and the

inequitable situation that in some areas

of the country fees for psychology

services were higher than the fees for

the same services provided by a

psychiatrist. Accordingly, these

commenters are supportive of our

requirement that psychologists may bill

only for psychotherapy without medical

evaluation and management. However,

two of the commenters suggested that

we consider our policy of a fee schedule

for psychologists’ services set at 100

percent of the physician fee schedule

amount to be an interim policy, pending

completion of ongoing survey work and

the RUC’s deliberations. Completion of

the RUC’s review of the work involved

in the new codes will help inform

decision makers about whether the

coding changes and RVUs have

adequately captured the resource cost

differences between psychotherapy

provided by psychiatrists and that

provided by psychologists.

Additionally, one of these

commenters stated that it is illogical to

permit psychologists to be paid at 100

percent of the physician fee schedule for

comparable services using the same

malpractice expense RVUs assigned to

physician codes. Malpractice insurance

premiums for psychologists are as low

as 10 percent of the premiums charged

to leading psychiatrists. Even when

psychiatrists provide psychotherapy

without evaluation and management,

their professional standard of care

exceeds the standard of care applicable

to psychologists. Psychologists do not

have the same responsibility as

psychiatrists in terms of being

accountable for failure to furnish

medications or recognize a nonpsychiatric medical condition when

providing psychotherapy without

medical evaluation and management.
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59057

Accordingly, this commenter believes

that the malpractice expense and

practice expense associated with the

significantly higher standard of care

required of psychiatrists requires that

we set payment for psychologists’

services at less than 100 percent of the

physician fee schedule amount.

Response: The temporary

psychotherapy ‘‘G’’ HCFA Common

Procedure Coding System (HCPCS)

codes (G0071 through G0094) were

implemented as interim codes, and the

RUC-recommended RVUs for these

services were also considered as

interim. Although these temporary ‘‘G’’

codes will be crosswalked directly to

permanent numeric HCPCS codes

effective January 1, 1998, the codes and

the assigned RVUs will continue to be

considered interim.

We believe that, for the most part, we

have addressed the situation when

malpractice insurance premiums for

psychiatrists are higher than the cost of

malpractice insurance for psychologists

by establishing an entire set of

psychotherapy codes that are exclusive

to physicians that psychologists are

precluded from billing under the

Medicare program. We established this

set of codes because the services that

both physicians and psychologists can

furnish are probably not the services

that are contributing to the psychiatrist’s

higher malpractice costs. The services

that are reserved to physicians alone are

those involving medications and

complexities that would contribute to

the higher malpractice costs.

Comment: One commenter expressed

that it has a major concern about our

continued exclusion of psychologists

from the use of CPT evaluation and

management codes as well as the ‘‘G’’

HCPCS codes that encompass an

evaluation and management component.

The commenter believes that we should

remove our longstanding restriction on

the use of these codes by psychologists

and, instead, incorporate into our

coding system a realistic reflection of

the present day practice of psychology.

Moreover, the commenter believes

that since psychologists play an

important evaluative role, we should

seriously reconsider our longstanding

exclusionary policy and permit payment

to psychologists for evaluation and

management codes that represent

services that psychologists are already

providing under the Medicare program.

Response: We believe that the CPT

diagnostic psychological testing CPT

codes 96100 through 96117 and the CPT

psychotherapy codes 90801 through

90899 capture the range of mental

health services, including nonmedical

evaluation services, that clinical

psychologists are expected to provide

for purposes of the Medicare clinical

psychologist benefit and that clinical

psychologists are authorized by law to

furnish. The evaluation and

management services included in the

codes that psychologists cannot bill

Medicare are services involving medical

evaluation and management.

Psychologists are not licensed to

perform these types of services.

Result of evaluation of comments: We

are finalizing our proposal to maintain

the clinical psychologist fee schedule at

100 percent of the physician fee

schedule amount for comparable

services. The RVUs for individual

psychotherapy services remain in effect

on an interim basis.

D. Diagnostic Tests

1. Ordering of Diagnostic Tests

In our November 22, 1996 final rule

for the 1997 physician fee schedule (61

FR 59490), we revised § 410.32

(Diagnostic x-ray tests, diagnostic

laboratory tests, and other diagnostic

tests: Conditions) to state that, to be

covered, diagnostic tests had to be

ordered by the physician who treats the

patient. Section 410.32 contained

exceptions for x-rays used by

chiropractors to demonstrate the

subluxation of the spine and for certain

nonphysician practitioners operating

within the scope of their statutory

benefit and State licenses. We are

adding an additional exception to

§ 410.32 to indicate that a physician

who meets the qualification

requirements for an interpreting

physician under section 354 of the

Public Health Service Act as provided

in § 410.34 (Mammography services:

Conditions for and limitations on

coverage), paragraph (a)(7), may order a

diagnostic mammogram based on the

findings of a screening mammogram

even though the physician does not treat

the beneficiary. We believe this is

appropriate because the Food and Drug

Administration, rather than HCFA, is

responsible for the conditions under

which mammograms are covered. It

would also facilitate additional and

necessary diagnostic testing to

investigate suspicious findings at the

time the beneficiary is present at the

testing site rather than requiring the

beneficiary to return at a later date for

follow-up testing.

In addition, commenters have asked

about the statutory basis for denial of

claims under the ordering rule adopted

in the 1996 physician fee schedule final

rule. We have determined that tests are

not demonstrably reasonable and

medically necessary unless they are

ordered by the patient’s physician who

will employ the tests to manage the

patient’s care. Thus, we are clarifying in

§ 410.32(a) that the denials are based on

the exclusion in section 1862(a)(1)(A) of

the Act, and contained in § 411.15(k)(1),

that is, the services ‘‘are not reasonable

and necessary for the diagnosis and

treatment of illness or injury or to

improve the functioning of a malformed

body member.’’ Beneficiaries may be

protected from liability for claims

denied on this basis by the limitation on

liability provision of section 1879 of the

Act.

All commenters addressing the

proposal to permit certain physicians to

order a diagnostic mammogram based

on the findings of a screening

mammogram even though the physician

does not treat the beneficiary

enthusiastically supported the proposal.

We received no comments on the

proposal to clarify that denial of claims

by carriers because the tests were not

ordered by a physician who uses the

findings in the management of the

beneficiary’s care are based on the

reasonable and necessary exclusion in

section 1862(a)(1)(A) of the Act and in

§ 411.15(k)(1).

Below is a discussion of the public

comments we received on our proposal

relating to ordering of diagnostic tests

and our responses:

Comment: Several commenters

requested clarification of the

applicability of the diagnostic test

ordering provision, adopted in the final

rule of November 22, 1996, to diagnostic

procedures performed in hospital

settings: the responses to comments

seemed to indicate that, although the

intent of the new policy was primarily

directed at nonhospital testing, the

requirement applied in all settings.

Response: The policy was set forth in

§ 410.32, which generally addresses

diagnostic tests covered under section

1861(s)(3) of the Act and payable by Part

B carriers rather than fiscal

intermediaries. Regulations other than

§ 410.32 govern the coverage of

diagnostic tests furnished to hospital

patients, which are payable through

fiscal intermediary payment

mechanisms. Specifically, the coverage

of diagnostic tests furnished to hospital

outpatients is addressed in § 410.28, and

the coverage of diagnostic tests

furnished to hospital inpatients is

addressed in § 409.16. Therefore, the

test ordering policy adopted in the final

rule of November 22, 1996, effective for

procedures furnished beginning January

1, 1997, does not apply to diagnostic

tests furnished in hospitals.

Comment: A few commenters

expressed concern that manual sections
59058 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

implementing the ordering rule have not

been issued. One commenter indicated

that interpreting physicians are in the

untenable position of having to choose

between performing additional tests

they know the patient needs based on

the findings of the initial procedure or

postponing procedures to ensure that

they do not violate HCFA rules. Another

indicated that there are times that the

referring physician cannot be reached

and delaying a procedure would not be

in the best interests of the patient.

Response: In adopting the testordering proposal, we intended to

establish the general principle that, to

be covered under Medicare, a diagnostic

test must be ordered by a physician who

will use the findings in the medical

management of the patient. The policy

did not require that the order be in

writing or instruct carriers to investigate

claims prior to payment to ensure the

existence of such an order. It was

intended for use by carriers in situations

in which a problem has been identified,

or is strongly suspected, as a basis for

recovery of payments for tests that did

not meet the reasonable and necessary

criteria of section 1862(a)(1)(A) of the

Act. In the situations cited by the

commenters, we do not think it would

be unreasonable to ask for the testing

physician to receive authorization from

the ordering physician’s office (either by

phone or FAX) for the additional tests

he or she believes to be necessary.

Certainly, provision could be made for

an emergency situation. We are trying to

address situations in which there is a

pattern of the testing entity’s adding

procedures to those ordered by the

patient’s personal physician.

Comment: Commenters representing

the interests of entities that furnish

nuclear medicine procedures indicated

a continuing problem with the ordering

requirement and stated that nuclear

medicine physicians, by State and

Federal regulations, are the only

physicians who can actually order

nuclear medicine tests.

Response: We see no conflict between

our proposal and State and Federal

regulations. However, in order to

address these concerns more fully we

would need more specific information

as to the State and Federal regulations

in question.

Comment: A national organization

representing psychologists indicated

that § 410.32 addresses the ordering and

supervision of diagnostic tests and

objected to some of the wording relating

to nonphysician practitioners, such as

clinical psychologists. The commenter

pointed out that § 410.32(a)(3) indicates

that certain nonphysician practitioners

who furnish services that would be

physician services if furnished by a

physician, and who are operating within

the scope of their authority under State

law and within the scope of their

Medicare statutory benefit, ‘‘may be

treated the same as physicians treating

beneficiaries for the purpose of this

section.’’ The commenter suggested that

the wording be changed to ‘‘shall be

treated the same . . .’’ because, as

written, the wording does not require

that these individuals always be treated

as physicians for purposes of this

section.

Response: The commenter raises an

interesting point that we agree needs

further clarification. The purpose of

§ 410.32(a)(3) is to ensure that the

nonphysician practitioners in question

may order tests for the beneficiaries they

are treating. (We are adding the same

wording to the section on independent

diagnostic testing facilities (IDTFs) to

clarify that the nonphysician

practitioners in question may order

diagnostic testing by IDTFs.) However,

we did not intend to permit these same

nonphysician practitioners to supervise

diagnostic testing performed by others.

Under the rule we are adopting, all

diagnostic tests payable under the

physician fee schedule must be

performed under the supervision of a

physician (as defined in section 1861(r)

of the Act) with certain exceptions set

forth in § 410.32(b). Therefore, we are

modifying the wording of § 410.32(a)(3)

to change the last word from ‘‘section’’

to ‘‘paragraph.’’ In other words, the

nonphysician practitioners are treated

as physicians as far as the ordering of

tests for the patients they are treating is

concerned but not for the other subject

of § 410.32, that is, the supervision of

the performance of tests. (However,

certain nonphysician practitioners may

personally perform certain diagnostic

tests without physician supervision.

This subject is addressed in the

discussion of the comments on both the

physician supervision and IDTF

proposals.)

Result of evaluation of comments: We

are adopting the proposals (with the

wording clarification indicated above)

to (1) permit certain physicians to order

a diagnostic mammogram based on the

findings of a screening mammogram

even though the physician does not treat

the beneficiary and (2) clarify that

carrier denial of claims because the tests

were not ordered by a physician who

uses the findings in the management of

the beneficiary’s care are based on the

reasonable and necessary exclusion in

section 1862(a)(1)(A) of the Act and in

§ 411.15(k)(1).

2. Supervision of Diagnostic Tests

We are clarifying in § 410.32 the

policy on physician supervision of

diagnostic x-ray and other diagnostic

tests that are payable under the

physician fee schedule. (Diagnostic

procedures may be split into

professional components (PCs) and

technical components (TCs) or be TConly.) The clarification is applicable to

the TCs of diagnostic procedures

covered under section 1861(s)(3) of the

Act (whether billed separately or as part

of a ‘‘global’’ charge with the PC) that

are furnished in settings in which the

Part B carrier pays for the TCs under the

physician fee schedule. The coverage of

diagnostic procedures furnished to

hospital patients is addressed in other

regulations and is not affected by this

clarification. In addition, diagnostic

laboratory tests as described in

paragraph (d) of § 410.32 are not

affected by this clarification. This final

rule represents our judgment that

diagnostic procedures are safe and

effective only when they are furnished

with appropriate physician supervision.

Therefore, denials of claims for failure

to meet the required level of physician

supervision would be based on the

exclusion in section 1862(a)(1)(A) of the

Act and in § 411.15(k)(1), that is, they

‘‘are not reasonable and necessary for

the diagnosis and treatment of illness or

injury or to improve the functioning of

a malformed body member.’’ This

means that the beneficiary may be

protected under the limitation on

liability provisions in section 1879 of

the Act.

We believe that the requirements of

§ 410.32 should be revised because,

except for the reference to ‘‘other

diagnostic tests’’ in the heading of

§ 410.32, x-rays are the only diagnostic

tests payable under the physician fee

schedule that are discussed in the

current § 410.32. We are clarifying that

some degree of physician supervision is

required for every diagnostic test

payable under the physician fee

schedule with a few exceptions.

Our specific revisions to the

regulations are:

• The definition and discussion of the

term ‘‘general supervision’’ currently

appears only in § 410.32(a)(2)

(concerning portable x-ray services). We

are clarifying that this level of

supervision is the minimal level

required for all diagnostic tests payable

under the physician fee schedule unless

specific exception is made by

regulation.

• The definition and discussion of the

term ‘‘direct supervision’’ is set forth in

revised § 410.32(b)(3)(ii), concerning
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59059

diagnostic x-ray and other diagnostic

tests. We are clarifying that this level of

supervision is required for some types

of diagnostic procedures that are not xrays.

• We are incorporating into

regulations at § 410.32(b)(3)(iii) the

existing policy that there are some

diagnostic procedures that require a

physician’s presence with the patient at

the time of performance of the

procedure for the procedure to be

covered.

We are setting forth a general rule that

diagnostic tests payable under the

physician fee schedule require at least

general supervision (and in some cases

either direct or personal supervision, as

defined in this final rule) by a physician

(as defined in section 1861(r) of the

Act). Because of the restrictive

definitions in section 1861(r), we

believe that nearly all tests will be

supervised by doctors of medicine or

osteopathy, or, in the case of procedures

related to the eyes and consistent with

State licensure, doctors of optometry.

We do not perceive a significant impact

on doctors of dentistry and chiropractic

in this regard since Medicare covers

limited services for these specialties and

we believe diagnostic test supervision

will not be an issue for these specialties.

We are excluding three types of

diagnostic tests from the physician

supervision requirements:

• Diagnostic mammography

procedures, which are regulated by the

Food and Drug Administration.

• Diagnostic tests personally

furnished by a ‘‘qualified audiologist’’

as defined in section 1861(ll)(3) of the

Act. These include ‘‘audiology services’’

as defined in section 1861(ll)(2) of the

Act that are payable by Medicare

carriers under the physician fee

schedule. We are excluding these

diagnostic tests from the physician

supervision requirement because the

Congress has defined these services

without requiring physician supervision

of their performance.

• Diagnostic psychological testing

services personally performed by a

qualified psychologist practicing

independently of an institution, agency,

or physician’s office as currently

defined in section 2070.2 of the

Medicare Carriers Manual (HCFA Pub.

14–3). These services are distinguished

from services of clinical psychologists,

which are covered under section

1861(ii) of the Act, rather than section

1861(s)(3). We are excluding these tests

from the physician supervision

requirement because we do not believe

that these services require physician

supervision of their performance.

We are setting forth the policy that the

minimal level of physician supervision,

which is applicable to all diagnostic

procedures payable under the physician

fee schedule, with the exceptions cited

above, is general supervision. ‘‘General

supervision’’ means the procedure is

furnished under the physician’s overall

direction and control, but physician

presence is not required during the

performance of the procedure. Under

general supervision, the training of the

nonphysician personnel who actually

perform the diagnostic procedure and

the maintenance of the necessary

equipment and supplies are the

continuing responsibility of the

physician. Examples of procedures

requiring only general physician

supervision include the following:

• Plain films (x-rays) involving the

extremities, pelvis, vertebral column, or

skull.

• Plain films of the chest and

abdomen that do not involve the use of

contrast media.

• Electrocardiograms except when the

code description specifies physician

supervision such as with a

cardiovascular stress test.

• Ultrasound diagnostic procedures

except when the code description

specifies a physician’s service such as

the placement of a probe in the case of

transesophageal echocardiography.

• Electroencephalograms,

polysomnography, and sleep studies.

We are setting forth the policy that the

existing definition of ‘‘direct

supervision’’ in § 410.32 be applied to

types of services other than diagnostic

x-rays. ‘‘Direct supervision’’ in the office

setting does not mean that the physician

must be present in the room when the

procedure is performed; however, the

physician must be present in the office

suite and immediately available to

furnish assistance and direction

throughout the performance of the

procedure. Examples of diagnostic

procedures requiring both general and

direct supervision include the

following:

• Magnetic resonance imaging,

computerized axial tomography, and

nuclear medicine procedures.

• Procedures in which contrast

materials are used.

• X-rays other than skeletal,

abdominal, and chest x-rays cited in the

discussion of ‘‘general supervision.’’

We are defining ‘‘personal

supervision’’ as follows: ‘‘Personal

supervision’’ means a physician must be

in attendance in the room during the

performance of the procedure. Examples

of procedures requiring both general

and personal supervision include the

following:

• Cardiovascular stress tests

including those furnished with nuclear

medicine and echocardiography

procedures.

• Cardiac catheterization.

• Radiological supervision and

interpretation procedures.

Under the changes made to section

1861(s)(3) of the Act by section 145(b)

of Public Law 103–432, the Congress

has added diagnostic mammography as

part of the portable x-ray benefit.

Therefore, we are adding diagnostic

mammograms (but not screening

mammograms) to the list of services a

portable x-ray supplier may furnish in

§ 410.32(c). However, the supplier must

meet the certification requirements of

section 354 of the Public Health Service

Act, as implemented by 21 CFR part

900, subpart B.

These supervision requirements are

applicable only for diagnostic tests

under section 1861(s)(3) of the Act.

Other statutory provisions such as CLIA,

the physician self-referral rules, etc.,

which contain supervisory standards for

physicians, are not affected by this rule,

and continue to be required, if

applicable.

Several commenters who objected to

various aspects of the physician

supervision proposal were obviously

addressing procedures performed in

hospitals, and we would like to clarify

this situation for them. As pointed out

in the first paragraph of the preamble

discussion of this proposal in the June

18, 1997 proposed rule (62 FR 33179),

we proposed to modify and clarify the

policy in § 410.32 on physician

supervision of diagnostic procedures

that are covered under section

1861(s)(3) of the Act and payable under

the physician fee schedule. Regulations

other than § 410.32 govern the coverage

of diagnostic tests furnished to hospital

patients. Specifically, the coverage of

diagnostic tests furnished to hospital

outpatients is addressed in § 410.28, and

the coverage of diagnostic tests

furnished to hospital inpatients is

addressed in § 409.16. Further, this

proposal addressed the coverage of the

technical component (TC) (including

TCs billed with the professional

component (PC) of the procedure in a

global bill) and other diagnostic

procedures that are not split into PC or

TC components and that do not have

RVUs reflecting physician work.

Diagnostic services that have physician

work RVUs are not ‘‘other diagnostic

tests’’ covered under section 1861(s)(3)

of the Act but physician services and

services incident to a physician’s

services covered under sections

1861(s)(1) and 1861(s)(2)(A) of the Act.

These services are either personally
59060 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

furnished by the physician or furnished

as an ‘‘incident to’’ service. In both

cases, the policy has been established

and is unaffected by this rule. Either the

physician is present because he or she

is personally furnishing the service or,

in the case of ‘‘incident to’’ services, the

physician is in the suite (the same

standard as proposed for direct

supervision under the proposal) during

the time the diagnostic service is

performed. To summarize, neither the

technical services associated with

diagnostic tests furnished in hospitals

nor diagnostic service codes containing

physician work RVUs (other than global

billings) are affected by this proposal.

Comment: Many physician

commenters disagreed with our

proposal to place diagnostic ultrasound

procedures in the category of tests

requiring general supervision. We

received the following comments:

• Most ultrasound diagnostic

procedures should be placed in the

direct or personal supervision

categories. The requirement for general

supervision is not sufficient to achieve

the needed degree of physician input in

the final product of the ultrasound

examination.

• Good ultrasound can only be

performed through a working

partnership between the technologist

and the supervising physician.

Commenters pointed out that

radiologists frequently will examine the

patient in real time to clarify uncertain

findings or to further characterize

pathology detected during the

technologist’s examination. If the

physician does not go back to scan these

patients himself, critical diagnoses

would be missed. The common and

correct practice of ultrasound is for a

technologist to perform the examination

and for a physician to check the study

before the patient leaves the examining

area.

• The performance of ultrasound

procedures requires more physician

supervision than magnetic resonance

imaging (MRIs), computerized axial

tomography (CTs), or nuclear medicine

procedures.

• One commenter referred to

unregulated ultrasound procedures in

the U.S. as a ‘‘cesspool of poor medical

practice.’’

• One commenter suggested that

Medicare should prohibit payments for

self-referred sonographic procedures

performed by physicians who purchase

this equipment for their offices and find

reasons to use the equipment on their

patients even though they are poorlytrained in the interpretations of the

findings.

• Several physicians commented that

they often performed these tests

personally without a technologist

present.

Response: In developing our proposal

on levels of physician supervision for

out-of-hospital diagnostic testing, we

placed ultrasound procedures in the

general category on the basis that it was

safe to perform these procedures

without the presence, either in the room

or in the suite, of a physician. However,

in determining whether services and

procedures are reasonable and

necessary, we also consider whether a

service or procedure is effective. Based

on the comments we received on the

proposal, primarily from physicians

who utilize ultrasound procedures in

diagnosing patients, we have become

convinced that the effectiveness of

ultrasound procedures is enhanced

when the performance of these tests is

supervised by a physician who is not

only on-site when the procedure is

performed, but who also monitors the

performance of the procedure.

Therefore, we are modifying our

proposal and are placing ultrasound

diagnostic procedures in the direct

category that requires the presence of

the physician in the office suite when

an individual procedure is performed.

Comment: Some commenters objected

to our proposal to place CTs, MRIs, and

nuclear medicine procedures in the

category of procedures requiring the

direct supervision of a physician. Some

commenters indicated that CTs and

MRIs required direct supervision only

when contrast media are used to

perform the tests. Commenters

suggested that such a requirement

would cause a dramatic reduction in the

availability of these services furnished

through mobile entities in rural areas. It

was alleged that the physician

supervision requirements contradict

those established by the United States

Nuclear Regulatory Commission for

nuclear medicine procedures. Some

commenters indicated that some nuclear

medicine procedures required direct

supervision, some required only general

supervision, and some required a midlevel of supervision in which the

physician could monitor the

performance of the test by telephone.

Response: Based on the comments

received, we have decided to move the

required level of supervision for

computerized axial tomography

procedures (CTs) and magnetic

resonance imagery procedures (MRIs)

performed without the introduction of

contrast media into the category of

general supervision. We have become

convinced that general supervision by a

physician has become the established

standard of practice for CTs and MRIs

performed without contrast media. CT

and MRI procedures in which contrast

materials are utilized will remain in the

direct category. We are adopting our

proposal of direct supervision with

regard to all nuclear medicine

procedures. (Also, see comment below

addressing supervision of nuclear

cardiology procedures.)

Comment: Several commenters

objected to the assignment of

cardiovascular stress tests, including

those furnished with nuclear medicine

and echocardiography procedures, to

the category of tests requiring

performance under the personal

supervision of a physician. Their

comments included the following:

• Cardiovascular stress tests

performed by well-trained physician

extenders, such as registered nurses and

physician assistants, using established

protocols and under the direct

supervision of a physician have proved

to be safe and effective.

• The use of exercise physiologists,

B.S.N. degree nurses, or physician

assistants was the ‘‘standard of care’’ in

their hospital.

• In the absence of data to suggest

that direct supervision is less safe than

personal supervision, only direct

supervision should be required.

• The requirement is contrary to the

position of the American College of

Physicians, the American College of

Cardiology, and the American Heart

Association, set forth in a 1990 task

force statement that endorses the

position that ‘‘exercise testing in

selected patients can be safely

performed by properly trained nurses,

exercise physiologists, physical

therapists, or medical technicians

working directly under the supervision

of a physician who should be in the

immediate vicinity and available for

emergencies.’’

• The success of cardiac

rehabilitation programs has

demonstrated the success of

nonsupervised exercise in the cardiac

patient.

• One physician commenter agreed

with our placing of stress tests in the

personal supervision category and

indicated that personal physician

supervision was absolutely essential for

the safety of the patient and for the test

to be of maximal diagnostic utility.

Response: We do not agree with the

general tone of the comments. It is

established policy under Medicare that

cardiovascular stress tests must be

performed under the direct supervision

of a physician to be covered. (For

example, the interim teaching physician

instructions, issued June 28, 1996,
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59061

placed the procedures in the category of

complex and dangerous procedures

requiring the presence of a teaching

physician (rather than a resident) during

their performance.) In addition, we do

not believe that the reference to

‘‘exercise’’ and cardiac rehabilitation

programs is the same thing as a

cardiovascular stress test. With regard to

the 1990 task force statement by the

three organizations cited above, we

believe that the reference to ‘‘selected

patients’’ being safely tested by

nonphysicians is a telling one. It is not

at all clear to us that the appropriate

level for ‘‘selected patients’’ should be

the general standard applicable to all

patients, particularly patients in the age

group of most Medicare beneficiaries.

The circumstances surrounding

cardiovascular stress tests are unusual

because, although the issue at hand for

Medicare coverage purposes is the

supervision of the performance of the

technical component of the test, this

supervision is described by the AMA’s

CPT coding system with a specific code

(CPT code 93016) for use in billing for

physician supervision of cardiovascular

stress tests when the physician who

supervises the performance of the test

differs from the physician who bills for

the interpretation and report of the

procedure. This means that the inperson supervision by a physician of

this particular procedure has been

determined to be so essential that it was

necessary to establish a separate code

for it. This code should be billed in

connection with a stress test that will be

interpreted and used in the diagnosis of

the patient. It may not be used to bill for

‘‘supervision’’ of exercise in connection

with a cardiac rehabilitation program.

We firmly believe that there should be

a physician in attendance during the

performance of cardiovascular stress

tests to provide—

• Medical expertise required for the

performance of the test;

• Medical treatment for

complications and side effects of the

test;

• Medical services required as part of

the test, for example, injections or the

administration of medications; and

• Medical expertise in the

interpretation of the test (some of which

may have to be provided while the test

is actually being performed).

We do not believe that nonphysician

personnel, even well-trained personnel,

possess the knowledge and skills to

immediately address all complications

that may occur.

The reference to cardiovascular stress

tests performed in hospitals indicates a

misunderstanding of the physician

supervision proposal. This proposal

does not apply in hospitals; it only

applies in settings in which the TC of

the procedure is payable by the carrier.

However, even in hospitals, if a

physician wishes to bill the carrier for

the supervision of the procedure using

CPT code 93016 (a physician’s service

covered under section 1861(s)(1) of the

Act rather than a diagnostic test covered

under 1861(s)(3) of the Act), the

physician must have been present for

the performance of the test. It is our

view that the physician’s presence to

deal with emergencies, as well as the

other activities listed above, is the

service that CPT code 93016 describes

and the appropriate level of physician

supervision for cardiovascular stress

tests.

Comment: Several commenters

indicated that it was inappropriate to

require direct supervision of nuclear

cardiology imaging procedures.

Commenters indicated that these

procedures can be provided under the

general supervision of a nuclear

cardiologist who is close at hand (but

not in the suite during the performance

of the procedure) or through supervision

of the procedure through telemedicine.

This latter position was described as a

mid-level of physician supervision

between general and direct. One

commenter indicated that ready

availability (within minutes) was

sufficient to address any procedural,

clinical, or radiation safety concerns

that arise. One commenter indicated

that the proposal was not rational and

that the requirement for the physician to

be in the office during a nuclear

cardiology imaging procedure would

make excessive demands upon a

physician’s schedule flexibility. The

commenters indicated that no data exist

to show that nuclear cardiology imaging

provided with direct supervision was in

any way superior to this imaging

provided under general supervision.

Some commenters made a distinction

between their comments on the direct

level of supervision standard applicable

to nuclear cardiology procedures

generally (as well as all other nuclear

medicine procedures) and the personal

supervision standard applicable to

nuclear cardiology procedures involving

cardiovascular stress tests. The

commenters cited the passage from the

1990 American College of Physicians/

American College of Cardiology/

American Heart Association Task Force

quoted in the prior discussion on stress

tests to justify their position that some

level of physician supervision between

general and direct was all that was

required. Finally, some commenters

suggested that the goal of improving

quality while reducing costs to the

Medicare program would be better

served by tightening standards for

physicians eligible to be paid for the

procedures.

Response: As stated earlier in these

comments, we believe that direct

supervision is the minimum level for all

diagnostic tests involving the use of

contrast materials including the

radionuclides used in nuclear medicine

procedures. We are not persuaded by

the comments that there is something

about nuclear cardiology procedures

that should, instead, require only

general physician supervision. With

regard to the statement used to support

only general and direct physician

supervision for stress testing, we would

point out that the July 1997 American

College of Cardiology/American Heart

Association Guidelines for Exercise

Testing in its introduction states:

For the purpose of this document, exercise

testing is a cardiovascular stress test using

treadmill or bicycle exercise and

electrocardiographic and blood pressure

monitoring. Pharmacological stress and the

use of imaging modalities (radionuclide

imaging, echocardiography) are beyond the

scope of these guidelines. (Emphasis added.)

This statement leads us to believe that

the argument with respect to stress

testing of ‘‘selected patients’’ by

nonphysicians was being quoted out of

context with respect to nuclear

cardiology procedures. We are not

persuaded that our proposal was wrong,

and we are adopting the proposed

standards of physician supervision for

the procedures. When the nuclear

cardiology procedure in question

involves a stress test and separate

nuclear medicine and cardiovascular

codes are used, personal supervision is

required for the portion of the procedure

involving stress, and the direct

supervision standard applies to the

nuclear portions of the overall

procedure.

Comment: One commenter objected to

the term ‘‘other diagnostic tests’’ in the

title of § 410.32, questioned why x-rays

are listed, and suggested that the term

‘‘ultrasound’’ be specifically cited. The

commenter argued that the level of

supervision cannot be appropriately

indicated unless ultrasound is

specifically named and the tests

requiring supervision indicated.

Response: ‘‘X-rays and other

diagnostic tests’’ is the term used in

section 1861(s)(3) of the Act. We will

indicate the appropriate level of

supervision for a code in the data base,

as indicated above. With regard to

ultrasound procedures, direct

supervision is required.
59062 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

Comment: Several commenters

suggested that direct supervision be

defined to include the presence of a

physician in a remote office suite to

accommodate teleradiology. The

physician would review the

examination remotely, in real time, and

arrange for a response team to handle

patient care or contrast media

emergencies at the site where the

procedure is performed.

Response: Medicare currently pays for

the interpretation of diagnostic

procedures using images or other data

transmitted via teleradiology. We would

have to have more information about the

arrangement the commenters have in

mind, but, under the policy we are

adopting, a physician cannot

appropriately provide direct or personal

supervision of diagnostic tests through

telemedicine.

Comment: One commenter suggested

that, for uroradiology procedures, the

radiologist may not be present for the

entire procedure; however, because of

the use of contrast material, the

appropriate level of supervision is

direct.

Response: We have placed some

uroradiology procedures in the direct

category and others in the personal

category. This is consistent with our

general policy of requiring the presence

of the physician during the imaging

portion of any procedure described with

a supervision and interpretation code.

Comment: One commenter suggested

that the definition of ‘‘personal

supervision’’ be clarified to provide for

situations in which a radiologist must

leave the procedure room for either

clinical or safety reasons. The example

was given of a radiologist leaving the

procedure room during filming due to

radiation exposure.

Response: If it is the customary

practice for radiologists to leave the

room for a short period of time for safety

reasons to avoid radiation exposure, we

would, of course, have no problem with

them continuing to do so. We would

expect the supervising physician to be

present for all portions of the procedure

that do not present a safety problem.

Comment: One commenter asked for

clarification of whether the personal

supervision standard applicable to

cardiac stress tests should be required

for pulmonary stress tests. The example

of ambulating the patient to obtain

oxygen saturation for oxygen

recertification was given.

Response: We are not exactly sure of

the specific procedures about which the

commenter is inquiring. If it is CPT code

94620 (Pulmonary stress testing, simple

or complex), the level is personal. For

CPT codes 94760 through 94762 for

noninvasive oximetry, the level is

general.

Comment: A national organization

representing psychologists questioned

our decision not to provide an exception

from the physician supervision

requirement for procedures performed

by clinical psychologists in the same

way that we did for qualified

independent psychologists (who are not

clinical psychologists as defined in

Medicare instructions). They requested

that the rules be rewritten to clarify that

both types of psychologists may perform

services without physician supervision.

Response: Under our proposal, we

explained that we were regulating

diagnostic procedures covered under

section 1861(s)(3) of the Act and

payable under the physician fee

schedule. We provided an exception to

the physician supervision requirement

in the case of diagnostic psychological

testing services personally performed by

qualified independent psychologists

because these tests are covered under

section 1861(s)(3), and there had been

longstanding specific national coverage

policy in the Medicare Carriers Manual

regarding these billings without any

requirement for physician supervision.

We pointed out in the proposal that

diagnostic tests performed by clinical

psychologists (the same range of tests as

those that qualified independent

psychologists are permitted to bill) were

covered under section 1861(ii) of the

Act, rather than section 1861(s)(3), and

we meant to convey the point that

diagnostic tests performed by clinical

psychologists were unaffected by the

proposal. That is, clinical psychologists

could continue to perform these tests

without physician supervision. We were

concerned about the logical consistency

of providing an exception to a

requirement in the regulations for a

class of services to which that regulation

did not apply. However, to clarify the

policy, we have decided to explicitly

include diagnostic psychological testing

personally performed by clinical

psychologists in the exception to the

physician supervision requirement.

Comment: Several commenters

indicated that physical therapists have

performed electromyography

procedures consistent with State laws

for years without physician supervision.

They pointed out that eliminating the

availability of physical therapistprovided electromyography services

would create a severe hardship for

Medicare enrolles in rural areas.

Response: We did not intend to limit

access to care in rural areas, and

therefore, we have modified our

proposal to provide two additional

exceptions to the requirement for

physician supervision for diagnostic

procedures in which physical therapists

are involved. These exceptions apply to

codes in the range of CPT codes 95860

through 95937. Under one exception

with a physician fee schedule data base

indicator of 6, that is, the procedure

must be personally performed by a

physician or a physical therapist who is

certified by the American Board of

Physical therapy Specialties as a

qualified electrophysiologic clinical

specialist and is permitted to provide

the service under State law. Under the

second exception with a data base

indicator of 7, the procedure must be

personally performed by a physical

therapist who is certified by the

American Board of Physical Therapy

Specialties as a qualified

electrophysiologic clinical specialist or

performed under the direct supervision

of a physician. We recognize that these

categories were not contained in the

proposed rule and specifically invite

further comment on the appropriateness

of these two exceptions to the CPT

codes 95860 through 95937.

Comment: Several commenters

expressed support for the physician

supervision proposal but pointed out

that we should state by CPT code into

which category each procedure falls.

One commenter pointed to the lack of

specific information about the category

of physician supervision into which

pulmonary and neurology testing

procedures should be placed and

suggested that the final rule address

these procedures to promote

consistency among carriers.

Response: We are providing such a

listing as a part of this preamble. It will

become a part of the physician fee

schedule data base and may be modified

from time to time in the same way other

data base indicators are changed;

therefore, there should be consistency

among carriers.

Result of evaluation of comments: We

are adopting our proposal to assign an

appropriate level of physician

supervision to every diagnostic test

payable under the physician fee

schedule with exceptions for certain

procedures personally performed by

qualified independent psychologists,

clinical psychologists, qualified

audiologists, and physical therapists

who are certified as qualified

electrophysiologic clinical specialists.

With respect to several groupings of

diagnostic codes, we have changed our

proposed policy based on comments

from the physician specialties most

involved with particular groups of

codes. In some cases, such as CTs and

MRIs performed without the use of

contrast materials, we have lowered the
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59063

level of required physician supervision.

In others, such as ultrasound

procedures, we have increased the level

of required supervision. We are

publishing a listing of diagnostic codes

in this preamble with the level of

physician supervision we have

determined to be appropriate. In

addition, we are adding a field to the

physician fee schedule data base

indicating the appropriate level of

supervision. We anticipate that there

will continue to be discussions among

HCFA, physician specialty groups, and

others about these levels of supervision,

and we expect that the indicators

applicable to individual procedures will

be changed from time to time as is

currently the case with other data base

indicators.

Physician Fee Schedule Data Base

Indicator

Physician Supervision of Diagnostic

Procedures

0=Vacant

1=Procedure must be performed under

the general supervision of a

physician

2=Procedure must be performed under

the direct supervision of a

physician

3=Procedure must be performed under

the personal supervision of a

physician

4=Physician supervision policy does not

apply when procedure personally

furnished by a qualified,

independent psychologist or a

clinical psychologist; otherwise

must be performed under the

general supervision of a physician

5=Physician supervision policy does not

apply when procedure personally

furnished by a qualified audiologist;

otherwise must be performed under

the general supervision of a

physician

6=Procedure must be personally

performed by a physician OR a

physical therapist who is certified

by the American Board of Physical

Therapy Specialties as a qualified

electrophysiologic clinical

specialist AND is permitted to

provide the service under State law

7=Procedure must be personally

performed by a physical therapist

who is certified by the American

Board of Physical Therapy

Specialties as a qualified

electrophysiologic clinical

specialist AND is permitted to

provide the service under State law

OR performed under the direct

supervision of a physician

9=Medicare physician diagnostic

supervision policy does not apply

P=Decision pending

LEVEL OF PHYSICIAN SUPERVISION OF DIAGNOSTIC TESTS

HCPCS Level HCPCS Level HCPCS Level

DIAGNOSTIC RADIOLOGY

HEAD AND NECK

70010 & TC ................................ 3 70015 & TC .............................. 3 70030 & TC .............................. 1

70100 & TC ................................ 1 70110 & TC .............................. 1 70120 & TC .............................. 1

70130 & TC ................................ 1 70134 & TC .............................. 1 70140 & TC .............................. 1

70150 & TC ................................ 1 70160 & TC .............................. 1 70170 & TC .............................. 3

70190 & TC ................................ 1 70200 & TC .............................. 1 70210 & TC .............................. 1

70220 & TC ................................ 1 70240 & TC .............................. 1 70250 & TC .............................. 1

70260 & TC ................................ 1 70300 & TC .............................. 1 70310 & TC .............................. 1

70320 & TC ................................ 1 70328 & TC .............................. 1 70330 & TC .............................. 1

70332 & TC ................................ 3 70336 & TC .............................. 1 70350 & TC .............................. 1

70355 & TC ................................ 1 70360 & TC .............................. 1 70370 & TC .............................. 3

70371 & TC ................................ 3 70373 & TC .............................. 3 70380 & TC .............................. 1

70390 & TC ................................ 3 70450 & TC .............................. 1 70460 & TC .............................. 2

70470 & TC ................................ 2 70480 & TC .............................. 1 70481 & TC .............................. 2

70482 & TC ................................ 2 70486 & TC .............................. 1 70487 & TC .............................. 2

70488 & TC ................................ 2 70490 & TC .............................. 1 70491 & TC .............................. 2

70492 & TC ................................ 2 70540 & TC .............................. 1 70541 & TC .............................. 2

70551 & TC ................................ 1 70552 & TC .............................. 2 70553 & TC .............................. 2

CHEST

71010 & TC ................................ 1 71015 & TC .............................. 1 71020 & TC .............................. 1

71021 & TC ................................ 1 71022 & TC .............................. 1 71023 & TC .............................. 3

71030 & TC ................................ 1 71034 & TC .............................. 3 71035 & TC .............................. 1

71036 & TC ................................ 3 71038 & TC .............................. 3 71040 & TC .............................. 3

71060 & TC ................................ 3 71090 & TC .............................. 3 71100 & TC .............................. 1

71101 & TC ................................ 1 71110 & TC .............................. 1 71111 & TC .............................. 1

71120 & TC ................................ 1 71130 & TC .............................. 1 71250 & TC .............................. 1

71260 & TC ................................ 2 71270 & TC .............................. 2 71550 & TC .............................. 1

71555 & TC ................................ 9

SPINE AND PELVIS

72010 & TC ................................ 1 72020 & TC .............................. 1 72040 & TC .............................. 1

72050 & TC ................................ 1 72052 & TC .............................. 1 72069 & TC .............................. 1

72070 & TC ................................ 1 72072 & TC .............................. 1 72074 & TC .............................. 1

72080 & TC ................................ 1 72090 & TC .............................. 1 72100 & TC .............................. 1

72110 & TC ................................ 1 72114 & TC .............................. 1 72120 & TC .............................. 1

72125 & TC ................................ 1 72126 & TC .............................. 2 72127 & TC .............................. 2

72128 & TC ................................ 1 72129 & TC .............................. 2 72130 & TC .............................. 2

72131 & TC ................................ 1 72132 & TC .............................. 2 72133 & TC .............................. 2

72141 & TC ................................ 1 72142 & TC .............................. 2 72146 & TC .............................. 1
59064 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

LEVEL OF PHYSICIAN SUPERVISION OF DIAGNOSTIC TESTS—Continued

HCPCS Level HCPCS Level HCPCS Level

72147 & TC ................................ 2 72148 & TC .............................. 1 72149 & TC .............................. 2

72156 & TC ................................ 2 72157 & TC .............................. 2 72158 & TC .............................. 2

72159 & TC ................................ 9 72170 & TC .............................. 1 72190 & TC .............................. 1

72192 & TC ................................ 1 72193 & TC .............................. 2 72194 & TC .............................. 2

72196 & TC ................................ 1 72198 & TC .............................. 9 72200 & TC .............................. 1

72202 & TC ................................ 1 72220 & TC .............................. 1 72240 & TC .............................. 3

72255 & TC ................................ 3 72265 & TC .............................. 3 72270 & TC .............................. 3

72285 & TC ................................ 3 72295 & TC .............................. 3

UPPER EXTREMITIES

73000 & TC ................................ 1 73010 & TC .............................. 1 73020 & TC .............................. 1

73030 & TC ................................ 1 73040 & TC .............................. 3 73050 & TC .............................. 1

73060 & TC ................................ 1 73070 & TC .............................. 1 73080 & TC .............................. 1

73085 & TC ................................ 3 73090 & TC .............................. 1 73092 & TC .............................. 1

73100 & TC ................................ 1 73110 & TC .............................. 1 73115 & TC .............................. 3

73120 & TC ................................ 1 73130 & TC .............................. 1 73140 & TC .............................. 1

73200 & TC ................................ 1 73201 & TC .............................. 2 73202 & TC .............................. 2

73220 & TC ................................ 1 73221 & TC .............................. 1 73225 & TC .............................. 9

LOWER EXTREMITIES

73500 & TC ................................ 1 73510 & TC .............................. 1 73520 & TC .............................. 1

73525 & TC ................................ 3 73530 & TC .............................. 3 73540 & TC .............................. 1

73550 & TC ................................ 3 73560 & TC .............................. 1 73562 & TC .............................. 1

73564 & TC ................................ 1 73565 & TC .............................. 1 73580 & TC .............................. 3

73590 & TC ................................ 1 73592 & TC .............................. 1 73600 & TC .............................. 1

73610 & TC ................................ 1 73615 & TC .............................. 3 73620 & TC .............................. 1

73630 & TC ................................ 1 73650 & TC .............................. 1 73660 & TC .............................. 1

73700 & TC ................................ 1 73701 & TC .............................. 2 73702 & TC .............................. 2

73720 & TC ................................ 1 73721 & TC .............................. 1 73725 & TC .............................. 2

ABDOMEN

74000 & TC ................................ 1 74010 & TC .............................. 1 74020 & TC .............................. 1

74022 & TC ................................ 1 74150 & TC .............................. 1 74160 & TC .............................. 2

74170 & TC ................................ 2 74181 & TC .............................. 1 74185 & TC .............................. 9

74190 & TC ................................ 3

GASTROINTESTINAL TRACT

74210 & TC ................................ 3 74220 & TC .............................. 3 74230 & TC .............................. 3

74235 & TC ................................ 3 74240 & TC .............................. 3 74241 & TC .............................. 3

74245 & TC ................................ 3 74246 & TC .............................. 3 74247 & TC .............................. 3

74249 & TC ................................ 3 74250 & TC .............................. 2 74251 & TC .............................. 3

74260 & TC ................................ 3 74270 & TC .............................. 3 74280 & TC .............................. 3

74283 & TC ................................ 3 74290 & TC .............................. 2 74291 & TC .............................. 2

74300 & TC ................................ 3 74301 & TC .............................. 3 74305 & TC .............................. 3

74320 & TC ................................ 3 74327 & TC .............................. 3 74328 & TC .............................. 3

74329 & TC ................................ 3 74330 & TC .............................. 3 74340 & TC .............................. 3

74350 & TC ................................ 3 74355 & TC .............................. 3 74360 & TC .............................. 3

74363 & TC ................................ 3

URINARY TRACT

74400 & TC ................................ 2 74405 & TC .............................. 2 74410 & TC .............................. 2

74415 & TC ................................ 2 74420 & TC .............................. 3 74425 & TC .............................. 3

74430 & TC ................................ 3 74440 & TC .............................. 3 74445 & TC .............................. 3

74450 & TC ................................ 3 74455 & TC .............................. 3 74470 & TC .............................. 3

74475 & TC ................................ 3 74480 & TC .............................. 3 74485 & TC .............................. 3

GYNECOLOGICAL AND OBSTETRICAL

74710 & TC ................................ 1 74740 & TC .............................. 3 74742 & TC .............................. 3

74775 & TC ................................ 3

HEART

75552 & TC ................................ 1 75553 & TC .............................. 2 75554 & TC .............................. 1

75555 & TC ................................ 1 75556 ........................................ 9
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59065

LEVEL OF PHYSICIAN SUPERVISION OF DIAGNOSTIC TESTS—Continued

HCPCS Level HCPCS Level HCPCS Level

AORTA AND ARTERIES

75600 & TC ................................ 3 75605 & TC .............................. 3 75625 & TC .............................. 3

75630 & TC ................................ 3 75650 & TC .............................. 3 75658 & TC .............................. 3

75660 & TC ................................ 3 75662 & TC .............................. 3 75665 & TC .............................. 3

75671 & TC ................................ 3 75676 & TC .............................. 3 75680 & TC .............................. 3

75685 & TC ................................ 3 75705 & TC .............................. 3 75710 & TC .............................. 3

75716 & TC ................................ 3 75722 & TC .............................. 3 75724 & TC .............................. 3

75726 & TC ................................ 3 75731 & TC .............................. 3 75733 & TC .............................. 3

75736 & TC ................................ 3 75741 & TC .............................. 3 75743 & TC .............................. 3

75746 & TC ................................ 3 75756 & TC .............................. 3 75774 & TC .............................. 3

75790 & TC ................................ 3

VEINS AND LYMPHATICS

75801 & TC ................................ 3 75803 & TC .............................. 3 75805 & TC .............................. 3

75807 & TC ................................ 3 75809 & TC .............................. 3 75810 & TC .............................. 3

75820 & TC ................................ 3 75822 & TC .............................. 3 75825 & TC .............................. 3

75827 & TC ................................ 3 75831 & TC .............................. 3 75833 & TC .............................. 3

75840 & TC ................................ 3 75842 & TC .............................. 3 75860 & TC .............................. 3

75870 & TC ................................ 3 75872 & TC .............................. 3 75880 & TC .............................. 3

75885 & TC ................................ 3 75887 & TC .............................. 3 75889 & TC .............................. 3

75891 & TC ................................ 3 75893 & TC .............................. 3

TRANSCATHETER PROCEDURES

75894 & TC ................................ 3 75896 & TC .............................. 3 75898 & TC .............................. 3

75900 & TC ................................ 3 75940 & TC .............................. 3 75945 & TC .............................. 3

75946 & TC ................................ 3 75960 & TC .............................. 3 75961 & TC .............................. 3

75962 & TC ................................ 3 75964 & TC .............................. 3 75966 & TC .............................. 3

75968 & TC ................................ 3 75970 & TC .............................. 3 75978 & TC .............................. 3

75980 & TC ................................ 3 75982 & TC .............................. 3 75984 & TC .............................. 3

75989 & TC ................................ 3

TRANSLUMINAL ATHERECTOMY

75992 & TC ................................ 3 75993 & TC .............................. 3 75994 & TC .............................. 3

75995 & TC ................................ 3 75996 & TC .............................. 3

OTHER PROCEDURES

76000 & TC ................................ 3 76001 & TC .............................. 3 76003 & TC .............................. 3

76010 & TC ................................ 1 76020 & TC .............................. 1 76040 & TC .............................. 1

76061 & TC ................................ 1 76062 & TC .............................. 1 76065 & TC .............................. 1

76066 & TC ................................ 1 76070 & TC .............................. 1

76075 & TC ................................ 1 76076 & TC .............................. 1 76078 & TC .............................. 1

76080 & TC ................................ 3 76086 & TC .............................. 3 76088 & TC .............................. 3

76090 & TC ................................ 9 76091 & TC .............................. 9 76092 ........................................ 9

76093 & TC ................................ 1 76094 & TC .............................. 1 76095 & TC .............................. 3

76096 & TC ................................ 3 76098 & TC .............................. 1 76100 & TC .............................. 2

76101 & TC ................................ 2 76102 & TC .............................. 2 76120 & TC .............................. 2

76125 & TC ................................ 2 76140 ........................................ 9 76150 ........................................ 1

76350 ......................................... 2 76355 & TC .............................. 3 76360 & TC .............................. 3

76365 & TC ................................ 3 76370 & TC .............................. 2 76375 & TC .............................. 1

76380 & TC ................................ 1 76400 & TC .............................. 1 76499 & TC .............................. 9

DIAGNOSTIC ULTRASOUND

HEAD AND NECK

76506 & TC ................................ 2 76511 & TC .............................. 2 76512 & TC .............................. 2

76513 & TC ................................ 2 76516 & TC .............................. 2 76519 & TC .............................. 2

76529 & TC ................................ 2 76536 & TC .............................. 2 ..............................................

CHEST

76604 & TC ................................ 2 76645 & TC .............................. 2

ABDOMEN AND RETROPERITONEUM

76700 & TC ................................ 2 76705 & TC .............................. 2 76770 & TC .............................. 2

76775 & TC ................................ 2 76778 & TC .............................. 2 ..............................................
59066 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

LEVEL OF PHYSICIAN SUPERVISION OF DIAGNOSTIC TESTS—Continued

HCPCS Level HCPCS Level HCPCS Level

SPINAL CANAL

76800 & TC ................................ 2

PELVIS

76805 & TC ................................ 2 76810 & TC .............................. 2 76815 & TC .............................. 2

76816 & TC ................................ 2 76818 & TC .............................. 2 76825 & TC .............................. 2

76826 & TC ................................ 2 76827 & TC .............................. 2 76828 & TC .............................. 2

76830 & TC ................................ 3 76856 & TC .............................. 2 76857 & TC .............................. 2

76870 & TC ................................ 2 76872 & TC .............................. 3 ..............................................

EXTREMITIES

76880 & TC ................................ 2

VASCULAR STUDIES

ULTRASONIC GUIDANCE PROCEDURES

76930 & TC ................................ 3 76932 & TC .............................. 3 76934 & TC .............................. 3

76936 & TC ................................ 3 76938 & TC .............................. 3 76941 & TC .............................. 3

76942 & TC ................................ 3 76945 & TC .............................. 3 76946 & TC .............................. 3

76948 & TC ................................ 3 76950 & TC .............................. 2 76960 & TC .............................. 2

76965 & TC ................................ 3 .............................................. ..............................................

OTHER PROCEDURES

76970 & TC ................................ 9 76975 & TC .............................. 3 76986 & TC .............................. 3

76999 & TC ................................ 9 .............................................. ..............................................

RADIATION ONCOLOGY

77417 ......................................... 1

DIAGNOSTIC NUCLEAR MEDICINE

ENDOCRINE SYSTEM

78000 & TC ................................ 2 78001 & TC .............................. 2 78003 & TC .............................. 2

78006 & TC ................................ 2 78007 & TC .............................. 2 78010 & TC .............................. 2

78011 & TC ................................ 2 78015 & TC .............................. 2 78016 & TC .............................. 2

78017 & TC ................................ 2 78018 & TC .............................. 2 78070 & TC .............................. 2

78075 & TC ................................ 2 78099 & TC .............................. 9 ..............................................

HEMATOPOIETIC, RETICULOENDOTHELIAL, AND LYMPHATIC SYSTEM

78102 & TC ................................ 2 78103 & TC .............................. 2 78104 & TC .............................. 2

78110 & TC ................................ 2 78111 & TC .............................. 2 78120 & TC .............................. 2

78121 & TC ................................ 2 78122 & TC .............................. 2 78130 & TC .............................. 2

78135 & TC ................................ 2 78140 & TC .............................. 2 78160 & TC .............................. 2

78162 & TC ................................ 2 78170 & TC .............................. 2 78172 & TC .............................. 2

78185 & TC ................................ 2 78190 & TC .............................. 2 78191 & TC .............................. 2

78195 & TC ................................ 2 78199 & TC .............................. 9 ..............................................

GASTROINTESTINAL SYSTEM

78201 & TC ................................ 2 78202 & TC .............................. 2 78205 & TC .............................. 2

78215 & TC ................................ 2 78216 & TC .............................. 2 78220 & TC .............................. 2

78223 & TC ................................ 2 78230 & TC .............................. 2 78231 & TC .............................. 2

78232 & TC ................................ 2 78258 & TC .............................. 2 78261 & TC .............................. 2

78262 & TC ................................ 2 78264 & TC .............................. 2 78270 & TC .............................. 2

78271 & TC ................................ 2 78272 & TC .............................. 2 78278 & TC .............................. 2

78282 & TC ................................ 2 78290 & TC .............................. 2 78291 & TC .............................. 2

78299 & TC ................................ 9 .............................................. ..............................................

MUSCULOSKELETAL SYSTEM

78300 & TC ................................ 2 78305 & TC .............................. 2 78306 & TC .............................. 2

78315 & TC ................................ 2 78320 & TC .............................. 2 78350 & TC .............................. 2

78351 ......................................... 9 78399 & TC .............................. 9 ..............................................
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59067

LEVEL OF PHYSICIAN SUPERVISION OF DIAGNOSTIC TESTS—Continued

HCPCS Level HCPCS Level HCPCS Level

CARDIOVASCULAR SYSTEM

78414 & TC ................................ 2 78428 & TC .............................. 2 78445 & TC .............................. 2

78455 & TC ................................ 2 78457 & TC .............................. 2 78458 & TC .............................. 2

78459 & TC ................................ 9 78460 & TC .............................. 2 78461 & TC .............................. 2

78464 & TC ................................ 2 78465 & TC .............................. 2 78466 & TC .............................. 2

78468 & TC ................................ 2 78469 & TC .............................. 2 78472 & TC .............................. 2

78473 & TC ................................ 2 78478 & TC .............................. 2 78480 & TC .............................. 2

78481 & TC ................................ 2 78483 & TC .............................. 2 78499 & TC .............................. 9

RESPIRATORY SYSTEM

78580 & TC ................................ 2 78584 & TC .............................. 2 78585 & TC .............................. 2

78586 & TC ................................ 2 78587 & TC .............................. 2 78591 & TC .............................. 2

78593 & TC ................................ 2 78594 & TC .............................. 2 78596 & TC .............................. 2

78599 & TC ................................ 9

NERVOUS SYSTEM

78600 & TC ................................ 2 78601 & TC .............................. 2 78605 & TC .............................. 2

78606 & TC ................................ 2 78607 & TC .............................. 2 78608 ........................................ 9

78609 ......................................... 9 78610 & TC .............................. 2 78615 & TC .............................. 2

78630 & TC ................................ 2 78635 & TC .............................. 2 78645 & TC .............................. 2

78647 & TC ................................ 2 78650 & TC .............................. 2 78660 & TC .............................. 2

78699 & TC ................................ 9

GENITOURINARY SYSTEM

78700 & TC ................................ 2 78701 & TC .............................. 2 78704 & TC .............................. 2

78707 & TC ................................ 2 78710 & TC .............................. 2 78715 & TC .............................. 2

78725 & TC ................................ 2 78726 & TC .............................. 2 78727 & TC .............................. 2

78730 & TC ................................ 2 78740 & TC .............................. 2 78760 & TC .............................. 2

78761 & TC ................................ 2 78799 & TC .............................. 9

OTHER DIAGNOSTIC NUCLEAR MEDICINE PROCEDURES

78800 & TC ................................ 2 78801 & TC .............................. 2 78802 & TC .............................. 2

78803 & TC ................................ 2‘ 78805 & TC .............................. 2 78806 & TC .............................. 2

78807 & TC ................................ 2 78810 & TC .............................. 9 78891 & TC .............................. 9

78990 ......................................... 9 78999 & TC .............................. 9

PATHOLOGY AND LABORATORY

85060 ......................................... 9 85095 ........................................ 9 85102 ........................................ 9

86485 ......................................... 1 86490 ........................................ 1 86510 ........................................ 1

86580 ......................................... 1 86585 ........................................ 1 86586 ........................................ 9

88104 & TC ................................ 9 88106 & TC .............................. 9 88107 & TC .............................. 9

88108 & TC ................................ 9 88125 & TC .............................. 1 88160 & TC .............................. 9

88161 & TC ................................ 9 88162 & TC .............................. 9 88170 & TC .............................. 1

88171 & TC ................................ 1 88172 & TC .............................. 9 88173 & TC .............................. 9

88180 & TC ................................ 9 88182 & TC .............................. 9 88300 & TC .............................. 9

88302 & TC ................................ 9 88304 & TC .............................. 9 88305 & TC .............................. 9

88307 & TC ................................ 9 88309 & TC .............................. 9 88311 & TC .............................. 1

88312 & TC ................................ 9 88313 & TC .............................. 9 88314 & TC .............................. 9

88318 & TC ................................ 9 88319 & TC .............................. 9 88323 & TC .............................. 9

88331 & TC ................................ 9 88332 & TC .............................. 9 88342 & TC .............................. 9

88346 & TC ................................ 9 88347 & TC .............................. 9 88348 & TC .............................. 9

88349 & TC ................................ 9 88355 & TC .............................. 9 88356 & TC .............................. 9

88358 & TC ................................ 9 88362 & TC .............................. 9 88365 & TC .............................. 9

89350 ......................................... 1 89360 ........................................ 9

MEDICINE

GASTROINTESTINAL

91000 & TC ................................ 3 91010 & TC .............................. 3 91011 & TC .............................. 3

91012 & TC ................................ 3 91020 & TC .............................. 3 91030 & TC .............................. 3

91032 & TC ................................ 3 91033 & TC .............................. 3 91052 & TC .............................. 3

91055 & TC ................................ 3 91060 & TC .............................. 3 91065 & TC .............................. 1

91100 ......................................... 9 91105 ........................................ 9 91122 & TC .............................. 3
59068 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

LEVEL OF PHYSICIAN SUPERVISION OF DIAGNOSTIC TESTS—Continued

HCPCS Level HCPCS Level HCPCS Level

SPECIAL OPHTHALMOLOGICAL SERVICES

92015 ......................................... 9 92081 & TC .............................. 1 92082 & TC .............................. 1

92083 & TC ................................ 1 92100 ........................................ 9 92120 ........................................ 9

92130 ......................................... 9 92140 ........................................ 9 92230 ........................................ 9

92235 & TC ................................ 2 92240 & TC .............................. 2 92250 & TC .............................. 2

92260 ......................................... 9

OTHER SPECIALIZED SERVICES

92265 & TC ................................ 3 92270 & TC .............................. 3 92275 & TC .............................. 3

92283 & TC ................................ 1 92284 & TC .............................. 3 92285 & TC .............................. 2

92286 & TC ................................ 3 92287 ........................................ 9

SPECIAL OTORHINOLARYNGOLOGIC SERVICES

92506 ......................................... 9 92507 ........................................ 9 92508 ........................................ 9

92511 ......................................... 9 92512 ........................................ 9 92516 ........................................ 9

92520 ......................................... 9 92525 ........................................ 9 92526 ........................................ 9

VESTIBULAR FUNCTION TESTS WITH OBSERVATION

92531 ......................................... 9 92532 ........................................ 9 92533 ........................................ 9

92534 ......................................... 9

VESTIBULAR FUNCTION TESTS WITH OBSERVATION

92531 ......................................... 9 92532 ........................................ 9 92533 ........................................ 9

92534 ......................................... 9

VESTIBULAR FUNCTION TESTS WITH RECORDING

92541 & TC ................................ 2 92542 & TC .............................. 2 92543 & TC .............................. 2

92544 & TC ................................ 2 92545 & TC .............................. 2 92546 & TC .............................. 2

92547 ......................................... 2 92548 & TC .............................. 2

AUDIOLOGIC FUNCTION TESTS

92551 ......................................... 9 92552 ........................................ 5 92553 ........................................ 5

92555 ......................................... 5 92556 ........................................ 5 92557 ........................................ 5

92559 ......................................... 9 92560 ........................................ 9 92561 ........................................ 5

92562 ......................................... 5 92563 ........................................ 5 92564 ........................................ 5

92565 ......................................... 5 92567 ........................................ 5 92568 ........................................ 5

92569 ......................................... 5 92571 ........................................ 5 92572 ........................................ 5

92573 ......................................... 5 92575 ........................................ 5 92576 ........................................ 5

92577 ......................................... 5 92579 ........................................ 5 92582 ........................................ 5

92583 ......................................... 5 92584 ........................................ 5 92585 & TC .............................. 5

92587 & TC ................................ 5 92588 & TC .............................. 5 92589 ........................................ 5

92590 ......................................... 9 92591 ........................................ 9 92592 ........................................ 9

92593 ......................................... 9 92594 ........................................ 9 92595 ........................................ 9

92596 ......................................... 5 92597 ........................................ 9 92598 ........................................ 9

CARDIOGRAPHY

93000 ......................................... 1 93005 ........................................ 1 93010 ........................................ 9

93012 ......................................... 1 93014 ........................................ 9 93015 ........................................ 3

93016 ......................................... 3 93017 ........................................ 3 93018 ........................................ 9

93024 & TC ................................ 3 93040 ........................................ 1 93041 ........................................ 1

93042 ......................................... 9 93224 ........................................ 1 93225 ........................................ 1

93226 ......................................... 1 93227 ........................................ 9 93230 ........................................ 1

93231 ......................................... 1 93232 ........................................ 9 93233 ........................................ 9

93235 ......................................... 1 93236 ........................................ 1 93237 ........................................ 9

93268 ......................................... 1 93270 ........................................ 1 93271 ........................................ 1

93272 ......................................... 9 93278 & TC .............................. 1

ECHOCARDIOGRAPHY

93303 & TC ................................ 2 93304 & TC .............................. 2 93307 ........................................ 2

93308 & TC ................................ 2 93312 & TC .............................. 3 93313 ........................................ 9

93314 ......................................... 9 93315 & TC .............................. 3 93316 ........................................ 9

93317 ......................................... 9 93320 & TC .............................. 2 93321 & TC .............................. 2

93325 & TC ................................ 2 93350 & TC .............................. 3
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59069

LEVEL OF PHYSICIAN SUPERVISION OF DIAGNOSTIC TESTS—Continued

HCPCS Level HCPCS Level HCPCS Level

CARDIAC CATHETERIZATION

93501 & TC ................................ 3 93503 ........................................ 9 93505 & TC .............................. 3

93510 & TC ................................ 3 93511 & TC .............................. 3 93514 & TC .............................. 3

93524 & TC ................................ 3 93526 & TC .............................. 3 93527 & TC .............................. 3

93528 & TC ................................ 3 93529 & TC .............................. 3 93536 ........................................ 9

93539 ......................................... 9 93540 ........................................ 9 93541 ........................................ 9

93542 ......................................... 9 93543 ........................................ 9 93544 ........................................ 9

93545 ......................................... 9 93555 & TC .............................. 3 93556 & TC .............................. 3

93561 & TC ................................ 3 93562 & TC .............................. 3

INTRACARDIAC ELECTROPHYSIOLOGICAL PROCEDURES

93600 & TC ................................ 3 93602 & TC .............................. 3 93603 & TC .............................. 3

93607 & TC ................................ 3 93609 & TC .............................. 3 93610 & TC .............................. 3

93612 & TC ................................ 3 93615 & TC .............................. 3 93616 & TC .............................. 3

93618 & TC ................................ 3 93619 & TC .............................. 3 93620 & TC .............................. 3

93621 & TC ................................ 3 93622 & TC .............................. 3 93623 & TC .............................. 3

93624 & TC ................................ 3 93631 & TC .............................. 3 93640 & TC .............................. 3

93641 & TC ................................ 3 93642 & TC .............................. 3 93650 ........................................ 9

93651 ......................................... 9 93652 ........................................ 9 93660 & TC .............................. 3

OTHER VASCULAR STUDIES

93720 ......................................... 1 93721 ........................................ 1 93722 ........................................ 9

93724 & TC ................................ 3 93731 ........................................ 2 93732 ........................................ 3

93733 & TC ................................ 2 93734 & TC .............................. 2 93735 & TC .............................. 3

93736 & TC ................................ 2 93737 & TC .............................. 3 93738 & TC .............................. 3

93740 & TC ................................ 2 93760 ........................................ 9 93762 ........................................ 9

93770 & TC ................................ 3 93784 ........................................ 9 93786 ........................................ 9

93788 ......................................... 9 93790 ........................................ 9

CEREBROVASCULAR ARTERIAL STUDIES

93875 & TC ................................ 2 93880 & TC .............................. 2 93882 & TC .............................. 2

93886 & TC ................................ 2 93888 & TC .............................. 2

EXTREMITY ARTERIAL STUDIES

.

93922 & TC ................................ 2 93923 & TC .............................. 2 93924 & TC .............................. 2

93925 & TC ................................ 2 93926 & TC .............................. 2 93930 & TC .............................. 2

93931 & TC ................................ 2

EXTREMITY VENOUS STUDIES

93965 & TC ................................ 2 93970 & TC .............................. 2 93971 & TC .............................. 2

VISCERAL AND PENILE VASCULAR STUDIES

93975 & TC ................................ 2 93976 & TC .............................. 2 93978 & TC .............................. 2

93979 & TC ................................ 2 93980 & TC .............................. 2 93981 & TC .............................. 2

PULMONARY

94010 & TC ................................ 1 ................................................... .................... 94070 & TC .............................. 3

94150 & TC ................................ 9 94200 & TC .............................. 1 94240 & TC .............................. 1

94250 & TC ................................ 1 94260 & TC .............................. 1 94350 & TC .............................. 1

94360 & TC ................................ 1 94370 & TC .............................. 1 94375 & TC .............................. 1

94400 & TC ................................ 2 94450 & TC .............................. 2 94620 & TC .............................. 3

94640 ......................................... 9 94642 ........................................ 9 94650 ........................................ 9

94651 ......................................... 9 94652 ........................................ 9 94656 ........................................ 9

94657 ......................................... 9 94660 ........................................ 9 94662 ........................................ 9

94664 ......................................... 2 94665 ........................................ 2 94667 ........................................ 9

94668 ......................................... 9 94680 & TC .............................. 2 94681 & TC .............................. 2

94690 & TC ................................ 1 94720 & TC .............................. 1 94725 & TC .............................. 1

94750 & TC ................................ 1 94760 ........................................ 1 94761 ........................................ 1

94762 ......................................... 1 94770 & TC .............................. 1 94772 & TC .............................. 1

94799 & TC ................................ 9

ALLERGY

95004 ......................................... 2 95010 ........................................ 9 95015 ........................................ 9
59070 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

LEVEL OF PHYSICIAN SUPERVISION OF DIAGNOSTIC TESTS—Continued

HCPCS Level HCPCS Level HCPCS Level

95024 ......................................... 2 95027 ........................................ 2 95028 ........................................ 2

95044 ......................................... 2 95052 ........................................ 2 95056 ........................................ 2

95060 ......................................... 3 95065 ........................................ 3 95070 ........................................ 3

95071 ......................................... 3 95075 ........................................ 9 95078 ........................................ 3

NEUROLOGY AND NEUROMUSCULAR PROCEDURES

SLEEP TESTING

95805 & TC ................................ 1 95807 & TC .............................. 1 95808 & TC .............................. 1

95810 & TC ................................ 1 95812 & TC .............................. 1 95813 & TC .............................. 1

95816 & TC ................................ 2 95819 & TC .............................. 2 95822 & TC .............................. 1

95824 & TC ................................ 1 95827 & TC .............................. 1 95829 & TC .............................. 1

95830 ......................................... 9 95831 ........................................ 9 95832 ........................................ 9

95833 ......................................... 9 95834 ........................................ 9 95851 ........................................ 9

95852 ......................................... 9 95857 ........................................ 9 95858 & TC .............................. 3

95860 & TC ................................ 6 95861 & TC .............................. 6 95863 & TC .............................. 6

95864 & TC ................................ 6 95867 & TC .............................. 6 95868 & TC .............................. 6

95869 & TC ................................ 6 95870 & TC .............................. 6 95872 & TC .............................. 3

95875 & TC ................................ 3

95900 & TC ................................ 7 95903 & TC .............................. 7 95904 & TC .............................. 7

95920 & TC ................................ 2 95921 & TC .............................. 2 95922 & TC .............................. 3

95923 & TC ................................ 3 95925 & TC .............................. 2 95926 & TC .............................. 2

95927 & TC ................................ 2 95930 & TC .............................. 2 95933 & TC .............................. 7

95934 & TC ................................ 7 95936 & TC .............................. 7 95937 & TC .............................. 7

95950 & TC ................................ 1 95951 & TC .............................. 1 95953 & TC .............................. 1

95954 & TC ................................ 3 95955 & TC .............................. 2 95956 & TC .............................. 1

95957 & TC ................................ 1 95958 & TC .............................. 3 95961 & TC .............................. 3

95962 & TC ................................ 3 95999 ........................................ 9

CENTRAL NERVOUS SYSTEM ASSESSMENTS

96100 ......................................... 4 96105 ........................................ 4 96110 ........................................ 4

96111 ......................................... 4 96115 ........................................ 4 96117 ........................................ 4

ALPHA-NUMERICS

G0001 ........................................ 9 G0002 ....................................... 9 G0004 ....................................... 1

G0005 ........................................ 1 G0006 ....................................... 1 G0007 ....................................... 9

G0015 ........................................ 1 G0016 ....................................... 9 G0026 ....................................... 9

G0027 ........................................ 9 G0030 & TC .............................. 2 G0031 & TC .............................. 2

G0032 & TC ............................... 2 G0033 & TC .............................. 2 G0034 & TC .............................. 2

G0035 & TC ............................... 2 G0036 & TC .............................. 2 G0037 & TC .............................. 2

G0038 & TC ............................... 2 G0039 & TC .............................. 2 G0040 & TC .............................. 2

G0041 & TC ............................... 2 G0042 & TC .............................. 2 G0043 & TC .............................. 2

G0044 & TC ............................... 2 G0045 & TC .............................. 2 G0046 & TC .............................. 2

G0047 & TC ............................... 2 G0050 ....................................... 1 M0302 ....................................... 9

P2028 ......................................... 9 P2029 ........................................ 9 P2031 ........................................ 9

P2033 ......................................... 9 P2038 ........................................ 9 P3000 ........................................ 9

P3001 ......................................... 9 P7001 ........................................ 9 P9610 ........................................ 9

P9615 ......................................... 9 Q0035 & TC .............................. 1 Q0091 ....................................... 1

Q0092 ........................................ 9 Q0111 ....................................... 9 Q0112 ....................................... 9

Q0113 ........................................ 9 Q0114 ....................................... 9 Q0115 ....................................... 9

R0070 ......................................... 9 R0075 ....................................... 9 R0076 ....................................... 9

V5008 ......................................... 9 V5010 ........................................ 9 V5011 ........................................ 9

V5014 ......................................... 9 V5020 ........................................ 9 V5362 ........................................ 9

V5363 ......................................... 2 V5364 ........................................ 2

3. Independent Diagnostic Testing

Facility

Section 2070.5 of the Medicare

Carriers Manual (HCFA Pub. 14–3) is

the current policy basis for the coverage

of Independent Physiological Laboratory

(IPL) services. The section does not

define the term ‘‘physiological’’ and

specifically mentions only

electrocardiograms and

electroencephalograms as types of

services the entity that has come to be

known as an IPL may furnish. The

section says little about the nature of

IPLs other than that they operate

independently of a hospital, physician’s

office, or rural health clinic and meet

applicable State and local licensure

laws. Few States regulate diagnostic

services, other than x-rays, and the

requirement for State and local

licensure has had little meaning in

practice. The other requirements for the

coverage of IPL services are that the

services be ordered by a ‘‘referring’’

physician and that the services be

determined by the carrier to be

reasonable and necessary. The

requirement that the diagnostic services

must be ordered by a referring physician

has been addressed by the policy we

adopted in the final rule for the 1997
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59071

physician fee schedule published in the

Federal Register November 22, 1996 (61

FR 59497 through 59498), under which

the physician who orders a diagnostic

service must be a physician who is

treating the patient.

We are setting aside the term ‘‘IPL’’

and are defining a new entity

independent of a hospital or physician’s

office in which diagnostic tests are

performed by licensed, certified

nonphysician personnel under

appropriate physician supervision. We

are calling this entity an Independent

Diagnostic Testing Facility (IDTF). The

new entity will replace the IPL. The

regulations are intended to resolve

confusion surrounding the structure of

entities Medicare previously classified

as IPLs, as well as the services they

furnish and to address the potential for

abuse and the quality and safety

concerns raised by the lack of Federal

and State IPL licensure and certification

requirements. The regulations will not

apply to approved portable x-ray

suppliers or to procedures furnished in

physicians’ offices including group

practices or multispecialty clinics.

We are defining an IDTF as a fixed

location, a mobile entity, or an

individual nonphysician practitioner.

The following diagnostic tests, which

are payable under the physician fee

schedule, are not required to be

furnished in accordance with the IDTF

criteria when furnished by a

nonhospital entity:

• Diagnostic mammograms, the

coverage of which is required by law to

be regulated by the Food and Drug

Administration rather than by HCFA.

• Diagnostic tests personally

furnished by a ‘‘qualified audiologist’’

as defined in section 1861(ll)(3) of the

Act. These include ‘‘audiology services’’

as defined in section 1861(ll)(2) of the

Act that are payable by Medicare

carriers under the physician fee

schedule. We are excluding these

diagnostic tests from the physician

supervision requirement because the

Congress has defined these services

without requiring physician supervision

of their performance.

• Diagnostic psychological testing

services personally furnished by a

qualified psychologist practicing

independently of an institution, agency,

or physician’s office as currently

defined in section 2070.2 of the

Medicare Carriers Manual (HCFA Pub.

14–3). The services are distinguished

from services of clinical psychologists,

which are covered under section

1861(ii) of the Act rather than

1861(s)(3). We are excluding these tests

from the physician supervision

requirement because we do not believe

that these services require physician

supervision of their performance.

IDTFs must meet the following

requirements:

• An IDTF must have one or more

supervising physicians who are

responsible for the direct and ongoing

oversight of the quality of the testing

performed, the proper operation and

calibration of the equipment used to

perform tests, and the qualification of

nonphysician personnel who use the

equipment. This level of supervision

equates to general supervision as

discussed in this section II.D. and

§ 410.32(b)(3)(i).

• The supervising physician must

evidence proficiency in the performance

and interpretation of each type of

diagnostic procedure performed by the

IDTF; however, there is no requirement

that the IDTF’s supervising physician

actually furnish the interpretation. (For

example, a physician might purchase

tests from the IDTF that he or she will

interpret.) Proficiency may be

documented by certification in specific

medical specialties or subspecialties or

by criteria established by the carrier for

the service area in which the IDTF is

located. In the case of a procedure

which would require the direct or

personal supervision of a physician

pursuant to II.D. in this section and

§ 410.32(b)(3)(ii) and (b)(3)(iii),

respectively, the IDTF’s supervising

physician must personally furnish this

level of supervision whether the

procedure is performed in the IDTF or,

in the case of mobile services, at a

remote location. The IDTF must

maintain documentation to demonstrate

sufficient physician attendance during

all hours of operation to assure that the

required physician supervision is

furnished. In the case of procedures

requiring direct supervision, the

supervising physician may oversee

concurrent procedures.

• Any nonphysician personnel used

by the IDTF to perform tests must

demonstrate the basic qualifications to

perform the tests in question and have

appropriate training and proficiency as

evidenced by licensure or certification

by the appropriate State health or

education department. In the absence of

a State licensing board, the technician

must be certified by the appropriate

national credentialing body. The IDTF

must maintain documentation available

for review that these requirements are

met.

• All procedures performed by the

IDTF must be specifically ordered in

writing by a physician who treats the

beneficiary, that is, the physician who is

furnishing a consultation or treating a

beneficiary for a specific medical

problem and who uses the results in the

management of the beneficiary’s specific

medical problem. This requirement

would be met when a beneficiary’s

primary care physician orders testing

the results of which may determine

whether or not the physician refers the

beneficiary to a specialist. In other

words, that physician is managing the

patient’s care. The order must specify

the diagnosis or other basis for the

testing. The supervising physician for

the IDTF may not order tests performed

by the IDTF, and the IDTF may not add

any procedures based on internal

protocols without written order from the

treating physician.

• An IDTF that operates across State

boundaries must maintain

documentation that its supervising

physicians and technicians are licensed

and certified in each of the States in

which it is furnishing services.

Below is a discussion of the public

comments we received on this proposal

and our responses:

Comment: We received many

favorable comments (with reservations)

from representatives of existing IPLs

who indicated their preference for

national standards rather than different

standards in each carrier service area.

Many expressed frustration with the

current situation in which there is no

national policy on the procedures an

IPL may perform, and carriers have

differing local medical review policies

on these procedures.

One commenter indicated that

limiting the types of diagnostic tests an

IPL or IDTF can furnish is a better way

to prevent unneeded and medically

unnecessary testing than our proposal.

He stated that adoption of the IDTF

proposal will produce a rise in

expenditures for diagnostic testing

without a concomitant decrease in

expenditures from other entities that

currently bill Medicare for diagnostic

tests.

Response: We believe that the time

has come to change the current situation

under which there are different local

medical review policies on the services

an IPL may perform in different carrier

service areas. If a facility meets the

standards established for IDTFs,

including the appropriate level of

physician supervision, it should be able

to furnish the same range of procedures

as other entities in the service area.

Carriers should be denying claims for

procedures that are not reasonable and

necessary for individual patients.

Comment: A supplier of mobile bone

density procedures commented that it

had been erroneously classified as a

portable x-ray supplier and supported

the proposal as a clarification of its
59072 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

mobile status under Medicare as an

IDTF. The commenter supported the

proposal.

Response: Under the IDTF policy, a

mobile diagnostic facility may furnish

the same procedures as a stationary

facility unless there is a national policy

indicating otherwise.

Comment: With regard to the

credentialing criteria for IDTF

personnel, several commenters

questioned the need for the IDTF

proposal and pointed out that there

already were voluntary certification

organizations in existence that

possessed greater expertise than we did

in these matters. Commenters cited

organizations that have been granted

membership by the National

Commission for Certifying Agencies,

such as The American Registry of

Diagnostic Medical Sonographers for

ultrasonography physician and

nonphysician personnel, the

Intersocietal Commission for the

Accreditation of Vascular Laboratories,

which deals with noninvasive vascular

procedures, and the Intersocietal

Commission for the Accreditation of

Echocardiographic Laboratories for

echocardiographic procedures. The

commenters indicated that criteria

established by these organizations are

more specific than the vague criteria we

proposed.

Response: We have no desire to

interfere with these private

accreditation activities. The IDTF

should maintain documentation of

recognition by these organizations for

verification by the carrier as necessary.

However, we do not believe that the

standards for accreditation by these

agencies are equivalent to ours. For

example, in commenting on our

proposal, one of the listed organizations

indicated that it required records of the

source of the order for the test in the

accredited laboratories. However, this

requirement is not the same as assuring

that all tests are ordered by a physician

who is treating the patient.

Comment: One commenter indicated

that the proposal that the supervising

physician in an IDTF cannot order tests

performed by the IDTF is unrealistic.

The commenter stated that if the IDTF

is appropriately accredited and the

supervising physician’s income is fixed

(rather than related to volume of

testing), the supervising physician

should be able to order any necessary

test for his or her patients.

Response: We have decided to modify

the prohibition in § 410.33(d) against

the supervising physician’s ordering of

tests to be performed by the IDTF

although we continue to believe there

are potential problems in permitting

such a practice. However, we

acknowledge that there could be

situations in which the IDTF’s

supervising physician is, in fact, the

beneficiary’s treating physician. The

modified wording of the requirement

indicates that, in these situations, the

physician in question would have had

a relationship with the beneficiary prior

to the testing and would be treating the

beneficiary for a specific medical

problem.

Comment: Some commenters

expressed concern that the policy

requires State-credentialed

nonphysician personnel to perform

tests; commenters point out the varying

State standards that may be applied.

Some believed that credentialing by a

national standardized body was

preferable.

Response: We believe that

credentialing of nonphysician

technologists by either a State

government or a recognized national

organization should be sufficient.

Comment: Several commenters stated

that the requirement that all procedures

performed by IDTFs must be specifically

ordered in writing by the treating

physician would be very burdensome

for the referring physician, patient, and

the examiner if it is found that the

patient needs additional tests and has to

come back another day with written

orders for them. Some indicated that the

generally-applicable ordering provisions

of § 410.32(a) were sufficient.

One commenter indicated that the

requirement for written orders was

redundant, time-consuming, and costly,

and requested the rationale for the

additional requirement applicable only

to IDTFs.

Response: We believe that the

physician responsible for the

management of the patient’s care (or

some aspect of the patient’s care) should

be aware of the testing being performed.

For that reason, we adopted a

modification to § 410.32 to that effect in

the physician fee schedule final rule of

November 22, 1996. That rule did not

explicitly require written orders but

served to establish the link between test

ordering and the treating physician as a

matter of national Medicare law. If the

testing entity chose not to maintain a

file of written orders from physicians for

the tests it performed, the entity might

not be able to demonstrate the medical

necessity of the tests to a reviewer from

a Medicare carrier or another

government agency. Some commenters

have requested the rationale for

requiring specific written orders for

tests performed by IDTFs while not

imposing the same requirement on

testing in physicians’ offices.

The rationale for requiring testing by

IDTFs to be ordered in writing by the

treating physician is based in our (and,

more specifically, HCFA’s contractors’)

experience with IPLs. There have been

instances in which IPLs have offered

‘‘free’’ screening to Medicare

beneficiaries in shopping malls and

senior citizen centers, which meant that

the IPL accepted the carrier payment for

the procedure and waived billing the

beneficiary for the coinsurance. There

have been instances of mass testing in

nursing facilities with questionable

orders for the tests performed and little

regard for the medical necessity of the

tests. There have been numerous

instances of IPLs performing tests in

addition to those ordered by referring

physicians.

The manual (Medicare Carriers

Manual section 2070.5) has always

required that the diagnostic services be

ordered by a referring physician.

Therefore, we believe there is little in

this requirement that is new other than

the explicit provision that the orders be

in writing. While we are certain that

many IPLs did not engage in the

practices referred to above, we

anticipate that the new rules will give

the carriers tools to use to address

abusive situations, when they do occur,

through post-payment reviews. We

believe that our experiences with waste

and abuse in IPLs justify these

requirements, including requiring the

treating physician’s order for a

procedure.

In response to the absence of

regulation of IPLs, we are creating the

IDTF designation to establish a degree of

national regulation of a diagnostic

facility that is distinct from a

physician’s office and does not directly

use the test results to treat a beneficiary.

The facility’s sole purpose is to furnish

a test. We believe that any distinctions

in treatment between IDTFs and

physicians’ offices or hospitals are

justified by our experiences with the

entities and the different degrees of

regulation to which the entities have

been subject.

We do not agree that the requirement

for written orders is an unnecessarily

burdensome requirement, or that there

is any necessity for a beneficiary to

return with written orders on another

day. If an IDTF determines that a patient

needs further testing, the IDTF may

contact the ordering physician’s office

and receive a FAX order for the

additional testing.

Comment: One commenter indicated

that the term ‘‘referring physician’’ must

be broadened to include appropriate

‘‘licensed medical practitioners,’’

including podiatrists, chiropractors,
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59073

optometrists and other similar alliedhealth care professionals. The

commenter further stated that IDTF

testing procedures should be ordered

only by an appropriately licensed

medical professional.

Response: The term ‘‘referring

physician’’ was used in the proposal

only in the description of the existing

IPL policy. The current proposals refer

to ‘‘ordering physician’’ and

‘‘supervising physician.’’ Podiatrists and

optometrists (when operating within the

scope of their State licensure) are

included in the Medicare definition of

a ‘‘physician’’ set forth in section

1861(r) of the Act and do not need to be

singled out as appropriate persons to

order tests. Chiropractors may not order

tests for Medicare beneficiaries under

any circumstances. The changes made

to § 410.32 by the physician fee

schedule final rule of November 22,

1996 (61 FR 59490) provided for the

ordering of diagnostic tests by

nonphysician practitioners under

certain conditions. We have modified

proposed § 410.33(d) in this final rule to

make it clear that nonphysician

practitioners who are working within

the scope of the laws of their States may

order testing from IDTFs.

Comment: Several commenters

expressed concern about the exemption

of physicians’ offices, group practices,

and multispecialty groups from the

rules governing IDTFs. One commenter

indicated that such an exemption would

lead to the potential for abuse and

quality and safety concerns. Others said

that the proposed rules would put

IDTFs at a competitive disadvantage

with entities such as hospitals and

physicians’ offices in the furnishing of

diagnostic tests and that the same rules

should apply in all settings.

Response: In several responses

immediately preceding this one, we

have given our reasoning regarding the

application of specific requirements to

IDTFs that do not apply to physicians’

offices. Our reasoning is that hospitals

are currently regulated, and physicians

must have State licensure to perform the

services they furnish. (We would like to

reiterate here, however, that the

physician supervision requirements for

specific tests discussed elsewhere in

this rule apply to all diagnostic tests

payable under the physician fee

schedule whether they are performed in

an IDTF, physicians’ office, or other

setting.)

On the other hand, IPLs do not exist

because of a specific statutory provision

but because of unique circumstances.

HCFA has, for a number of years,

permitted payment for diagnostic tests

to entities that were not created by law.

The implementing manual instruction

for IPLs (section 2070.5 of the Medicare

Carriers Manual) clearly presumes the

existence of ‘‘applicable State and local

licensure laws’’ for these facilities

although very little regulation actually

exists.

Comment: A commenter objected to

the requirement in § 410.33(b)(2) that

the supervising physician must have

demonstrated proficiency in the

performance and interpretation of each

type of diagnostic test performed by the

IDTF when there is no such requirement

for hospital outpatient departments or

physician groups. The commenter

indicated that, for radiology procedures,

State Board Certification in Radiology

should be deemed sufficient for

supervision of procedures requiring

direct or general supervision.

Response: As we have pointed out

elsewhere in this discussion, hospitals

are regulated through the accreditation

process. For example, § 482.26(c) of the

Medicare Conditions of Participation for

Hospitals establishes standards for a

qualified supervisory radiologist in a

hospital. Further, all States have

licensure requirements that apply to

physicians’ offices, and we are not

aware of significant problems with

physicians and physician groups

performing tests they are not qualified

to perform.

On the other hand, the performance of

diagnostic tests in IPLs (including the

physician supervision of this testing) is

generally not regulated by State or local

laws. Our regional offices and carriers

cite many problems with the way

diagnostic procedures have been

furnished in IPLs, such as IPLs entering

into arrangements with physicians to

serve as pro forma supervisors when

these physicians had little expertise in

the area of diagnostic testing involved.

Because of systemic problems in IPLs,

we believe that it is reasonable for

Medicare to require physicians who

supervise the performance of tests in

IDTFs to demonstrate proficiency in the

type of testing being performed while

not imposing the same requirement on

physicians’ offices, which operate under

the authority of the physician’s State

licensure.

Comment: A commenter indicated

that the nonphysician credentialing

requirements would impose significant

additional costs and requirements on

IDTFs that would not be borne by

medical groups or hospitals.

Response: Most commenters from

existing IPLs, many of whom indicated

that their employees had already met

these standards, did not raise this issue,

and, therefore, we believe that any

burden on IPLs will not be widespread.

We believe it to be entirely appropriate

to require the technologists who

perform tests in IDTFs to possess

appropriate credentialing while not

imposing the same requirements on

hospitals that must meet accreditation

standards imposed by governmental and

other bodies or on physicians’ offices

that operate under the authority of the

physician’s State licensure.

Comment: One commenter objected to

the proposed requirement for

documentation of physician supervision

in IDTFs not being required of other

entities.

Response: We believe that this

requirement is justified by the past

performance of IPLS. Moreover, when

carriers identify a problem with lack of

supervision of diagnostic testing in

physicians’ offices, they may request

this information from the physician in

the same way they currently request

additional information on the medical

necessity of a service or procedure.

Comment: One commenter indicated

that record retention for CLIA

laboratories was determined to be 2

years and that the same requirement

should apply to IDTFs.

Response: We will review our record

retention guidelines and will provide

further advice through program

instructions.

Comment: One commenter indicated

that an IDTF should be allowed to bill

globally for radiological procedures

when it contracts with a medical group

for interpretations and the medical

group reassigns benefits to the IDTF.

Response: These billings are

permitted under the policy in section

3060.5 of the Medicare Carriers Manual.

In these situations, the IDTF would bill

the carrier in such a way as to identify

itself as an IDTF.

Comment: One commenter objected to

the proposed requirement that an IDTF

that operates across State boundaries

maintain documentation that its

supervising physicians are licensed in

each of the States in which it is

furnishing services. The commenter

indicated that this requirement would

be unnecessarily burdensome and cost

prohibitive if the facility must engage

physicians licensed in every State the

facility serves.

Response: We believe it appropriate

for a physician who is supervising the

performance of tests performed in State

to be licensed in that State.

Comment: One commenter indicated

that we are creating a new regulatory

scheme without Congressional

authorization. The commenter stated

that if a problem exists with respect to

independent diagnostic facilities, the

problem should be explored and
59074 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

debated in public before rules are

established.

Response: The commenter is correct

in recognizing that IPLs are not created

in the Medicare statute. Nonetheless, we

have paid for services they furnish for

a number of years. Over the years,

however, a number of problems have

become manifest in the operation of

these entities. We believe that our

general rulemaking authority is

sufficient to permit us to deal with these

problems and that the facts require our

exercise of that authority. In addition,

the publication of a proposed rule has

provided the opportunity for public

comment and debate.

Comment: Several commenters

indicated that the regulation should

address the competency of physicians to

perform interpretations of, rather than

supervision of, diagnostic tests. Some

suggested that the responsibilities of the

supervising physician in an IDTF

include interpretation of the results of

the procedures. One commenter

supported the proposal that

technologists in IDTFs be certified and

recommended a requirement that

radiologic procedures performed in

IDTFs be interpreted by physicians who

are qualified through: (1) Completing an

approved residency program, (2)

postresidency training, or (3) sufficient

clinical experience.

Response: The performance of the

interpretation (the physician’s service

covered under section 1861(s)(1) of the

Act, as opposed to the diagnostic test

covered under section 1861(s)(3) of the

Act) is beyond the scope of this

proposal except for the requirement that

an IDTF’s supervising physician

evidence proficiency in the

interpretation of each type of diagnostic

procedure performed by the facility. In

developing the IDTF proposal, we

considered requiring IDTFs to furnish

the interpretation as well as the test, but

we decided not to include such a

requirement because of the likelihood it

would lead to unintended problems. For

example, the physician who provides

the general supervision for an IDTF may

not be available to furnish an

interpretation for a period of time and

that could unnecessarily delay making a

diagnosis in an urgent situation. In

another situation, a beneficiary might

want his or her test interpreted by a

particular physician he or she has dealt

with in the past.

Comment: One commenter pointed

out that the proposal indicated that the

IDTF policy did not apply to procedures

furnished in physicians’ offices and

suggested that we clarify the status of

procedures performed by IDTFs in

physicians’ offices.

Response: The IDTF requirements

would apply to any procedures

furnished by the IDTF either in its own

facility or in a physician’s office, clinic,

or other nonprovider setting. For

example, if a procedure requires direct

supervision, it would be necessary for

the IDTF’s supervising physician to be

present in the suite during performance.

We have modified § 410.33(a)(1) to state

that the IDTF policy applies to

procedures performed by IDTFs in

physicians’ offices.

Comment: One commenter indicated

that the IDTF proposal should apply to

any noninvasive vascular procedure

performed by portable x-ray suppliers.

Response: Noninvasive vascular

procedures (or any test other than

certain x-rays, diagnostic

mammography, and EKGs) are not

included in the portable x-ray benefit. If

an approved portable x-ray supplier

wishes to furnish these procedures, it

would have to become an IDTF. No

transportation payment would be made

in connection with these types of

procedures.

Comment: A national organization

representing psychologists pointed out

that, as written, the IDTF proposal

would apply to individual nonphysician

practitioners, including clinical

psychologists and asked us to clarify

that clinical psychologists do not have

to become IDTFs and perform diagnostic

psychological testing under physician

supervision.

Response: We did not intend the IDTF

proposal to apply to diagnostic

psychological testing personally

performed by clinical psychologists

because these services are not covered

under section 1861(s)(3) of the Act.

However, in order to promote

understanding of the policy by all

concerned, we are explicitly excluding

diagnostic psychological testing

personally performed by clinical

psychologists from the requirement that

out-of-hospital, out-of-physician-office

tests that must be performed under the

supervision of a physician in an IDTF.

In other words, a clinical psychologist

does not have to become an IDTF to be

paid by the carrier for the performance

of diagnostic psychological testing.

Comment: A State Department of

Health cited several aspects of the IDTF

proposal that would conflict with the

laws of its State. The commenter also

indicated that the proposed rule did not

define the types of diagnostic tests that

could be covered by Medicare when

performed by an IDTF, whether IDTFs

can furnish radiologic services, or who

will receive the Medicare payments for

services performed by an IDTF.

Response: In making the IDTF

proposal, we were recognizing the

problems with the existing situation of

largely unregulated entities that

performed diagnostic tests. Neither

IDTFs nor IPLs were established

because of statutory mandate from the

Congress. In making this proposal, it is

not our intention to preempt any State

licensing requirements; however, it is

not clear to us how IPLs could have

operated in a State and IDTFs cannot.

However, in order to address these

concerns, we have added an additional

requirement in paragraph (f) of § 410.33

(Independent Diagnostic Testing

Facility). Under this requirement, an

IDTF must comply with the applicable

laws of any State in which it operates.

In IDTFs, Medicare would cover all tests

payable under the Medicare physician

fee schedule, including radiologic

procedures, other than clinical

laboratory tests. In many cases, the

carrier will pay the IDTF for the

technical component of the procedures.

In some cases, an IDTF may purchase

the interpretation of the test from a

physician and bill for both professional

and technical components, while in

other cases, an interpreting physician

may purchase the test from the IDTF

and bill for both professional and

technical components.

Comment: Some commenters

expressed concern about the January 1,

1998 effective date of the IDTF proposal.

They suggested transition periods of up

to 1 year.

Response: We are addressing these

comments in the discussion below.

Result of evaluation of comments: We

are adopting the proposal to have IDTFs

replace IPLs with the modifications or

clarifications discussed above. In

addition, we are providing that the

replacement occur on a phased-in basis

scheduled to be completed on July 1,

1998. Entities wishing to be recognized

as IDTFs must send a letter to the Part

B carrier for their service areas attesting

that they meet all IDTF criteria. As soon

as a carrier accepts the entity as an

IDTF, the carrier notifies the entity of its

new status and billing number. Once an

entity becomes an IDTF, it is no longer

subject to local medical review policies

that currently preclude IPLs from

furnishing procedures or groups of

procedures while allowing other entities

to perform them. An IDTF must comply

with the applicable laws of any State in

which it operates.
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59075

E. Reasonable Compensation Equivalent

Limit Update Factor

1. Background

Section 1887(a)(2)(B) of the Act

provided for the reasonable

compensation equivalent limits used to

determine the reasonableness of costs

incurred by providers for professional

services furnished by physicians for the

benefit of provider patients in a hospital

or skilled nursing facility. Regulations

set forth at § 415.70 (Limits on

compensation for physician services in

providers), paragraph (b), concerning

the methodology for establishing limits,

established a methodology for

determining reasonable annual

compensation equivalents, considering

average physician incomes by specialty

and type of location, to the extent

possible using the best available data.

The regulations also expanded the

application of the reasonable

compensation equivalent limits to

include comprehensive outpatient

rehabilitation facilities. The initial and

still current methodology for

establishing reasonable compensation

equivalent limits is based on an internal

working paper (‘‘A Methodology for

Determination of Reasonable FTE

Compensation for Hospital-Based

Physicians’’ by James R. Cantwell and

William J. Sobaski (Working Paper No.

OR–32, revised December 1982))

developed by HCFA’s Office of Strategic

Planning, (formerly the Office of

Research and Demonstrations). Copies

of this paper are available on request

from: OSP Publications, Office of

Strategic Planning, Health Care

Financing Administration, Room C3–

20–11, 7500 Security Boulevard,

Baltimore, MD 21244, (410) 786–6588.

The inflation factor employed in the

methodology used to develop the initial

limits and, subsequently, to update

those limits to reflect increases in net

physician compensation was the

Consumer Price Index for All Urban

Consumers (CPI-U).

2. Change in the Methodology Used to

Develop Reasonable Compensation

Equivalent Limits

The methodology currently employed

to update the physician fee schedule

uses an inflation factor distinct from the

CPI-U, which is used to update the

reasonable compensation equivalent

limits. To achieve a measure of

consistency in the methodologies

employed to determine reasonable

payments to physicians for physicians’

direct medical and surgical services

furnished to individual patients and

reasonable compensation levels for

physicians’ services that benefit

provider patients generally, we are

revising the methodology used to

update the reasonable compensation

equivalent limits that would entail the

adoption of the physician fee schedule’s

inflation factor (the MEI) to update the

reasonable compensation equivalent

limits. For cost reporting periods

beginning on or after January 1, 1998,

updates to the reasonable compensation

equivalent limits would be calculated

using the MEI.

Comment: One association favored

the adoption of the MEI in place of the

CPI-U as the update factor for the

reasonable compensation equivalent

limits. Another medical association

stated that, while it did not object to the

adoption of the MEI, it recommended

that the reasonable compensation

equivalent limits methodology be

replaced with a relative value based

methodology.

Response: We will consider the

development of a relative value based

reasonable compensation equivalent

limits methodology in the immediate

future, but we are proceeding with the

adoption of the MEI as the reasonable

compensation equivalent limits update

factor at the present time.

Result of evaluation of comments: As

proposed, we are revising the reasonable

compensation equivalent limits update

methodology by replacing the CPI-U

with the MEI as the update factor.

F. Payment to Participating and

Nonparticipating Suppliers

Section 1848(a)(1) of the Act requires

that payment for physician services (as

defined in 1848(j)(3)) be based on the

lesser of the actual charge for the service

or the fee schedule amount. We

proposed to revise the regulations at

§ 414.21 (Medicare payment basis) to

ensure that they contain this statutory

provision. (Our proposed definition of

‘‘actual charges’’ was discussed

separately in section II.J. of our June 18,

1997 proposed rule (62 FR 33192).)

Section 1848(a)(3) of the Act provides

incentives for participating physicians

and suppliers by setting the fee

schedule amount for those who

participate at 100 percent of the amount

calculated under the fee schedule for

the service as provided in the formula

at section 1848(b)(1) of the Act. It also

provides that the fee schedule amount

for nonparticipating physicians and

suppliers be set at 95 percent of the

amount for participating physicians and

suppliers. Since regulations at § 400.202

(Definitions specific to Medicare) define

the term ‘‘supplier’’ as including

physicians and all other persons who

provide services for which payment

may be made under Part B except for

‘‘providers of services’’ as defined in

1861(u) of the Act, we proposed to

define nonparticipating suppliers in

§ 400.202 as being suppliers who do not

have a Part B participation agreement in

effect on the date of the service. We also

proposed to define participating

suppliers as being suppliers who have

an agreement to participate in Part B in

effect on the date of the service. These

definitions mirror the definitions of

participating and nonparticipating

physicians, suppliers, and other persons

that are in section 1842(h) of the Act.

Section 1848(g)(2)(C) of the Act states

that the Medicare limiting charge is to

be set at 115 percent of the ‘‘* * *

payment amount for nonparticipating

physicians or nonparticipating suppliers

or other persons.’’ Hence, we proposed

to reflect this requirement in regulations

in proposed § 414.48(b) (concerning

specific limits on actual charges of

nonparticipating suppliers).

We received two comments related to

these proposed changes.

Comment: Some physicians objected

to being considered ‘‘suppliers,’’ and

some physicians did not recognize that,

under current regulations, the term

‘‘supplier’’ includes physicians. These

commenters wanted us to revise the

terminology in the regulations to

consider physicians not to be

‘‘suppliers.’’

Response: We did not accept this

comment because the term ‘‘supplier’’ is

used to include physicians for all other

Medicare regulations (except where

otherwise specified), all of which would

have to be revised if we were to remove

physicians from the definition of

‘‘supplier’’ for general Medicare

regulations. Doing this would be

impractical and would risk removing

rules that apply to physicians in the

same manner in which they apply to

other persons who bill and are paid for

services covered under Part B of

Medicare.

Comment: Some commenters objected

to the requirement that Medicare fee

schedule payment be based on the lower

of the actual charge or the fee schedule

amount. They argued that the fee

schedule amount should be the only

basis for payment.

Response: We did not accept this

comment because the law requires that

the payment be based on the lesser of

the actual charge or the fee schedule

amount. Including it should have no

practical effect on payment since

carriers are already instructed to

compare the submitted charge to the fee

schedule amount and to base payment

on the lesser of the two amounts.

Moreover, we believe that some of these

commenters may have confused this
59076 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

general requirement with our proposed

definition of ‘‘actual charges’’ (which is

discussed in section II. J. of this

preamble).

Result of evaluation of comments: We

are making final the technical change to

the regulations to conform them to

statutory provisions and operating

instructions (Medicare Carriers Manual).

G. Increase in Work Relative Value

Units for Global Surgical Services to

Account for the 1997 Increases for Work

Relative Value Units in Evaluation and

Management Services

In our November 22, 1996 final rule

with comment period, as part of the 5-

year review of all physician work RVUs,

we increased most of the work RVUs for

evaluation and management services for

hospital and office or other outpatient

visits. We revised the work RVUs for

evaluation and management services

partly in recognition of the increase in

preservice and postservice work. At that

time, we made no adjustments to the

work RVUs assigned to global surgical

services, which, in addition to the

surgical procedure, include the related

preservice and postservice evaluation

and management visits a surgeon

provides within a defined period of

time.

Upon further examination of this

issue, we are increasing the work RVUs

for global surgical services to be

consistent with the 1997 increases in

the work RVUs for evaluation and

management services.

Because the increases in the work

RVUs for global surgical services will

cause an increase in payments for those

services, we must reduce all work

payments by 0.7 percent to maintain

budget neutrality.

We received the following public

comments on this proposal:

Comment: Several commenters,

ranging from individual physicians to

physician specialty societies, expressed

support for our proposal because it

makes the increased work associated

with the preservice and postservice

work of global surgical services

consistent with the increases that were

made to evaluation and management

services for the 1997 physician fee

schedule.

Response: We agree that our proposal

will make payment amounts for the

increased evaluation and management

services present in the preservice and

postservice work of global surgical

services more consistent with the

increases in work that were made to

evaluation and management services.

Comment: Several commenters

expressed concerns that our proposal

did not include all global surgical

services. Commenters requested that we

review our list of global surgical

services to be affected by these work

RVU increases.

Response: We agree with commenters

that we inadvertently omitted certain

global surgical services from our

proposal. We addressed this oversight

by reviewing the list of global surgical

services, identifying those services

which were omitted. After this residual

list of services was compiled, we

contacted the specialty societies most

closely identified with the omitted CPT

codes in order to attach the appropriate

number of office visits associated with

each individual CPT code.

Result of evaluation of comments: We

are adopting our proposal to increase

the work RVUs associated with global

surgical services to reflect the increased

evaluation and management present in

the preservice and postservice portions

of these services. We have added the

services referred to above. This will

assure that the evaluation and

management portions of global surgical

services are consistent with our 1997

increases to evaluation and management

services. Those codes that have been

changed due to the increase of work

RVUs of global surgical services are

identified in Addendum B.

H. Caloric Vestibular Testing

We proposed to reduce the RVUs for

caloric vestibular testing, CPT code

92543, to 25 percent of what the values

would have otherwise been. We made

this proposal in order to permit

physicians and suppliers to bill four

units of service instead of the one unit

now permitted. The use of four units is

consistent with the AMA’s

interpretation of the code.

Addendum C in the June 18, 1997

proposed rule contained an error. The

reduction to 25 percent of the RVUs

otherwise applicable was reflected for

the practice expense RVUs, but we

incorrectly published unreduced RVUs

for work and malpractice. On August

18, 1997, we published a correction

notice (62 FR 43962) to reflect the

correct values. The new values for work

and malpractice were 25 percent of the

numbers previously published.

The reduction to the direct practice

expense RVUs had been correctly noted

in the proposed rule. However, because

the indirect practice expense RVUs are

partially based on the work RVUs, the

reduction to the work RVUs caused a

reduction to the indirect practice

expense RVUs. The new total practice

expense RVUs published in the

correction notice reflect the reduced

indirect practice expense RVUs.

Because resource-based practice

expense RVUs will not be implemented

effective January 1998, the practice

expense RVUs published in this final

rule differ from those published in the

proposed rule and the correction notice.

The final practice expense RVUs

continue to be based on charge-based

data and are simply 25 percent of the

charge-based RVUs currently in effect.

The final work and malpractice RVUs

are those published in the correction

notice. They too are 25 percent of the

values currently in effect.

Two physician organizations

expressed support for this change. Other

comments are discussed below.

Comment: One commenter suggested

that Medicare should recognize four

units of service when four irrigations are

performed but that we should not make

a reduction in RVU amounts.

Response: This change is not intended

to reflect a decision that our relative

payment amounts are too low for caloric

vestibular testing. Medicare has not

made such a decision. Instead, we are

simply reconciling our interpretation of

the code with the AMA’s interpretation

and, in order to do this in a budget

neutral fashion, we are reducing the

RVUs to 25 percent of the amount

otherwise applicable.

Comment: Another commenter did

not oppose this proposal but opposed

the proposed resource-based practice

expense RVUs for the service.

Response: Since we are no longer

proceeding with resource-based practice

expense RVUs for 1998, the merits of

these comments will not be addressed

in this final rule.

Result of evaluation of comments:

Beginning in 1998, when a physician

performs and interprets four irrigations,

the physician will bill Medicare for four

units of CPT code 92543 (that is, the

global service). When a physician

interprets four irrigations, the physician

will bill four units of CPT code 92543–

26. When a physician or supplier

performs four irrigations, the physician

or supplier will bill four units of CPT

code 92543–TC.

I. Clinical Consultations

There are two CPT codes for clinical

consultations, CPT codes 80500

(Clinical pathology consultation;

limited, without review of patient’s

history and medical records) and 80502

(Clinical pathology consultation;

comprehensive, for a complex

diagnostic problem, with review of

patient’s history and medical records),

which were added to the CPT in 1985.

The regulations set forth at § 415.130

(Conditions for payment: Physician

pathology services), paragraph (b)
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59077

(Clinical consultation services), require

that a clinical consultation meet four

criteria before it can be paid. One of

these criteria is that the clinical

consultation must be requested by the

patient’s attending physician. As we

indicated in the preamble to the

proposed rule, we have allowed a

standing order policy to be used as a

substitute for the individual request by

the patient’s attending physician since a

1984 law suit. However, we believe that

this policy is no longer appropriate.

Because the policy was not embodied in

the court’s judgment or otherwise

required by law and because we view it

as creating opportunities for abuse and

waste, effective January 1, 1998, we are

not accepting a standing order as a

substitute for the individual request by

the attending physician. We are

instructing the Medicare carriers to

enforce § 415.130(b) as it is presently

written.

Comment: We received comments

from two organizations and many

individual pathologists from Florida.

These commenters argue that standing

orders are an efficient mechanism of

providing interpretive reports of specific

clinical laboratory tests to attending

physicians without prolonging care or

the length of a hospital stay. Therefore,

the proposed elimination of standing

orders would create unnecessary delays

and could adversely affect patient care

and increase the cost of care.

Response: As we explained in the

June 1997 proposed rule, pathologists

could use a standing order policy to

generate unnecessary consultations.

These consultations may occur even

though the attending physician can

properly interpret the test results and

does not need the assistance of the

pathologist. We readily admit that

standing orders can offer efficiencies

over individual requests by attending

physicians when attending physicians

need interpretations from pathologists.

However, we must balance this concern

with the risk that the Medicare program

may be inappropriately paying for

medically unnecessary services under a

standing order policy.

Comment: Individual commenters

stated that there are several tests when

prompt interpretation of tests is needed

and the tests require interpretation by

pathologists. Examples of these tests

include cardiac enzymes, serum protein

electrophoresis, and

immunoelectrophoresis.

Response: These commenters appear

to be confusing our policy on clinical

laboratory interpretation services with

clinical consultations. Before the

implementation of the physician fee

schedule in 1992, we worked with the

College of American Pathologists and

our carrier medical directors to identify

those clinical laboratory tests for which

the attending physician would

ordinarily need the pathologist’s

interpretation. The clinical laboratory

tests, which the commenters mentioned,

were on the original list of tests which

our carrier medical directors reviewed.

Working with the carrier medical

directors, we identified a list of 15

clinical laboratory tests for which we

would recognize a clinical laboratory

interpretation service. These tests were

listed in the November 1991 final rule

(56 FR 59565) and can be found at

section 15020 E of the Medicare Carriers

Manual. The list includes CPT codes

86320, 86325 and 86327, which

describe immunoelectrophoresis

services, and CPT code 84165, which

describes serum protein electrophoresis.

Since these tests are ordinarily

interpreted by a pathologist, we allow a

standing order policy to be used in

place of an individual request by an

attending physician.

Result of evaluation of comments:

Except for the clinical laboratory tests

mentioned above, we will not accept a

standing order as a substitute for the

individual request by the attending

physician. We will instruct the

Medicare carriers to enforce § 415.130(b)

as it is presently written.

J. Actual Charges

In the June 18, 1997 proposed rule (62

FR 33184), we defined the term ‘‘actual

charge’’ to be the lesser of the amount

the physician, supplier, or other person

charges for the service to a particular

beneficiary or the amount they have

voluntarily agreed to accept as payment

in full under a private plan contract that

also covers the beneficiary when

Medicare is primary and the private

plan is secondary. We proposed this

policy to protect Medicare beneficiaries

from incurring greater deductible and

coinsurance expenses as a result of

enrollment in Part B of Medicare if the

private plan’s payment amount is less

than the Medicare payment, and the

Medicare coinsurance is more than the

private plan’s copayment.

For example, a retiree age 64, enrolled

in a managed care plan, has a cataract

removed by a physician who

participates in Medicare and in the

managed care plan. The managed care

plan pays $800 of the physician’s $1,500

actual charge. The retiree pays a $5

copayment. The physician cannot bill

the retiree for the remaining amount

under the terms of the contract with the

managed care plan.

The retiree reaches age 65 and enrolls

in Medicare Part B, which is usually

required by the employer or the plan in

order for the beneficiary to stay in the

managed care plan. The beneficiary

pays the Medicare premium each month

and has the second cataract removed.

Medicare is now the primary payer and

the managed care plan is a secondary

payer. The physician takes assignment

on the Medicare claim and Medicare

allows $1,000 of the physician’s $1,500

charge. Medicare pays $800, its share of

the payment. The physician bills the

managed care plan for the $200

coinsurance but the plan may refuse to

pay because the physician has already

received the $800 that the plan

considers to be payment in full. The

physician may attempt to collect the

coinsurance from the beneficiary. When

this occurs, the beneficiary may have

more out-of-pocket expense after age 65

than before. The potential for higher

out-of-pocket expenses occurs also with

the services of other practitioners and

suppliers, especially suppliers of

durable medical equipment, prosthetics,

orthotics, and supplies, who often

deeply discount the price they charge

managed care organizations in exchange

for exclusivity and guaranteed business.

We received numerous comments

from individual physicians and

suppliers and the organizations that

represent them in opposition of this

proposal. In general, the comments have

the following common themes:

• Physicians and suppliers do not

know what the plans will pay for their

services, either because the plans

change the payment amounts without

notice or, in the case of physicians,

because of withholds and bonuses that

do not permit establishing actual

payment for the service until after the

end of the year—certainly not in time

for the actual payment to be placed on

the claim for Medicare payment.

• The proposal would increase

physicians’ and suppliers’

administrative cost and burden to bill

Medicare.

• There is no statutory basis for

interpreting the term ‘‘actual charges’’ in

any manner other than the plain

meaning of the words, for example,

whatever the physician or supplier

chooses to charge.

• There is no standard coding and/or

bundling among payers, hence, there is

no standard description of services on

which to base a comparison of Medicare

and managed care payments.

• The proposal constitutes a breach of

faith with the physician community that

supports the physician fee schedule

because of the participatory nature of its

development.

As a result of our review of the

comments, we have decided that the
59078 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

actual charge issue, including the

implications for beneficiary out-ofpocket expense, requires further study.

Although we are not issuing a final rule

requiring physicians and suppliers to

show the lower negotiated payment as

their submitted charge for the service,

we continue to believe that the lower

negotiated rate should be the submitted

charge in this situation.

III. Implementation of the Balanced

Budget Act of 1997

In addition to the physician fee

schedule provisions of the Balanced

Budget Act of 1997, the new legislation

expands the previously enacted

Medicare screening mammography

benefit and adds several new screening

benefits to the law—the colorectal

cancer screening benefit and the

screening pelvic examination benefit

effective January 1, 1998. For many

years physicians have understood the

value of prevention and early detection

measures in dealing with medical

problems. Preventive services for the

early detection of disease have also been

associated with substantial reductions

in morbidity. For example, dramatic

reductions in the incidence of invasive

cervical cancer and in cervical cancer

mortality have occurred following the

implementation of screening programs

using Papanicolaou testing to detect

cervical dysplasia.

Although sound clinical reasons exist

for emphasizing prevention in

medicine, studies have shown that

clinicians often fail to provide

recommended clinical preventive

services. This is due to a variety of

factors, including inadequate

reimbursement for preventive services,

fragmentation of health care delivery,

and insufficient time with patients to

deliver the range of preventive services

that are recommended. It is our

expectation that implementation of the

recently enacted new Medicare benefit

provisions should help to overcome at

least some of the barriers to the use of

preventive services, and may lead to

substantial reductions in morbidity and

mortality.

A. Changes in Practice Expense Relative

Value Units for 1998

Section 4505 of the Balanced Budget

Act of 1997 delays the implementation

of the resource-based practice expense

RVU system until January 1, 1999 and

specifies the manner in which practice

expense RVUs in 1998 are adjusted.

The 1998 practice expense RVUs for

certain services are reduced to 110

percent of their work RVUs for the

service. The reductions are used to

increase practice expense RVUs for

office visits. (Section 4505 of the BBA

1997 also provides the Secretary with

the authority to adjust the 110 percent

figure if the aggregate amount of

reductions exceeds $390 million. Since

the application of the 110 percent

results in reductions of about $330

million, we did not need to make an

additional adjustment.)

There are two categories of services

that are excluded from this limitation:

(1) The service provided more than 75

percent of the time in an office setting;

and (2) the service had a proposed

resource-based practice expense RVU

(that is, the practice expense RVU for

the service published in the June 18,

1997 proposed rule (62 FR 33158 et

seq.)) that was an increase from its 1997

practice expense RVU.

In addition, there are services whose

work RVU is zero and therefore are not

affected by this provision. These

services include technical component

(TC) services (such as the TC of

radiology services, surgical pathology

services, and other services that have a

corresponding PC service) and

diagnostic tests, such as psychological

tests, that are not TC services (because

there is no corresponding PC service).

The exclusion for services because

they have a value that increased in the

June 1997 proposed rule (62 FR 33160)

is applied separately by site-of-service

with the distinction made between inoffice and out-of-office services. For

most codes, the June 1997 proposed rule

provided a practice expense RVU for

both the in-office and the out-of-office

setting. Thus, if the proposed 1998

resource-based practice expense RVU

for a code for the in-office setting

increased in relation to its 1997 practice

expense RVU even though the proposed

value exceeded 110 percent of the work

RVU, this code, for this service and this

site, was excluded from the practice

expense RVU reduction. Similarly, if the

proposed 1998 resource-based practice

expense RVU for the same code for the

out-of-office setting decreased in

relation to its 1997 practice expense

RVU and the proposed value exceeded

110 percent of the work RVU, then this

code, for this service and this site, was

subject to the practice expense RVU

reduction.

For 1998, the carriers will apply the

same site-of-service differential policy

they applied in 1997. Under the site-ofservice differential, the practice expense

RVUs for a procedure code that is

furnished outside the office are reduced

by 50 percent. There are approximately

700 codes affected by this policy. To

coordinate this policy with the site-ofservice distinctions in the June 1997

proposed rule and the interaction of the

provisions of section 4505 of the BBA

1997, we are listing in Addendum B the

practice expense RVUs for the two sites

for the 700 procedure codes instead of

allowing the carrier to calculate the 50

percent reduction.

The practice expense RVUs for office

visit procedure codes are increased by a

uniform percentage. This uniform

percentage (13 percent) is calculated so

that the aggregate increase in practice

expense RVUs for office visit procedures

is equal to the decrease in Practice

expense RVUs for services whose

practice expense RVUs are reduced.

This results in an increase in total

payments of between 3 percent and 5

percent for the office visit codes.

B. Coverage of Screening Mammography

and Related Payment Changes

Before the enactment of the BBA

1997, section 1834(c)(2) of the Act

prescribed certain limitations on the

frequency of coverage of mammography

screenings for women over 39 years of

age with no waiver of the yearly Part B

deductible requirement. Specifically, for

a woman over age 39 but under 50 years

of age, the law provided for coverage of

screening mammography either once a

year or twice a year depending upon

whether the woman was considered to

be at high risk of developing breast

cancer, as determined pursuant to

factors identified by the Secretary and

specified in regulations. In the case of

a woman over 49 years of age but under

65 years of age, the law specified that

payment could be made for a screening

mammography once a year (that is, if at

least 11 months had passed following

the month in which the last screening

mammography was performed). Finally,

in the case of a woman over 64 years of

age, the law provided that payment

could be made for a screening

mammography once every 2 years

following the month in which the last

screening mammography was

performed.

Section 4101(a) of the BBA 1997

amends section 1834(c)(2)(A) of the Act

effective January 1, 1998 to simply

provide that in the case of any woman

over 39 years of age, payment may be

made for a screening mammography if

at least 11 months have passed

following the month in which the last

screening mammography was

performed. Section 4101(b) of the BBA

1997 amends sections 1833(b) and

1834(c)(1)(C) of the Act to waive the

Part B deductible requirement.

In view of the statutory changes in the

(1) limitations on the frequency of

coverage of screening mammographies

for all women over 39 years of age and

(2) the Part B deductible requirement as
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59079

it relates to all screening mammography

services, we are amending § 410.34(d)

(relating to limitations on coverage of

screening mammography) and are

adding a new exception as paragraph (5)

in § 410.160(b) (relating to exceptions to

the Part B annual deductible) to reflect

these changes in the regulations.

C. Colorectal Cancer Screening

Section 4104 of the BBA 1997

provides for Medicare coverage of

colorectal cancer screening tests

effective for services provided on or

after January 1, 1998. The law provides

for coverage for screening fecal-occult

blood tests, screening flexible

sigmoidoscopy, screening colonoscopy,

and other tests we determined to be

appropriate, subject to certain frequency

and payment limits.

Present Medicare coverage policy

allows payment for diagnostic tests to

diagnose colorectal cancer and related

medically necessary services that are

furnished to beneficiaries. Under this

policy, diagnostic colorectal cancer tests

are covered if they are medically

necessary to evaluate a specific

complaint from or monitor an existing

medical condition of an individual who

has had a history of colon cancer or

inflammatory bowel disease. This

coverage is based, in part, on section

1861(s)(3) of the Act, which provides

general Medicare coverage for

diagnostic x-ray, clinical laboratory, and

other diagnostic tests. However, prior to

the enactment of the BBA 1997,

screening colorectal cancer tests have

been excluded from coverage based on

section 1862(a)(7) of the Act, which

states that routine physical checkups are

excluded services. This exclusion is

described in Medicare regulations in

§ 411.15(a).

1. Coverage Determination in Screening

Barium Enemas

Section 4104(a)(2) of the BBA 1997

requires us to publish a notice in the

Federal Register related to the coverage

of screening barium enema as a

colorectal cancer screening test. As

provided by section 4104(a)(2) of the

BBA 1997, this notice is to be published

in the Federal Register by November 3,

1997, within 90 days after the date of

enactment.

To the three colorectal cancer

screening tests specifically designated

as covered under sections

1861(pp)(1)(A), (B), and (C) of the Act,

section 4104(a)(2) of the BBA 1997

added a new section 1861(pp)(1)(D) to

the Act to provide that colorectal cancer

screening tests may also include

coverage of other tests or procedures the

Secretary determines to be appropriate

based on consultation with appropriate

organizations.

As required by section 1861(pp)(1)(D)

of the Act, we, acting on behalf of the

Secretary, consulted with appropriate

Federal government organizations and

other organizations regarding the

efficacy of a barium enema examination

for detecting colorectal cancer. We also

inquired about how this coverage

should be included under Medicare. We

contacted representatives of various

Federal agencies, including the Agency

for Health Care Policy and Research, the

Centers for Disease Control and

Prevention, the Food and Drug

Administration, and the National

Cancer Institute, knowledgeable about

using a barium enema as a screening test

to detect colorectal cancer. We also

consulted with staff from the American

Cancer Society. In addition, the

American Medical Association

convened a preventive medicine expert

panel that included representatives from

the United States Preventive Services

Task Force and various medical

specialty organizations, such as the

American Medical Association Council

on Scientific Affairs, the American

Medical Association Council on

Medical Services, the American

Academy of Family Physicians, the

American College of Physicians, the

American College of Preventive

Medicine, the American College of

Radiology, and the American Society of

Colon and Rectal Surgeons.

Based on our review of this

information and our evaluation of other

data, we concluded that while there is

not a consensus in the medical

community regarding the specific role of

a barium enema examination under the

Medicare colorectal cancer screening

benefit when compared to the use of the

flexible sigmoidoscopy and colonoscopy

examinations, there is a sufficient basis

for us to include the use of barium

enema as part of the new national

Medicare coverage for colorectal

screening.

In its Executive Summary, (AHCPR

Publication Number 97–0302) Evidence

Report No. 1: Colorectal Cancer

Screening, the Agency for Health Care

Policy and Research concluded that

there is indirect evidence that supports

the use of double contrast barium enema

in screening for colorectal cancer. They

also noted that the double contrast

barium enema can image the entire

colon and detect cancers and large

polyps. (Medicare policy already allows

payment for diagnostic barium enemas

that are performed to evaluate a

beneficiary’s specific complaint or to

monitor an existing medical condition

for an individual with a history of colon

cancer.) Additionally, the role of the

barium enema examination as a

colorectal cancer screening examination

has recently been studied by several

multi-disciplinary expert panels and, as

a result of those studies, it appears that

the usefulness of the examination is

becoming widely accepted in the United

States. First, the American

Gastroenterological Association initially

in conjunction with the Agency for

Health Care Policy and Research,

completed their report earlier this year.

The double contrast barium enema was

recommended as a screening option for

all average risk patients (those with no

predisposing factors) and selected

groups of high risk patients (those with

a history of prior polyps, or those with

a first degree relative with colorectal

cancer). Only in the case of the subset

of patients at high risk with a family

history of familial adenomatous

polyposis, hereditary non-polyposis

colorectal cancer, and inflammatory

bowel disease was a colonoscopy

recommended as the only screening

modality. (This subset of patients

represents a minority of the high risk

population as defined by statute.)

Second, earlier this year the American

Cancer Society recently revised their

guidelines to include the double

contrast barium enema as an option for

patients at average and moderate risk

(nearly identical to the above described

American Gastroenterological

Association guidelines).

The American Gastroenterological

Association and the National Cancer

Institute studies have indicated that one

of the major advantages of the barium

enema examination is that it permits the

imaging of the entire colorectum and it

appears to have the ability to detect

precursor adenomas as well as

colorectal cancers. Anatomic

visualization of the entire colorectum is

believed to be highly desirable and is

widely considered optimum for

evaluating the colon. (It is generally

acknowledged that one limitation of the

flexible sigmoidoscopy examination is

that it only allows for direct

examination of the lower third to onehalf of the colorectum.) There is also

some evidence that racial differences

exist in the distribution of colorectal

cancers, with African-Americans having

a higher proportion of cancers in the

right side of the colon than Caucasians.

Thus, tests that allow full structural

coverage of the entire colorectum are

needed as a choice for certain segments

of the population.

Furthermore, on the basis of the

information we have reviewed, the

barium enema screening examination

appears to have a superior safety profile
59080 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

when compared to the screening flexible

sigmoidoscopy and colonoscopy

examinations, and it does not require

sedation as is the case with colonoscopy

examinations. Our information indicates

that patients are typically exposed to

300 to 500 mrad of radiation during a

barium enema examination, which is

about equivalent to the dose of radiation

that results from a single screening

mammography examination.

Considering the age and frequency at

which screening is recommended for a

barium enema examination, it is

estimated by the American College of

Radiology that a screening strategy

using a barium enema x-ray every 2 or

4 years would deliver a lifetime dose of

radiation that is lower than the radiation

that would result from use of the annual

Medicare screening mammography

benefit.

Specifically, in view of the

information summarized above, we have

determined that a barium enema is a

reasonable and necessary screening test

for colorectal cancer, and have decided

to cover screening barium enema

examinations in the following manner:

First, such a screening examination

may be covered as an alternative to a

flexible sigmoidoscopy examination

(that is, as a substitute for, and not as

an added optional benefit) for an

individual attaining age 50 and not at

high risk for colorectal cancer, if the

individual’s attending physician orders

the test in writing after a determination

that the test is the appropriate screening

test. That is, the attending physician

must determine that, in the case of a

particular individual, the estimated

screening potential for the barium

enema is equal to or greater than the

screening potential that has been

estimated for a flexible sigmoidoscopy

for that same individual. For example,

in the case of an individual who is

taking anti-coagulant medications, the

individual’s attending physician may

decide to order a barium enema instead

of a flexible sigmoidoscopy because it is

less likely to produce bleeding and

typically allows for a total inspection of

the colon, while the flexible

sigmoidoscopy does not.

Second, we are establishing a

frequency limitation for the coverage of

the screening barium enema for an

individual age 50 and over who is not

at high risk for colorectal cancer at the

same time interval that is specified in

the statute for screening flexible

sigmoidoscopy examination (that is,

once every 48 months for the same

individual.)

Third, we are providing that a

screening barium enema may be covered

as an alternative to a screening

colonoscopy (that is, as a substitute and

not as an added optional benefit) for

individuals at high risk for colorectal

cancer, if the individual’s attending

physician orders the test in writing

following a determination that the

screening barium enema is the

appropriate test for that particular

individual. This means that the

attending physician must determine, in

the case of a particular individual, that

the estimated screening potential for the

barium enema examination is equal to

or greater than the screening potential

that has been estimated for the

colonoscopy examination. For instance,

in the case of an individual at high risk

for colorectal cancer who may not be

able to receive a complete colonoscopy

due to a markedly long and twisting

loop(s) of colon, the individual’s

attending physician may decide to order

a barium enema in lieu of a screening

colonoscopy because it is more likely to

permit a complete view of the entire

colon.

Fourth, we are establishing the

frequency limitation for coverage of the

screening barium enema for an

individual who is at high risk for

colorectal cancer at the same time

interval that is specified in the statute

for screening colorectal examinations

(that is, once every 24 months for the

same individual.)

Fifth, we are establishing the double

contrast barium enema as the standard

type of screening barium enema that

will be covered under the Medicare

program because, based on information

obtained from the American College of

Radiology, we understand that it is

regarded as the most sensitive for small

colonic lesions in patients who are

adequately prepared and optimally

imaged. In the case of some patients

who are infirm, immobile, or

debilitated, however, a technically

optimal double contrast examination

may not be possible. In these patients a

single contrast barium examination may

be performed with high quality results

despite the limitations of the patient’s

condition. In these situations, we are

covering the single contrast method if it

would satisfy the test described above

for allowing coverage of the barium

enema examination as an alternative to

one of the other two colorectal cancer

screening tests. That is, the individual’s

attending physician would have to

determine that the estimated screening

potential from the use of the single

contrast barium enema is equal to or

exceeds the estimated screening

potential that would result from the use

of the flexible sigmoidoscopy and the

colonoscopy examinations.

In summary, effective January 1, 1998,

we will pay for screening barium

enemas as an alternative to either a

screening flexible sigmoidoscopy or a

screening colonoscopy, in accordance

with the same frequency parameters

specified in the law for the other two

colorectal screening services identified.

2. Provisions of the Final Rule

We are specifying an exception to the

list of examples of routine physical

checkups excluded from coverage in

§ 411.15(a)(1) (Particular services

excluded from coverage). The exception

is for colorectal cancer screening tests

that meet the frequency limitations and

the conditions for coverage that we are

specifying under § 410.37. Coverage of

colorectal cancer screening tests is

provided under Medicare Part B only.

3. Frequency Limits and Conditions of

Coverage

Section 4104 of the BBA 1997 adds

new subparagraph (R) to section

1861(s)(2) of the Act authorizing

Medicare coverage of certain colorectal

screening services as defined in section

1861(pp) that are furnished on or after

January 1, 1998. These statutorily

mandated colorectal services include

screening fecal-occult blood tests,

screening flexible sigmoidoscopy

examinations, and screening

colonoscopy examinations. Section

4104(b) of the BBA 1997 also establishes

frequency of coverage limitations for all

three of these colorectal screening

services. The frequency of coverage

limitations specified for fecal-occult

blood tests is that payment may be made

only for an individual 50 years of age or

over, if the test has not been performed

within the 11 months that have passed

following the month in which the last

screening fecal-occult blood test was

performed. The frequency of coverage

limitation indicated for screening

flexible sigmoidoscopy examinations is

that payment may be made only for an

individual age 50 years of age or over,

if the procedure has not been performed

within the 47 months that have passed

following the month in which the last

screening flexible sigmoidoscopy

examination was performed. In the case

of screening colonoscopy examinations,

section 4104 of the BBA 1997 provides

for coverage of screening colonoscopies

for individuals at high risk for

developing colorectal cancer (as now

defined in section 1861(pp)(2) of the

Act), if the screening examination has

not been performed within the 23

months that have passed following the

month in which the last screening

colonoscopy was performed.
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59081

We have added § 410.37 to provide for

coverage of four types of colorectal

cancer screening tests. First, we are

specifying several definitions of terms

that are included to implement the

statutory provisions and to help the

reader in understanding the regulation

provisions. These include definitions of

the terms (1) colorectal cancer screening

tests, (2) fecal-occult blood test, (3)

individual at high risk for colorectal

cancer, (4) screening barium enema, and

(5) attending physician. Second, we are

establishing conditions of coverage for

all four of the colorectal cancer

screening tests that we will be paying

for, effective January 1, 1998. Under our

authority under the ‘‘reasonable and

necesary’’ clause of the Act, section

1862(a)(1)(A), we are establishing

conditions under which we would cover

colorectal screening services. In

§ 410.37(b) (Conditions for coverage of

screening fecal-occult blood tests) and

§ 410.37 (h) (Conditions for coverage of

screening barium enemas) we are

specifying that coverage is available for

screening fecal-occult blood tests and

screening barium enema examinations

only if they are ordered in writing by

the beneficiary’s attending physician.

We are including these coverage

requirements to make certain that

beneficiaries receive appropriate

preventive counseling about the

implications and possible results of

having these examinations performed.

In addition, in the case of the screening

barium enema, which we will cover as

an alternative to either the screening

flexible sigmoidoscopy or the

colonoscopy examination, we want to

ensure that the beneficiary’s attending

physician has made a determination

that the screening potential of that exam

is at least equal to or greater than the

screening potential for the alternative

examination. Third, in order to ensure

that the screening flexible

sigmoidoscopy and screening

colonoscopy exams are performed as

safely and accurately as possible, we are

requiring in § 410.37(d) (Conditions for

coverage of screening flexible

sigmoidoscopies) and § 410.37(f)

(Conditions for coverage of screening

colonoscopies) that the examinations

must be performed by a doctor of

medicine or osteopathy (as defined in

section 1861(r)(1) of the Act.)

Additionally, in §§ 410.37(c),

410.37(e), 410.37(g), and 410.37(i)

(Limitations on coverage of screening

fecal-occult blood tests, Limitations on

coverage of screening flexible

sigmoidoscopies, Limitations on

coverage of screening colonoscopies,

and limitations on coverage of screening

barium enemas, respectively), we are

setting forth the following frequency

and payment restrictions for the four

types of colorectal cancer screening test

covered, which are mandated by

sections 1834(d)(1)(B), 1834(d)(2)(E) and

1834(d)(3)(E) of the Act, except for those

relating to screening barium enema

examinations, which the law did not

specifically address.

Limits on Fecal-Occult Blood Tests

• Payment may not be made for a

screening fecal-occult blood test

performed for an individual under age

50.

• For an individual 50 years of age or

over, payment may be made for a

screening fecal-occult blood test

performed after at least 11 months have

passed following the month in which

the last fecal-occult blood test was

performed.

Limits on Flexible Sigmoidoscopies

• Payment may not be made for a

screening flexible sigmoidoscopy

performed for an individual under age

50.

• For an individual 50 years of age or

over, payment may be made for a

screening flexible sigmoidoscopy

performed after at least 47 months have

passed following the month in which

the last screening flexible

sigmoidoscopy, or the last screening

barium enema was performed.

Limits on Colonoscopies

• Payment may not be made for a

screening colonoscopy performed for an

individual who is not at high risk for

colorectal cancer.

• Payment may be made for a

screening colonoscopy performed for an

individual at high risk for colorectal

cancer after at least 23 months have

passed following the month in which

the last screening colonoscopy or the

last screening barium enema was

performed.

Limits for Barium Enemas

• In the case of an individual age 50

and over who is not at high risk for

colorectal cancer, payment may be made

for a screening barium enema after 47

months have passed following the

month in which the last screening

barium enema, or the last screening

flexible sigmoidoscopy was performed.

• In the case of an individual who is

at high risk for colorectal cancer,

payment may be made for a screening

barium enema after at least 23 months

have passed following the month in

which the last screening barium enema,

or the last screening colonoscopy was

performed.

As indicated previously, in explaining

our national coverage determination on

screening barium enemas, we have

decided to pay for this examination as

an alternative to either the flexible

sigmoidoscopy or the colonoscopy

coverage provisions (that is, as a

substitute for, and not as add-on

coverage.) In reviewing the matter of the

appropriate frequency limits for

screening barium enemas, we did

consider the possibility of providing for

payment for these services as an add-on

to the other two major screening

coverage provisions. However, since the

screening barium enema allows for a

complete examination of the colon, we

have not adopted this alternative

because we believe it would be

duplicative for us to permit coverage of

both a screening barium enema and a

screening flexible sigmoidoscopy (or a

screening colonoscopy for an individual

at high risk of colorectal cancer) during

the same 2 or 4 year time period,

respectively. In the case of a suspicious

or equivocal examination, other tests

would be necessary but would be

considered diagnostic tests, not

screening, and would be covered under

Medicare. It is generally unnecessary to

perform duplicate screening tests.

4. Payment Limits

Payment amounts for screening fecaloccult blood tests, screening

sigmoidoscopies, screening

colonoscopies, and barium enemas as

follows:

• Screening fecal occult blood tests

are covered at a frequency of once every

12 months for beneficiaries who have

attained age 50. Section 1834(d)(1) of

the Act provides that screening fecal

occult blood tests are paid at the same

rate as diagnostic fecal-occult blood

tests (CPT code 82270) are paid under

the clinical laboratory fee schedule. We

have created a new HCPCS code G0107,

colorectal cancer screening; fecal-occult

blood test, one to three simultaneous

determinations, to be used for screening

fecal-occult blood tests. This code will

be carrier-priced at the payment amount

that the Medicare carrier pays for CPT

code 82270 under the clinical laboratory

fee schedule.

• Screening flexible sigmoidoscopy is

covered at a frequency of once every 48

months for beneficiaries who have

attained age 50. Section 1861(pp)(2) of

the Act provides that payment for

screening flexible sigmoidoscopies be

paid at rates consistent with payment

for similar or related services under the

physician fee schedule, not to exceed

the rates for a diagnostic flexible

sigmoidoscopy (CPT code 45330).
59082 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

We have created a new HCPCS code

G0104, colorectal cancer screening;

flexible sigmoidoscopy, to be used for

screening flexible sigmoidoscopy. We

believe that the work is the same

whether the procedure is a screening or

a diagnostic sigmoidoscopy and are,

therefore, assigning the same RVUs to

HCPCS code G0104 as those assigned to

CPT code 45330 in Addendum B. If

during the course of the screening

flexible sigmoidoscopy a lesion or a

growth is detected that results in a

biopsy or removal of the growth, section

1834(d)(2)(D) of the Act provides that

the physician should bill for a flexible

sigmoidoscopy with biopsy or removal,

rather than using the screening HCPCS

code G0104.

• Screening colonoscopy is covered at

a frequency of once every 24 months for

beneficiaries at high risk for colorectal

cancer under section 1834(d)(3)(E) of

the Act. Section 1861(pp)(2) of the Act

defines high risk as a person who,

because of family history, prior

experience of cancer or precursor

neoplastic polyps, a history of chronic

digestive disease condition (including

inflammatory bowel disease, Crohn’s

disease, or ulcerative colitis), the

presence of any appropriate recognized

gene markers for colorectal cancer, or

other predisposing factors, faces a high

risk for colorectal cancer. The law

provides that payment for screening

colonoscopies be paid at rates consistent

with payment for similar or related

services under the physician fee

schedule, not to exceed the rates for a

diagnostic colonoscopy (CPT code

45378).

We have created a new HCPCS code

G0105, colorectal cancer screening;

colonoscopy for an individual at high

risk, to be used for screening

colonoscopy. We believe that the work

is the same whether the procedure is a

screening or a diagnostic colonoscopy,

and we are, therefore, assigning the

same RVUs to HCPCS code G0105 as

those assigned to CPT code 45378 in

Addendum B. If during the course of the

screening colonoscopy a lesion or

growth is detected that results in a

biopsy or removal of the growth, section

1834(d)(3)(D) of the Act provides that

the physician should bill for a

colonoscopy with biopsy or removal,

rather than using the screening HCPCS

code G0105.

• The frequency of payment

limitations for the screening barium

exams will be exactly the same as the

frequency of payment limitations that

would apply if the barium examination

were not being substituted for the other

screening service (that is, once every 4

years for a flexible sigmoidoscopy

examination for individuals age 50 or

over and once every 2 years for

colonoscopy screening for individuals at

high risk for colorectal cancer).

We have created the following new

HCPCS codes:

HCPCS code Descriptor

G0106 .............................................. Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema.

G0120 .............................................. Colorectal cancer screening; alternative to G0105, screening colonoscopy, barium enema.

G0121 .............................................. Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk (non-covered).

G0122 .............................................. Colorectal cancer screening; barium enema (non-covered).

The first two codes (G0106, and G0120)

are to be used for the barium enema

when the barium enema is being

substituted for either the sigmoidoscopy

or the colonoscopy, as indicated by the

code nomenclature. The RVUs for these

procedures will be the same as for the

diagnostic barium enema procedure,

CPT code 74280, and are shown in

Addendum B.

The second two codes are to be used

when the high risk criteria are not met,

or a barium enema is performed but not

a substitute for either a sigmoidoscopy

or colonoscopy. These are non-covered

services.

5. Screening Colonoscopy in an

Ambulatory Surgical Center

CPT code 45378, which is used to

code a diagnostic colonoscopy, is on the

list of procedures approved by Medicare

for payment of an ambulatory surgical

center (ASC) facility fee under section

1833(I) of the Act. CPT code 45378 is

currently assigned to ASC payment

group 2. We propose to add the new

HCPCS code G0105, colorectal cancer

screening; colonoscopy on individual at

high risk, to the ASC list. We believe

that the facility services are the same

whether the procedure is a screening or

a diagnostic colonoscopy and are,

therefore, assigning HCPCS code G0105

to payment group 2, which is the same

payment rate assigned to CPT code

45378. If during the course of the

screening colonoscopy performed at an

ASC a lesion or growth is detected

which results in a biopsy or removal of

the growth, the appropriate procedure

classified as a colonoscopy with biopsy

or removal should be billed and paid

rather than HCPCS code G0105.

D. Coverage of Screening Pelvic

Examination (Including a Clinical

Breast Examination) and Related

Payment Changes

Section 4102 of the BBA 1997

provides for coverage of screening

pelvic examinations (including a

clinical breast examination) for all

female beneficiaries, effective January 1,

1998, subject to certain frequency and

other limitations. A screening pelvic

examination (including a clinical breast

examination) should include at least

seven of the following eleven elements:

• Inspection and palpation of breasts

for masses or lumps, tenderness,

symmetry, or nipple discharge.

• Digital rectal examination including

sphincter tone, presence of

hemorrhoids, and rectal masses. Pelvic

examination (with or without specimen

collection for smears and cultures)

including:

• External genitalia (for example,

general appearance, hair distribution, or

lesions).

• Urethral meatus (for example, size,

location, lesions, or prolapse).

• Urethra (for example, masses,

tenderness, or scarring).

• Bladder (for example, fullness,

masses, or tenderness).

• Vagina (for example, general

appearance, estrogen effect, discharge,

lesions, pelvic support, cystocele, or

rectocele).

• Cervix (for example, general

appearance, lesions, or discharge).

• Uterus (for example, size, contour,

position, mobility, tenderness,

consistency, descent, or support).

• Adnexa/parametria (for example,

masses, tenderness, organomegaly, or

nodularity).

• Anus and perineum.

This description is from

Documentation Guidelines for

Evaluation and Management Services,

published in May 1997, and was

developed by the Health Care Financing

Administration and the American

Medical Association. Section

1862(a)(1)(A) of the Act provides that

Medicare cover only services that are

reasonable and necessary for the

diagnosis or treatment of illness or

injury. We believe that a pelvic

screening procedure should examine
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59083

various anatomical structures to avoid

missing detection of as many potential

disorders as practical. We will be

including this description in

instructions in the Medicare Carriers

Manual.

This coverage allows payment for one

pelvic examination for every female

beneficiary every 3 years but includes

the allowance of payment once every

year for certain women of childbearing

age as well as certain women at high

risk for cervical or vaginal cancer.

Specifically, section 4102(a) of the BBA

1997 provides for the following

frequency of coverage limitations:

As reflected in the law, payment may

be made for a screening pelvic

examination on an annual basis if one

of the following occurs:

• The woman is of childbearing age

and has had an examination indicating

the presence of cervical or vaginal

cancer or other abnormality during any

of the preceding 3 years.

• The woman is considered by her

physician or other practitioner to be at

high risk of developing cervical or

vaginal cancer as we have defined in

these regulations.

We are adding § 410.56 (Screening

pelvic examinations) to include this

new coverage. In § 410.56(a) (Conditions

for screening pelvic examinations), we

are requiring that to be covered by

Medicare Part B the screening pelvic

examination must be performed by a

doctor of medicine or osteopathy (as

defined in section 1861(r)(1) of the Act),

or by a certified nurse midwife (as

defined in section 1861(gg) of the Act),

or a physician assistant, nurse

practitioner, or clinical nurse specialist

(as defined in section 1861(aa) of the

Act) who is authorized under State law

to perform the examination. We have

included this requirement to ensure that

the screening exam is performed as

safely and accurately as possible.

To implement the statutory mandate

that requires us to identify in

regulations the high risk factors for

cervical and vaginal cancer, we are

specifying in § 410.56(b)(2) (More

frequent screening based on high-risk

factors), the following factors that have

been recommended to us by the

National Cancer Institute and the

Centers for Disease Prevention and

Control. While other factors may have

been identified such as low

socioeconomic status, the lack of precise

and verifiable definitions does not make

them amenable to regulation at this

time.

1. High Risk Factors for Cervical Cancer

• Early onset of sexual activity (under

16 years of age).

• Multiple sexual partners (five or

more in a lifetime).

• History of a sexually transmitted

disease (including the human

immunodeficiency virus (HIV).

• Absence of three negative Pap

smears or any Pap smears within the

previous 7 years.

2. High Risk Factors for Vaginal Cancer

• Prenatal exposure to

diethylstilbestrol.

Based on consultation with

representatives of the American College

of Gynecologists and Obstetricians and

others, we have defined a woman of

childbearing age in § 410.56(b)(3) (More

frequent screening for women of

childbearing age) to mean a woman who

is premenopausal, and has been

determined by her physician or other

practitioner, as specified in § 410.56(a),

to be of childbearing age, based on her

medical history or other findings.

This new section also provides for a

waiver of the Part B deductible

requirement that would otherwise be

applicable to these services.

E. Reinstatement of the Payment for

Transportation of EKG Equipment

As set forth in section 4559 of the

BBA 1997, effective for services

furnished after December 31, 1997 and

before January 1, 1999, carriers will

make separate payments for HCPCS

code R0076 (Transportation of portable

EKG to facility or location, per patient)

based upon payment methods in effect

for these services as of December 31,

1996. EKG transportation payments are

made at the carrier-priced level that was

in effect on December 31, 1996. The

procedure codes involved are CPT code

93000 (a 12-lead EKG with

interpretation and report) or CPT code

93005 (a 12-lead EKG, tracing only,

without interpretation and report).

When multiple patients receive services

at the same site, the transportation

payment amount must be prorated

among all patients seen. These

payments may be made only under the

following circumstances:

• The transportation service is

furnished in connection with standard

EKG procedures furnished by approved

suppliers of portable x-ray services as

set forth in section 2070.4.F. of the

Medicare Carriers Manual.

• The transportation service is

furnished in connection with standard

EKG procedures by an independent

diagnostic testing facility or an

independent physiological laboratory

under the conditions set forth in section

2070.1.G. of the Medicare Carriers

Manual.

F. Waiver of Proposed Rulemaking for

Provisions in the Balanced Budget Act

of 1997

We ordinarily publish a notice of

proposed rulemaking in the Federal

Register and invite prior public

comment on proposed rules. We have

found good cause that a notice-andcomment procedure can be waived for

the BBA 1997 provisions discussed

above. A complete explanation of

reasons is given in section VII. of this

preamble.

IV. Refinement of Relative Value Units

for Calendar Year 1998 and Responses

to Public Comments on Interim Relative

Value Units for 1997

A. Summary of Issues Discussed Related

to the Adjustment of Relative Value

Units

Section IV.B. of this final rule

describes the methodology used to

review the comments received on the

RVUs for physician work and the

process used to establish RVUs for new

and revised CPT codes. Changes to

codes on the physician fee schedule

reflected in Addendum B are effective

for services furnished beginning January

1, 1998.

B. Process for Establishing Work

Relative Value Units for the 1998 Fee

Schedule

Our November 22, 1996 final rule on

the 1997 physician fee schedule (61 FR

59490) announced the final RVUs for

Medicare payment for existing

procedure codes under the physician fee

schedule and interim RVUs for new and

revised codes. The RVUs contained in

the rule apply to physician services

furnished beginning January 1, 1997.

We announced that we considered the

RVUs for the interim codes to be subject

to public comment under the annual

refinement process. In this section, we

summarize the refinements to the

interim work RVUs that have occurred

since publication of the November 1996

final rule and our establishment of the

work RVUs for new and revised codes

for the 1998 fee schedule.

1. Work Relative Value Unit

Refinements of Interim and Related

Relative Value Units (Includes Table 1—

Work Relative Value Unit Refinements

of 1997 Interim and Related Relative

Value Units)

Although the RVUs in the November

1996 final rule were used to calculate

1997 payment amounts, we considered

the RVUs for the new or revised codes

to be interim. We accepted comments

for a period of 60 days. We received

substantive comments from
59084 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

approximately five specialty societies

on approximately nine CPT codes with

interim RVUs. Only comments received

on codes listed in Addendum C of the

November 1996 final rule were

considered this year.

Due to the low volume of comments

we received for 1997 CPT codes with

interim RVUs, we adjusted the

refinement process we have used in

previous years. (See the November 22,

1996 final rule on the physician fee

schedule (61 FR 59536) for a detailed

explanation of the refinement of CPT

codes with interim RVUs.) Instead, we

invited one representative from each of

the five specialty societies from which

comments were received to attend a

discussion of the codes commented on

by their respective societies. In

attendance at this meeting were the

following representatives:

• A clinician representing each of the

specialties most identified with the

procedures in question. Each specialist

was nominated by the specialty society

that submitted the comments.

• Representatives from the AMA’s

RUC.

• Carrier medical directors.

• HCFA medical officers.

• HCFA staff.

The group discussed the work

involved in each procedure under

review in comparison to the work

associated with other services on the fee

schedule. We had assembled a set of

reference services and asked the group

members to compare the clinical aspects

of the work of services they believed

were incorrectly valued to one or more

of the reference services. In compiling

the set, we attempted to include: (1)

Services that are commonly performed

whose work RVUs are not controversial;

(2) services that span the entire

spectrum from the easiest to the most

difficult; and (3) at least three services

performed by each of the major

specialties so that each specialty would

be represented. The set listed

approximately 300 services. Group

members were encouraged to make

comparisons to reference services.

The specialty society’s

recommendations were accepted for all

nine of the CPT codes that were

reviewed. We will continue with the

regular refinement process for future

years.

Table 1—Work Relative Value Unit

Refinements of 1997 Interim and

Related Relative Value Units

Table 1 lists the interim and related

codes reviewed during the 1997

refinement process described in this

section. This table includes the

following information:

• CPT Code. This is the CPT code for

a service.

• Description. This is an abbreviated

version of the narrative description of

the code.

• 1997 Work RVU. The work RVUs

that appeared in the November 1996

rule are shown for each reviewed code.

• Requested Work RVU. This column

identifies the work RVUs requested by

commenters.

• 1998 Work RVU. This column

contains the final RVUs for physician

work.

The new values emerged from

analysis of the specialty representative’s

presentation.

TABLE 1.—WORK RVU REFINEMENT OF 1997 INTERIM AND RELATED RVUS

CPT* MOD Description 1997 work

RVU

Requested

work RVU

1998 work

RVU

37250 .......... Intravascular us ......................................................................................................... 1.51 2.10 2.10

37251 .......... Intravascular us ......................................................................................................... 1.15 1.60 1.60

56300 .......... Pelvis laparoscopy, dx .............................................................................................. 3.65 5.00 5.00

56305 .......... Pelvic laparoscopy, biopsy ........................................................................................ 3.97 5.30 5.30

75945 26 Intravascular us ......................................................................................................... 0.29 0.40 0.40

75946 26 Intravascular us ......................................................................................................... 0.29 0.40 0.40

95921 26 Autonomic nerve function test ................................................................................... 0.45 0.90 0.90

95922 26 Autonomic nerve function test ................................................................................... 0.48 0.96 0.96

95923 26 Autonomic nerve function test ................................................................................... 0.45 0.90 0.90

*All CPT and descriptors copyright 1997 American Medical Association

2. Establishment of Interim Work

Relative Value Units for New and

Revised Physicians’ Current Procedural

Terminology Codes and New HCFA

Common Procedure Coding System

Codes for 1998

a. Methodology (Includes Table 2—

American Medical Association

Specialty Society Relative Value Update

Committee and Health Care

Professionals Advisory Committee

Recommendations and HCFA’s

Decisions for New and Revised 1998

CPT Codes). One aspect of establishing

work RVUs for 1998 was related to the

assignment of interim work RVUs for all

new and revised CPT codes. As

described in our November 25, 1992

notice on the 1993 fee schedule (57 FR

55938) and in section III.B. of our

November 26, 1996 final rule (61 FR

59505 through 59506), we established a

process, based on recommendations

received from the AMA’s Specialty

Society Relative Value Update

Committee (RUC), for establishing

interim RVUs for new and revised

codes.

We received work RVU

recommendations for approximately 208

new and revised codes from the RUC.

Physician panels consisting of carrier

medical directors and our staff reviewed

the RUC recommendations by

comparing them to our reference set or

to other comparable services on the fee

schedule for which work RVUs had

been established previously, or to both

of these criteria. The panels also

considered the relationships among the

new and revised codes for which we

received the RUC recommendations. We

agreed with a majority of those

relationships reflected in the RUC

values. In some cases when we agreed

with the RUC relationships, we revised

the work RVUs recommended by the

RUC in order to achieve work neutrality

within families of codes. That is, the

work RVUs have been adjusted so that

the sum of the new or revised work

RVUs (weighted by projected frequency

of use) for a family of codes will be the

same as the sum of the current work

RVUs (weighted by their current

frequency of use). For approximately 96

percent of the RUC recommendations,

proposed work RVUs were accepted or

increased, and, for approximately 4

percent, work RVUs were decreased.

We received 11 recommendations

from the Health Care Professionals

Advisory Committee (HCPAC) for new

or revised codes for which the RUC did

not provide a recommendation. For 7 of

the HCPAC’s recommendations, the

proposed work RVUs were accepted.
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59085

There were also 5 CPT codes for

which HCFA did not receive a RUC

recommendation. HCFA established

interim work RVUs for 3 of these codes.

Table 2 is a listing of those codes that

will be new or revised in 1998 as well

as their associated work RVUs. This

table includes the following

information:

• A ‘‘#’’ identifies a new code for

1998.

• CPT code. This is the CPT code for

a service.

• Modifier. A ‘‘26’’ in this column

indicates that the work RVUs are for the

professional component of the code.

• Description. This is an abbreviated

version of the narrative description of

the code.

• RUC recommendations. This

column identifies the work RVUs

recommended by the RUC.

• HCPAC recommendations. This

column identifies work RVUs

recommended by the HCPAC.

• HCFA decision. This column

indicates whether we agreed with the

RUC recommendation (‘‘agree’’); we

established work RVUs that are higher

than the RUC recommendation

(‘‘increase’’); or we established work

RVUs that were less than the RUC

recommendation (‘‘decrease’’). Codes for

which we did not accept the RUC

recommendation are discussed in

greater detail following Table 2 in

section IV.B.2.b. below. An ‘‘(a)’’

indicates that no RUC recommendation

was provided. A discussion follows the

table in section IV.B.2.b.

• HCFA work RVUs. This column

contains the RVUs for physician work

based on our reviews of the RUC

recommendations. The RVUs shown for

global surgical services have not been

adjusted to account for the 1997

increases for work RVUs in evaluation

and management services.

1998 work RVUs. This column

contains the 1998 RVUs for physician

work. The RVUs shown for global

surgical services have been adjusted to

account for the 1997 increases for work

RVUs in evaluation and management.

This table includes only those codes

that were reviewed by the full RUC or

for which we received a

recommendation from the HCPAC.

TABLE 2.—AMA RUC AND HCPAC RECOMMENDATIONS AND HCFA DECISIONS FOR NEW AND REVISED 1998 CPT

CODES

CPT*

code MOD Description RUCrecommendation

HCPAC

recommendation

HCFA

decision

HCFA work

RVU

1998 work b

RVU

11055# ..... ............ Paring, Cutting, and Trimming of Nails .... ............................ 0.43 Decrease .............. 0.27 0.27

11056# ..... ............ Paring, Cutting, and Trimming of Nails .... ............................ 0.61 Decrease .............. 0.39 0.39

11057# ..... ............ Paring, Cutting, and Trimming of Nails .... ............................ 0.79 Decrease .............. 0.50 0.50

11719# ..... ............ Paring, Cutting, and Trimming of Nails .... ............................ 0.17 Decrease .............. 0.06 0.06

11200 ....... ............ Destruction of lesions ............................... 0.69 ............................ Decrease .............. 0.67 0.77

11201 ....... ............ Destruction of lesions ............................... 0.35 ............................ Decrease .............. 0.29 0.29

15756 ....... ............ Free muscle flap ....................................... 33.23 ............................ Agree .................... 33.23 35.23

17000 ....... ............ Destruction of lesions ............................... 0.55 ............................ Agree .................... 0.55 0.60

17003# ..... ............ Destruction of lesions ............................... 0.15 ............................ Agree .................... 0.15 0.15

17004# ..... ............ Destruction of lesions ............................... 2.65 ............................ Agree .................... 2.65 2.79

17110 ....... ............ Destruction of lesions ............................... 0.55 ............................ Agree .................... 0.55 0.65

17111# ..... ............ Destruction of lesions ............................... 0.82 ............................ Agree .................... 0.82 0.92

17250 ....... ............ Destruction of lesions ............................... 0.50 ............................ Agree .................... 0.50 0.50

19120 ....... ............ Excision of cyst ........................................ 5.35 ............................ Agree .................... 5.35 5.56

20664# ..... ............ Application of halo .................................... 7.00 ............................ Agree .................... 7.00 8.06

22818# ..... ............ Kyphectomy .............................................. 30.00 ............................ Agree .................... 30.00 31.83

22819# ..... ............ Kyphectomy .............................................. 34.50 ............................ Agree .................... 34.50 36.44

29860# ..... ............ Arthroscopy of hip .................................... 7.75 ............................ Agree .................... 7.75 8.05

29861# ..... ............ Arthroscopy of hip .................................... 9.00 ............................ Agree .................... 9.00 9.15

29862# ..... ............ Arthroscopy of hip .................................... 9.50 ............................ Agree .................... 9.50 9.90

29863# ..... ............ Arthroscopy of hip .................................... 9.50 ............................ Agree .................... 9.50 9.90

29891# ..... ............ Arthroscopy of ankle ................................ 8.00 ............................ Agree .................... 8.00 8.40

29892# ..... ............ Arthroscopy of ankle ................................ 8.60 ............................ Agree .................... 8.60 9.00

29893# ..... ............ Arthroscopy of ankle ................................ ............................ 4.92 Agree .................... 4.92 5.22

32200 ....... ............ Percutaneous abscess drainage .............. 13.10 ............................ Agree .................... 13.10 15.29

32201# ..... ............ Percutaneous abscess drainage .............. 4.00 ............................ Agree .................... 4.00 4.00

33496# ..... ............ Repair of non-structural valve dysfunction 25.64 ............................ Agree .................... 25.64 27.25

33530 ....... ............ Repair of non-structural valve dysfunction 5.86 ............................ Agree .................... 5.86 5.86

35400# ..... ............ Intraoperative Endovascular Angioscopy 3.00 ............................ Agree .................... 3.00 3.00

36215 ....... ............ Coronary Angiography ............................. 4.68 ............................ Agree .................... 4.68 4.68

37195# ..... ............ Thrombolytic therapy for acute ischemic 0.00 ............................ Agree .................... 0.00 0.00

37250 ....... ............ Intravascular us ........................................ 1.51 ............................ Agree .................... 1.51 2.10

37251 ....... ............ Intravascular us ........................................ 1.15 ............................ Agree .................... 1.15 1.60

43116 ....... ............ Partial esophagectomy ............................. 29.67 ............................ Agree .................... 29.67 31.22

43496 ....... ............ Free jejunum transfer ............................... carrier ............................ Agree .................... carrier carrier

43635 ....... ............ Vagotomy ................................................. 2.06 ............................ Agree .................... 2.06 2.06

44625 ....... ............ Closure of colostomy ................................ 12.10 ............................ Agree .................... 12.10 13.41

44626# ..... ............ Closure of colostomy ................................ 21.29 ............................ Agree .................... 21.29 22.59

44700# ..... ............ Intestinal sling procedure ......................... 13.00 ............................ Agree .................... 13.00 14.35

44900 ....... ............ Percutaneous abscess drainage .............. 7.86 ............................ Agree .................... 7.86 8.82

44901# ..... ............ Percutaneous abscess drainage .............. 3.38 ............................ Agree .................... 3.38 3.38

45112 ....... ............ Proctectomy with coloanal anastomosis .. 24.02 ............................ Agree .................... 24.02 25.96

45119# ..... ............ Proctectomy with coloanal anastomosis .. 23.50 ............................ Increase ............... 24.50 26.21

47010 ....... ............ Percutaneous abscess drainage .............. 8.75 ............................ Agree .................... 8.75 10.28

47011# ..... ............ Percutaneous abscess drainage .............. 3.70 ............................ Agree .................... 3.70 3.70

48510 ....... ............ Percutaneous abscess drainage .............. 11.22 ............................ Agree .................... 11.22 12.96

48511# ..... ............ Percutaneous abscess drainage .............. 4.00 ............................ Agree .................... 4.00 4.00

49040 ....... ............ Percutaneous abscess drainage .............. 8.74 ............................ Agree .................... 8.74 9.94

49041# ..... ............ Percutaneous abscess drainage .............. 4.00 ............................ Agree .................... 4.00 4.00

49060 ....... ............ Percutaneous abscess drainage .............. 10.55 ............................ Agree .................... 10.55 11.66

49061# ..... ............ Percutaneous abscess drainage .............. 3.70 ............................ Agree .................... 3.70 3.70

49062# ..... ............ Lymphocele drainage ............................... 10.78 ............................ Agree .................... 10.78 11.36

49423# ..... ............ Percutaneous abscess drainage .............. 1.46 ............................ Agree .................... 1.46 1.46
59086 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

TABLE 2.—AMA RUC AND HCPAC RECOMMENDATIONS AND HCFA DECISIONS FOR NEW AND REVISED 1998 CPT

CODES—Continued

CPT*

code MOD Description RUCrecommendation

HCPAC

recommendation

HCFA

decision

HCFA work

RVU

1998 work b

RVU

49424# ..... ............ Percutaneous abscess drainage .............. 0.76 ............................ Agree .................... 0.76 0.76

49560 ....... ............ Ventral herniorgraphy ............................... 9.48 ............................ Agree .................... 9.48 9.88

49565 ....... ............ Ventral herniorgraphy ............................... 9.48 ............................ Agree .................... 9.48 9.88

49568 ....... ............ Ventral herniorgraphy ............................... 4.89 ............................ Agree .................... 4.89 4.89

50020 ....... ............ Percutaneous abscess drainage .............. 12.41 ............................ Agree .................... 12.41 14.66

50021# ..... ............ Percutaneous abscess drainage .............. 3.38 ............................ Agree .................... 3.38 3.38

51840 ....... ............ Burch procedure ....................................... 9.78 ............................ Agree .................... 9.78 10.71

52281 ....... ............ Cystourethroscopy .................................... 2.80 ............................ Agree .................... 2.80 2.80

52282# ..... ............ Urethral endoprosthesis ........................... 6.40 ............................ Agree .................... 6.40 6.40

53850# ..... ............ Transurethral destruction of prostate ....... 9.58 ............................ Decrease .............. 9.25 9.45

53852# ..... ............ Transurethral destruction of prostate ....... 9.58 ............................ Agree .................... 9.58 9.88

56300 ....... ............ Laparoscopic surgery ............................... 5.00 ............................ Agree .................... 5.00 5.10

56301 ....... ............ Laparoscopic surgery ............................... 5.50 ............................ Agree .................... 5.50 5.60

56302 ....... ............ Laparoscopic surgery ............................... 5.50 ............................ Agree .................... 5.50 5.60

56303 ....... ............ Laparoscopic surgery ............................... 10.50 ............................ Increase ............... 10.95 11.79

56304 ....... ............ Laparoscopic surgery ............................... 10.00 ............................ Increase ............... 10.45 11.29

56305 ....... ............ Laparoscopic surgery ............................... 5.30 ............................ Agree .................... 5.30 5.40

56306 ....... ............ Laparoscopic surgery ............................... 5.60 ............................ Agree .................... 5.60 5.70

56309 ....... ............ Laparoscopic surgery ............................... 13.79 ............................ Agree .................... 13.79 14.21

56310# ..... ............ Laparoscopic surgery ............................... 13.50 ............................ Agree .................... 13.50 14.44

56314# ..... ............ Laparoscopic surgery ............................... 8.93 ............................ Agree .................... 8.93 9.48

56318# ..... ............ Laparoscopic surgery ............................... 10.63 ............................ Agree .................... 10.63 10.96

56345# ..... ............ Laparoscopic surgery ............................... ............................ ............................ (a) .......................... carrier carrier

56346# ..... ............ Laparoscopic surgery ............................... 7.18 ............................ Agree .................... 7.18 7.73

56347# ..... ............ Laparoscopic surgery ............................... ............................ ............................ (a) .......................... carrier carrier

56348# ..... ............ Laparoscopy with intestinal resection ...... 20.00 ............................ Increase ............... 21.00 22.04

56349# ..... ............ Laparoscopic surgery ............................... 17.75 ............................ Decrease .............. 16.47 17.25

56350 ....... ............ Hysteroscopy ............................................ 3.33 ............................ Agree .................... 3.33 3.33

56351 ....... ............ Hysteroscopy ............................................ 4.75 ............................ Agree .................... 4.75 4.75

56352 ....... ............ Hysteroscopy ............................................ 6.17 ............................ Agree .................... 6.17 6.17

56353 ....... ............ Hysteroscopy ............................................ 7.00 ............................ Agree .................... 7.00 7.00

56354 ....... ............ Hysteroscopy ............................................ 10.00 ............................ Agree .................... 10.00 10.00

56355 ....... ............ Hysteroscopy ............................................ 5.21 ............................ Agree .................... 5.21 5.21

56356 ....... ............ Hysteroscopy ............................................ 9.50 ............................ Decrease .............. 6.17 6.17

57308 ....... ............ Closure of rectovaginal fistula .................. 9.31 ............................ Agree .................... 9.31 9.94

57531 ....... ............ Radical trachelectomy .............................. 28.00 ............................ Agree .................... 28.00 29.60

58152 ....... ............ Burch procedure ....................................... 14.10 ............................ Agree .................... 14.10 15.09

58340 ....... ............ Hysterosonography .................................. 0.88 ............................ Agree .................... 0.88 0.88

58820 ....... ............ Percutaneous abscess drainage .............. 3.96 ............................ Agree .................... 3.96 4.22

58822 ....... ............ Percutaneous abscess drainage .............. 9.06 ............................ Agree .................... 9.06 10.13

58823# ..... ............ Percutaneous abscess drainage .............. 3.38 ............................ Agree .................... 3.38 3.38

59050 ....... ............ Fetal monitoring ........................................ 0.89 ............................ Agree .................... 0.89 0.89

59051 ....... ............ Fetal monitoring ........................................ 0.74 ............................ Agree .................... 0.74 0.74

59160 ....... ............ Curettage, postpartum .............................. 2.66 ............................ Agree .................... 2.66 2.71

59871# ..... ............ Removal of cerclage suture ..................... 2.13 ............................ Agree .................... 2.13 2.13

61793 ....... ............ Stereotactic radiosurgery ......................... 16.70 ............................ Agree .................... 16.70 17.24

67027# ..... ............ Ganciclovir implant ................................... 10.35 ............................ Agree .................... 10.35 10.85

70553 ....... 26 MI, brain ................................................... 2.36 ............................ Agree .................... 2.36 2.36

74283 ....... 26 Therapeutic Enema .................................. 2.02 ............................ Agree .................... 2.02 2.02

74740 ....... 26 Hysterosonography .................................. 0.38 ............................ Agree .................... 0.38 0.38

75989 ....... 26 Percutaneous Abscess drainage ............. 1.19 ............................ Agree .................... 1.19 1.19

76070 ....... 26 Bone density studies ................................ 0.25 ............................ Agree .................... 0.25 0.25

76075 ....... 26 Bone density studies ................................ 0.30 ............................ Agree .................... 0.30 0.30

76076# ..... 26 Bone density studies ................................ 0.22 ............................ Agree .................... 0.22 0.22

76078# ..... 26 Bone density studies ................................ 0.20 ............................ Agree .................... 0.20 0.20

76080 ....... 26 Percutaneous Abscess drainage ............. 0.54 ............................ Agree .................... 0.54 0.54

76095 ....... 26 Stereotactic breast biopsy ........................ 1.59 ............................ Agree .................... 1.59 1.59

76375 ....... 26 Medical holography .................................. 0.16 ............................ Agree .................... 0.16 0.16

76390# ..... 26 Magnetic resonance spectroscopy ........... 1.40 ............................ Agree .................... 1.40 1.40

76815 ....... 26 Echography, pregant uterus ..................... 0.65 ............................ Agree .................... 0.65 0.65

76830 ....... 26 Hysterosonography .................................. 0.69 ............................ Agree .................... 0.69 0.69

76831# ..... 26 Hysterosonography .................................. 0.72 ............................ Agree .................... 0.72 0.72

76885# ..... 26 Echography of infant hip .......................... 0.74 ............................ Agree .................... 0.74 0.74

76886# ..... 26 Echography of infant hip .......................... 0.62 ............................ Agree .................... 0.62 0.62

77295 ....... 26 Therapeutic radiology simulation-aided .... 4.57 ............................ Agree .................... 4.57 4.57

78350 ....... 26 Bone density studies ................................ 0.22 ............................ Agree .................... 0.22 0.22

78351 ....... ............ Bone density studies ................................ 0.30 ............................ Agree .................... 0.30 0.30

78459 ....... 26 PET myocardial perfusion imaging .......... 1.88 ............................ Agree .................... 1.88 1.88

78491# ..... 26 PET myocardial perfusion imaging .......... 1.50 ............................ Agree .................... 1.50 1.50

78492# ..... 26 PET myocardial perfusion imaging .......... 1.87 ............................ Agree .................... 1.87 1.87

78707 ....... 26 Renal nuclear medicine ............................ 0.96 ............................ Agree .................... 0.96 0.96

78708# ..... 26 Renal nuclear medicine ............................ 1.21 ............................ Agree .................... 1.21 1.21

78709# ..... 26 Renal nuclear medicine ............................ 1.41 ............................ Agree .................... 1.41 1.41

78710 ....... 26 Kidney imaging ......................................... 0.66 ............................ Agree .................... 0.66 0.66

88108 ....... 26 Cervical or vaginal cytopathology ............ 0.56 ............................ Agree .................... 0.56 0.56

88141# ..... ............ Cervical or vaginal cytopathology ............ 0.42 ............................ Agree .................... 0.42 0.42

90801 ....... ............ Psychotherapy .......................................... 2.80 ............................ Agree .................... 2.80 2.80

90802# ..... ............ Psychotherapy .......................................... 3.01 ............................ Agree .................... 3.01 3.01

90804# ..... ............ Psychotherapy .......................................... 1.11 ............................ Agree .................... 1.11 1.11
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59087

TABLE 2.—AMA RUC AND HCPAC RECOMMENDATIONS AND HCFA DECISIONS FOR NEW AND REVISED 1998 CPT

CODES—Continued

CPT*

code MOD Description RUCrecommendation

HCPAC

recommendation

HCFA

decision

HCFA work

RVU

1998 work b

RVU

90805# ..... ............ Psychotherapy .......................................... 1.47 ............................ Agree .................... 1.47 1.47

90806# ..... ............ Psychotherapy .......................................... 1.72 ............................ Agree .................... 1.72 1.72

90807# ..... ............ Psychotherapy .......................................... 2.00 ............................ Agree .................... 2.00 2.00

90808# ..... ............ Psychotherapy .......................................... 2.76 ............................ Agree .................... 2.76 2.76

90809# ..... ............ Psychotherapy .......................................... 3.15 ............................ Agree .................... 3.15 3.15

90810# ..... ............ Psychotherapy .......................................... 1.19 ............................ Agree .................... 1.19 1.19

90811# ..... ............ Psychotherapy .......................................... 1.58 ............................ Agree .................... 1.58 1.58

90812# ..... ............ Psychotherapy .......................................... 1.86 ............................ Agree .................... 1.86 1.86

90813# ..... ............ Psychotherapy .......................................... 2.15 ............................ Agree .................... 2.15 2.15

90814# ..... ............ Psychotherapy .......................................... 2.97 ............................ Agree .................... 2.97 2.97

90815# ..... ............ Psychotherapy .......................................... 3.39 ............................ Agree .................... 3.39 3.39

90816# ..... ............ Psychotherapy .......................................... 1.24 ............................ Agree .................... 1.24 1.24

90817# ..... ............ Psychotherapy .......................................... 1.65 ............................ Agree .................... 1.65 1.65

90818# ..... ............ Psychotherapy .......................................... 1.94 ............................ Agree .................... 1.94 1.94

90819# ..... ............ Psychotherapy .......................................... 2.24 ............................ Agree .................... 2.24 2.24

90821# ..... ............ Psychotherapy .......................................... 3.09 ............................ Agree .................... 3.09 3.09

90822# ..... ............ Psychotherapy .......................................... 3.53 ............................ Agree .................... 3.53 3.53

90823# ..... ............ Psychotherapy .......................................... 1.33 ............................ Agree .................... 1.33 1.33

90824# ..... ............ Psychotherapy .......................................... 1.77 ............................ Agree .................... 1.77 1.77

90826# ..... ............ Psychotherapy .......................................... 2.08 ............................ Agree .................... 2.08 2.08

90827# ..... ............ Psychotherapy .......................................... 2.41 ............................ Agree .................... 2.41 2.41

90828# ..... ............ Psychotherapy .......................................... 3.32 ............................ Agree .................... 3.32 3.32

90829# ..... ............ Psychotherapy .......................................... 3.80 ............................ Agree .................... 3.80 3.80

90845 ....... ............ Psychotherapy .......................................... 1.79 ............................ Agree .................... 1.79 1.79

90846 ....... ............ Psychotherapy .......................................... 1.83 ............................ Agree .................... 1.83 1.83

90847 ....... ............ Psychotherapy .......................................... 2.21 ............................ Agree .................... 2.21 2.21

90849 ....... ............ Psychotherapy .......................................... 0.59 ............................ Agree .................... 0.59 0.59

90853 ....... ............ Psychotherapy .......................................... 0.59 ............................ Agree .................... 0.59 0.59

90857 ....... ............ Psychotherapy .......................................... 0.63 ............................ Agree .................... 0.63 0.63

90865# ..... ............ Psychotherapy .......................................... 2.84 ............................ Agree .................... 2.84 2.84

90875 ....... ............ Psychotherapy .......................................... ............................ 1.20 Agree .................... 1.20 1.20

90876 ....... ............ Psychotherapy .......................................... ............................ 1.90 Agree .................... 1.90 1.90

90880 ....... ............ Psychotherapy .......................................... 2.19 ............................ Agree .................... 2.19 2.19

90885# ..... ............ Psychotherapy .......................................... 0.97 ............................ Agree .................... 0.97 0.97

90911 ....... ............ Biofeedback training ................................. 0.89 ............................ Agree .................... 0.89 0.89

91010 ....... ............ Esophageal motility studies ...................... 1.25 ............................ Agree .................... 1.25 1.25

91020 ....... ............ Esophageal motility studies ...................... 1.44 ............................ Agree .................... 1.44 1.44

92978 ....... 26 Intravascular us ........................................ 1.80 ............................ Agree .................... 1.80 1.80

92979 ....... 26 Intravascular us ........................................ 1.44 ............................ Agree .................... 1.44 1.44

92992 ....... ............ Atrial septectomy of septostomy .............. carrier ............................ Agree .................... carrier carrier

92997# ..... ............ Pulmonary artery angioplasty ................... 12.00 ............................ Agree .................... 12.00 12.00

92998# ..... ............ Pulmonary artery angioplasty ................... 6.00 ............................ Agree .................... 6.00 6.00

93320 ....... ............ Doppler echo ............................................ 0.38 ............................ Agree .................... 0.38 0.38

93325 ....... ............ Doppler echo ............................................ 0.07 ............................ Agree .................... 0.07 0.07

93508# ..... 26 Coronary angiography .............................. 4.10 ............................ Agree .................... 4.10 4.10

93530# ..... 26 Pediatric cardiac catheterization .............. 4.23 ............................ Agree .................... 4.23 4.23

93531# ..... 26 Pediatric cardiac catheterization .............. 8.35 ............................ Agree .................... 8.35 8.35

93532# ..... 26 Pediatric cardiac catheterization .............. 10.00 ............................ Agree .................... 10.00 10.00

93533# ..... 26 Pediatric cardiac catheterization .............. 6.70 ............................ Agree .................... 6.70 6.70

94010 ....... 26 Spirometry ................................................ 0.17 ............................ Agree .................... 0.17 0.17

94070 ....... 26 Pulmonary procedures ............................. 0.60 ............................ Agree .................... 0.60 0.60

95805 ....... 26 Sleep studies ............................................ 1.88 ............................ Agree .................... 1.88 1.88

95806 ....... 26 Sleep studies ............................................ 1.85 ............................ Decrease .............. 1.66 1.66

95807 ....... 26 Sleep studies ............................................ 1.66 ............................ Agree .................... 1.66 1.66

95811# ..... 26 Sleep studies ............................................ 3.80 ............................ Agree .................... 3.80 3.80

95860 ....... 26 Needle EMG ............................................. 0.96 ............................ Agree .................... 0.96 0.96

95861 ....... 26 Needle EMG ............................................. 1.54 ............................ Agree .................... 1.54 1.54

95863 ....... 26 Needle EMG ............................................. 1.87 ............................ Agree .................... 1.87 1.87

95864 ....... 26 Needle EMG ............................................. 1.99 ............................ Agree .................... 1.99 1.99

95869 ....... 26 Needle EMG ............................................. 0.37 ............................ Agree .................... 0.37 0.37

95870# ..... 26 Needle EMG ............................................. ............................ ............................ (a) .......................... 0.37 0.37

96902# ..... ............ Trichogram ............................................... 0.41 ............................ Agree .................... 0.41 0.41

97001# ..... ............ Occupational and Physical Therapy ........ ............................ 1.20 Agree .................... 1.20 1.20

97002# ..... ............ Occupational and Physical Therapy ........ ............................ 0.60 Agree .................... 0.60 0.60

97003# ..... ............ Occupational and Physical Therapy ........ ............................ 1.20 Agree .................... 1.20 1.20

97004# ..... ............ Occupational and Physical Therapy ........ ............................ 0.60 Agree .................... 0.60 0.60

97780# ..... ............ Acupuncture ............................................. ............................ ............................ (a) .......................... 0.00 0.00

97781# ..... ............ Acupuncture ............................................. ............................ ............................ (a) .......................... 0.00 0.00

99141# ..... ............ Conscious sedation .................................. 0.80 ............................ Agree .................... 0.80 0.80

99142# ..... ............ Conscious sedation .................................. 0.60 ............................ Agree .................... 0.60 0.60

99217 ....... ............ Observation same day discharge ............. 1.28 ............................ Agree .................... 1.28 1.28

99234# ..... ............ Observation same day discharge ............. 2.56 ............................ Agree .................... 2.56 2.56

99235# ..... ............ Observation same day discharge ............. 3.42 ............................ Agree .................... 3.42 3.42

99236# ..... ............ Observation same day discharge ............. 4.27 ............................ Agree .................... 4.27 4.27

99315# ..... ............ Nursing facility discharge ......................... 1.20 ............................ Decrease .............. 1.13 1.13

99316# ..... ............ Nursing facility discharge ......................... 1.60 ............................ Decrease .............. 1.50 1.50

99341 ....... ............ Home care visits ....................................... 0.89 ............................ Increase ............... 1.01 1.01

99342 ....... ............ Home care visits ....................................... 1.33 ............................ Increase ............... 1.52 1.52

99343 ....... ............ Home care visits ....................................... 1.99 ............................ Increase ............... 2.27 2.27
59088 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

TABLE 2.—AMA RUC AND HCPAC RECOMMENDATIONS AND HCFA DECISIONS FOR NEW AND REVISED 1998 CPT

CODES—Continued

CPT*

code MOD Description RUCrecommendation

HCPAC

recommendation

HCFA

decision

HCFA work

RVU

1998 work b

RVU

99344# ..... ............ Home care visits ....................................... 2.66 ............................ Increase ............... 3.03 3.03

99345# ..... ............ Home care visits ....................................... 3.32 ............................ Increase ............... 3.79 3.79

99347 ....... ............ Home care visits ....................................... 0.66 ............................ Increase ............... 0.76 0.76

99348 ....... ............ Home care visits ....................................... 1.11 ............................ Increase ............... 1.26 1.26

99349 ....... ............ Home care visits ....................................... 1.77 ............................ Increase ............... 2.02 2.02

99350# ..... ............ Home care visits ....................................... 2.66 ............................ Increase ............... 3.03 3.03

99374# ..... ............ Care plan oversight .................................. 1.10 ............................ Agree .................... 1.10 1.10

99375 ....... ............ Care plan oversight .................................. 1.73 ............................ Agree .................... 1.73 1.73

99377# ..... ............ Care plan oversight .................................. 1.10 ............................ Agree .................... 1.10 1.10

99378# ..... ............ Care plan oversight .................................. 1.73 ............................ Agree .................... 1.73 1.73

99379# ..... ............ Care plan oversight .................................. 1.10 ............................ Agree .................... 1.10 1.10

99380# ..... ............ Care plan oversight .................................. 1.73 ............................ Agree .................... 1.73 1.73

99436# ..... ............ Attendance at delivery .............................. 1.50 ............................ Agree .................... 1.50 1.50

a No RUC recommendation provided

bWork RVU changes due to global surgery evaluation and management increases.

# New Codes

*All numeric HCPCS CPT Copyright 1997 American Medical Association

b. Discussion of Codes for Which the

RUC Recommendations Were Not

Accepted. The following is a summary

of our rationale for not accepting

particular recommendations. It is

arranged by type of service in CPT code

order. This summary refers only to work

RVUs.

CPT codes 11055 (Paring or cutting of

benign hyperkeratotic lesion (eg, corn or

callus), single lesion), 11056 (two to four

lesions), 11057 (more than four lesions),

and 11719 (Trimming of nails)).

CPT 1998 will include three new

codes for paring or cutting of benign

hyperkeratotic lesion(s) and one new

code for trimming of nails. These new

CPT codes will replace CPT codes

11050 through 11052 (Paring or

curettement of benign hyperkeratotic

skin lesion(s)) and HCFA Common

Procedure Coding System (HCPCS) code

M0101 (Cutting or removal of corns,

calluses and/or trimming of nails,

application of skin creams and other

hygienic and preventive maintenance

care).

We agreed with the work RVU

relationship established by the RUC

HCPAC Review Board for these four

codes. However, we have not accepted

the actual work RVUs recommended

because the total number of RVUs

associated with the new codes would

exceed the total number of RVUs

associated with code M0101. We believe

the expectation of the RUC HCPAC

Review Board was that the RVU

recommendations would achieve work

neutrality within the family of codes.

However, some of the services

previously reported with M0101 will

now be reported with codes used to

report the destruction of skin lesions.

These codes, for example, CPT code

17000, have higher work RVUs than

M0101. Thus, the result of the coding

changes and the recommended work

RVUs would be an increase in the total

number of RVUs for these services.

Consequently, we revised the work

RVUs recommended by the RUC HCPC

Review Board in order to achieve work

neutrality within this family of codes.

That is, the work RVUs have been

adjusted so that the sum of the new

work RVUs (weighted by projected

frequency of use) for this family of

codes will be the same as the sum of the

current work RVUs (weighted by their

current frequency of use).

CPT

code Descriptor WorkRVUs

11055 Paring or cutting of benign

hyperkeratotic lesion (single).

0.27

11056 Two to four lesions ............... 0.39

11057 More than four lesions ......... 0.50

11719 Trimming of nails .................. 0.06

CPT codes 11200 (Removal of skin

tags, multiple fibrocutaneous tags, any

area; up to and including 15 lesions)

and 11201 (each additional ten lesions).

The RUC recommended 0.69 work

RVUs for CPT code 11200 and 0.35

work RVUs for CPT code 11201. These

codes encompass services that were

previously reported using CPT codes

11200, 11201, 17200, and 17201. When

valuing new and revised codes that

replace deleted codes, we typically have

used Medicare frequency data and used

the work RVUs of the deleted and

revised codes in order to arrive at

weighted average values for the revised

codes in a budget neutral fashion. We

have used this method to arrive at the

work RVUs for revised CPT codes 11200

and 11201. We are establishing 0.67

work RVUs for CPT code 11200, which

is a weighted average of CPT codes

17200 and 11200. We are establishing

0.29 work RVUs for CPT code 11201,

which is the weighted average of CPT

codes 17201 and 11201.

CPT code 45119 (Proctectomy,

combined abdominoperineal pull

through procedure (eg, colo-anal

anastomosis) with creation of colonic

reservoir (eg, J-pouch), with or without

proximal diverting ostomy).

CPT 1998 will include a new code for

proctectomy with colo-anal

anastomosis. The RUC recommended

23.50 work RVUs for CPT code 45119.

Upon review of these values, we

concluded that CPT code 45119 was

undervalued. CPT code 45119 is nearly

an identical procedure to CPT code

45112 with the exception of the creation

of the colonic reservoir included in CPT

code 45119. We agree with the current

work value for CPT code 45112 (24.02

work RVUs). CPT code 45119 is a more

extensive procedure and should be

valued higher than CPT code 45112. We

believe CPT code 45119 is undervalued,

and we are increasing the RUCrecommended work RVUs from 23.50

work RVUs to 24.50 work RVUs for the

1998 physician fee schedule.

CPT code 53850 (Transurethral

destruction of prostate tissue; by

microwave therapy) and 53852

(Transurethral destruction of prostate

tissue; by radiofrequency

thermotherapy).

CPT 1998 will include two new codes

for the transurethral destruction of

prostate tissue. We agree with the RUC

value for CPT code 53852 (the RUC

recommended 9.58 work RVUs) but not

with the work value assigned to CPT

code 53850. The RUC recommendations

would make the work values for these

two codes identical. While both

procedures require skillful technique,

we believe the actual physician work

involved for microwave therapy (CPT

code 53850) is less than that of

radiofrequency thermotherapy (CPT
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59089

code 53852). Radiofrequency

thermotherapy requires the physician to

retract and reposition an electrode

numerous times in order to destroy

selected prostate tissue. Microwave

therapy on the other hand does not

require the repositioning of an electrode

throughout the procedure. We are

decreasing the RUC recommendation of

9.58 work RVUs to 9.25 interim work

RVUs for CPT code 53850.

CPT codes 56300 through 56349

(Laparoscopic surgery) and CPT code

56356 (Hysteroscopy).

The RUC submitted recommendations

to us during the 5-year review of the

resource-based relative value scale for

increases in the work RVUs for CPT

code 56300 (Laparoscopy

(peritoneoscopy), diagnostic; (separate

procedure)) and CPT code 56305 (with

biopsy (single or multiple)). At that

time, we did not adopt those

recommendations because we believed

they would create rank order anomalies

within the laparoscopy and

hysteroscopy family of codes.

Subsequently, at the request of HCFA,

the entire family of codes was reviewed

by the RUC. Following is a discussion

of all of the codes that were affected by

this review. The discussion is in order

by CPT code. In some instances, global

periods or work RVUs were changed in

order to address inconsistencies within

this family of codes. We believe

additional review of the global period

may be warranted and invite comment

on this issue.

CPT codes 56300 (Laparoscopy,

diagnostic; (separate procedure)) and

56305 (with biopsy (single or multiple)).

The RUC recommended 5.00 work

RVUs for CPT code 56300 and 5.50

work RVUs for CPT code 56305. We

agree with these work RVUs but will be

changing the global period of both of

these codes to 010 days.

CPT code 56304 Laparoscopy,

surgical; with fulguration of oviducts

(with or without transection), with lysis

of adhesions).

The RUC recommended 10.00 work

RVUs for this CPT code. We generally

agree with the rank order of this

recommendation but are increasing it to

10.45 work RVUs. We are increasing

this recommendation because we added

a level 2 office visit to the RUC

recommendation (0.45 RVUs) to account

for changing the global period from 010

to 090 days. Additionally, we will be

discussing a change in the descriptor

associated with CPT code 56304 with

the CPT Editorial Panel. We will be

asking the CPT Editorial Panel to

revised the code descriptor to specify

that it includes an extensive lysis of

adhesions. A limited lysis of adhesions

is included in CPT codes 56300 and

56305 and is not paid separately. CPT

code 56304 should only be used for

extensive lysis of adhesions.

CPT code 56303 (Laparoscopy,

surgical; with fulguration of oviducts

(with or without transection); with

fulguration or excision of lesions of the

ovary, pelvic viscera, or peritoneal

surface by any method).

The RUC recommended 10.50 work

RVUs to CPT code 56303. We changed

this CPT code from a 010 day global

period to a 090 day global period. Due

to this increase in the global period, we

are adding a level 2 office visit to the

RUC recommendation. The resulting

work RVUs for CPT code 56303 are

10.95.

CPT code 56345 (Laparoscopy,

surgical; splenectomy) and CPT code

56347 (Laparoscopy, surgical;

jejunostomy (eg, for decompression or

feeding)).

We did not receive a RUC

recommendation for CPT codes 56345

and 56347. We decided that we will

make these as carrier-priced codes until

we receive recommended RVUs from

the RUC. Therefore, no RVUs are shown

for these codes.

CPT code 56348 (Laparoscopy with

intestinal resection).

The RUC recommended 20.00 work

RVUs for CPT code 56348. We believe

that the work involved with this

procedure is comparable to that of CPT

code 44145 (Partial removal of colon),

which is valued at 21.29 work RVUs.

We decided to value CPT code 56348 at

the median value extracted from a RUC

survey issued to colorectal surgeons. For

the 1998 physician fee schedule, we are

assigning 21.00 work RVUs to CPT code

56348.

CPT code 56349 (Laparoscopy,

surgical, esophagogastric fundoplasty

(eg, Nissen, Belsey IV, Hill, Toupet

procedures)).

The RUC stated that the work

represented by CPT code 56349 is more

difficult than that in its corresponding

open procedure (CPT code 43324 valued

at 15.18 work RVUs). We do not agree

that this procedure has more work

involved than either a lobectomy (CPT

code 32540 valued at 13.31 work RVUs)

or colon resection (CPT code 44140

valued at 16.97 work RVUs). We are

reducing the RUC recommendation of

17.75 work RVUs to 16.47 work RVUs

for the 1998 physician fee schedule.

CPT code 56356 (Hysteroscopy,

ablation).

The RUC recommended 9.50 work

RVUs for CPT code 56356. Upon

comparison of CPT code 56356 to other

codes within this family, we decided to

reduce the work RVUs to 6.17. This

decision was based upon a comparison

of CPT code 56356 to CPT code 56352

(Hysteroscopy, surgical; with sampling

(biopsy) of endometrium and/or

polypectomy, with or without D&C,

with lysis of intrauterine adhesions (any

method)) which is valued at 6.17 work

RVUs. These codes had identical times

and intensities identified in the survey

of the clinical vignettes supplied to the

RUC. Therefore, we decided to reduce

the work RVU of CPT code 56356 to

6.17 work RVUs for the 1998 physician

fee schedule.

CPT codes 59150 (Laparoscopic

treatment of ectopic pregnancy; without

salpingectomy and/or oophorectomy)

and 59151 (Laparoscopic treatment of

ectopic pregnancy; with salpingectomy

and/or oophorectomy).

The RUC stated that the survey

respondents substantially

underestimated the number of postprocedure office visits associated with

these procedures. We agree with the

RUC and are increasing the work RVUs

for both of these codes. We are assigning

11.20 work RVUs to CPT code 59150,

and 11.10 work RVUs to CPT code

59151 for the 1998 physician fee

schedule.

CPT code 95806 (Sleep study,

simultaneous recording of ventilation,

respiratory effort, ECG or heart rate, and

oxygen saturation, unattended by a

technologist).

CPT 1998 will include a new code for

an unattended sleep study. Currently,

CPT code 95807 (1.66 work RVUs) is

used for a sleep study that is attended

by a technologist. The RUC

recommended 1.85 work RVUs for CPT

code 95806. We do not agree that there

is more work involved in an unattended

sleep study as opposed to an attended

sleep study. We are assigning 1.66

interim work RVUs to CPT code 95806,

which will make the work RVUs

identical to those of CPT code 95807.

CPT codes 99315 (Nursing facility

discharge day management; 30 minutes

or less) and 99316 (Nursing facility

discharge day management; more than

30 minutes).

CPT 1998 will include two new codes

for nursing facility discharge day

management. The RUC recommended

1.20 work RVUs for CPT code 99315

and 1.60 work RVUs for CPT code

99316. Upon review of these values, we

found that the projected utilization of

these new nursing facility discharge

codes causes a significant work

neutrality problem within the family of

nursing facility CPT codes. While the

codes are new, the work is already

reflected within the current codes. In

order to maintain the same total pool of

work RVUs within this family, we are
59090 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

reducing the two new CPT codes (that

is, CPT codes 99315 and 99316), as well

as six existing codes within the nursing

facility family of codes (CPT codes

99301, 99302, 99303, 99311, 99312, and

99313), by 6.0 percent.

CPT

code Descriptor WorkRVUs

99301 Comprehensive nursing facility assessment.1.20

99302 Comprehensive nursing facility assessment.1.61

99303 Comprehensive nursing facility assessment.2.01

99311 Subsequent nursing facility

care.

0.60

99312 Subsequent nursing facility

care.

1.00

99313 Subsequent nursing facility

care.

1.42

99315 Nursing facility discharge

day management; 30 minutes or less.

1.13

99316 Nursing facility discharge

day management; more

than 30 minutes.

1.50

CPT codes 99341 through 99345

(Home care visits; new patient) and

99347 through 99350 (Home care visits;

established patient).

The RUC-recommended RVUs for the

home care visit codes were established

through comparisons to CPT’s current

office visit codes. Although we agree

with the use of the office visit codes as

key reference services, we believe that

the RUC underestimated the pre-, intra-

, and post-service intensities associated

with the home visit codes. We note that

the intensity values of the survey

respondents were higher for the home

visit codes than the reference codes for

office visits. We increased the RUC

recommendations by applying a

uniform intensity factor increase of 10

percent to the pre-, intra-, and postservice times of the office visits codes.

These increased intensities were then

multiplied by the typical times specified

in the new and revised CPT codes for

the home visits.

CPT

code Descriptor WorkRVUs

99341 Home services; new patient 1.01

99342 Home services; new patient 1.52

99343 Home services; new patient 2.27

99344 Home services; new patient 3.03

99345 Home services; new patient 3.79

99347 Home services; established

patient.

.76

99348 Home services; established

patient.

1.26

99349 Home services; established

patient.

2.02

99350 Home services; established

patient.

3.03

C. Other Changes to the 1998 Physician

Fee Schedule and Clarification of CPT

Definitions

For the 1998 physician fee schedule,

we are establishing or revising several

alpha-numeric HCPCS codes for the

reporting of certain services that are not

clearly described by existing CPT codes.

We view these codes as temporary since

we will be referring them to the CPT

Editorial Panel for possible inclusion in

future editions of the CPT. Additionally,

included in this section are some

clarifications of proper usages of some

new or revised codes.

HCPCS codes G0062 (peripheral

bone mineral density) and G0063

(central bone density).

Effective January 1, 1998, HCPCS

codes G0062, G0062–26, G0062-TC,

G0063, G0063–26, and G0063-TC have

been deleted. Use the appropriate code

from the 70000 section of the CPT to bill

for bone mineral density studies.

CPT code 35400 (Intraoperative

endovascular angioscopy non-coronary

vessels or grafts).

Although we agree with the

recommended RUC work RVUs for this

CPT code, some clarification of proper

usage is needed. When billing CPT code

35400, units can only equal 1.00

because the code descriptor specifies

vessels or grafts. The RVUs assigned are

based on an assumption that angioscopy

may be performed on multiple vessels.

CPT codes 44625 and 44626 (Closure

of colostomy).

CPT codes 44625 and 44626 should

not be billed with CPT code 44139,

which is used to report the

immobilization (take down) of the

splenic flexure. By CPT definition, code

44139 can be used only in conjunction

with the partial colectomy codes 44140

through 44147. We will be establishing

a national claims edit to ensure that

neither of these two codes are billed

with CPT code 44139.

CPT codes 99217 and 99234 through

99236 (Observation same day

discharge).

We will be consulting with the CPT

Editorial Panel to clarify that the use of

these codes should be restricted to

observation care services of at least 12

hours duration.

CPT code 49021 (Percutaneous

abscess drainage).

Based on the recommendation of the

RUC, we are changing the global period

of CPT code 49021 from 010 days to 000

days. Post-operative care during the 90

day period following the procedure is

not typically provided for this

procedure.

CPT codes 95860 through 95870

(Needle EMGs).

Although we have accepted the RUC

recommendations for this family of

codes, we believe some clarification on

the proper use of these codes would be

beneficial.

CPT codes 95860, 95861, 95863, and

95864 (Needle electromyogram of 1, 2,

3, or 4 limbs with or without paraspinals

(cannot bill paraspinals separately—

unless studying paraspinals between

T3–T11)).

To bill these codes, extremity muscles

innervated by three nerves (for example,

radial, ulnar, median, tibial, peroneal,

femoral, not sub branches) or four spinal

levels must be evaluated, with a

minimum of five muscles studied.

CPT code 95869 (Needle

electromyography, thoracic

paraspinals).

This CPT code should be used when

exclusively studying thoracic

paraspinals. One unit can be billed,

despite the number of levels studied or

whether unilateral or bilateral. This

cannot be billed with CPT codes 95860,

95861, 95863, or 95864 if only T1 and/

or T2 are studied when an upper

extremity was also studied.

CPT code 95870 (Needle

electromyography, limited study).

This CPT code can be billed at one

unit per extremity. Muscles on the

thorax or abdomen (unilateral or

bilateral). One unit may be billed for

studying cervical or lumbar paraspinal

muscles (unilateral or bilateral),

regardless of the number of level tested.

This code should not be billed when the

paraspinal muscles corresponding to an

extremity are tested and when the

extremity codes 95860, 95861, 95863, or

95864 are also billed.

PET Myocardial Perfusion Imaging

(HCPCS Codes G0030 Through G0047)

When the PET myocardial perfusion

imaging tests were originally valued,

they were considered analogous to the

SPECT codes. In consultation with the

RUC, we have decided to raise the

values of the PET procedures. Unlike

the large field of view of SPECT

scanners, PET scanners have a much

smaller field. In addition, due to the

short half-life of the Rb-82 tracer,

physician involvement in patient

positioning is critical when using the

PET scanner. For these reasons, we are

raising the single PET myocardial

perfusion image to 1.50 work RVUs and

the multiple PET myocardial perfusion

image to 1.87 work RVUs.

Cervical or Vaginal Cancer Screening;

Pelvic and Clinical Breast Examination

(HCPCS Code G0101)

The law provides for coverage and

payment of screening pelvic and clinical
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59091

breast examinations effective January 1,

1998. We decided that this service is

comparable to a level 2 evaluation and

management new patient office visit.

HCPCS

code

Work

RVUs

Practice

Expense

RVUs

Malpractice

Expense

RVUs

G0101 ...... 0.45 0.28 0.02

Colorectal Cancer Screening (HCPCS

Codes G0104 Through G0107)

Section 4104 of the BBA 1997

provides for Medicare coverage of

colorectal cancer screening tests

effective for services provided on or

after January 1, 1998. The law provides

for coverage and payment for screening

fecal-occult blood tests, screening

flexible sigmoidoscopy, screening

colonoscopy, and other such tests

determined to be appropriate by the

Secretary. We are setting payment

amounts for screening sigmoidoscopy,

screening colonoscopy, barium enema,

and screening fecal-occult blood tests,

as follows:

Flexible Sigmoidoscopy (HCPCS Code

G0104)

The law provides that payment for

screening flexible sigmoidoscopies be

made at rates consistent with payment

for similar or related services under the

physician fee schedule, not to exceed

the rates for a diagnostic flexible

sigmoidoscopy (CPT 45330). We have

created a new code— HCPCS code

G0104 (Colorectal cancer screening;

flexible sigmoidoscopy)—to be used for

screening flexible sigmoidoscopy. We

believe that the work is the same

whether the procedure is a screening or

a diagnostic sigmoidoscopy and are

therefore assigning the same RVUs to

HCPCS code G0104 as those assigned to

CPT code 45330 in Addendum B.

Screening Colonoscopy (HCPCS Code

G0105)

The law provides that payment for

screening colonoscopies be paid at rates

consistent with payment for similar or

related services under the physician fee

schedule, not to exceed the rates for a

diagnostic colonoscopy (CPT 45378).

We have created a new code— HCPCS

code G0105 (Colorectal cancer

screening; colonoscopy on individual at

high risk)—to be used for screening

colonoscopy. We believe that the work

is the same whether the procedure is a

screening or a diagnostic colonoscopy,

and we are therefore assigning the same

RVUs to HCPCS code G0105 as those

assigned to CPT code 45378 in

Addendum B.

Barium Enema (HCPCS Code G0106)

The law provides that payment for

colorectal cancer screening-barium

enema be paid at rates consistent with

payment for similar or related services

under the physician fee schedule. We

believe that the work is analogous to

CPT code 74280 (Contrast x-ray exam of

the colon), and we are therefore

assigning the same RVUs to HCPCS

code G0106 as those assigned to CPT

code 74280 in Addendum B.

Fecal-Occult Blood Tests (HCPCS Code

G0107)

The law provides that screening fecaloccult blood tests be paid at the same

rate as diagnostic fecal-occult blood

tests (CPT code 82270) paid under the

clinical laboratory fee schedule. We

have created a new code— HCPCS code

G0107 (Colorectal cancer screening;

fecal-occult blood test, 1–3

simultaneous determinations)—to be

used for screening fecal-occult blood

tests. This code will be carrier-priced at

the payment amount that the carrier

pays for CPT code 82270 under the

clinical laboratory fee schedule.

HCPCS

code

Work

RVUs

Practice

expense

RVUs

Malpractice

expense

RVUs

G0104 ...... 0.96 1.23 0.12

G0105 ...... 3.70 4.13 0.39

G0106 ...... 0.99 2.58 0.21

G0107 ...... Lab Fee Schedule

National Emphysema Treatment Trials

(NETT) (CPT Codes G0110 Through

G0116)

The following codes have been added

to the physician fee schedule for the use

of physicians participating in the NETT

study. The National Emphysema

Treatment Trials (NETT) are cosponsored by HCFA and the National

Heart, Lung, and Blood Institute with

the Johns Hopkins University as the

coordinating center for the study. The

study is to last 7 years starting August

1, 1997. Since the use of these codes

will be limited to some 18 clinical

centers and physicians associated with

these centers, either directly, as in

furnishing services in the centers’

outpatient departments or in rural areas

where some of the participating

beneficiaries live, these codes will be

listed as restricted and can only be

billed by those participating in the

NETT study.

HCPCS code Descriptor Work

RVUs

Practice

expense

RVUs

Malpractice

expense

RVUs

G0110 .......... NETT Pulm Rehab; education/skills training, individual .................................................. 0.90 0.26 0.04

G0111 .......... NETT Pulm Rehab; education/skills training, group ........................................................ 0.27 0.20 0.02

G0112 .......... NETT Pulm Rehab; nutritional guidance—initial ............................................................. 1.72 0.97 0.10

G0113 .......... NETT Pulm Rehab; nutritional guidance—subsequent ................................................... 1.29 0.77 0.09

G0114 .......... NETT Pulm Rehab; psychosocial consultation ................................................................ 1.20 0.35 0.11

G0115 .......... NETT Pulm Rehab; psychological testing ....................................................................... 1.20 0.35 0.11

G0116 .......... NETT Pulm Rehab; Psycho-social counseling—individual ............................................. 1.11 0.35 0.05

V. Provisions of the Final Rule

The provisions of this final rule

restate the provisions of the June 18,

1997, proposed rule except as noted

elsewhere in this preamble. Following is

a highlight of the exceptions:

For our proposal relating to physician

supervision, we are adopting our

proposal to assign an appropriate level

of physician supervision to every

diagnostic test payable under the

physician fee schedule with exceptions

for certain procedures personally

performed by qualified independent

psychologists, clinical psychologists,

qualified audiologists, and physical

therapists who are certified as qualified

electrophysiologic clinical specialists.

With respect to several groupings of

diagnostic codes, we have changed our

proposed policy based on comments

from the physician specialities most

involved with particular groups of

codes. In some cases, such as CTs and

MRIs performed without the use of

contrast materials, we have lowered the

level of required physician supervision.

In others, such as ultrasound

procedures, we have increased the level

of required supervision. We are

publishing a listing of diagnostic codes

in the preamble of this document with

the level of physician supervision we
59092 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

have determined to be appropriate. In

addition, we are adding a field to the

physician fee schedule data base

indicating the appropriate level of

supervision. We anticipate that there

will continue to be discussions among

HCFA, physician specialty groups, and

others about these levels of supervision,

and we expect that the indicators

applicable to individual procedures will

be changed from time to time as is

currently the case with other data base

indicators.

As a result of our review of the

comments, we have decided that the

actual charge issue, including the

implications for beneficiary out-ofpocket expense, requires further study.

We received numerous comments from

individual physicians and suppliers and

the organizations that represent them in

opposition to this proposal.

Based on provisions in the BBA 1997,

we are not implementing the system of

resource-based practice expense RVUs

contained in the proposed rule for 1998.

Rather, we are implementing the

provision of the BBA 1997 that reduces

practice expense RVUs for certain

services and uses the monies to increase

practice expense RVUs for office visits.

Specifically, we are making the

following changes from the regulations

proposed in our June 18, 1997 proposed

rule:

• In § 414.22 (Relative value units

(RVUs)), we are stating that the practice

expense RVUs for certain services are

reduced to 110 percent of the work

RVUs for those services. We are also

stating that the following two categories

of services are excluded from this

limitation:

• The service is provided more than

75 percent of the time in an office

setting; or

• The 1998 proposed resource-based

practice expense RVUs (as specified in

the June 18, 1997 physician fee

schedule proposed rule) for the specific

site, either in-office or out-of-office,

increased from its 1997 practice expense

RVUs.

In § 414.32 (Determining payments for

certain physician services furnished in

facility settings), we are revising

paragraph (b) to state that if physician

services of the type routinely furnished

in a physician’s office are furnished in

facility settings, the fee schedule

amount for those services is determined

by reducing the applicable practice

expense RVUs for the service by 50

percent.

We are not revising § 414.34 (Payment

for services and supplies incident to a

physician’s service) because our

resource-based practice expense system

is not being implemented as proposed

in the June 18, 1997 proposed rule.

We are adding the following changes

to regulations required by the BBA

1997:

• In § 410.34 (Mammography

services: Conditions for and limitations

on coverage), we are expanding

coverage of screening mammography

services, effective January 1, 1998, to

provide for payment for annual

screening for all women beneficiaries

age 40 and over.

• We are adding a new § 410.37

(Colorectal cancer screening tests:

Conditions for and limitations on

coverage) to provide for Medicare

coverage of colorectal cancer screening

tests effective for services provided on

or after January 1, 1998.

• We are adding a new § 410.56

(Screening pelvic examinations) to

provide for new coverage of screening

pelvic exams (including a clinical breast

exam) for all women beneficiaries

subject to certain frequency and

payment limitations.

VI. Collection of Information

Requirements

Under the Paperwork Reduction Act

of 1995 (PRA), agencies are required to

provide a 60-day notice in the Federal

Register and solicit public comment

before a collection of information

requirement is submitted to the Office of

Management and Budget (OMB) for

review and approval. In order to fairly

evaluate whether an information

collection should be approved by OMB,

section 3506(c)(2)(A) of the PRA

requires that we solicit comment on the

following issues:

• Whether the information collection

is necessary and useful to carry out the

proper functions of the agency;

• The accuracy of the agency’s

estimate of the information collection

burden;

• The quality, utility, and clarity of

the information to be collected; and

• Recommendations to minimize the

information collection burden on the

affected public, including automated

collection techniques.

Therefore, we are soliciting public

comment on each of these issues for the

information collection requirements

discussed below.

Under 5 CFR 1320.3(b)(2), the burden

associated with the time, effort and

financial resources necessary to comply

with a collection of information that

would be incurred by persons in the

normal course of business is excluded

from an information collection. The

burden in connection with such types of

collection activities can be disregarded

if it can be demonstrated that such

collection activities are usual and

customary. Each of the collection

requirements referenced below are of

the type that are usual and customary in

the conduct of commercial business.

Thus, we believe they fall under this

exception.

Under 5 CFR 1320.3(b)(3), a collection

of information conducted or sponsored

by a Federal agency that is also

conducted or sponsored by a unit of

State, local or tribal government is

presumed to impose a Federal burden

except to the extent that the agency

shows that such State, local, or tribal

requirement would be imposed even in

the absence of a Federal requirement.

The following sections contain

information collection requirements that

we believe meet these requirements

listed above; therefore, the burden is

exempt from the Act.

Section 410.33(b)(2) (Supervising

physicians) must maintain

documentation of sufficient physician

resources during all hours of operation

to assure that the required physician

supervision is furnished.

Section 410.33(c) (Non-physician

personnel) must maintain

documentation available for review

certifying that non-physician personnel

have the training and proficiency as

evidenced by licensure or certification

by the appropriate State health or

education department or, in the absence

of a State licensing board, a national

credentialing body.

Section 410.33(e) (Multi-State

entities) that operate across State

boundaries must maintain

documentation that its supervising

physicians and technicians are licensed

and certified in each of the States in

which it is furnishing services.

The information collection

requirement and associated burden as

summarized below is subject to the

PRA:

Section 410.33(b)(2) (Supervising

physicians) must evidence proficiency

in the performance and interpretation of

each type of diagnostic procedure

performed by the IDTF. The proficiency

may be documented by certification in

specific medical specialties or

subspecialties or by criteria established

by the carrier for the service area in

which the IDTF is located.

The public reporting burden for this

record keeping requirement is minimal.

There are about 500 IPLs, which we

assume will wish to become IDTFs, each

requiring five minutes to document

proficiency by certification in specific

medical specialties or subspecialties or

by criteria established by the carrier for

the service area in which the IDTF is
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59093

located. The total public burden is 42

hours.

We have submitted a copy of this final

rule with comment to OMB for its

review of the information collection

requirements in § 410.33(b)(2). This

requirement is not effective until it has

been approved by OMB.

If you comment on any of these

information collection and

recordkeeping requirements, please mail

copies directly to the following:

Health Care Financing Administration,

Office of Information Services,

Information Technology Investment

Management Group, Division of

HCFA Enterprise Standards, Room

C2–26–17, 7500 Security Boulevard,

Baltimore, MD 21244–1850, Attn:

Louis Blank BPD–884

Office of Information and Regulatory

Affairs, Office of Management and

Budget, Room 10235, New Executive

Office Building, Washington, DC

20503, Attn.: Allison Herron Eydt,

HCFA Desk Officer

VII. Waiver of Proposed Rulemaking

and Response to Comments

We ordinarily publish a notice of

proposed rulemaking in the Federal

Register and invite prior public

comment on proposed rules. The notice

of proposed rulemaking can be waived,

however, if an agency finds good cause

that a notice-and-comment procedure is

impracticable, unnecessary, or contrary

to the public interest and it incorporates

a statement of the finding and its

reasons in the rule issued. We find good

cause to waive the notice-and-comment

procedure with respect to a number of

provisions included in this final rule, as

explained below.

With respect to the BBA 1997

provisions in this final rule affecting

payment under the RVU system, we

noted that the BBA 1997 was enacted

shortly after the proposed rule was

published. It delayed the

implementation of the resource-based

practice expense RVU system until

January 1, 1999 and specifies the

manner in which practice expense

RVUs in 1998 are adjusted. As

explained in section III. A. of this

preamble, we are conforming the rules

to be in compliance with these

provisions of the statute. Our change is

technical in nature and does not

interpret the law. To submit such a

technical, conforming change to noticeand-comment rulemaking would be

both impracticable and unnecessary.

Since the Congress intended that these

provisions be effective on January 1,

1998 and intended to forestall

significant adjustments in payment that

would have occurred under the preamendment practice expense provision,

it is in the public interest to issue this

rule in final form.

With respect to the BBA 1997

provisions relating to coverage of

screening mammography, coverage of

screening pelvic examinations and

colorectal cancer screening, and the

related payment changes, our reasoning

is somewhat similar. This rule conforms

the regulations to the revisions

contained in sections 4104 and 4102 of

the BBA 1997. In addition, insofar as

these regulations relate to coverage

conditions under authority granted by

section 1862(a)(1)(A) of the Act, they are

exempted from public comment

requirements pursuant to section

1869(b)(3)(B) of the Act. If we were to

delay issuing a final rule beyond

January, 1998, the statutory effective

date of the benefit, our rules would be

in conflict with the statute, which could

cause confusion and would not be in the

public interest.

We also note that, under express

authority contained in section

1871(b)(2)(B) of the Act (42 U.S.C.

1395hh(b)(2)(B)) issuing a proposed rule

is unnecessary if a statute establishes a

specific deadline for the

implementation of a provision and the

deadline is less than 150 days after the

enactment of the statute in which the

deadline is contained. The BBA 1997

was enacted on August 5, 1997, less

than 150 days from the statute’s

effective date of January 1, 1998.

The BBA 1997 provision related to

colorectal cancer screening, as described

in section III. C. of this preamble,

requires us to publish a statement of

coverage or noncoverage of screening

barium enemas in the Federal Register

by November 3, 1997. As noted in our

preamble discussion, there was

extensive consultation before we

reached our decision. According to the

National Cancer Institute, colorectal

cancer is the second leading cause of

death from cancer in the United States.

It is clearly in the public interest to

make this benefit available without

delay and to bring our regulations into

line with the expanded coverage.

In part IV. B. 2. of this preamble, we

identify a number of interim 1997

codes. Since medical practice is

dynamic, changes occur in coding or

procedures and it is always possible that

some changes occur after we have

submitted our proposal for public

comment. To address these changes, we

identify ‘‘interim’’ RVUs for new and

revised codes. To the extent possible,

we subject these interim RVUs to all the

procedures and considerations

applicable to all RVUs, except

publishing them in the Federal Register

for public comment. It has been our

practice to implement these interim

RVUs, along with the ‘‘final’’ RVUs so

that payment can be consistently made

during the upcoming fee schedule year,

and to solicit comments on the interim

codes. We evaluate and respond to the

comments in the next annual final rule.

The public has recognized over the

years that this approach has been in the

public interest by allowing public

participation yet permitting immediate,

consistent payment to be made.

For the above reasons, we find good

cause to waive notice-and-comment

rulemaking. We invite written

comments on the BBA 1997 provisions

and the interim RVUs for selected

procedures identified in Addendum C.

Because of the large number of items

of correspondence we normally receive

on Federal Register documents

published for comment, we are not able

to acknowledge or respond to them

individually. We will consider all

comments we receive by the date and

time specified in the DATES section of

this preamble, and, if we proceed with

a subsequent document, we will

respond to the comments in the

preamble to that document.

VIII. Regulatory Impact Analysis

We have examined the impacts of this

final rule under Executive Order (E.O.)

12866, the Unfunded Mandates Act of

1995, and the Regulatory Flexibility Act.

E.O. 12866 directs agencies to assess all

costs and benefits of available regulatory

alternatives and, when regulation is

necessary, to select regulatory

approaches that maximize net benefits

(including potential economic,

environmental, public health and safety

effects; distributive impacts and equity).

A regulatory impact analysis (RIA) must

be prepared for major rules with

economically significant effects ($100

million or more annually). The benefit

changes in this final rule due to the BBA

1997 will result in additional

expenditures for calendar year 1998 in

excess of $100 million.

Because the expenditures resulting

from this final rule are expected to

exceed $100 million, it is considered a

major rule, and, as required by law, this

final rule is subject to congressional

review. Therefore, this final rule is

being forwarded to the Congress for a

60-day review period.

The Unfunded Mandates Reform Act

of 1995 also requires (in section 202)

that agencies prepare an assessment of

anticipated costs and benefits for any

rule that may result in an annual

expenditure by State, local, or tribal

governments, in the aggregate, or by the

private sector, of $100 million. The final
59094 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

rule has no consequential effect on

State, local, or tribal governments. We

believe the private sector costs of this

rule fall below these thresholds, as well.

A. Regulatory Flexibility Act

Consistent with the provisions of the

Regulatory Flexibility Act we analyze

options for regulatory relief for small

businesses and other small entities. We

prepare a Regulatory Flexibility

Analysis (RFA) unless we certify that a

rule will not have a significant

economic impact on a substantial

number of small entities. The RFA is to

include a justification of why action is

being taken, the kinds and number of

small entities the final rule will affect,

and an explanation of any considered

meaningful options that achieve the

objectives and will lessen any

significant adverse economic impact on

the small entities.

For purposes of the Act, all

physicians are considered to be small

entities. Thus, we have prepared the

following analysis, which, together with

the rest of this preamble, meets all three

assessment requirements. It explains the

rationale for and purposes of the rule,

details the costs and benefits of the rule,

analyzes alternatives, and presents the

measures to minimize the burden on

small entities.

B. Geographic Practice Cost Index

Changes

Changes in GPCIs do not affect total

payments under the physician fee

schedule but rather redistribute

payments among payment localities. An

estimate of the overall redistributive

effects can be seen by examining the

changes in locality geographic

adjustment factors or GAFs. The GAFs

are a weighted composite of the locality

GPCIs. Addendum F is a comparison of

1997 and 1999 locality GAFs. As this

comparison shows, 58 of the 89

localities will experience changes in

payments of less than 0.5 percent; 76 of

the 89 localities will experience changes

in payments of less than 1 percent; and

only 3 of the 89 localities will

experience changes in payment of 2

percent. The effects will be even less in

1998 as the GPCI revisions are phased

in equally over a 2-year period. The

effects of the GPCI revisions are thus

negligible in most cases, and very

minimal in all others.

C. Fee Schedule for Clinical

Psychologist Services

Before January 1, 1997, the clinical

psychologist fee schedule was derived

from the reasonable charge payment

system and was updated by an

economic index different from that used

for the physician fee schedule. As a

result, relative to physicians’ services,

Medicare allowances for certain clinical

psychologist services in many localities

were artificially high or low. Moreover,

there were wide geographic variations

in Medicare rates for clinical

psychologists as well as for clinical

social workers, whose rates are set, by

statute, at 75 percent of clinical

psychologists’ rates.

Effective January 1, 1997, the fee

schedule for clinical psychologist

services is linked to the physician fee

schedule. The fee schedule for clinical

psychologist services is set at 100

percent of the physician fee schedule

amount for the corresponding service.

This payment policy was prompted by

the creation of new psychotherapy

codes that make a distinction between

services that include or exclude medical

evaluation and management.

Both previous and current clinical

psychologist fee schedules were

implemented through carrier

instruction. Because this final rule will

codify current payment policy, there

will be no impact on Medicare program

or beneficiary expenditures.

D. Diagnostic Tests

Our policy specifies the level of

physician supervision required for

diagnostic tests furnished in settings in

which such services are payable under

the physician fee schedule. All of these

tests will require at least a general level

of physician supervision (that is,

responsibility for the equipment and

nonphysician personnel). The following

services will be excepted from this

provision:

• Diagnostic mammography

procedures regulated by the FDA.

• Certain tests personally performed

by qualified audiologists as discussed

earlier.

• Certain testing services personally

performed by qualified independent

psychologists and clinical psychologists

as discussed earlier.

This policy may result in some

program savings due to the denial of

payments for tests that are not

reasonable and necessary because the

required level of physician supervision

was not furnished. However, we do not

have data on which to base an estimate

of savings. We expect that most testing

entities that did not previously furnish

testing with the level of physician

supervision required under the proposal

in our June 18, 1997 proposed rule (62

FR 33179 through 33181) will modify

the way they furnish testing services to

conform to the new policy.

We will also create a new type of

entity known as an independent

diagnostic testing facility (IDTF) with

specific national standards. It will

replace the existing IPL. Since the

current IPL national policy is based on

State law and local Medicare carrier

policy, it is likely that some IPLs in

certain areas will be more affected by

this proposal than others. We do not

have any data upon which to base any

estimates of savings at this time. There

are wide-spread allegations of

unnecessary testing furnished by IPLs

under the current policy. Our new

policy is designed to assist Medicare

carriers in addressing these allegations.

E. Reasonable Compensation Equivalent

Limit Update Factor

The methodology currently employed

to update the physician fee schedule

uses an inflation factor distinct from the

CPI-U used to update the reasonable

compensation equivalent limits. To

achieve a measure of consistency in the

methodologies employed to determine

reasonable payments to physicians for

physicians’ direct medical and surgical

services furnished to individual patients

and reasonable compensation levels for

physicians’ services that benefit

provider patients generally, we are

revising the methodology used to

update the reasonable compensation

equivalent limits by adopting the

physician fee schedule’s inflation factor

(the MEI) to update the reasonable

compensation equivalent limits. For

cost reporting periods beginning on or

after January 1, 1998, updates to the

reasonable compensation equivalent

limits will be calculated using the MEI.

Because we are not making an actual

update to the reasonable compensation

equivalent limits at this time that is

based on the MEI for cost reporting

periods beginning on or after January 1,

1998, this change in policy will not

have an impact on Medicare program or

beneficiary expenditures at this time.

F. Payment to Participating and

Nonparticipating Suppliers

We are revising the definitions at

§ 414.2 (Definitions) to define a

‘‘participating supplier’’ as being a

supplier as defined in § 400.202, which

includes physicians as suppliers, when

they have an agreement with HCFA to

participate in Part B of Medicare in

effect on the date of the service.

Similarly, we are defining

‘‘nonparticipating supplier’’ as a

supplier that does not have an

agreement with HCFA to participate in

Part B of Medicare in effect on the date

of the service.

We are also revising § 414.20

(Formula for computing payment

amounts) to clarify that the formula in
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59095

the section computes the fee schedule

amount, which may differ from the

payment basis, and to clarify that the fee

schedule amount for a nonparticipating

supplier is 95 percent of the fee

schedule amount for a participating

supplier. We are also revising the

heading of § 414.20 to read ‘‘Formula for

computing fee schedule amounts’’ to

reflect more accurately the content of

the section.

We are revising § 414.48 (Limits on

actual charges of nonparticipating

suppliers), which describes the

Medicare limiting charge for

nonparticipating suppliers to clarify that

the limiting charge is 115 percent of the

fee schedule amount for

nonparticipating physicians as

calculated in § 414.20(b).

The changes to §§ 414.2, 414.20, and

414.48 will have no impact on Medicare

payment, beneficiaries, physicians,

other suppliers of physician services,

Medicare carriers, or other insurers. We

believe that Medicare carriers are

currently properly calculating the fee

schedule amounts for participating and

nonparticipating suppliers and are

paying based on those properly

calculated amounts. These changes are

intended to conform our regulations to

the law and current practice.

G. Increase in Work Relative Value

Units for Global Surgical Services to

Account for the 1997 Increases for Work

Relative Value Units in Evaluation and

Management Services

In our November 22, 1996 final rule

with comment period, as part of the 5-

year review of all physician work RVUs,

we increased most of the work RVUs for

evaluation and management services for

hospital and office or other outpatient

visits. We revised the work RVUs for

evaluation and management services

partly in recognition of the increase in

preservice and postservice work. At that

time, we made no adjustments to the

work RVUs assigned to global surgical

services, which, in addition to the

surgical procedure, include the related

preservice and postservice evaluation

and management visits a surgeon

provides within a defined period of

time.

Upon further examination of this

issue, we are increasing the work RVUs

for global surgical services to be

consistent with the 1997 increases in

the work RVUs for evaluation and

management services.

Because the increases in the work

RVUs for global surgical services will

cause an increase in payments for those

services, we must reduce all payments

by 0.7 percent to maintain budget

neutrality.

H. Caloric Vestibular Testing

We are reducing the work and

malpractice RVUs for CPT code 92543

global service and CPT code 92543–26,

and the malpractice RVUs for CPT code

92543–TC to 25 percent of what they

would otherwise be. Therefore,

beginning in 1998, when a physician

performs and interprets four irrigations,

the physician will bill Medicare for four

units of CPT code 92543 (that is, the

global service). When a physician

interprets four irrigations, the physician

will bill four units of CPT code 92543–

26. When a physician or supplier

performs four irrigations, the physician

or supplier will bill four units of CPT

code 92543–TC.

As part of the overall policy of

resource-based practice expense RVUs

for all codes, we are establishing

practice expense RVUs for CPT code

92543 global service, -26, and -TC based

on the assumption that one unit of the

service equals one irrigation or the

interpretation of one irrigation.

We expect the changes to the RVUs

for caloric vestibular testing to have no

impact on Medicare program or

beneficiary expenditures because this is

actually a change in coding

interpretation rather than a change in

value. Medicare has interpreted one unit

of CPT code 92543 to mean up to four

irrigations and has established its RVUs

based on that interpretation. The AMA

interprets one unit to mean one

irrigation. Therefore, when the usual

service is furnished (that is, a total of

four irrigations—two to each ear),

Medicare instructed physicians to bill

for that as one unit of service, while the

AMA’s instructions considered it four.

We are now, in a budget-neutral fashion,

adopting the AMA interpretation to

reduce billing confusion regarding this

code. The change is being made by

having what used to be one service—for

Medicare purposes—now equal four

services, while at the same time

establishing the RVU levels at 25

percent of what they would have

otherwise been.

I. Clinical Consultations

The regulations set forth at § 415.130

(Conditions for payment: Physician

pathology services), paragraph (b)

(Clinical consultation services), require

that a clinical consultation meet four

criteria before it can be paid. One of

these criteria is that the clinical

consultation must be requested by the

patient’s attending physician. We have

allowed a standing order policy to be

used as a substitute for the individual

request by the patient’s attending

physician. However, effective January 1,

1998, we will not accept a standing

order as a substitute for the individual

request by the attending physician. We

will instruct the Medicare carriers to

enforce § 415.130(b) as it is presently

written.

The national allowed charges for CPT

code 80500 (Clinical pathology

consultation; limited, without review of

patient’s history and medical records)

for 1996 are $5.6 million. Of this

amount, 70 percent of total allowed

charges are from seven States. These are:

Florida, Texas, Oklahoma, Illinois,

Kentucky, California, and Missouri.

Florida accounts for $2.5 million or 45

percent of the total.

We believe that the use of standing

orders has clearly contributed to

increased payments for clinical

consultations in Florida relative to other

States. We do not know the prevalence

of standing orders in other States but,

generally, the data do not seem to

indicate a widespread problem.

J. Changes in Practice Expense Relative

Value Units for 1998

As discussed earlier, section 4505 of

the BBA 1997 specifies the manner in

which practice expense RVUs in 1998

are adjusted. The 1998 practice expense

RVUs for certain services are reduced to

110 percent of their work RVUs for the

service. The reductions are used to

increase practice expense RVUs for

office visits. We estimate that the

aggregate reduction in the practice

expense RVUs for services subject to

this 110 percent is about $330 million.

(See section III. A. above for a detailed

explanation of the calculation of this

provision of the BBA 1997.) Because

these funds are used to increase the

practice expense RVUs for office visits,

there is no change in total spending as

a result of this provision.

K. Coverage of Screening Mammography

and Related Payment Changes

Section 4101 of the BBA 1997

provides for expanded coverage and

waiver of the Part B deductible for

screening mammography services

furnished on or after January 1, 1998.

Specifically, the revised benefit will

allow for annual coverage of screening

mammographies for all women age 40

and over, including women age 65 and

over. Before enactment of the BBA 1997,

biennial coverage of screening

mammograms was available for (1)

women at least age 40 but not yet age

50 who were not at high risk for breast

cancer, and (2) women age 65 and over.

Annual coverage of screening

mammograms was only available for (1)

women at least age 40 but not yet age

50 who were at high risk for breast
59096 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

cancer, and (2) women at least age 50

but not yet age 65. We estimate that

these changes in the frequency

limitations and in the Part B deductible

will result in an increase in Medicare

payments. These payments will be made

to many screening mammography

suppliers, including the physicians who

interpret the results of these

examinations, as well as to other

physicians who may be involved in

providing any medically necessary

follow-up tests or treatment that may be

required as a result of the screening

tests.

L. Colorectal Cancer Screening

Section 4104 of the BBA 1997

authorizes coverage of certain colorectal

screening tests, effective January 1,

1998, subject to certain frequency and

payment limits. The new tests include

(1) screening fecal-occult blood tests, (2)

screening flexible sigmoidoscopy

exams, (3) screening colonoscopy

exams, and (4) screening barium enema

exams. Based on the projected

utilization of these various screening

services and related medically necessary

follow-up tests and treatment that may

be required for the beneficiaries

screened, we estimate that this new

benefit will result in an increase in

Medicare payments. These payments

will be made to many primary care

physicians for the screening fecal-occult

blood tests, and mostly to physician

specialists such as gastroenterologists

(in the case of screening flexible

sigmoidoscopies and screening

colonoscopies) and radiologists (in the

case of screening barium enema

procedures).

M. Coverage of Screening Pelvic

Examination (Including a Clinical

Breast Examination) and Related

Payment Changes

Effective for services furnished

beginning January 1, 1998, section 4102

of the BBA 1997 provides for coverage

and waiver of the Part B deductible for

screening pelvic examinations

(including a clinical breast examination)

subject to certain frequency and

payment limitations. We estimate that

this new coverage provision will

increase program expenditures. These

payments will be made to a large

number of physicians and other

practitioners who provide these tests or

any medically necessary follow-up tests

or treatment that may be required as a

result of the screening tests throughout

the United States.

N. Reinstatement of the Payment for

Transportation of EKG Equipment

As set forth in section 4559 of the

BBA 1997, effective for services

furnished after December 31, 1997 and

before January 1, 1999, carriers will

make separate payments for HCPCS

code R0076 (Transportation of portable

EKG to facility or location, per patient)

based upon payment methods in effect

for these services as of December 31,

1996. EKG transportation payments

should be made at the carrier-priced

level that was in effect on December 31,

1996. The procedure codes involved are

CPT code 93000 (a 12-lead EKG with

interpretation and report) or CPT code

93005 (a 12-lead EKG, tracing only,

without interpretation and report).

When multiple patients receive services

at the same site, the transportation

payment amount must be prorated

among all patients seen. These

payments may be made only under the

following circumstances:

• The transportation service is

furnished in connection with standard

EKG procedures furnished by approved

suppliers of portable x-ray services as

set forth in section 2070.4.F. of the

Medicare Carriers Manual.

• The transportation service is

furnished in connection with standard

EKG procedures by an independent

diagnostic testing facility or an

independent physiological laboratory

under the condition set forth in section

2070.1.G. of the Medicare Carriers

Manual. We estimate that this provision

will result in some increase in program

expenditures.

O. Elimination of the Separate BudgetNeutrality Adjuster for the Work

Relative Value Units

As discussed in the November 22,

1996 final rule (61 FR 59532) for the

1997 physician fee schedule, we intend

to eliminate the separate 8.3 percent

budget-neutrality adjustment to the

work RVUs that resulted from changes

made during the 5-year review of work

RVUs. We will accomplish this by

increasing the practice and malpractice

expense RVUs by 8.3 percent and

reducing the CF by 8.3 percent. This

allows us to eliminate the separate

adjuster while not changing the

payment for any service. However, due

to the affects of the BBA 1997, we are

postponing the elimination of the

separate budget neutrality adjustment

until 1999.

P. Effect of Changes Resulting From

Adjustments to Relative Value Units

Because the new RVUs cause an

increase in total estimated payments

under the physician fee schedule, we

must reduce payments by 0.8 percent in

order to maintain budget neutrality as

required by section 1848(c)(2)(B)(ii)(II)

of the Act. This reduction in payments

is being implemented through a 0.8

percent reduction to the conversion

factor.

We anticipate that the reduction of

net Medicare revenues for some

physician practices due to the changes

contained in this regulation will result

in a volume and intensity response that

will cause overall physician

expenditures to increase by 0.1 percent,

requiring an offsetting 0.1 percent

reduction in the CF to maintain budget

neutrality. This 0.1 percent reduction is

included in the 0.8 percent reduction

described above.

We increased the Sustainable Growth

Rate target for physician spending by

the anticipated 0.1 volume and intensity

response. Because we increased the

target, if the anticipated volume and

intensity response does not occur, the

Sustainable Growth Rate system will

return the 0.1 percent reduction to the

CF in the form of higher future updates.

Q. Net Impact of Relative Value Unit

Changes on Medicare Specialties

1. Impact Estimation Methodology

Physician fee schedule impacts were

estimated by comparing predicted

physician payments under a

continuation of the current RVUs to the

estimated payments under the new

RVUs.

2. Overall Fee Schedule Impact

As described above, we are making

the budget neutrality adjustment

required for changes in relative value

units through an adjustment to the CF.

In the discussion below of differential

impacts by specialty, we have

incorporated the separate 0.8 percent

downward adjustment on the CF. The

table below does not contain the

impacts of the single CF.

3. Specialty Level Effect (Includes Table

3—Impact on Medicare Payments by

Specialty Due to Changes in Relative

Value Units)

Table 3, ‘‘Impact on Medicare

Payments by Specialty Due to Changes

in Relative Value Units,’’ shows the

estimated percentage change in

Medicare physician fees from the

current RVUs to the new RVUs and by

specialty. The specialties are ranked

according to the impact of the changes

to Medicare fees. The impact of the

changes contained in this regulation on

the total revenue (Medicare and nonMedicare) for a given specialty is less
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59097

than impact displayed in Table 3 since physicians provide services to Medicare

and non-Medicare patients.

TABLE 3.—IMPACT ON MEDICARE PAYMENTS BY SPECIALITY DUE TO CHANGES IN RELATIVE VALUE UNITS

[In percent]

Specialty

Impact on

total payments

Impact on

work payments

Impact on

practice expense payments

M.D./D.O. Physicians:

Obstetrics/Gynecology ...................................................................................................................... 3.0 2.8 3.9

General Surgery ................................................................................................................................ 1.8 3.8 ¥0.4

Plastic Surgery .................................................................................................................................. 1.7 3.9 ¥0.6

Vascular Surgery ............................................................................................................................... 1.5 4.3 0.7

Rheumatology ................................................................................................................................... 1.4 ¥0.9 5.0

Family Practice .................................................................................................................................. 1.3 ¥1.0 5.3

General Practice ............................................................................................................................... 1.2 ¥0.4 4.1

Anesthesiology .................................................................................................................................. 0.9 1.0 0.7

Hematology/Oncology ....................................................................................................................... 0.8 ¥0.6 2.5

Orthopedic Surgery ........................................................................................................................... 0.8 4.0 ¥2.0

Internal Medicine ............................................................................................................................... 0.6 ¥0.9 3.0

Otolaryngology .................................................................................................................................. 0.6 0.3 1.1

Urology .............................................................................................................................................. 0.4 0.6 0.3

Dermatology ...................................................................................................................................... 0.2 ¥0.6 1.7

Neurology .......................................................................................................................................... 0.0 0.7 1.2

Clinics ................................................................................................................................................ ¥0.1 ¥0.3 0.2

Neurosurgery ..................................................................................................................................... ¥0.2 3.2 ¥3.6

Thoracic Surgery ............................................................................................................................... ¥0.2 5.0 ¥4.7

All Other Physicians .......................................................................................................................... ¥0.2 ¥0.6 0.5

Pulmonary ......................................................................................................................................... ¥0.4 ¥0.8 0.4

Emergency Medicine ......................................................................................................................... ¥0.6 ¥0.7 ¥0.5

Psychiatry .......................................................................................................................................... ¥0.7 ¥0.9 ¥0.4

Radiology .......................................................................................................................................... ¥0.7 ¥0.9 0.6

Cardiac Surgery ................................................................................................................................ ¥0.7 5.4 ¥5.9

Radiation Oncology ........................................................................................................................... ¥0.7 ¥0.7 ¥0.7

Pathology .......................................................................................................................................... ¥1.1 ¥0.8 ¥1.5

Nephrology ........................................................................................................................................ ¥1.2 ¥0.8 ¥1.9

Gastroenterology ............................................................................................................................... ¥1.3 ¥0.8 ¥2.0

Cardiology ......................................................................................................................................... ¥1.4 ¥0.6 ¥2.3

Ophthalmology .................................................................................................................................. ¥2.6 1.6 ¥6.8

Others:

Podiatry ............................................................................................................................................. 0.8 0.5 1.4

Optometry .......................................................................................................................................... 0.1 ¥0.9 1.8

Nonphysician Practitioner ................................................................................................................. ¥0.6 0.3 ¥2.2

Chiropractic ....................................................................................................................................... ¥0.8 ¥0.8 ¥0.8

Suppliers ........................................................................................................................................... ¥1.0 ¥0.8 ¥1.1

R. Five-Year Impacts of Benefit Changes

(Includes Table 4—Projected Budget

Impact of New Benefits)

We estimate that the benefit changes

enacted in the BBA 1997 described in

this final rule will result in the

following Medicare expenditures over

the next 5 fiscal years:

TABLE 4.—PROJECTED BUDGET IMPACT OF NEW BENEFITS

[In millions]

FY 1998 FY 1999 FY 2000 FY 2001 FY 2002

Total budget impact .................................................................................. $160 $385 $510 $685 $780

S. Rural Hospital Impact Statement

Section 1102(b) of the Act requires the

Secretary to prepare a regulatory impact

analysis if a rule may have a significant

impact on the operations of a substantial

number of small rural hospitals. This

analysis must conform to the provisions

of section 604 of the Regulatory

Flexibility Act. For purposes of section

1102(b) of the Act, we define a small

rural hospital as a hospital that is

located outside of a Metropolitan

Statistical Area and has fewer than 50

beds.

This final rule will have little direct

effect on payments to rural hospitals

since this rule will change only

payments made to physicians and

certain other practitioners under Part B

of the Medicare program and will make

no change in payments to hospitals

under Part A. We do not believe the
59098 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

changes will have a major, indirect

effect on rural hospitals.

Therefore, we are not preparing an

analysis for section 1102(b) of the Act

since we have determined, and the

Secretary certifies, that this rule will not

have a significant impact on the

operations of a substantial number of

small rural hospitals.

In accordance with the provisions of

Executive Order 12866, this regulation

was reviewed by the Office of

Management and Budget.

List of Subjects

42 CFR Part 400

Grant programs-health, Health

facilities, Health maintenance

organizations (HMO), Medicaid,

Medicare, Reporting and recordkeeping

requirements.

42 CFR Part 405

Administrative practice and

procedure, Health facilities, Health

professions, Kidney diseases, Medicare,

Reporting and recordkeeping

requirements, Rural areas, X-rays.

42 CFR Part 410

Health facilities, Health professions,

Kidney diseases, Laboratories,

Medicare, Rural areas, X-rays.

42 CFR Part 411

Kidney diseases, Medicare, Reporting

and recordkeeping requirements.

42 CFR Part 414

Administrative practice and

procedure, Health facilities, Health

professions, Kidney diseases, Medicare,

Reporting and recordkeeping

requirements, Rural areas, X-rays.

42 CFR chapter IV is amended as set

forth below:

PART 400—INTRODUCTION;

DEFINITIONS

A. Part 400 is amended as set forth

below:

1. The authority citation for part 400

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

Social Security Act (42 U.S.C. 1302 and

1395hh), and 44 U.S.C. Chapter 35.

2. In § 400.202, the introductory text

is republished, and the following

definitions are added in alphabetical

order:

§ 400.202 Definitions specific to Medicare.

As used in connection with the

Medicare program, unless the context

indicates otherwise—

* * * * *

Nonparticipating supplier means a

supplier that does not have an

agreement with HCFA to participate in

Part B of Medicare in effect on the date

of the service.

Participating supplier means a

supplier that has an agreement with

HCFA to participate in Part B of

Medicare in effect on the date of the

service.

* * * * *

B. Part 405 is amended as set forth

below:

PART 405—FEDERAL HEALTH

INSURANCE FOR THE AGED AND

DISABLED

Subpart E—Criteria for Determination

of Reasonable Charges

1. The authority citation for part 405,

subpart E, continues to read as follows:

Authority: Secs. 1102 and 1871 of the

Social Security Act (42 U.S.C. 1302 and

1395hh).

§ 405.535 [Amended]

2. In § 405.535(b), ‘‘§ 414.48(b)(3)’’ is

removed and ‘‘§ 414.48(b)’’ is added in

its place.

PART 410—SUPPLEMENTARY

MEDICAL INSURANCE (SMI)

BENEFITS

C. Part 410 is amended as set forth

below:

1. The authority citation for part 410

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

Social Security Act (42 U.S.C. 1302 and

1395hh), unless otherwise indicated.

2. Section 410.32 is revised to read as

follows:

§ 410.32 Diagnostic x-ray tests, diagnostic

laboratory tests, and other diagnostic tests:

Conditions.

(a) Ordering diagnostic tests. All

diagnostic x-ray tests, diagnostic

laboratory tests, and other diagnostic

tests must be ordered by the physician

who is treating the beneficiary, that is,

the physician who furnishes a

consultation or treats a beneficiary for a

specific medical problem and who uses

the results in the management of the

beneficiary’s specific medical problem.

Tests not ordered by the physician who

is treating the beneficiary are not

reasonable and necessary (see

§ 411.15(k)(1) of this chapter).

(1) Chiropractic exception. A

physician may order an x-ray to be used

by a chiropractor to demonstrate the

subluxation of the spine that is the basis

for a beneficiary to receive manual

manipulation treatments even though

the physician does not treat the

beneficiary.

(2) Mammography exception. A

physician who meets the qualification

requirements for an interpreting

physician under section 354 of the

Public Health Service Act as provided

in § 410.34(a)(7) may order a diagnostic

mammogram based on the findings of a

screening mammogram even though the

physician does not treat the beneficiary.

(3) Application to nonphysician

practitioners. Nonphysician

practitioners (that is, clinical nurse

specialists, clinical psychologists,

clinical social workers, nurse-midwives,

nurse practitioners, and physician

assistants) who furnish services that

would be physician services if furnished

by a physician, and who are operating

within the scope of their authority

under State law and within the scope of

their Medicare statutory benefit, may be

treated the same as physicians treating

beneficiaries for the purpose of this

section.

(b) Diagnostic x-ray and other

diagnostic tests. (1) Basic rule. Except as

indicated in paragraph (b)(2) of this

section, all diagnostic x-ray and other

diagnostic tests covered under section

1861(s)(3) of the Act and payable under

the physician fee schedule must be

furnished under the appropriate level of

supervision by a physician as defined in

section 1861(r) of the Act. Services

furnished without the required level of

supervision are not reasonable and

necessary (see § 411.15(k)(1) of this

chapter).

(2) Exceptions. The following

diagnostic tests payable under the

physician fee schedule are excluded

from the basic rule set forth in

paragraph (b)(1) of this section:

(i) Diagnostic mammography

procedures, which are regulated by the

Food and Drug Administration.

(ii) Diagnostic tests personally

furnished by a qualified audiologist as

defined in section 1861(ll)(3) of the Act.

(iii) Diagnostic psychological testing

services personally furnished by a

clinical psychologist or a qualified

independent psychologist as defined in

program instructions.

(iv) Diagnostic tests (as established

through program instructions)

personally performed by a physical

therapist who is certified by the

American Board of Physical Therapy

Specialties as a qualified

electrophysiologic clinical specialist

and permitted to provide the service

under State law.

(3) Levels of supervision. Except

where otherwise indicated, all

diagnostic x-ray and other diagnostic

tests subject to this provision and

payable under the physician fee

schedule must be furnished under at
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59099

least a general level of physician

supervision as defined in paragraph

(b)(3)(i) of this section. In addition,

some of these tests also require either

direct or personal supervision as

defined in paragraphs (b)(3)(ii) or

(b)(3)(iii) of this section, respectively.

When direct or personal supervision is

required, physician supervision at the

specified level is required throughout

the performance of the test.

(i) General supervision means the

procedure is furnished under the

physician’s overall direction and

control, but the physician’s presence is

not required during the performance of

the procedure. Under general

supervision, the training of the

nonphysician personnel who actually

perform the diagnostic procedure and

the maintenance of the necessary

equipment and supplies are the

continuing responsibility of the

physician.

(ii) Direct supervision in the office

setting means the physician must be

present in the office suite and

immediately available to furnish

assistance and direction throughout the

performance of the procedure. It does

not mean that the physician must be

present in the room when the procedure

is performed.

(iii) Personal supervision means a

physician must be in attendance in the

room during the performance of the

procedure.

(c) Portable x-ray services. Portable xray services furnished in a place of

residence used as the patient’s home are

covered if the following conditions are

met:

(1) These services are furnished under

the general supervision of a physician,

as defined in paragraph (b)(3)(i) of this

section.

(2) The supplier of these services

meets the requirements set forth in part

486, subpart C of this chapter,

concerning conditions for coverage for

portable x-ray services.

(3) The procedures are limited to—

(i) Skeletal films involving the

extremities, pelvis, vertebral column, or

skull;

(ii) Chest or abdominal films that do

not involve the use of contrast media;

and

(iii) Diagnostic mammograms if the

approved portable x-ray supplier, as

defined in subpart C of part 486 of this

chapter, meets the certification

requirements of section 354 of the

Public Health Service Act, as

implemented by 21 CFR part 900,

subpart B.

(d) Diagnostic laboratory tests.

Medicare Part B pays for covered

diagnostic laboratory tests that are

furnished by any of the following:

(1) A participating hospital or

participating RPCH.

(2) A nonparticipating hospital that

meets the requirements for emergency

outpatient services specified in subpart

G of part 424 of this chapter and the

laboratory requirements specified in

part 493 of this chapter.

(3) The office of the patient’s

attending or consulting physician if that

physician is a doctor of medicine,

osteopathy, podiatric medicine, dental

surgery, or dental medicine.

(4) An RHC.

(5) A laboratory, if it meets the

applicable requirements for laboratories

of part 493 of this chapter, including the

laboratory of a nonparticipating hospital

that does not meet the requirements for

emergency outpatient services in

subpart G of part 424 of this chapter.

(6) An FQHC.

3. New § 410.33 is added to read as

follows:

§ 410.33 Independent diagnostic testing

facility.

(a) General rule. (1) Effective for

diagnostic procedures performed on or

after July 1, 1998, carriers will pay for

diagnostic procedures under the

physician fee schedule only when

performed by a physician, a group

practice of physicians, an approved

supplier of portable x-ray services, or an

independent diagnostic testing facility

(IDTF). An IDTF may be a fixed

location, a mobile entity, or an

individual nonphysician practitioner. It

is independent of a physician’s office or

hospital; however, these rules apply

when an IDTF furnishes diagnostic

procedures in a physician’s office.

(2) Exceptions. The following

diagnostic tests that are payable under

the physician fee schedule and

furnished by a nonhospital testing entity

are not required to be furnished in

accordance with the criteria set forth in

paragraphs (b) through (e) of this

section:

(i) Diagnostic mammography

procedures, which are regulated by the

Food and Drug Administration.

(ii) Diagnostic tests personally

furnished by a qualified audiologist as

defined in section 1861(ll)(3) of the Act.

(iii) Diagnostic psychological testing

services personally furnished by a

clinical psychologist or a qualified

independent psychologist as defined in

program instructions.

(iv) Diagnostic tests (as established

through program instructions)

personally performed by a physical

therapist who is certified by the

American Board of Physical Therapy

Specialties as a qualified

electrophysiologic clinical specialist

and permitted to provide the service

under State law.

(b) Supervising physician. (1) An

IDTF must have one or more

supervising physicians who are

responsible for the direct and ongoing

oversight of the quality of the testing

performed, the proper operation and

calibration of the equipment used to

perform tests, and the qualification of

nonphysician personnel who use the

equipment. This level of supervision is

that required for general supervision set

forth in § 410.32(b)(3)(i).

(2) The supervising physician must

evidence proficiency in the performance

and interpretation of each type of

diagnostic procedure performed by the

IDTF. The proficiency may be

documented by certification in specific

medical specialties or subspecialties or

by criteria established by the carrier for

the service area in which the IDTF is

located. In the case of a procedure

requiring the direct or personal

supervision of a physician as set forth

in § 410.32(b)(3)(ii) or (b)(3)(iii), the

IDTF’s supervising physician must

personally furnish this level of

supervision whether the procedure is

performed in the IDTF or, in the case of

mobile services, at the remote location.

The IDTF must maintain documentation

of sufficient physician resources during

all hours of operations to assure that the

required physician supervision is

furnished. In the case of procedures

requiring direct supervision, the

supervising physician may oversee

concurrent procedures.

(c) Nonphysician personnel. Any

nonphysician personnel used by the

IDTF to perform tests must demonstrate

the basic qualifications to perform the

tests in question and have training and

proficiency as evidenced by licensure or

certification by the appropriate State

health or education department. In the

absence of a State licensing board, the

technician must be certified by an

appropriate national credentialing body.

The IDTF must maintain documentation

available for review that these

requirements are met.

(d) Ordering of tests. All procedures

performed by the IDTF must be

specifically ordered in writing by the

physician who is treating the

beneficiary, that is, the physician who is

furnishing a consultation or treating a

beneficiary for a specific medical

problem and who uses the results in the

management of the beneficiary’s specific

medical problem. (Nonphysician

practitioners may order tests as set forth

in § 410.32(a)(3).) The order must

specify the diagnosis or other basis for
59100 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

the testing. The supervising physician

for the IDTF may not order tests to be

performed by the IDTF, unless the

IDTF’s supervising physician is in fact

the beneficiary’s treating physician.

That is, the physician in question had

a relationship with the beneficiary prior

to the performance of the testing and is

treating the beneficiary for a specific

medical problem. The IDTF may not

add any procedures based on internal

protocols without a written order from

the treating physician.

(e) Multi-State entities. An IDTF that

operates across State boundaries must

maintain documentation that its

supervising physicians and technicians

are licensed and certified in each of the

States in which it is furnishing services.

(f) Applicability of State law. An IDTF

must comply with the applicable laws

of any State in which it operates.

4. In § 410.34, the introductory text to

paragraph (d) and paragraph (d)(4) are

revised to read as follows:

§ 410.34 Mammography services:

Conditions for and limitations on coverage.

* * * * *

(d) Limitations on coverage of

screening mammography services. The

following limitations apply to coverage

of screening mammography services as

described in paragraphs (c) and (d) of

this section:

* * * * *

(4) For an asymptomatic woman over

39 years of age, payment may be made

for a screening mammography

performed after at least 11 months have

passed following the month in which

the last screening mammography was

performed.

* * * * *

5. A new § 410.37 is added to read as

follows:

§ 410.37 Colorectal cancer screening

tests: Conditions for and limitations on

coverage.

(a) Definitions. As used in this

section, the following definitions apply:

(1) Colorectal cancer screening tests

means any of the following procedures

furnished to an individual for the

purpose of early detection of colorectal

cancer:

(i) Screening fecal-occult blood tests.

(ii) Screening flexible

sigmoidoscopies.

(iii) In the case of an individual at

high risk for colorectal cancer, screening

colonoscopies.

(iv) Screening barium enemas.

(v) Other tests or procedures, and

modifications to tests under this

paragraph, with such frequency and

payment limits as HCFA determines

appropriate, in consultation with

appropriate organizations.

(2) Screening fecal-occult blood test

means a guaiac-based test for peroxidase

activity, testing two samples from each

of three consecutive stools.

(3) An individual at high risk for

colorectal cancer means an individual

with—

(i) A close relative (sibling, parent, or

child) who has had colorectal cancer or

an adenomatous polyp;

(ii) A family history of familial

adenomatous polyposis;

(iii) A family history of hereditary

nonpolyposis colorectal cancer;

(iv) A personal history of

adenomatous polyps; or

(v) A personal history of colorectal

cancer; or

(vi) Inflammatory bowel disease,

including Crohn’s Disease, and

ulcerative colitis.

(4) Screening barium enema means—

(i) A screening double contrast barium

enema of the entire colorectum

(including a physician’s interpretation

of the results of the procedure); or

(ii) In the case of an individual whose

attending physician decides that he or

she cannot tolerate a screening double

contrast barium enema, a screening

single contrast barium enema of the

entire colorectum (including a

physician’s interpretation of the results

of the procedure).

(5) An attending physician for

purposes of this provision is a doctor of

medicine or osteopathy (as defined in

section 1861(r)(1) of the Act) who is

fully knowledgeable about the

beneficiary’s medical condition, and

who would be responsible using the

results of any examination performed in

the overall management of the

beneficiary’s specific medical problem.

(b) Condition for coverage of

screening fecal-occult blood tests.

Medicare Part B pays for a screening

fecal-occult blood test if it is ordered in

writing by the beneficiary’s attending

physician.

(c) Limitations on coverage of

screening fecal-occult blood tests. (1)

Payment may not be made for a

screening fecal-occult blood test

performed for an individual under age

50.

(2) For an individual 50 years of age

or over, payment may be made for a

screening fecal-occult blood test

performed after at least 11 months have

passed following the month in which

the last screening fecal-occult blood test

was performed.

(d) Condition for coverage of

screening flexible sigmoidoscopies.

Medicare Part B pays for a screening

flexible sigmoidoscopy service if it is

performed by a doctor of medicine or

osteopathy (as defined in section

1861(r)(1) of the Act).

(e) Limitations on coverage of

screening flexible sigmoidoscopies. (1)

Payment may not be made for a

screening flexible sigmoidoscopy

performed for an individual under age

50.

(2) For an individual 50 years of age

or over, payment may be made for a

screening flexible sigmoidoscopy after

at least 47 months have passed

following the month in which the last

screening flexible sigmoidoscopy or, as

provided in paragraphs (h) and (i) of

this section, the last screening barium

enema was performed.

(f) Condition for coverage of screening

colonoscopies. Medicare Part B pays for

a screening colonoscopy if it is

performed by a doctor of medicine or

osteopathy (as defined in section

1861(r)(1) of the Act).

(g) Limitations on coverage of

screening colonoscopies. (1) Payment

may not be made for a screening

colonoscopy for an individual who is

not at high risk for colorectal cancer as

described in paragraph (a)(3) of this

section.

(2) Payment may be made for a

screening colonoscopy performed for an

individual who is at high risk for

colorectal cancer as described in

paragraph (a)(3) of this section, after at

least 23 months have passed following

the month in which the last screening

colonoscopy was performed, or as

provided in paragraphs (h) and (i) of

this section, the last screening barium

enema was performed.

(h) Conditions for coverage of

screening barium enemas. Medicare Part

B pays for a screening barium enema if

it is ordered in writing by the

beneficiary’s attending physician.

(i) Limitations on coverage of

screening barium enemas.

(1) In the case of an individual age 50

or over who is not at high risk of

colorectal cancer, payment may be made

for a screening barium enema

examination performed after at least 47

months have passed following the

month in which the last screening

barium enema or screening flexible

sigmoidoscopy was performed.

(2) In the case of an individual who

is at high risk for colorectal cancer,

payment may be made for a screening

barium enema examination performed

after at least 23 months have passed

following the month in which the last

screening barium enema or the last

screening colonoscopy was performed.

6. A new § 410.56 is added to read as

follows:
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59101

§ 410.56 Screening pelvic examinations.

(a) Conditions for screening pelvic

examinations. Medicare Part B pays for

a screening pelvic examination

(including a clinical breast examination)

if it is performed by a doctor of

medicine or osteopathy (as defined in

section 1861(r)(1) of the Act), or by a

certified nurse midwife (as defined in

section 1861(gg) of the Act), or a

physician assistant, nurse practitioner,

or clinic nurse specialist (as defined in

section 1861(aa) of the Act) who is

authorized under State law to perform

the examination.

(b) Limits on coverage of screening

pelvic examinations. The following

limitations apply to coverage of

screening pelvic examination services:

(1) General rule. Except as specified

in paragraphs (b)(2) and (b)(3) of this

section, payment may be made for a

pelvic examination performed on an

asymptomatic woman only if the

individual has not had a pelvic

examination paid for by Medicare

during the preceding 35 months

following the month in which her last

Medicare-covered screening pelvic

examination was performed and found

to be normal.

(2) More frequent screening based on

high-risk factors. Subject to the

limitation as specified in paragraph

(b)(4) of this section, payment may be

made for a screening pelvic examination

performed more frequently than once

every 36 months if the test is performed

by a physician or other practitioner

specified in paragraph (a) of this

section, and there is evidence that the

woman is at high risk (on the basis of

her medical history or other findings) of

developing cervical cancer, or vaginal

cancer, as determined in accordance

with the following risk factors:

(i) High risk factors for cervical

cancer:

(A) Early onset of sexual activity

(under 16 years of age).

(B) Multiple sexual partners (five or

more in a lifetime).

(C) History of a sexually transmitted

disease (including HIV infection).

(D) Absence of three negative or any

Pap smears within the previous 7 years.

(ii) High risk factor for vaginal cancer:

DES (diethylstilbestrol)-exposed

daughters of women who took DES

during pregnancy.

(3) More frequent screening for

women of childbearing age. Subject to

the limitation as specified in paragraph

(b)(4) of this section, payment may be

made for a screening pelvic examination

performed more frequently than once

every 36 months if the test is performed

by a physician or other practitioner as

specified in paragraph (a) of this section

for a woman of childbearing age who

has had such an examination that

indicated the presence of cervical or

vaginal cancer or other abnormality

during any of the preceding 3 years. The

term ‘‘woman of childbearing age’’

means a woman who is premenopausal,

and has been determined by a

physician, or qualified practitioner as

specified in paragraph (a) of this

section, to be of childbearing age, based

on her medical history or other findings.

(4) Limitation applicable to women at

high risk and those of childbearing age.

Payment is not made for a screening

pelvic examination for women

considered to be at high risk (under any

of the criteria described in paragraph

(b)(2) of this section), or who qualify for

coverage under the childbearing

provision (under the criteria described

in paragraph (b)(3) of this section) more

frequently than once every 11 months

after the month that the last screening

pelvic examination covered by Medicare

was performed and found to be normal.

7. In § 410.160, the introductory text

to paragraph (b) is republished, and new

paragraphs (b)(5) and (b)(6) are added to

read as follows:

§ 410.160 Part B annual deductible.

* * * * *

(b) Exceptions. Expenses incurred for

the following services are not subject to

the Part B annual deductible and do not

count toward meeting that deductible:

* * * * *

(5) Screening mammography services

as described in § 410.34 (c) and (d).

(6) Screening pelvic examinations as

described in § 410.56.

* * * * *

PART 411—EXCLUSIONS FROM

MEDICARE AND LIMITATIONS ON

MEDICARE PAYMENT

D. Part 411 is amended as set forth

below:

1. The authority citation for part 411

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

Social Security Act (42 U.S.C. 1302 and

1395hh).

2. In § 411.15 the introductory text to

the section and to paragraph (a) is

republished, paragraph (a)(1) is revised,

the introductory text to paragraph (k) is

republished, and new paragraphs (k)(6),

(k)(7), and (k)(8) are added to read as

follows:

§ 411.15 Particular services excluded from

coverage.

The following services are excluded

from coverage.

(a) Routine physical checkups such

as—

(1) Examinations performed for a

purpose other than treatment or

diagnosis of a specific illness, symptom,

complaint, or injury, except for

screening mammography, colorectal

cancer screening tests, or screening

pelvic examinations that meet the

criteria specified in paragraphs (k)(6),

(k)(7), and (k)(8) of this section.

* * * * *

(k) Any services that are not

reasonable and necessary for one of the

following purposes:

* * * * *

(6) In the case of screening

mammography, for the purpose of early

detection of breast cancer subject to the

conditions and limitations specified in

§ 410.34 of this chapter.

(7) In the case of colorectal cancer

screening tests, for the purpose of early

detection of colorectal cancer subject to

the conditions and limitations specified

in § 410.37 of this chapter.

(8) In the case of screening pelvic

examinations, for the purpose of early

detection of cervical or vaginal cancer

subject to the conditions and limitations

specified in § 410.56 of this chapter.

* * * * *

PART 414—PAYMENT FOR PART B

MEDICAL AND OTHER HEALTH

SERVICES

E. Part 414 is amended as set forth

below:

1. The authority citation for part 414

continues to read as follows:

Authority: Secs. 1102, 1871, and 1881(b)(1)

of the Social Security Act (42 U.S.C. 1302,

1395hh, and 1395rr(b)(1)).

2. Section 414.20 is revised to read as

follows:

§ 414.20 Formula for computing fee

schedule amounts.

(a) Participating supplier. The fee

schedule amount for a participating

supplier for a physician service as

defined in § 414.2 is computed as the

product of the following amounts:

(1) The RVUs for the service.

(2) The GAF for the fee schedule area.

(3) The CF.

(b) Nonparticipating supplier. The fee

schedule amount for a nonparticipating

supplier for a physician service as

defined in § 414.2 is 95 percent of the

fee schedule amount as calculated in

paragraph (a) of this section.

3. A new § 414.21 is added to read as

follows:

§ 414.21 Medicare payment basis.

Medicare payment is based on the

lesser of the actual charge or the

applicable fee schedule amount.
59102 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

4. In § 414.22, the introductory text to

the section and to paragraph (b) is

republished, and new paragraph (b)(4) is

added to read as follows:

§ 414.22 Relative value units (RVUs).

HCFA establishes RVUs for physician

work, physician practice expense, and

malpractice insurance.

* * * * *

(b) Practice expense RVUs. * * *

(4) For services furnished beginning

January 1, 1998, practice expense RVUs

for certain services are reduced to 110

percent of the work RVUs for those

services. The following two categories of

services are excluded from this

limitation:

(i) The service is provided more than

75 percent of the time in an office

setting; or

(ii) The service is one described in

section 1848(c)(2)(G)(v) of the Act,

codified at 42 U.S.C. 1395w–4(c)(2)(G).

Section 1848(c)(2)(G)(v) of the Act refers

to the 1998 proposed resource-based

practice expense RVUs (as specified in

the June 18, 1997 physician fee

schedule proposed rule (62 FR 33158))

for the specific site, either in-office or

out-of-office, increased from its 1997

practice expense RVUs.)

* * * * *

5. In § 414.32, paragraph (b) is revised

to read as follows:

§ 414.32 Determining payments for certain

physician services furnished in facility

settings.

* * * * *

(b) General rule. If physician services

of the type routinely furnished in a

physician’s office are furnished in

facility settings, the fee schedule

amount for those services is determined

by reducing the applicable practice

expense RVUs for the service by 50

percent.

* * * * *

6. In § 414.48, paragraph (b) is revised

to read as follows:

§ 414.48 Limits on actual charges of

nonparticipating suppliers.

* * * * *

(b) Specific limits. For items or

services paid under the physician fee

schedule, the limiting charge is 115

percent of the fee schedule amount for

nonparticipating suppliers. For items or

services HCFA excludes from payment

under the physician fee schedule (in

accordance with section 1848 (j)(3) of

the Act), the limiting charge is 115

percent of 95 percent of the payment

basis applicable to participating

suppliers as calculated in § 414.20(b).

7. Section 414.62 is added to read as

follows:

§ 414.62 Fee schedule for clinical

psychologist services.

The fee schedule for clinical

psychologist services is set at 100

percent of the amount determined for

corresponding services under the

physician fee schedule.

(Catalog of Federal Domestic Assistance

Program No. 93.774, Medicare—

Supplementary Medical Insurance Program)

Dated: October 23, 1997.

Nancy-Ann Min DeParle,

Deputy Administrator, Health Care Financing

Administration.

Dated: October 27, 1997.

Donna E. Shalala,

Secretary.

Note: These addenda will not appear in the

Code of Federal Regulations.

Addendum A—Explanation and Use of

Addenda B Through G

The addenda on the following pages

provide various data pertaining to the

Medicare fee schedule for physician

services furnished in 1998. Addendum

B contains the RVUs for work, practice

expense, and malpractice expense, and

other information for all services

included in the physician fee schedule.

Addendum C provides interim RVUs

and related information for codes that

are subject to comment. Each code listed

in Addendum C is also included in

Addendum B. Further explanations of

the information in these addenda are

provided at the beginning of each

addendum.

Addendum D contains the 1999 GPCIs

by Medicare carrier and locality.

Addendum E contains the 1998 GPCIs

by Medicare carrier and locality.

Addendum F contains the 1999 versus

1997 geographic adjustment factor by

1998 fee schedule area. Addendum G

contains counties included in 1998

localities (listed alphabetically by State

and locality name within the State).

To compute a fee schedule amount

according to the formula provided in the

final rule, use the RVUs listed in

Addendum B and the GPCIs for 1998

listed in Addendum E of this final rule.

In applying the formula, use the CF of

$36.6873. The work adjuster for 1998 is

0.917.

Addendum B—1998 Relative Value

Units and Related Information Used in

Determining Medicare Payments for

1998

This addendum contains the

following information for each CPT

code and alphanumeric HCPCS code,

except for alphanumeric codes

beginning with B (enteral and parenteral

therapy), E (durable medical

equipment), K (temporary codes for

nonphysician services or items), or L

(orthotics), and codes for

anesthesiology.

1. CPT/HCPCS code. This is the CPT

or alphanumeric HCPCS number for the

service. Alphanumeric HCPCS codes are

included at the end of this addendum.

2. Modifier. A modifier is shown if

there is a technical component (modifier

TC) and a professional component (PC)

(modifier -26) for the service. If there is

a PC and a TC for the service,

Addendum B contains three entries for

the code: One for the global values (both

professional and technical); one for

modifier -26 (PC); and one for modifier

TC. The global service is not designated

by a modifier, and physicians must bill

using the code without a modifier if the

physician furnishes both the PC and the

TC of the service.

Modifier -53 is shown for a

discontinued procedure. There will be

RVUs for the code (CPT code 45378)

with this modifier.

3. Status indicator. This indicator

shows whether the CPT/HCPCS code is

in the physician fee schedule and

whether it is separately payable if the

service is covered.

A = Active code. These codes are

separately payable under the fee

schedule if covered. There will be RVUs

for codes with this status. The presence

of an ‘‘A’’ indicator does not mean that

Medicare has made a national decision

regarding the coverage of the service.

Carriers remain responsible for coverage

decisions in the absence of a national

Medicare policy.

B = Bundled code. Payment for

covered services is always bundled into

payment for other services not specified.

If RVUs are shown, they are not used for

Medicare payment. If these services are

covered, payment for them is subsumed

by the payment for the services to which

they are incident. (An example is a

telephone call from a hospital nurse

regarding care of a patient.)

C = Carrier-priced code. Carriers will

establish RVUs and payment amounts

for these services, generally on a caseby-case basis following review of

documentation, such as an operative

report.

D = Deleted code. These codes are

deleted effective with the beginning of

the calendar year.

E = Excluded from physician fee

schedule by regulation. These codes are

for items or services that we chose to

exclude from the physician fee schedule

payment by regulation. No RVUs are

shown, and no payment may be made

under the physician fee schedule for

these codes. Payment for them, if they

are covered, continues under reasonable

charge or other payment procedures.
59103

G = Code not valid for Medicare

purposes. Medicare does not recognize

codes assigned this status. Medicare

uses another code for reporting of, and

payment for, these services.

N = Noncovered service. These codes

are noncovered services. Medicare

payment may not be made for these

codes. If RVUs are shown, they are not

used for Medicare payment.

P = Bundled or excluded code. There

are no RVUs for these services. No

separate payment should be made for

them under the physician fee schedule.

— If the item or service is covered as

incident to a physician service and is

furnished on the same day as a

physician service, payment for it is

bundled into the payment for the

physician service to which it is

incident (an example is an elastic

bandage furnished by a physician

incident to a physician service).

— If the item or service is covered as

other than incident to a physician

service, it is excluded from the

physician fee schedule (for example,

colostomy supplies) and is paid under

the other payment provisions of the

Act.

R = Restricted coverage. Special

coverage instructions apply. If the

service is covered and no RVUs are

shown, it is carrier-priced.

T = Injections. There are RVUs for

these services, but they are only paid if

there are no other services payable

under the physician fee schedule billed

on the same date by the same provider.

If any other services payable under the

physician fee schedule are billed on the

same date by the same provider, these

services are bundled into the service(s)

for which payment is made.

X = Exclusion by law. These codes

represent an item or service that is not

within the definition of ‘‘physician

services’’ for physician fee schedule

payment purposes. No RVUs are shown

for these codes, and no payment may be

made under the physician fee schedule.

(Examples are ambulance services and

clinical diagnostic laboratory services.)

4. Description of code. This is an

abbreviated version of the narrative

description of the code.

5. Physician work RVUs. These are the

RVUs for the physician work for this

service in 1998. Codes that are not used

for Medicare payment are identified

with a ‘‘+.’’

6. Practice expense RVUs. These are

the RVUs for the practice expense for

the service for 1998.

7. Malpractice expense RVUs. These

are the RVUs for the malpractice

expense for the service for 1998.

8. Total RVUs. This is the sum of the

work, practice expense, and malpractice

expense RVUs for 1998.

9. Global period. This indicator shows

the number of days in the global period

for the code (0, 10, or 90 days). An

explanation of the alpha codes follows:

MMM = The code describes a service

furnished in uncomplicated maternity

cases including antepartum care,

delivery, and postpartum care. The

usual global surgical concept does not

apply. See the 1998 Physicians’ Current

Procedural Terminology for specific

definitions.

XXX = The global concept does not

apply.

YYY = The global period is to be set

by the carrier (for example, unlisted

surgery codes).

ZZZ = The code is part of another

service and falls within the global

period for the other service.

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

10040 ............ A Acne surgery of skin abscess ............................ *1.18 0.32 0.32 0.03 1.53 1.53 010

10060 ............ A Drainage of skin abscess ................................... *1.17 0.44 0.44 0.04 1.65 1.65 010

10061 ............ A Drainage of skin abscess ................................... *2.40 0.64 0.64 0.06 3.10 3.10 010

10080 ............ A Drainage of pilonidal cyst ................................... *1.17 0.50 0.50 0.05 1.72 1.72 010

10081 ............ A Drainage of pilonidal cyst ................................... *2.45 1.11 1.11 0.16 3.72 3.72 010

10120 ............ A Remove foreign body ......................................... *1.22 0.46 0.46 0.05 1.73 1.73 010

10121 ............ A Remove foreign body ......................................... *2.69 1.00 1.00 0.12 3.81 3.81 010

10140 ............ A Drainage of hematoma/fluid ............................... *1.53 0.48 0.48 0.05 2.06 2.06 010

10160 ............ A Puncture drainage of lesion ............................... *1.20 0.38 0.38 0.05 1.63 1.63 010

10180 ............ A Complex drainage, wound ................................. *2.25 1.05 1.05 0.18 3.48 3.48 010

11000 ............ A Debride infected skin ......................................... 0.60 0.40 0.40 0.04 1.04 1.04 000

11001 ............ A Debride infect skin add ...................................... 0.30 0.26 0.26 0.02 0.58 0.58 ZZZ

11010 ............ A Debride skin, fx .................................................. *4.20 3.96 3.96 0.65 8.81 8.81 010

11011 ............ A Debride skin/muscle, fx ...................................... 4.95 4.72 4.72 0.77 10.44 10.44 000

11012 ............ A Debride skin/muscle/bone, fx ............................. 6.88 6.56 6.56 1.07 14.51 14.51 000

11040 ............ A Debride skin partial ............................................ 0.50 0.40 0.40 0.04 0.94 0.94 000

11041 ............ A Debride skin full ................................................. 0.82 0.56 0.56 0.06 1.44 1.44 000

11042 ............ A Debride skin/tissue ............................................. 1.12 0.65 0.65 0.08 1.85 1.85 000

11043 ............ A Debride tissue/muscle ........................................ *2.38 1.81 1.81 0.34 4.53 4.53 010

11044 ............ A Debride tissue/muscle/bone ............................... *3.06 2.82 2.82 0.49 6.37 6.37 010

11050 ............ D Trim skin lesion .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 000

11051 ............ D Trim 2 to 4 skin lesions ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 000

11052 ............ D Trim over 4 skin lesions ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 000

11055 ............ R Trim skin lesion .................................................. 0.27 0.19 0.19 0.01 0.47 0.47 000

11056 ............ R Trim 2 to 4 skin lesions ...................................... 0.39 0.26 0.26 0.02 0.67 0.67 000

11057 ............ R Trim over 4 skin lesions ..................................... 0.50 0.21 0.21 0.02 0.73 0.73 000

11100 ............ A Biopsy of skin lesion .......................................... 0.81 0.51 0.51 0.04 1.36 1.36 000

11101 ............ A Biopsy, each added lesion ................................. 0.41 0.29 0.29 0.02 0.72 0.72 ZZZ

11200 ............ A Removal of skin tags ......................................... *0.77 0.43 0.43 0.04 1.24 1.24 010

11201 ............ A Removal of added skin tags .............................. 0.29 0.17 0.17 0.02 0.48 0.48 ZZZ

11300 ............ A Shave skin lesion ............................................... 0.51 0.53 0.53 0.05 1.09 1.09 000

11301 ............ A Shave skin lesion ............................................... 0.85 0.67 0.67 0.06 1.58 1.58 000

11302 ............ A Shave skin lesion ............................................... 1.05 0.89 0.89 0.09 2.03 2.03 000

11303 ............ A Shave skin lesion ............................................... 1.24 1.36 1.36 0.17 2.77 2.77 000

11305 ............ A Shave skin lesion ............................................... 0.67 0.52 0.52 0.05 1.24 1.24 000
59104

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

11306 ............ A Shave skin lesion ............................................... 0.99 0.71 0.71 0.07 1.77 1.77 000

11307 ............ A Shave skin lesion ............................................... 1.14 0.94 0.94 0.10 2.18 2.18 000

11308 ............ A Shave skin lesion ............................................... 1.41 1.40 1.40 0.17 2.98 2.98 000

11310 ............ A Shave skin lesion ............................................... 0.73 0.69 0.69 0.06 1.48 1.48 000

11311 ............ A Shave skin lesion ............................................... 1.05 0.85 0.85 0.08 1.98 1.98 000

11312 ............ A Shave skin lesion ............................................... 1.20 1.12 1.12 0.11 2.43 2.43 000

11313 ............ A Shave skin lesion ............................................... 1.62 1.49 1.49 0.15 3.26 3.26 000

11400 ............ A Removal of skin lesion ....................................... *0.91 0.53 0.53 0.05 1.49 1.49 010

11401 ............ A Removal of skin lesion ....................................... *1.32 0.67 0.67 0.06 2.05 2.05 010

11402 ............ A Removal of skin lesion ....................................... *1.61 0.89 0.89 0.09 2.59 2.59 010

11403 ............ A Removal of skin lesion ....................................... *1.92 1.17 1.17 0.13 3.22 3.22 010

11404 ............ A Removal of skin lesion ....................................... *2.20 1.38 1.38 0.17 3.75 3.75 010

11406 ............ A Removal of skin lesion ....................................... *2.76 1.88 1.88 0.33 4.97 4.97 010

11420 ............ A Removal of skin lesion ....................................... *1.06 0.52 0.52 0.05 1.63 1.63 010

11421 ............ A Removal of skin lesion ....................................... *1.53 0.71 0.71 0.07 2.31 2.31 010

11422 ............ A Removal of skin lesion ....................................... *1.76 0.94 0.94 0.10 2.80 2.80 010

11423 ............ A Removal of skin lesion ....................................... *2.17 1.31 1.31 0.15 3.63 3.63 010

11424 ............ A Removal of skin lesion ....................................... *2.62 1.39 1.39 0.16 4.17 4.17 010

11426 ............ A Removal of skin lesion ....................................... *3.78 1.83 1.83 0.29 5.90 5.90 010

11440 ............ A Removal of skin lesion ....................................... *1.15 0.69 0.69 0.06 1.90 1.90 010

11441 ............ A Removal of skin lesion ....................................... *1.61 0.85 0.85 0.08 2.54 2.54 010

11442 ............ A Removal of skin lesion ....................................... *1.87 1.12 1.12 0.11 3.10 3.10 010

11443 ............ A Removal of skin lesion ....................................... *2.49 1.45 1.45 0.15 4.09 4.09 010

11444 ............ A Removal of skin lesion ....................................... *3.42 1.47 1.47 0.14 5.03 5.03 010

11446 ............ A Removal of skin lesion ....................................... *4.49 1.78 1.78 0.18 6.45 6.45 010

11450 ............ A Removal, sweat gland lesion ............................. *2.73 2.68 2.68 0.44 5.85 5.85 090

11451 ............ A Removal, sweat gland lesion ............................. *3.95 2.90 2.90 0.46 7.31 7.31 090

11462 ............ A Removal, sweat gland lesion ............................. *2.51 2.41 2.41 0.36 5.28 5.28 090

11463 ............ A Removal, sweat gland lesion ............................. *3.95 2.00 2.00 0.34 6.29 6.29 090

11470 ............ A Removal, sweat gland lesion ............................. *3.25 2.78 2.78 0.45 6.48 6.48 090

11471 ............ A Removal, sweat gland lesion ............................. *4.41 2.46 2.46 0.48 7.35 7.35 090

11600 ............ A Removal of skin lesion ....................................... *1.41 1.13 1.13 0.10 2.64 2.64 010

11601 ............ A Removal of skin lesion ....................................... *1.93 1.39 1.39 0.12 3.44 3.44 010

11602 ............ A Removal of skin lesion ....................................... *2.09 1.82 1.82 0.16 4.07 4.07 010

11603 ............ A Removal of skin lesion ....................................... *2.35 2.25 2.25 0.21 4.81 4.81 010

11604 ............ A Removal of skin lesion ....................................... *2.58 2.59 2.59 0.26 5.43 5.43 010

11606 ............ A Removal of skin lesion ....................................... *3.43 3.11 3.11 0.49 7.03 7.03 010

11620 ............ A Removal of skin lesion ....................................... *1.34 1.34 1.34 0.12 2.80 2.80 010

11621 ............ A Removal of skin lesion ....................................... *1.97 1.75 1.75 0.16 3.88 3.88 010

11622 ............ A Removal of skin lesion ....................................... *2.34 2.20 2.20 0.19 4.73 4.73 010

11623 ............ A Removal of skin lesion ....................................... *2.93 2.58 2.58 0.25 5.76 5.76 010

11624 ............ A Removal of skin lesion ....................................... *3.43 3.21 3.21 0.32 6.96 6.96 010

11626 ............ A Removal of skin lesion ....................................... *4.30 3.41 3.41 0.51 8.22 8.22 010

11640 ............ A Removal of skin lesion ....................................... *1.53 1.65 1.65 0.15 3.33 3.33 010

11641 ............ A Removal of skin lesion ....................................... *2.44 2.09 2.09 0.18 4.71 4.71 010

11642 ............ A Removal of skin lesion ....................................... *2.93 2.57 2.57 0.23 5.73 5.73 010

11643 ............ A Removal of skin lesion ....................................... *3.50 3.01 3.01 0.28 6.79 6.79 010

11644 ............ A Removal of skin lesion ....................................... *4.55 3.51 3.51 0.33 8.39 8.39 010

11646 ............ A Removal of skin lesion ....................................... *5.95 4.32 4.32 0.60 10.87 10.87 010

11719 ............ R Trim nail(s) ......................................................... 0.06 0.18 #0.07 0.01 0.25 0.14 000

11720 ............ A Debride nail, 1–5 ................................................ 0.32 0.32 0.32 0.03 0.67 0.67 000

11721 ............ A Debride nail, 6 or more ...................................... 0.54 0.54 0.54 0.05 1.13 1.13 000

11730 ............ A Removal of nail plate ......................................... 1.13 0.45 0.45 0.04 1.62 1.62 000

11731 ............ A Removal of second nail plate ............................ 0.57 0.51 0.51 0.05 1.13 1.13 ZZZ

11732 ............ A Remove additional nail plate .............................. 0.57 0.25 0.25 0.02 0.84 0.84 ZZZ

11740 ............ A Drain blood from under nail ............................... 0.37 0.39 0.39 0.04 0.80 0.80 000

11750 ............ A Removal of nail bed ........................................... *1.86 2.10 2.10 0.19 4.15 4.15 010

11752 ............ A Remove nail bed/finger tip ................................. *2.67 2.82 2.82 0.36 5.85 5.85 010

11755 ............ A Biopsy, nail unit .................................................. 1.31 0.99 0.99 0.12 2.42 2.42 000

11760 ............ A Reconstruction of nail bed ................................. *1.58 0.93 0.93 0.09 2.60 2.60 010

11762 ............ A Reconstruction of nail bed ................................. *2.89 2.57 2.57 0.24 5.70 5.70 010

11765 ............ A Excision of nail fold, toe ..................................... *0.69 0.51 0.51 0.05 1.25 1.25 010

11770 ............ A Removal of pilonidal lesion ................................ *2.61 2.67 2.67 0.44 5.72 5.72 010

11771 ............ A Removal of pilonidal lesion ................................ *5.74 4.52 4.52 0.92 11.18 11.18 090

11772 ............ A Removal of pilonidal lesion ................................ *6.98 4.82 4.82 1.01 12.81 12.81 090

11900 ............ A Injection into skin lesions ................................... 0.52 0.25 0.25 0.02 0.79 0.79 000

11901 ............ A Added skin lesions injection ............................... 0.80 0.41 0.41 0.03 1.24 1.24 000

11920 ............ R Correct skin color defects .................................. 1.61 1.18 1.18 0.23 3.02 3.02 000

11921 ............ R Correct skin color defects .................................. 1.93 1.40 1.40 0.28 3.61 3.61 000

11922 ............ R Correct skin color defects .................................. 0.49 0.36 0.36 0.07 0.92 0.92 ZZZ

11950 ............ R Therapy for contour defects ............................... 0.84 1.19 1.19 0.11 2.14 2.14 000

11951 ............ R Therapy for contour defects ............................... 1.19 1.19 1.19 0.11 2.49 2.49 000

11952 ............ R Therapy for contour defects ............................... 1.69 1.19 1.19 0.11 2.99 2.99 000

11954 ............ R Therapy for contour defects ............................... 1.85 1.19 1.19 0.11 3.15 3.15 000
59105

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

11960 ............ A Insert tissue expander(s) ................................... *9.08 7.73 7.73 1.48 18.29 18.29 090

11970 ............ A Replace tissue expander ................................... *7.06 #7.77 #7.77 1.61 16.44 16.44 090

11971 ............ A Remove tissue expander(s) ............................... *2.13 2.30 2.30 0.82 5.25 5.25 090

11975 ............ N Insert contraceptive cap ..................................... +1.48 1.06 1.06 0.25 2.79 2.79 XXX

11976 ............ R Removal of contraceptive cap ........................... 1.78 1.28 1.28 0.30 3.36 3.36 XXX

11977 ............ N Removal/reinsert contra cap .............................. +3.30 2.36 2.36 0.55 6.21 6.21 XXX

12001 ............ A Repair superficial wound(s) ............................... *1.70 0.57 0.57 0.05 2.32 2.32 010

12002 ............ A Repair superficial wound(s) ............................... *1.86 0.79 0.79 0.07 2.72 2.72 010

12004 ............ A Repair superficial wound(s) ............................... *2.24 1.14 1.14 0.10 3.48 3.48 010

12005 ............ A Repair superficial wound(s) ............................... *2.86 1.47 1.47 0.14 4.47 4.47 010

12006 ............ A Repair superficial wound(s) ............................... *3.67 1.78 1.78 0.19 5.64 5.64 010

12007 ............ A Repair superficial wound(s) ............................... *4.12 1.80 1.80 0.19 6.11 6.11 010

12011 ............ A Repair superficial wound(s) ............................... *1.76 0.74 0.74 0.06 2.56 2.56 010

12013 ............ A Repair superficial wound(s) ............................... *1.99 1.03 1.03 0.08 3.10 3.10 010

12014 ............ A Repair superficial wound(s) ............................... *2.46 1.19 1.19 0.10 3.75 3.75 010

12015 ............ A Repair superficial wound(s) ............................... *3.19 1.62 1.62 0.14 4.95 4.95 010

12016 ............ A Repair superficial wound(s) ............................... *3.93 2.26 2.26 0.19 6.38 6.38 010

12017 ............ A Repair superficial wound(s) ............................... *4.71 3.36 3.36 0.31 8.38 8.38 010

12018 ............ A Repair superficial wound(s) ............................... *5.53 5.15 5.15 0.48 11.16 11.16 010

12020 ............ A Closure of split wound ....................................... *2.62 1.19 1.19 0.18 3.99 3.99 010

12021 ............ A Closure of split wound ....................................... *1.84 0.62 0.62 0.11 2.57 2.57 010

12031 ............ A Layer closure of wound(s) ................................. *2.15 0.72 0.72 0.07 2.94 2.94 010

12032 ............ A Layer closure of wound(s) ................................. *2.47 1.05 1.05 0.10 3.62 3.62 010

12034 ............ A Layer closure of wound(s) ................................. *2.92 1.47 1.47 0.15 4.54 4.54 010

12035 ............ A Layer closure of wound(s) ................................. *3.43 1.92 1.92 0.23 5.58 5.58 010

12036 ............ A Layer closure of wound(s) ................................. *4.05 2.32 2.32 0.37 6.74 6.74 010

12037 ............ A Layer closure of wound(s) ................................. *4.67 3.09 3.09 0.48 8.24 8.24 010

12041 ............ A Layer closure of wound(s) ................................. *2.37 0.84 0.84 0.08 3.29 3.29 010

12042 ............ A Layer closure of wound(s) ................................. *2.74 1.17 1.17 0.12 4.03 4.03 010

12044 ............ A Layer closure of wound(s) ................................. *3.14 1.62 1.62 0.17 4.93 4.93 010

12045 ............ A Layer closure of wound(s) ................................. *3.64 2.13 2.13 0.23 6.00 6.00 010

12046 ............ A Layer closure of wound(s) ................................. *4.25 2.82 2.82 0.37 7.44 7.44 010

12047 ............ A Layer closure of wound(s) ................................. *4.65 4.02 4.02 0.56 9.23 9.23 010

12051 ............ A Layer closure of wound(s) ................................. *2.47 1.01 1.01 0.10 3.58 3.58 010

12052 ............ A Layer closure of wound(s) ................................. *2.77 1.47 1.47 0.14 4.38 4.38 010

12053 ............ A Layer closure of wound(s) ................................. *3.12 1.76 1.76 0.17 5.05 5.05 010

12054 ............ A Layer closure of wound(s) ................................. *3.46 2.60 2.60 0.25 6.31 6.31 010

12055 ............ A Layer closure of wound(s) ................................. *4.43 3.24 3.24 0.37 8.04 8.04 010

12056 ............ A Layer closure of wound(s) ................................. *5.24 4.74 4.74 0.52 10.50 10.50 010

12057 ............ A Layer closure of wound(s) ................................. *5.96 5.57 5.57 0.48 12.01 12.01 010

13100 ............ A Repair of wound or lesion .................................. *3.12 1.14 1.14 0.13 4.39 4.39 010

13101 ............ A Repair of wound or lesion .................................. *3.92 2.08 2.08 0.21 6.21 6.21 010

13120 ............ A Repair of wound or lesion .................................. *3.30 1.35 1.35 0.17 4.82 4.82 010

13121 ............ A Repair of wound or lesion .................................. *4.33 2.65 2.65 0.33 7.31 7.31 010

13131 ............ A Repair of wound or lesion .................................. *3.79 1.98 1.98 0.23 6.00 6.00 010

13132 ............ A Repair of wound or lesion .................................. *5.95 4.57 4.57 0.44 10.96 10.96 010

13150 ............ A Repair of wound or lesion .................................. *3.81 1.76 1.76 0.23 5.80 5.80 010

13151 ............ A Repair of wound or lesion .................................. *4.45 2.45 2.45 0.35 7.25 7.25 010

13152 ............ A Repair of wound or lesion .................................. *6.33 5.13 5.13 0.68 12.14 12.14 010

13160 ............ A Late closure of wound ........................................ *10.48 3.33 3.33 0.58 14.39 14.39 090

13300 ............ A Repair of wound or lesion .................................. *5.27 5.71 5.71 0.86 11.84 11.84 010

14000 ............ A Skin tissue rearrangement ................................. *5.89 3.41 3.41 0.38 9.68 9.68 090

14001 ............ A Skin tissue rearrangement ................................. *8.47 4.75 4.75 0.76 13.98 13.98 090

14020 ............ A Skin tissue rearrangement ................................. *6.59 4.90 4.90 0.49 11.98 11.98 090

14021 ............ A Skin tissue rearrangement ................................. *10.06 6.21 6.21 0.94 17.21 17.21 090

14040 ............ A Skin tissue rearrangement ................................. *7.87 6.77 6.77 0.65 15.29 15.29 090

14041 ............ A Skin tissue rearrangement ................................. *11.49 7.88 7.88 1.02 20.39 20.39 090

14060 ............ A Skin tissue rearrangement ................................. *8.50 7.75 7.75 1.04 17.29 17.29 090

14061 ............ A Skin tissue rearrangement ................................. *12.29 10.49 10.49 1.27 24.05 24.05 090

14300 ............ A Skin tissue rearrangement ................................. *11.76 11.31 11.31 1.84 24.91 24.91 090

14350 ............ A Skin tissue rearrangement ................................. *9.61 6.07 6.07 1.05 16.73 16.73 090

15000 ............ A Skin graft procedure ........................................... 1.95 #2.15 #2.15 0.53 4.63 4.63 ZZZ

15050 ............ A Skin pinch graft procedure ................................. *4.30 1.79 1.79 0.30 6.39 6.39 090

15100 ............ A Skin split graft procedure ................................... *9.05 4.54 4.54 0.89 14.48 14.48 090

15101 ............ A Skin split graft procedure ................................... 1.72 1.59 1.59 0.33 3.64 3.64 ZZZ

15120 ............ A Skin split graft procedure ................................... *9.83 6.05 6.05 0.94 16.82 16.82 090

15121 ............ A Skin split graft procedure ................................... 2.67 2.91 2.91 0.53 6.11 6.11 ZZZ

15200 ............ A Skin full graft procedure ..................................... *8.03 4.13 4.13 0.69 12.85 12.85 090

15201 ............ A Skin full graft procedure ..................................... 1.32 1.68 #1.45 0.50 3.50 3.27 ZZZ

15220 ............ A Skin full graft procedure ..................................... *7.87 4.84 4.84 0.85 13.56 13.56 090

15221 ............ A Skin full graft procedure ..................................... 1.19 1.59 #1.31 0.50 3.28 3.00 ZZZ

15240 ............ A Skin full graft procedure ..................................... *9.04 6.10 6.10 1.03 16.17 16.17 090

15241 ............ A Skin full graft procedure ..................................... 1.86 2.38 #2.05 0.58 4.82 4.49 ZZZ

15260 ............ A Skin full graft procedure ..................................... *10.06 7.46 7.46 0.99 18.51 18.51 090
59106

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

15261 ............ A Skin full graft procedure ..................................... 2.23 2.85 #2.45 0.60 5.68 5.28 ZZZ

15350 ............ A Skin homograft procedure .................................. *4.36 2.15 2.15 0.42 6.93 6.93 090

15400 ............ A Skin heterograft procedure ................................ *5.78 1.06 1.06 0.17 7.01 7.01 090

15570 ............ A Form skin pedicle flap ........................................ *9.21 5.50 5.50 2.08 16.79 16.79 090

15572 ............ A Form skin pedicle flap ........................................ *9.27 5.38 5.38 1.86 16.51 16.51 090

15574 ............ A Form skin pedicle flap ........................................ *9.88 5.40 5.40 1.66 16.94 16.94 090

15576 ............ A Form skin pedicle flap ........................................ *8.69 3.12 3.12 0.60 12.41 12.41 090

15580 ............ A Attach skin pedicle graft ..................................... *9.46 4.31 4.31 1.30 15.07 15.07 090

15600 ............ A Skin graft procedure ........................................... *1.91 2.51 #2.10 0.88 5.30 4.89 090

15610 ............ A Skin graft procedure ........................................... *2.42 2.82 #2.66 0.80 6.04 5.88 090

15620 ............ A Skin graft procedure ........................................... *2.94 3.44 #3.23 0.86 7.24 7.03 090

15625 ............ A Skin graft procedure ........................................... *1.91 #2.10 #2.10 0.78 4.79 4.79 090

15630 ............ A Skin graft procedure ........................................... *3.27 #3.60 #3.60 0.90 7.77 7.77 090

15650 ............ A Transfer skin pedicle flap ................................... *3.97 #4.37 #4.37 0.93 9.27 9.27 090

15732 ............ A Muscle-skin graft, head/neck ............................. *17.84 15.48 15.48 3.46 36.78 36.78 090

15734 ............ A Muscle-skin graft, trunk ...................................... *17.79 19.01 19.01 3.24 40.04 40.04 090

15736 ............ A Muscle-skin graft, arm ........................................ *16.27 16.21 16.21 3.02 35.50 35.50 090

15738 ............ A Muscle-skin graft, leg ......................................... *17.92 12.89 12.89 3.29 34.10 34.10 090

15740 ............ A Island pedicle flap graft ...................................... *10.25 10.39 10.39 1.62 22.26 22.26 090

15750 ............ A Neurovascular pedicle graft ............................... *11.41 11.96 11.96 2.03 25.40 25.40 090

15756 ............ A Free muscle flap, microvasc .............................. *35.23 30.09 30.09 5.33 70.65 70.65 090

15757 ............ A Free skin flap, microvasc ................................... *35.23 30.09 30.09 5.33 70.65 70.65 090

15758 ............ A Free fascial flap, microvasc ............................... *35.10 30.09 30.09 5.33 70.52 70.52 090

15760 ............ A Composite skin graft .......................................... *8.74 7.29 7.29 1.11 17.14 17.14 090

15770 ............ A Derma-fat-fascia graft ........................................ *7.52 7.46 7.46 0.95 15.93 15.93 090

15775 ............ R Hair transplant punch grafts ............................... 3.96 2.88 2.88 0.56 7.40 7.40 000

15776 ............ R Hair transplant punch grafts ............................... 5.54 4.03 4.03 0.79 10.36 10.36 000

15780 ............ A Abrasion treatment of skin ................................. *7.29 1.53 1.53 0.13 8.95 8.95 090

15781 ............ A Abrasion treatment of skin ................................. *4.85 3.77 3.77 0.39 9.01 9.01 090

15782 ............ A Abrasion treatment of skin ................................. *4.32 1.19 1.19 0.13 5.64 5.64 090

15783 ............ A Abrasion treatment of skin ................................. *4.29 1.85 1.85 0.19 6.33 6.33 090

15786 ............ A Abrasion treatment of lesion .............................. *2.03 0.62 0.62 0.06 2.71 2.71 010

15787 ............ A Abrasion, added skin lesions ............................. 0.33 0.23 0.23 0.03 0.59 0.59 ZZZ

15788 ............ R Chemical peel, face, epiderm ............................ *2.09 1.48 1.48 0.12 3.69 3.69 090

15789 ............ R Chemical peel, face, dermal .............................. *4.92 1.48 1.48 0.12 6.52 6.52 090

15792 ............ R Chemical peel, nonfacial .................................... *1.86 0.50 0.50 0.05 2.41 2.41 090

15793 ............ A Chemical peel, nonfacial .................................... *3.74 0.50 0.50 0.05 4.29 4.29 090

15810 ............ A Salabrasion ........................................................ *4.74 3.80 3.80 0.29 8.83 8.83 090

15811 ............ A Salabrasion ........................................................ *5.39 3.74 3.74 0.73 9.86 9.86 090

15819 ............ A Plastic surgery, neck .......................................... *9.38 8.01 8.01 0.87 18.26 18.26 090

15820 ............ A Revision of lower eyelid ..................................... *5.15 #5.67 #5.67 0.64 11.46 11.46 090

15821 ............ A Revision of lower eyelid ..................................... *5.72 #6.29 #6.29 0.68 12.69 12.69 090

15822 ............ A Revision of upper eyelid .................................... *4.45 #4.90 #4.90 0.56 9.91 9.91 090

15823 ............ A Revision of upper eyelid .................................... *7.05 7.71 7.71 0.61 15.37 15.37 090

15824 ............ R Removal of forehead wrinkles ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

15825 ............ R Removal of neck wrinkles .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

15826 ............ R Removal of brow wrinkles .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

15828 ............ R Removal of face wrinkles ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

15829 ............ R Removal of skin wrinkles ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

15831 ............ A Excise excessive skin tissue .............................. *12.40 9.84 9.84 2.01 24.25 24.25 090

15832 ............ A Excise excessive skin tissue .............................. *11.59 8.29 8.29 1.33 21.21 21.21 090

15833 ............ A Excise excessive skin tissue .............................. *10.64 6.22 6.22 1.12 17.98 17.98 090

15834 ............ A Excise excessive skin tissue .............................. *10.85 7.18 7.18 1.22 19.25 19.25 090

15835 ............ A Excise excessive skin tissue .............................. *11.67 7.00 7.00 1.22 19.89 19.89 090

15836 ............ A Excise excessive skin tissue .............................. *9.34 5.80 5.80 1.10 16.24 16.24 090

15837 ............ A Excise excessive skin tissue .............................. *8.43 5.97 5.97 0.85 15.25 15.25 090

15838 ............ A Excise excessive skin tissue .............................. *7.13 5.88 5.88 0.73 13.74 13.74 090

15839 ............ A Excise excessive skin tissue .............................. *9.38 2.44 2.44 0.46 12.28 12.28 090

15840 ............ A Graft for face nerve palsy .................................. *13.26 #14.59 #14.59 2.28 30.13 30.13 090

15841 ............ A Graft for face nerve palsy .................................. *23.26 16.87 16.87 2.76 42.89 42.89 090

15842 ............ A Graft for face nerve palsy .................................. *37.96 29.00 29.00 2.68 69.64 69.64 090

15845 ............ A Skin and muscle repair, face ............................. *12.57 #13.83 #13.83 2.54 28.94 28.94 090

15850 ............ B Removal of sutures ............................................ +0.78 0.36 0.36 0.04 1.18 1.18 XXX

15851 ............ A Removal of sutures ............................................ 0.86 0.30 0.30 0.03 1.19 1.19 000

15852 ............ A Dressing change, not for burn ........................... 0.86 0.44 0.44 0.07 1.37 1.37 000

15860 ............ A Test for blood flow in graft ................................. 1.95 1.35 1.35 0.25 3.55 3.55 000

15876 ............ R Suction assisted lipectomy ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

15877 ............ R Suction assisted lipectomy ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

15878 ............ R Suction assisted lipectomy ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

15879 ............ R Suction assisted lipectomy ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

15920 ............ A Removal of tail bone ulcer ................................. *7.95 2.95 2.95 0.63 11.53 11.53 090

15922 ............ A Removal of tail bone ulcer ................................. *9.90 5.98 5.98 1.19 17.07 17.07 090

15931 ............ A Remove sacrum pressure sore .......................... *9.24 2.93 2.93 0.55 12.72 12.72 090

15933 ............ A Remove sacrum pressure sore .......................... *10.85 6.92 6.92 1.43 19.20 19.20 090
59107

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

15934 ............ A Remove sacrum pressure sore .......................... *12.69 7.46 7.46 1.50 21.65 21.65 090

15935 ............ A Remove sacrum pressure sore .......................... *14.57 11.24 11.24 2.27 28.08 28.08 090

15936 ............ A Remove sacrum pressure sore .......................... *12.38 10.27 10.27 2.05 24.70 24.70 090

15937 ............ A Remove sacrum pressure sore .......................... *14.21 13.47 13.47 2.67 30.35 30.35 090

15940 ............ A Removal of pressure sore .................................. *9.34 3.55 3.55 0.73 13.62 13.62 090

15941 ............ A Removal of pressure sore .................................. *11.43 7.05 7.05 1.39 19.87 19.87 090

15944 ............ A Removal of pressure sore .................................. *11.46 9.26 9.26 1.82 22.54 22.54 090

15945 ............ A Removal of pressure sore .................................. *12.69 11.14 11.14 2.09 25.92 25.92 090

15946 ............ A Removal of pressure sore .................................. *21.57 16.61 16.61 3.24 41.42 41.42 090

15950 ............ A Remove thigh pressure sore .............................. *7.54 3.01 3.01 0.58 11.13 11.13 090

15951 ............ A Remove thigh pressure sore .............................. *10.72 7.65 7.65 1.58 19.95 19.95 090

15952 ............ A Remove thigh pressure sore .............................. *11.39 7.13 7.13 1.37 19.89 19.89 090

15953 ............ A Remove thigh pressure sore .............................. *12.63 9.08 9.08 1.87 23.58 23.58 090

15956 ............ A Remove thigh pressure sore .............................. *15.52 #17.07 #17.07 3.39 35.98 35.98 090

15958 ............ A Remove thigh pressure sore .............................. *15.48 #17.03 #17.03 3.76 36.27 36.27 090

15999 ............ C Removal of pressure sore .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

16000 ............ A Initial treatment of burn(s) .................................. 0.89 0.35 0.35 0.03 1.27 1.27 000

16010 ............ A Treatment of burn(s) .......................................... 0.87 0.32 0.32 0.03 1.22 1.22 000

16015 ............ A Treatment of burn(s) .......................................... 2.35 2.04 2.04 0.38 4.77 4.77 000

16020 ............ A Treatment of burn(s) .......................................... 0.80 0.34 0.34 0.03 1.17 1.17 000

16025 ............ A Treatment of burn(s) .......................................... 1.85 0.45 0.45 0.05 2.35 2.35 000

16030 ............ A Treatment of burn(s) .......................................... 2.08 0.52 0.52 0.08 2.68 2.68 000

16035 ............ A Incision of burn scab .......................................... *4.82 1.88 1.88 0.34 7.04 7.04 090

16040 ............ A Burn wound excision .......................................... 1.02 1.56 #1.12 0.53 3.11 2.67 000

16041 ............ A Burn wound excision .......................................... 2.70 #2.97 #2.97 0.53 6.20 6.20 000

16042 ............ A Burn wound excision .......................................... 2.35 #2.59 #2.59 0.53 5.47 5.47 000

17000 ............ A Destroy benign/premal lesion ............................ *0.60 0.42 0.42 0.03 1.05 1.05 010

17001 ............ D Destruction of added lesions ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ

17002 ............ D Destruction of added lesions ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ

17003 ............ A Destroy 2–14 lesions ......................................... 0.15 0.13 0.13 0.01 0.29 0.29 ZZZ

17004 ............ A Destroy 15 & more lesions ................................ *2.79 2.25 2.25 0.20 5.24 5.24 010

17010 ............ D 12 Destruction skin lesion(s) .............................. *0.00 0.00 0.00 0.00 0.00 0.00 010

17100 ............ D 12 Destruction of skin lesion .............................. *0.00 0.00 0.00 0.00 0.00 0.00 010

17101 ............ D Destruction of 2nd lesion ................................... 0.00 #0.00 #0.00 0.00 0.00 0.00 ZZZ

17102 ............ D Destruction of added lesions ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ

17104 ............ D Destruction of skin lesions ................................. *0.00 0.00 0.00 0.00 0.00 0.00 010

17105 ............ D Destruction of skin lesions ................................. *0.00 0.00 0.00 0.00 0.00 0.00 010

17106 ............ A Destruction of skin lesions ................................. *4.59 1.93 1.93 0.18 6.70 6.70 090

17107 ............ A Destruction of skin lesions ................................. *9.16 3.70 3.70 0.39 13.25 13.25 090

17108 ............ A Destruction of skin lesions ................................. *13.20 9.32 9.32 0.69 23.21 23.21 090

17110 ............ A Destruct lesion, 1–14 ......................................... *0.65 0.40 0.40 0.03 1.08 1.08 010

17111 ............ A Destruct lesion, 15 or more ............................... *0.92 0.60 0.60 0.05 1.57 1.57 010

17200 ............ D 1 Electrocautery of skin tags ............................. *0.00 0.00 0.00 0.00 0.00 0.00 010

17201 ............ D Electrocautery added lesions ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ

17250 ............ A Chemical cautery, tissue .................................... 0.50 0.34 0.34 0.04 0.88 0.88 000

17260 ............ A Destruction of skin lesions ................................. *0.91 1.13 1.13 0.10 2.14 2.14 010

17261 ............ A Destruction of skin lesions ................................. *1.17 1.39 1.39 0.12 2.68 2.68 010

17262 ............ A Destruction of skin lesions ................................. *1.58 1.82 1.82 0.16 3.56 3.56 010

17263 ............ A Destruction of skin lesions ................................. *1.79 2.25 2.25 0.21 4.25 4.25 010

17264 ............ A Destruction of skin lesions ................................. *1.94 2.59 2.59 0.26 4.79 4.79 010

17266 ............ A Destruction of skin lesions ................................. *2.34 3.11 3.11 0.49 5.94 5.94 010

17270 ............ A Destruction of skin lesions ................................. *1.32 1.34 1.34 0.12 2.78 2.78 010

17271 ............ A Destruction of skin lesions ................................. *1.49 1.75 1.75 0.16 3.40 3.40 010

17272 ............ A Destruction of skin lesions ................................. *1.77 2.20 2.20 0.19 4.16 4.16 010

17273 ............ A Destruction of skin lesions ................................. *2.05 2.58 2.58 0.25 4.88 4.88 010

17274 ............ A Destruction of skin lesions ................................. *2.59 3.21 3.21 0.32 6.12 6.12 010

17276 ............ A Destruction of skin lesions ................................. *3.20 3.41 3.41 0.51 7.12 7.12 010

17280 ............ A Destruction of skin lesions ................................. *1.17 1.65 1.65 0.15 2.97 2.97 010

17281 ............ A Destruction of skin lesions ................................. *1.72 2.09 2.09 0.18 3.99 3.99 010

17282 ............ A Destruction of skin lesions ................................. *2.04 2.57 2.57 0.23 4.84 4.84 010

17283 ............ A Destruction of skin lesions ................................. *2.64 3.01 3.01 0.28 5.93 5.93 010

17284 ............ A Destruction of skin lesions ................................. *3.21 3.51 3.51 0.33 7.05 7.05 010

17286 ............ A Destruction of skin lesions ................................. *4.44 4.32 4.32 0.60 9.36 9.36 010

17304 ............ A Chemosurgery of skin lesion ............................. 7.60 4.02 4.02 0.31 11.93 11.93 000

17305 ............ A 2nd stage chemosurgery ................................... 2.85 2.26 2.26 0.17 5.28 5.28 000

17306 ............ A 3rd stage chemosurgery .................................... 2.85 1.40 1.40 0.11 4.36 4.36 000

17307 ............ A Followup skin lesion therapy .............................. 2.85 1.47 1.47 0.12 4.44 4.44 000

17310 ............ A Extensive skin chemosurgery ............................ 0.95 0.13 0.13 0.01 1.09 1.09 000

17340 ............ A Cryotherapy of skin ............................................ *0.76 0.28 0.28 0.02 1.06 1.06 010

17360 ............ A Skin peel therapy ............................................... *1.43 0.27 0.27 0.02 1.72 1.72 010

17380 ............ R Hair removal by electrolysis ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

17999 ............ C Skin tissue procedure ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

19000 ............ A Drainage of breast lesion ................................... 0.84 0.38 0.38 0.07 1.29 1.29 000

19001 ............ A Drain added breast lesion .................................. 0.42 0.24 0.24 0.05 0.71 0.71 ZZZ
59108

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

19020 ............ A Incision of breast lesion ..................................... *3.57 1.40 1.40 0.28 5.25 5.25 090

19030 ............ A Injection for breast x-ray .................................... 1.53 0.49 0.49 0.04 2.06 2.06 000

19100 ............ A Biopsy of breast ................................................. 1.27 0.64 0.64 0.13 2.04 2.04 000

19101 ............ A Biopsy of breast ................................................. *3.18 2.34 2.34 0.45 5.97 5.97 010

19110 ............ A Nipple exploration .............................................. *4.30 2.46 2.46 0.51 7.27 7.27 090

19112 ............ A Excise breast duct fistula ................................... *3.67 2.34 2.34 0.35 6.36 6.36 090

19120 ............ A Removal of breast lesion ................................... *5.56 2.90 2.90 0.60 9.06 9.06 090

19125 ............ A Excision, breast lesion ....................................... *6.06 2.90 2.90 0.60 9.56 9.56 090

19126 ............ A Excision, added breast lesion ............................ 2.93 1.45 1.45 0.31 4.69 4.69 ZZZ

19140 ............ A Removal of breast tissue ................................... *5.14 4.29 4.29 0.91 10.34 10.34 090

19160 ............ A Removal of breast tissue ................................... *5.99 4.13 4.13 0.88 11.00 11.00 090

19162 ............ A Remove breast tissue, nodes ............................ *13.53 9.38 9.38 1.96 24.87 24.87 090

19180 ............ A Removal of breast .............................................. *8.80 5.61 5.61 1.17 15.58 15.58 090

19182 ............ A Removal of breast .............................................. *7.73 6.07 6.07 1.27 15.07 15.07 090

19200 ............ A Removal of breast .............................................. *15.49 10.22 10.22 2.15 27.86 27.86 090

19220 ............ A Removal of breast .............................................. *15.72 10.73 10.73 2.38 28.83 28.83 090

19240 ............ A Removal of breast .............................................. *16.00 9.44 9.44 1.99 27.43 27.43 090

19260 ............ A Removal of chest wall lesion ............................. *15.44 5.05 5.05 1.04 21.53 21.53 090

19271 ............ A Revision of chest wall ........................................ *18.90 13.95 13.95 2.77 35.62 35.62 090

19272 ............ A Extensive chest wall surgery ............................. *21.55 12.60 12.60 2.56 36.71 36.71 090

19290 ............ A Place needle wire, breast .................................. 1.27 0.44 0.44 0.07 1.78 1.78 000

19291 ............ A Place needle wire, breast .................................. 0.63 0.25 0.25 0.04 0.92 0.92 ZZZ

19316 ............ A Suspension of breast ......................................... *10.69 #11.76 #11.76 2.43 24.88 24.88 090

19318 ............ A Reduction of large breast ................................... *15.62 14.18 14.18 3.23 33.03 33.03 090

19324 ............ A Enlarge breast .................................................... *5.85 3.29 3.29 0.67 9.81 9.81 090

19325 ............ A Enlarge breast with implant ............................... *8.45 5.87 5.87 1.13 15.45 15.45 090

19328 ............ A Removal of breast implant ................................. *5.68 3.76 3.76 0.73 10.17 10.17 090

19330 ............ A Removal of implant material .............................. *7.59 3.88 3.88 0.75 12.22 12.22 090

19340 ............ A Immediate breast prosthesis .............................. 6.33 #6.96 #6.96 2.06 15.35 15.35 ZZZ

19342 ............ A Delayed breast prosthesis ................................. *11.20 10.81 10.81 2.03 24.04 24.04 090

19350 ............ A Breast reconstruction ......................................... *8.92 7.08 7.08 1.38 17.38 17.38 090

19355 ............ A Correct inverted nipple(s) ................................... *7.57 4.93 4.93 1.00 13.50 13.50 090

19357 ............ A Breast reconstruction ......................................... *18.16 12.15 12.15 2.37 32.68 32.68 090

19361 ............ A Breast reconstruction ......................................... *19.26 20.13 20.13 3.88 43.27 43.27 090

19364 ............ A Breast reconstruction ......................................... *29.04 16.68 16.68 3.58 49.30 49.30 090

19366 ............ A Breast reconstruction ......................................... *21.28 16.40 16.40 3.18 40.86 40.86 090

19367 ............ A Breast reconstruction ......................................... *25.73 20.13 20.13 3.88 49.74 49.74 090

19368 ............ A Breast reconstruction ......................................... *32.42 20.13 20.13 3.88 56.43 56.43 090

19369 ............ A Breast reconstruction ......................................... *29.82 20.13 20.13 3.88 53.83 53.83 090

19370 ............ A Surgery of breast capsule .................................. *8.05 6.17 6.17 1.19 15.41 15.41 090

19371 ............ A Removal of breast capsule ................................ *9.35 7.91 7.91 1.54 18.80 18.80 090

19380 ............ A Revise breast reconstruction ............................. *9.14 8.11 8.11 1.57 18.82 18.82 090

19396 ............ A Design custom breast implant ........................... 2.17 1.57 1.57 0.31 4.05 4.05 000

19499 ............ C Breast surgery procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

20000 ............ A Incision of abscess ............................................. *2.12 0.85 0.85 0.08 3.05 3.05 010

20005 ............ A Incision of deep abscess ................................... *3.42 1.83 1.83 0.28 5.53 5.53 010

20100 ............ A Explore wound, neck .......................................... *10.08 4.97 4.97 1.16 16.21 16.21 010

20101 ............ A Explore wound, chest ......................................... *3.22 1.57 1.57 0.37 5.16 5.16 010

20102 ............ A Explore wound, abdomen .................................. *3.94 1.92 1.92 0.45 6.31 6.31 010

20103 ............ A Explore wound, extremity ................................... *5.30 2.59 2.59 0.60 8.49 8.49 010

20150 ............ A Excise epiphyseal bar ........................................ *13.69 12.40 12.40 2.03 28.12 28.12 090

20200 ............ A Muscle biopsy .................................................... 1.46 1.12 1.12 0.18 2.76 2.76 000

20205 ............ A Deep muscle biopsy ........................................... 2.35 1.88 1.88 0.33 4.56 4.56 000

20206 ............ A Needle biopsy, muscle ....................................... 0.99 0.96 0.96 0.14 2.09 2.09 000

20220 ............ A Bone biopsy, trocar/needle ................................ 1.27 1.31 1.31 0.09 2.67 2.67 000

20225 ............ A Bone biopsy, trocar/needle ................................ 1.87 2.39 #2.06 0.28 4.54 4.21 000

20240 ............ A Bone biopsy, excisional ..................................... *3.23 1.88 1.88 0.18 5.29 5.29 010

20245 ............ A Bone biopsy, excisional ..................................... *3.95 3.58 3.58 0.44 7.97 7.97 010

20250 ............ A Open bone biopsy .............................................. *5.03 5.07 5.07 0.76 10.86 10.86 010

20251 ............ A Open bone biopsy .............................................. *5.56 5.84 5.84 0.92 12.32 12.32 010

20500 ............ A Injection of sinus tract ........................................ *1.23 0.36 0.36 0.04 1.63 1.63 010

20501 ............ A Inject sinus tract for x-ray .................................. 0.76 0.30 0.30 0.02 1.08 1.08 000

20520 ............ A Removal of foreign body .................................... *1.85 0.71 0.71 0.08 2.64 2.64 010

20525 ............ A Removal of foreign body .................................... *3.50 2.23 2.23 0.33 6.06 6.06 010

20550 ............ A Inj tendon/ligament/cyst ..................................... 0.86 0.38 0.38 0.04 1.28 1.28 000

20600 ............ A Drain/inject joint/bursa ........................................ 0.66 0.47 0.47 0.05 1.18 1.18 000

20605 ............ A Drain/inject joint/bursa ........................................ 0.68 0.45 0.45 0.05 1.18 1.18 000

20610 ............ A Drain/inject joint/bursa ........................................ 0.79 0.45 0.45 0.05 1.29 1.29 000

20615 ............ A Treatment of bone cyst ...................................... *2.28 0.49 0.49 0.06 2.83 2.83 010

20650 ............ A Insert and remove bone pin ............................... *2.23 1.08 1.08 0.14 3.45 3.45 010

20660 ............ A Apply, remove fixation device ............................ 2.51 1.56 1.56 0.21 4.28 4.28 000

20661 ............ A Application of head brace .................................. *4.89 3.82 3.82 0.65 9.36 9.36 090

20662 ............ A Application of pelvis brace ................................. *6.07 6.54 6.54 1.03 13.64 13.64 090

20663 ............ A Application of thigh brace .................................. *5.43 4.64 4.64 0.76 10.83 10.83 090
59109

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

20664 ............ A Halo brace application ....................................... *8.06 3.82 3.82 0.65 12.53 12.53 090

20665 ............ A Removal of fixation device ................................. *1.31 0.50 0.50 0.07 1.88 1.88 010

20670 ............ A Removal of support implant ............................... *1.74 0.74 0.74 0.11 2.59 2.59 010

20680 ............ A Removal of support implant ............................... *3.35 3.33 3.33 0.51 7.19 7.19 090

20690 ............ A Apply bone fixation device ................................. 3.52 3.66 3.66 0.58 7.76 7.76 ZZZ

20692 ............ A Apply bone fixation device ................................. 6.41 5.51 5.51 0.89 12.81 12.81 ZZZ

20693 ............ A Adjust bone fixation device ................................ *5.86 2.49 2.49 0.42 8.77 8.77 090

20694 ............ A Remove bone fixation device ............................. *4.16 2.60 2.60 0.41 7.17 7.17 090

20802 ............ A Replantation, arm, complete .............................. *41.15 37.72 37.72 6.17 85.04 85.04 090

20805 ............ A Replant forearm, complete ................................. *50.00 46.17 46.17 7.56 103.73 103.73 090

20808 ............ A Replantation, hand, complete ............................ *61.65 57.40 57.40 9.40 128.45 128.45 090

20816 ............ A Replantation digit, complete ............................... *30.94 28.30 28.30 4.63 63.87 63.87 090

20822 ............ A Replantation digit, complete ............................... *25.59 23.39 23.39 3.83 52.81 52.81 090

20824 ............ A Replantation thumb, complete ........................... *30.94 28.30 28.30 4.63 63.87 63.87 090

20827 ............ A Replantation thumb, complete ........................... *26.41 24.05 24.05 3.94 54.40 54.40 090

20838 ............ A Replantation, foot, complete .............................. *41.41 37.72 37.72 6.17 85.30 85.30 090

20900 ............ A Removal of bone for graft .................................. *5.58 2.80 2.80 0.45 8.83 8.83 090

20902 ............ A Removal of bone for graft .................................. *7.55 4.95 4.95 0.80 13.30 13.30 090

20910 ............ A Remove cartilage for graft ................................. *5.34 0.79 0.79 0.09 6.22 6.22 090

20912 ............ A Remove cartilage for graft ................................. *6.35 4.62 4.62 0.64 11.61 11.61 090

20920 ............ A Removal of fascia for graft ................................. *5.31 3.93 3.93 0.50 9.74 9.74 090

20922 ............ A Removal of fascia for graft ................................. *6.61 4.39 4.39 0.71 11.71 11.71 090

20924 ............ A Removal of tendon for graft ............................... *6.48 5.45 5.45 0.85 12.78 12.78 090

20926 ............ A Removal of tissue for graft ................................. *5.53 2.59 2.59 0.39 8.51 8.51 090

20930 ............ B Spinal bone allograft .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

20931 ............ A Spinal bone allograft .......................................... 1.81 1.73 1.73 0.28 3.82 3.82 ZZZ

20936 ............ B Spinal bone autograft ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

20937 ............ A Spinal bone autograft ......................................... 2.79 2.66 2.66 0.44 5.89 5.89 ZZZ

20938 ............ A Spinal bone autograft ......................................... 3.02 2.88 2.88 0.47 6.37 6.37 ZZZ

20950 ............ A Record fluid pressure, muscle ........................... 1.26 1.09 1.09 0.17 2.52 2.52 000

20955 ............ A Fibula bone graft, microvasc .............................. *39.21 35.84 35.84 5.87 80.92 80.92 090

20956 ............ A Iliac bone graft, microvasc ................................. *39.27 26.90 26.90 5.26 71.43 71.43 090

20957 ............ A Mt bone graft, microvasc ................................... *40.65 27.87 27.87 5.45 73.97 73.97 090

20962 ............ A Other bone graft, microvasc .............................. *39.27 26.90 26.90 5.26 71.43 71.43 090

20969 ............ A Bone/skin graft, microvasc ................................. *43.92 40.13 40.13 6.57 90.62 90.62 090

20970 ............ A Bone/skin graft, iliac crest .................................. *43.06 39.31 39.31 6.44 88.81 88.81 090

20972 ............ A Bone-skin graft, metatarsal ................................ *42.99 39.61 39.61 6.49 89.09 89.09 090

20973 ............ A Bone-skin graft, great toe .................................. *45.76 42.25 42.25 6.91 94.92 94.92 090

20974 ............ A Electrical bone stimulation ................................. 0.62 3.42 3.42 0.53 4.57 4.57 000

20975 ............ A Electrical bone stimulation ................................. 2.60 #2.86 #2.86 0.56 6.02 6.02 ZZZ

20999 ............ C Musculoskeletal surgery ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

21010 ............ A Incision of jaw joint ............................................. *10.14 10.24 10.24 0.93 21.31 21.31 090

21015 ............ A Resection of facial tumor ................................... *5.29 #5.82 #5.82 1.13 12.24 12.24 090

21025 ............ A Excision of bone, lower jaw ............................... *10.06 4.14 4.14 0.38 14.58 14.58 090

21026 ............ A Excision of facial bone(s) ................................... *4.85 3.14 3.14 0.28 8.27 8.27 090

21029 ............ A Contour of face bone lesion ............................... *7.71 #8.48 #8.48 0.78 16.97 16.97 090

21030 ............ A Removal of face bone lesion ............................. *6.46 3.35 3.35 0.29 10.10 10.10 090

21031 ............ A Remove exostosis, mandible ............................. *3.24 3.68 3.68 0.32 7.24 7.24 090

21032 ............ A Remove exostosis, maxilla ................................ *3.24 3.88 3.88 0.35 7.47 7.47 090

21034 ............ A Removal of face bone lesion ............................. *16.17 6.98 6.98 0.89 24.04 24.04 090

21040 ............ A Removal of jaw bone lesion ............................... *2.11 2.76 2.76 0.24 5.11 5.11 090

21041 ............ A Removal of jaw bone lesion ............................... *6.71 5.76 5.76 0.50 12.97 12.97 090

21044 ............ A Removal of jaw bone lesion ............................... *11.86 9.55 9.55 1.11 22.52 22.52 090

21045 ............ A Extensive jaw surgery ........................................ *16.17 13.83 13.83 1.58 31.58 31.58 090

21050 ............ A Removal of jaw joint ........................................... *10.77 #11.85 #11.85 1.08 23.70 23.70 090

21060 ............ A Remove jaw joint cartilage ................................. *10.23 #11.25 #11.25 1.04 22.52 22.52 090

21070 ............ A Remove coronoid process ................................. *8.20 6.81 6.81 0.82 15.83 15.83 090

21076 ............ A Prepare face/oral prosthesis .............................. *13.42 #14.76 #14.76 1.35 29.53 29.53 010

21077 ............ A Prepare face/oral prosthesis .............................. *33.75 #37.13 #37.13 3.39 74.27 74.27 090

21079 ............ A Prepare face/oral prosthesis .............................. *22.34 27.93 27.93 2.25 52.52 52.52 090

21080 ............ A Prepare face/oral prosthesis .............................. *25.10 31.38 31.38 2.52 59.00 59.00 090

21081 ............ A Prepare face/oral prosthesis .............................. *22.88 28.59 28.59 2.30 53.77 53.77 090

21082 ............ A Prepare face/oral prosthesis .............................. *20.87 #22.96 #22.96 2.10 45.93 45.93 090

21083 ............ A Prepare face/oral prosthesis .............................. *19.30 24.13 24.13 1.94 45.37 45.37 090

21084 ............ A Prepare face/oral prosthesis .............................. *22.51 28.14 28.14 2.28 52.93 52.93 090

21085 ............ A Prepare face/oral prosthesis .............................. *9.00 #9.90 #9.90 0.90 19.80 19.80 010

21086 ............ A Prepare face/oral prosthesis .............................. *24.92 31.15 31.15 2.51 58.58 58.58 090

21087 ............ A Prepare face/oral prosthesis .............................. *24.92 #27.41 #27.41 2.51 54.84 54.84 090

21088 ............ C Prepare face/oral prosthesis .............................. 0.00 0.00 0.00 0.00 0.00 0.00 090

21089 ............ C Prepare face/oral prosthesis .............................. 0.00 0.00 0.00 0.00 0.00 0.00 090

21100 ............ A Maxillofacial fixation ........................................... *4.22 1.06 1.06 0.11 5.39 5.39 090

21110 ............ A Interdental fixation .............................................. *5.21 5.53 5.53 0.46 11.20 11.20 090

21116 ............ A Injection, jaw joint x-ray ..................................... 0.81 0.73 0.73 0.06 1.60 1.60 000

21120 ............ A Reconstruction of chin ....................................... *4.93 3.59 3.59 0.42 8.94 8.94 090
59110

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

21121 ............ A Reconstruction of chin ....................................... *7.64 5.65 5.65 0.66 13.95 13.95 090

21122 ............ A Reconstruction of chin ....................................... *8.52 6.23 6.23 0.73 15.48 15.48 090

21123 ............ A Reconstruction of chin ....................................... *11.16 8.14 8.14 0.95 20.25 20.25 090

21125 ............ A Augmentation lower jaw bone ............................ *10.62 4.72 4.72 0.54 15.88 15.88 090

21127 ............ A Augmentation lower jaw bone ............................ *11.12 7.91 7.91 0.92 19.95 19.95 090

21137 ............ A Reduction of forehead ........................................ *9.82 7.11 7.11 0.83 17.76 17.76 090

21138 ............ A Reduction of forehead ........................................ *12.19 8.86 8.86 1.04 22.09 22.09 090

21139 ............ A Reduction of forehead ........................................ *14.61 10.64 10.64 1.25 26.50 26.50 090

21141 ............ A Reconstruct midface, lefort ................................ *18.10 14.34 14.34 1.68 34.12 34.12 090

21142 ............ A Reconstruct midface, lefort ................................ *18.81 14.84 14.84 1.74 35.39 35.39 090

21143 ............ A Reconstruct midface, lefort ................................ *19.58 15.40 15.40 1.81 36.79 36.79 090

21145 ............ A Reconstruct midface, lefort ................................ *19.94 14.34 14.34 1.68 35.96 35.96 090

21146 ............ A Reconstruct midface, lefort ................................ *20.71 14.84 14.84 1.74 37.29 37.29 090

21147 ............ A Reconstruct midface, lefort ................................ *21.77 15.40 15.40 1.81 38.98 38.98 090

21150 ............ A Reconstruct midface, lefort ................................ *25.24 18.46 18.46 2.17 45.87 45.87 090

21151 ............ A Reconstruct midface, lefort ................................ *28.30 20.68 20.68 2.42 51.40 51.40 090

21154 ............ A Reconstruct midface, lefort ................................ *30.52 22.15 22.15 2.59 55.26 55.26 090

21155 ............ A Reconstruct midface, lefort ................................ *34.45 25.11 25.11 2.94 62.50 62.50 090

21159 ............ A Reconstruct midface, lefort ................................ *42.38 31.02 31.02 3.63 77.03 77.03 090

21160 ............ A Reconstruct midface, lefort ................................ *46.44 33.96 33.96 3.98 84.38 84.38 090

21172 ............ A Reconstruct orbit/forehead ................................. *27.80 20.30 20.30 2.37 50.47 50.47 090

21175 ............ A Reconstruct orbit/forehead ................................. *33.17 24.37 24.37 2.85 60.39 60.39 090

21179 ............ A Reconstruct entire forehead ............................... *22.25 16.24 16.24 1.90 40.39 40.39 090

21180 ............ A Reconstruct entire forehead ............................... *25.19 18.46 18.46 2.17 45.82 45.82 090

21181 ............ A Contour cranial bone lesion ............................... *9.90 7.11 7.11 0.83 17.84 17.84 090

21182 ............ A Reconstruct cranial bone ................................... *32.19 23.63 23.63 2.77 58.59 58.59 090

21183 ............ A Reconstruct cranial bone ................................... *35.31 25.85 25.85 3.03 64.19 64.19 090

21184 ............ A Reconstruct cranial bone ................................... *38.24 28.06 28.06 3.28 69.58 69.58 090

21188 ............ A Reconstruction of midface ................................. *22.46 16.24 16.24 1.90 40.60 40.60 090

21193 ............ A Reconstruct lower jaw bone ............................... *17.15 12.31 12.31 1.44 30.90 30.90 090

21194 ............ A Reconstruct lower jaw bone ............................... *19.84 14.26 14.26 1.67 35.77 35.77 090

21195 ............ A Reconstruct lower jaw bone ............................... *17.24 12.34 12.34 1.44 31.02 31.02 090

21196 ............ A Reconstruct lower jaw bone ............................... *18.91 13.61 13.61 1.58 34.10 34.10 090

21198 ............ A Reconstruct lower jaw bone ............................... *14.16 14.82 14.82 1.74 30.72 30.72 090

21206 ............ A Reconstruct upper jaw bone .............................. *14.10 10.14 10.14 1.19 25.43 25.43 090

21208 ............ A Augmentation of facial bones ............................ *10.23 #11.25 #11.25 1.07 22.55 22.55 090

21209 ............ A Reduction of facial bones .................................. *6.72 4.59 4.59 0.76 12.07 12.07 090

21210 ............ A Face bone graft .................................................. *10.23 #11.25 #11.25 1.29 22.77 22.77 090

21215 ............ A Lower jaw bone graft ......................................... *10.77 #11.85 #11.85 1.42 24.04 24.04 090

21230 ............ A Rib cartilage graft ............................................... *10.77 10.37 10.37 1.69 22.83 22.83 090

21235 ............ A Ear cartilage graft ............................................... *6.72 #7.39 #7.39 1.09 15.20 15.20 090

21240 ............ A Reconstruction of jaw joint ................................. *14.05 #15.46 #15.46 2.09 31.60 31.60 090

21242 ............ A Reconstruction of jaw joint ................................. *12.95 #14.25 #14.25 2.25 29.45 29.45 090

21243 ............ A Reconstruction of jaw joint ................................. *20.79 14.40 14.40 1.68 36.87 36.87 090

21244 ............ A Reconstruction of lower jaw ............................... *11.86 #13.05 #13.05 1.93 26.84 26.84 090

21245 ............ A Reconstruction of jaw ......................................... *11.86 11.47 11.47 1.31 24.64 24.64 090

21246 ............ A Reconstruction of jaw ......................................... *12.47 8.83 8.83 1.04 22.34 22.34 090

21247 ............ A Reconstruct lower jaw bone ............................... *22.63 #24.89 #24.89 2.27 49.79 49.79 090

21248 ............ A Reconstruction of jaw ......................................... *11.48 #12.63 #12.63 1.75 25.86 25.86 090

21249 ............ A Reconstruction of jaw ......................................... *17.52 #19.27 #19.27 3.29 40.08 40.08 090

21255 ............ A Reconstruct lower jaw bone ............................... *16.72 #18.39 #18.39 1.68 36.79 36.79 090

21256 ............ A Reconstruction of orbit ....................................... *16.19 #17.81 #17.81 1.63 35.63 35.63 090

21260 ............ A Revise eye sockets ............................................ *16.52 #18.17 #18.17 1.66 36.35 36.35 090

21261 ............ A Revise eye sockets ............................................ *31.49 17.78 17.78 1.65 50.92 50.92 090

21263 ............ A Revise eye sockets ............................................ *28.42 #31.26 #31.26 2.86 62.54 62.54 090

21267 ............ A Revise eye sockets ............................................ *18.90 14.61 14.61 2.13 35.64 35.64 090

21268 ............ A Revise eye sockets ............................................ *24.48 15.35 15.35 3.13 42.96 42.96 090

21270 ............ A Augmentation cheek bone ................................. *10.23 9.60 9.60 1.41 21.24 21.24 090

21275 ............ A Revision orbitofacial bones ................................ *11.24 8.95 8.95 1.26 21.45 21.45 090

21280 ............ A Revision of eyelid ............................................... *6.03 #6.63 #6.63 0.61 13.27 13.27 090

21282 ............ A Revision of eyelid ............................................... *3.49 #3.84 #3.84 0.79 8.12 8.12 090

21295 ............ A Revision of jaw muscle/bone ............................. *1.53 0.96 0.96 0.13 2.62 2.62 090

21296 ............ A Revision of jaw muscle/bone ............................. *4.25 3.62 3.62 0.22 8.09 8.09 090

21299 ............ C Cranio/maxillofacial surgery ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

21300 ............ A Treatment of skull fracture ................................. 0.72 0.92 #0.79 0.11 1.75 1.62 000

21310 ............ A Treatment of nose fracture ................................ 0.58 0.75 #0.64 0.09 1.42 1.31 000

21315 ............ A Treatment of nose fracture ................................ *1.51 1.81 #1.66 0.21 3.53 3.38 010

21320 ............ A Treatment of nose fracture ................................ *1.85 2.33 #2.04 0.34 4.52 4.23 010

21325 ............ A Repair of nose fracture ...................................... *3.77 4.09 4.09 0.52 8.38 8.38 090

21330 ............ A Repair of nose fracture ...................................... *5.38 #5.92 #5.92 0.86 12.16 12.16 090

21335 ............ A Repair of nose fracture ...................................... *8.61 #9.47 #9.47 1.56 19.64 19.64 090

21336 ............ A Repair nasal septal fracture ............................... *5.72 4.09 4.09 0.52 10.33 10.33 090

21337 ............ A Repair nasal septal fracture ............................... *2.70 2.82 2.82 0.38 5.90 5.90 090

21338 ............ A Repair nasoethmoid fracture .............................. *6.46 5.01 5.01 0.66 12.13 12.13 090
59111

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

21339 ............ A Repair nasoethmoid fracture .............................. *8.09 7.09 7.09 0.70 15.88 15.88 090

21340 ............ A Repair of nose fracture ...................................... *10.77 8.91 8.91 1.04 20.72 20.72 090

21343 ............ A Repair of sinus fracture ...................................... *12.95 9.17 9.17 1.08 23.20 23.20 090

21344 ............ A Repair of sinus fracture ...................................... *19.72 9.17 9.17 1.08 29.97 29.97 090

21345 ............ A Repair of nose/jaw fracture ................................ *8.16 7.90 7.90 0.81 16.87 16.87 090

21346 ............ A Repair of nose/jaw fracture ................................ *10.61 9.40 9.40 1.04 21.05 21.05 090

21347 ............ A Repair of nose/jaw fracture ................................ *12.69 10.36 10.36 1.36 24.41 24.41 090

21348 ............ A Repair of nose/jaw fracture ................................ *16.69 11.34 11.34 2.22 30.25 30.25 090

21355 ............ A Repair cheek bone fracture ............................... *3.77 1.56 1.56 0.17 5.50 5.50 010

21356 ............ A Repair cheek bone fracture ............................... *4.15 #4.57 #4.57 0.89 9.61 9.61 010

21360 ............ A Repair cheek bone fracture ............................... *6.46 #7.11 #7.11 0.89 14.46 14.46 090

21365 ............ A Repair cheek bone fracture ............................... *14.95 12.35 12.35 1.63 28.93 28.93 090

21366 ............ A Repair cheek bone fracture ............................... *17.77 12.08 12.08 2.36 32.21 32.21 090

21385 ............ A Repair eye socket fracture ................................. *9.16 9.59 9.59 1.13 19.88 19.88 090

21386 ............ A Repair eye socket fracture ................................. *9.16 9.07 9.07 1.25 19.48 19.48 090

21387 ............ A Repair eye socket fracture ................................. *9.70 7.45 7.45 0.96 18.11 18.11 090

21390 ............ A Repair eye socket fracture ................................. *10.13 #11.14 #11.14 1.37 22.64 22.64 090

21395 ............ A Repair eye socket fracture ................................. *12.68 9.63 9.63 1.37 23.68 23.68 090

21400 ............ A Treat eye socket fracture ................................... *1.40 1.67 #1.54 0.17 3.24 3.11 090

21401 ............ A Repair eye socket fracture ................................. *3.26 2.58 2.58 0.32 6.16 6.16 090

21406 ............ A Repair eye socket fracture ................................. *7.01 5.21 5.21 0.74 12.96 12.96 090

21407 ............ A Repair eye socket fracture ................................. *8.61 7.09 7.09 0.78 16.48 16.48 090

21408 ............ A Repair eye socket fracture ................................. *12.38 8.49 8.49 0.99 21.86 21.86 090

21421 ............ A Treat mouth roof fracture ................................... *5.14 6.14 #5.65 0.62 11.90 11.41 090

21422 ............ A Repair mouth roof fracture ................................. *8.32 #9.15 #9.15 1.19 18.66 18.66 090

21423 ............ A Repair mouth roof fracture ................................. *10.40 9.80 9.80 1.19 21.39 21.39 090

21431 ............ A Treat craniofacial fracture .................................. *7.05 6.02 6.02 0.71 13.78 13.78 090

21432 ............ A Repair craniofacial fracture ................................ *8.61 6.76 6.76 0.84 16.21 16.21 090

21433 ............ A Repair craniofacial fracture ................................ *25.35 17.96 17.96 2.10 45.41 45.41 090

21435 ............ A Repair craniofacial fracture ................................ *17.25 13.25 13.25 1.88 32.38 32.38 090

21436 ............ A Repair craniofacial fracture ................................ *28.04 14.65 14.65 2.08 44.77 44.77 090

21440 ............ A Repair dental ridge fracture ............................... *2.70 3.07 #2.97 0.28 6.05 5.95 090

21445 ............ A Repair dental ridge fracture ............................... *5.38 6.11 #5.92 0.56 12.05 11.86 090

21450 ............ A Treat lower jaw fracture ..................................... *2.97 2.84 2.84 0.26 6.07 6.07 090

21451 ............ A Treat lower jaw fracture ..................................... *4.87 5.83 #5.36 0.74 11.44 10.97 090

21452 ............ A Treat lower jaw fracture ..................................... *1.98 1.39 1.39 0.17 3.54 3.54 090

21453 ............ A Treat lower jaw fracture ..................................... *5.54 6.64 #6.09 0.55 12.73 12.18 090

21454 ............ A Treat lower jaw fracture ..................................... *6.46 #7.11 #7.11 1.42 14.99 14.99 090

21461 ............ A Repair lower jaw fracture ................................... *8.09 #8.90 #8.90 1.30 18.29 18.29 090

21462 ............ A Repair lower jaw fracture ................................... *9.79 #10.77 #10.77 1.34 21.90 21.90 090

21465 ............ A Repair lower jaw fracture ................................... *11.91 8.44 8.44 0.99 21.34 21.34 090

21470 ............ A Repair lower jaw fracture ................................... *15.34 #16.87 #16.87 1.74 33.95 33.95 090

21480 ............ A Reset dislocated jaw .......................................... 0.61 0.78 #0.67 0.09 1.48 1.37 000

21485 ............ A Reset dislocated jaw .......................................... *3.99 2.19 2.19 0.20 6.38 6.38 090

21490 ............ A Repair dislocated jaw ......................................... *11.86 6.31 6.31 0.52 18.69 18.69 090

21493 ............ A Treat hyoid bone fracture ................................... *1.27 1.52 #1.40 0.13 2.92 2.80 090

21494 ............ A Repair hyoid bone fracture ................................ *6.28 7.52 7.52 0.63 14.43 14.43 090

21495 ............ A Repair hyoid bone fracture ................................ *5.69 4.82 4.82 0.51 11.02 11.02 090

21497 ............ A Interdental wiring ................................................ *3.86 3.97 3.97 0.38 8.21 8.21 090

21499 ............ C Head surgery procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

21501 ............ A Drain neck/chest lesion ...................................... *3.81 1.82 1.82 0.26 5.89 5.89 090

21502 ............ A Drain chest lesion .............................................. *7.12 4.22 4.22 0.75 12.09 12.09 090

21510 ............ A Drainage of bone lesion ..................................... *5.74 3.82 3.82 0.50 10.06 10.06 090

21550 ............ A Biopsy of neck/chest .......................................... *2.06 0.85 0.85 0.12 3.03 3.03 010

21555 ............ A Remove lesion neck/chest ................................. *4.35 1.60 1.60 0.25 6.20 6.20 090

21556 ............ A Remove lesion neck/chest ................................. *5.57 3.80 3.80 0.64 10.01 10.01 090

21557 ............ A Remove tumor, neck or chest ............................ *8.88 8.50 8.50 1.41 18.79 18.79 090

21600 ............ A Partial removal of rib .......................................... *6.89 4.50 4.50 0.88 12.27 12.27 090

21610 ............ A Partial removal of rib .......................................... *14.61 5.17 5.17 0.76 20.54 20.54 090

21615 ............ A Removal of rib .................................................... *9.87 10.13 10.13 1.96 21.96 21.96 090

21616 ............ A Removal of rib and nerves ................................. *12.04 7.26 7.26 1.50 20.80 20.80 090

21620 ............ A Partial removal of sternum ................................. *6.79 6.85 6.85 1.23 14.87 14.87 090

21627 ............ A Sternal debridement ........................................... *6.81 5.03 5.03 0.90 12.74 12.74 090

21630 ............ A Extensive sternum surgery ................................ *17.38 12.89 12.89 2.40 32.67 32.67 090

21632 ............ A Extensive sternum surgery ................................ *18.14 11.54 11.54 2.22 31.90 31.90 090

21700 ............ A Revision of neck muscle .................................... *6.19 4.16 4.16 0.50 10.85 10.85 090

21705 ............ A Revision of neck muscle/rib ............................... *9.60 4.85 4.85 0.96 15.41 15.41 090

21720 ............ A Revision of neck muscle .................................... *5.68 3.84 3.84 0.52 10.04 10.04 090

21725 ............ A Revision of neck muscle .................................... *6.99 4.84 4.84 0.74 12.57 12.57 090

21740 ............ A Reconstruction of sternum ................................. *16.50 8.99 8.99 1.64 27.13 27.13 090

21750 ............ A Repair of sternum separation ............................ *10.77 7.33 7.33 1.43 19.53 19.53 090

21800 ............ A Treatment of rib fracture .................................... *0.96 0.77 0.77 0.07 1.80 1.80 090

21805 ............ A Treatment of rib fracture .................................... *2.75 1.35 1.35 0.17 4.27 4.27 090

21810 ............ A Treatment of rib fracture(s) ................................ *6.86 7.33 7.33 0.61 14.80 14.80 090
59112

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

21820 ............ A Treat sternum fracture ....................................... *1.28 1.36 1.36 0.17 2.81 2.81 090

21825 ............ A Repair sternum fracture ..................................... *7.41 6.90 6.90 1.12 15.43 15.43 090

21899 ............ C Neck/chest surgery procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

21920 ............ A Biopsy soft tissue of back .................................. *2.06 0.79 0.79 0.11 2.96 2.96 010

21925 ............ A Biopsy soft tissue of back .................................. *4.49 1.95 1.95 0.32 6.76 6.76 090

21930 ............ A Remove lesion, back or flank ............................ *5.00 2.72 2.72 0.49 8.21 8.21 090

21935 ............ A Remove tumor of back ....................................... *17.96 6.59 6.59 1.30 25.85 25.85 090

22100 ............ A Remove part of neck vertebra ........................... *9.73 7.64 7.64 1.09 18.46 18.46 090

22101 ............ A Remove part, thorax vertebra ............................ *9.81 8.01 8.01 1.38 19.20 19.20 090

22102 ............ A Remove part, lumbar vertebra ........................... *9.81 4.50 4.50 0.67 14.98 14.98 090

22103 ............ A Remove extra spine segment ............................ 2.34 2.23 2.23 0.37 4.94 4.94 ZZZ

22110 ............ A Remove part of neck vertebra ........................... *12.74 9.72 9.72 1.64 24.10 24.10 090

22112 ............ A Remove part, thorax vertebra ............................ *12.81 9.90 9.90 1.63 24.34 24.34 090

22114 ............ A Remove part, lumbar vertebra ........................... *12.81 7.25 7.25 1.17 21.23 21.23 090

22116 ............ A Remove extra spine segment ............................ 2.32 2.21 2.21 0.36 4.89 4.89 ZZZ

22210 ............ A Revision of neck spine ....................................... *23.82 13.83 13.83 2.43 40.08 40.08 090

22212 ............ A Revision of thorax spine .................................... *19.42 17.29 17.29 2.83 39.54 39.54 090

22214 ............ A Revision of lumbar spine ................................... *19.45 15.11 15.11 2.68 37.24 37.24 090

22216 ............ A Revise, extra spine segment ............................. 6.04 5.07 5.07 0.89 12.00 12.00 ZZZ

22220 ............ A Revision of neck spine ....................................... *21.37 16.64 16.64 2.63 40.64 40.64 090

22222 ............ A Revision of thorax spine .................................... *21.52 13.61 13.61 1.58 36.71 36.71 090

22224 ............ A Revision of lumbar spine ................................... *21.52 14.68 14.68 2.66 38.86 38.86 090

22226 ............ A Revise, extra spine segment ............................. 6.04 5.07 5.07 0.89 12.00 12.00 ZZZ

22305 ............ A Treat spine process fracture .............................. *2.05 #2.26 #2.26 0.37 4.68 4.68 090

22310 ............ A Treat spine fracture ............................................ *2.61 2.52 2.52 0.69 5.82 5.82 090

22315 ............ A Treat spine fracture ............................................ *8.84 5.51 5.51 0.86 15.21 15.21 090

22325 ............ A Repair of spine fracture ..................................... *18.30 8.32 8.32 1.34 27.96 27.96 090

22326 ............ A Repair neck spine fracture ................................. *19.59 15.93 15.93 2.74 38.26 38.26 090

22327 ............ A Repair thorax spine fracture .............................. *19.20 15.95 15.95 2.35 37.50 37.50 090

22328 ............ A Repair each add spine fx ................................... 4.61 4.40 4.40 0.72 9.73 9.73 ZZZ

22505 ............ A Manipulation of spine ......................................... *1.87 1.31 1.31 0.17 3.35 3.35 010

22548 ............ A Neck spine fusion ............................................... *25.82 22.74 22.74 3.82 52.38 52.38 090

22554 ............ A Neck spine fusion ............................................... *18.62 19.81 19.81 3.52 41.95 41.95 090

22556 ............ A Thorax spine fusion ............................................ *23.46 21.68 21.68 3.58 48.72 48.72 090

22558 ............ A Lumbar spine fusion ........................................... *22.28 20.17 20.17 3.38 45.83 45.83 090

22585 ............ A Additional spinal fusion ...................................... 5.53 5.40 5.40 0.93 11.86 11.86 ZZZ

22590 ............ A Spine & skull spinal fusion ................................. *20.51 21.57 21.57 3.44 45.52 45.52 090

22595 ............ A Neck spinal fusion .............................................. *19.39 #21.33 #21.33 3.87 44.59 44.59 090

22600 ............ A Neck spine fusion ............................................... *16.14 #17.75 #17.75 3.32 37.21 37.21 090

22610 ............ A Thorax spine fusion ............................................ *16.02 #17.62 #17.62 2.75 36.39 36.39 090

22612 ............ A Lumbar spine fusion ........................................... *21.00 20.60 20.60 3.33 44.93 44.93 090

22614 ............ A Spine fusion, extra segment .............................. 6.44 5.65 5.65 0.92 13.01 13.01 ZZZ

22630 ............ A Lumbar spine fusion ........................................... *20.84 18.44 18.44 3.15 42.43 42.43 090

22632 ............ A Spine fusion, extra segment .............................. 5.23 4.99 4.99 0.82 11.04 11.04 ZZZ

22800 ............ A Fusion of spine ................................................... *18.25 #20.08 #20.08 3.58 41.91 41.91 090

22802 ............ A Fusion of spine ................................................... *30.88 28.32 28.32 4.61 63.81 63.81 090

22804 ............ A Fusion of spine ................................................... *36.27 28.32 28.32 4.61 69.20 69.20 090

22808 ............ A Fusion of spine ................................................... *26.27 18.41 18.41 3.15 47.83 47.83 090

22810 ............ A Fusion of spine ................................................... *30.27 18.41 18.41 3.15 51.83 51.83 090

22812 ............ A Fusion of spine ................................................... *32.70 25.93 25.93 4.24 62.87 62.87 090

22818 ............ A Kyphectomy, 1–2 segments ............................... *31.83 28.25 28.25 4.85 64.93 64.93 090

22819 ............ A Kyphectomy, 3 & more segment ....................... *36.44 28.25 28.25 4.85 69.54 69.54 090

22830 ............ A Exploration of spinal fusion ................................ *10.85 #11.94 #11.94 2.18 24.97 24.97 090

22840 ............ A Insert spine fixation device ................................ 12.54 5.98 5.98 0.98 19.50 19.50 ZZZ

22841 ............ B Insert spine fixation device ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

22842 ............ A Insert spine fixation device ................................ 12.58 6.86 6.86 1.12 20.56 20.56 ZZZ

22843 ............ A Insert spine fixation device ................................ 13.46 8.55 8.55 1.40 23.41 23.41 ZZZ

22844 ............ A Insert spine fixation device ................................ 16.44 10.45 10.45 1.71 28.60 28.60 ZZZ

22845 ............ A Insert spine fixation device ................................ 11.96 5.70 5.70 0.93 18.59 18.59 ZZZ

22846 ............ A Insert spine fixation device ................................ 12.42 7.90 7.90 1.29 21.61 21.61 ZZZ

22847 ............ A Insert spine fixation device ................................ 13.80 8.77 8.77 1.44 24.01 24.01 ZZZ

22848 ............ A Insert pelvic fixationdevice ................................. 6.00 5.72 5.72 0.94 12.66 12.66 ZZZ

22849 ............ A Reinsert spinal fixation ....................................... *18.51 11.76 11.76 1.97 32.24 32.24 090

22850 ............ A Remove spine fixation device ............................ *9.52 9.17 9.17 1.50 20.19 20.19 090

22851 ............ A Apply spine prosth device .................................. 6.71 6.40 6.40 1.05 14.16 14.16 ZZZ

22852 ............ A Remove spine fixation device ............................ *9.01 9.80 9.80 1.57 20.38 20.38 090

22855 ............ A Remove spine fixation device ............................ *15.13 7.46 7.46 1.25 23.84 23.84 090

22899 ............ C Spine surgery procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

22900 ............ A Remove abdominal wall lesion .......................... *5.80 3.03 3.03 0.60 9.43 9.43 090

22999 ............ C Abdomen surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

23000 ............ A Removal of calcium deposits ............................. *4.36 3.24 3.24 0.47 8.07 8.07 090

23020 ............ A Release shoulder joint ....................................... *8.93 7.27 7.27 1.09 17.29 17.29 090

23030 ............ A Drain shoulder lesion ......................................... *3.43 2.16 2.16 0.35 5.94 5.94 010

23031 ............ A Drain shoulder bursa .......................................... *2.74 0.50 0.50 0.05 3.29 3.29 010
59113

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

23035 ............ A Drain shoulder bone lesion ................................ *8.61 6.22 6.22 1.04 15.87 15.87 090

23040 ............ A Exploratory shoulder surgery ............................. *9.20 9.27 9.27 1.47 19.94 19.94 090

23044 ............ A Exploratory shoulder surgery ............................. *7.12 6.91 6.91 1.18 15.21 15.21 090

23065 ............ A Biopsy shoulder tissues ..................................... *2.27 0.66 0.66 0.09 3.02 3.02 010

23066 ............ A Biopsy shoulder tissues ..................................... *4.16 1.18 1.18 0.10 5.44 5.44 090

23075 ............ A Removal of shoulder lesion ............................... *2.39 1.68 1.68 0.29 4.36 4.36 010

23076 ............ A Removal of shoulder lesion ............................... *7.63 3.54 3.54 0.65 11.82 11.82 090

23077 ............ A Remove tumor of shoulder ................................ *16.09 7.38 7.38 1.38 24.85 24.85 090

23100 ............ A Biopsy of shoulder joint ...................................... *6.03 #6.63 #6.63 1.24 13.90 13.90 090

23101 ............ A Shoulder joint surgery ........................................ *5.58 #6.14 #6.14 1.21 12.93 12.93 090

23105 ............ A Remove shoulder joint lining .............................. *8.23 #9.05 #9.05 1.73 19.01 19.01 090

23106 ............ A Incision of collarbone joint ................................. *5.96 4.75 4.75 0.80 11.51 11.51 090

23107 ............ A Explore,treat shoulder joint ................................ *8.62 #9.48 #9.48 1.60 19.70 19.70 090

23120 ............ A Partial removal, collar bone ............................... *7.11 4.61 4.61 0.74 12.46 12.46 090

23125 ............ A Removal of collarbone ....................................... *9.39 8.49 8.49 1.27 19.15 19.15 090

23130 ............ A Partial removal,shoulderbone ............................ *7.55 7.05 7.05 1.14 15.74 15.74 090

23140 ............ A Removal of bone lesion ..................................... *6.89 4.16 4.16 0.73 11.78 11.78 090

23145 ............ A Removal of bone lesion ..................................... *9.09 8.13 8.13 1.33 18.55 18.55 090

23146 ............ A Removal of bone lesion ..................................... *7.83 5.23 5.23 1.01 14.07 14.07 090

23150 ............ A Removal of humerus lesion ............................... *8.48 6.64 6.64 1.01 16.13 16.13 090

23155 ............ A Removal of humerus lesion ............................... *10.35 8.80 8.80 1.37 20.52 20.52 090

23156 ............ A Removal of humerus lesion ............................... *8.68 7.64 7.64 1.25 17.57 17.57 090

23170 ............ A Remove collarbone lesion .................................. *6.86 4.81 4.81 0.78 12.45 12.45 090

23172 ............ A Remove shoulder blade lesion .......................... *6.90 5.16 5.16 0.73 12.79 12.79 090

23174 ............ A Remove humerus lesion .................................... *9.51 8.55 8.55 1.21 19.27 19.27 090

23180 ............ A Remove collar bone lesion ................................ *8.53 4.30 4.30 0.67 13.50 13.50 090

23182 ............ A Remove shoulder blade lesion .......................... *8.15 6.57 6.57 1.13 15.85 15.85 090

23184 ............ A Remove humerus lesion .................................... *9.38 8.83 8.83 1.48 19.69 19.69 090

23190 ............ A Partial removal of scapula ................................. *7.24 6.07 6.07 0.98 14.29 14.29 090

23195 ............ A Removal of head of humerus ............................ *9.81 8.91 8.91 1.45 20.17 20.17 090

23200 ............ A Removal of collar bone ...................................... *12.08 9.17 9.17 1.26 22.51 22.51 090

23210 ............ A Removal of shoulderblade ................................. *12.49 9.01 9.01 1.41 22.91 22.91 090

23220 ............ A Partial removal of humerus ................................ *14.56 12.05 12.05 2.03 28.64 28.64 090

23221 ............ A Partial removal of humerus ................................ *17.74 18.13 18.13 1.19 37.06 37.06 090

23222 ............ A Partial removal of humerus ................................ *23.92 15.02 15.02 2.30 41.24 41.24 090

23330 ............ A Remove shoulder foreign body .......................... *1.85 0.55 0.55 0.07 2.47 2.47 010

23331 ............ A Remove shoulder foreign body .......................... *7.38 2.26 2.26 0.38 10.02 10.02 090

23332 ............ A Remove shoulder foreign body .......................... *11.62 9.72 9.72 1.57 22.91 22.91 090

23350 ............ A Injection for shoulder x-ray ................................ 1.00 0.52 0.52 0.05 1.57 1.57 000

23395 ............ A Muscle transfer, shoulder/arm ........................... *16.85 11.13 11.13 1.84 29.82 29.82 090

23397 ............ A Muscle transfers ................................................. *16.13 13.97 13.97 2.34 32.44 32.44 090

23400 ............ A Fixation of shoulder blade .................................. *13.54 9.84 9.84 1.68 25.06 25.06 090

23405 ............ A Incision of tendon & muscle ............................... *8.37 7.49 7.49 0.99 16.85 16.85 090

23406 ............ A Incise tendon(s) & muscle(s) ............................. *10.79 9.41 9.41 1.58 21.78 21.78 090

23410 ............ A Repair of tendon(s) ............................................ *12.45 10.94 10.94 1.75 25.14 25.14 090

23412 ............ A Repair of tendon(s) ............................................ *13.31 13.37 13.37 2.16 28.84 28.84 090

23415 ............ A Release of shoulder ligament ............................ *9.97 5.18 5.18 0.83 15.98 15.98 090

23420 ............ A Repair of shoulder .............................................. *13.30 #14.63 #14.63 2.34 30.27 30.27 090

23430 ............ A Repair biceps tendon ......................................... *9.98 7.34 7.34 1.19 18.51 18.51 090

23440 ............ A Removal/transplant tendon ................................ *10.48 7.17 7.17 1.17 18.82 18.82 090

23450 ............ A Repair shoulder capsule .................................... *13.40 12.75 12.75 2.04 28.19 28.19 090

23455 ............ A Repair shoulder capsule .................................... *14.37 15.56 15.56 2.50 32.43 32.43 090

23460 ............ A Repair shoulder capsule .................................... *15.37 14.07 14.07 2.24 31.68 31.68 090

23462 ............ A Repair shoulder capsule .................................... *15.30 15.13 15.13 2.48 32.91 32.91 090

23465 ............ A Repair shoulder capsule .................................... *15.85 14.15 14.15 2.27 32.27 32.27 090

23466 ............ A Repair shoulder capsule .................................... *14.22 #15.64 #15.64 2.67 32.53 32.53 090

23470 ............ A Reconstruct shoulder joint ................................. *17.15 16.76 16.76 2.65 36.56 36.56 090

23472 ............ A Reconstruct shoulder joint ................................. *16.92 #18.61 #18.61 4.89 40.42 40.42 090

23480 ............ A Revision of collarbone ........................................ *11.18 6.59 6.59 1.02 18.79 18.79 090

23485 ............ A Revision of collar bone ...................................... *13.43 11.35 11.35 1.87 26.65 26.65 090

23490 ............ A Reinforce clavicle ............................................... *11.86 9.98 9.98 0.80 22.64 22.64 090

23491 ............ A Reinforce shoulder bones .................................. *14.21 12.70 12.70 2.11 29.02 29.02 090

23500 ............ A Treat clavicle fracture ......................................... *2.08 1.65 1.65 0.21 3.94 3.94 090

23505 ............ A Treat clavicle fracture ......................................... *3.69 2.57 2.57 0.38 6.64 6.64 090

23515 ............ A Repair clavicle fracture ...................................... *7.41 6.93 6.93 1.12 15.46 15.46 090

23520 ............ A Treat clavicle dislocation .................................... *2.16 1.38 1.38 0.19 3.73 3.73 090

23525 ............ A Treat clavicle dislocation .................................... *3.60 1.98 1.98 0.27 5.85 5.85 090

23530 ............ A Repair clavicle dislocation .................................. *7.31 6.58 6.58 0.91 14.80 14.80 090

23532 ............ A Repair clavicle dislocation .................................. *8.01 7.23 7.23 1.19 16.43 16.43 090

23540 ............ A Treat clavicle dislocation .................................... *2.23 1.55 1.55 0.19 3.97 3.97 090

23545 ............ A Treat clavicle dislocation .................................... *3.25 1.98 1.98 0.29 5.52 5.52 090

23550 ............ A Repair clavicle dislocation .................................. *7.24 #7.96 #7.96 1.46 16.66 16.66 090

23552 ............ A Repair clavicle dislocation .................................. *8.45 7.29 7.29 1.17 16.91 16.91 090

23570 ............ A Treat shoulderblade fracture .............................. *2.23 1.70 1.70 0.25 4.18 4.18 090
59114

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

23575 ............ A Treat shoulderblade fracture .............................. *4.06 2.75 2.75 0.43 7.24 7.24 090

23585 ............ A Repair scapula fracture ...................................... *8.96 7.70 7.70 1.29 17.95 17.95 090

23600 ............ A Treat humerus fracture ...................................... *2.93 2.90 2.90 0.43 6.26 6.26 090

23605 ............ A Treat humerus fracture ...................................... *4.87 4.76 4.76 0.76 10.39 10.39 090

23615 ............ A Repair humerus fracture .................................... *9.35 #10.29 #10.29 1.78 21.42 21.42 090

23616 ............ A Repair humerus fracture .................................... *21.27 22.32 22.32 3.54 47.13 47.13 090

23620 ............ A Treat humerus fracture ...................................... *2.40 2.88 #2.64 0.46 5.74 5.50 090

23625 ............ A Treat humerus fracture ...................................... *3.93 3.82 3.82 0.60 8.35 8.35 090

23630 ............ A Repair humerus fracture .................................... *7.35 #8.09 #8.09 1.40 16.84 16.84 090

23650 ............ A Treat shoulder dislocation .................................. *3.39 2.10 2.10 0.24 5.73 5.73 090

23655 ............ A Treat shoulder dislocation .................................. *4.57 2.93 2.93 0.44 7.94 7.94 090

23660 ............ A Repair shoulder dislocation ................................ *7.49 #8.24 #8.24 1.40 17.13 17.13 090

23665 ............ A Treat dislocation/fracture .................................... *4.47 3.35 3.35 0.51 8.33 8.33 090

23670 ............ A Repair dislocation/fracture ................................. *7.90 #8.69 #8.69 1.85 18.44 18.44 090

23675 ............ A Treat dislocation/fracture .................................... *6.05 3.93 3.93 0.61 10.59 10.59 090

23680 ............ A Repair dislocation/fracture ................................. *10.06 #11.07 #11.07 2.13 23.26 23.26 090

23700 ............ A Fixation of shoulder ............................................ *2.52 2.09 2.09 0.34 4.95 4.95 010

23800 ............ A Fusion of shoulder joint ...................................... *14.16 #15.58 #15.58 2.63 32.37 32.37 090

23802 ............ A Fusion of shoulder joint ...................................... *16.60 14.07 14.07 2.24 32.91 32.91 090

23900 ............ A Amputation of arm & girdle ................................ *19.72 12.57 12.57 2.40 34.69 34.69 090

23920 ............ A Amputation at shoulder joint .............................. *14.61 13.85 13.85 2.54 31.00 31.00 090

23921 ............ A Amputation follow-up surgery ............................ *5.49 4.27 4.27 0.74 10.50 10.50 090

23929 ............ C Shoulder surgery procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

23930 ............ A Drainage of arm lesion ....................................... *2.94 1.61 1.61 0.24 4.79 4.79 010

23931 ............ A Drainage of arm bursa ....................................... *1.79 0.75 0.75 0.11 2.65 2.65 010

23935 ............ A Drain arm/elbow bone lesion ............................. *6.09 4.69 4.69 0.78 11.56 11.56 090

24000 ............ A Exploratory elbow surgery ................................. *5.82 #6.40 #6.40 1.44 13.66 13.66 090

24006 ............ A Release elbow joint ............................................ *9.31 7.14 7.14 1.17 17.62 17.62 090

24065 ............ A Biopsy arm/elbow soft tissue ............................. *2.08 0.79 0.79 0.10 2.97 2.97 010

24066 ............ A Biopsy arm/elbow soft tissue ............................. *5.21 2.71 2.71 0.41 8.33 8.33 090

24075 ............ A Remove arm/elbow lesion .................................. *3.92 1.98 1.98 0.35 6.25 6.25 090

24076 ............ A Remove arm/elbow lesion .................................. *6.30 3.68 3.68 0.67 10.65 10.65 090

24077 ............ A Remove tumor of arm/elbow .............................. *11.76 9.79 9.79 1.87 23.42 23.42 090

24100 ............ A Biopsy elbow joint lining ..................................... *4.93 4.23 4.23 0.69 9.85 9.85 090

24101 ............ A Explore/treat elbow joint ..................................... *6.13 #6.74 #6.74 1.41 14.28 14.28 090

24102 ............ A Remove elbow joint lining .................................. *8.03 #8.83 #8.83 1.81 18.67 18.67 090

24105 ............ A Removal of elbow bursa .................................... *3.61 3.77 3.77 0.63 8.01 8.01 090

24110 ............ A Remove humerus lesion .................................... *7.39 7.69 7.69 1.22 16.30 16.30 090

24115 ............ A Remove/graft bone lesion .................................. *9.63 7.68 7.68 1.33 18.64 18.64 090

24116 ............ A Remove/graft bone lesion .................................. *11.81 9.72 9.72 1.47 23.00 23.00 090

24120 ............ A Remove elbow lesion ......................................... *6.65 6.02 6.02 0.98 13.65 13.65 090

24125 ............ A Remove/graft bone lesion .................................. *7.89 5.79 5.79 0.61 14.29 14.29 090

24126 ............ A Remove/graft bone lesion .................................. *8.31 7.40 7.40 1.21 16.92 16.92 090

24130 ............ A Removal of head of radius ................................. *6.25 6.72 6.72 1.08 14.05 14.05 090

24134 ............ A Removal of arm bone lesion .............................. *9.73 8.69 8.69 1.24 19.66 19.66 090

24136 ............ A Remove radius bone lesion ............................... *7.99 8.78 8.78 0.92 17.69 17.69 090

24138 ............ A Remove elbow bone lesion ................................ *8.05 6.39 6.39 1.06 15.50 15.50 090

24140 ............ A Partial removal of arm bone .............................. *9.18 8.77 8.77 1.45 19.40 19.40 090

24145 ............ A Partial removal of radius .................................... *7.58 6.38 6.38 1.03 14.99 14.99 090

24147 ............ A Partial removal of elbow .................................... *7.54 6.61 6.61 1.08 15.23 15.23 090

24149 ............ A Radical resection of elbow ................................. *14.20 12.64 12.64 2.07 28.91 28.91 090

24150 ............ A Extensive humerus surgery ............................... *13.27 14.08 14.08 2.24 29.59 29.59 090

24151 ............ A Extensive humerus surgery ............................... *15.58 13.83 13.83 2.11 31.52 31.52 090

24152 ............ A Extensive radius surgery .................................... *10.06 6.80 6.80 1.16 18.02 18.02 090

24153 ............ A Extensive radius surgery .................................... *11.54 10.44 10.44 1.71 23.69 23.69 090

24155 ............ A Removal of elbow joint ....................................... *11.73 10.75 10.75 1.72 24.20 24.20 090

24160 ............ A Remove elbow joint implant ............................... *7.83 4.84 4.84 0.80 13.47 13.47 090

24164 ............ A Remove radius head implant ............................. *6.23 5.53 5.53 0.90 12.66 12.66 090

24200 ............ A Removal of arm foreign body ............................ *1.76 0.56 0.56 0.06 2.38 2.38 010

24201 ............ A Removal of arm foreign body ............................ *4.56 3.06 3.06 0.49 8.11 8.11 090

24220 ............ A Injection for elbow x-ray ..................................... 1.31 0.51 0.51 0.05 1.87 1.87 000

24301 ............ A Muscle/tendon transfer ....................................... *10.20 7.90 7.90 1.23 19.33 19.33 090

24305 ............ A Arm tendon lengthening ..................................... *7.45 3.08 3.08 0.29 10.82 10.82 090

24310 ............ A Revision of arm tendon ...................................... *5.98 2.95 2.95 0.48 9.41 9.41 090

24320 ............ A Repair of arm tendon ......................................... *10.56 9.20 9.20 1.29 21.05 21.05 090

24330 ............ A Revision of arm muscles .................................... *9.60 8.74 8.74 1.43 19.77 19.77 090

24331 ............ A Revision of arm muscles .................................... *10.65 9.62 9.62 1.57 21.84 21.84 090

24340 ............ A Repair of biceps tendon ..................................... *7.89 7.00 7.00 1.13 16.02 16.02 090

24341 ............ A Repair tendon/muscle arm ................................. *7.90 6.99 6.99 1.14 16.03 16.03 090

24342 ............ A Repair of ruptured tendon .................................. *10.62 10.38 10.38 1.76 22.76 22.76 090

24350 ............ A Repair of tennis elbow ....................................... *5.25 4.23 4.23 0.69 10.17 10.17 090

24351 ............ A Repair of tennis elbow ....................................... *5.91 4.57 4.57 0.73 11.21 11.21 090

24352 ............ A Repair of tennis elbow ....................................... *6.43 5.69 5.69 0.93 13.05 13.05 090

24354 ............ A Repair of tennis elbow ....................................... *6.48 5.61 5.61 0.94 13.03 13.03 090
59115

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

24356 ............ A Revision of tennis elbow .................................... *6.68 7.28 7.28 1.18 15.14 15.14 090

24360 ............ A Reconstruct elbow joint ...................................... *12.34 #13.57 #13.57 2.47 28.38 28.38 090

24361 ............ A Reconstruct elbow joint ...................................... *14.08 13.13 13.13 2.00 29.21 29.21 090

24362 ............ A Reconstruct elbow joint ...................................... *14.99 13.14 13.14 0.80 28.93 28.93 090

24363 ............ A Replace elbow joint ............................................ *18.49 #20.34 #20.34 4.13 42.96 42.96 090

24365 ............ A Reconstruct head of radius ................................ *8.39 7.52 7.52 1.19 17.10 17.10 090

24366 ............ A Reconstruct head of radius ................................ *9.13 #10.04 #10.04 1.80 20.97 20.97 090

24400 ............ A Revision of humerus .......................................... *11.06 8.43 8.43 1.37 20.86 20.86 090

24410 ............ A Revision of humerus .......................................... *14.82 14.04 14.04 2.06 30.92 30.92 090

24420 ............ A Revision of humerus .......................................... *13.44 12.30 12.30 2.01 27.75 27.75 090

24430 ............ A Repair of humerus ............................................. *12.81 #14.09 #14.09 2.34 29.24 29.24 090

24435 ............ A Repair humerus with graft .................................. *13.17 #14.49 #14.49 2.84 30.50 30.50 090

24470 ............ A Revision of elbow joint ....................................... *8.74 7.92 7.92 1.30 17.96 17.96 090

24495 ............ A Decompression of forearm ................................. *8.12 5.75 5.75 1.10 14.97 14.97 090

24498 ............ A Reinforce humerus ............................................. *11.92 10.37 10.37 1.62 23.91 23.91 090

24500 ............ A Treat humerus fracture ...................................... *3.21 2.54 2.54 0.36 6.11 6.11 090

24505 ............ A Treat humerus fracture ...................................... *5.17 4.50 4.50 0.71 10.38 10.38 090

24515 ............ A Repair humerus fracture .................................... *11.65 9.65 9.65 1.54 22.84 22.84 090

24516 ............ A Repair humerus fracture .................................... *11.65 9.65 9.65 1.54 22.84 22.84 090

24530 ............ A Treat humerus fracture ...................................... *3.50 2.73 2.73 0.42 6.65 6.65 090

24535 ............ A Treat humerus fracture ...................................... *6.87 4.85 4.85 0.78 12.50 12.50 090

24538 ............ A Treat humerus fracture ...................................... *9.43 7.98 7.98 1.26 18.67 18.67 090

24545 ............ A Repair humerus fracture .................................... *10.46 9.97 9.97 1.59 22.02 22.02 090

24546 ............ A Repair humerus fracture .................................... *15.69 9.97 9.97 1.59 27.25 27.25 090

24560 ............ A Treat humerus fracture ...................................... *2.80 2.16 2.16 0.30 5.26 5.26 090

24565 ............ A Treat humerus fracture ...................................... *5.56 3.45 3.45 0.54 9.55 9.55 090

24566 ............ A Treat humerus fracture ...................................... *7.79 6.06 6.06 0.96 14.81 14.81 090

24575 ............ A Repair humerus fracture .................................... *10.66 7.79 7.79 1.24 19.69 19.69 090

24576 ............ A Treat humerus fracture ...................................... *2.86 2.16 2.16 0.33 5.35 5.35 090

24577 ............ A Treat humerus fracture ...................................... *5.79 4.00 4.00 0.61 10.40 10.40 090

24579 ............ A Repair humerus fracture .................................... *11.60 8.37 8.37 1.35 21.32 21.32 090

24582 ............ A Treat humerus fracture ...................................... *8.55 6.62 6.62 1.06 16.23 16.23 090

24586 ............ A Repair elbow fracture ......................................... *15.21 14.72 14.72 2.36 32.29 32.29 090

24587 ............ A Repair elbow fracture ......................................... *15.16 13.72 13.72 2.17 31.05 31.05 090

24600 ............ A Treat elbow dislocation ...................................... *4.23 1.95 1.95 0.26 6.44 6.44 090

24605 ............ A Treat elbow dislocation ...................................... *5.42 2.29 2.29 0.37 8.08 8.08 090

24615 ............ A Repair elbow dislocation .................................... *9.42 9.29 9.29 1.48 20.19 20.19 090

24620 ............ A Treat elbow fracture ........................................... *6.98 3.78 3.78 0.57 11.33 11.33 090

24635 ............ A Repair elbow fracture ......................................... *13.19 11.06 11.06 1.78 26.03 26.03 090

24640 ............ A Treat elbow dislocation ...................................... *1.20 1.01 1.01 0.08 2.29 2.29 010

24650 ............ A Treat radius fracture ........................................... *2.16 2.25 2.25 0.33 4.74 4.74 090

24655 ............ A Treat radius fracture ........................................... *4.40 3.01 3.01 0.45 7.86 7.86 090

24665 ............ A Repair radius fracture ........................................ *8.14 7.13 7.13 1.14 16.41 16.41 090

24666 ............ A Repair radius fracture ........................................ *9.49 10.27 10.27 1.60 21.36 21.36 090

24670 ............ A Treatment of ulna fracture ................................. *2.54 1.95 1.95 0.27 4.76 4.76 090

24675 ............ A Treatment of ulna fracture ................................. *4.72 3.51 3.51 0.54 8.77 8.77 090

24685 ............ A Repair ulna fracture ........................................... *8.80 8.40 8.40 1.34 18.54 18.54 090

24800 ............ A Fusion of elbow joint .......................................... *11.20 10.59 10.59 1.55 23.34 23.34 090

24802 ............ A Fusion/graft of elbow joint .................................. *13.69 12.18 12.18 1.99 27.86 27.86 090

24900 ............ A Amputation of upper arm ................................... *9.60 7.68 7.68 1.39 18.67 18.67 090

24920 ............ A Amputation of upper arm ................................... *9.54 6.78 6.78 1.19 17.51 17.51 090

24925 ............ A Amputation follow-up surgery ............................ *7.07 6.27 6.27 0.75 14.09 14.09 090

24930 ............ A Amputation follow-up surgery ............................ *10.25 8.16 8.16 1.17 19.58 19.58 090

24931 ............ A Amputate upper arm & implant .......................... *12.72 11.17 11.17 1.84 25.73 25.73 090

24935 ............ A Revision of amputation ...................................... *15.56 13.70 13.70 2.24 31.50 31.50 090

24940 ............ C Revision of upper arm ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 090

24999 ............ C Upper arm/elbow surgery ................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

25000 ............ A Incision of tendon sheath ................................... *3.38 #3.72 #3.72 0.62 7.72 7.72 090

25020 ............ A Decompression of forearm ................................. *5.92 4.35 4.35 0.77 11.04 11.04 090

25023 ............ A Decompression of forearm ................................. *12.96 5.44 5.44 0.94 19.34 19.34 090

25028 ............ A Drainage of forearm lesion ................................ *5.25 2.06 2.06 0.36 7.67 7.67 090

25031 ............ A Drainage of forearm bursa ................................. *4.14 0.66 0.66 0.09 4.89 4.89 090

25035 ............ A Treat forearm bone lesion .................................. *7.36 6.30 6.30 1.01 14.67 14.67 090

25040 ............ A Explore/treat wrist joint ....................................... *7.18 5.69 5.69 0.90 13.77 13.77 090

25065 ............ A Biopsy forearm soft tissues ................................ *1.99 0.75 0.75 0.09 2.83 2.83 010

25066 ............ A Biopsy forearm soft tissues ................................ *4.13 1.54 1.54 0.22 5.89 5.89 090

25075 ............ A Removal of forearm lesion ................................. *3.74 2.19 2.19 0.37 6.30 6.30 090

25076 ............ A Removal of forearm lesion ................................. *4.92 3.77 3.77 0.67 9.36 9.36 090

25077 ............ A Remove tumor, forearm/wrist ............................. *9.76 8.48 8.48 1.67 19.91 19.91 090

25085 ............ A Incision of wrist capsule ..................................... *5.50 4.62 4.62 0.71 10.83 10.83 090

25100 ............ A Biopsy of wrist joint ............................................ *3.90 #4.29 #4.29 0.79 8.98 8.98 090

25101 ............ A Explore/treat wrist joint ....................................... *4.69 #5.16 #5.16 0.98 10.83 10.83 090

25105 ............ A Remove wrist joint lining .................................... *5.85 #6.44 #6.44 1.19 13.48 13.48 090

25107 ............ A Remove wrist joint cartilage ............................... *6.43 5.28 5.28 0.89 12.60 12.60 090
59116

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

25110 ............ A Remove wrist tendon lesion ............................... *3.92 2.80 2.80 0.46 7.18 7.18 090

25111 ............ A Remove wrist tendon lesion ............................... *3.39 3.22 3.22 0.55 7.16 7.16 090

25112 ............ A Reremove wrist tendon lesion ........................... *4.53 3.72 3.72 0.66 8.91 8.91 090

25115 ............ A Remove wrist/forearm lesion ............................. *8.82 7.14 7.14 1.23 17.19 17.19 090

25116 ............ A Remove wrist/forearm lesion ............................. *7.11 #7.82 #7.82 1.38 16.31 16.31 090

25118 ............ A Excise wrist tendon sheath ................................ *4.37 #4.81 #4.81 1.02 10.20 10.20 090

25119 ............ A Partial removal of ulna ....................................... *6.04 #6.64 #6.64 1.32 14.00 14.00 090

25120 ............ A Removal of forearm lesion ................................. *6.10 6.53 6.53 1.14 13.77 13.77 090

25125 ............ A Remove/graft forearm lesion .............................. *7.48 6.84 6.84 1.04 15.36 15.36 090

25126 ............ A Remove/graft forearm lesion .............................. *7.55 6.80 6.80 1.12 15.47 15.47 090

25130 ............ A Removal of wrist lesion ...................................... *5.26 4.21 4.21 0.67 10.14 10.14 090

25135 ............ A Remove & graft wrist lesion ............................... *6.89 5.46 5.46 0.97 13.32 13.32 090

25136 ............ A Remove & graft wrist lesion ............................... *5.97 4.74 4.74 0.85 11.56 11.56 090

25145 ............ A Remove forearm bone lesion ............................. *6.37 5.95 5.95 0.75 13.07 13.07 090

25150 ............ A Partial removal of ulna ....................................... *7.09 6.67 6.67 1.12 14.88 14.88 090

25151 ............ A Partial removal of radius .................................... *7.39 5.75 5.75 1.02 14.16 14.16 090

25170 ............ A Extensive forearm surgery ................................. *11.09 9.79 9.79 1.51 22.39 22.39 090

25210 ............ A Removal of wrist bone ....................................... *5.95 4.88 4.88 0.80 11.63 11.63 090

25215 ............ A Removal of wrist bones ..................................... *7.89 8.68 8.68 1.42 17.99 17.99 090

25230 ............ A Partial removal of radius .................................... *5.23 5.57 5.57 0.85 11.65 11.65 090

25240 ............ A Partial removal of ulna ....................................... *5.17 5.30 5.30 0.86 11.33 11.33 090

25246 ............ A Injection for wrist x-ray ....................................... 1.45 0.50 0.50 0.05 2.00 2.00 000

25248 ............ A Remove forearm foreign body ........................... *5.14 2.18 2.18 0.37 7.69 7.69 090

25250 ............ A Removal of wrist prosthesis ............................... *6.60 5.63 5.63 0.91 13.14 13.14 090

25251 ............ A Removal of wrist prosthesis ............................... *9.57 8.25 8.25 1.39 19.21 19.21 090

25260 ............ A Repair forearm tendon/muscle ........................... *7.80 4.61 4.61 0.78 13.19 13.19 090

25263 ............ A Repair forearm tendon/muscle ........................... *7.82 5.77 5.77 1.03 14.62 14.62 090

25265 ............ A Repair forearm tendon/muscle ........................... *9.88 7.93 7.93 1.41 19.22 19.22 090

25270 ............ A Repair forearm tendon/muscle ........................... *6.00 3.36 3.36 0.55 9.91 9.91 090

25272 ............ A Repair forearm tendon/muscle ........................... *7.04 3.44 3.44 0.54 11.02 11.02 090

25274 ............ A Repair forearm tendon/muscle ........................... *8.75 6.62 6.62 1.13 16.50 16.50 090

25280 ............ A Revise wrist/forearm tendon .............................. *7.22 4.22 4.22 0.69 12.13 12.13 090

25290 ............ A Incise wrist/forearm tendon ................................ *5.29 2.47 2.47 0.41 8.17 8.17 090

25295 ............ A Release wrist/forearm tendon ............................ *6.55 3.05 3.05 0.52 10.12 10.12 090

25300 ............ A Fusion of tendons at wrist .................................. *8.80 7.36 7.36 1.19 17.35 17.35 090

25301 ............ A Fusion of tendons at wrist .................................. *8.40 6.77 6.77 1.18 16.35 16.35 090

25310 ............ A Transplant forearm tendon ................................. *8.14 7.14 7.14 1.17 16.45 16.45 090

25312 ............ A Transplant forearm tendon ................................. *9.57 7.63 7.63 1.31 18.51 18.51 090

25315 ............ A Revise palsy hand tendon(s) ............................. *10.20 8.06 8.06 1.34 19.60 19.60 090

25316 ............ A Revise palsy hand tendon(s) ............................. *12.33 10.58 10.58 1.78 24.69 24.69 090

25320 ............ A Repair/revise wrist joint ...................................... *10.77 8.60 8.60 1.45 20.82 20.82 090

25332 ............ A Revise wrist joint ................................................ *11.41 9.98 9.98 1.61 23.00 23.00 090

25335 ............ A Realignment of hand .......................................... *12.88 11.41 11.41 1.56 25.85 25.85 090

25337 ............ A Reconstruct ulna/radioulnar ............................... *10.17 8.60 8.60 1.45 20.22 20.22 090

25350 ............ A Revision of radius .............................................. *8.78 7.61 7.61 1.26 17.65 17.65 090

25355 ............ A Revision of radius .............................................. *10.17 9.12 9.12 1.49 20.78 20.78 090

25360 ............ A Revision of ulna ................................................. *8.43 6.41 6.41 0.99 15.83 15.83 090

25365 ............ A Revise radius & ulna .......................................... *12.40 10.31 10.31 1.57 24.28 24.28 090

25370 ............ A Revise radius or ulna ......................................... *13.36 11.76 11.76 1.92 27.04 27.04 090

25375 ............ A Revise radius & ulna .......................................... *13.04 13.38 13.38 0.87 27.29 27.29 090

25390 ............ A Shorten radius/ulna ............................................ *10.40 8.82 8.82 1.50 20.72 20.72 090

25391 ............ A Lengthen radius/ulna .......................................... *13.65 11.25 11.25 1.93 26.83 26.83 090

25392 ............ A Shorten radius & ulna ........................................ *13.95 12.44 12.44 2.04 28.43 28.43 090

25393 ............ A Lengthen radius & ulna ...................................... *15.87 14.21 14.21 2.32 32.40 32.40 090

25400 ............ A Repair radius or ulna ......................................... *10.92 10.78 10.78 1.75 23.45 23.45 090

25405 ............ A Repair/graft radius or ulna ................................. *14.38 12.42 12.42 2.02 28.82 28.82 090

25415 ............ A Repair radius & ulna .......................................... *13.35 11.42 11.42 1.92 26.69 26.69 090

25420 ............ A Repair/graft radius & ulna .................................. *16.33 14.70 14.70 2.28 33.31 33.31 090

25425 ............ A Repair/graft radius or ulna ................................. *13.21 12.02 12.02 1.87 27.10 27.10 090

25426 ............ A Repair/graft radius & ulna .................................. *15.82 11.72 11.72 2.13 29.67 29.67 090

25440 ............ A Repair/graft wrist bone ....................................... *10.44 9.05 9.05 1.50 20.99 20.99 090

25441 ............ A Reconstruct wrist joint ........................................ *12.90 11.36 11.36 1.89 26.15 26.15 090

25442 ............ A Reconstruct wrist joint ........................................ *10.85 7.06 7.06 1.22 19.13 19.13 090

25443 ............ A Reconstruct wrist joint ........................................ *10.39 9.38 9.38 1.52 21.29 21.29 090

25444 ............ A Reconstruct wrist joint ........................................ *11.15 10.14 10.14 1.66 22.95 22.95 090

25445 ............ A Reconstruct wrist joint ........................................ *9.69 10.36 10.36 1.72 21.77 21.77 090

25446 ............ A Wrist replacement .............................................. *16.55 #18.21 #18.21 3.49 38.25 38.25 090

25447 ............ A Repair wrist joint(s) ............................................ *10.37 9.65 9.65 1.56 21.58 21.58 090

25449 ............ A Remove wrist joint implant ................................. *14.49 7.84 7.84 1.16 23.49 23.49 090

25450 ............ A Revision of wrist joint ......................................... *7.87 7.31 7.31 1.19 16.37 16.37 090

25455 ............ A Revision of wrist joint ......................................... *9.49 8.71 8.71 1.42 19.62 19.62 090

25490 ............ A Reinforce radius ................................................. *9.54 8.69 8.69 1.42 19.65 19.65 090

25491 ............ A Reinforce ulna .................................................... *9.96 9.10 9.10 1.49 20.55 20.55 090

25492 ............ A Reinforce radius and ulna .................................. *12.33 11.20 11.20 1.84 25.37 25.37 090
59117

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

25500 ............ A Treat fracture of radius ...................................... *2.45 2.33 2.33 0.29 5.07 5.07 090

25505 ............ A Treat fracture of radius ...................................... *5.21 3.57 3.57 0.51 9.29 9.29 090

25515 ............ A Repair fracture of radius .................................... *9.18 7.63 7.63 1.22 18.03 18.03 090

25520 ............ A Repair fracture of radius .................................... *6.26 5.74 5.74 0.94 12.94 12.94 090

25525 ............ A Repair fracture of radius .................................... *12.24 11.15 11.15 1.83 25.22 25.22 090

25526 ............ A Repair fracture of radius .................................... *12.98 11.85 11.85 1.94 26.77 26.77 090

25530 ............ A Treat fracture of ulna ......................................... *2.09 2.44 #2.30 0.35 4.88 4.74 090

25535 ............ A Treat fracture of ulna ......................................... *5.14 3.57 3.57 0.54 9.25 9.25 090

25545 ............ A Repair fracture of ulna ....................................... *8.90 7.58 7.58 1.20 17.68 17.68 090

25560 ............ A Treat fracture radius & ulna ............................... *2.44 2.27 2.27 0.27 4.98 4.98 090

25565 ............ A Treat fracture radius & ulna ............................... *5.63 4.66 4.66 0.70 10.99 10.99 090

25574 ............ A Treat fracture radius & ulna ............................... *7.01 #7.71 #7.71 1.73 16.45 16.45 090

25575 ............ A Repair fracture radius/ulna ................................. *10.45 10.70 10.70 1.73 22.88 22.88 090

25600 ............ A Treat fracture radius/ulna ................................... *2.63 2.84 2.84 0.42 5.89 5.89 090

25605 ............ A Treat fracture radius/ulna ................................... *5.81 3.95 3.95 0.61 10.37 10.37 090

25611 ............ A Repair fracture radius/ulna ................................. *7.77 6.01 6.01 0.97 14.75 14.75 090

25620 ............ A Repair fracture radius/ulna ................................. *8.55 7.13 7.13 1.14 16.82 16.82 090

25622 ............ A Treat wrist bone fracture .................................... *2.61 2.28 2.28 0.33 5.22 5.22 090

25624 ............ A Treat wrist bone fracture .................................... *4.53 3.67 3.67 0.57 8.77 8.77 090

25628 ............ A Repair wrist bone fracture .................................. *8.43 7.13 7.13 1.16 16.72 16.72 090

25630 ............ A Treat wrist bone fracture .................................... *2.88 2.19 2.19 0.30 5.37 5.37 090

25635 ............ A Treat wrist bone fracture .................................... *4.39 3.36 3.36 0.50 8.25 8.25 090

25645 ............ A Repair wrist bone fracture .................................. *7.25 6.68 6.68 0.95 14.88 14.88 090

25650 ............ A Repair wrist bone fracture .................................. *3.05 2.66 2.66 0.36 6.07 6.07 090

25660 ............ A Treat wrist dislocation ........................................ *4.76 1.82 1.82 0.26 6.84 6.84 090

25670 ............ A Repair wrist dislocation ...................................... *7.92 7.08 7.08 1.12 16.12 16.12 090

25675 ............ A Treat wrist dislocation ........................................ *4.67 2.28 2.28 0.34 7.29 7.29 090

25676 ............ A Repair wrist dislocation ...................................... *8.04 7.32 7.32 1.11 16.47 16.47 090

25680 ............ A Treat wrist fracture ............................................. *5.99 2.44 2.44 0.36 8.79 8.79 090

25685 ............ A Repair wrist fracture ........................................... *9.78 8.79 8.79 1.44 20.01 20.01 090

25690 ............ A Treat wrist dislocation ........................................ *5.50 4.89 4.89 0.73 11.12 11.12 090

25695 ............ A Repair wrist dislocation ...................................... *8.34 7.04 7.04 1.17 16.55 16.55 090

25800 ............ A Fusion of wrist joint ............................................ *9.76 #10.74 #10.74 1.80 22.30 22.30 090

25805 ............ A Fusion/graft of wrist joint .................................... *11.28 #12.41 #12.41 2.09 25.78 25.78 090

25810 ............ A Fusion/graft of wrist joint .................................... *10.57 #11.63 #11.63 2.06 24.26 24.26 090

25820 ............ A Fusion of hand bones ........................................ *7.45 #8.20 #8.20 1.48 17.13 17.13 090

25825 ............ A Fusion hand bones with graft ............................ *9.27 #10.20 #10.20 1.99 21.46 21.46 090

25830 ............ A Fusion radioulnar jnt/ulna ................................... *10.06 8.60 8.60 1.45 20.11 20.11 090

25900 ............ A Amputation of forearm ....................................... *9.01 7.08 7.08 1.31 17.40 17.40 090

25905 ............ A Amputation of forearm ....................................... *9.12 7.11 7.11 1.15 17.38 17.38 090

25907 ............ A Amputation follow-up surgery ............................ *7.80 5.74 5.74 1.00 14.54 14.54 090

25909 ............ A Amputation follow-up surgery ............................ *8.96 5.55 5.55 1.06 15.57 15.57 090

25915 ............ A Amputation of forearm ....................................... *17.08 15.83 15.83 2.59 35.50 35.50 090

25920 ............ A Amputate hand at wrist ...................................... *8.68 7.00 7.00 1.20 16.88 16.88 090

25922 ............ A Amputate hand at wrist ...................................... *7.42 5.55 5.55 1.02 13.99 13.99 090

25924 ............ A Amputation follow-up surgery ............................ *8.46 7.50 7.50 1.22 17.18 17.18 090

25927 ............ A Amputation of hand ............................................ *8.80 6.29 6.29 1.22 16.31 16.31 090

25929 ............ A Amputation follow-up surgery ............................ *7.59 4.74 4.74 0.96 13.29 13.29 090

25931 ............ A Amputation follow-up surgery ............................ *7.81 4.54 4.54 0.90 13.25 13.25 090

25999 ............ C Forearm or wrist surgery .................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

26010 ............ A Drainage of finger abscess ................................ *1.54 0.48 0.48 0.05 2.07 2.07 010

26011 ............ A Drainage of finger abscess ................................ *2.19 1.54 1.54 0.24 3.97 3.97 010

26020 ............ A Drain hand tendon sheath ................................. *4.67 3.72 3.72 0.63 9.02 9.02 090

26025 ............ A Drainage of palm bursa ..................................... *4.82 4.51 4.51 0.76 10.09 10.09 090

26030 ............ A Drainage of palm bursa(s) ................................. *5.93 5.73 5.73 0.98 12.64 12.64 090

26034 ............ A Treat hand bone lesion ...................................... *6.23 4.23 4.23 0.71 11.17 11.17 090

26035 ............ A Decompress fingers/hand .................................. *9.51 5.17 5.17 0.86 15.54 15.54 090

26037 ............ A Decompress fingers/hand .................................. *7.25 6.37 6.37 1.05 14.67 14.67 090

26040 ............ A Release palm contracture .................................. *3.33 2.86 2.86 0.49 6.68 6.68 090

26045 ............ A Release palm contracture .................................. *5.56 4.83 4.83 0.81 11.20 11.20 090

26055 ............ A Incise finger tendon sheath ................................ *2.69 3.28 3.28 0.56 6.53 6.53 090

26060 ............ A Incision of finger tendon ..................................... *2.81 1.13 1.13 0.17 4.11 4.11 090

26070 ............ A Explore/treat hand joint ...................................... *3.69 2.76 2.76 0.42 6.87 6.87 090

26075 ............ A Explore/treat finger joint ..................................... *3.79 3.78 3.78 0.62 8.19 8.19 090

26080 ............ A Explore/treat finger joint ..................................... *4.24 3.14 3.14 0.51 7.89 7.89 090

26100 ............ A Biopsy hand joint lining ...................................... *3.67 2.99 2.99 0.45 7.11 7.11 090

26105 ............ A Biopsy finger joint lining ..................................... *3.71 4.17 4.17 0.67 8.55 8.55 090

26110 ............ A Biopsy finger joint lining ..................................... *3.53 2.93 2.93 0.50 6.96 6.96 090

26115 ............ A Removal of hand lesion ..................................... *3.86 2.01 2.01 0.34 6.21 6.21 090

26116 ............ A Removal of hand lesion ..................................... *5.53 3.71 3.71 0.62 9.86 9.86 090

26117 ............ A Remove tumor, hand/finger ............................... *8.55 5.07 5.07 0.91 14.53 14.53 090

26121 ............ A Release palm contracture .................................. *7.54 #8.29 #8.29 1.61 17.44 17.44 090

26123 ............ A Release palm contracture .................................. *9.29 9.10 9.10 1.53 19.92 19.92 090

26125 ............ A Release palm contracture .................................. 4.61 2.62 2.62 0.45 7.68 7.68 ZZZ
59118

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

26130 ............ A Remove wrist joint lining .................................... *5.42 5.01 5.01 0.86 11.29 11.29 090

26135 ............ A Revise finger joint, each .................................... *6.96 4.86 4.86 0.82 12.64 12.64 090

26140 ............ A Revise finger joint, each .................................... *6.17 4.40 4.40 0.75 11.32 11.32 090

26145 ............ A Tendon excision, palm/finger ............................. *6.32 4.71 4.71 0.80 11.83 11.83 090

26160 ............ A Remove tendon sheath lesion ........................... *3.15 2.32 2.32 0.40 5.87 5.87 090

26170 ............ A Removal of palm tendon, each .......................... *4.77 2.83 2.83 0.45 8.05 8.05 090

26180 ............ A Removal of finger tendon ................................... *5.18 4.01 4.01 0.71 9.90 9.90 090

26185 ............ A Remove finger bone ........................................... *5.25 4.24 4.24 0.41 9.90 9.90 090

26200 ............ A Remove hand bone lesion ................................. *5.51 4.48 4.48 0.72 10.71 10.71 090

26205 ............ A Remove/graft bone lesion .................................. *7.70 6.40 6.40 1.03 15.13 15.13 090

26210 ............ A Removal of finger lesion .................................... *5.15 3.90 3.90 0.64 9.69 9.69 090

26215 ............ A Remove/graft finger lesion ................................. *7.10 5.55 5.55 0.94 13.59 13.59 090

26230 ............ A Partial removal of hand bone ............................. *6.33 4.26 4.26 0.69 11.28 11.28 090

26235 ............ A Partial removal, finger bone ............................... *6.19 4.17 4.17 0.71 11.07 11.07 090

26236 ............ A Partial removal, finger bone ............................... *5.32 3.86 3.86 0.66 9.84 9.84 090

26250 ............ A Extensive hand surgery ..................................... *7.55 6.00 6.00 1.07 14.62 14.62 090

26255 ............ A Extensive hand surgery ..................................... *12.43 8.94 8.94 1.54 22.91 22.91 090

26260 ............ A Extensive finger surgery .................................... *7.03 5.73 5.73 0.97 13.73 13.73 090

26261 ............ A Extensive finger surgery .................................... *9.09 7.70 7.70 1.31 18.10 18.10 090

26262 ............ A Partial removal of finger ..................................... *5.67 4.75 4.75 0.76 11.18 11.18 090

26320 ............ A Removal of implant from hand ........................... *3.98 3.54 3.54 0.57 8.09 8.09 090

26350 ............ A Repair finger/hand tendon ................................. *5.99 5.74 5.74 0.99 12.72 12.72 090

26352 ............ A Repair/graft hand tendon ................................... *7.68 6.60 6.60 1.10 15.38 15.38 090

26356 ............ A Repair finger/hand tendon ................................. *8.07 7.21 7.21 1.24 16.52 16.52 090

26357 ............ A Repair finger/hand tendon ................................. *8.58 6.58 6.58 1.19 16.35 16.35 090

26358 ............ A Repair/graft hand tendon ................................... *9.14 7.40 7.40 1.27 17.81 17.81 090

26370 ............ A Repair finger/hand tendon ................................. *7.11 6.71 6.71 1.13 14.95 14.95 090

26372 ............ A Repair/graft hand tendon ................................... *8.76 6.39 6.39 1.15 16.30 16.30 090

26373 ............ A Repair finger/hand tendon ................................. *8.16 6.85 6.85 1.11 16.12 16.12 090

26390 ............ A Revise hand/finger tendon ................................. *9.19 7.95 7.95 1.23 18.37 18.37 090

26392 ............ A Repair/graft hand tendon ................................... *10.26 8.61 8.61 1.26 20.13 20.13 090

26410 ............ A Repair hand tendon ........................................... *4.63 3.29 3.29 0.51 8.43 8.43 090

26412 ............ A Repair/graft hand tendon ................................... *6.31 6.01 6.01 0.97 13.29 13.29 090

26415 ............ A Excision, hand/finger tendon .............................. *8.34 6.75 6.75 0.90 15.99 15.99 090

26416 ............ A Graft hand or finger tendon ............................... *9.37 8.64 8.64 1.41 19.42 19.42 090

26418 ............ A Repair finger tendon .......................................... *4.25 3.58 3.58 0.59 8.42 8.42 090

26420 ............ A Repair/graft finger tendon .................................. *6.77 5.68 5.68 0.96 13.41 13.41 090

26426 ............ A Repair finger/hand tendon ................................. *6.15 6.31 6.31 1.07 13.53 13.53 090

26428 ............ A Repair/graft finger tendon .................................. *7.21 5.50 5.50 1.00 13.71 13.71 090

26432 ............ A Repair finger tendon .......................................... *4.02 3.15 3.15 0.51 7.68 7.68 090

26433 ............ A Repair finger tendon .......................................... *4.56 3.94 3.94 0.66 9.16 9.16 090

26434 ............ A Repair/graft finger tendon .................................. *6.09 4.95 4.95 0.84 11.88 11.88 090

26437 ............ A Realignment of tendons ..................................... *5.82 4.05 4.05 0.68 10.55 10.55 090

26440 ............ A Release palm/finger tendon ............................... *5.02 3.57 3.57 0.59 9.18 9.18 090

26442 ............ A Release palm & finger tendon ........................... *8.16 3.37 3.37 0.59 12.12 12.12 090

26445 ............ A Release hand/finger tendon ............................... *4.31 3.25 3.25 0.54 8.10 8.10 090

26449 ............ A Release forearm/hand tendon ........................... *7.00 5.57 5.57 0.96 13.53 13.53 090

26450 ............ A Incision of palm tendon ...................................... *3.67 2.28 2.28 0.36 6.31 6.31 090

26455 ............ A Incision of finger tendon ..................................... *3.64 1.89 1.89 0.33 5.86 5.86 090

26460 ............ A Incise hand/finger tendon ................................... *3.46 1.72 1.72 0.30 5.48 5.48 090

26471 ............ A Fusion of finger tendons .................................... *5.73 4.15 4.15 0.67 10.55 10.55 090

26474 ............ A Fusion of finger tendons .................................... *5.32 4.61 4.61 0.75 10.68 10.68 090

26476 ............ A Tendon lengthening ........................................... *5.18 2.89 2.89 0.27 8.34 8.34 090

26477 ............ A Tendon shortening ............................................. *5.15 3.99 3.99 0.73 9.87 9.87 090

26478 ............ A Lengthening of hand tendon .............................. *5.80 4.30 4.30 0.72 10.82 10.82 090

26479 ............ A Shortening of hand tendon ................................ *5.74 5.29 5.29 0.86 11.89 11.89 090

26480 ............ A Transplant hand tendon ..................................... *6.69 6.53 6.53 1.11 14.33 14.33 090

26483 ............ A Transplant/graft hand tendon ............................. *8.29 8.50 8.50 1.40 18.19 18.19 090

26485 ............ A Transplant palm tendon ..................................... *7.70 6.50 6.50 1.08 15.28 15.28 090

26489 ............ A Transplant/graft palm tendon ............................. *9.55 3.40 3.40 0.51 13.46 13.46 090

26490 ............ A Revise thumb tendon ......................................... *8.41 7.80 7.80 1.28 17.49 17.49 090

26492 ............ A Tendon transfer with graft .................................. *9.62 8.75 8.75 1.21 19.58 19.58 090

26494 ............ A Hand tendon/muscle transfer ............................. *8.47 7.28 7.28 1.23 16.98 16.98 090

26496 ............ A Revise thumb tendon ......................................... *9.59 8.73 8.73 1.53 19.85 19.85 090

26497 ............ A Finger tendon transfer ........................................ *9.57 8.02 8.02 1.38 18.97 18.97 090

26498 ............ A Finger tendon transfer ........................................ *14.00 11.78 11.78 2.04 27.82 27.82 090

26499 ............ A Revision of finger ............................................... *8.98 7.75 7.75 1.25 17.98 17.98 090

26500 ............ A Hand tendon reconstruction ............................... *5.96 3.49 3.49 0.60 10.05 10.05 090

26502 ............ A Hand tendon reconstruction ............................... *7.14 5.27 5.27 0.95 13.36 13.36 090

26504 ............ A Hand tendon reconstruction ............................... *7.47 6.72 6.72 1.11 15.30 15.30 090

26508 ............ A Release thumb contracture ................................ *6.01 4.15 4.15 0.72 10.88 10.88 090

26510 ............ A Thumb tendon transfer ....................................... *5.43 4.15 4.15 0.68 10.26 10.26 090

26516 ............ A Fusion of knuckle joint ....................................... *7.15 4.16 4.16 0.67 11.98 11.98 090

26517 ............ A Fusion of knuckle joints ..................................... *8.83 7.07 7.07 1.23 17.13 17.13 090
59119

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

26518 ............ A Fusion of knuckle joints ..................................... *9.02 6.51 6.51 1.22 16.75 16.75 090

26520 ............ A Release knuckle contracture .............................. *5.30 4.48 4.48 0.71 10.49 10.49 090

26525 ............ A Release finger contracture ................................. *5.33 3.64 3.64 0.62 9.59 9.59 090

26530 ............ A Revise knuckle joint ........................................... *6.69 5.16 5.16 0.85 12.70 12.70 090

26531 ............ A Revise knuckle with implant ............................... *7.91 6.65 6.65 1.11 15.67 15.67 090

26535 ............ A Revise finger joint .............................................. *5.24 4.84 4.84 0.58 10.66 10.66 090

26536 ............ A Revise/implant finger joint .................................. *6.37 #7.01 #7.01 1.19 14.57 14.57 090

26540 ............ A Repair hand joint ................................................ *6.43 6.64 6.64 1.12 14.19 14.19 090

26541 ............ A Repair hand joint with graft ................................ *8.62 8.94 8.94 1.47 19.03 19.03 090

26542 ............ A Repair hand joint with graft ................................ *6.78 5.67 5.67 0.97 13.42 13.42 090

26545 ............ A Reconstruct finger joint ...................................... *6.92 5.27 5.27 0.94 13.13 13.13 090

26546 ............ A Repair non-union hand ...................................... *8.92 8.11 8.11 1.33 18.36 18.36 090

26548 ............ A Reconstruct finger joint ...................................... *8.03 5.79 5.79 1.00 14.82 14.82 090

26550 ............ A Construct thumb replacement ............................ *21.24 19.81 19.81 3.24 44.29 44.29 090

26551 ............ A Great toe-hand transfer ...................................... *46.58 42.25 42.25 6.92 95.75 95.75 090

26553 ............ A Single toe-hand transfer ..................................... *46.27 41.96 41.96 6.87 95.10 95.10 090

26554 ............ A Double toe-hand transfer ................................... *54.95 50.06 50.06 8.20 113.21 113.21 090

26555 ............ A Positional change of finger ................................ *16.63 15.41 15.41 2.52 34.56 34.56 090

26556 ............ A Toe joint transfer ................................................ *47.26 42.67 42.67 6.99 96.92 96.92 090

26560 ............ A Repair of web finger ........................................... *5.38 4.65 4.65 0.66 10.69 10.69 090

26561 ............ A Repair of web finger ........................................... *10.92 8.89 8.89 1.56 21.37 21.37 090

26562 ............ A Repair of web finger ........................................... *9.68 #10.65 #10.65 0.82 21.15 21.15 090

26565 ............ A Correct metacarpal flaw ..................................... *6.74 5.82 5.82 0.85 13.41 13.41 090

26567 ............ A Correct finger deformity ..................................... *6.82 4.28 4.28 0.67 11.77 11.77 090

26568 ............ A Lengthen metacarpal/finger ............................... *9.08 8.45 8.45 1.06 18.59 18.59 090

26580 ............ A Repair hand deformity ........................................ *18.18 16.89 16.89 2.76 37.83 37.83 090

26585 ............ A Repair finger deformity ....................................... *14.05 12.95 12.95 2.12 29.12 29.12 090

26587 ............ C Reconstruct extra finger ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 090

26590 ............ A Repair finger deformity ....................................... *17.96 16.63 16.63 2.72 37.31 37.31 090

26591 ............ A Repair muscles of hand ..................................... *3.25 2.29 2.29 0.39 5.93 5.93 090

26593 ............ A Release muscles of hand .................................. *5.31 4.12 4.12 0.70 10.13 10.13 090

26596 ............ A Excision constricting tissue ................................ *8.95 8.24 8.24 1.35 18.54 18.54 090

26597 ............ A Release of scar contracture ............................... *9.82 8.02 8.02 1.37 19.21 19.21 090

26600 ............ A Treat metacarpal fracture ................................... *1.96 1.54 1.54 0.22 3.72 3.72 090

26605 ............ A Treat metacarpal fracture ................................... *2.85 2.29 2.29 0.36 5.50 5.50 090

26607 ............ A Treat metacarpal fracture ................................... *5.36 3.55 3.55 0.57 9.48 9.48 090

26608 ............ A Treat metacarpal fracture ................................... *5.36 3.55 3.55 0.57 9.48 9.48 090

26615 ............ A Repair metacarpal fracture ................................ *5.33 4.87 4.87 0.80 11.00 11.00 090

26641 ............ A Treat thumb dislocation ...................................... *3.94 1.11 1.11 0.14 5.19 5.19 090

26645 ............ A Treat thumb fracture .......................................... *4.41 2.20 2.20 0.33 6.94 6.94 090

26650 ............ A Repair thumb fracture ........................................ *5.72 4.01 4.01 0.64 10.37 10.37 090

26665 ............ A Repair thumb fracture ........................................ *7.60 6.39 6.39 1.09 15.08 15.08 090

26670 ............ A Treat hand dislocation ........................................ *3.69 0.96 0.96 0.10 4.75 4.75 090

26675 ............ A Treat hand dislocation ........................................ *4.64 4.34 4.34 0.60 9.58 9.58 090

26676 ............ A Pin hand dislocation ........................................... *5.52 4.86 4.86 0.67 11.05 11.05 090

26685 ............ A Repair hand dislocation ..................................... *6.98 5.76 5.76 0.91 13.65 13.65 090

26686 ............ A Repair hand dislocation ..................................... *7.94 6.31 6.31 1.04 15.29 15.29 090

26700 ............ A Treat knuckle dislocation ................................... *3.69 0.88 0.88 0.10 4.67 4.67 090

26705 ............ A Treat knuckle dislocation ................................... *4.19 1.78 1.78 0.27 6.24 6.24 090

26706 ............ A Pin knuckle dislocation ....................................... *5.12 4.68 4.68 0.75 10.55 10.55 090

26715 ............ A Repair knuckle dislocation ................................. *5.74 4.13 4.13 0.66 10.53 10.53 090

26720 ............ A Treat finger fracture, each ................................. *1.66 1.10 1.10 0.15 2.91 2.91 090

26725 ............ A Treat finger fracture, each ................................. *3.33 1.54 1.54 0.23 5.10 5.10 090

26727 ............ A Treat finger fracture, each ................................. *5.23 2.45 2.45 0.38 8.06 8.06 090

26735 ............ A Repair finger fracture, each ............................... *5.98 3.73 3.73 0.61 10.32 10.32 090

26740 ............ A Treat finger fracture, each ................................. *1.94 1.16 1.16 0.16 3.26 3.26 090

26742 ............ A Treat finger fracture, each ................................. *3.85 1.98 1.98 0.32 6.15 6.15 090

26746 ............ A Repair finger fracture, each ............................... *5.81 4.75 4.75 0.80 11.36 11.36 090

26750 ............ A Treat finger fracture, each ................................. *1.70 0.83 0.83 0.10 2.63 2.63 090

26755 ............ A Treat finger fracture, each ................................. *3.10 1.08 1.08 0.15 4.33 4.33 090

26756 ............ A Pin finger fracture, each ..................................... *4.39 1.90 1.90 0.33 6.62 6.62 090

26765 ............ A Repair finger fracture, each ............................... *4.17 2.66 2.66 0.45 7.28 7.28 090

26770 ............ A Treat finger dislocation ....................................... *3.02 0.76 0.76 0.08 3.86 3.86 090

26775 ............ A Treat finger dislocation ....................................... *3.71 1.13 1.13 0.17 5.01 5.01 090

26776 ............ A Pin finger dislocation .......................................... *4.80 2.08 2.08 0.35 7.23 7.23 090

26785 ............ A Repair finger dislocation .................................... *4.21 2.97 2.97 0.48 7.66 7.66 090

26820 ............ A Thumb fusion with graft ..................................... *8.26 6.65 6.65 1.05 15.96 15.96 090

26841 ............ A Fusion of thumb ................................................. *7.13 6.17 6.17 1.00 14.30 14.30 090

26842 ............ A Thumb fusion with graft ..................................... *8.24 8.58 8.58 1.37 18.19 18.19 090

26843 ............ A Fusion of hand joint ........................................... *7.61 6.37 6.37 1.10 15.08 15.08 090

26844 ............ A Fusion/graft of hand joint ................................... *8.73 7.35 7.35 1.19 17.27 17.27 090

26850 ............ A Fusion of knuckle ............................................... *6.97 4.63 4.63 0.76 12.36 12.36 090

26852 ............ A Fusion of knuckle with graft ............................... *8.46 5.72 5.72 1.00 15.18 15.18 090

26860 ............ A Fusion of finger joint .......................................... *4.69 4.30 4.30 0.68 9.67 9.67 090
59120

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

26861 ............ A Fusion of finger joint, added .............................. 1.74 #1.91 #1.91 0.43 4.08 4.08 ZZZ

26862 ............ A Fusion/graft of finger joint .................................. *7.37 5.16 5.16 0.85 13.38 13.38 090

26863 ............ A Fuse/graft added joint ........................................ 3.90 3.37 3.37 0.57 7.84 7.84 ZZZ

26910 ............ A Amputate metacarpal bone ................................ *7.60 5.16 5.16 0.93 13.69 13.69 090

26951 ............ A Amputation of finger/thumb ................................ *4.59 2.87 2.87 0.49 7.95 7.95 090

26952 ............ A Amputation of finger/thumb ................................ *6.31 4.00 4.00 0.69 11.00 11.00 090

26989 ............ C Hand/finger surgery ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

26990 ............ A Drainage of pelvis lesion .................................... *7.48 3.10 3.10 0.51 11.09 11.09 090

26991 ............ A Drainage of pelvis bursa .................................... *6.68 1.81 1.81 0.29 8.78 8.78 090

26992 ............ A Drainage of bone lesion ..................................... *13.02 6.38 6.38 1.05 20.45 20.45 090

27000 ............ A Incision of hip tendon ......................................... *5.62 1.85 1.85 0.24 7.71 7.71 090

27001 ............ A Incision of hip tendon ......................................... *6.94 2.34 2.34 0.38 9.66 9.66 090

27003 ............ A Incision of hip tendon ......................................... *7.34 6.77 6.77 1.08 15.19 15.19 090

27005 ............ A Incision of hip tendon ......................................... *9.66 3.37 3.37 0.54 13.57 13.57 090

27006 ............ A Incision of hip tendons ....................................... *9.68 4.64 4.64 0.77 15.09 15.09 090

27025 ............ A Incision of hip/thigh fascia .................................. *11.16 6.12 6.12 1.02 18.30 18.30 090

27030 ............ A Drainage of hip joint ........................................... *13.01 11.42 11.42 1.86 26.29 26.29 090

27033 ............ A Exploration of hip joint ....................................... *13.39 11.52 11.52 1.85 26.76 26.76 090

27035 ............ A Denervation of hip joint ...................................... *16.69 11.86 11.86 2.21 30.76 30.76 090

27036 ............ A Excision of hip joint/muscle ................................ *12.88 11.44 11.44 1.87 26.19 26.19 090

27040 ............ A Biopsy of soft tissues ......................................... *2.87 0.72 0.72 0.11 3.70 3.70 010

27041 ............ A Biopsy of soft tissues ......................................... *9.89 2.67 2.67 0.44 13.00 13.00 090

27047 ............ A Remove hip/pelvis lesion ................................... *7.45 1.89 1.89 0.32 9.66 9.66 090

27048 ............ A Remove hip/pelvis lesion ................................... *6.25 4.33 4.33 0.82 11.40 11.40 090

27049 ............ A Remove tumor, hip/pelvis .................................. *13.66 10.14 10.14 1.87 25.67 25.67 090

27050 ............ A Biopsy of sacroiliac joint .................................... *4.36 4.78 4.78 0.90 10.04 10.04 090

27052 ............ A Biopsy of hip joint ............................................... *6.23 #6.85 #6.85 1.59 14.67 14.67 090

27054 ............ A Removal of hip joint lining .................................. *8.54 #9.39 #9.39 2.26 20.19 20.19 090

27060 ............ A Removal of ischial bursa .................................... *5.43 3.93 3.93 0.68 10.04 10.04 090

27062 ............ A Remove femur lesion/bursa ............................... *5.37 4.23 4.23 0.70 10.30 10.30 090

27065 ............ A Removal of hip bone lesion ............................... *5.90 5.59 5.59 0.90 12.39 12.39 090

27066 ............ A Removal of hip bone lesion ............................... *10.33 7.90 7.90 1.30 19.53 19.53 090

27067 ............ A Remove/graft hip bone lesion ............................ *13.83 11.63 11.63 1.93 27.39 27.39 090

27070 ............ A Partial removal of hip bone ................................ *10.72 7.41 7.41 1.21 19.34 19.34 090

27071 ............ A Partial removal of hip bone ................................ *11.46 8.50 8.50 1.45 21.41 21.41 090

27075 ............ A Extensive hip surgery ......................................... *17.23 13.54 13.54 2.32 33.09 33.09 090

27076 ............ A Extensive hip surgery ......................................... *22.12 16.37 16.37 2.61 41.10 41.10 090

27077 ............ A Extensive hip surgery ......................................... *23.13 18.98 18.98 3.24 45.35 45.35 090

27078 ............ A Extensive hip surgery ......................................... *13.44 9.20 9.20 1.67 24.31 24.31 090

27079 ............ A Extensive hip surgery ......................................... *13.75 8.64 8.64 1.66 24.05 24.05 090

27080 ............ A Removal of tail bone .......................................... *6.39 4.78 4.78 0.87 12.04 12.04 090

27086 ............ A Remove hip foreign body ................................... *1.87 0.58 0.58 0.07 2.52 2.52 010

27087 ............ A Remove hip foreign body ................................... *8.54 3.62 3.62 0.60 12.76 12.76 090

27090 ............ A Removal of hip prosthesis ................................. *11.15 9.09 9.09 1.46 21.70 21.70 090

27091 ............ A Removal of hip prosthesis ................................. *22.14 19.81 19.81 3.16 45.11 45.11 090

27093 ............ A Injection for hip x-ray ......................................... 1.30 0.82 0.82 0.11 2.23 2.23 000

27095 ............ A Injection for hip x-ray ......................................... 1.50 0.93 0.93 0.13 2.56 2.56 000

27097 ............ A Revision of hip tendon ....................................... *8.80 7.71 7.71 1.26 17.77 17.77 090

27098 ............ A Transfer tendon to pelvis ................................... *8.83 7.71 7.71 1.26 17.80 17.80 090

27100 ............ A Transfer of abdominal muscle ........................... *11.08 7.68 7.68 1.42 20.18 20.18 090

27105 ............ A Transfer of spinal muscle ................................... *11.77 5.89 5.89 1.36 19.02 19.02 090

27110 ............ A Transfer of iliopsoas muscle .............................. *13.26 10.61 10.61 1.86 25.73 25.73 090

27111 ............ A Transfer of iliopsoas muscle .............................. *12.15 11.63 11.63 1.65 25.43 25.43 090

27120 ............ A Reconstruction of hip socket .............................. *18.01 18.10 18.10 2.95 39.06 39.06 090

27122 ............ A Reconstruction of hip socket .............................. *14.98 #16.48 #16.48 2.94 34.40 34.40 090

27125 ............ A Partial hip replacement ...................................... *14.69 #16.16 #16.16 3.01 33.86 33.86 090

27130 ............ A Total hip replacement ........................................ *20.12 #22.13 #22.13 4.58 46.83 46.83 090

27132 ............ A Total hip replacement ........................................ *23.30 #25.63 #25.63 5.09 54.02 54.02 090

27134 ............ A Revise hip joint replacement .............................. *28.52 #31.37 #31.37 5.96 65.85 65.85 090

27137 ............ A Revise hip joint replacement .............................. *21.17 #23.29 #23.29 4.82 49.28 49.28 090

27138 ............ A Revise hip joint replacement .............................. *22.17 24.23 24.23 4.58 50.98 50.98 090

27140 ............ A Transplant of femur ridge ................................... *12.24 11.05 11.05 1.71 25.00 25.00 090

27146 ............ A Incision of hip bone ............................................ *17.43 10.88 10.88 1.35 29.66 29.66 090

27147 ............ A Revision of hip bone .......................................... *20.58 16.97 16.97 2.76 40.31 40.31 090

27151 ............ A Incision of hip bones .......................................... *22.51 17.71 17.71 2.90 43.12 43.12 090

27156 ............ A Revision of hip bones ........................................ *24.63 18.32 18.32 3.08 46.03 46.03 090

27158 ............ A Revision of pelvis ............................................... *19.74 14.42 14.42 2.64 36.80 36.80 090

27161 ............ A Incision of neck of femur .................................... *16.71 14.31 14.31 2.31 33.33 33.33 090

27165 ............ A Incision/fixation of femur .................................... *17.91 16.76 16.76 2.63 37.30 37.30 090

27170 ............ A Repair/graft femur head/neck ............................ *16.07 16.41 16.41 2.65 35.13 35.13 090

27175 ............ A Treat slipped epiphysis ...................................... *8.46 1.18 1.18 0.18 9.82 9.82 090

27176 ............ A Treat slipped epiphysis ...................................... *12.05 10.39 10.39 1.70 24.14 24.14 090

27177 ............ A Repair slipped epiphysis .................................... *15.08 12.39 12.39 2.05 29.52 29.52 090

27178 ............ A Repair slipped epiphysis .................................... *11.99 10.46 10.46 1.55 24.00 24.00 090
59121

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

27179 ............ A Revise head/neck of femur ................................ *12.98 11.15 11.15 1.83 25.96 25.96 090

27181 ............ A Repair slipped epiphysis .................................... *14.68 13.14 13.14 2.16 29.98 29.98 090

27185 ............ A Revision of femur epiphysis ............................... *9.18 2.77 2.77 0.87 12.82 12.82 090

27187 ............ A Reinforce hip bones ........................................... *13.54 #14.89 #14.89 2.76 31.19 31.19 090

27193 ............ A Treat pelvic ring fracture .................................... *5.56 2.41 2.41 0.39 8.36 8.36 090

27194 ............ A Treat pelvic ring fracture .................................... *9.65 3.90 3.90 0.50 14.05 14.05 090

27200 ............ A Treat tail bone fracture ....................................... *1.84 1.49 1.49 0.17 3.50 3.50 090

27202 ............ A Repair tail bone fracture .................................... *7.04 6.15 6.15 0.89 14.08 14.08 090

27215 ............ A Pelvic fracture(s) treatment ................................ *10.05 #11.06 #11.06 2.33 23.44 23.44 090

27216 ............ A Treat pelvic ring fracture .................................... *15.19 4.30 4.30 0.66 20.15 20.15 090

27217 ............ A Treat pelvic ring fracture .................................... *14.11 14.55 14.55 2.33 30.99 30.99 090

27218 ............ A Treat pelvic ring fracture .................................... *20.15 14.55 14.55 2.33 37.03 37.03 090

27220 ............ A Treat hip socket fracture .................................... *6.18 4.26 4.26 0.64 11.08 11.08 090

27222 ............ A Treat hip socket fracture .................................... *12.70 6.37 6.37 1.03 20.10 20.10 090

27226 ............ A Treat hip wall fracture ........................................ *14.91 15.78 15.78 2.52 33.21 33.21 090

27227 ............ A Treat hip fracture(s) ........................................... *23.45 19.70 19.70 3.20 46.35 46.35 090

27228 ............ A Treat hip fracture(s) ........................................... *27.16 19.95 19.95 3.20 50.31 50.31 090

27230 ............ A Treat fracture of thigh ........................................ *5.50 3.30 3.30 0.41 9.21 9.21 090

27232 ............ A Treat fracture of thigh ........................................ *10.68 8.98 8.98 1.46 21.12 21.12 090

27235 ............ A Repair of thigh fracture ...................................... *12.16 #13.38 #13.38 2.60 28.14 28.14 090

27236 ............ A Repair of thigh fracture ...................................... *15.60 16.91 16.91 2.71 35.22 35.22 090

27238 ............ A Treatment of thigh fracture ................................ *5.52 4.91 4.91 0.71 11.14 11.14 090

27240 ............ A Treatment of thigh fracture ................................ *12.50 9.70 9.70 1.53 23.73 23.73 090

27244 ............ A Repair of thigh fracture ...................................... *15.94 16.30 16.30 2.62 34.86 34.86 090

27245 ............ A Repair of thigh fracture ...................................... *20.31 16.30 16.30 2.62 39.23 39.23 090

27246 ............ A Treatment of thigh fracture ................................ *4.71 3.87 3.87 0.60 9.18 9.18 090

27248 ............ A Repair of thigh fracture ...................................... *10.45 #11.50 #11.50 2.11 24.06 24.06 090

27250 ............ A Treat hip dislocation ........................................... *6.95 3.19 3.19 0.45 10.59 10.59 090

27252 ............ A Treat hip dislocation ........................................... *10.39 4.34 4.34 0.68 15.41 15.41 090

27253 ............ A Repair of hip dislocation .................................... *12.92 13.14 13.14 2.11 28.17 28.17 090

27254 ............ A Repair of hip dislocation .................................... *18.26 13.47 13.47 2.27 34.00 34.00 090

27256 ............ A Treatment of hip dislocation ............................... *4.12 1.88 1.88 0.31 6.31 6.31 010

27257 ............ A Treatment of hip dislocation ............................... *5.22 4.62 4.62 0.73 10.57 10.57 010

27258 ............ A Repair of hip dislocation .................................... *15.43 13.73 13.73 2.25 31.41 31.41 090

27259 ............ A Repair of hip dislocation .................................... *21.55 17.20 17.20 2.82 41.57 41.57 090

27265 ............ A Treatment of hip dislocation ............................... *5.05 3.46 3.46 0.54 9.05 9.05 090

27266 ............ A Treatment of hip dislocation ............................... *7.49 4.45 4.45 0.71 12.65 12.65 090

27275 ............ A Manipulation of hip joint ..................................... *2.27 1.88 1.88 0.30 4.45 4.45 010

27280 ............ A Fusion of sacroiliac joint .................................... *13.39 10.06 10.06 1.77 25.22 25.22 090

27282 ............ A Fusion of pubic bones ........................................ *11.34 9.01 9.01 1.69 22.04 22.04 090

27284 ............ A Fusion of hip joint ............................................... *16.76 14.50 14.50 2.40 33.66 33.66 090

27286 ............ A Fusion of hip joint ............................................... *16.79 15.20 15.20 2.26 34.25 34.25 090

27290 ............ A Amputation of leg at hip ..................................... *23.28 25.40 25.40 4.70 53.38 53.38 090

27295 ............ A Amputation of leg at hip ..................................... *18.65 16.54 16.54 2.95 38.14 38.14 090

27299 ............ C Pelvis/hip joint surgery ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

27301 ............ A Drain thigh/knee lesion ...................................... *6.49 2.46 2.46 0.40 9.35 9.35 090

27303 ............ A Drainage of bone lesion ..................................... *8.28 5.86 5.86 0.96 15.10 15.10 090

27305 ............ A Incise thigh tendon & fascia ............................... *5.92 3.80 3.80 0.68 10.40 10.40 090

27306 ............ A Incision of thigh tendon ...................................... *4.62 1.99 1.99 0.32 6.93 6.93 090

27307 ............ A Incision of thigh tendons .................................... *5.80 3.01 3.01 0.48 9.29 9.29 090

27310 ............ A Exploration of knee joint .................................... *9.27 9.60 9.60 1.51 20.38 20.38 090

27315 ............ A Partial removal, thigh nerve ............................... *6.97 5.38 5.38 0.96 13.31 13.31 090

27320 ............ A Partial removal, thigh nerve ............................... *6.30 5.18 5.18 0.73 12.21 12.21 090

27323 ............ A Biopsy thigh soft tissues .................................... *2.28 0.91 0.91 0.13 3.32 3.32 010

27324 ............ A Biopsy thigh soft tissues .................................... *4.90 2.63 2.63 0.45 7.98 7.98 090

27327 ............ A Removal of thigh lesion ..................................... *4.47 2.29 2.29 0.40 7.16 7.16 090

27328 ............ A Removal of thigh lesion ..................................... *5.57 4.07 4.07 0.73 10.37 10.37 090

27329 ............ A Remove tumor, thigh/knee ................................. *14.14 11.69 11.69 2.14 27.97 27.97 090

27330 ............ A Biopsy knee joint lining ...................................... *4.97 #5.47 #5.47 1.19 11.63 11.63 090

27331 ............ A Explore/treat knee joint ...................................... *5.88 #6.47 #6.47 1.49 13.84 13.84 090

27332 ............ A Removal of knee cartilage ................................. *8.27 #9.10 #9.10 1.73 19.10 19.10 090

27333 ............ A Removal of knee cartilage ................................. *7.30 #8.03 #8.03 2.52 17.85 17.85 090

27334 ............ A Remove knee joint lining .................................... *8.70 #9.57 #9.57 1.77 20.04 20.04 090

27335 ............ A Remove knee joint lining .................................... *10.00 #11.00 #11.00 2.05 23.05 23.05 090

27340 ............ A Removal of kneecap bursa ................................ *4.18 3.85 3.85 0.62 8.65 8.65 090

27345 ............ A Removal of knee cyst ........................................ *5.92 5.63 5.63 0.95 12.50 12.50 090

27350 ............ A Removal of kneecap .......................................... *8.17 #8.99 #8.99 1.54 18.70 18.70 090

27355 ............ A Remove femur lesion ......................................... *7.65 7.58 7.58 1.23 16.46 16.46 090

27356 ............ A Remove femur lesion/graft ................................. *9.48 8.20 8.20 1.34 19.02 19.02 090

27357 ............ A Remove femur lesion/graft ................................. *10.53 8.80 8.80 1.43 20.76 20.76 090

27358 ............ A Remove femur lesion/fixation ............................. 4.74 4.55 4.55 0.72 10.01 10.01 ZZZ

27360 ............ A Partial removal leg bone(s) ................................ *10.50 8.56 8.56 1.40 20.46 20.46 090

27365 ............ A Extensive leg surgery ......................................... *16.27 13.94 13.94 2.43 32.64 32.64 090

27370 ............ A Injection for knee x-ray ...................................... 0.96 0.60 0.60 0.05 1.61 1.61 000
59122

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

27372 ............ A Removal of foreign body .................................... *5.07 3.42 3.42 0.54 9.03 9.03 090

27380 ............ A Repair of kneecap tendon .................................. *7.16 #7.88 #7.88 1.29 16.33 16.33 090

27381 ............ A Repair/graft kneecap tendon .............................. *10.34 11.27 11.27 1.82 23.43 23.43 090

27385 ............ A Repair of thigh muscle ....................................... *7.76 #8.54 #8.54 1.42 17.72 17.72 090

27386 ............ A Repair/graft of thigh muscle ............................... *10.56 #11.62 #11.62 2.02 24.20 24.20 090

27390 ............ A Incision of thigh tendon ...................................... *5.33 4.36 4.36 0.71 10.40 10.40 090

27391 ............ A Incision of thigh tendons .................................... *7.20 5.42 5.42 0.90 13.52 13.52 090

27392 ............ A Incision of thigh tendons .................................... *9.20 7.67 7.67 1.28 18.15 18.15 090

27393 ............ A Lengthening of thigh tendon .............................. *6.39 5.67 5.67 0.93 12.99 12.99 090

27394 ............ A Lengthening of thigh tendons ............................ *8.50 5.73 5.73 0.94 15.17 15.17 090

27395 ............ A Lengthening of thigh tendons ............................ *11.73 10.48 10.48 1.65 23.86 23.86 090

27396 ............ A Transplant of thigh tendon ................................. *7.86 7.06 7.06 1.11 16.03 16.03 090

27397 ............ A Transplants of thigh tendons ............................. *11.28 8.88 8.88 1.45 21.61 21.61 090

27400 ............ A Revise thigh muscles/tendons ........................... *9.02 7.89 7.89 1.24 18.15 18.15 090

27403 ............ A Repair of knee cartilage ..................................... *8.33 8.79 8.79 1.44 18.56 18.56 090

27405 ............ A Repair of knee ligament ..................................... *8.65 #9.52 #9.52 1.67 19.84 19.84 090

27407 ............ A Repair of knee ligament ..................................... *10.28 8.87 8.87 1.42 20.57 20.57 090

27409 ............ A Repair of knee ligaments ................................... *12.90 #14.19 #14.19 2.48 29.57 29.57 090

27418 ............ A Repair degenerated kneecap ............................. *10.85 #11.94 #11.94 1.85 24.64 24.64 090

27420 ............ A Revision of unstable kneecap ............................ *9.83 #10.81 #10.81 1.74 22.38 22.38 090

27422 ............ A Revision of unstable kneecap ............................ *9.78 #10.76 #10.76 1.83 22.37 22.37 090

27424 ............ A Revision/removal of kneecap ............................. *9.81 #10.79 #10.79 1.89 22.49 22.49 090

27425 ............ A Lateral retinacular release ................................. *5.22 #5.74 #5.74 1.08 12.04 12.04 090

27427 ............ A Reconstruction, knee ......................................... *9.36 #10.30 #10.30 2.25 21.91 21.91 090

27428 ............ A Reconstruction, knee ......................................... *14.00 13.67 13.67 2.71 30.38 30.38 090

27429 ............ A Reconstruction, knee ......................................... *15.52 11.27 11.27 1.83 28.62 28.62 090

27430 ............ A Revision of thigh muscles .................................. *9.67 9.36 9.36 1.50 20.53 20.53 090

27435 ............ A Incision of knee joint .......................................... *9.49 7.03 7.03 1.13 17.65 17.65 090

27437 ............ A Revise kneecap .................................................. *8.46 #9.31 #9.31 1.55 19.32 19.32 090

27438 ............ A Revise kneecap with implant ............................. *11.23 #12.35 #12.35 2.14 25.72 25.72 090

27440 ............ A Revision of knee joint ......................................... *10.43 #11.47 #11.47 2.10 24.00 24.00 090

27441 ............ A Revision of knee joint ......................................... *10.82 9.14 9.14 1.51 21.47 21.47 090

27442 ............ A Revision of knee joint ......................................... *11.89 #13.08 #13.08 3.05 28.02 28.02 090

27443 ............ A Revision of knee joint ......................................... *10.93 #12.02 #12.02 3.34 26.29 26.29 090

27445 ............ A Revision of knee joint ......................................... *17.68 #19.45 #19.45 4.21 41.34 41.34 090

27446 ............ A Revision of knee joint ......................................... *15.84 #17.42 #17.42 3.87 37.13 37.13 090

27447 ............ A Total knee replacement ..................................... *21.48 #23.63 #23.63 4.95 50.06 50.06 090

27448 ............ A Incision of thigh .................................................. *11.06 #12.17 #12.17 2.09 25.32 25.32 090

27450 ............ A Incision of thigh .................................................. *13.98 14.84 14.84 2.36 31.18 31.18 090

27454 ............ A Realignment of thigh bone ................................. *17.56 15.70 15.70 2.82 36.08 36.08 090

27455 ............ A Realignment of knee .......................................... *12.82 12.01 12.01 1.95 26.78 26.78 090

27457 ............ A Realignment of knee .......................................... *13.45 13.30 13.30 2.14 28.89 28.89 090

27465 ............ A Shortening of thigh bone .................................... *13.87 12.24 12.24 2.00 28.11 28.11 090

27466 ............ A Lengthening of thigh bone ................................. *16.33 13.43 13.43 2.27 32.03 32.03 090

27468 ............ A Shorten/lengthen thighs ..................................... *18.97 16.84 16.84 2.75 38.56 38.56 090

27470 ............ A Repair of thigh .................................................... *16.07 16.67 16.67 2.60 35.34 35.34 090

27472 ............ A Repair/graft of thigh ........................................... *17.72 #19.49 #19.49 3.16 40.37 40.37 090

27475 ............ A Surgery to stop leg growth ................................. *8.64 7.74 7.74 1.27 17.65 17.65 090

27477 ............ A Surgery to stop leg growth ................................. *9.85 #10.84 #10.84 2.57 23.26 23.26 090

27479 ............ A Surgery to stop leg growth ................................. *12.80 11.63 11.63 1.89 26.32 26.32 090

27485 ............ A Surgery to stop leg growth ................................. *8.84 7.91 7.91 1.30 18.05 18.05 090

27486 ............ A Revise knee joint replace ................................... *19.27 #21.20 #21.20 4.26 44.73 44.73 090

27487 ............ A Revise knee joint replace ................................... *25.27 27.76 27.76 5.97 59.00 59.00 090

27488 ............ A Removal of knee prosthesis .............................. *15.74 16.16 16.16 2.58 34.48 34.48 090

27495 ............ A Reinforce thigh ................................................... *15.55 #17.11 #17.11 2.82 35.48 35.48 090

27496 ............ A Decompression of thigh/knee ............................ *6.11 4.53 4.53 0.74 11.38 11.38 090

27497 ............ A Decompression of thigh/knee ............................ *7.17 5.55 5.55 0.91 13.63 13.63 090

27498 ............ A Decompression of thigh/knee ............................ *7.99 6.32 6.32 1.04 15.35 15.35 090

27499 ............ A Decompression of thigh/knee ............................ *9.00 7.28 7.28 1.19 17.47 17.47 090

27500 ............ A Treatment of thigh fracture ................................ *5.92 5.41 5.41 0.82 12.15 12.15 090

27501 ............ A Treatment of thigh fracture ................................ *5.92 5.41 5.41 0.82 12.15 12.15 090

27502 ............ A Treatment of thigh fracture ................................ *10.58 7.67 7.67 1.21 19.46 19.46 090

27503 ............ A Treatment of thigh fracture ................................ *10.58 7.67 7.67 1.21 19.46 19.46 090

27506 ............ A Repair of thigh fracture ...................................... *17.45 16.02 16.02 2.56 36.03 36.03 090

27507 ............ A Treatment of thigh fracture ................................ *13.99 #15.39 #15.39 2.56 31.94 31.94 090

27508 ............ A Treatment of thigh fracture ................................ *5.83 4.22 4.22 0.65 10.70 10.70 090

27509 ............ A Treatment of thigh fracture ................................ *7.71 4.22 4.22 0.65 12.58 12.58 090

27510 ............ A Treatment of thigh fracture ................................ *9.13 6.82 6.82 1.09 17.04 17.04 090

27511 ............ A Treatment of thigh fracture ................................ *13.64 #15.00 #15.00 2.56 31.20 31.20 090

27513 ............ A Treatment of thigh fracture ................................ *17.92 16.02 16.02 2.56 36.50 36.50 090

27514 ............ A Repair of thigh fracture ...................................... *17.30 15.76 15.76 2.53 35.59 35.59 090

27516 ............ A Repair of thigh growth plate ............................... *5.37 4.82 4.82 0.71 10.90 10.90 090

27517 ............ A Repair of thigh growth plate ............................... *8.78 7.82 7.82 1.28 17.88 17.88 090

27519 ............ A Repair of thigh growth plate ............................... *15.02 12.68 12.68 2.05 29.75 29.75 090
59123

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

27520 ............ A Treat kneecap fracture ....................................... *2.86 3.04 3.04 0.45 6.35 6.35 090

27524 ............ A Repair of kneecap fracture ................................ *10.00 10.34 10.34 1.65 21.99 21.99 090

27530 ............ A Treatment of knee fracture ................................ *3.78 3.40 3.40 0.51 7.69 7.69 090

27532 ............ A Treatment of knee fracture ................................ *7.30 5.68 5.68 0.91 13.89 13.89 090

27535 ............ A Treatment of knee fracture ................................ *11.50 11.69 11.69 1.88 25.07 25.07 090

27536 ............ A Repair of knee fracture ...................................... *15.65 11.69 11.69 1.88 29.22 29.22 090

27538 ............ A Treat knee fracture(s) ........................................ *4.87 3.37 3.37 0.51 8.75 8.75 090

27540 ............ A Repair of knee fracture ...................................... *13.10 10.95 10.95 1.74 25.79 25.79 090

27550 ............ A Treat knee dislocation ........................................ *5.76 2.57 2.57 0.36 8.69 8.69 090

27552 ............ A Treat knee dislocation ........................................ *7.90 3.43 3.43 0.53 11.86 11.86 090

27556 ............ A Repair of knee dislocation ................................. *14.41 12.48 12.48 1.95 28.84 28.84 090

27557 ............ A Repair of knee dislocation ................................. *16.77 14.60 14.60 2.43 33.80 33.80 090

27558 ............ A Repair of knee dislocation ................................. *17.72 14.60 14.60 2.43 34.75 34.75 090

27560 ............ A Treat kneecap dislocation .................................. *3.82 1.43 1.43 0.16 5.41 5.41 090

27562 ............ A Treat kneecap dislocation .................................. *5.79 5.18 5.18 0.76 11.73 11.73 090

27566 ............ A Repair kneecap dislocation ................................ *12.23 10.58 10.58 1.67 24.48 24.48 090

27570 ............ A Fixation of knee joint .......................................... *1.74 1.72 1.72 0.28 3.74 3.74 010

27580 ............ A Fusion of knee ................................................... *19.37 15.70 15.70 2.56 37.63 37.63 090

27590 ............ A Amputate leg at thigh ......................................... *12.03 9.11 9.11 1.80 22.94 22.94 090

27591 ............ A Amputate leg at thigh ......................................... *12.68 11.77 11.77 2.11 26.56 26.56 090

27592 ............ A Amputate leg at thigh ......................................... *10.02 8.11 8.11 1.61 19.74 19.74 090

27594 ............ A Amputation follow-up surgery ............................ *6.92 3.65 3.65 0.68 11.25 11.25 090

27596 ............ A Amputation follow-up surgery ............................ *10.60 7.37 7.37 1.42 19.39 19.39 090

27598 ............ A Amputate lower leg at knee ............................... *10.53 10.04 10.04 1.78 22.35 22.35 090

27599 ............ C Leg surgery procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

27600 ............ A Decompression of lower leg .............................. *5.65 3.39 3.39 0.64 9.68 9.68 090

27601 ............ A Decompression of lower leg .............................. *5.64 3.38 3.38 0.67 9.69 9.69 090

27602 ............ A Decompression of lower leg .............................. *7.35 4.05 4.05 0.77 12.17 12.17 090

27603 ............ A Drain lower leg lesion ........................................ *4.94 2.38 2.38 0.41 7.73 7.73 090

27604 ............ A Drain lower leg bursa ......................................... *4.47 1.02 1.02 0.14 5.63 5.63 090

27605 ............ A Incision of achilles tendon .................................. *2.87 1.18 1.18 0.14 4.19 4.19 010

27606 ............ A Incision of achilles tendon .................................. *4.14 2.12 2.12 0.35 6.61 6.61 010

27607 ............ A Treat lower leg bone lesion ............................... *7.97 6.01 6.01 0.98 14.96 14.96 090

27610 ............ A Explore/treat ankle joint ..................................... *8.34 7.43 7.43 1.13 16.90 16.90 090

27612 ............ A Exploration of ankle joint .................................... *7.33 7.97 7.97 1.30 16.60 16.60 090

27613 ............ A Biopsy lower leg soft tissue ............................... *2.17 0.67 0.67 0.10 2.94 2.94 010

27614 ............ A Biopsy lower leg soft tissue ............................... *5.66 2.26 2.26 0.38 8.30 8.30 090

27615 ............ A Remove tumor, lower leg ................................... *12.56 8.23 8.23 1.42 22.21 22.21 090

27618 ............ A Remove lower leg lesion .................................... *5.09 2.10 2.10 0.32 7.51 7.51 090

27619 ............ A Remove lower leg lesion .................................... *8.40 4.13 4.13 0.67 13.20 13.20 090

27620 ............ A Explore, treat ankle joint .................................... *5.98 6.03 6.03 0.96 12.97 12.97 090

27625 ............ A Remove ankle joint lining ................................... *8.30 8.71 8.71 1.27 18.28 18.28 090

27626 ............ A Remove ankle joint lining ................................... *8.91 #9.80 #9.80 1.25 19.96 19.96 090

27630 ............ A Removal of tendon lesion .................................. *4.80 3.10 3.10 0.46 8.36 8.36 090

27635 ............ A Remove lower leg bone lesion .......................... *7.78 8.04 8.04 1.27 17.09 17.09 090

27637 ............ A Remove/graft leg bone lesion ............................ *9.85 8.47 8.47 1.40 19.72 19.72 090

27638 ............ A Remove/graft leg bone lesion ............................ *10.57 9.15 9.15 1.52 21.24 21.24 090

27640 ............ A Partial removal of tibia ....................................... *11.37 9.81 9.81 1.57 22.75 22.75 090

27641 ............ A Partial removal of fibula ..................................... *9.24 7.13 7.13 1.18 17.55 17.55 090

27645 ............ A Extensive lower leg surgery ............................... *14.17 11.64 11.64 1.98 27.79 27.79 090

27646 ............ A Extensive lower leg surgery ............................... *12.66 10.75 10.75 1.71 25.12 25.12 090

27647 ............ A Extensive ankle/heel surgery ............................. *12.24 9.95 9.95 1.35 23.54 23.54 090

27648 ............ A Injection for ankle x-ray ...................................... 0.96 0.52 0.52 0.05 1.53 1.53 000

27650 ............ A Repair achilles tendon ....................................... *9.69 8.98 8.98 1.41 20.08 20.08 090

27652 ............ A Repair/graft achilles tendon ............................... *10.33 10.41 10.41 1.56 22.30 22.30 090

27654 ............ A Repair of achilles tendon ................................... *10.02 10.93 10.93 1.65 22.60 22.60 090

27656 ............ A Repair leg fascia defect ..................................... *4.57 3.18 3.18 0.54 8.29 8.29 090

27658 ............ A Repair of leg tendon, each ................................ *4.98 4.02 4.02 0.60 9.60 9.60 090

27659 ............ A Repair of leg tendon, each ................................ *6.81 5.87 5.87 0.86 13.54 13.54 090

27664 ............ A Repair of leg tendon, each ................................ *4.59 3.41 3.41 0.52 8.52 8.52 090

27665 ............ A Repair of leg tendon, each ................................ *5.40 4.95 4.95 0.76 11.11 11.11 090

27675 ............ A Repair lower leg tendons ................................... *7.18 6.40 6.40 0.94 14.52 14.52 090

27676 ............ A Repair lower leg tendons ................................... *8.42 7.56 7.56 1.14 17.12 17.12 090

27680 ............ A Release of lower leg tendon .............................. *5.74 4.12 4.12 0.61 10.47 10.47 090

27681 ............ A Release of lower leg tendons ............................ *6.82 5.97 5.97 0.86 13.65 13.65 090

27685 ............ A Revision of lower leg tendon ............................. *6.50 3.83 3.83 0.41 10.74 10.74 090

27686 ............ A Revise lower leg tendons ................................... *7.46 6.56 6.56 0.90 14.92 14.92 090

27687 ............ A Revision of calf tendon ...................................... *6.24 5.45 5.45 0.76 12.45 12.45 090

27690 ............ A Revise lower leg tendon .................................... *8.71 6.74 6.74 0.88 16.33 16.33 090

27691 ............ A Revise lower leg tendon .................................... *9.96 7.89 7.89 1.23 19.08 19.08 090

27692 ............ A Revise additional leg tendon .............................. 1.87 2.03 2.03 0.29 4.19 4.19 ZZZ

27695 ............ A Repair of ankle ligament .................................... *6.51 #7.16 #7.16 1.32 14.99 14.99 090

27696 ............ A Repair of ankle ligaments .................................. *8.27 7.06 7.06 1.16 16.49 16.49 090

27698 ............ A Repair of ankle ligament .................................... *9.36 #10.30 #10.30 1.86 21.52 21.52 090
59124

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

27700 ............ A Revision of ankle joint ........................................ *9.29 #10.22 #10.22 1.51 21.02 21.02 090

27702 ............ A Reconstruct ankle joint ....................................... *13.67 #15.04 #15.04 3.99 32.70 32.70 090

27703 ............ A Reconstruction, ankle joint ................................. *15.87 13.82 13.82 2.25 31.94 31.94 090

27704 ............ A Removal of ankle implant .................................. *7.62 5.84 5.84 0.98 14.44 14.44 090

27705 ............ A Incision of tibia ................................................... *10.38 10.74 10.74 1.76 22.88 22.88 090

27707 ............ A Incision of fibula ................................................. *4.37 4.75 4.75 0.79 9.91 9.91 090

27709 ............ A Incision of tibia & fibula ...................................... *9.95 #10.95 #10.95 2.14 23.04 23.04 090

27712 ............ A Realignment of lower leg ................................... *14.25 10.99 10.99 1.63 26.87 26.87 090

27715 ............ A Revision of lower leg .......................................... *14.39 12.61 12.61 1.88 28.88 28.88 090

27720 ............ A Repair of tibia ..................................................... *11.79 #12.97 #12.97 2.25 27.01 27.01 090

27722 ............ A Repair/graft of tibia ............................................. *11.82 10.50 10.50 1.64 23.96 23.96 090

27724 ............ A Repair/graft of tibia ............................................. *14.99 15.50 15.50 2.87 33.36 33.36 090

27725 ............ A Repair of lower leg ............................................. *15.59 10.43 10.43 1.53 27.55 27.55 090

27727 ............ A Repair of lower leg ............................................. *14.01 9.38 9.38 1.84 25.23 25.23 090

27730 ............ A Repair of tibia epiphysis ..................................... *7.41 3.59 3.59 0.84 11.84 11.84 090

27732 ............ A Repair of fibula epiphysis ................................... *5.32 4.84 4.84 0.79 10.95 10.95 090

27734 ............ A Repair lower leg epiphyses ................................ *8.48 7.54 7.54 1.23 17.25 17.25 090

27740 ............ A Repair of leg epiphyses ..................................... *9.30 8.36 8.36 1.36 19.02 19.02 090

27742 ............ A Repair of leg epiphyses ..................................... *10.30 9.29 9.29 1.52 21.11 21.11 090

27745 ............ A Reinforce tibia .................................................... *10.07 8.97 8.97 1.39 20.43 20.43 090

27750 ............ A Treatment of tibia fracture .................................. *3.19 3.45 3.45 0.50 7.14 7.14 090

27752 ............ A Treatment of tibia fracture .................................. *5.84 5.09 5.09 0.81 11.74 11.74 090

27756 ............ A Repair of tibia fracture ....................................... *6.78 #7.46 #7.46 1.70 15.94 15.94 090

27758 ............ A Repair of tibia fracture ....................................... *11.67 #12.84 #12.84 2.22 26.73 26.73 090

27759 ............ A Repair of tibia fracture ....................................... *13.76 13.74 13.74 2.22 29.72 29.72 090

27760 ............ A Treatment of ankle fracture ................................ *3.01 2.58 2.58 0.37 5.96 5.96 090

27762 ............ A Treatment of ankle fracture ................................ *5.25 3.36 3.36 0.50 9.11 9.11 090

27766 ............ A Repair of ankle fracture ..................................... *8.36 7.87 7.87 1.26 17.49 17.49 090

27780 ............ A Treatment of fibula fracture ................................ *2.65 1.97 1.97 0.26 4.88 4.88 090

27781 ............ A Treatment of fibula fracture ................................ *4.40 3.29 3.29 0.49 8.18 8.18 090

27784 ............ A Repair of fibula fracture ..................................... *7.11 5.59 5.59 0.87 13.57 13.57 090

27786 ............ A Treatment of ankle fracture ................................ *2.84 2.52 2.52 0.38 5.74 5.74 090

27788 ............ A Treatment of ankle fracture ................................ *4.45 3.27 3.27 0.50 8.22 8.22 090

27792 ............ A Repair of ankle fracture ..................................... *7.66 7.38 7.38 1.17 16.21 16.21 090

27808 ............ A Treatment of ankle fracture ................................ *2.83 2.79 2.79 0.39 6.01 6.01 090

27810 ............ A Treatment of ankle fracture ................................ *5.13 5.05 5.05 0.80 10.98 10.98 090

27814 ............ A Repair of ankle fracture ..................................... *10.68 10.00 10.00 1.60 22.28 22.28 090

27816 ............ A Treatment of ankle fracture ................................ *2.89 3.47 #3.18 0.55 6.91 6.62 090

27818 ............ A Treatment of ankle fracture ................................ *5.50 #6.05 #6.05 1.06 12.61 12.61 090

27822 ............ A Repair of ankle fracture ..................................... *9.20 #10.12 #10.12 1.88 21.20 21.20 090

27823 ............ A Repair of ankle fracture ..................................... *11.80 12.79 12.79 2.05 26.64 26.64 090

27824 ............ A Treat lower leg fracture ...................................... *2.89 3.47 #3.18 0.55 6.91 6.62 090

27825 ............ A Treat lower leg fracture ...................................... *6.19 6.51 6.51 1.06 13.76 13.76 090

27826 ............ A Treat lower leg fracture ...................................... *8.54 #9.39 #9.39 1.88 19.81 19.81 090

27827 ............ A Treat lower leg fracture ...................................... *14.06 11.71 11.71 1.88 27.65 27.65 090

27828 ............ A Treat lower leg fracture ...................................... *16.23 12.79 12.79 2.05 31.07 31.07 090

27829 ............ A Treat lower leg joint ........................................... *5.49 #6.04 #6.04 1.37 12.90 12.90 090

27830 ............ A Treat lower leg dislocation ................................. *3.79 3.25 3.25 0.46 7.50 7.50 090

27831 ............ A Treat lower leg dislocation ................................. *4.56 3.98 3.98 0.59 9.13 9.13 090

27832 ............ A Repair lower leg dislocation ............................... *6.49 5.70 5.70 0.89 13.08 13.08 090

27840 ............ A Treat ankle dislocation ....................................... *4.58 1.87 1.87 0.21 6.66 6.66 090

27842 ............ A Treat ankle dislocation ....................................... *6.21 2.22 2.22 0.34 8.77 8.77 090

27846 ............ A Repair ankle dislocation ..................................... *9.79 8.59 8.59 1.37 19.75 19.75 090

27848 ............ A Repair ankle dislocation ..................................... *11.20 8.36 8.36 1.32 20.88 20.88 090

27860 ............ A Fixation of ankle joint ......................................... *2.34 1.39 1.39 0.23 3.96 3.96 010

27870 ............ A Fusion of ankle joint ........................................... *13.91 13.34 13.34 2.22 29.47 29.47 090

27871 ............ A Fusion of tibiofibular joint ................................... *9.17 7.79 7.79 1.21 18.17 18.17 090

27880 ............ A Amputation of lower leg ..................................... *11.85 8.36 8.36 1.60 21.81 21.81 090

27881 ............ A Amputation of lower leg ..................................... *12.34 10.82 10.82 1.87 25.03 25.03 090

27882 ............ A Amputation of lower leg ..................................... *8.94 7.36 7.36 1.42 17.72 17.72 090

27884 ............ A Amputation follow-up surgery ............................ *8.21 3.37 3.37 0.61 12.19 12.19 090

27886 ............ A Amputation follow-up surgery ............................ *9.32 7.17 7.17 1.34 17.83 17.83 090

27888 ............ A Amputation of foot at ankle ................................ *9.67 9.49 9.49 1.65 20.81 20.81 090

27889 ............ A Amputation of foot at ankle ................................ *9.98 8.43 8.43 1.55 19.96 19.96 090

27892 ............ A Decompression of leg ........................................ *7.39 3.39 3.39 0.64 11.42 11.42 090

27893 ............ A Decompression of leg ........................................ *7.35 3.38 3.38 0.67 11.40 11.40 090

27894 ............ A Decompression of leg ........................................ *10.49 4.05 4.05 0.77 15.31 15.31 090

27899 ............ C Leg/ankle surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

28001 ............ A Drainage of bursa of foot ................................... *2.73 0.52 0.52 0.05 3.30 3.30 010

28002 ............ A Treatment of foot infection ................................. *4.62 2.25 2.25 0.33 7.20 7.20 010

28003 ............ A Treatment of foot infection ................................. *8.41 3.50 3.50 0.59 12.50 12.50 090

28005 ............ A Treat foot bone lesion ........................................ *8.68 4.08 4.08 0.61 13.37 13.37 090

28008 ............ A Incision of foot fascia ......................................... *4.45 2.68 2.68 0.29 7.42 7.42 090

28010 ............ A Incision of toe tendon ......................................... *2.84 3.62 3.62 0.33 6.79 6.79 090
59125

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

28011 ............ A Incision of toe tendons ....................................... *4.14 1.77 1.77 0.19 6.10 6.10 090

28020 ............ A Exploration of a foot joint ................................... *5.01 4.40 4.40 0.56 9.97 9.97 090

28022 ............ A Exploration of a foot joint ................................... *4.67 2.74 2.74 0.31 7.72 7.72 090

28024 ............ A Exploration of a toe joint .................................... *4.38 2.39 2.39 0.24 7.01 7.01 090

28030 ............ A Removal of foot nerve ........................................ *6.15 3.93 3.93 0.42 10.50 10.50 090

28035 ............ A Decompression of tibia nerve ............................ *5.09 6.18 #5.60 0.90 12.17 11.59 090

28043 ............ A Excision of foot lesion ........................................ *3.54 1.73 1.73 0.20 5.47 5.47 090

28045 ............ A Excision of foot lesion ........................................ *4.72 3.99 3.99 0.46 9.17 9.17 090

28046 ............ A Resection of tumor, foot ..................................... *10.18 5.35 5.35 0.79 16.32 16.32 090

28050 ............ A Biopsy of foot joint lining .................................... *4.25 3.84 3.84 0.53 8.62 8.62 090

28052 ............ A Biopsy of foot joint lining .................................... *3.94 3.82 3.82 0.43 8.19 8.19 090

28054 ............ A Biopsy of toe joint lining ..................................... *3.45 2.24 2.24 0.28 5.97 5.97 090

28060 ............ A Partial removal foot fascia ................................. *5.23 4.22 4.22 0.53 9.98 9.98 090

28062 ............ A Removal of foot fascia ....................................... *6.52 7.06 7.06 0.86 14.44 14.44 090

28070 ............ A Removal of foot joint lining ................................ *5.10 4.48 4.48 0.48 10.06 10.06 090

28072 ............ A Removal of foot joint lining ................................ *4.58 3.21 3.21 0.42 8.21 8.21 090

28080 ............ A Removal of foot lesion ....................................... *3.58 4.07 4.07 0.45 8.10 8.10 090

28086 ............ A Excise foot tendon sheath ................................. *4.78 3.12 3.12 0.46 8.36 8.36 090

28088 ............ A Excise foot tendon sheath ................................. *3.86 3.62 3.62 0.40 7.88 7.88 090

28090 ............ A Removal of foot lesion ....................................... *4.41 3.02 3.02 0.29 7.72 7.72 090

28092 ............ A Removal of toe lesions ...................................... *3.64 2.03 2.03 0.25 5.92 5.92 090

28100 ............ A Removal of ankle/heel lesion ............................. *5.66 4.58 4.58 0.56 10.80 10.80 090

28102 ............ A Remove/graft foot lesion .................................... *7.73 6.84 6.84 0.85 15.42 15.42 090

28103 ............ A Remove/graft foot lesion .................................... *6.50 5.61 5.61 0.69 12.80 12.80 090

28104 ............ A Removal of foot lesion ....................................... *5.12 4.33 4.33 0.49 9.94 9.94 090

28106 ............ A Remove/graft foot lesion .................................... *7.16 6.42 6.42 0.79 14.37 14.37 090

28107 ............ A Remove/graft foot lesion .................................... *5.56 4.86 4.86 0.48 10.90 10.90 090

28108 ............ A Removal of toe lesions ...................................... *4.16 4.20 4.20 0.38 8.74 8.74 090

28110 ............ A Part removal of metatarsal ................................. *4.08 3.48 3.48 0.39 7.95 7.95 090

28111 ............ A Part removal of metatarsal ................................. *5.01 5.04 5.04 0.65 10.70 10.70 090

28112 ............ A Part removal of metatarsal ................................. *4.49 3.96 3.96 0.45 8.90 8.90 090

28113 ............ A Part removal of metatarsal ................................. *4.79 4.44 4.44 0.48 9.71 9.71 090

28114 ............ A Removal of metatarsal heads ............................ *9.79 9.17 9.17 1.42 20.38 20.38 090

28116 ............ A Revision of foot .................................................. *7.75 5.48 5.48 0.57 13.80 13.80 090

28118 ............ A Removal of heel bone ........................................ *5.96 5.71 5.71 0.66 12.33 12.33 090

28119 ............ A Removal of heel spur ......................................... *5.39 5.44 5.44 0.57 11.40 11.40 090

28120 ............ A Part removal of ankle/heel ................................. *5.40 5.04 5.04 0.67 11.11 11.11 090

28122 ............ A Partial removal of foot bone ............................... *7.29 4.48 4.48 0.54 12.31 12.31 090

28124 ............ A Partial removal of toe ......................................... *4.81 4.11 4.11 0.37 9.29 9.29 090

28126 ............ A Partial removal of toe ......................................... *3.52 3.98 3.98 0.36 7.86 7.86 090

28130 ............ A Removal of ankle bone ...................................... *8.11 7.03 7.03 0.88 16.02 16.02 090

28140 ............ A Removal of metatarsal ....................................... *6.91 4.93 4.93 0.62 12.46 12.46 090

28150 ............ A Removal of toe ................................................... *4.09 3.29 3.29 0.38 7.76 7.76 090

28153 ............ A Partial removal of toe ......................................... *3.66 3.99 3.99 0.36 8.01 8.01 090

28160 ............ A Partial removal of toe ......................................... *3.74 4.12 4.12 0.38 8.24 8.24 090

28171 ............ A Extensive foot surgery ....................................... *9.60 7.99 7.99 0.88 18.47 18.47 090

28173 ............ A Extensive foot surgery ....................................... *8.80 5.74 5.74 0.74 15.28 15.28 090

28175 ............ A Extensive foot surgery ....................................... *6.05 5.38 5.38 0.58 12.01 12.01 090

28190 ............ A Removal of foot foreign body ............................. *1.96 0.52 0.52 0.05 2.53 2.53 010

28192 ............ A Removal of foot foreign body ............................. *4.64 1.95 1.95 0.24 6.83 6.83 090

28193 ............ A Removal of foot foreign body ............................. *5.73 2.38 2.38 0.30 8.41 8.41 090

28200 ............ A Repair of foot tendon ......................................... *4.60 5.06 5.06 0.50 10.16 10.16 090

28202 ............ A Repair/graft of foot tendon ................................. *6.84 5.82 5.82 0.77 13.43 13.43 090

28208 ............ A Repair of foot tendon ......................................... *4.37 2.81 2.81 0.28 7.46 7.46 090

28210 ............ A Repair/graft of foot tendon ................................. *6.35 5.60 5.60 0.60 12.55 12.55 090

28220 ............ A Release of foot tendon ....................................... *4.53 3.87 3.87 0.43 8.83 8.83 090

28222 ............ A Release of foot tendons ..................................... *5.62 6.40 6.40 0.63 12.65 12.65 090

28225 ............ A Release of foot tendon ....................................... *3.66 2.37 2.37 0.25 6.28 6.28 090

28226 ............ A Release of foot tendons ..................................... *4.53 3.38 3.38 0.40 8.31 8.31 090

28230 ............ A Incision of foot tendon(s) ................................... *4.24 2.43 2.43 0.22 6.89 6.89 090

28232 ............ A Incision of toe tendon ......................................... *3.39 1.60 1.60 0.15 5.14 5.14 090

28234 ............ A Incision of foot tendon ........................................ *3.37 1.53 1.53 0.14 5.04 5.04 090

28238 ............ A Revision of foot tendon ...................................... *7.73 7.23 7.23 0.85 15.81 15.81 090

28240 ............ A Release of big toe .............................................. *4.36 2.13 2.13 0.23 6.72 6.72 090

28250 ............ A Revision of foot fascia ........................................ *5.92 4.46 4.46 0.50 10.88 10.88 090

28260 ............ A Release of midfoot joint ..................................... *7.96 4.43 4.43 0.48 12.87 12.87 090

28261 ............ A Revision of foot tendon ...................................... *11.73 5.91 5.91 0.58 18.22 18.22 090

28262 ............ A Revision of foot and ankle ................................. *15.83 11.91 11.91 1.44 29.18 29.18 090

28264 ............ A Release of midfoot joint ..................................... *10.35 9.56 9.56 1.17 21.08 21.08 090

28270 ............ A Release of foot contracture ................................ *4.76 2.63 2.63 0.23 7.62 7.62 090

28272 ............ A Release of toe joint, each .................................. *3.80 2.04 2.04 0.18 6.02 6.02 090

28280 ............ A Fusion of toes .................................................... *5.19 2.22 2.22 0.30 7.71 7.71 090

28285 ............ A Repair of hammertoe ......................................... *4.59 4.37 4.37 0.39 9.35 9.35 090

28286 ............ A Repair of hammertoe ......................................... *4.56 3.58 3.58 0.38 8.52 8.52 090
59126

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

28288 ............ A Partial removal of foot bone ............................... *4.74 3.75 3.75 0.43 8.92 8.92 090

28290 ............ A Correction of bunion ........................................... *5.66 5.36 5.36 0.63 11.65 11.65 090

28292 ............ A Correction of bunion ........................................... *7.04 7.05 7.05 0.74 14.83 14.83 090

28293 ............ A Correction of bunion ........................................... *9.15 9.55 9.55 0.98 19.68 19.68 090

28294 ............ A Correction of bunion ........................................... *8.56 9.16 9.16 0.86 18.58 18.58 090

28296 ............ A Correction of bunion ........................................... *9.18 8.81 8.81 0.98 18.97 18.97 090

28297 ............ A Correction of bunion ........................................... *9.18 9.02 9.02 1.05 19.25 19.25 090

28298 ............ A Correction of bunion ........................................... *7.94 #8.73 #8.73 0.79 17.46 17.46 090

28299 ............ A Correction of bunion ........................................... *8.88 #9.77 #9.77 1.08 19.73 19.73 090

28300 ............ A Incision of heel bone .......................................... *9.54 6.52 6.52 0.79 16.85 16.85 090

28302 ............ A Incision of ankle bone ........................................ *9.55 8.89 8.89 1.12 19.56 19.56 090

28304 ............ A Incision of midfoot bones ................................... *9.16 6.44 6.44 0.70 16.30 16.30 090

28305 ............ A Incise/graft midfoot bones .................................. *10.50 9.85 9.85 1.03 21.38 21.38 090

28306 ............ A Incision of metatarsal ......................................... *5.86 4.57 4.57 0.47 10.90 10.90 090

28307 ............ A Incision of metatarsal ......................................... *6.33 5.87 5.87 0.76 12.96 12.96 090

28308 ............ A Incision of metatarsal ......................................... *5.29 5.71 5.71 0.50 11.50 11.50 090

28309 ............ A Incision of metatarsals ....................................... *12.78 6.87 6.87 1.00 20.65 20.65 090

28310 ............ A Revision of big toe ............................................. *5.43 4.17 4.17 0.42 10.02 10.02 090

28312 ............ A Revision of toe ................................................... *4.55 4.56 4.56 0.45 9.56 9.56 090

28313 ............ A Repair deformity of toe ...................................... *5.01 2.57 2.57 0.31 7.89 7.89 090

28315 ............ A Removal of sesamoid bone ............................... *4.86 4.24 4.24 0.41 9.51 9.51 090

28320 ............ A Repair of foot bones .......................................... *9.18 8.69 8.69 1.03 18.90 18.90 090

28322 ............ A Repair of metatarsals ......................................... *8.34 4.67 4.67 0.52 13.53 13.53 090

28340 ............ A Resect enlarged toe tissue ................................ *6.98 6.34 6.34 0.91 14.23 14.23 090

28341 ............ A Resect enlarged toe ........................................... *8.41 7.66 7.66 0.96 17.03 17.03 090

28344 ............ A Repair extra toe(s) ............................................. *4.26 3.70 3.70 0.60 8.56 8.56 090

28345 ............ A Repair webbed toe(s) ......................................... *5.92 5.34 5.34 0.73 11.99 11.99 090

28360 ............ A Reconstruct cleft foot ......................................... *13.34 11.91 11.91 1.95 27.20 27.20 090

28400 ............ A Treatment of heel fracture ................................. *2.16 2.57 2.57 0.40 5.13 5.13 090

28405 ............ A Treatment of heel fracture ................................. *4.57 3.90 3.90 0.58 9.05 9.05 090

28406 ............ A Treatment of heel fracture ................................. *6.31 6.09 6.09 0.93 13.33 13.33 090

28415 ............ A Repair of heel fracture ....................................... *15.97 9.02 9.02 1.39 26.38 26.38 090

28420 ............ A Repair/graft heel fracture ................................... *16.64 10.89 10.89 1.63 29.16 29.16 090

28430 ............ A Treatment of ankle fracture ................................ *2.09 2.45 2.45 0.35 4.89 4.89 090

28435 ............ A Treatment of ankle fracture ................................ *3.40 3.36 3.36 0.50 7.26 7.26 090

28436 ............ A Treatment of ankle fracture ................................ *4.71 4.19 4.19 0.68 9.58 9.58 090

28445 ............ A Repair of ankle fracture ..................................... *9.33 8.80 8.80 1.40 19.53 19.53 090

28450 ............ A Treat midfoot fracture, each ............................... *1.90 1.87 1.87 0.25 4.02 4.02 090

28455 ............ A Treat midfoot fracture, each ............................... *3.09 2.54 2.54 0.34 5.97 5.97 090

28456 ............ A Repair midfoot fracture ...................................... *2.68 2.27 2.27 0.38 5.33 5.33 090

28465 ............ A Repair midfoot fracture, each ............................ *7.01 5.54 5.54 0.81 13.36 13.36 090

28470 ............ A Treat metatarsal fracture .................................... *1.99 1.80 1.80 0.23 4.02 4.02 090

28475 ............ A Treat metatarsal fracture .................................... *2.97 2.34 2.34 0.30 5.61 5.61 090

28476 ............ A Repair metatarsal fracture ................................. *3.38 3.37 3.37 0.45 7.20 7.20 090

28485 ............ A Repair metatarsal fracture ................................. *5.71 4.68 4.68 0.60 10.99 10.99 090

28490 ............ A Treat big toe fracture ......................................... *1.09 0.90 0.90 0.10 2.09 2.09 090

28495 ............ A Treat big toe fracture ......................................... *1.58 1.12 1.12 0.13 2.83 2.83 090

28496 ............ A Repair big toe fracture ....................................... *2.33 2.07 2.07 0.31 4.71 4.71 090

28505 ............ A Repair big toe fracture ....................................... *3.81 2.99 2.99 0.43 7.23 7.23 090

28510 ............ A Treatment of toe fracture ................................... *1.09 0.89 0.89 0.09 2.07 2.07 090

28515 ............ A Treatment of toe fracture ................................... *1.46 1.12 1.12 0.11 2.69 2.69 090

28525 ............ A Repair of toe fracture ......................................... *3.32 2.06 2.06 0.29 5.67 5.67 090

28530 ............ A Treat sesamoid bone fracture ............................ *1.06 1.00 1.00 0.10 2.16 2.16 090

28531 ............ A Treat sesamoid bone fracture ............................ *2.35 1.91 1.91 0.32 4.58 4.58 090

28540 ............ A Treat foot dislocation .......................................... *2.04 0.60 0.60 0.06 2.70 2.70 090

28545 ............ A Treat foot dislocation .......................................... *2.45 1.31 1.31 0.14 3.90 3.90 090

28546 ............ A Treat foot dislocation .......................................... *3.20 2.74 2.74 0.45 6.39 6.39 090

28555 ............ A Repair foot dislocation ....................................... *6.30 5.58 5.58 0.73 12.61 12.61 090

28570 ............ A Treat foot dislocation .......................................... *1.66 1.59 1.59 0.17 3.42 3.42 090

28575 ............ A Treat foot dislocation .......................................... *3.31 2.77 2.77 0.42 6.50 6.50 090

28576 ............ A Treat foot dislocation .......................................... *4.17 2.77 2.77 0.42 7.36 7.36 090

28585 ............ A Repair foot dislocation ....................................... *7.99 4.96 4.96 0.55 13.50 13.50 090

28600 ............ A Treat foot dislocation .......................................... *1.89 0.68 0.68 0.08 2.65 2.65 090

28605 ............ A Treat foot dislocation .......................................... *2.71 2.26 2.26 0.34 5.31 5.31 090

28606 ............ A Treat foot dislocation .......................................... *4.90 3.49 3.49 0.55 8.94 8.94 090

28615 ............ A Repair foot dislocation ....................................... *7.77 4.96 4.96 0.78 13.51 13.51 090

28630 ............ A Treat toe dislocation ........................................... *1.70 1.03 1.03 0.11 2.84 2.84 010

28635 ............ A Treat toe dislocation ........................................... *1.91 1.45 1.45 0.18 3.54 3.54 010

28636 ............ A Treat toe dislocation ........................................... *2.77 2.56 2.56 0.42 5.75 5.75 010

28645 ............ A Repair toe dislocation ........................................ *4.22 3.24 3.24 0.38 7.84 7.84 090

28660 ............ A Treat toe dislocation ........................................... *1.23 0.63 0.63 0.06 1.92 1.92 010

28665 ............ A Treat toe dislocation ........................................... *1.92 0.98 0.98 0.11 3.01 3.01 010

28666 ............ A Treat toe dislocation ........................................... *2.66 2.44 2.44 0.40 5.50 5.50 010

28675 ............ A Repair of toe dislocation .................................... *2.92 3.00 3.00 0.41 6.33 6.33 090
59127

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

28705 ............ A Fusion of foot bones .......................................... *15.21 15.11 15.11 2.35 32.67 32.67 090

28715 ............ A Fusion of foot bones .......................................... *13.10 12.33 12.33 1.89 27.32 27.32 090

28725 ............ A Fusion of foot bones .......................................... *11.61 9.44 9.44 1.44 22.49 22.49 090

28730 ............ A Fusion of foot bones .......................................... *10.76 9.00 9.00 1.33 21.09 21.09 090

28735 ............ A Fusion of foot bones .......................................... *10.85 9.76 9.76 1.37 21.98 21.98 090

28737 ............ A Revision of foot bones ....................................... *9.64 8.87 8.87 1.13 19.64 19.64 090

28740 ............ A Fusion of foot bones .......................................... *8.02 5.14 5.14 0.72 13.88 13.88 090

28750 ............ A Fusion of big toe joint ........................................ *7.30 5.32 5.32 0.82 13.44 13.44 090

28755 ............ A Fusion of big toe joint ........................................ *4.74 3.69 3.69 0.45 8.88 8.88 090

28760 ............ A Fusion of big toe joint ........................................ *7.75 5.40 5.40 0.65 13.80 13.80 090

28800 ............ A Amputation of midfoot ........................................ *8.21 6.65 6.65 1.19 16.05 16.05 090

28805 ............ A Amputation thru metatarsal ................................ *8.39 6.32 6.32 1.21 15.92 15.92 090

28810 ............ A Amputation toe & metatarsal ............................. *6.21 3.91 3.91 0.75 10.87 10.87 090

28820 ............ A Amputation of toe ............................................... *4.41 2.58 2.58 0.46 7.45 7.45 090

28825 ............ A Partial amputation of toe .................................... *3.59 2.40 2.40 0.41 6.40 6.40 090

28899 ............ C Foot/toes surgery procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

29000 ............ A Application of body cast ..................................... 2.25 1.85 1.85 0.21 4.31 4.31 000

29010 ............ A Application of body cast ..................................... 2.06 2.33 #2.27 0.34 4.73 4.67 000

29015 ............ A Application of body cast ..................................... 2.41 2.33 2.33 0.33 5.07 5.07 000

29020 ............ A Application of body cast ..................................... 2.11 1.82 1.82 0.23 4.16 4.16 000

29025 ............ A Application of body cast ..................................... 2.40 0.75 0.75 0.14 3.29 3.29 000

29035 ............ A Application of body cast ..................................... 1.77 1.95 1.95 0.32 4.04 4.04 000

29040 ............ A Application of body cast ..................................... 2.22 2.02 2.02 0.30 4.54 4.54 000

29044 ............ A Application of body cast ..................................... 2.12 2.09 2.09 0.34 4.55 4.55 000

29046 ............ A Application of body cast ..................................... 2.41 2.23 2.23 0.36 5.00 5.00 000

29049 ............ A Application of figure eight .................................. 0.89 0.42 0.42 0.06 1.37 1.37 000

29055 ............ A Application of shoulder cast ............................... 1.78 1.20 1.20 0.17 3.15 3.15 000

29058 ............ A Application of shoulder cast ............................... 1.31 0.65 0.65 0.09 2.05 2.05 000

29065 ............ A Application of long arm cast .............................. 0.87 0.80 0.80 0.13 1.80 1.80 000

29075 ............ A Application of forearm cast ................................ 0.77 0.61 0.61 0.10 1.48 1.48 000

29085 ............ A Apply hand/wrist cast ......................................... 0.87 0.50 0.50 0.08 1.45 1.45 000

29105 ............ A Apply long arm splint ......................................... 0.87 0.50 0.50 0.08 1.45 1.45 000

29125 ............ A Apply forearm splint ........................................... 0.59 0.37 0.37 0.05 1.01 1.01 000

29126 ............ A Apply forearm splint ........................................... 0.77 0.40 0.40 0.06 1.23 1.23 000

29130 ............ A Application of finger splint .................................. 0.50 0.17 0.17 0.02 0.69 0.69 000

29131 ............ A Application of finger splint .................................. 0.55 0.39 0.39 0.06 1.00 1.00 000

29200 ............ A Strapping of chest .............................................. 0.65 0.27 0.27 0.03 0.95 0.95 000

29220 ............ A Strapping of low back ........................................ 0.64 0.38 0.38 0.05 1.07 1.07 000

29240 ............ A Strapping of shoulder ......................................... 0.71 0.27 0.27 0.03 1.01 1.01 000

29260 ............ A Strapping of elbow or wrist ................................ 0.55 0.23 0.23 0.03 0.81 0.81 000

29280 ............ A Strapping of hand or finger ................................ 0.51 0.21 0.21 0.02 0.74 0.74 000

29305 ............ A Application of hip cast ........................................ 2.03 1.88 1.88 0.31 4.22 4.22 000

29325 ............ A Application of hip casts ...................................... 2.32 1.94 1.94 0.28 4.54 4.54 000

29345 ............ A Application of long leg cast ................................ 1.40 1.02 1.02 0.16 2.58 2.58 000

29355 ............ A Application of long leg cast ................................ 1.53 1.10 1.10 0.17 2.80 2.80 000

29358 ............ A Apply long leg cast brace .................................. 1.43 #1.57 #1.57 0.33 3.33 3.33 000

29365 ............ A Application of long leg cast ................................ 1.18 0.86 0.86 0.14 2.18 2.18 000

29405 ............ A Apply short leg cast ........................................... 0.86 0.79 0.79 0.12 1.77 1.77 000

29425 ............ A Apply short leg cast ........................................... 1.01 0.97 0.97 0.14 2.12 2.12 000

29435 ............ A Apply short leg cast ........................................... 1.18 1.18 1.18 0.18 2.54 2.54 000

29440 ............ A Addition of walker to cast ................................... 0.57 0.23 0.23 0.03 0.83 0.83 000

29445 ............ A Apply rigid leg cast ............................................. 1.78 1.70 1.70 0.28 3.76 3.76 000

29450 ............ A Application of leg cast ........................................ 1.02 0.39 0.39 0.04 1.45 1.45 000

29505 ............ A Application long leg splint .................................. 0.69 0.57 0.57 0.07 1.33 1.33 000

29515 ............ A Application lower leg splint ................................ 0.73 0.47 0.47 0.06 1.26 1.26 000

29520 ............ A Strapping of hip .................................................. 0.54 0.36 0.36 0.03 0.93 0.93 000

29530 ............ A Strapping of knee ............................................... 0.57 0.35 0.35 0.05 0.97 0.97 000

29540 ............ A Strapping of ankle .............................................. 0.51 0.30 0.30 0.03 0.84 0.84 000

29550 ............ A Strapping of toes ................................................ 0.47 0.28 0.28 0.03 0.78 0.78 000

29580 ............ A Application of paste boot ................................... 0.57 0.79 0.79 0.04 1.40 1.40 000

29590 ............ A Application of foot splint ..................................... 0.76 0.28 0.28 0.03 1.07 1.07 000

29700 ............ A Removal/revision of cast .................................... 0.57 0.32 0.32 0.05 0.94 0.94 000

29705 ............ A Removal/revision of cast .................................... 0.76 0.35 0.35 0.05 1.16 1.16 000

29710 ............ A Removal/revision of cast .................................... 1.34 0.45 0.45 0.07 1.86 1.86 000

29715 ............ A Removal/revision of cast .................................... 0.94 0.86 0.86 0.12 1.92 1.92 000

29720 ............ A Repair of body cast ............................................ 0.68 0.23 0.23 0.04 0.95 0.95 000

29730 ............ A Windowing of cast .............................................. 0.75 0.26 0.26 0.04 1.05 1.05 000

29740 ............ A Wedging of cast ................................................. 1.12 0.38 0.38 0.06 1.56 1.56 000

29750 ............ A Wedging of clubfoot cast ................................... 1.26 0.50 0.50 0.07 1.83 1.83 000

29799 ............ C Casting/strapping procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

29800 ............ A Jaw arthroscopy/surgery .................................... *6.43 4.01 4.01 0.46 10.90 10.90 090

29804 ............ A Jaw arthroscopy/surgery .................................... *8.14 #8.95 #8.95 1.46 18.55 18.55 090

29815 ............ A Shoulder arthroscopy ......................................... *5.89 4.84 4.84 0.76 11.49 11.49 090

29819 ............ A Shoulder arthroscopy/surgery ............................ *7.62 #8.38 #8.38 1.73 17.73 17.73 090
59128

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

29820 ............ A Shoulder arthroscopy/surgery ............................ *7.07 #7.78 #7.78 1.73 16.58 16.58 090

29821 ............ A Shoulder arthroscopy/surgery ............................ *7.72 #8.49 #8.49 2.13 18.34 18.34 090

29822 ............ A Shoulder arthroscopy/surgery ............................ *7.43 #8.17 #8.17 1.74 17.34 17.34 090

29823 ............ A Shoulder arthroscopy/surgery ............................ *8.17 #8.99 #8.99 2.32 19.48 19.48 090

29825 ............ A Shoulder arthroscopy/surgery ............................ *7.62 #8.38 #8.38 2.05 18.05 18.05 090

29826 ............ A Shoulder arthroscopy/surgery ............................ *8.99 #9.89 #9.89 2.31 21.19 21.19 090

29830 ............ A Elbow arthroscopy .............................................. *5.76 5.32 5.32 0.83 11.91 11.91 090

29834 ............ A Elbow arthroscopy/surgery ................................. *6.28 5.84 5.84 0.96 13.08 13.08 090

29835 ............ A Elbow arthroscopy/surgery ................................. *6.48 6.03 6.03 0.99 13.50 13.50 090

29836 ............ A Elbow arthroscopy/surgery ................................. *7.55 7.03 7.03 1.15 15.73 15.73 090

29837 ............ A Elbow arthroscopy/surgery ................................. *6.87 6.40 6.40 1.06 14.33 14.33 090

29838 ............ A Elbow arthroscopy/surgery ................................. *7.71 7.05 7.05 1.14 15.90 15.90 090

29840 ............ A Wrist arthroscopy ............................................... *5.54 3.29 3.29 0.54 9.37 9.37 090

29843 ............ A Wrist arthroscopy/surgery .................................. *6.01 5.60 5.60 0.91 12.52 12.52 090

29844 ............ A Wrist arthroscopy/surgery .................................. *6.37 5.59 5.59 0.95 12.91 12.91 090

29845 ............ A Wrist arthroscopy/surgery .................................. *7.52 7.00 7.00 1.15 15.67 15.67 090

29846 ............ A Wrist arthroscopy/surgery .................................. *6.75 #7.43 #7.43 2.20 16.38 16.38 090

29847 ............ A Wrist arthroscopy/surgery .................................. *7.08 6.78 6.78 0.97 14.83 14.83 090

29848 ............ A Wrist arthroscopy/surgery .................................. *5.44 3.85 3.85 0.62 9.91 9.91 090

29850 ............ A Knee arthroscopy/surgery .................................. *8.19 #9.01 #9.01 1.74 18.94 18.94 090

29851 ............ A Knee arthroscopy/surgery .................................. *13.10 10.95 10.95 1.74 25.79 25.79 090

29855 ............ A Tibial arthroscopy/surgery .................................. *10.62 #11.68 #11.68 1.88 24.18 24.18 090

29856 ............ A Tibial arthroscopy/surgery .................................. *14.14 11.69 11.69 1.88 27.71 27.71 090

29860 ............ A Hip arthroscopy, dx ............................................ *8.05 4.84 4.84 0.76 13.65 13.65 090

29861 ............ A Hip arthroscopy/surgery ..................................... *9.15 9.38 9.38 1.73 20.26 20.26 090

29862 ............ A Hip arthroscopy/surgery ..................................... *9.90 10.07 10.07 2.32 22.29 22.29 090

29863 ............ A Hip arthroscopy/surgery ..................................... *9.90 8.72 8.72 1.73 20.35 20.35 090

29870 ............ A Knee arthroscopy, diagnostic ............................. *5.07 4.02 4.02 0.64 9.73 9.73 090

29871 ............ A Knee arthroscopy/drainage ................................ *6.55 6.77 6.77 0.96 14.28 14.28 090

29874 ............ A Knee arthroscopy/surgery .................................. *7.05 #7.76 #7.76 1.52 16.33 16.33 090

29875 ............ A Knee arthroscopy/surgery .................................. *6.31 #6.94 #6.94 1.61 14.86 14.86 090

29876 ............ A Knee arthroscopy/surgery .................................. *7.92 #8.71 #8.71 1.95 18.58 18.58 090

29877 ............ A Knee arthroscopy/surgery .................................. *7.35 #8.09 #8.09 1.81 17.25 17.25 090

29879 ............ A Knee arthroscopy/surgery .................................. *8.04 #8.84 #8.84 2.19 19.07 19.07 090

29880 ............ A Knee arthroscopy/surgery .................................. *8.50 #9.35 #9.35 2.22 20.07 20.07 090

29881 ............ A Knee arthroscopy/surgery .................................. *7.76 #8.54 #8.54 1.82 18.12 18.12 090

29882 ............ A Knee arthroscopy/surgery .................................. *8.65 #9.52 #9.52 1.90 20.07 20.07 090

29883 ............ A Knee arthroscopy/surgery .................................. *9.46 #10.41 #10.41 2.80 22.67 22.67 090

29884 ............ A Knee arthroscopy/surgery .................................. *7.33 #8.06 #8.06 1.56 16.95 16.95 090

29885 ............ A Knee arthroscopy/surgery .................................. *9.09 8.23 8.23 1.35 18.67 18.67 090

29886 ............ A Knee arthroscopy/surgery .................................. *7.54 6.80 6.80 1.12 15.46 15.46 090

29887 ............ A Knee arthroscopy/surgery .................................. *9.04 #9.94 #9.94 1.71 20.69 20.69 090

29888 ............ A Knee arthroscopy/surgery .................................. *13.90 #15.29 #15.29 3.18 32.37 32.37 090

29889 ............ A Knee arthroscopy/surgery .................................. *15.13 10.26 10.26 1.68 27.07 27.07 090

29891 ............ A Ankle arthroscopy/surgery ................................. *8.40 8.86 8.86 1.77 19.03 19.03 090

29892 ............ A Ankle arthroscopy/surgery ................................. *9.00 8.86 8.86 1.77 19.63 19.63 090

29893 ............ A Scope, plantar fasciotomy .................................. *5.22 5.20 5.20 0.46 10.88 10.88 090

29894 ............ A Ankle arthroscopy/surgery ................................. *7.21 #7.93 #7.93 1.47 16.61 16.61 090

29895 ............ A Ankle arthroscopy/surgery ................................. *6.99 #7.69 #7.69 1.51 16.19 16.19 090

29897 ............ A Ankle arthroscopy/surgery ................................. *7.18 #7.90 #7.90 1.77 16.85 16.85 090

29898 ............ A Ankle arthroscopy/surgery ................................. *8.32 #9.15 #9.15 1.91 19.38 19.38 090

29909 ............ C Arthroscopy of joint ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

30000 ............ A Drainage of nose lesion ..................................... *1.43 0.58 0.58 0.05 2.06 2.06 010

30020 ............ A Drainage of nose lesion ..................................... *1.43 0.60 0.60 0.06 2.09 2.09 010

30100 ............ A Intranasal biopsy ................................................ 0.94 0.69 0.69 0.08 1.71 1.71 000

30110 ............ A Removal of nose polyp(s) .................................. *1.63 1.29 1.29 0.14 3.06 3.06 010

30115 ............ A Removal of nose polyp(s) .................................. *4.35 2.81 2.81 0.30 7.46 7.46 090

30117 ............ A Removal of intranasal lesion .............................. *3.16 2.84 2.84 0.31 6.31 6.31 090

30118 ............ A Removal of intranasal lesion .............................. *9.69 8.01 8.01 0.92 18.62 18.62 090

30120 ............ A Revision of nose ................................................ *5.27 #5.80 #5.80 1.00 12.07 12.07 090

30124 ............ A Removal of nose lesion ..................................... *3.10 1.34 1.34 0.16 4.60 4.60 090

30125 ............ A Removal of nose lesion ..................................... *7.16 5.55 5.55 0.73 13.44 13.44 090

30130 ............ A Removal of turbinate bones ............................... *3.38 1.67 1.67 0.17 5.22 5.22 090

30140 ............ A Removal of turbinate bones ............................... *3.43 3.04 3.04 0.34 6.81 6.81 090

30150 ............ A Partial removal of nose ...................................... *9.14 7.92 7.92 1.07 18.13 18.13 090

30160 ............ A Removal of nose ................................................ *9.58 #10.54 #10.54 1.73 21.85 21.85 090

30200 ............ A Injection treatment of nose ................................ 0.78 0.37 0.37 0.04 1.19 1.19 000

30210 ............ A Nasal sinus therapy ........................................... *1.08 0.26 0.26 0.03 1.37 1.37 010

30220 ............ A Insert nasal septal button ................................... *1.54 1.51 1.51 0.16 3.21 3.21 010

30300 ............ A Remove nasal foreign body ............................... *1.04 0.46 0.46 0.05 1.55 1.55 010

30310 ............ A Remove nasal foreign body ............................... *1.96 1.62 1.62 0.18 3.76 3.76 010

30320 ............ A Remove nasal foreign body ............................... *4.52 4.29 4.29 0.43 9.24 9.24 090

30400 ............ R Reconstruction of nose ...................................... *9.83 9.97 9.97 1.36 21.16 21.16 090

30410 ............ R Reconstruction of nose ...................................... *12.98 #14.28 #14.28 2.01 29.27 29.27 090
59129

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

30420 ............ R Reconstruction of nose ...................................... *15.88 #17.47 #17.47 2.22 35.57 35.57 090

30430 ............ R Revision of nose ................................................ *7.21 6.09 6.09 0.66 13.96 13.96 090

30435 ............ R Revision of nose ................................................ *11.71 10.17 10.17 1.10 22.98 22.98 090

30450 ............ R Revision of nose ................................................ *18.65 11.24 11.24 0.91 30.80 30.80 090

30460 ............ A Revision of nose ................................................ *9.96 8.58 8.58 0.93 19.47 19.47 090

30462 ............ A Revision of nose ................................................ *19.57 17.16 17.16 1.87 38.60 38.60 090

30520 ............ A Repair of nasal septum ...................................... *5.70 #6.27 #6.27 0.96 12.93 12.93 090

30540 ............ A Repair nasal defect ............................................ *7.75 6.63 6.63 0.70 15.08 15.08 090

30545 ............ A Repair nasal defect ............................................ *11.38 10.83 10.83 0.93 23.14 23.14 090

30560 ............ A Release of nasal adhesions ............................... *1.26 0.55 0.55 0.06 1.87 1.87 010

30580 ............ A Repair upper jaw fistula ..................................... *6.69 6.24 6.24 0.57 13.50 13.50 090

30600 ............ A Repair mouth/nose fistula .................................. *6.02 3.77 3.77 0.36 10.15 10.15 090

30620 ............ A Intranasal reconstruction .................................... *5.97 #6.57 #6.57 1.10 13.64 13.64 090

30630 ............ A Repair nasal septum defect ............................... *7.12 6.24 6.24 0.71 14.07 14.07 090

30801 ............ A Cauterization inner nose .................................... *1.09 0.47 0.47 0.05 1.61 1.61 010

30802 ............ A Cauterization inner nose .................................... *2.03 0.94 0.94 0.11 3.08 3.08 010

30901 ............ A Control of nosebleed .......................................... 1.21 0.56 0.56 0.06 1.83 1.83 000

30903 ............ A Control of nosebleed .......................................... 1.54 0.85 0.85 0.08 2.47 2.47 000

30905 ............ A Control of nosebleed .......................................... 1.97 1.79 1.79 0.17 3.93 3.93 000

30906 ............ A Repeat control of nosebleed .............................. 2.45 1.08 1.08 0.11 3.64 3.64 000

30915 ............ A Ligation nasal sinus artery ................................. *7.20 4.95 4.95 0.52 12.67 12.67 090

30920 ............ A Ligation upper jaw artery ................................... *9.83 9.54 9.54 1.32 20.69 20.69 090

30930 ............ A Therapy fracture of nose .................................... *1.26 0.71 0.71 0.08 2.05 2.05 010

30999 ............ C Nasal surgery procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

31000 ............ A Irrigation maxillary sinus .................................... *1.15 0.43 0.43 0.05 1.63 1.63 010

31002 ............ A Irrigation sphenoid sinus .................................... *1.91 0.46 0.46 0.05 2.42 2.42 010

31020 ............ A Exploration maxillary sinus ................................ *2.94 2.66 2.66 0.29 5.89 5.89 090

31030 ............ A Exploration maxillary sinus ................................ *5.92 #6.51 #6.51 0.86 13.29 13.29 090

31032 ............ A Explore sinus, remove polyps ............................ *6.57 #7.23 #7.23 0.99 14.79 14.79 090

31040 ............ A Exploration behind upper jaw ............................ *9.42 7.98 7.98 0.86 18.26 18.26 090

31050 ............ A Exploration sphenoid sinus ................................ *5.28 #5.81 #5.81 0.64 11.73 11.73 090

31051 ............ A Sphenoid sinus surgery ..................................... *7.11 #7.82 #7.82 0.85 15.78 15.78 090

31070 ............ A Exploration of frontal sinus ................................ *4.28 4.69 4.69 0.50 9.47 9.47 090

31075 ............ A Exploration of frontal sinus ................................ *9.16 #10.08 #10.08 1.10 20.34 20.34 090

31080 ............ A Removal of frontal sinus .................................... *11.42 9.21 9.21 1.12 21.75 21.75 090

31081 ............ A Removal of frontal sinus .................................... *12.75 10.32 10.32 1.30 24.37 24.37 090

31084 ............ A Removal of frontal sinus .................................... *13.51 14.79 14.79 1.62 29.92 29.92 090

31085 ............ A Removal of frontal sinus .................................... *14.20 #15.62 #15.62 1.76 31.58 31.58 090

31086 ............ A Removal of frontal sinus .................................... *12.86 10.87 10.87 1.15 24.88 24.88 090

31087 ............ A Removal of frontal sinus .................................... *13.10 10.39 10.39 1.33 24.82 24.82 090

31090 ............ A Exploration of sinuses ........................................ *9.53 #10.48 #10.48 2.12 22.13 22.13 090

31200 ............ A Removal of ethmoid sinus ................................. *4.97 4.62 4.62 0.48 10.07 10.07 090

31201 ............ A Removal of ethmoid sinus ................................. *8.37 7.01 7.01 0.75 16.13 16.13 090

31205 ............ A Removal of ethmoid sinus ................................. *10.24 8.03 8.03 0.81 19.08 19.08 090

31225 ............ A Removal of upper jaw ........................................ *19.23 19.44 19.44 2.37 41.04 41.04 090

31230 ............ A Removal of upper jaw ........................................ *21.94 21.74 21.74 2.48 46.16 46.16 090

31231 ............ A Nasal endoscopy, dx .......................................... 1.10 1.37 1.37 0.15 2.62 2.62 000

31233 ............ A Nasal/sinus endoscopy, dx ................................ 2.18 2.79 2.79 0.31 5.28 5.28 000

31235 ............ A Nasal/sinus endoscopy, dx ................................ 2.64 2.39 2.39 0.26 5.29 5.29 000

31237 ............ A Nasal/sinus endoscopy, surg ............................. 2.98 #3.28 #3.28 0.37 6.63 6.63 000

31238 ............ A Nasal/sinus endoscopy, surg ............................. 3.26 #3.59 #3.59 0.45 7.30 7.30 000

31239 ............ A Nasal/sinus endoscopy, surg ............................. *8.70 #9.57 #9.57 1.18 19.45 19.45 010

31240 ............ A Nasal/sinus endoscopy, surg ............................. 2.61 #2.87 #2.87 0.37 5.85 5.85 000

31254 ............ A Revision of ethmoid sinus .................................. 4.65 #5.12 #5.12 0.69 10.46 10.46 000

31255 ............ A Removal of ethmoid sinus ................................. 6.96 #7.66 #7.66 1.14 15.76 15.76 000

31256 ............ A Exploration maxillary sinus ................................ 3.29 #3.62 #3.62 0.41 7.32 7.32 000

31267 ............ A Endoscopy, maxillary sinus ................................ 5.46 5.23 5.23 0.81 11.50 11.50 000

31276 ............ A Sinus surgical endoscopy .................................. 8.85 6.72 6.72 0.73 16.30 16.30 000

31287 ............ A Nasal/sinus endoscopy, surg ............................. 3.92 #4.31 #4.31 0.65 8.88 8.88 000

31288 ............ A Nasal/sinus endoscopy, surg ............................. 4.58 #5.04 #5.04 0.78 10.40 10.40 000

31290 ............ A Nasal/sinus endoscopy, surg ............................. *17.24 16.47 16.47 1.80 35.51 35.51 010

31291 ............ A Nasal/sinus endoscopy, surg ............................. *18.19 17.31 17.31 1.88 37.38 37.38 010

31292 ............ A Nasal/sinus endoscopy, surg ............................. *14.76 13.38 13.38 1.45 29.59 29.59 010

31293 ............ A Nasal/sinus endoscopy, surg ............................. *16.21 14.64 14.64 1.59 32.44 32.44 010

31294 ............ A Nasal/sinus endoscopy, surg ............................. *19.06 16.72 16.72 1.83 37.61 37.61 010

31299 ............ C Sinus surgery procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

31300 ............ A Removal of larynx lesion .................................... *14.29 11.58 11.58 1.28 27.15 27.15 090

31320 ............ A Diagnostic incision larynx ................................... *5.26 3.87 3.87 0.48 9.61 9.61 090

31360 ............ A Removal of larynx .............................................. *17.08 #18.79 #18.79 2.19 38.06 38.06 090

31365 ............ A Removal of larynx .............................................. *24.16 #26.58 #26.58 3.10 53.84 53.84 090

31367 ............ A Partial removal of larynx .................................... *21.86 17.22 17.22 1.88 40.96 40.96 090

31368 ............ A Partial removal of larynx .................................... *27.09 26.76 26.76 3.06 56.91 56.91 090

31370 ............ A Partial removal of larynx .................................... *21.38 17.18 17.18 1.88 40.44 40.44 090

31375 ............ A Partial removal of larynx .................................... *20.21 14.84 14.84 1.56 36.61 36.61 090
59130

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

31380 ............ A Partial removal of larynx .................................... *20.21 17.27 17.27 1.88 39.36 39.36 090

31382 ............ A Partial removal of larynx .................................... *20.52 16.06 16.06 1.78 38.36 38.36 090

31390 ............ A Removal of larynx & pharynx ............................. *27.53 27.08 27.08 4.05 58.66 58.66 090

31395 ............ A Reconstruct larynx & pharynx ............................ *31.09 33.52 33.52 4.42 69.03 69.03 090

31400 ............ A Revision of larynx ............................................... *10.31 7.81 7.81 0.91 19.03 19.03 090

31420 ............ A Removal of epiglottis .......................................... *10.22 8.08 8.08 0.84 19.14 19.14 090

31500 ............ A Insert emergency airway .................................... 2.33 1.14 1.14 0.14 3.61 3.61 000

31502 ............ A Change of windpipe airway ................................ 0.65 0.58 0.58 0.07 1.30 1.30 000

31505 ............ A Diagnostic laryngoscopy .................................... 0.61 0.43 0.43 0.05 1.09 1.09 000

31510 ............ A Laryngoscopy with biopsy .................................. 1.92 0.55 0.55 0.07 2.54 2.54 000

31511 ............ A Remove foreign body, larynx ............................. 2.16 0.96 0.96 0.10 3.22 3.22 000

31512 ............ A Removal of larynx lesion .................................... 2.07 1.79 1.79 0.20 4.06 4.06 000

31513 ............ A Injection into vocal cord ..................................... 2.10 #2.31 #2.31 0.38 4.79 4.79 000

31515 ............ A Laryngoscopy for aspiration ............................... 1.80 1.13 1.13 0.14 3.07 3.07 000

31520 ............ A Diagnostic laryngoscopy .................................... 2.56 1.64 1.64 0.18 4.38 4.38 000

31525 ............ A Diagnostic laryngoscopy .................................... 2.63 2.20 2.20 0.23 5.06 5.06 000

31526 ............ A Diagnostic laryngoscopy .................................... 2.57 #2.83 #2.83 0.38 5.78 5.78 000

31527 ............ A Laryngoscopy for treatment ............................... 3.27 2.99 2.99 0.30 6.56 6.56 000

31528 ............ A Laryngoscopy and dilatation .............................. 2.37 #2.61 #2.61 0.30 5.28 5.28 000

31529 ............ A Laryngoscopy and dilatation .............................. 2.68 2.46 2.46 0.25 5.39 5.39 000

31530 ............ A Operative laryngoscopy ..................................... 3.39 3.63 3.63 0.39 7.41 7.41 000

31531 ............ A Operative laryngoscopy ..................................... 3.59 #3.95 #3.95 0.60 8.14 8.14 000

31535 ............ A Operative laryngoscopy ..................................... 3.16 #3.48 #3.48 0.45 7.09 7.09 000

31536 ............ A Operative laryngoscopy ..................................... 3.56 #3.92 #3.92 0.59 8.07 8.07 000

31540 ............ A Operative laryngoscopy ..................................... 4.13 #4.54 #4.54 0.61 9.28 9.28 000

31541 ............ A Operative laryngoscopy ..................................... 4.53 4.56 4.56 0.75 9.84 9.84 000

31560 ............ A Operative laryngoscopy ..................................... 5.46 4.99 4.99 0.51 10.96 10.96 000

31561 ............ A Operative laryngoscopy ..................................... 6.00 6.27 6.27 1.08 13.35 13.35 000

31570 ............ A Laryngoscopy with injection ............................... 3.87 #4.26 #4.26 0.60 8.73 8.73 000

31571 ............ A Laryngoscopy with injection ............................... 4.27 4.51 4.51 0.69 9.47 9.47 000

31575 ............ A Diagnostic laryngoscopy .................................... 1.10 1.56 1.56 0.17 2.83 2.83 000

31576 ............ A Laryngoscopy with biopsy .................................. 1.97 #2.17 #2.17 0.33 4.47 4.47 000

31577 ............ A Remove foreign body, larynx ............................. 2.47 #2.72 #2.72 0.37 5.56 5.56 000

31578 ............ A Removal of larynx lesion .................................... 2.84 #3.12 #3.12 0.48 6.44 6.44 000

31579 ............ A Diagnostic laryngoscopy .................................... 2.26 2.33 2.33 0.26 4.85 4.85 000

31580 ............ A Revision of larynx ............................................... *12.38 #13.62 #13.62 1.63 27.63 27.63 090

31582 ............ A Revision of larynx ............................................... *21.62 17.87 17.87 1.94 41.43 41.43 090

31584 ............ A Repair of larynx fracture .................................... *19.64 12.72 12.72 1.34 33.70 33.70 090

31585 ............ A Repair of larynx fracture .................................... *4.64 3.77 3.77 0.40 8.81 8.81 090

31586 ............ A Repair of larynx fracture .................................... *8.03 6.55 6.55 0.71 15.29 15.29 090

31587 ............ A Revision of larynx ............................................... *11.99 7.21 7.21 0.79 19.99 19.99 090

31588 ............ A Revision of larynx ............................................... *13.11 10.70 10.70 1.16 24.97 24.97 090

31590 ............ A Reinnervate larynx ............................................. *6.97 5.76 5.76 0.62 13.35 13.35 090

31595 ............ A Larynx nerve surgery ......................................... *8.34 6.84 6.84 0.74 15.92 15.92 090

31599 ............ C Larynx surgery procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

31600 ............ A Incision of windpipe ............................................ 3.62 #3.98 #3.98 0.65 8.25 8.25 000

31601 ............ A Incision of windpipe ............................................ 4.45 #4.90 #4.90 0.66 10.01 10.01 000

31603 ............ A Incision of windpipe ............................................ 4.15 4.23 4.23 0.66 9.04 9.04 000

31605 ............ A Incision of windpipe ............................................ 3.58 #3.94 #3.94 0.50 8.02 8.02 000

31610 ............ A Incision of windpipe ............................................ *8.76 6.67 6.67 0.92 16.35 16.35 090

31611 ............ A Surgery/speech prosthesis ................................. *5.64 6.45 6.45 1.04 13.13 13.13 090

31612 ............ A Puncture/clear windpipe ..................................... 0.91 1.17 #1.00 0.12 2.20 2.03 000

31613 ............ A Repair windpipe opening ................................... *4.59 2.21 2.21 0.28 7.08 7.08 090

31614 ............ A Repair windpipe opening ................................... *7.12 6.74 6.74 0.73 14.59 14.59 090

31615 ............ A Visualization of windpipe .................................... 2.09 1.95 1.95 0.22 4.26 4.26 000

31622 ............ A Diagnostic bronchoscopy ................................... 2.80 #3.08 #3.08 0.34 6.22 6.22 000

31625 ............ A Bronchoscopy with biopsy ................................. 3.37 #3.71 #3.71 0.35 7.43 7.43 000

31628 ............ A Bronchoscopy with biopsy ................................. 3.81 #4.19 #4.19 0.38 8.38 8.38 000

31629 ............ A Bronchoscopy with biopsy ................................. 3.37 #3.71 #3.71 0.34 7.42 7.42 000

31630 ............ A Bronchoscopy with repair ................................... 3.82 3.72 3.72 0.50 8.04 8.04 000

31631 ............ A Bronchoscopy with dilation ................................ 4.37 3.94 3.94 0.48 8.79 8.79 000

31635 ............ A Remove foreign body, airway ............................ 3.68 #4.05 #4.05 0.53 8.26 8.26 000

31640 ............ A Bronchoscopy & remove lesion ......................... 4.94 5.02 5.02 0.67 10.63 10.63 000

31641 ............ A Bronchoscopy, treat blockage ............................ 5.03 #5.53 #5.53 0.85 11.41 11.41 000

31645 ............ A Bronchoscopy, clear airways ............................. 3.16 #3.48 #3.48 0.30 6.94 6.94 000

31646 ............ A Bronchoscopy, reclear airways .......................... 2.72 #2.99 #2.99 0.27 5.98 5.98 000

31656 ............ A Bronchoscopy, inject for x-ray ........................... 2.17 #2.39 #2.39 0.31 4.87 4.87 000

31700 ............ A Insertion of airway catheter ................................ 1.34 1.38 1.38 0.17 2.89 2.89 000

31708 ............ A Instill airway contrast dye ................................... 1.41 0.77 0.77 0.09 2.27 2.27 000

31710 ............ A Insertion of airway catheter ................................ 1.30 0.90 0.90 0.12 2.32 2.32 000

31715 ............ A Injection for bronchus x-ray ............................... 1.11 0.48 0.48 0.04 1.63 1.63 000

31717 ............ A Bronchial brush biopsy ....................................... 2.12 0.73 0.73 0.06 2.91 2.91 000

31720 ............ A Clearance of airways ......................................... 1.06 0.74 0.74 0.09 1.89 1.89 000

31725 ............ A Clearance of airways ......................................... 1.96 1.41 1.41 0.15 3.52 3.52 000
59131

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

31730 ............ A Intro windpipe wire/tube ..................................... 2.85 2.47 2.47 0.23 5.55 5.55 000

31750 ............ A Repair of windpipe ............................................. *13.02 8.88 8.88 1.09 22.99 22.99 090

31755 ............ A Repair of windpipe ............................................. *15.93 13.30 13.30 1.44 30.67 30.67 090

31760 ............ A Repair of windpipe ............................................. *22.35 10.92 10.92 2.55 35.82 35.82 090

31766 ............ A Reconstruction of windpipe ................................ *30.43 18.40 18.40 1.12 49.95 49.95 090

31770 ............ A Repair/graft of bronchus .................................... *22.51 15.07 15.07 2.08 39.66 39.66 090

31775 ............ A Reconstruct bronchus ........................................ *23.54 16.37 16.37 1.92 41.83 41.83 090

31780 ............ A Reconstruct windpipe ......................................... *17.72 17.33 17.33 2.08 37.13 37.13 090

31781 ............ A Reconstruct windpipe ......................................... *23.53 16.86 16.86 1.96 42.35 42.35 090

31785 ............ A Remove windpipe lesion .................................... *17.23 8.92 8.92 1.17 27.32 27.32 090

31786 ............ A Remove windpipe lesion .................................... *23.98 13.30 13.30 2.24 39.52 39.52 090

31800 ............ A Repair of windpipe injury ................................... *7.43 4.90 4.90 0.76 13.09 13.09 090

31805 ............ A Repair of windpipe injury ................................... *13.13 9.82 9.82 1.41 24.36 24.36 090

31820 ............ A Closure of windpipe lesion ................................. *4.49 3.58 3.58 0.46 8.53 8.53 090

31825 ............ A Repair of windpipe defect .................................. *6.81 5.00 5.00 0.58 12.39 12.39 090

31830 ............ A Revise windpipe scar ......................................... *4.50 3.66 3.66 0.42 8.58 8.58 090

31899 ............ C Airways surgical procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

32000 ............ A Drainage of chest ............................................... 1.54 0.90 0.90 0.08 2.52 2.52 000

32002 ............ A Treatment of collapsed lung .............................. 2.19 1.34 1.34 0.22 3.75 3.75 000

32005 ............ A Treat lung lining chemically ............................... 2.19 1.09 1.09 0.15 3.43 3.43 000

32020 ............ A Insertion of chest tube ....................................... 3.98 2.63 2.63 0.43 7.04 7.04 000

32035 ............ A Exploration of chest ........................................... *8.67 6.76 6.76 1.25 16.68 16.68 090

32036 ............ A Exploration of chest ........................................... *9.68 7.13 7.13 1.32 18.13 18.13 090

32095 ............ A Biopsy through chest wall .................................. *8.36 8.25 8.25 1.45 18.06 18.06 090

32100 ............ A Exploration/biopsy of chest ................................ *11.84 11.24 11.24 2.10 25.18 25.18 090

32110 ............ A Explore/repair chest ........................................... *13.62 11.51 11.51 2.01 27.14 27.14 090

32120 ............ A Re-exploration of chest ...................................... *11.54 9.45 9.45 1.72 22.71 22.71 090

32124 ............ A Explore chest, free adhesions ........................... *12.72 10.94 10.94 2.21 25.87 25.87 090

32140 ............ A Removal of lung lesion(s) .................................. *13.93 12.37 12.37 2.42 28.72 28.72 090

32141 ............ A Remove/treat lung lesions ................................. *14.00 13.42 13.42 2.53 29.95 29.95 090

32150 ............ A Removal of lung lesion(s) .................................. *14.15 10.34 10.34 2.01 26.50 26.50 090

32151 ............ A Remove lung foreign body ................................. *14.21 9.15 9.15 1.37 24.73 24.73 090

32160 ............ A Open chest heart massage ................................ *9.30 9.13 9.13 1.52 19.95 19.95 090

32200 ............ A Open drainage, lung lesion ................................ *15.29 6.89 6.89 0.93 23.11 23.11 090

32201 ............ A Percut drainage, lung lesion .............................. 4.00 3.03 3.03 0.35 7.38 7.38 000

32215 ............ A Treat chest lining ................................................ *11.33 7.62 7.62 1.28 20.23 20.23 090

32220 ............ A Release of lung .................................................. *19.27 15.81 15.81 3.01 38.09 38.09 090

32225 ............ A Partial release of lung ........................................ *13.96 11.84 11.84 2.28 28.08 28.08 090

32310 ............ A Removal of chest lining ...................................... *13.44 11.64 11.64 2.10 27.18 27.18 090

32320 ............ A Free/remove chest lining .................................... *20.54 18.10 18.10 3.40 42.04 42.04 090

32400 ............ A Needle biopsy chest lining ................................. 1.76 1.48 1.48 0.12 3.36 3.36 000

32402 ............ A Open biopsy chest lining .................................... *7.56 7.58 7.58 1.34 16.48 16.48 090

32405 ............ A Biopsy, lung or mediastinum .............................. 1.93 2.12 2.12 0.18 4.23 4.23 000

32420 ............ A Puncture/clear lung ............................................ 2.18 1.50 1.50 0.13 3.81 3.81 000

32440 ............ A Removal of lung ................................................. *21.02 18.56 18.56 3.55 43.13 43.13 090

32442 ............ A Sleeve pneumonectomy ..................................... *26.24 17.94 17.94 3.50 47.68 47.68 090

32445 ............ A Removal of lung ................................................. *25.09 20.46 20.46 3.88 49.43 49.43 090

32480 ............ A Partial removal of lung ....................................... *18.32 17.15 17.15 3.23 38.70 38.70 090

32482 ............ A Bilobectomy ........................................................ *19.71 17.15 17.15 3.23 40.09 40.09 090

32484 ............ A Segmentectomy ................................................. *20.69 17.15 17.15 3.23 41.07 41.07 090

32486 ............ A Sleeve lobectomy ............................................... *23.92 16.54 16.54 3.23 43.69 43.69 090

32488 ............ A Completion pneumonectomy ............................. *25.71 17.74 17.74 3.46 46.91 46.91 090

32491 ............ R Lung volume reduction ....................................... 21.25 15.45 15.45 3.02 39.72 39.72 090

32500 ............ A Partial removal of lung ....................................... *14.30 13.47 13.47 2.56 30.33 30.33 090

32501 ............ A Repair bronchus (add-on) .................................. 4.69 4.31 4.31 0.70 9.70 9.70 ZZZ

32520 ............ A Remove lung & revise chest .............................. *21.68 20.67 20.67 3.93 46.28 46.28 090

32522 ............ A Remove lung & revise chest .............................. *24.20 21.90 21.90 4.19 50.29 50.29 090

32525 ............ A Remove lung & revise chest .............................. *26.50 23.50 23.50 4.61 54.61 54.61 090

32540 ............ A Removal of lung lesion ...................................... *14.64 11.67 11.67 2.05 28.36 28.36 090

32601 ............ A Thoracoscopy, diagnostic .................................. 5.46 3.47 3.47 0.57 9.50 9.50 000

32602 ............ A Thoracoscopy, diagnostic .................................. 5.96 3.87 3.87 0.64 10.47 10.47 000

32603 ............ A Thoracoscopy, diagnostic .................................. 7.81 3.47 3.47 0.57 11.85 11.85 000

32604 ............ A Thoracoscopy, diagnostic .................................. 8.78 3.87 3.87 0.64 13.29 13.29 000

32605 ............ A Thoracoscopy, diagnostic .................................. 6.93 3.47 3.47 0.57 10.97 10.97 000

32606 ............ A Thoracoscopy, diagnostic .................................. 8.40 3.87 3.87 0.64 12.91 12.91 000

32650 ............ A Thoracoscopy, surgical ...................................... *10.75 7.62 7.62 1.28 19.65 19.65 090

32651 ............ A Thoracoscopy, surgical ...................................... *12.91 11.84 11.84 2.28 27.03 27.03 090

32652 ............ A Thoracoscopy, surgical ...................................... *18.66 15.81 15.81 3.01 37.48 37.48 090

32653 ............ A Thoracoscopy, surgical ...................................... *12.87 10.34 10.34 2.01 25.22 25.22 090

32654 ............ A Thoracoscopy, surgical ...................................... *12.44 11.51 11.51 2.01 25.96 25.96 090

32655 ............ A Thoracoscopy, surgical ...................................... *13.10 13.42 13.42 2.53 29.05 29.05 090

32656 ............ A Thoracoscopy, surgical ...................................... *12.91 13.36 13.36 2.36 28.63 28.63 090

32657 ............ A Thoracoscopy, surgical ...................................... *13.65 13.47 13.47 2.56 29.68 29.68 090

32658 ............ A Thoracoscopy, surgical ...................................... *11.63 #12.79 #12.79 2.52 26.94 26.94 090
59132

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

32659 ............ A Thoracoscopy, surgical ...................................... *11.59 #12.75 #12.75 2.61 26.95 26.95 090

32660 ............ A Thoracoscopy, surgical ...................................... *17.43 #19.17 #19.17 3.56 40.16 40.16 090

32661 ............ A Thoracoscopy, surgical ...................................... *13.25 9.25 9.25 1.47 23.97 23.97 090

32662 ............ A Thoracoscopy, surgical ...................................... *16.44 14.55 14.55 2.74 33.73 33.73 090

32663 ............ A Thoracoscopy, surgical ...................................... *18.47 17.15 17.15 3.23 38.85 38.85 090

32664 ............ A Thoracoscopy, surgical ...................................... *14.20 10.55 10.55 2.04 26.79 26.79 090

32665 ............ A Thoracoscopy, surgical ...................................... *15.54 14.33 14.33 2.64 32.51 32.51 090

32800 ............ A Repair lung hernia .............................................. *13.69 8.28 8.28 1.58 23.55 23.55 090

32810 ............ A Close chest after drainage ................................. *13.05 6.50 6.50 1.19 20.74 20.74 090

32815 ............ A Close bronchial fistula ........................................ *23.15 15.22 15.22 2.62 40.99 40.99 090

32820 ............ A Reconstruct injured chest .................................. *21.48 19.01 19.01 3.24 43.73 43.73 090

32850 ............ X Donor pneumonectomy ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

32851 ............ A Lung transplant, single ....................................... *38.63 25.55 25.55 4.99 69.17 69.17 090

32852 ............ A Lung transplant w/bypass .................................. *41.80 27.71 27.71 5.41 74.92 74.92 090

32853 ............ A Lung transplant, double ..................................... *47.81 31.94 31.94 6.24 85.99 85.99 090

32854 ............ A Lung transplant w/bypass .................................. *50.98 34.10 34.10 6.67 91.75 91.75 090

32900 ............ A Removal of rib(s) ................................................ *20.27 8.47 8.47 1.63 30.37 30.37 090

32905 ............ A Revise & repair chest wall ................................. *20.75 12.74 12.74 2.60 36.09 36.09 090

32906 ............ A Revise & repair chest wall ................................. *26.77 15.42 15.42 2.92 45.11 45.11 090

32940 ............ A Revision of lung ................................................. *19.43 11.37 11.37 1.75 32.55 32.55 090

32960 ............ A Therapeutic pneumothorax ................................ 1.84 0.93 0.93 0.13 2.90 2.90 000

32999 ............ C Chest surgery procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

33010 ............ A Drainage of heart sac ........................................ 2.24 1.54 1.54 0.14 3.92 3.92 000

33011 ............ A Repeat drainage of heart sac ............................ 2.24 1.11 1.11 0.12 3.47 3.47 000

33015 ............ A Incision of heart sac ........................................... *6.80 4.26 4.26 0.62 11.68 11.68 090

33020 ............ A Incision of heart sac ........................................... *12.61 13.26 13.26 2.52 28.39 28.39 090

33025 ............ A Incision of heart sac ........................................... *12.09 #13.30 #13.30 2.61 28.00 28.00 090

33030 ............ A Partial removal of heart sac ............................... *18.71 #20.58 #20.58 3.92 43.21 43.21 090

33031 ............ A Partial removal of heart sac ............................... *21.79 13.25 13.25 2.50 37.54 37.54 090

33050 ............ A Removal of heart sac lesion .............................. *14.36 9.25 9.25 1.47 25.08 25.08 090

33120 ............ A Removal of heart lesion ..................................... *24.56 #27.02 #27.02 5.17 56.75 56.75 090

33130 ............ A Removal of heart lesion ..................................... *21.39 13.50 13.50 2.22 37.11 37.11 090

33200 ............ A Insertion of heart pacemaker ............................. *12.48 12.27 12.27 1.90 26.65 26.65 090

33201 ............ A Insertion of heart pacemaker ............................. *10.18 11.19 11.19 1.67 23.04 23.04 090

33206 ............ A Insertion of heart pacemaker ............................. *6.67 #7.34 #7.34 1.34 15.35 15.35 090

33207 ............ A Insertion of heart pacemaker ............................. *8.04 #8.84 #8.84 1.33 18.21 18.21 090

33208 ............ A Insertion of heart pacemaker ............................. *8.13 #8.94 #8.94 1.54 18.61 18.61 090

33210 ............ A Insertion of heart electrode ................................ 3.30 3.30 3.30 0.27 6.87 6.87 000

33211 ............ A Insertion of heart electrode ................................ 3.40 3.30 3.30 0.27 6.97 6.97 000

33212 ............ A Insertion of pulse generator ............................... *5.52 5.38 5.38 0.88 11.78 11.78 090

33213 ............ A Insertion of pulse generator ............................... *6.37 5.38 5.38 0.88 12.63 12.63 090

33214 ............ A Upgrade of pacemaker system .......................... *7.75 5.40 5.40 1.06 14.21 14.21 090

33216 ............ A Revision implanted electrode ............................. *5.39 5.02 5.02 0.55 10.96 10.96 090

33217 ............ A Insert/revise electrode ........................................ *5.75 5.02 5.02 0.55 11.32 11.32 090

33218 ............ A Repair pacemaker electrodes ............................ *5.44 4.59 4.59 0.62 10.65 10.65 090

33220 ............ A Repair pacemaker electrode .............................. *5.52 4.59 4.59 0.62 10.73 10.73 090

33222 ............ A Pacemaker aicd pocket ...................................... *4.96 #5.46 #5.46 1.01 11.43 11.43 090

33223 ............ A Pacemaker aicd pocket ...................................... *6.46 5.70 5.70 1.01 13.17 13.17 090

33233 ............ A Removal of pacemaker system ......................... *3.29 2.64 2.64 0.05 5.98 5.98 090

33234 ............ A Removal of pacemaker system ......................... *7.82 2.84 2.84 0.23 10.89 10.89 090

33235 ............ A Removal pacemaker electrode .......................... *9.40 3.14 3.14 0.33 12.87 12.87 090

33236 ............ A Remove electrode/thoracotomy ......................... *12.60 3.98 3.98 0.62 17.20 17.20 090

33237 ............ A Remove electrode/thoracotomy ......................... *13.71 9.60 9.60 1.13 24.44 24.44 090

33238 ............ A Remove electrode/thoracotomy ......................... *15.22 10.29 10.29 2.01 27.52 27.52 090

33240 ............ A Insert/replace pulse gener ................................. *7.60 5.38 5.38 0.88 13.86 13.86 090

33241 ............ A Remove pulse generator only ............................ *3.24 2.16 2.16 0.43 5.83 5.83 090

33242 ............ A Repair pulse generator/leads ............................. *6.17 #6.79 #6.79 1.54 14.50 14.50 090

33243 ............ A Remove generator/thoracotomy ......................... *22.64 9.02 9.02 1.54 33.20 33.20 090

33244 ............ A Remove generator ............................................. *8.97 9.02 9.02 1.54 19.53 19.53 090

33245 ............ A Implant heart defibrillator ................................... *14.30 #15.73 #15.73 2.36 32.39 32.39 090

33246 ............ A Implant heart defibrillator ................................... *20.71 20.79 20.79 3.19 44.69 44.69 090

33247 ............ A Insert/replace leads ............................................ *10.21 #11.23 #11.23 2.36 23.80 23.80 090

33249 ............ A Insert/replace leads/gener .................................. *13.28 #14.61 #14.61 3.19 31.08 31.08 090

33250 ............ A Ablate heart dysrhythm focus ............................ *21.85 11.56 11.56 0.86 34.27 34.27 090

33251 ............ A Ablate heart dysrhythm focus ............................ *24.88 16.41 16.41 3.21 44.50 44.50 090

33253 ............ A Reconstruct atria ................................................ *31.06 21.81 21.81 4.26 57.13 57.13 090

33261 ............ A Ablate heart dysrhythm focus ............................ *24.88 13.96 13.96 2.73 41.57 41.57 090

33300 ............ A Repair of heart wound ....................................... *17.92 14.36 14.36 2.60 34.88 34.88 090

33305 ............ A Repair of heart wound ....................................... *21.44 17.40 17.40 3.07 41.91 41.91 090

33310 ............ A Exploratory heart surgery ................................... *18.51 11.28 11.28 1.93 31.72 31.72 090

33315 ............ A Exploratory heart surgery ................................... *22.37 14.48 14.48 2.57 39.42 39.42 090

33320 ............ A Repair major blood vessel(s) ............................. *16.79 14.14 14.14 2.51 33.44 33.44 090

33321 ............ A Repair major vessel ........................................... *20.20 21.75 21.75 3.61 45.56 45.56 090

33322 ............ A Repair major blood vessel(s) ............................. *20.62 21.75 21.75 3.61 45.98 45.98 090
59133

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

33330 ............ A Insert major vessel graft .................................... *21.43 12.67 12.67 1.93 36.03 36.03 090

33332 ............ A Insert major vessel graft .................................... *23.96 15.07 15.07 2.39 41.42 41.42 090

33335 ............ A Insert major vessel graft .................................... *30.01 15.07 15.07 2.39 47.47 47.47 090

33400 ............ A Repair of aortic valve ......................................... *25.34 26.21 26.21 2.83 54.38 54.38 090

33401 ............ A Valvuloplasty, open ............................................ *23.91 26.21 26.21 2.83 52.95 52.95 090

33403 ............ A Valvuloplasty, w/cp bypass ................................ *24.89 26.21 26.21 2.83 53.93 53.93 090

33404 ............ A Prepare heart-aorta conduit ............................... *28.54 31.25 31.25 5.59 65.38 65.38 090

33405 ............ A Replacement of aortic valve .............................. *30.61 30.48 30.48 5.33 66.42 66.42 090

33406 ............ A Replacement, aortic valve .................................. *32.30 #35.53 #35.53 7.45 75.28 75.28 090

33411 ............ A Replacement of aortic valve .............................. *32.47 #35.72 #35.72 7.45 75.64 75.64 090

33412 ............ A Replacement of aortic valve .............................. *34.79 #38.27 #38.27 7.45 80.51 80.51 090

33413 ............ A Replacement, aortic valve .................................. *35.24 #38.76 #38.76 7.23 81.23 81.23 090

33414 ............ A Repair, aortic valve ............................................ *30.35 #33.39 #33.39 7.45 71.19 71.19 090

33415 ............ A Revision, subvalvular tissue ............................... *27.15 #29.87 #29.87 5.33 62.35 62.35 090

33416 ............ A Revise ventricle muscle ..................................... *30.35 28.14 28.14 4.99 63.48 63.48 090

33417 ............ A Repair of aortic valve ......................................... *28.53 #31.38 #31.38 6.18 66.09 66.09 090

33420 ............ A Revision of mitral valve ...................................... *22.70 19.82 19.82 2.45 44.97 44.97 090

33422 ............ A Revision of mitral valve ...................................... *25.94 #28.53 #28.53 6.45 60.92 60.92 090

33425 ............ A Repair of mitral valve ......................................... *27.00 #29.70 #29.70 5.42 62.12 62.12 090

33426 ............ A Repair of mitral valve ......................................... *31.03 31.96 31.96 5.80 68.79 68.79 090

33427 ............ A Repair of mitral valve ......................................... *33.72 34.71 34.71 6.30 74.73 74.73 090

33430 ............ A Replacement of mitral valve .............................. *31.43 #34.57 #34.57 6.11 72.11 72.11 090

33460 ............ A Revision of tricuspid valve ................................. *23.60 #25.96 #25.96 4.73 54.29 54.29 090

33463 ............ A Valvuloplasty, tricuspid ....................................... *25.62 #28.18 #28.18 5.95 59.75 59.75 090

33464 ............ A Valvuloplasty, tricuspid ....................................... *27.33 #30.06 #30.06 5.95 63.34 63.34 090

33465 ............ A Replace tricuspid valve ...................................... *28.79 #31.67 #31.67 5.95 66.41 66.41 090

33468 ............ A Revision of tricuspid valve ................................. *30.12 #33.13 #33.13 6.30 69.55 69.55 090

33470 ............ A Revision of pulmonary valve .............................. *20.81 19.82 19.82 2.45 43.08 43.08 090

33471 ............ A Valvotomy, pulmonary valve .............................. *22.25 #24.48 #24.48 2.83 49.56 49.56 090

33472 ............ A Revision of pulmonary valve .............................. *22.25 #24.48 #24.48 2.83 49.56 49.56 090

33474 ............ A Revision of pulmonary valve .............................. *23.04 #25.34 #25.34 2.83 51.21 51.21 090

33475 ............ A Replacement, pulmonary valve .......................... *28.41 #31.25 #31.25 6.11 65.77 65.77 090

33476 ............ A Revision of heart chamber ................................. *25.77 28.14 28.14 4.99 58.90 58.90 090

33478 ............ A Revision of heart chamber ................................. *26.74 #29.41 #29.41 5.42 61.57 61.57 090

33496 ............ A Repair, prosth valve clot .................................... *27.25 #29.98 #29.98 5.33 62.56 62.56 090

33500 ............ A Repair heart vessel fistula ................................. *25.55 #28.11 #28.11 5.20 58.86 58.86 090

33501 ............ A Repair heart vessel fistula ................................. *17.78 14.14 14.14 2.51 34.43 34.43 090

33502 ............ A Coronary artery correction ................................. *21.04 14.14 14.14 2.51 37.69 37.69 090

33503 ............ A Coronary artery graft .......................................... *21.78 #23.96 #23.96 5.20 50.94 50.94 090

33504 ............ A Coronary artery graft .......................................... *24.66 #27.13 #27.13 5.20 56.99 56.99 090

33505 ............ A Repair artery w/tunnel ........................................ *26.84 #29.52 #29.52 6.03 62.39 62.39 090

33506 ............ A Repair artery, translocation ................................ *26.71 #29.38 #29.38 6.03 62.12 62.12 090

33510 ............ A CABG, vein, single ............................................. *25.12 #27.63 #27.63 5.20 57.95 57.95 090

33511 ............ A CABG, vein, two ................................................. *27.40 #30.14 #30.14 5.71 63.25 63.25 090

33512 ............ A CABG, vein, three .............................................. *29.67 #32.64 #32.64 6.22 68.53 68.53 090

33513 ............ A CABG, vein, four ................................................ *31.95 #35.15 #35.15 6.73 73.83 73.83 090

33514 ............ A CABG, vein, five ................................................. *35.00 #38.50 #38.50 7.23 80.73 80.73 090

33516 ............ A CABG, vein, six+ ................................................ *37.40 #41.14 #41.14 7.74 86.28 86.28 090

33517 ............ A CABG, artery-vein, single .................................. *2.57 #2.83 #2.83 0.50 5.90 5.90 090

33518 ............ A CABG, artery-vein, two ...................................... *4.85 #5.34 #5.34 1.02 11.21 11.21 090

33519 ............ A CABG, artery-vein, three .................................... *7.12 #7.83 #7.83 1.52 16.47 16.47 090

33521 ............ A CABG, artery-vein, four ...................................... *9.40 #10.34 #10.34 2.03 21.77 21.77 090

33522 ............ A CABG, artery-vein, five ...................................... *11.67 #12.84 #12.84 2.54 27.05 27.05 090

33523 ............ A CABG, artery-vein, six+ ..................................... *13.95 #15.35 #15.35 3.05 32.35 32.35 090

33530 ............ A Coronary artery, bypass/reop ............................ 5.86 #6.45 #6.45 2.18 14.49 14.49 ZZZ

33533 ............ A CABG, arterial, single ........................................ *25.83 #28.41 #28.41 5.36 59.60 59.60 090

33534 ............ A CABG, arterial, two ............................................ *28.82 #31.70 #31.70 6.03 66.55 66.55 090

33535 ............ A CABG, arterial, three .......................................... *31.81 #34.99 #34.99 6.70 73.50 73.50 090

33536 ............ A CABG, arterial, four+ .......................................... *34.79 #38.27 #38.27 7.37 80.43 80.43 090

33542 ............ A Removal of heart lesion ..................................... *28.85 30.73 30.73 5.53 65.11 65.11 090

33545 ............ A Repair of heart damage ..................................... *36.78 34.92 34.92 6.28 77.98 77.98 090

33572 ............ A Open coronary endarterectomy ......................... 4.45 3.23 3.23 0.63 8.31 8.31 ZZZ

33600 ............ A Closure of valve ................................................. *29.51 #32.46 #32.46 6.11 68.08 68.08 090

33602 ............ A Closure of valve ................................................. *28.54 30.48 30.48 5.33 64.35 64.35 090

33606 ............ A Anastomosis/artery-aorta ................................... *30.74 #33.81 #33.81 7.45 72.00 72.00 090

33608 ............ A Repair anomaly w/conduit .................................. *31.09 #34.20 #34.20 7.45 72.74 72.74 090

33610 ............ A Repair by enlargement ....................................... *30.61 #33.67 #33.67 7.45 71.73 71.73 090

33611 ............ A Repair double ventricle ...................................... *32.30 #35.53 #35.53 7.45 75.28 75.28 090

33612 ............ A Repair double ventricle ...................................... *33.26 #36.59 #36.59 7.45 77.30 77.30 090

33615 ............ A Repair (simple fontan) ........................................ *32.06 #35.27 #35.27 7.45 74.78 74.78 090

33617 ............ A Repair by modified fontan .................................. *34.03 #37.43 #37.43 7.45 78.91 78.91 090

33619 ............ A Repair single ventricle ........................................ *37.57 #41.33 #41.33 8.04 86.94 86.94 090

33641 ............ A Repair heart septum defect ............................... *21.39 #23.53 #23.53 4.87 49.79 49.79 090

33645 ............ A Revision of heart veins ...................................... *24.82 #27.30 #27.30 4.87 56.99 56.99 090
59134

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

33647 ............ A Repair heart septum defects .............................. *28.73 #31.60 #31.60 6.28 66.61 66.61 090

33660 ............ A Repair of heart defects ...................................... *25.54 #28.09 #28.09 5.42 59.05 59.05 090

33665 ............ A Repair of heart defects ...................................... *28.60 31.27 31.27 5.42 65.29 65.29 090

33670 ............ A Repair of heart chambers .................................. *32.73 #36.00 #36.00 7.45 76.18 76.18 090

33681 ............ A Repair heart septum defect ............................... *27.67 #30.44 #30.44 6.28 64.39 64.39 090

33684 ............ A Repair heart septum defect ............................... *29.65 #32.62 #32.62 6.28 68.55 68.55 090

33688 ............ A Repair heart septum defect ............................... *30.62 #33.68 #33.68 6.28 70.58 70.58 090

33690 ............ A Reinforce pulmonary artery ................................ *19.55 #21.51 #21.51 4.29 45.35 45.35 090

33692 ............ A Repair of heart defects ...................................... *30.75 #33.83 #33.83 7.45 72.03 72.03 090

33694 ............ A Repair of heart defects ...................................... *31.73 #34.90 #34.90 7.45 74.08 74.08 090

33697 ............ A Repair of heart defects ...................................... *33.71 #37.08 #37.08 7.45 78.24 78.24 090

33702 ............ A Repair of heart defects ...................................... *26.54 #29.19 #29.19 5.33 61.06 61.06 090

33710 ............ A Repair of heart defects ...................................... *29.71 #32.68 #32.68 6.28 68.67 68.67 090

33720 ............ A Repair of heart defect ........................................ *26.56 #29.22 #29.22 5.33 61.11 61.11 090

33722 ............ A Repair of heart defect ........................................ *28.41 30.48 30.48 5.33 64.22 64.22 090

33730 ............ A Repair heart-vein defect(s) ................................ *31.67 #34.84 #34.84 7.45 73.96 73.96 090

33732 ............ A Repair heart-vein defect ..................................... *28.16 #30.98 #30.98 5.42 64.56 64.56 090

33735 ............ A Revision of heart chamber ................................. *21.39 25.69 25.69 4.87 51.95 51.95 090

33736 ............ A Revision of heart chamber ................................. *23.52 25.69 25.69 4.87 54.08 54.08 090

33737 ............ A Revision of heart chamber ................................. *21.76 #23.94 #23.94 4.87 50.57 50.57 090

33750 ............ A Major vessel shunt ............................................. *21.41 22.10 22.10 4.29 47.80 47.80 090

33755 ............ A Major vessel shunt ............................................. *21.79 22.10 22.10 4.29 48.18 48.18 090

33762 ............ A Major vessel shunt ............................................. *21.79 22.10 22.10 4.29 48.18 48.18 090

33764 ............ A Major vessel shunt & graft ................................. *21.79 22.10 22.10 4.29 48.18 48.18 090

33766 ............ A Major vessel shunt ............................................. *22.76 22.10 22.10 4.29 49.15 49.15 090

33767 ............ A Atrial septectomy/septostomy ............................ *24.50 25.69 25.69 4.87 55.06 55.06 090

33770 ............ A Repair great vessels defect ............................... *33.29 #36.62 #36.62 7.45 77.36 77.36 090

33771 ............ A Repair great vessels defect ............................... *34.65 #38.12 #38.12 7.45 80.22 80.22 090

33774 ............ A Repair great vessels defect ............................... *30.98 31.27 31.27 5.42 67.67 67.67 090

33775 ............ A Repair great vessels defect ............................... *32.20 31.27 31.27 5.42 68.89 68.89 090

33776 ............ A Repair great vessels defect ............................... *34.04 34.92 34.92 6.28 75.24 75.24 090

33777 ............ A Repair great vessels defect ............................... *33.46 31.27 31.27 5.42 70.15 70.15 090

33778 ............ A Repair great vessels defect ............................... *35.82 #39.40 #39.40 7.37 82.59 82.59 090

33779 ............ A Repair great vessels defect ............................... *36.21 #39.83 #39.83 7.37 83.41 83.41 090

33780 ............ A Repair great vessels defect ............................... *36.94 #40.63 #40.63 7.37 84.94 84.94 090

33781 ............ A Repair great vessels defect ............................... *36.45 #40.10 #40.10 7.37 83.92 83.92 090

33786 ............ A Repair arterial trunk ........................................... *34.84 #38.32 #38.32 7.45 80.61 80.61 090

33788 ............ A Revision of pulmonary artery ............................. *26.62 #29.28 #29.28 5.20 61.10 61.10 090

33800 ............ A Aortic suspension ............................................... *16.24 14.14 14.14 2.51 32.89 32.89 090

33802 ............ A Repair vessel defect .......................................... *17.66 #19.43 #19.43 4.29 41.38 41.38 090

33803 ............ A Repair vessel defect .......................................... *19.60 #21.56 #21.56 4.29 45.45 45.45 090

33813 ............ A Repair septal defect ........................................... *20.65 22.10 22.10 4.29 47.04 47.04 090

33814 ............ A Repair septal defect ........................................... *25.77 #28.35 #28.35 5.33 59.45 59.45 090

33820 ............ A Revise major vessel ........................................... *16.29 #17.92 #17.92 4.29 38.50 38.50 090

33822 ............ A Revise major vessel ........................................... *17.32 #19.05 #19.05 4.29 40.66 40.66 090

33824 ............ A Revise major vessel ........................................... *19.52 #21.47 #21.47 4.29 45.28 45.28 090

33840 ............ A Remove aorta constriction ................................. *20.63 #22.69 #22.69 5.59 48.91 48.91 090

33845 ............ A Remove aorta constriction ................................. *22.12 #24.33 #24.33 5.59 52.04 52.04 090

33851 ............ A Remove aorta constriction ................................. *21.27 #23.40 #23.40 5.59 50.26 50.26 090

33852 ............ A Repair septal defect ........................................... *23.71 #26.08 #26.08 5.59 55.38 55.38 090

33853 ............ A Repair septal defect ........................................... *31.72 #34.89 #34.89 7.45 74.06 74.06 090

33860 ............ A Ascending aorta graft ......................................... *33.96 34.71 34.71 6.18 74.85 74.85 090

33861 ............ A Ascending aorta graft ......................................... *34.52 34.71 34.71 6.18 75.41 75.41 090

33863 ............ A Ascending aorta graft ......................................... *36.47 34.71 34.71 6.18 77.36 77.36 090

33870 ............ A Transverse aortic arch graft ............................... *40.31 44.30 44.30 8.04 92.65 92.65 090

33875 ............ A Thoracic aorta graft ............................................ *33.06 31.25 31.25 5.59 69.90 69.90 090

33877 ............ A Thoracoabdominal graft ..................................... *42.60 44.11 44.11 8.38 95.09 95.09 090

33910 ............ A Remove lung artery emboli ................................ *24.59 14.65 14.65 2.77 42.01 42.01 090

33915 ............ A Remove lung artery emboli ................................ *21.02 12.02 12.02 2.22 35.26 35.26 090

33916 ............ A Surgery of great vessel ...................................... *25.83 17.57 17.57 3.43 46.83 46.83 090

33917 ............ A Repair pulmonary artery .................................... *24.50 #26.95 #26.95 6.30 57.75 57.75 090

33918 ............ A Repair pulmonary atresia ................................... *26.45 #29.10 #29.10 5.20 60.75 60.75 090

33919 ............ A Repair pulmonary atresia ................................... *32.67 #35.94 #35.94 7.45 76.06 76.06 090

33920 ............ A Repair pulmonary atresia ................................... *31.95 #35.15 #35.15 7.45 74.55 74.55 090

33922 ............ A Transect pulmonary artery ................................. *23.52 #25.87 #25.87 2.83 52.22 52.22 090

33924 ............ A Remove pulmonary shunt .................................. 5.50 4.00 4.00 0.78 10.28 10.28 ZZZ

33930 ............ X Removal of donor heart/lung ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

33935 ............ R Transplantation, heart/lung ................................ *60.96 #67.06 #67.06 13.54 141.56 141.56 090

33940 ............ X Removal of donor heart ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

33945 ............ R Transplantation of heart ..................................... *42.10 #46.31 #46.31 11.05 99.46 99.46 090

33960 ............ A External circulation assist .................................. 19.36 7.01 7.01 0.94 27.31 27.31 XXX

33961 ............ A External circulation assist .................................. 10.93 7.01 7.01 0.94 18.88 18.88 XXX

33970 ............ A Aortic circulation assist ...................................... 6.75 #7.43 #7.43 1.00 15.18 15.18 000

33971 ............ A Aortic circulation assist ...................................... *9.69 5.16 5.16 0.91 15.76 15.76 090
59135

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

33973 ............ A Insert balloon device .......................................... 9.76 7.54 7.54 1.00 18.30 18.30 000

33974 ............ A Remove intra-aortic balloon ............................... *14.41 5.56 5.56 0.91 20.88 20.88 090

33975 ............ A Implant ventricular device .................................. *21.60 14.19 14.19 2.77 38.56 38.56 090

33976 ............ A Implant ventricular device .................................. *29.10 19.33 19.33 3.78 52.21 52.21 090

33977 ............ A Remove ventricular device ................................. *19.29 12.41 12.41 2.43 34.13 34.13 090

33978 ............ A Remove ventricular device ................................. *21.73 14.19 14.19 2.77 38.69 38.69 090

33999 ............ C Cardiac surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

34001 ............ A Removal of artery clot ........................................ *12.91 9.58 9.58 1.87 24.36 24.36 090

34051 ............ A Removal of artery clot ........................................ *15.21 8.81 8.81 1.59 25.61 25.61 090

34101 ............ A Removal of artery clot ........................................ *9.97 8.34 8.34 1.71 20.02 20.02 090

34111 ............ A Removal of arm artery clot ................................ *8.07 7.59 7.59 1.59 17.25 17.25 090

34151 ............ A Removal of artery clot ........................................ *16.86 11.96 11.96 2.39 31.21 31.21 090

34201 ............ A Removal of artery clot ........................................ *9.13 8.90 8.90 1.78 19.81 19.81 090

34203 ............ A Removal of leg artery clot .................................. *12.21 8.63 8.63 1.72 22.56 22.56 090

34401 ............ A Removal of vein clot .......................................... *12.86 8.07 8.07 1.39 22.32 22.32 090

34421 ............ A Removal of vein clot .......................................... *9.93 7.45 7.45 1.51 18.89 18.89 090

34451 ............ A Removal of vein clot .......................................... *14.44 10.69 10.69 2.14 27.27 27.27 090

34471 ............ A Removal of vein clot .......................................... *10.18 3.51 3.51 0.55 14.24 14.24 090

34490 ............ A Removal of vein clot .......................................... *7.60 7.27 7.27 1.54 16.41 16.41 090

34501 ............ A Repair valve, femoral vein ................................. *10.93 7.35 7.35 0.86 19.14 19.14 090

34502 ............ A Reconstruct, vena cava ..................................... *26.95 18.65 18.65 3.64 49.24 49.24 090

34510 ............ A Transposition of vein valve ................................ *13.25 8.89 8.89 1.04 23.18 23.18 090

34520 ............ A Cross-over vein graft .......................................... *13.74 9.33 9.33 1.09 24.16 24.16 090

34530 ............ A Leg vein fusion ................................................... *17.61 12.35 12.35 1.44 31.40 31.40 090

35001 ............ A Repair defect of artery ....................................... *19.64 15.90 15.90 3.18 38.72 38.72 090

35002 ............ A Repair artery rupture, neck ................................ *21.00 12.64 12.64 2.41 36.05 36.05 090

35005 ............ A Repair defect of artery ....................................... *18.12 10.28 10.28 2.19 30.59 30.59 090

35011 ............ A Repair defect of artery ....................................... *11.65 #12.82 #12.82 2.76 27.23 27.23 090

35013 ............ A Repair artery rupture, arm ................................. *17.40 14.70 14.70 3.03 35.13 35.13 090

35021 ............ A Repair defect of artery ....................................... *19.65 18.13 18.13 3.06 40.84 40.84 090

35022 ............ A Repair artery rupture, chest ............................... *23.18 14.78 14.78 2.80 40.76 40.76 090

35045 ............ A Repair defect of arm artery ................................ *11.26 12.35 12.35 2.50 26.11 26.11 090

35081 ............ A Repair defect of artery ....................................... *28.01 21.45 21.45 4.18 53.64 53.64 090

35082 ............ A Repair artery rupture, aorta ............................... *36.35 22.91 22.91 4.59 63.85 63.85 090

35091 ............ A Repair defect of artery ....................................... *35.40 22.67 22.67 4.25 62.32 62.32 090

35092 ............ A Repair artery rupture, aorta ............................... *38.39 26.27 26.27 5.21 69.87 69.87 090

35102 ............ A Repair defect of artery ....................................... *30.76 22.15 22.15 4.32 57.23 57.23 090

35103 ............ A Repair artery rupture, groin ................................ *33.57 26.16 26.16 5.21 64.94 64.94 090

35111 ............ A Repair defect of artery ....................................... *16.43 17.60 17.60 3.70 37.73 37.73 090

35112 ............ A Repair artery rupture, spleen ............................. *18.69 10.45 10.45 2.22 31.36 31.36 090

35121 ............ A Repair defect of artery ....................................... *25.99 19.12 19.12 3.66 48.77 48.77 090

35122 ............ A Repair artery rupture, belly ................................ *33.45 17.92 17.92 3.96 55.33 55.33 090

35131 ............ A Repair defect of artery ....................................... *18.55 15.88 15.88 3.15 37.58 37.58 090

35132 ............ A Repair artery rupture, groin ................................ *21.95 18.68 18.68 3.58 44.21 44.21 090

35141 ............ A Repair defect of artery ....................................... *14.46 14.70 14.70 2.88 32.04 32.04 090

35142 ............ A Repair artery rupture, thigh ................................ *15.86 16.10 16.10 3.24 35.20 35.20 090

35151 ............ A Repair defect of artery ....................................... *17.00 15.36 15.36 2.94 35.30 35.30 090

35152 ............ A Repair artery rupture, knee ................................ *16.70 9.27 9.27 1.95 27.92 27.92 090

35161 ............ A Repair defect of artery ....................................... *18.76 15.88 15.88 3.15 37.79 37.79 090

35162 ............ A Repair artery rupture .......................................... *19.78 18.68 18.68 3.58 42.04 42.04 090

35180 ............ A Repair blood vessel lesion ................................. *13.62 7.37 7.37 1.48 22.47 22.47 090

35182 ............ A Repair blood vessel lesion ................................. *17.74 10.65 10.65 1.61 30.00 30.00 090

35184 ............ A Repair blood vessel lesion ................................. *12.25 9.73 9.73 1.96 23.94 23.94 090

35188 ............ A Repair blood vessel lesion ................................. *14.28 8.11 8.11 1.59 23.98 23.98 090

35189 ............ A Repair blood vessel lesion ................................. *18.43 11.33 11.33 2.21 31.97 31.97 090

35190 ............ A Repair blood vessel lesion ................................. *12.75 10.34 10.34 2.14 25.23 25.23 090

35201 ............ A Repair blood vessel lesion ................................. *9.99 10.07 10.07 1.94 22.00 22.00 090

35206 ............ A Repair blood vessel lesion ................................. *9.25 10.15 10.15 2.03 21.43 21.43 090

35207 ............ A Repair blood vessel lesion ................................. *10.15 10.80 10.80 1.93 22.88 22.88 090

35211 ............ A Repair blood vessel lesion ................................. *22.12 13.38 13.38 2.59 38.09 38.09 090

35216 ............ A Repair blood vessel lesion ................................. *18.75 10.68 10.68 2.08 31.51 31.51 090

35221 ............ A Repair blood vessel lesion ................................. *16.42 11.09 11.09 2.20 29.71 29.71 090

35226 ............ A Repair blood vessel lesion ................................. *9.06 #9.97 #9.97 1.95 20.98 20.98 090

35231 ............ A Repair blood vessel lesion ................................. *12.00 #13.20 #13.20 2.91 28.11 28.11 090

35236 ............ A Repair blood vessel lesion ................................. *10.54 #11.59 #11.59 2.56 24.69 24.69 090

35241 ............ A Repair blood vessel lesion ................................. *23.12 13.49 13.49 2.60 39.21 39.21 090

35246 ............ A Repair blood vessel lesion ................................. *19.84 16.95 16.95 2.15 38.94 38.94 090

35251 ............ A Repair blood vessel lesion ................................. *17.49 9.59 9.59 1.88 28.96 28.96 090

35256 ............ A Repair blood vessel lesion ................................. *11.38 12.40 12.40 2.39 26.17 26.17 090

35261 ............ A Repair blood vessel lesion ................................. *11.63 #12.79 #12.79 2.66 27.08 27.08 090

35266 ............ A Repair blood vessel lesion ................................. *10.30 #11.33 #11.33 2.41 24.04 24.04 090

35271 ............ A Repair blood vessel lesion ................................. *22.12 12.53 12.53 2.56 37.21 37.21 090

35276 ............ A Repair blood vessel lesion ................................. *18.75 10.85 10.85 2.26 31.86 31.86 090

35281 ............ A Repair blood vessel lesion ................................. *16.48 17.28 17.28 3.37 37.13 37.13 090
59136

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

35286 ............ A Repair blood vessel lesion ................................. *11.87 11.71 11.71 2.33 25.91 25.91 090

35301 ............ A Rechanneling of artery ....................................... *18.70 14.46 14.46 2.81 35.97 35.97 090

35311 ............ A Rechanneling of artery ....................................... *23.85 22.06 22.06 4.61 50.52 50.52 090

35321 ............ A Rechanneling of artery ....................................... *11.97 12.96 12.96 2.69 27.62 27.62 090

35331 ............ A Rechanneling of artery ....................................... *23.52 13.34 13.34 2.66 39.52 39.52 090

35341 ............ A Rechanneling of artery ....................................... *25.11 17.37 17.37 3.53 46.01 46.01 090

35351 ............ A Rechanneling of artery ....................................... *20.11 14.95 14.95 2.97 38.03 38.03 090

35355 ............ A Rechanneling of artery ....................................... *16.09 15.42 15.42 2.99 34.50 34.50 090

35361 ............ A Rechanneling of artery ....................................... *23.59 19.37 19.37 3.88 46.84 46.84 090

35363 ............ A Rechanneling of artery ....................................... *24.66 22.77 22.77 4.40 51.83 51.83 090

35371 ............ A Rechanneling of artery ....................................... *11.64 12.51 12.51 2.50 26.65 26.65 090

35372 ............ A Rechanneling of artery ....................................... *13.56 11.20 11.20 2.28 27.04 27.04 090

35381 ............ A Rechanneling of artery ....................................... *15.81 13.67 13.67 2.71 32.19 32.19 090

35390 ............ A Reoperation, carotid ........................................... 3.19 1.67 1.67 0.39 5.25 5.25 ZZZ

35400 ............ A Angioscopy ......................................................... 3.00 2.27 2.27 0.27 5.54 5.54 ZZZ

35450 ............ A Repair arterial blockage ..................................... 10.07 #11.08 #11.08 1.38 22.53 22.53 000

35452 ............ A Repair arterial blockage ..................................... 6.91 4.35 4.35 0.61 11.87 11.87 000

35454 ............ A Repair arterial blockage ..................................... 6.04 #6.64 #6.64 1.53 14.21 14.21 000

35456 ............ A Repair arterial blockage ..................................... 7.35 #8.09 #8.09 1.69 17.13 17.13 000

35458 ............ A Repair arterial blockage ..................................... 9.49 10.13 10.13 1.83 21.45 21.45 000

35459 ............ A Repair arterial blockage ..................................... 8.63 #9.49 #9.49 1.69 19.81 19.81 000

35460 ............ A Repair venous blockage .................................... 6.04 3.16 3.16 0.74 9.94 9.94 000

35470 ............ A Repair arterial blockage ..................................... 8.63 #9.49 #9.49 1.69 19.81 19.81 000

35471 ............ A Repair arterial blockage ..................................... 10.07 #11.08 #11.08 1.38 22.53 22.53 000

35472 ............ A Repair arterial blockage ..................................... 6.91 3.61 3.61 0.85 11.37 11.37 000

35473 ............ A Repair arterial blockage ..................................... 6.04 #6.64 #6.64 1.53 14.21 14.21 000

35474 ............ A Repair arterial blockage ..................................... 7.36 #8.10 #8.10 1.69 17.15 17.15 000

35475 ............ R Repair arterial blockage ..................................... 9.49 10.13 10.13 1.83 21.45 21.45 000

35476 ............ A Repair venous blockage .................................... 6.04 3.16 3.16 0.74 9.94 9.94 000

35480 ............ A Atherectomy, open ............................................. 11.08 #12.19 #12.19 1.38 24.65 24.65 000

35481 ............ A Atherectomy, open ............................................. 7.61 4.35 4.35 0.61 12.57 12.57 000

35482 ............ A Atherectomy, open ............................................. 6.65 #7.32 #7.32 1.53 15.50 15.50 000

35483 ............ A Atherectomy, open ............................................. 8.10 #8.91 #8.91 1.69 18.70 18.70 000

35484 ............ A Atherectomy, open ............................................. 10.44 10.13 10.13 1.83 22.40 22.40 000

35485 ............ A Atherectomy, open ............................................. 9.49 4.52 4.52 1.06 15.07 15.07 000

35490 ............ A Atherectomy, percutaneous ............................... 11.08 #12.19 #12.19 1.38 24.65 24.65 000

35491 ............ A Atherectomy, percutaneous ............................... 7.61 4.35 4.35 0.61 12.57 12.57 000

35492 ............ A Atherectomy, percutaneous ............................... 6.65 #7.32 #7.32 1.53 15.50 15.50 000

35493 ............ A Atherectomy, percutaneous ............................... 8.10 #8.91 #8.91 1.69 18.70 18.70 000

35494 ............ A Atherectomy, percutaneous ............................... 10.44 10.13 10.13 1.83 22.40 22.40 000

35495 ............ A Atherectomy, percutaneous ............................... 9.49 4.52 4.52 1.06 15.07 15.07 000

35501 ............ A Artery bypass graft ............................................. *19.19 19.35 19.35 3.49 42.03 42.03 090

35506 ............ A Artery bypass graft ............................................. *19.67 19.17 19.17 3.64 42.48 42.48 090

35507 ............ A Artery bypass graft ............................................. *19.67 17.92 17.92 3.61 41.20 41.20 090

35508 ............ A Artery bypass graft ............................................. *18.65 18.11 18.11 3.43 40.19 40.19 090

35509 ............ A Artery bypass graft ............................................. *18.07 18.90 18.90 3.92 40.89 40.89 090

35511 ............ A Artery bypass graft ............................................. *16.83 10.40 10.40 1.92 29.15 29.15 090

35515 ............ A Artery bypass graft ............................................. *18.65 11.25 11.25 2.01 31.91 31.91 090

35516 ............ A Artery bypass graft ............................................. *16.32 17.37 17.37 3.54 37.23 37.23 090

35518 ............ A Artery bypass graft ............................................. *15.42 #16.96 #16.96 3.38 35.76 35.76 090

35521 ............ A Artery bypass graft ............................................. *16.17 17.53 17.53 3.34 37.04 37.04 090

35526 ............ A Artery bypass graft ............................................. *20.00 12.95 12.95 2.44 35.39 35.39 090

35531 ............ A Artery bypass graft ............................................. *25.61 20.25 20.25 3.90 49.76 49.76 090

35533 ............ A Artery bypass graft ............................................. *20.52 21.04 21.04 4.43 45.99 45.99 090

35536 ............ A Artery bypass graft ............................................. *23.11 21.37 21.37 4.17 48.65 48.65 090

35541 ............ A Artery bypass graft ............................................. *25.80 19.55 19.55 3.65 49.00 49.00 090

35546 ............ A Artery bypass graft ............................................. *25.54 21.39 21.39 4.26 51.19 51.19 090

35548 ............ A Artery bypass graft ............................................. *21.57 19.55 19.55 3.65 44.77 44.77 090

35549 ............ A Artery bypass graft ............................................. *23.35 21.39 21.39 4.26 49.00 49.00 090

35551 ............ A Artery bypass graft ............................................. *26.67 19.25 19.25 3.87 49.79 49.79 090

35556 ............ A Artery bypass graft ............................................. *21.76 18.71 18.71 3.71 44.18 44.18 090

35558 ............ A Artery bypass graft ............................................. *14.04 #15.44 #15.44 3.23 32.71 32.71 090

35560 ............ A Artery bypass graft ............................................. *23.56 20.22 20.22 3.93 47.71 47.71 090

35563 ............ A Artery bypass graft ............................................. *15.14 8.32 8.32 1.70 25.16 25.16 090

35565 ............ A Artery bypass graft ............................................. *15.14 #16.65 #16.65 3.51 35.30 35.30 090

35566 ............ A Artery bypass graft ............................................. *26.92 20.62 20.62 4.08 51.62 51.62 090

35571 ............ A Artery bypass graft ............................................. *18.58 19.36 19.36 3.87 41.81 41.81 090

35582 ............ A Vein bypass graft ............................................... *27.13 23.74 23.74 4.89 55.76 55.76 090

35583 ............ A Vein bypass graft ............................................... *22.37 20.44 20.44 4.13 46.94 46.94 090

35585 ............ A Vein bypass graft ............................................... *28.39 22.95 22.95 4.63 55.97 55.97 090

35587 ............ A Vein bypass graft ............................................... *19.05 #20.96 #20.96 4.13 44.14 44.14 090

35601 ............ A Artery bypass graft ............................................. *17.50 18.83 18.83 3.33 39.66 39.66 090

35606 ............ A Artery bypass graft ............................................. *18.71 17.55 17.55 3.51 39.77 39.77 090

35612 ............ A Artery bypass graft ............................................. *15.76 16.75 16.75 3.30 35.81 35.81 090
59137

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

35616 ............ A Artery bypass graft ............................................. *15.70 16.79 16.79 3.42 35.91 35.91 090

35621 ............ A Artery bypass graft ............................................. *14.54 #15.99 #15.99 3.80 34.33 34.33 090

35623 ............ A Bypass graft, not vein ........................................ *16.62 8.06 8.06 1.88 26.56 26.56 090

35626 ............ A Artery bypass graft ............................................. *23.63 20.51 20.51 4.08 48.22 48.22 090

35631 ............ A Artery bypass graft ............................................. *24.60 17.87 17.87 3.57 46.04 46.04 090

35636 ............ A Artery bypass graft ............................................. *22.46 13.50 13.50 2.45 38.41 38.41 090

35641 ............ A Artery bypass graft ............................................. *24.57 20.56 20.56 4.08 49.21 49.21 090

35642 ............ A Artery bypass graft ............................................. *17.98 10.33 10.33 2.20 30.51 30.51 090

35645 ............ A Artery bypass graft ............................................. *17.47 11.15 11.15 2.05 30.67 30.67 090

35646 ............ A Artery bypass graft ............................................. *25.81 23.78 23.78 4.73 54.32 54.32 090

35650 ............ A Artery bypass graft ............................................. *14.36 #15.80 #15.80 3.56 33.72 33.72 090

35651 ............ A Artery bypass graft ............................................. *25.04 24.09 24.09 4.69 53.82 53.82 090

35654 ............ A Artery bypass graft ............................................. *18.61 #20.47 #20.47 4.42 43.50 43.50 090

35656 ............ A Artery bypass graft ............................................. *19.53 17.73 17.73 3.60 40.86 40.86 090

35661 ............ A Artery bypass graft ............................................. *13.18 #14.50 #14.50 3.30 30.98 30.98 090

35663 ............ A Artery bypass graft ............................................. *14.17 #15.59 #15.59 3.80 33.56 33.56 090

35665 ............ A Artery bypass graft ............................................. *15.40 #16.94 #16.94 3.57 35.91 35.91 090

35666 ............ A Artery bypass graft ............................................. *19.19 20.06 20.06 4.00 43.25 43.25 090

35671 ............ A Artery bypass graft ............................................. *14.80 15.60 15.60 4.08 34.48 34.48 090

35681 ............ A Artery bypass graft ............................................. 8.05 #8.86 #8.86 3.52 20.43 20.43 ZZZ

35691 ............ A Arterial transposition .......................................... *18.05 19.62 19.62 3.81 41.48 41.48 090

35693 ............ A Arterial transposition .......................................... *15.36 9.40 9.40 1.91 26.67 26.67 090

35694 ............ A Arterial transposition .......................................... *19.16 9.33 9.33 2.17 30.66 30.66 090

35695 ............ A Arterial transposition .......................................... *19.16 9.33 9.33 2.17 30.66 30.66 090

35700 ............ A Reoperation, bypass graft .................................. 3.08 1.61 1.61 0.38 5.07 5.07 ZZZ

35701 ............ A Exploration, carotid artery .................................. *5.55 5.82 5.82 1.25 12.62 12.62 090

35721 ............ A Exploration, femoral artery ................................. *5.28 5.56 5.56 1.11 11.95 11.95 090

35741 ............ A Exploration popliteal artery ................................ *5.37 5.73 5.73 1.15 12.25 12.25 090

35761 ............ A Exploration of artery/vein ................................... *5.37 5.81 5.81 1.14 12.32 12.32 090

35800 ............ A Explore neck vessels ......................................... *7.02 5.28 5.28 0.97 13.27 13.27 090

35820 ............ A Explore chest vessels ........................................ *12.88 7.92 7.92 1.43 22.23 22.23 090

35840 ............ A Explore abdominal vessels ................................ *9.77 7.23 7.23 1.44 18.44 18.44 090

35860 ............ A Explore limb vessels .......................................... *5.55 5.81 5.81 1.15 12.51 12.51 090

35870 ............ A Repair vessel graft defect .................................. *22.17 10.64 10.64 2.47 35.28 35.28 090

35875 ............ A Removal of clot in graft ...................................... *10.01 8.21 8.21 1.65 19.87 19.87 090

35876 ............ A Removal of clot in graft ...................................... *13.67 8.21 8.21 1.65 23.53 23.53 090

35901 ............ A Excision, graft, neck ........................................... *8.19 7.18 7.18 1.46 16.83 16.83 090

35903 ............ A Excision, graft, extremity .................................... *9.39 7.18 7.18 1.46 18.03 18.03 090

35905 ............ A Excision, graft, thorax ........................................ *18.19 7.18 7.18 1.46 26.83 26.83 090

35907 ............ A Excision, graft, abdomen ................................... *19.24 7.18 7.18 1.46 27.88 27.88 090

36000 ............ A Place needle in vein ........................................... 0.18 0.24 #0.20 0.04 0.46 0.42 XXX

36005 ............ A Injection, venography ......................................... 0.95 0.47 0.47 0.04 1.46 1.46 000

36010 ............ A Place catheter in vein ........................................ 2.43 2.11 2.11 0.31 4.85 4.85 XXX

36011 ............ A Place catheter in vein ........................................ 3.14 1.90 1.90 0.22 5.26 5.26 XXX

36012 ............ A Place catheter in vein ........................................ 3.52 2.67 2.67 0.32 6.51 6.51 XXX

36013 ............ A Place catheter in artery ...................................... 2.52 2.11 2.11 0.31 4.94 4.94 XXX

36014 ............ A Place catheter in artery ...................................... 3.02 2.28 2.28 0.27 5.57 5.57 XXX

36015 ............ A Place catheter in artery ...................................... 3.52 2.67 2.67 0.32 6.51 6.51 XXX

36100 ............ A Establish access to artery .................................. 3.02 2.59 2.59 0.32 5.93 5.93 XXX

36120 ............ A Establish access to artery .................................. 2.01 #2.21 #2.21 0.30 4.52 4.52 XXX

36140 ............ A Establish access to artery .................................. 2.01 1.41 1.41 0.24 3.66 3.66 XXX

36145 ............ A Artery to vein shunt ............................................ 2.01 #2.21 #2.21 0.49 4.71 4.71 XXX

36160 ............ A Establish access to aorta ................................... 2.52 2.32 2.32 0.35 5.19 5.19 XXX

36200 ............ A Place catheter in aorta ....................................... 3.02 2.73 2.73 0.28 6.03 6.03 XXX

36215 ............ A Place catheter in artery ...................................... 4.68 2.78 2.78 0.23 7.69 7.69 XXX

36216 ............ A Place catheter in artery ...................................... 5.28 3.29 3.29 0.27 8.84 8.84 XXX

36217 ............ A Place catheter in artery ...................................... 6.30 3.92 3.92 0.32 10.54 10.54 XXX

36218 ............ A Place catheter in artery ...................................... 1.01 0.62 0.62 0.05 1.68 1.68 XXX

36245 ............ A Place catheter in artery ...................................... 4.68 3.15 3.15 0.26 8.09 8.09 XXX

36246 ............ A Place catheter in artery ...................................... 5.28 3.29 3.29 0.27 8.84 8.84 XXX

36247 ............ A Place catheter in artery ...................................... 6.30 3.92 3.92 0.32 10.54 10.54 XXX

36248 ............ A Place catheter in artery ...................................... 1.01 0.62 0.62 0.05 1.68 1.68 XXX

36260 ............ A Insertion of infusion pump .................................. *9.71 6.74 6.74 1.41 17.86 17.86 090

36261 ............ A Revision of infusion pump .................................. *5.45 2.23 2.23 0.42 8.10 8.10 090

36262 ............ A Removal of infusion pump ................................. *4.02 1.93 1.93 0.40 6.35 6.35 090

36299 ............ C Vessel injection procedure ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

36400 ............ A Drawing blood .................................................... 0.18 0.09 0.09 0.01 0.28 0.28 XXX

36405 ............ A Drawing blood .................................................... 0.18 0.45 0.45 0.03 0.66 0.66 XXX

36406 ............ A Drawing blood .................................................... 0.18 0.16 0.16 0.01 0.35 0.35 XXX

36410 ............ A Drawing blood .................................................... 0.18 0.22 #0.20 0.02 0.42 0.40 XXX

36415 ............ I Drawing blood .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

36420 ............ A Establish access to vein .................................... 1.01 0.51 0.51 0.05 1.57 1.57 XXX

36425 ............ A Establish access to vein .................................... 0.76 0.08 0.08 0.01 0.85 0.85 XXX

36430 ............ A Blood transfusion service ................................... 0.00 0.96 0.96 0.07 1.03 1.03 XXX
59138

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

36440 ............ A Blood transfusion service ................................... 1.03 0.94 0.94 0.07 2.04 2.04 XXX

36450 ............ A Exchange transfusion service ............................ 2.23 1.88 1.88 0.18 4.29 4.29 XXX

36455 ............ A Exchange transfusion service ............................ 2.43 2.27 2.27 0.22 4.92 4.92 XXX

36460 ............ A Transfusion service, fetal ................................... 6.59 4.71 4.71 1.09 12.39 12.39 XXX

36468 ............ R Injection(s); spider veins .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

36469 ............ R Injection(s); spider veins .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

36470 ............ A Injection therapy of vein ..................................... *1.09 0.27 0.27 0.04 1.40 1.40 010

36471 ............ A Injection therapy of veins ................................... *1.57 0.39 0.39 0.05 2.01 2.01 010

36481 ............ A Insertion of catheter, vein .................................. 6.99 5.30 5.30 0.61 12.90 12.90 000

36488 ............ A Insertion of catheter, vein .................................. 1.35 0.97 0.97 0.14 2.46 2.46 000

36489 ............ A Insertion of catheter, vein .................................. 1.22 1.12 1.12 0.17 2.51 2.51 000

36490 ............ A Insertion of catheter, vein .................................. 1.67 1.38 1.38 0.20 3.25 3.25 000

36491 ............ A Insertion of catheter, vein .................................. 1.43 #1.57 #1.57 0.32 3.32 3.32 000

36493 ............ A Repositioning of cvc ........................................... 1.21 0.63 0.63 0.16 2.00 2.00 000

36500 ............ A Insertion of catheter, vein .................................. 3.52 0.08 0.08 0.01 3.61 3.61 000

36510 ............ A Insertion of catheter, vein .................................. 1.09 0.34 0.34 0.02 1.45 1.45 000

36520 ............ A Plasma and/or cell exchange ............................. 1.74 #1.91 #1.91 0.12 3.77 3.77 000

36522 ............ A Photopheresis .................................................... 1.67 2.48 #1.84 0.37 4.52 3.88 000

36530 ............ R Insertion of infusion pump .................................. *6.20 4.82 4.82 1.02 12.04 12.04 010

36531 ............ R Revision of infusion pump .................................. *4.87 4.37 4.37 0.27 9.51 9.51 010

36532 ............ R Removal of infusion pump ................................. *3.30 1.77 1.77 0.37 5.44 5.44 010

36533 ............ A Insertion of access port ...................................... *5.32 4.29 4.29 0.85 10.46 10.46 010

36534 ............ A Revision of access port ...................................... *2.80 #3.08 #3.08 0.21 6.09 6.09 010

36535 ............ A Removal of access port ..................................... *2.27 1.81 1.81 0.38 4.46 4.46 010

36600 ............ A Withdrawal of arterial blood ............................... 0.32 0.28 0.28 0.02 0.62 0.62 XXX

36620 ............ A Insertion catheter, artery .................................... 1.15 0.66 0.66 0.14 1.95 1.95 000

36625 ............ A Insertion catheter, artery .................................... 2.11 0.86 0.86 0.18 3.15 3.15 000

36640 ............ A Insertion catheter, artery .................................... 2.10 #2.31 #2.31 0.40 4.81 4.81 000

36660 ............ A Insertion catheter, artery .................................... 1.40 0.49 0.49 0.04 1.93 1.93 000

36680 ............ A Insert needle, bone cavity .................................. 1.20 1.24 1.24 0.10 2.54 2.54 000

36800 ............ A Insertion of cannula ............................................ 2.43 2.22 2.22 0.28 4.93 4.93 000

36810 ............ A Insertion of cannula ............................................ 3.97 #4.37 #4.37 0.74 9.08 9.08 000

36815 ............ A Insertion of cannula ............................................ 2.62 #2.88 #2.88 0.70 6.20 6.20 000

36821 ............ A Artery-vein fusion ............................................... *8.93 7.24 7.24 1.46 17.63 17.63 090

36822 ............ A Insertion of cannula(s) ....................................... *5.42 5.60 5.60 0.77 11.79 11.79 090

36825 ............ A Artery-vein graft .................................................. *9.84 #10.82 #10.82 2.21 22.87 22.87 090

36830 ............ A Artery-vein graft .................................................. *12.00 9.96 9.96 2.36 24.32 24.32 090

36832 ............ A Revise artery-vein fistula .................................... *6.45 #7.10 #7.10 2.38 15.93 15.93 090

36834 ............ A Repair A–V aneurysm ........................................ *9.93 7.80 7.80 1.66 19.39 19.39 090

36835 ............ A Artery to vein shunt ............................................ *7.15 3.42 3.42 0.79 11.36 11.36 090

36860 ............ A Cannula declotting ............................................. 2.01 2.57 #2.21 0.43 5.01 4.65 000

36861 ............ A Cannula declotting ............................................. 2.52 #2.77 #2.77 1.01 6.30 6.30 000

37140 ............ A Revision of circulation ........................................ *23.60 16.29 16.29 3.34 43.23 43.23 090

37145 ............ A Revision of circulation ........................................ *24.61 17.13 17.13 1.72 43.46 43.46 090

37160 ............ A Revision of circulation ........................................ *21.60 17.74 17.74 3.79 43.13 43.13 090

37180 ............ A Revision of circulation ........................................ *24.61 14.19 14.19 2.76 41.56 41.56 090

37181 ............ A Splice spleen/kidney veins ................................. *26.68 16.41 16.41 3.52 46.61 46.61 090

37195 ............ A Thrombolytic therapy, stroke .............................. 0.00 7.68 7.68 0.54 8.22 8.22 XXX

37200 ............ A Transcatheter biopsy .......................................... 4.56 1.59 1.59 0.13 6.28 6.28 000

37201 ............ A Transcatheter therapy infuse ............................. 5.00 5.50 5.50 0.64 11.14 11.14 000

37202 ............ A Transcatheter therapy infuse ............................. 5.68 4.30 4.30 0.50 10.48 10.48 000

37203 ............ A Transcatheter retrieval ....................................... 5.03 3.82 3.82 0.45 9.30 9.30 000

37204 ............ A Transcatheter occlusion ..................................... 18.14 13.76 13.76 1.60 33.50 33.50 000

37205 ............ A Transcatheter stent ............................................ 8.28 5.16 5.16 0.42 13.86 13.86 000

37206 ............ A Transcatheter stent ............................................ 4.13 2.58 2.58 0.21 6.92 6.92 ZZZ

37207 ............ A Transcatheter stent ............................................ 8.28 5.16 5.16 0.42 13.86 13.86 000

37208 ............ A Transcatheter stent ............................................ 4.13 2.58 2.58 0.21 6.92 6.92 ZZZ

37209 ............ A Exchange arterial catheter ................................. 2.27 1.41 1.41 0.11 3.79 3.79 000

37250 ............ A Intravascular us .................................................. 2.10 1.14 1.14 0.13 3.37 3.37 ZZZ

37251 ............ A Intravascular us .................................................. 1.60 0.87 0.87 0.10 2.57 2.57 ZZZ

37565 ............ A Ligation of neck vein .......................................... *4.44 3.79 3.79 0.74 8.97 8.97 090

37600 ............ A Ligation of neck artery ....................................... *4.57 4.98 4.98 0.80 10.35 10.35 090

37605 ............ A Ligation of neck artery ....................................... *6.19 5.56 5.56 1.04 12.79 12.79 090

37606 ............ A Ligation of neck artery ....................................... *6.28 5.92 5.92 0.72 12.92 12.92 090

37607 ............ A Ligation of fistula ................................................ *6.16 3.06 3.06 0.71 9.93 9.93 090

37609 ............ A Temporal artery procedure ................................ *2.30 2.22 2.22 0.38 4.90 4.90 010

37615 ............ A Ligation of neck artery ....................................... *5.73 5.62 5.62 1.11 12.46 12.46 090

37616 ............ A Ligation of chest artery ...................................... *16.49 4.21 4.21 0.83 21.53 21.53 090

37617 ............ A Ligation of abdomen artery ................................ *15.95 8.00 8.00 1.54 25.49 25.49 090

37618 ............ A Ligation of extremity artery ................................ *4.84 4.98 4.98 1.06 10.88 10.88 090

37620 ............ A Revision of major vein ....................................... *10.56 8.81 8.81 1.48 20.85 20.85 090

37650 ............ A Revision of major vein ....................................... *5.13 4.02 4.02 0.52 9.67 9.67 090

37660 ............ A Revision of major vein ....................................... *10.61 5.75 5.75 1.07 17.43 17.43 090

37700 ............ A Revise leg vein ................................................... *3.73 3.64 3.64 0.73 8.10 8.10 090
59139

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

37720 ............ A Removal of leg vein ........................................... *5.66 5.11 5.11 1.04 11.81 11.81 090

37730 ............ A Removal of leg veins ......................................... *7.33 6.95 6.95 1.40 15.68 15.68 090

37735 ............ A Removal of leg veins/lesion ............................... *10.53 8.34 8.34 1.68 20.55 20.55 090

37760 ............ A Revision of leg veins .......................................... *10.47 7.48 7.48 1.52 19.47 19.47 090

37780 ............ A Revision of leg vein ............................................ *3.84 1.89 1.89 0.35 6.08 6.08 090

37785 ............ A Revise secondary varicosity .............................. *3.88 0.98 0.98 0.18 5.04 5.04 090

37788 ............ A Revascularization, penis .................................... *22.01 15.14 15.14 1.48 38.63 38.63 090

37790 ............ A Penile venous occlusion .................................... *8.34 5.70 5.70 0.55 14.59 14.59 090

37799 ............ C Vascular surgery procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

38100 ............ A Removal of spleen, total .................................... *13.01 8.55 8.55 1.81 23.37 23.37 090

38101 ............ A Removal of spleen, partial ................................. *13.74 6.99 6.99 1.51 22.24 22.24 090

38102 ............ A Removal of spleen, total .................................... 4.80 2.51 2.51 0.58 7.89 7.89 ZZZ

38115 ............ A Repair of ruptured spleen .................................. *14.19 7.64 7.64 1.49 23.32 23.32 090

38200 ............ A Injection for spleen x-ray .................................... 2.64 1.71 1.71 0.15 4.50 4.50 000

38230 ............ R Bone marrow collection ...................................... *4.54 2.78 2.78 0.21 7.53 7.53 010

38231 ............ R Stem cell collection ............................................ 1.50 1.37 1.37 0.08 2.95 2.95 000

38240 ............ R Bone marrow/stem transplant ............................ 2.24 2.08 2.08 0.14 4.46 4.46 XXX

38241 ............ R Bone marrow/stem transplant ............................ 2.24 2.04 2.04 0.13 4.41 4.41 XXX

38300 ............ A Drainage lymph node lesion .............................. *1.53 0.58 0.58 0.10 2.21 2.21 010

38305 ............ A Drainage lymph node lesion .............................. *4.61 1.96 1.96 0.36 6.93 6.93 090

38308 ............ A Incision of lymph channels ................................. *4.95 3.37 3.37 0.45 8.77 8.77 090

38380 ............ A Thoracic duct procedure .................................... *7.46 4.44 4.44 0.76 12.66 12.66 090

38381 ............ A Thoracic duct procedure .................................... *12.88 7.56 7.56 1.50 21.94 21.94 090

38382 ............ A Thoracic duct procedure .................................... *10.08 4.84 4.84 1.13 16.05 16.05 090

38500 ............ A Biopsy/removal, lymph node(s) .......................... *2.88 1.59 1.59 0.31 4.78 4.78 010

38505 ............ A Needle biopsy, lymph node(s) ........................... 1.14 1.12 1.12 0.17 2.43 2.43 000

38510 ............ A Biopsy/removal, lymph node(s) .......................... *4.14 2.54 2.54 0.45 7.13 7.13 090

38520 ............ A Biopsy/removal, lymph node(s) .......................... *5.12 2.99 2.99 0.56 8.67 8.67 090

38525 ............ A Biopsy/removal, lymph node(s) .......................... *4.66 2.59 2.59 0.53 7.78 7.78 090

38530 ............ A Biopsy/removal, lymph node(s) .......................... *6.13 3.17 3.17 0.65 9.95 9.95 090

38542 ............ A Explore deep node(s), neck ............................... *5.91 4.26 4.26 0.59 10.76 10.76 090

38550 ............ A Removal neck/armpit lesion ............................... *6.73 3.23 3.23 0.63 10.59 10.59 090

38555 ............ A Removal neck/armpit lesion ............................... *14.27 7.27 7.27 1.38 22.92 22.92 090

38562 ............ A Removal, pelvic lymph nodes ............................ *10.49 6.88 6.88 1.20 18.57 18.57 090

38564 ............ A Removal, abdomen lymph nodes ...................... *10.83 7.39 7.39 1.51 19.73 19.73 090

38700 ............ A Removal of lymph nodes, neck ......................... *8.24 #9.06 #9.06 1.31 18.61 18.61 090

38720 ............ A Removal of lymph nodes, neck ......................... *13.61 #14.97 #14.97 2.04 30.62 30.62 090

38724 ............ A Removal of lymph nodes, neck ......................... *14.54 14.36 14.36 2.00 30.90 30.90 090

38740 ............ A Remove armpit lymph nodes ............................. *6.77 4.72 4.72 1.00 12.49 12.49 090

38745 ............ A Remove armpits lymph nodes ........................... *8.84 8.28 8.28 1.76 18.88 18.88 090

38746 ............ A Remove thoracic lymph nodes .......................... 4.39 2.29 2.29 0.53 7.21 7.21 ZZZ

38747 ............ A Remove abdominal lymph nodes ...................... 4.89 2.56 2.56 0.59 8.04 8.04 ZZZ

38760 ............ A Remove groin lymph nodes ............................... *8.74 6.63 6.63 1.35 16.72 16.72 090

38765 ............ A Remove groin lymph nodes ............................... *16.06 12.67 12.67 2.42 31.15 31.15 090

38770 ............ A Remove pelvis lymph nodes .............................. *13.23 #14.55 #14.55 1.73 29.51 29.51 090

38780 ............ A Remove abdomen lymph nodes ........................ *16.59 16.06 16.06 3.13 35.78 35.78 090

38790 ............ A Injection for lymphatic x-ray ............................... 1.29 1.64 #1.42 0.19 3.12 2.90 000

38794 ............ A Access thoracic lymph duct ............................... *4.45 2.84 2.84 0.38 7.67 7.67 090

38999 ............ C Blood/lymph system procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

39000 ............ A Exploration of chest ........................................... *6.10 6.05 6.05 1.08 13.23 13.23 090

39010 ............ A Exploration of chest ........................................... *11.79 11.46 11.46 2.08 25.33 25.33 090

39200 ............ A Removal chest lesion ......................................... *13.62 11.58 11.58 2.14 27.34 27.34 090

39220 ............ A Removal chest lesion ......................................... *17.42 14.94 14.94 2.83 35.19 35.19 090

39400 ............ A Visualization of chest ......................................... *5.61 5.12 5.12 0.95 11.68 11.68 010

39499 ............ C Chest procedure ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

39501 ............ A Repair diaphragm laceration .............................. *13.19 10.66 10.66 2.10 25.95 25.95 090

39502 ............ A Repair paraesophageal hernia ........................... *16.33 11.93 11.93 2.45 30.71 30.71 090

39503 ............ A Repair of diaphragm hernia ............................... *34.85 25.18 25.18 2.94 62.97 62.97 090

39520 ............ A Repair of diaphragm hernia ............................... *16.10 12.53 12.53 2.46 31.09 31.09 090

39530 ............ A Repair of diaphragm hernia ............................... *15.41 14.06 14.06 2.71 32.18 32.18 090

39531 ............ A Repair of diaphragm hernia ............................... *16.42 10.00 10.00 1.80 28.22 28.22 090

39540 ............ A Repair of diaphragm hernia ............................... *13.32 11.98 11.98 2.51 27.81 27.81 090

39541 ............ A Repair of diaphragm hernia ............................... *14.41 12.16 12.16 2.37 28.94 28.94 090

39545 ............ A Revision of diaphragm ....................................... *13.37 7.90 7.90 1.31 22.58 22.58 090

39599 ............ C Diaphragm surgery procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

40490 ............ A Biopsy of lip ........................................................ 1.22 0.74 0.74 0.07 2.03 2.03 000

40500 ............ A Partial excision of lip .......................................... *4.28 #4.71 #4.71 0.94 9.93 9.93 090

40510 ............ A Partial excision of lip .......................................... *4.70 #5.17 #5.17 0.83 10.70 10.70 090

40520 ............ A Partial excision of lip .......................................... *4.67 4.50 4.50 0.68 9.85 9.85 090

40525 ............ A Reconstruct lip with flap ..................................... *7.55 #8.31 #8.31 1.43 17.29 17.29 090

40527 ............ A Reconstruct lip with flap ..................................... *9.13 #10.04 #10.04 1.65 20.82 20.82 090

40530 ............ A Partial removal of lip .......................................... *5.40 5.10 5.10 0.74 11.24 11.24 090

40650 ............ A Repair lip ............................................................ *3.64 #4.00 #4.00 0.65 8.29 8.29 090

40652 ............ A Repair lip ............................................................ *4.26 #4.69 #4.69 0.79 9.74 9.74 090
59140

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

40654 ............ A Repair lip ............................................................ *5.31 #5.84 #5.84 1.00 12.15 12.15 090

40700 ............ A Repair cleft lip/nasal ........................................... *12.79 8.46 8.46 1.28 22.53 22.53 090

40701 ............ A Repair cleft lip/nasal ........................................... *15.85 19.33 19.33 1.62 36.80 36.80 090

40702 ............ A Repair cleft lip/nasal ........................................... *13.04 9.37 9.37 1.10 23.51 23.51 090

40720 ............ A Repair cleft lip/nasal ........................................... *13.55 9.59 9.59 1.79 24.93 24.93 090

40761 ............ A Repair cleft lip/nasal ........................................... *14.72 10.84 10.84 1.74 27.30 27.30 090

40799 ............ C Lip surgery procedure ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

40800 ............ A Drainage of mouth lesion ................................... *1.17 0.74 0.74 0.07 1.98 1.98 010

40801 ............ A Drainage of mouth lesion ................................... *2.53 1.70 1.70 0.16 4.39 4.39 010

40804 ............ A Removal foreign body, mouth ............................ *1.24 0.58 0.58 0.06 1.88 1.88 010

40805 ............ A Removal foreign body, mouth ............................ *2.69 2.50 2.50 0.30 5.49 5.49 010

40806 ............ A Incision of lip fold ............................................... 0.31 0.36 0.36 0.03 0.70 0.70 000

40808 ............ A Biopsy of mouth lesion ....................................... *0.96 0.76 0.76 0.08 1.80 1.80 010

40810 ............ A Excision of mouth lesion .................................... *1.31 1.18 1.18 0.11 2.60 2.60 010

40812 ............ A Excise/repair mouth lesion ................................. *2.31 1.50 1.50 0.14 3.95 3.95 010

40814 ............ A Excise/repair mouth lesion ................................. *3.42 3.23 3.23 0.32 6.97 6.97 090

40816 ............ A Excision of mouth lesion .................................... *3.67 3.22 3.22 0.33 7.22 7.22 090

40818 ............ A Excise oral mucosa for graft .............................. *2.41 2.25 2.25 0.20 4.86 4.86 090

40819 ............ A Excise lip or cheek fold ...................................... *2.41 1.23 1.23 0.14 3.78 3.78 090

40820 ............ A Treatment of mouth lesion ................................. *1.28 0.53 0.53 0.06 1.87 1.87 010

40830 ............ A Repair mouth laceration ..................................... *1.76 0.67 0.67 0.07 2.50 2.50 010

40831 ............ A Repair mouth laceration ..................................... *2.46 1.94 1.94 0.21 4.61 4.61 010

40840 ............ R Reconstruction of mouth .................................... *8.73 6.28 6.28 0.73 15.74 15.74 090

40842 ............ R Reconstruction of mouth .................................... *8.73 6.28 6.28 0.73 15.74 15.74 090

40843 ............ R Reconstruction of mouth .................................... *12.10 8.80 8.80 1.03 21.93 21.93 090

40844 ............ R Reconstruction of mouth .................................... *16.01 11.63 11.63 1.36 29.00 29.00 090

40845 ............ R Reconstruction of mouth .................................... *18.58 #20.44 #20.44 1.93 40.95 40.95 090

40899 ............ C Mouth surgery procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

41000 ............ A Drainage of mouth lesion ................................... *1.30 0.76 0.76 0.08 2.14 2.14 010

41005 ............ A Drainage of mouth lesion ................................... *1.26 0.62 0.62 0.07 1.95 1.95 010

41006 ............ A Drainage of mouth lesion ................................... *3.24 1.01 1.01 0.11 4.36 4.36 090

41007 ............ A Drainage of mouth lesion ................................... *3.10 2.90 2.90 0.30 6.30 6.30 090

41008 ............ A Drainage of mouth lesion ................................... *3.37 1.06 1.06 0.11 4.54 4.54 090

41009 ............ A Drainage of mouth lesion ................................... *3.59 3.31 3.31 0.34 7.24 7.24 090

41010 ............ A Incision of tongue fold ........................................ *1.06 0.37 0.37 0.04 1.47 1.47 010

41015 ............ A Drainage of mouth lesion ................................... *3.96 0.87 0.87 0.10 4.93 4.93 090

41016 ............ A Drainage of mouth lesion ................................... *4.07 3.69 3.69 0.38 8.14 8.14 090

41017 ............ A Drainage of mouth lesion ................................... *4.07 1.40 1.40 0.14 5.61 5.61 090

41018 ............ A Drainage of mouth lesion ................................... *5.10 3.93 3.93 0.38 9.41 9.41 090

41100 ............ A Biopsy of tongue ................................................ *1.63 0.80 0.80 0.08 2.51 2.51 010

41105 ............ A Biopsy of tongue ................................................ *1.42 1.03 1.03 0.12 2.57 2.57 010

41108 ............ A Biopsy of floor of mouth ..................................... *1.05 0.85 0.85 0.09 1.99 1.99 010

41110 ............ A Excision of tongue lesion ................................... *1.51 1.30 1.30 0.15 2.96 2.96 010

41112 ............ A Excision of tongue lesion ................................... *2.73 2.39 2.39 0.23 5.35 5.35 090

41113 ............ A Excision of tongue lesion ................................... *3.19 3.41 3.41 0.37 6.97 6.97 090

41114 ............ A Excision of tongue lesion ................................... *8.47 6.39 6.39 0.73 15.59 15.59 090

41115 ............ A Excision of tongue fold ....................................... *1.74 1.78 1.78 0.17 3.69 3.69 010

41116 ............ A Excision of mouth lesion .................................... *2.44 2.49 2.49 0.27 5.20 5.20 090

41120 ............ A Partial removal of tongue ................................... *9.77 7.28 7.28 0.88 17.93 17.93 090

41130 ............ A Partial removal of tongue ................................... *11.15 9.06 9.06 1.14 21.35 21.35 090

41135 ............ A Tongue and neck surgery .................................. *23.09 18.30 18.30 2.64 44.03 44.03 090

41140 ............ A Removal of tongue ............................................. *25.50 18.89 18.89 2.45 46.84 46.84 090

41145 ............ A Tongue removal; neck surgery .......................... *30.06 22.79 22.79 2.95 55.80 55.80 090

41150 ............ A Tongue, mouth, jaw surgery .............................. *23.04 18.96 18.96 2.46 44.46 44.46 090

41153 ............ A Tongue, mouth, neck surgery ............................ *23.77 25.00 25.00 3.03 51.80 51.80 090

41155 ............ A Tongue, jaw, & neck surgery ............................. *27.72 29.95 29.95 3.75 61.42 61.42 090

41250 ............ A Repair tongue laceration .................................... *1.91 1.07 1.07 0.11 3.09 3.09 010

41251 ............ A Repair tongue laceration .................................... *2.27 2.07 2.07 0.21 4.55 4.55 010

41252 ............ A Repair tongue laceration .................................... *2.97 2.35 2.35 0.26 5.58 5.58 010

41500 ............ A Fixation of tongue .............................................. *3.71 3.29 3.29 0.26 7.26 7.26 090

41510 ............ A Tongue to lip surgery ......................................... *3.42 2.53 2.53 0.45 6.40 6.40 090

41520 ............ A Reconstruction, tongue fold ............................... *2.73 2.88 2.88 0.28 5.89 5.89 090

41599 ............ C Tongue and mouth surgery ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

41800 ............ A Drainage of gum lesion ...................................... *1.17 0.69 0.69 0.07 1.93 1.93 010

41805 ............ A Removal foreign body, gum ............................... *1.24 0.84 0.84 0.08 2.16 2.16 010

41806 ............ A Removal foreign body, jawbone ........................ *2.69 1.64 1.64 0.15 4.48 4.48 010

41820 ............ R Excision, gum, each quadrant ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

41821 ............ R Excision of gum flap ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

41822 ............ R Excision of gum lesion ....................................... *2.31 3.03 3.03 0.25 5.59 5.59 010

41823 ............ R Excision of gum lesion ....................................... *3.30 #3.63 #3.63 0.34 7.27 7.27 090

41825 ............ A Excision of gum lesion ....................................... *1.31 1.49 1.49 0.14 2.94 2.94 010

41826 ............ A Excision of gum lesion ....................................... *2.31 2.07 2.07 0.18 4.56 4.56 010

41827 ............ A Excision of gum lesion ....................................... *3.42 #3.76 #3.76 0.38 7.56 7.56 090

41828 ............ R Excision of gum lesion ....................................... *3.09 4.07 4.07 0.33 7.49 7.49 010
59141

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

41830 ............ R Removal of gum tissue ...................................... *3.35 #3.69 #3.69 0.36 7.40 7.40 010

41850 ............ R Treatment of gum lesion .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

41870 ............ R Gum graft ........................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

41872 ............ R Repair gum ......................................................... *2.59 #2.85 #2.85 0.27 5.71 5.71 090

41874 ............ R Repair tooth socket ............................................ *3.09 #3.40 #3.40 0.32 6.81 6.81 090

41899 ............ C Dental surgery procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

42000 ............ A Drainage mouth roof lesion ................................ *1.23 0.62 0.62 0.06 1.91 1.91 010

42100 ............ A Biopsy roof of mouth .......................................... *1.31 0.79 0.79 0.08 2.18 2.18 010

42104 ............ A Excision lesion, mouth roof ................................ *1.64 1.62 1.62 0.17 3.43 3.43 010

42106 ............ A Excision lesion, mouth roof ................................ *2.10 2.22 2.22 0.21 4.53 4.53 010

42107 ............ A Excision lesion, mouth roof ................................ *4.44 #4.88 #4.88 0.50 9.82 9.82 090

42120 ............ A Remove palate/lesion ......................................... *6.17 #6.79 #6.79 1.01 13.97 13.97 090

42140 ............ A Excision of uvula ................................................ *1.62 1.35 1.35 0.15 3.12 3.12 090

42145 ............ A Repair, palate, pharynx/uvula ............................ *8.05 #8.86 #8.86 1.45 18.36 18.36 090

42160 ............ A Treatment mouth roof lesion .............................. *1.80 1.53 1.53 0.16 3.49 3.49 010

42180 ............ A Repair palate ...................................................... *2.50 2.24 2.24 0.26 5.00 5.00 010

42182 ............ A Repair palate ...................................................... *3.83 3.47 3.47 0.38 7.68 7.68 010

42200 ............ A Reconstruct cleft palate ..................................... *12.00 7.19 7.19 0.85 20.04 20.04 090

42205 ............ A Reconstruct cleft palate ..................................... *9.59 #10.55 #10.55 0.79 20.93 20.93 090

42210 ............ A Reconstruct cleft palate ..................................... *14.50 12.51 12.51 0.95 27.96 27.96 090

42215 ............ A Reconstruct cleft palate ..................................... *8.82 7.68 7.68 0.86 17.36 17.36 090

42220 ............ A Reconstruct cleft palate ..................................... *7.02 5.40 5.40 0.81 13.23 13.23 090

42225 ............ A Reconstruct cleft palate ..................................... *9.54 6.90 6.90 1.08 17.52 17.52 090

42226 ............ A Lengthening of palate ........................................ *10.01 7.89 7.89 0.86 18.76 18.76 090

42227 ............ A Lengthening of palate ........................................ *9.52 7.41 7.41 0.38 17.31 17.31 090

42235 ............ A Repair palate ...................................................... *7.87 5.55 5.55 0.49 13.91 13.91 090

42260 ............ A Repair nose to lip fistula .................................... *9.80 3.98 3.98 0.44 14.22 14.22 090

42280 ............ A Preparation, palate mold .................................... *1.54 1.99 1.99 0.17 3.70 3.70 010

42281 ............ A Insertion, palate prosthesis ................................ *1.93 1.47 1.47 0.15 3.55 3.55 010

42299 ............ C Palate/uvula surgery .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

42300 ............ A Drainage of salivary gland ................................. *1.93 0.96 0.96 0.12 3.01 3.01 010

42305 ............ A Drainage of salivary gland ................................. *6.07 2.18 2.18 0.27 8.52 8.52 090

42310 ............ A Drainage of salivary gland ................................. *1.56 1.03 1.03 0.12 2.71 2.71 010

42320 ............ A Drainage of salivary gland ................................. *2.35 1.83 1.83 0.22 4.40 4.40 010

42325 ............ A Create salivary cyst drain .................................. *2.75 2.12 2.12 0.20 5.07 5.07 090

42326 ............ A Create salivary cyst drain .................................. *3.78 #4.16 #4.16 0.33 8.27 8.27 090

42330 ............ A Removal of salivary stone .................................. *2.21 1.10 1.10 0.12 3.43 3.43 010

42335 ............ A Removal of salivary stone .................................. *3.31 2.47 2.47 0.27 6.05 6.05 090

42340 ............ A Removal of salivary stone .................................. *4.60 4.25 4.25 0.45 9.30 9.30 090

42400 ............ A Biopsy of salivary gland ..................................... 0.78 0.79 0.79 0.10 1.67 1.67 000

42405 ............ A Biopsy of salivary gland ..................................... *3.29 1.54 1.54 0.19 5.02 5.02 010

42408 ............ A Excision of salivary cyst ..................................... *4.54 3.24 3.24 0.38 8.16 8.16 090

42409 ............ A Drainage of salivary cyst .................................... *2.81 2.81 2.81 0.30 5.92 5.92 090

42410 ............ A Excise parotid gland/lesion ................................ *9.34 5.94 5.94 0.92 16.20 16.20 090

42415 ............ A Excise parotid gland/lesion ................................ *16.89 12.68 12.68 1.68 31.25 31.25 090

42420 ............ A Excise parotid gland/lesion ................................ *19.59 14.82 14.82 1.87 36.28 36.28 090

42425 ............ A Excise parotid gland/lesion ................................ *13.02 11.10 11.10 1.43 25.55 25.55 090

42426 ............ A Excise parotid gland/lesion ................................ *21.26 #23.39 #23.39 3.21 47.86 47.86 090

42440 ............ A Excision submaxillary gland ............................... *6.97 #7.67 #7.67 0.99 15.63 15.63 090

42450 ............ A Excision sublingual gland ................................... *4.62 3.42 3.42 0.35 8.39 8.39 090

42500 ............ A Repair salivary duct ........................................... *4.30 4.61 4.61 0.50 9.41 9.41 090

42505 ............ A Repair salivary duct ........................................... *6.18 #6.80 #6.80 0.86 13.84 13.84 090

42507 ............ A Parotid duct diversion ........................................ *6.11 4.65 4.65 0.67 11.43 11.43 090

42508 ............ A Parotid duct diversion ........................................ *9.10 7.61 7.61 0.94 17.65 17.65 090

42509 ............ A Parotid duct diversion ........................................ *11.54 7.31 7.31 1.23 20.08 20.08 090

42510 ............ A Parotid duct diversion ........................................ *8.15 7.65 7.65 0.84 16.64 16.64 090

42550 ............ A Injection for salivary x-ray .................................. 1.25 0.44 0.44 0.04 1.73 1.73 000

42600 ............ A Closure of salivary fistula ................................... *4.82 3.89 3.89 0.46 9.17 9.17 090

42650 ............ A Dilation of salivary duct ...................................... 0.77 0.39 0.39 0.04 1.20 1.20 000

42660 ............ A Dilation of salivary duct ...................................... 1.13 0.50 0.50 0.06 1.69 1.69 000

42665 ............ A Ligation of salivary duct ..................................... *2.53 2.04 2.04 0.25 4.82 4.82 090

42699 ............ C Salivary surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

42700 ............ A Drainage of tonsil abscess ................................. *1.62 0.85 0.85 0.10 2.57 2.57 010

42720 ............ A Drainage of throat abscess ................................ *5.42 1.89 1.89 0.22 7.53 7.53 010

42725 ............ A Drainage of throat abscess ................................ *10.72 4.45 4.45 0.53 15.70 15.70 090

42800 ............ A Biopsy of throat .................................................. *1.39 0.74 0.74 0.08 2.21 2.21 010

42802 ............ A Biopsy of throat .................................................. *1.54 1.02 1.02 0.12 2.68 2.68 010

42804 ............ A Biopsy of upper nose/throat ............................... *1.24 1.09 1.09 0.13 2.46 2.46 010

42806 ............ A Biopsy of upper nose/throat ............................... *1.58 1.40 1.40 0.16 3.14 3.14 010

42808 ............ A Excise pharynx lesion ........................................ *2.30 2.52 2.52 0.29 5.11 5.11 010

42809 ............ A Remove pharynx foreign body ........................... *1.81 0.82 0.82 0.08 2.71 2.71 010

42810 ............ A Excision of neck cyst ......................................... *3.33 3.14 3.14 0.47 6.94 6.94 090

42815 ............ A Excision of neck cyst ......................................... *7.23 #7.95 #7.95 1.12 16.30 16.30 090

42820 ............ A Remove tonsils and adenoids ............................ *3.91 3.15 3.15 0.32 7.38 7.38 090
59142

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

42821 ............ A Remove tonsils and adenoids ............................ *4.29 3.93 3.93 0.46 8.68 8.68 090

42825 ............ A Removal of tonsils .............................................. *3.42 2.64 2.64 0.33 6.39 6.39 090

42826 ............ A Removal of tonsils .............................................. *3.38 #3.72 #3.72 0.43 7.53 7.53 090

42830 ............ A Removal of adenoids ......................................... *2.57 1.86 1.86 0.27 4.70 4.70 090

42831 ............ A Removal of adenoids ......................................... *2.71 2.36 2.36 0.25 5.32 5.32 090

42835 ............ A Removal of adenoids ......................................... *2.30 1.86 1.86 0.10 4.26 4.26 090

42836 ............ A Removal of adenoids ......................................... *3.18 2.79 2.79 0.31 6.28 6.28 090

42842 ............ A Extensive surgery of throat ................................ *8.76 6.69 6.69 0.73 16.18 16.18 090

42844 ............ A Extensive surgery of throat ................................ *14.31 10.85 10.85 1.27 26.43 26.43 090

42845 ............ A Extensive surgery of throat ................................ *24.29 18.62 18.62 2.22 45.13 45.13 090

42860 ............ A Excision of tonsil tags ........................................ *2.22 1.89 1.89 0.21 4.32 4.32 090

42870 ............ A Excision of lingual tonsil ..................................... *5.40 2.32 2.32 0.26 7.98 7.98 090

42890 ............ A Partial removal of pharynx ................................. *12.94 8.99 8.99 1.03 22.96 22.96 090

42892 ............ A Revision of pharyngeal walls ............................. *15.83 10.92 10.92 1.27 28.02 28.02 090

42894 ............ A Revision of pharyngeal walls ............................. *22.88 16.06 16.06 1.83 40.77 40.77 090

42900 ............ A Repair throat wound ........................................... *5.25 4.26 4.26 0.48 9.99 9.99 010

42950 ............ A Reconstruction of throat ..................................... *8.10 #8.91 #8.91 1.10 18.11 18.11 090

42953 ............ A Repair throat, esophagus ................................... *8.96 6.34 6.34 0.93 16.23 16.23 090

42955 ............ A Surgical opening of throat .................................. *7.39 3.32 3.32 0.43 11.14 11.14 090

42960 ............ A Control throat bleeding ....................................... *2.33 1.08 1.08 0.12 3.53 3.53 010

42961 ............ A Control throat bleeding ....................................... *5.59 1.75 1.75 0.19 7.53 7.53 090

42962 ............ A Control throat bleeding ....................................... *7.14 5.98 5.98 0.68 13.80 13.80 090

42970 ............ A Control nose/throat bleeding .............................. *5.43 1.03 1.03 0.10 6.56 6.56 090

42971 ............ A Control nose/throat bleeding .............................. *6.21 2.90 2.90 0.34 9.45 9.45 090

42972 ............ A Control nose/throat bleeding .............................. *7.20 4.55 4.55 0.73 12.48 12.48 090

42999 ............ C Throat surgery procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

43020 ............ A Incision of esophagus ........................................ *8.09 6.58 6.58 0.71 15.38 15.38 090

43030 ............ A Throat muscle surgery ....................................... *7.69 #8.46 #8.46 1.21 17.36 17.36 090

43045 ............ A Incision of esophagus ........................................ *20.12 12.45 12.45 2.36 34.93 34.93 090

43100 ............ A Excision of esophagus lesion ............................ *9.19 6.19 6.19 0.95 16.33 16.33 090

43101 ............ A Excision of esophagus lesion ............................ *16.24 9.48 9.48 1.88 27.60 27.60 090

43107 ............ A Removal of esophagus ...................................... *28.79 22.50 22.50 4.42 55.71 55.71 090

43108 ............ A Removal of esophagus ...................................... *34.19 25.27 25.27 4.77 64.23 64.23 090

43112 ............ A Removal of esophagus ...................................... *31.22 21.65 21.65 4.22 57.09 57.09 090

43113 ............ A Removal of esophagus ...................................... *35.27 25.27 25.27 4.77 65.31 65.31 090

43116 ............ A Partial removal of esophagus ............................ *31.22 25.27 25.27 4.77 61.26 61.26 090

43117 ............ A Partial removal of esophagus ............................ *30.02 25.27 25.27 4.77 60.06 60.06 090

43118 ............ A Partial removal of esophagus ............................ *33.20 25.27 25.27 4.77 63.24 63.24 090

43121 ............ A Partial removal of esophagus ............................ *29.19 21.36 21.36 4.19 54.74 54.74 090

43122 ............ A Parital removal of esophagus ............................ *29.11 21.36 21.36 4.19 54.66 54.66 090

43123 ............ A Partial removal of esophagus ............................ *33.20 25.27 25.27 4.77 63.24 63.24 090

43124 ............ A Removal of esophagus ...................................... *27.32 22.50 22.50 4.42 54.24 54.24 090

43130 ............ A Removal of esophagus pouch ........................... *11.75 10.51 10.51 1.60 23.86 23.86 090

43135 ............ A Removal of esophagus pouch ........................... *16.10 11.72 11.72 2.17 29.99 29.99 090

43200 ............ A Esophagus endoscopy ....................................... 1.59 2.04 #1.75 0.26 3.89 3.60 000

43202 ............ A Esophagus endoscopy, biopsy .......................... 1.89 2.41 #2.08 0.31 4.61 4.28 000

43204 ............ A Esophagus endoscopy & inject .......................... 3.77 #4.15 #4.15 0.36 8.28 8.28 000

43205 ............ A Esophagus endoscopy/ligation .......................... 3.79 2.70 2.70 0.18 6.67 6.67 000

43215 ............ A Esophagus endoscopy ....................................... 2.60 #2.86 #2.86 0.46 5.92 5.92 000

43216 ............ A Esophagus endoscopy/lesion ............................ 2.40 #2.64 #2.64 0.37 5.41 5.41 000

43217 ............ A Esophagus endoscopy ....................................... 2.90 #3.19 #3.19 0.37 6.46 6.46 000

43219 ............ A Esophagus endoscopy ....................................... 2.80 #3.08 #3.08 0.34 6.22 6.22 000

43220 ............ A Esophagus endoscopy, dilation ......................... 2.10 #2.31 #2.31 0.27 4.68 4.68 000

43226 ............ A Esophagus endoscopy, dilation ......................... 2.34 #2.57 #2.57 0.26 5.17 5.17 000

43227 ............ A Esophagus endoscopy, repair ........................... 3.60 #3.96 #3.96 0.34 7.90 7.90 000

43228 ............ A Esophagus endoscopy, ablation ........................ 3.77 #4.15 #4.15 0.38 8.30 8.30 000

43234 ............ A Upper GI endoscopy, exam ............................... 2.01 2.57 #2.21 0.30 4.88 4.52 000

43235 ............ A Upper gi endoscopy, diagnosis .......................... 2.39 3.07 #2.63 0.29 5.75 5.31 000

43239 ............ A Upper GI endoscopy, biopsy ............................. 2.69 3.44 #2.96 0.33 6.46 5.98 000

43241 ............ A Upper GI endoscopy with tube .......................... 2.59 #2.85 #2.85 0.38 5.82 5.82 000

43243 ............ A Upper GI endoscopy & inject. ............................ 4.57 #5.03 #5.03 0.39 9.99 9.99 000

43244 ............ A Upper GI endoscopy/ligation .............................. 4.59 3.47 3.47 0.41 8.47 8.47 000

43245 ............ A Operative upper GI endoscopy .......................... 3.39 #3.73 #3.73 0.40 7.52 7.52 000

43246 ............ A Place gastrostomy tube ..................................... 4.33 #4.76 #4.76 0.51 9.60 9.60 000

43247 ............ A Operative upper GI endoscopy .......................... 3.39 #3.73 #3.73 0.38 7.50 7.50 000

43248 ............ A Upper GI endoscopy/guidewire .......................... 3.15 #3.47 #3.47 0.35 6.97 6.97 000

43249 ............ A Esophagus endoscopy, dilation ......................... 2.90 #3.19 #3.19 0.30 6.39 6.39 000

43250 ............ A Upper GI endoscopy/tumor ................................ 3.20 #3.52 #3.52 0.43 7.15 7.15 000

43251 ............ A Operative upper GI endoscopy .......................... 3.70 #4.07 #4.07 0.43 8.20 8.20 000

43255 ............ A Operative upper GI endoscopy .......................... 4.40 #4.84 #4.84 0.38 9.62 9.62 000

43258 ............ A Operative upper GI endoscopy .......................... 4.55 #5.01 #5.01 0.38 9.94 9.94 000

43259 ............ A Endoscopic ultrasound exam ............................. 4.89 4.02 4.02 0.35 9.26 9.26 000

43260 ............ A Endoscopy, bile duct/pancreas .......................... 5.96 5.98 5.98 0.39 12.33 12.33 000

43261 ............ A Endoscopy, bile duct/pancreas .......................... 6.27 5.98 5.98 0.39 12.64 12.64 000
59143

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

43262 ............ A Endoscopy, bile duct/pancreas .......................... 7.39 #8.13 #8.13 0.58 16.10 16.10 000

43263 ............ A Endoscopy, bile duct/pancreas .......................... 6.19 5.83 5.83 0.38 12.40 12.40 000

43264 ............ A Endoscopy, bile duct/pancreas .......................... 8.90 8.92 8.92 0.61 18.43 18.43 000

43265 ............ A Endoscopy, bile duct/pancreas .......................... 8.90 6.82 6.82 0.49 16.21 16.21 000

43267 ............ A Endoscopy, bile duct/pancreas .......................... 7.39 7.41 7.41 0.48 15.28 15.28 000

43268 ............ A Endoscopy, bile duct/pancreas .......................... 7.39 #8.13 #8.13 0.56 16.08 16.08 000

43269 ............ A Endoscopy, bile duct/pancreas .......................... 6.04 #6.64 #6.64 0.51 13.19 13.19 000

43271 ............ A Endoscopy, bile duct/pancreas .......................... 7.39 7.63 7.63 0.50 15.52 15.52 000

43272 ............ A Endoscopy, bile duct/pancreas .......................... 7.39 5.60 5.60 0.42 13.41 13.41 000

43300 ............ A Repair of esophagus .......................................... *9.14 #10.05 #10.05 1.70 20.89 20.89 090

43305 ............ A Repair esophagus and fistula ............................ *17.15 13.71 13.71 1.78 32.64 32.64 090

43310 ............ A Repair of esophagus .......................................... *25.39 16.99 16.99 3.23 45.61 45.61 090

43312 ............ A Repair esophagus and fistula ............................ *28.42 13.72 13.72 2.30 44.44 44.44 090

43320 ............ A Fuse esophagus & stomach .............................. *16.07 11.68 11.68 2.05 29.80 29.80 090

43324 ............ A Revise esophagus & stomach ........................... *16.58 11.88 11.88 2.53 30.99 30.99 090

43325 ............ A Revise esophagus & stomach ........................... *16.17 11.61 11.61 2.29 30.07 30.07 090

43326 ............ A Revise esophagus & stomach ........................... *15.91 7.52 7.52 1.75 25.18 25.18 090

43330 ............ A Repair of esophagus .......................................... *15.94 11.36 11.36 2.39 29.69 29.69 090

43331 ............ A Repair of esophagus .......................................... *16.23 14.33 14.33 2.64 33.20 33.20 090

43340 ............ A Fuse esophagus & intestine .............................. *15.81 12.44 12.44 2.52 30.77 30.77 090

43341 ............ A Fuse esophagus & intestine .............................. *16.81 9.90 9.90 1.56 28.27 28.27 090

43350 ............ A Surgical opening, esophagus ............................. *12.72 7.88 7.88 1.15 21.75 21.75 090

43351 ............ A Surgical opening, esophagus ............................. *14.79 8.77 8.77 1.53 25.09 25.09 090

43352 ............ A Surgical opening, esophagus ............................. *12.30 8.86 8.86 1.47 22.63 22.63 090

43360 ............ A Gastrointestinal repair ........................................ *28.78 21.36 21.36 4.19 54.33 54.33 090

43361 ............ A Gastrointestinal repair ........................................ *32.65 25.27 25.27 4.77 62.69 62.69 090

43400 ............ A Ligate esophagus veins ..................................... *17.09 10.82 10.82 1.63 29.54 29.54 090

43401 ............ A Esophagus surgery for veins ............................. *17.81 9.59 9.59 1.93 29.33 29.33 090

43405 ............ A Ligate/staple esophagus .................................... *16.13 14.33 14.33 2.64 33.10 33.10 090

43410 ............ A Repair esophagus wound .................................. *10.86 8.90 8.90 1.54 21.30 21.30 090

43415 ............ A Repair esophagus wound .................................. *17.06 12.74 12.74 2.52 32.32 32.32 090

43420 ............ A Repair esophagus opening ................................ *11.57 5.88 5.88 0.78 18.23 18.23 090

43425 ............ A Repair esophagus opening ................................ *16.95 9.94 9.94 1.71 28.60 28.60 090

43450 ............ A Dilate esophagus ............................................... 1.38 0.68 0.68 0.05 2.11 2.11 000

43453 ............ A Dilate esophagus ............................................... 1.51 1.51 1.51 0.11 3.13 3.13 000

43456 ............ A Dilate esophagus ............................................... 2.57 2.47 2.47 0.24 5.28 5.28 000

43458 ............ A Dilation of esophagus ........................................ 3.06 1.52 1.52 0.27 4.85 4.85 000

43460 ............ A Pressure treatment esophagus .......................... 3.80 1.67 1.67 0.15 5.62 5.62 000

43496 ............ C Free jejunum flap, microvasc ............................. 0.00 0.00 0.00 0.00 0.00 0.00 090

43499 ............ C Esophagus surgery procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

43500 ............ A Surgical opening of stomach ............................. *8.44 6.13 6.13 1.20 15.77 15.77 090

43501 ............ A Surgical repair of stomach ................................. *15.31 8.58 8.58 1.83 25.72 25.72 090

43502 ............ A Surgical repair of stomach ................................. *17.67 8.58 8.58 1.83 28.08 28.08 090

43510 ............ A Surgical opening of stomach ............................. *9.99 8.29 8.29 0.94 19.22 19.22 090

43520 ............ A Incision of pyloric muscle ................................... *7.63 4.48 4.48 0.87 12.98 12.98 090

43600 ............ A Biopsy of stomach .............................................. 1.91 0.50 0.50 0.05 2.46 2.46 000

43605 ............ A Biopsy of stomach .............................................. *9.15 5.91 5.91 1.29 16.35 16.35 090

43610 ............ A Excision of stomach lesion ................................ *11.15 8.17 8.17 1.71 21.03 21.03 090

43611 ............ A Excision of stomach lesion ................................ *13.63 8.17 8.17 1.71 23.51 23.51 090

43620 ............ A Removal of stomach .......................................... *22.54 15.38 15.38 3.19 41.11 41.11 090

43621 ............ A Removal of stomach .......................................... *23.06 15.38 15.38 3.19 41.63 41.63 090

43622 ............ A Removal of stomach .......................................... *24.41 15.38 15.38 3.19 42.98 42.98 090

43631 ............ A Removal of stomach, partial .............................. *19.66 12.42 12.42 2.66 34.74 34.74 090

43632 ............ A Removal stomach, partial .................................. *19.66 12.42 12.42 2.66 34.74 34.74 090

43633 ............ A Removal stomach, partial .................................. *20.10 12.42 12.42 2.66 35.18 35.18 090

43634 ............ A Removal stomach, partial .................................. *21.86 20.83 20.83 4.57 47.26 47.26 090

43635 ............ A Partial removal of stomach ................................ 2.06 1.08 1.08 0.26 3.40 3.40 ZZZ

43638 ............ A Partial removal of stomach ................................ *21.76 12.75 12.75 2.73 37.24 37.24 090

43639 ............ A Removal stomach, partial .................................. *22.25 12.75 12.75 2.73 37.73 37.73 090

43640 ............ A Vagotomy & pylorus repair ................................ *14.81 10.34 10.34 2.19 27.34 27.34 090

43641 ............ A Vagotomy & pylorus repair ................................ *15.03 10.34 10.34 2.18 27.55 27.55 090

43750 ............ A Place gastrostomy tube ..................................... *4.49 4.35 4.35 0.56 9.40 9.40 010

43760 ............ A Change gastrostomy tube .................................. 1.10 0.69 0.69 0.09 1.88 1.88 000

43761 ............ A Reposition gastrostomy tube ............................. 2.01 1.06 1.06 0.25 3.32 3.32 000

43800 ............ A Reconstruction of pylorus .................................. *10.46 6.85 6.85 1.47 18.78 18.78 090

43810 ............ A Fusion of stomach and bowel ............................ *11.19 7.64 7.64 1.53 20.36 20.36 090

43820 ............ A Fusion of stomach and bowel ............................ *11.74 8.29 8.29 1.75 21.78 21.78 090

43825 ............ A Fusion of stomach and bowel ............................ *14.68 11.08 11.08 2.30 28.06 28.06 090

43830 ............ A Place gastrostomy tube ..................................... *7.28 6.19 6.19 1.19 14.66 14.66 090

43831 ............ A Place gastrostomy tube ..................................... *7.33 5.20 5.20 0.93 13.46 13.46 090

43832 ............ A Place gastrostomy tube ..................................... *11.92 7.95 7.95 1.36 21.23 21.23 090

43840 ............ A Repair of stomach lesion ................................... *11.89 7.84 7.84 1.66 21.39 21.39 090

43842 ............ A Gastroplasty for obesity ..................................... *14.71 13.72 13.72 2.93 31.36 31.36 090

43843 ............ A Gastroplasty for obesity ..................................... *14.85 13.72 13.72 2.93 31.50 31.50 090
59144

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

43846 ............ A Gastric bypass for obesity ................................. *19.15 14.80 14.80 3.30 37.25 37.25 090

43847 ............ A Gastric bypass for obesity ................................. *21.44 14.80 14.80 3.30 39.54 39.54 090

43848 ............ A Revision gastroplasty ......................................... *23.41 14.80 14.80 3.30 41.51 41.51 090

43850 ............ A Revise stomach-bowel fusion ............................ *19.69 11.64 11.64 2.25 33.58 33.58 090

43855 ............ A Revise stomach-bowel fusion ............................ *20.83 10.44 10.44 2.28 33.55 33.55 090

43860 ............ A Revise stomach-bowel fusion ............................ *19.91 11.46 11.46 2.51 33.88 33.88 090

43865 ............ A Revise stomach-bowel fusion ............................ *21.12 13.39 13.39 2.98 37.49 37.49 090

43870 ............ A Repair stomach opening .................................... *7.40 5.77 5.77 1.14 14.31 14.31 090

43880 ............ A Repair stomach-bowel fistula ............................. *19.63 8.25 8.25 1.76 29.64 29.64 090

43999 ............ C Stomach surgery procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

44005 ............ A Freeing of bowel adhesion ................................. *13.84 8.28 8.28 1.75 23.87 23.87 090

44010 ............ A Incision of small bowel ....................................... *10.68 6.91 6.91 1.42 19.01 19.01 090

44015 ............ A Insert needle catheter, bowel ............................. 2.62 #2.88 #2.88 0.45 5.95 5.95 ZZZ

44020 ............ A Exploration of small bowel ................................. *11.93 7.81 7.81 1.65 21.39 21.39 090

44021 ............ A Decompress small bowel ................................... *12.01 7.00 7.00 1.48 20.49 20.49 090

44025 ............ A Incision of large bowel ....................................... *12.18 7.74 7.74 1.61 21.53 21.53 090

44050 ............ A Reduce bowel obstruction .................................. *11.40 7.77 7.77 1.64 20.81 20.81 090

44055 ............ A Correct malrotation of bowel .............................. *13.14 7.66 7.66 1.60 22.40 22.40 090

44100 ............ A Biopsy of bowel .................................................. 2.01 1.38 1.38 0.13 3.52 3.52 000

44110 ............ A Excision of bowel lesion(s) ................................ *10.07 7.67 7.67 1.58 19.32 19.32 090

44111 ............ A Excision of bowel lesion(s) ................................ *12.19 9.67 9.67 2.14 24.00 24.00 090

44120 ............ A Removal of small intestine ................................. *14.50 9.46 9.46 2.02 25.98 25.98 090

44121 ............ A Removal of small intestine ................................. 4.45 2.32 2.32 0.54 7.31 7.31 ZZZ

44125 ............ A Removal of small intestine ................................. *14.96 10.75 10.75 2.28 27.99 27.99 090

44130 ............ A Bowel to bowel fusion ........................................ *12.36 8.67 8.67 1.86 22.89 22.89 090

44139 ............ A Mobilization of colon .......................................... 2.23 1.17 1.17 0.27 3.67 3.67 ZZZ

44140 ............ A Partial removal of colon ..................................... *18.35 11.37 11.37 2.40 32.12 32.12 090

44141 ............ A Partial removal of colon ..................................... *19.51 11.86 11.86 2.55 33.92 33.92 090

44143 ............ A Partial removal of colon ..................................... *20.17 12.26 12.26 2.62 35.05 35.05 090

44144 ............ A Partial removal of colon ..................................... *18.89 12.06 12.06 2.53 33.48 33.48 090

44145 ............ A Partial removal of colon ..................................... *23.18 13.25 13.25 2.78 39.21 39.21 090

44146 ............ A Partial removal of colon ..................................... *24.16 14.98 14.98 3.14 42.28 42.28 090

44147 ............ A Partial removal of colon ..................................... *18.17 15.34 15.34 3.30 36.81 36.81 090

44150 ............ A Removal of colon ............................................... *21.01 14.84 14.84 3.17 39.02 39.02 090

44151 ............ A Removal of colon/ileostomy ............................... *20.04 10.21 10.21 2.22 32.47 32.47 090

44152 ............ A Removal of colon/ileostomy ............................... *24.41 15.44 15.44 3.36 43.21 43.21 090

44153 ............ A Removal of colon/ileostomy ............................... *26.83 19.35 19.35 3.63 49.81 49.81 090

44155 ............ A Removal of colon ............................................... *24.44 16.65 16.65 3.50 44.59 44.59 090

44156 ............ A Removal of colon/ileostomy ............................... *23.01 11.40 11.40 2.52 36.93 36.93 090

44160 ............ A Removal of colon ............................................... *15.88 12.44 12.44 2.68 31.00 31.00 090

44300 ............ A Open bowel to skin ............................................ *8.88 6.03 6.03 1.29 16.20 16.20 090

44310 ............ A Ileostomy/jejunostomy ........................................ *11.70 7.88 7.88 1.66 21.24 21.24 090

44312 ............ A Revision of ileostomy ......................................... *5.88 3.08 3.08 0.45 9.41 9.41 090

44314 ............ A Revision of ileostomy ......................................... *11.04 6.68 6.68 1.21 18.93 18.93 090

44316 ............ A Devise bowel pouch ........................................... *15.47 9.64 9.64 1.43 26.54 26.54 090

44320 ............ A Colostomy .......................................................... *12.94 7.46 7.46 1.57 21.97 21.97 090

44322 ............ A Colostomy with biopsies .................................... *11.98 9.07 9.07 1.88 22.93 22.93 090

44340 ............ A Revision of colostomy ........................................ *5.66 1.68 1.68 0.35 7.69 7.69 090

44345 ............ A Revision of colostomy ........................................ *11.32 4.84 4.84 1.03 17.19 17.19 090

44346 ............ A Revision of colostomy ........................................ *12.46 6.65 6.65 1.38 20.49 20.49 090

44360 ............ A Small bowel endoscopy ..................................... 2.92 #3.21 #3.21 0.32 6.45 6.45 000

44361 ............ A Small bowel endoscopy, biopsy ......................... 3.23 #3.55 #3.55 0.34 7.12 7.12 000

44363 ............ A Small bowel endoscopy ..................................... 3.94 2.99 2.99 0.36 7.29 7.29 000

44364 ............ A Small bowel endoscopy ..................................... 4.22 #4.64 #4.64 0.72 9.58 9.58 000

44365 ............ A Small bowel endoscopy ..................................... 3.73 #4.10 #4.10 0.72 8.55 8.55 000

44366 ............ A Small bowel endoscopy ..................................... 4.97 #5.47 #5.47 0.45 10.89 10.89 000

44369 ............ A Small bowel endoscopy ..................................... 5.09 #5.60 #5.60 0.50 11.19 11.19 000

44372 ............ A Small bowel endoscopy ..................................... 4.97 #5.47 #5.47 0.67 11.11 11.11 000

44373 ............ A Small bowel endoscopy ..................................... 3.94 #4.33 #4.33 0.50 8.77 8.77 000

44376 ............ A Small bowel endoscopy ..................................... 5.69 4.05 4.05 0.26 10.00 10.00 000

44377 ............ A Small bowel endoscopy ..................................... 5.98 4.26 4.26 0.28 10.52 10.52 000

44378 ............ A Small bowel endoscopy ..................................... 7.71 5.27 5.27 0.35 13.33 13.33 000

44380 ............ A Small bowel endoscopy ..................................... 1.51 #1.66 #1.66 0.22 3.39 3.39 000

44382 ............ A Small bowel endoscopy ..................................... 1.82 #2.00 #2.00 0.29 4.11 4.11 000

44385 ............ A Endoscopy of bowel pouch ................................ 1.82 2.33 #2.00 0.34 4.49 4.16 000

44386 ............ A Endoscopy, bowel pouch, biopsy ...................... 2.12 1.54 1.54 0.15 3.81 3.81 000

44388 ............ A Colon endoscopy ............................................... 2.82 3.61 #3.10 0.50 6.93 6.42 000

44389 ............ A Colonoscopy with biopsy ................................... 3.13 4.00 #3.44 0.45 7.58 7.02 000

44390 ............ A Colonoscopy for foreign body ............................ 3.83 2.63 2.63 0.28 6.74 6.74 000

44391 ............ A Colonoscopy for bleeding .................................. 4.32 5.26 #4.75 0.53 10.11 9.60 000

44392 ............ A Colonoscopy & polypectomy .............................. 3.82 5.16 #4.20 0.70 9.68 8.72 000

44393 ............ A Colonoscopy, lesion removal ............................. 4.84 5.41 #5.32 0.70 10.95 10.86 000

44394 ............ A Colonoscopy w/snare ......................................... 4.43 5.16 #4.87 0.70 10.29 10.00 000

44500 ............ A Intro, gastrointestinal tube .................................. 0.49 0.36 0.36 0.02 0.87 0.87 000
59145

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

44602 ............ A Suture, small intestine ........................................ *10.61 7.65 7.65 1.62 19.88 19.88 090

44603 ............ A Suture, small intestine ........................................ *14.00 9.09 9.09 1.96 25.05 25.05 090

44604 ............ A Suture, large intestine ........................................ *14.28 7.87 7.87 1.67 23.82 23.82 090

44605 ............ A Repair of bowel lesion ....................................... *15.37 9.37 9.37 2.02 26.76 26.76 090

44615 ............ A Intestinal stricturoplasty ...................................... *14.19 6.74 6.74 1.57 22.50 22.50 090

44620 ............ A Repair bowel opening ........................................ *10.87 5.97 5.97 1.26 18.10 18.10 090

44625 ............ A Repair bowel opening ........................................ *13.41 9.58 9.58 2.03 25.02 25.02 090

44626 ............ A Repair bowel opening ........................................ *22.59 11.37 11.37 2.40 36.36 36.36 090

44640 ............ A Repair bowel-skin fistula .................................... *14.83 6.54 6.54 1.35 22.72 22.72 090

44650 ............ A Repair bowel fistula ............................................ *15.25 7.33 7.33 1.46 24.04 24.04 090

44660 ............ A Repair bowel-bladder fistula .............................. *14.63 8.34 8.34 1.21 24.18 24.18 090

44661 ............ A Repair bowel-bladder fistula .............................. *16.99 13.94 13.94 2.52 33.45 33.45 090

44680 ............ A Surgical revision, intestine ................................. *13.72 9.71 9.71 2.14 25.57 25.57 090

44700 ............ A Suspend bowel w/prosthesis ............................. *14.35 11.37 11.37 2.40 28.12 28.12 090

44799 ............ C Intestine surgery procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

44800 ............ A Excision of bowel pouch .................................... *11.23 5.24 5.24 1.08 17.55 17.55 090

44820 ............ A Excision of mesentery lesion ............................. *10.31 5.80 5.80 1.21 17.32 17.32 090

44850 ............ A Repair of mesentery ........................................... *9.57 5.60 5.60 1.18 16.35 16.35 090

44899 ............ C Bowel surgery procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

44900 ............ A Drain, app abscess, open .................................. *8.82 4.28 4.28 0.88 13.98 13.98 090

44901 ............ A Drain, app abscess, perc ................................... 3.38 2.56 2.56 0.30 6.24 6.24 000

44950 ............ A Appendectomy ................................................... *8.70 4.89 4.89 1.01 14.60 14.60 090

44955 ............ A Appendectomy ................................................... 1.53 #1.68 #1.68 0.60 3.81 3.81 ZZZ

44960 ............ A Appendectomy ................................................... *10.74 5.89 5.89 1.24 17.87 17.87 090

45000 ............ A Drainage of pelvic abscess ................................ *4.52 1.59 1.59 0.24 6.35 6.35 090

45005 ............ A Drainage of rectal abscess ................................ *1.99 1.29 1.29 0.21 3.49 3.49 010

45020 ............ A Drainage of rectal abscess ................................ *4.72 2.61 2.61 0.51 7.84 7.84 090

45100 ............ A Biopsy of rectum ................................................ *3.68 1.88 1.88 0.35 5.91 5.91 090

45108 ............ A Removal of anorectal lesion .............................. *4.76 2.66 2.66 0.53 7.95 7.95 090

45110 ............ A Removal of rectum ............................................. *23.80 16.32 16.32 3.43 43.55 43.55 090

45111 ............ A Partial removal of rectum ................................... *16.48 11.77 11.77 2.49 30.74 30.74 090

45112 ............ A Removal of rectum ............................................. *25.96 16.06 16.06 3.36 45.38 45.38 090

45113 ............ A Partial proctectomy ............................................ *25.99 16.06 16.06 3.36 45.41 45.41 090

45114 ............ A Partial removal of rectum ................................... *23.22 15.39 15.39 3.24 41.85 41.85 090

45116 ............ A Partial removal of rectum ................................... *20.89 10.77 10.77 2.34 34.00 34.00 090

45119 ............ A Remove, rectum w/reservoir .............................. *26.21 16.06 16.06 3.36 45.63 45.63 090

45120 ............ A Removal of rectum ............................................. *24.60 16.39 16.39 3.54 44.53 44.53 090

45121 ............ A Removal of rectum and colon ............................ *27.04 10.79 10.79 2.01 39.84 39.84 090

45123 ............ A Partial proctectomy ............................................ *14.20 11.77 11.77 2.49 28.46 28.46 090

45130 ............ A Excision of rectal prolapse ................................. *13.97 8.92 8.92 1.79 24.68 24.68 090

45135 ............ A Excision of rectal prolapse ................................. *16.39 15.95 15.95 3.50 35.84 35.84 090

45150 ............ A Excision of rectal stricture .................................. *5.67 3.38 3.38 0.63 9.68 9.68 090

45160 ............ A Excision of rectal lesion ..................................... *13.02 7.46 7.46 1.56 22.04 22.04 090

45170 ............ A Excision of rectal lesion ..................................... *9.77 4.62 4.62 0.96 15.35 15.35 090

45190 ............ A Destruction, rectal tumor .................................... *8.28 5.09 5.09 1.06 14.43 14.43 090

45300 ............ A Proctosigmoidoscopy ......................................... 0.70 0.55 0.55 0.07 1.32 1.32 000

45303 ............ A Proctosigmoidoscopy ......................................... 0.80 0.64 0.64 0.12 1.56 1.56 000

45305 ............ A Proctosigmoidoscopy; biopsy ............................. 1.01 0.84 0.84 0.14 1.99 1.99 000

45307 ............ A Proctosigmoidoscopy ......................................... 1.71 1.27 1.27 0.18 3.16 3.16 000

45308 ............ A Proctosigmoidoscopy ......................................... 1.51 1.13 1.13 0.20 2.84 2.84 000

45309 ............ A Proctosigmoidoscopy ......................................... 2.01 1.13 1.13 0.20 3.34 3.34 000

45315 ............ A Proctosigmoidoscopy ......................................... 2.54 1.19 1.19 0.18 3.91 3.91 000

45317 ............ A Proctosigmoidoscopy ......................................... 2.73 1.26 1.26 0.19 4.18 4.18 000

45320 ............ A Proctosigmoidoscopy ......................................... 2.88 1.87 1.87 0.34 5.09 5.09 000

45321 ............ A Proctosigmoidoscopy ......................................... 2.12 1.47 1.47 0.27 3.86 3.86 000

45330 ............ A Sigmoidoscopy, diagnostic ................................. 0.96 1.23 #1.06 0.12 2.31 2.14 000

45331 ............ A Sigmoidoscopy and biopsy ................................ 1.26 1.61 #1.39 0.15 3.02 2.80 000

45332 ............ A Sigmoidoscopy ................................................... 1.96 1.76 1.76 0.16 3.88 3.88 000

45333 ............ A Sigmoidoscopy & polypectomy .......................... 1.96 2.24 #2.16 0.26 4.46 4.38 000

45334 ............ A Sigmoidoscopy for bleeding ............................... 2.99 2.71 2.71 0.23 5.93 5.93 000

45337 ............ A Sigmoidoscopy, decompression ........................ 2.36 #2.60 #2.60 0.38 5.34 5.34 000

45338 ............ A Sigmoidoscopy ................................................... 2.57 2.24 2.24 0.26 5.07 5.07 000

45339 ............ A Sigmoidoscopy ................................................... 3.14 3.24 3.24 0.31 6.69 6.69 000

45355 ............ A Surgical colonoscopy ......................................... 3.52 1.17 1.17 0.10 4.79 4.79 000

45378 ............ A Diagnostic colonoscopy ..................................... 3.70 4.13 #4.07 0.39 8.22 8.16 000

45378 53 A Diagnostic colonoscopy ..................................... 0.96 1.23 #1.06 0.12 2.31 2.14 000

45379 ............ A Colonoscopy ....................................................... 4.72 5.33 #5.19 0.45 10.50 10.36 000

45380 ............ A Colonoscopy and biopsy .................................... 4.01 4.79 #4.41 0.40 9.20 8.82 000

45382 ............ A Colonoscopy, control bleeding ........................... 5.73 5.87 5.87 0.41 12.01 12.01 000

45383 ............ A Colonoscopy, lesion removal ............................. 5.87 5.92 5.92 0.50 12.29 12.29 000

45384 ............ A Colonoscopy ....................................................... 4.70 #5.17 #5.17 0.58 10.45 10.45 000

45385 ............ A Colonoscopy, lesion removal ............................. 5.31 6.65 #5.84 0.58 12.54 11.73 000

45500 ............ A Repair of rectum ................................................ *7.29 5.95 5.95 1.21 14.45 14.45 090

45505 ............ A Repair of rectum ................................................ *6.02 6.29 6.29 1.23 13.54 13.54 090
59146

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

45520 ............ A Treatment of rectal prolapse .............................. 0.55 0.61 0.61 0.10 1.26 1.26 000

45540 ............ A Correct rectal prolapse ....................................... *12.92 9.89 9.89 2.10 24.91 24.91 090

45541 ............ A Correct rectal prolapse ....................................... *10.64 10.17 10.17 2.04 22.85 22.85 090

45550 ............ A Repair rectum; remove sigmoid ......................... *18.26 11.49 11.49 2.38 32.13 32.13 090

45560 ............ A Repair of rectocele ............................................. *8.40 4.79 4.79 0.98 14.17 14.17 090

45562 ............ A Exploration/repair of rectum ............................... *12.21 8.09 8.09 1.58 21.88 21.88 090

45563 ............ A Exploration/repair of rectum ............................... *18.63 12.77 12.77 2.49 33.89 33.89 090

45800 ............ A Repair rectumbladder fistula .............................. *14.11 9.82 9.82 1.45 25.38 25.38 090

45805 ............ A Repair fistula; colostomy .................................... *16.50 12.32 12.32 2.39 31.21 31.21 090

45820 ............ A Repair rectourethral fistula ................................. *14.67 8.98 8.98 1.23 24.88 24.88 090

45825 ............ A Repair fistula; colostomy .................................... *16.87 9.87 9.87 1.66 28.40 28.40 090

45900 ............ A Reduction of rectal prolapse .............................. *1.83 0.58 0.58 0.11 2.52 2.52 010

45905 ............ A Dilation of anal sphincter ................................... *1.61 0.71 0.71 0.12 2.44 2.44 010

45910 ............ A Dilation of rectal narrowing ................................ *1.96 0.87 0.87 0.13 2.96 2.96 010

45915 ............ A Remove rectal obstruction ................................. *2.20 0.78 0.78 0.09 3.07 3.07 010

45999 ............ C Rectum surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

46030 ............ A Removal of rectal marker ................................... *1.23 0.40 0.40 0.07 1.70 1.70 010

46040 ............ A Incision of rectal abscess ................................... *4.96 1.69 1.69 0.34 6.99 6.99 090

46045 ............ A Incision of rectal abscess ................................... *4.32 1.85 1.85 0.38 6.55 6.55 090

46050 ............ A Incision of anal abscess ..................................... *1.19 0.60 0.60 0.11 1.90 1.90 010

46060 ............ A Incision of rectal abscess ................................... *5.69 5.35 5.35 1.12 12.16 12.16 090

46070 ............ A Incision of anal septum ...................................... *2.71 1.37 1.37 0.33 4.41 4.41 090

46080 ............ A Incision of anal sphincter ................................... *2.49 2.13 2.13 0.43 5.05 5.05 010

46083 ............ A Incise external hemorrhoid ................................. *1.40 0.63 0.63 0.08 2.11 2.11 010

46200 ............ A Removal of anal fissure ..................................... *3.42 3.29 3.29 0.66 7.37 7.37 090

46210 ............ A Removal of anal crypt ........................................ *2.67 0.77 0.77 0.14 3.58 3.58 090

46211 ............ A Removal of anal crypts ...................................... *4.25 1.90 1.90 0.38 6.53 6.53 090

46220 ............ A Removal of anal tab ........................................... *1.56 0.63 0.63 0.12 2.31 2.31 010

46221 ............ A Ligation of hemorrhoid(s) ................................... *1.43 0.66 0.66 0.14 2.23 2.23 010

46230 ............ A Removal of anal tabs ......................................... *2.57 0.83 0.83 0.12 3.52 3.52 010

46250 ............ A Hemorrhoidectomy ............................................. *4.53 2.84 2.84 0.52 7.89 7.89 090

46255 ............ A Hemorrhoidectomy ............................................. *5.36 4.72 4.72 0.85 10.93 10.93 090

46257 ............ A Remove hemorrhoids & fissure ......................... *6.28 5.23 5.23 1.08 12.59 12.59 090

46258 ............ A Remove hemorrhoids & fistula ........................... *6.67 5.87 5.87 1.22 13.76 13.76 090

46260 ............ A Hemorrhoidectomy ............................................. *7.42 6.07 6.07 1.25 14.74 14.74 090

46261 ............ A Remove hemorrhoids & fissure ......................... *8.24 6.62 6.62 1.34 16.20 16.20 090

46262 ............ A Remove hemorrhoids & fistula ........................... *8.73 6.72 6.72 1.39 16.84 16.84 090

46270 ............ A Removal of anal fistula ...................................... *3.72 1.87 1.87 0.37 5.96 5.96 090

46275 ............ A Removal of anal fistula ...................................... *4.56 #5.02 #5.02 1.13 10.71 10.71 090

46280 ............ A Removal of anal fistula ...................................... *5.98 6.08 6.08 1.24 13.30 13.30 090

46285 ............ A Removal of anal fistula ...................................... *4.09 2.28 2.28 0.43 6.80 6.80 090

46288 ............ A Repair anal fistula .............................................. *7.13 3.57 3.57 0.83 11.53 11.53 090

46320 ............ A Removal of hemorrhoid clot ............................... *1.61 0.70 0.70 0.11 2.42 2.42 010

46500 ............ A Injection into hemorrhoids .................................. *1.61 0.32 0.32 0.06 1.99 1.99 010

46600 ............ A Diagnostic anoscopy .......................................... 0.50 0.28 0.28 0.03 0.81 0.81 000

46604 ............ A Anoscopy and dilation ........................................ 1.31 0.38 0.38 0.06 1.75 1.75 000

46606 ............ A Anoscopy and biopsy ......................................... 0.81 0.36 0.36 0.06 1.23 1.23 000

46608 ............ A Anoscopy; remove foreign body ........................ 1.51 1.07 1.07 0.12 2.70 2.70 000

46610 ............ A Anoscopy; remove lesion ................................... 1.32 0.85 0.85 0.15 2.32 2.32 000

46611 ............ A Anoscopy ............................................................ 1.81 0.85 0.85 0.15 2.81 2.81 000

46612 ............ A Anoscopy; remove lesions ................................. 2.34 1.39 1.39 0.20 3.93 3.93 000

46614 ............ A Anoscopy; control bleeding ................................ 2.01 1.55 1.55 0.25 3.81 3.81 000

46615 ............ A Anoscopy ............................................................ 2.68 1.55 1.55 0.25 4.48 4.48 000

46700 ............ A Repair of anal stricture ....................................... *7.25 6.14 6.14 1.24 14.63 14.63 090

46705 ............ A Repair of anal stricture ....................................... *7.17 3.60 3.60 0.77 11.54 11.54 090

46715 ............ A Repair of anovaginal fistula ............................... *7.46 3.51 3.51 0.82 11.79 11.79 090

46716 ............ A Repair of anovaginal fistula ............................... *12.15 6.05 6.05 1.40 19.60 19.60 090

46730 ............ A Construction of absent anus .............................. *21.57 10.74 10.74 2.50 34.81 34.81 090

46735 ............ A Construction of absent anus .............................. *25.94 13.04 13.04 3.04 42.02 42.02 090

46740 ............ A Construction of absent anus .............................. *23.11 11.55 11.55 2.68 37.34 37.34 090

46742 ............ A Repair, imperforated anus ................................. *29.67 19.75 19.75 1.93 51.35 51.35 090

46744 ............ A Repair, cloacal anomaly ..................................... *33.21 22.17 22.17 2.17 57.55 57.55 090

46746 ............ A Repair, cloacal anomaly ..................................... *36.74 24.26 24.26 2.37 63.37 63.37 090

46748 ............ A Repair, cloacal anomaly ..................................... *40.52 27.03 27.03 2.64 70.19 70.19 090

46750 ............ A Repair of anal sphincter ..................................... *8.14 6.00 6.00 1.22 15.36 15.36 090

46751 ............ A Repair of anal sphincter ..................................... *8.56 4.07 4.07 0.95 13.58 13.58 090

46753 ............ A Reconstruction of anus ...................................... *6.58 4.89 4.89 1.02 12.49 12.49 090

46754 ............ A Removal of suture from anus ............................ *1.54 1.48 1.48 0.30 3.32 3.32 010

46760 ............ A Repair of anal sphincter ..................................... *11.46 6.80 6.80 1.41 19.67 19.67 090

46761 ............ A Repair of anal sphincter ..................................... *10.99 6.83 6.83 1.35 19.17 19.17 090

46762 ............ A Implant artificial sphincter .................................. *10.09 5.72 5.72 1.21 17.02 17.02 090

46900 ............ A Destruction, anal lesion(s) ................................. *1.91 0.39 0.39 0.06 2.36 2.36 010

46910 ............ A Destruction, anal lesion(s) ................................. *1.86 0.64 0.64 0.08 2.58 2.58 010

46916 ............ A Cryosurgery, anal lesion(s) ................................ *1.86 0.67 0.67 0.06 2.59 2.59 010
59147

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

46917 ............ A Laser surgery, anal lesion(s) ............................. *1.86 1.94 1.94 0.31 4.11 4.11 010

46922 ............ A Excision of anal lesion(s) ................................... *1.86 1.28 1.28 0.23 3.37 3.37 010

46924 ............ A Destruction, anal lesion(s) ................................. *2.76 2.56 2.56 0.46 5.78 5.78 010

46934 ............ A Destruction of hemorrhoids ................................ *4.08 1.19 1.19 0.17 5.44 5.44 090

46935 ............ A Destruction of hemorrhoids ................................ *2.43 1.62 1.62 0.22 4.27 4.27 010

46936 ............ A Destruction of hemorrhoids ................................ *4.30 2.29 2.29 0.24 6.83 6.83 090

46937 ............ A Cryotherapy of rectal lesion ............................... *2.69 2.35 2.35 0.45 5.49 5.49 010

46938 ............ A Cryotherapy of rectal lesion ............................... *4.66 2.50 2.50 0.52 7.68 7.68 090

46940 ............ A Treatment of anal fissure ................................... *2.32 0.51 0.51 0.09 2.92 2.92 010

46942 ............ A Treatment of anal fissure ................................... *2.04 0.46 0.46 0.08 2.58 2.58 010

46945 ............ A Ligation of hemorrhoids ..................................... *2.14 0.63 0.63 0.12 2.89 2.89 090

46946 ............ A Ligation of hemorrhoids ..................................... *3.00 0.94 0.94 0.17 4.11 4.11 090

46999 ............ C Anus surgery procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

47000 ............ A Needle biopsy of liver ........................................ 1.90 1.40 1.40 0.13 3.43 3.43 000

47001 ............ A Needle biopsy, liver ............................................ 1.90 1.40 1.40 0.13 3.43 3.43 ZZZ

47010 ............ A Open drainage, liver lesion ................................ *10.28 6.75 6.75 1.13 18.16 18.16 090

47011 ............ A Percut drain, liver lesion .................................... 3.70 2.80 2.80 0.33 6.83 6.83 000

47015 ............ A Inject/aspirate liver cyst ...................................... *9.70 6.75 6.75 1.13 17.58 17.58 090

47100 ............ A Wedge biopsy of liver ........................................ *7.49 3.29 3.29 0.67 11.45 11.45 090

47120 ............ A Partial removal of liver ....................................... *22.79 12.00 12.00 2.48 37.27 37.27 090

47122 ............ A Extensive removal of liver .................................. *35.39 17.58 17.58 3.59 56.56 56.56 090

47125 ............ A Partial removal of liver ....................................... *31.58 17.43 17.43 3.61 52.62 52.62 090

47130 ............ A Partial removal of liver ....................................... *34.25 19.19 19.19 3.89 57.33 57.33 090

47133 ............ X Removal of donor liver ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

47134 ............ R Partial removal, donor liver ................................ 39.15 20.48 20.48 4.77 64.40 64.40 XXX

47135 ............ R Transplantation of liver ....................................... *81.52 54.48 54.48 8.49 144.49 144.49 090

47136 ............ R Transplantation of liver ....................................... *68.60 33.50 33.50 7.79 109.89 109.89 090

47300 ............ A Surgery for liver lesion ....................................... *9.68 7.67 7.67 1.59 18.94 18.94 090

47350 ............ A Repair liver wound ............................................. *12.56 7.46 7.46 1.49 21.51 21.51 090

47360 ............ A Repair liver wound ............................................. *17.28 10.93 10.93 2.18 30.39 30.39 090

47361 ............ A Repair liver wound ............................................. *30.25 14.64 14.64 3.41 48.30 48.30 090

47362 ............ A Repair liver wound ............................................. *11.88 5.23 5.23 1.22 18.33 18.33 090

47399 ............ C Liver surgery procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

47400 ............ A Incision of liver duct ........................................... *20.86 8.53 8.53 1.36 30.75 30.75 090

47420 ............ A Incision of bile duct ............................................ *16.72 9.48 9.48 1.99 28.19 28.19 090

47425 ............ A Incision of bile duct ............................................ *16.68 11.71 11.71 2.45 30.84 30.84 090

47460 ............ A Incise bile duct sphincter ................................... *15.17 15.54 15.54 1.82 32.53 32.53 090

47480 ............ A Incision of gallbladder ........................................ *9.10 7.60 7.60 1.59 18.29 18.29 090

47490 ............ A Incision of gallbladder ........................................ *7.23 3.57 3.57 0.38 11.18 11.18 090

47500 ............ A Injection for liver x-rays ...................................... 1.96 1.51 1.51 0.14 3.61 3.61 000

47505 ............ A Injection for liver x-rays ...................................... 0.76 0.98 #0.84 0.14 1.88 1.74 000

47510 ............ A Insert catheter, bile duct .................................... *7.83 2.87 2.87 0.25 10.95 10.95 090

47511 ............ A Insert bile duct drain .......................................... *10.50 2.87 2.87 0.25 13.62 13.62 090

47525 ............ A Change bile duct catheter .................................. *5.55 1.59 1.59 0.16 7.30 7.30 010

47530 ............ A Revise, reinsert bile tube ................................... *5.85 1.51 1.51 0.19 7.55 7.55 090

47550 ............ A Bile duct endoscopy ........................................... 3.02 1.56 1.56 0.35 4.93 4.93 000

47552 ............ A Biliary endoscopy, thru skin ............................... 6.04 1.36 1.36 0.21 7.61 7.61 000

47553 ............ A Biliary endoscopy, thru skin ............................... 6.35 3.80 3.80 0.62 10.77 10.77 000

47554 ............ A Biliary endoscopy, thru skin ............................... 9.06 3.93 3.93 0.67 13.66 13.66 000

47555 ............ A Biliary endoscopy, thru skin ............................... 7.56 2.63 2.63 0.30 10.49 10.49 000

47556 ............ A Biliary endoscopy, thru skin ............................... 8.56 2.63 2.63 0.30 11.49 11.49 000

47600 ............ A Removal of gallbladder ...................................... *11.42 7.53 7.53 1.58 20.53 20.53 090

47605 ............ A Removal of gallbladder ...................................... *12.36 8.14 8.14 1.75 22.25 22.25 090

47610 ............ A Removal of gallbladder ...................................... *15.83 9.37 9.37 2.00 27.20 27.20 090

47612 ............ A Removal of gallbladder ...................................... *15.80 14.23 14.23 3.05 33.08 33.08 090

47620 ............ A Removal of gallbladder ...................................... *17.36 11.23 11.23 2.36 30.95 30.95 090

47630 ............ A Remove bile duct stone ..................................... *9.11 3.75 3.75 0.40 13.26 13.26 090

47700 ............ A Exploration of bile ducts ..................................... *14.93 7.63 7.63 1.58 24.14 24.14 090

47701 ............ A Bile duct revision ................................................ *27.81 8.21 8.21 1.90 37.92 37.92 090

47711 ............ A Excision of bile duct tumor ................................. *19.37 12.06 12.06 2.46 33.89 33.89 090

47712 ............ A Excision of bile duct tumor ................................. *25.44 12.06 12.06 2.46 39.96 39.96 090

47715 ............ A Excision of bile duct cyst ................................... *15.81 8.22 8.22 1.71 25.74 25.74 090

47716 ............ A Fusion of bile duct cyst ...................................... *13.83 6.56 6.56 1.53 21.92 21.92 090

47720 ............ A Fuse gallbladder & bowel .................................. *13.38 9.16 9.16 1.93 24.47 24.47 090

47721 ............ A Fuse upper gi structures .................................... *16.08 11.42 11.42 2.47 29.97 29.97 090

47740 ............ A Fuse gallbladder & bowel .................................. *15.54 10.21 10.21 2.14 27.89 27.89 090

47741 ............ A Fuse gallbladder & bowel .................................. *17.95 14.35 14.35 3.02 35.32 35.32 090

47760 ............ A Fuse bile ducts and bowel ................................. *21.74 11.61 11.61 2.53 35.88 35.88 090

47765 ............ A Fuse liver ducts & bowel .................................... *20.93 14.61 14.61 2.97 38.51 38.51 090

47780 ............ A Fuse bile ducts and bowel ................................. *22.29 13.07 13.07 2.73 38.09 38.09 090

47785 ............ A Fuse bile ducts and bowel ................................. *26.23 13.07 13.07 2.73 42.03 42.03 090

47800 ............ A Reconstruction of bile ducts ............................... *19.60 13.22 13.22 2.43 35.25 35.25 090

47801 ............ A Placement, bile duct support ............................. *12.76 5.48 5.48 0.81 19.05 19.05 090

47802 ............ A Fuse liver duct & intestine ................................. *18.13 10.27 10.27 1.75 30.15 30.15 090
59148

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

47900 ............ A Suture bile duct injury ........................................ *16.74 13.22 13.22 2.43 32.39 32.39 090

47999 ............ C Bile tract surgery procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

48000 ............ A Drainage of abdomen ........................................ *14.91 7.05 7.05 1.40 23.36 23.36 090

48001 ............ A Placement of drain, pancreas ............................ *18.83 8.13 8.13 1.89 28.85 28.85 090

48005 ............ A Resect/debride pancreas ................................... *22.40 9.19 9.19 2.14 33.73 33.73 090

48020 ............ A Removal of pancreatic stone ............................. *14.22 6.78 6.78 1.57 22.57 22.57 090

48100 ............ A Biopsy of pancreas ............................................ *11.08 4.21 4.21 0.79 16.08 16.08 090

48102 ............ A Needle biopsy, pancreas ................................... *4.68 2.41 2.41 0.25 7.34 7.34 010

48120 ............ A Removal of pancreas lesion .............................. *14.36 9.72 9.72 2.07 26.15 26.15 090

48140 ............ A Partial removal of pancreas ............................... *20.78 13.29 13.29 2.83 36.90 36.90 090

48145 ............ A Partial removal of pancreas ............................... *21.76 15.71 15.71 3.16 40.63 40.63 090

48146 ............ A Pancreatectomy ................................................. *23.91 16.49 16.49 1.92 42.32 42.32 090

48148 ............ A Removal of pancreatic duct ............................... *15.71 8.23 8.23 1.68 25.62 25.62 090

48150 ............ A Partial removal of pancreas ............................... *43.48 22.54 22.54 4.75 70.77 70.77 090

48152 ............ A Pancreatectomy ................................................. *39.63 22.54 22.54 4.75 66.92 66.92 090

48153 ............ A Pancreatectomy ................................................. *43.38 22.54 22.54 4.75 70.67 70.67 090

48154 ............ A Pancreatectomy ................................................. *39.95 22.54 22.54 4.75 67.24 67.24 090

48155 ............ A Removal of pancreas ......................................... *22.32 20.40 20.40 4.26 46.98 46.98 090

48160 ............ N Pancreas removal, transplant ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

48180 ............ A Fuse pancreas and bowel .................................. *22.39 12.60 12.60 2.63 37.62 37.62 090

48400 ............ A Injection, intraoperative ...................................... 1.95 1.03 1.03 0.24 3.22 3.22 ZZZ

48500 ............ A Surgery of pancreas cyst ................................... *13.84 8.53 8.53 1.66 24.03 24.03 090

48510 ............ A Drain pancreatic pseudocyst .............................. *12.96 7.54 7.54 1.44 21.94 21.94 090

48511 ............ A Drain pancreatic pseudocyst .............................. 4.00 3.03 3.03 0.35 7.38 7.38 000

48520 ............ A Fuse pancreas cyst and bowel .......................... *14.12 11.30 11.30 2.43 27.85 27.85 090

48540 ............ A Fuse pancreas cyst and bowel .......................... *17.86 12.66 12.66 2.65 33.17 33.17 090

48545 ............ A Pancreatorrhaphy ............................................... *16.47 7.66 7.66 1.79 25.92 25.92 090

48547 ............ A Duodenal exclusion ............................................ *23.40 11.08 11.08 2.58 37.06 37.06 090

48550 ............ N Donor pancreatectomy ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

48554 ............ N Transplantallograft pancreas .............................. +34.17 17.87 17.87 4.16 56.20 56.20 XXX

48556 ............ A Removal, allograft pancreas .............................. *15.71 7.26 7.26 1.69 24.66 24.66 090

48999 ............ C Pancreas surgery procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

49000 ............ A Exploration of abdomen ..................................... *11.68 6.79 6.79 1.40 19.87 19.87 090

49002 ............ A Reopening of abdomen ...................................... *10.49 6.05 6.05 1.21 17.75 17.75 090

49010 ............ A Exploration behind abdomen ............................. *12.28 6.95 6.95 1.31 20.54 20.54 090

49020 ............ A Drain abdominal abscess ................................... *16.79 4.82 4.82 0.91 22.52 22.52 090

49021 ............ A Drain abdominal abscess ................................... *3.38 #3.72 #3.72 0.91 8.01 8.01 000

49040 ............ A Open drainage abdom abscess ......................... *9.94 6.54 6.54 1.27 17.75 17.75 090

49041 ............ A Percut drain abdom abscess ............................. 4.00 3.03 3.03 0.35 7.38 7.38 000

49060 ............ A Open drain retroper abscess ............................. *11.66 5.54 5.54 1.01 18.21 18.21 090

49061 ............ A Percutdrain retroper abscess ............................. 3.70 2.80 2.80 0.33 6.83 6.83 000

49062 ............ A Drain to peritoneal cavity ................................... *11.36 8.07 8.07 0.79 20.22 20.22 090

49080 ............ A Puncture, peritoneal cavity ................................. 1.35 0.87 0.87 0.08 2.30 2.30 000

49081 ............ A Removal of abdominal fluid ............................... 1.26 0.75 0.75 0.07 2.08 2.08 000

49085 ............ A Remove abdomen foreign body ......................... *8.93 3.46 3.46 0.67 13.06 13.06 090

49180 ............ A Biopsy, abdominal mass .................................... 1.73 1.82 1.82 0.20 3.75 3.75 000

49200 ............ A Removal of abdominal lesion ............................. *10.25 8.38 8.38 1.70 20.33 20.33 090

49201 ............ A Removal of abdominal lesion ............................. *14.84 12.10 12.10 2.50 29.44 29.44 090

49215 ............ A Excise sacral spine tumor .................................. *22.36 8.50 8.50 1.59 32.45 32.45 090

49220 ............ A Multiple surgery, abdomen ................................. *14.88 12.30 12.30 2.53 29.71 29.71 090

49250 ............ A Excision of umbilicus .......................................... *8.35 4.52 4.52 0.96 13.83 13.83 090

49255 ............ A Removal of omentum ......................................... *11.14 5.16 5.16 1.15 17.45 17.45 090

49400 ............ A Air injection into abdomen ................................. 1.88 1.12 1.12 0.17 3.17 3.17 000

49420 ............ A Insert abdominal drain ....................................... 2.22 1.58 1.58 0.20 4.00 4.00 000

49421 ............ A Insert abdominal drain ....................................... *5.54 4.14 4.14 0.81 10.49 10.49 090

49422 ............ A Remove perm cannula/catheter ......................... *6.25 4.14 4.14 0.81 11.20 11.20 010

49423 ............ A Exchange drainage cath .................................... 1.46 1.10 1.10 0.13 2.69 2.69 000

49424 ............ A Assess cyst, contrast inj .................................... 0.76 0.57 0.57 0.07 1.40 1.40 000

49425 ............ A Insert abdomen-venous drain ............................ *11.37 8.48 8.48 1.78 21.63 21.63 090

49426 ............ A Revise abdomen-venous shunt ......................... *9.63 5.39 5.39 1.07 16.09 16.09 090

49427 ............ A Injection, abdominal shunt ................................. 0.89 0.49 0.49 0.03 1.41 1.41 000

49428 ............ A Ligation of shunt ................................................. *2.38 1.04 1.04 0.24 3.66 3.66 010

49429 ............ A Removal of shunt ............................................... *7.40 3.32 3.32 0.77 11.49 11.49 010

49495 ............ A Repair inguinal hernia, init ................................. *5.89 4.98 4.98 0.95 11.82 11.82 090

49496 ............ A Repair inguinal hernia, init ................................. *8.79 5.04 5.04 1.08 14.91 14.91 090

49500 ............ A Repair inguinal hernia ........................................ *4.68 4.98 4.98 0.95 10.61 10.61 090

49501 ............ A Repair inguinal hernia, init ................................. *7.58 5.04 5.04 1.08 13.70 13.70 090

49505 ............ A Repair inguinal hernia ........................................ *6.49 4.51 4.51 0.94 11.94 11.94 090

49507 ............ A Repair, inguinal hernia ....................................... *8.17 5.04 5.04 1.08 14.29 14.29 090

49520 ............ A Rerepair inguinal hernia ..................................... *8.22 5.22 5.22 1.11 14.55 14.55 090

49521 ............ A Repair inguinal hernia, rec ................................. *10.22 5.04 5.04 1.08 16.34 16.34 090

49525 ............ A Repair inguinal hernia ........................................ *7.32 5.55 5.55 1.16 14.03 14.03 090

49540 ............ A Repair lumbar hernia ......................................... *8.87 5.20 5.20 1.12 15.19 15.19 090

49550 ............ A Repair femoral hernia ........................................ *7.37 4.61 4.61 0.97 12.95 12.95 090
59149

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

49553 ............ A Repair femoral hernia, init .................................. *8.06 4.61 4.61 0.97 13.64 13.64 090

49555 ............ A Repair femoral hernia ........................................ *7.71 6.07 6.07 1.26 15.04 15.04 090

49557 ............ A Repair femoral hernia, recur .............................. *9.52 6.07 6.07 1.26 16.85 16.85 090

49560 ............ A Repair abdominal hernia .................................... *9.88 5.65 5.65 1.19 16.72 16.72 090

49561 ............ A Repair incisional hernia ...................................... *12.17 5.65 5.65 1.19 19.01 19.01 090

49565 ............ A Rerepair abdominal hernia ................................. *9.88 6.41 6.41 1.35 17.64 17.64 090

49566 ............ A Repair incisional hernia ...................................... *12.30 6.41 6.41 1.35 20.06 20.06 090

49568 ............ A Hernia repair w/mesh ......................................... 4.89 2.56 2.56 0.59 8.04 8.04 ZZZ

49570 ............ A Repair epigastric hernia ..................................... *4.86 4.38 4.38 0.91 10.15 10.15 090

49572 ............ A Repair, epigastric hernia .................................... *5.75 5.60 5.60 1.18 12.53 12.53 090

49580 ............ A Repair umbilical hernia ...................................... *3.51 #3.86 #3.86 0.94 8.31 8.31 090

49582 ............ A Repair umbilical hernia ...................................... *5.68 4.61 4.61 0.94 11.23 11.23 090

49585 ............ A Repair umbilical hernia ...................................... *5.32 4.41 4.41 0.91 10.64 10.64 090

49587 ............ A Repair umbilical hernia ...................................... *6.46 4.41 4.41 0.91 11.78 11.78 090

49590 ............ A Repair abdominal hernia .................................... *7.29 5.63 5.63 1.22 14.14 14.14 090

49600 ............ A Repair umbilical lesion ....................................... *10.35 5.26 5.26 0.77 16.38 16.38 090

49605 ............ A Repair umbilical lesion ....................................... *22.66 8.57 8.57 1.77 33.00 33.00 090

49606 ............ A Repair umbilical lesion ....................................... *18.60 8.31 8.31 0.96 27.87 27.87 090

49610 ............ A Repair umbilical lesion ....................................... *10.50 5.48 5.48 1.27 17.25 17.25 090

49611 ............ A Repair umbilical lesion ....................................... *8.92 9.00 9.00 0.58 18.50 18.50 090

49900 ............ A Repair of abdominal wall ................................... *12.28 3.66 3.66 0.75 16.69 16.69 090

49905 ............ A Omental flap ....................................................... 6.55 3.42 3.42 0.80 10.77 10.77 ZZZ

49906 ............ C Free omental flap, microvasc ............................. 0.00 0.00 0.00 0.00 0.00 0.00 090

49999 ............ C Abdomen surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

50010 ............ A Exploration of kidney .......................................... *10.98 9.55 9.55 1.13 21.66 21.66 090

50020 ............ A Open drain renal abscess .................................. *14.66 6.80 6.80 0.85 22.31 22.31 090

50021 ............ A Percut drain renal abscess ................................ 3.38 2.56 2.56 0.30 6.24 6.24 000

50040 ............ A Drainage of kidney ............................................. *14.94 7.18 7.18 0.62 22.74 22.74 090

50045 ............ A Exploration of kidney .......................................... *15.46 9.81 9.81 0.89 26.16 26.16 090

50060 ............ A Removal of kidney stone ................................... *19.30 12.25 12.25 1.21 32.76 32.76 090

50065 ............ A Incision of kidney ............................................... *20.79 13.93 13.93 1.35 36.07 36.07 090

50070 ............ A Incision of kidney ............................................... *20.32 12.87 12.87 1.35 34.54 34.54 090

50075 ............ A Removal of kidney stone ................................... *25.34 16.87 16.87 1.62 43.83 43.83 090

50080 ............ A Removal of kidney stone ................................... *14.71 12.20 12.20 1.15 28.06 28.06 090

50081 ............ A Removal of kidney stone ................................... *21.80 14.96 14.96 1.44 38.20 38.20 090

50100 ............ A Revise kidney blood vessels .............................. *16.09 10.34 10.34 1.35 27.78 27.78 090

50120 ............ A Exploration of kidney .......................................... *15.91 10.91 10.91 1.24 28.06 28.06 090

50125 ............ A Explore and drain kidney ................................... *16.52 10.95 10.95 1.06 28.53 28.53 090

50130 ............ A Removal of kidney stone ................................... *17.29 12.80 12.80 1.26 31.35 31.35 090

50135 ............ A Exploration of kidney .......................................... *19.18 17.05 17.05 1.63 37.86 37.86 090

50200 ............ A Biopsy of kidney ................................................. 2.63 2.61 2.61 0.22 5.46 5.46 000

50205 ............ A Biopsy of kidney ................................................. *11.31 5.64 5.64 0.69 17.64 17.64 090

50220 ............ A Removal of kidney ............................................. *17.15 13.31 13.31 1.43 31.89 31.89 090

50225 ............ A Removal of kidney ............................................. *20.23 16.52 16.52 1.70 38.45 38.45 090

50230 ............ A Removal of kidney ............................................. *22.07 18.40 18.40 1.84 42.31 42.31 090

50234 ............ A Removal of kidney & ureter ............................... *22.40 16.65 16.65 1.65 40.70 40.70 090

50236 ............ A Removal of kidney & ureter ............................... *24.86 17.74 17.74 1.74 44.34 44.34 090

50240 ............ A Partial removal of kidney ................................... *22.00 16.00 16.00 1.70 39.70 39.70 090

50280 ............ A Removal of kidney lesion ................................... *15.67 10.86 10.86 1.16 27.69 27.69 090

50290 ............ A Removal of kidney lesion ................................... *14.73 8.87 8.87 1.19 24.79 24.79 090

50300 ............ X Removal of donor kidney ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

50320 ............ A Removal of donor kidney ................................... *22.21 16.49 16.49 2.40 41.10 41.10 090

50340 ............ A Removal of kidney ............................................. *12.15 12.49 12.49 2.24 26.88 26.88 090

50360 ............ A Transplantation of kidney ................................... *31.53 24.45 24.45 4.24 60.22 60.22 090

50365 ............ A Transplantation of kidney ................................... *36.81 30.71 30.71 3.89 71.41 71.41 090

50370 ............ A Remove transplanted kidney ............................. *13.72 11.08 11.08 1.92 26.72 26.72 090

50380 ............ A Reimplantation of kidney .................................... *20.76 10.12 10.12 1.71 32.59 32.59 090

50390 ............ A Drainage of kidney lesion .................................. 1.96 1.69 1.69 0.15 3.80 3.80 000

50392 ............ A Insert kidney drain .............................................. 3.38 2.36 2.36 0.20 5.94 5.94 000

50393 ............ A Insert ureteral tube ............................................. 4.16 3.01 3.01 0.26 7.43 7.43 000

50394 ............ A Injection for kidney x-ray .................................... 0.76 0.55 0.55 0.05 1.36 1.36 000

50395 ............ A Create passage to kidney .................................. 3.38 3.33 3.33 0.29 7.00 7.00 000

50396 ............ A Measure kidney pressure ................................... 2.09 0.50 0.50 0.05 2.64 2.64 000

50398 ............ A Change kidney tube ........................................... 1.46 0.53 0.53 0.05 2.04 2.04 000

50400 ............ A Revision of kidney/ureter ................................... *19.50 13.66 13.66 1.36 34.52 34.52 090

50405 ............ A Revision of kidney/ureter ................................... *23.93 17.29 17.29 1.74 42.96 42.96 090

50500 ............ A Repair of kidney wound ..................................... *19.57 12.46 12.46 1.64 33.67 33.67 090

50520 ............ A Close kidney-skin fistula .................................... *17.23 10.34 10.34 1.50 29.07 29.07 090

50525 ............ A Repair renal-abdomen fistula ............................. *22.27 12.61 12.61 1.99 36.87 36.87 090

50526 ............ A Repair renal-abdomen fistula ............................. *24.02 7.39 7.39 2.32 33.73 33.73 090

50540 ............ A Revision of horseshoe kidney ............................ *19.93 13.41 13.41 1.54 34.88 34.88 090

50551 ............ A Kidney endoscopy .............................................. 5.60 2.19 2.19 0.21 8.00 8.00 000

50553 ............ A Kidney endoscopy .............................................. 5.99 1.66 1.66 0.17 7.82 7.82 000

50555 ............ A Kidney endoscopy & biopsy ............................... 6.53 4.70 4.70 0.45 11.68 11.68 000
59150

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

50557 ............ A Kidney endoscopy & treatment .......................... 6.62 4.71 4.71 0.49 11.82 11.82 000

50559 ............ A Renal endoscopy; radiotracer ............................ 6.78 1.34 1.34 0.14 8.26 8.26 000

50561 ............ A Kidney endoscopy & treatment .......................... 7.59 5.12 5.12 0.49 13.20 13.20 000

50570 ............ A Kidney endoscopy .............................................. 9.54 1.45 1.45 0.14 11.13 11.13 000

50572 ............ A Kidney endoscopy .............................................. 10.35 7.25 7.25 0.75 18.35 18.35 000

50574 ............ A Kidney endoscopy & biopsy ............................... 11.02 7.08 7.08 0.64 18.74 18.74 000

50575 ............ A Kidney endoscopy .............................................. 13.98 9.93 9.93 0.97 24.88 24.88 000

50576 ............ A Kidney endoscopy & treatment .......................... 10.99 8.69 8.69 0.77 20.45 20.45 000

50578 ............ A Renal endoscopy; radiotracer ............................ 11.35 3.79 3.79 1.19 16.33 16.33 000

50580 ............ A Kidney endoscopy & treatment .......................... 11.86 3.58 3.58 0.35 15.79 15.79 000

50590 ............ A Fragmenting of kidney stone ............................. *9.09 #10.00 #10.00 0.97 20.06 20.06 090

50600 ............ A Exploration of ureter ........................................... *15.84 9.69 9.69 1.01 26.54 26.54 090

50605 ............ A Insert ureteral support ........................................ *15.46 6.11 6.11 0.60 22.17 22.17 090

50610 ............ A Removal of ureter stone .................................... *15.92 11.77 11.77 1.17 28.86 28.86 090

50620 ............ A Removal of ureter stone .................................... *15.16 11.49 11.49 1.16 27.81 27.81 090

50630 ............ A Removal of ureter stone .................................... *14.94 12.71 12.71 1.25 28.90 28.90 090

50650 ............ A Removal of ureter .............................................. *17.41 12.07 12.07 1.21 30.69 30.69 090

50660 ............ A Removal of ureter .............................................. *19.55 12.49 12.49 1.53 33.57 33.57 090

50684 ............ A Injection for ureter x-ray ..................................... 0.76 0.49 0.49 0.05 1.30 1.30 000

50686 ............ A Measure ureter pressure .................................... 1.51 0.37 0.37 0.04 1.92 1.92 000

50688 ............ A Change of ureter tube ........................................ *1.17 0.39 0.39 0.04 1.60 1.60 010

50690 ............ A Injection for ureter x-ray ..................................... 1.16 0.32 0.32 0.03 1.51 1.51 000

50700 ............ A Revision of ureter ............................................... *15.21 12.57 12.57 1.29 29.07 29.07 090

50715 ............ A Release of ureter ............................................... *18.90 11.24 11.24 1.49 31.63 31.63 090

50722 ............ A Release of ureter ............................................... *16.35 10.32 10.32 1.97 28.64 28.64 090

50725 ............ A Release/revise ureter ......................................... *18.49 12.05 12.05 1.75 32.29 32.29 090

50727 ............ A Revise ureter ...................................................... *8.18 5.37 5.37 0.51 14.06 14.06 090

50728 ............ A Revise ureter ...................................................... *12.02 7.90 7.90 0.77 20.69 20.69 090

50740 ............ A Fusion of ureter & kidney ................................... *18.42 13.03 13.03 1.88 33.33 33.33 090

50750 ............ A Fusion of ureter & kidney ................................... *19.51 14.04 14.04 1.26 34.81 34.81 090

50760 ............ A Fusion of ureters ................................................ *18.42 13.47 13.47 1.48 33.37 33.37 090

50770 ............ A Splicing of ureters .............................................. *19.51 15.23 15.23 1.53 36.27 36.27 090

50780 ............ A Reimplant ureter in bladder ............................... *18.36 13.78 13.78 1.46 33.60 33.60 090

50782 ............ A Reimplant ureter in bladder ............................... *19.54 13.78 13.78 1.46 34.78 34.78 090

50783 ............ A Reimplant ureter in bladder ............................... *20.55 13.78 13.78 1.46 35.79 35.79 090

50785 ............ A Reimplant ureter in bladder ............................... *20.52 15.42 15.42 1.80 37.74 37.74 090

50800 ............ A Implant ureter in bowel ...................................... *14.52 14.67 14.67 1.51 30.70 30.70 090

50810 ............ A Fusion of ureter & bowel .................................... *20.05 12.57 12.57 1.75 34.37 34.37 090

50815 ............ A Urine shunt to bowel .......................................... *19.93 19.76 19.76 2.75 42.44 42.44 090

50820 ............ A Construct bowel bladder .................................... *21.89 18.97 18.97 2.50 43.36 43.36 090

50825 ............ A Construct bowel bladder .................................... *28.18 30.54 30.54 3.33 62.05 62.05 090

50830 ............ A Revise urine flow ................................................ *31.28 20.93 20.93 2.27 54.48 54.48 090

50840 ............ A Replace ureter by bowel .................................... *20.00 13.32 13.32 1.35 34.67 34.67 090

50845 ............ A Appendico-vesicostomy ..................................... *20.89 13.87 13.87 1.35 36.11 36.11 090

50860 ............ A Transplant ureter to skin .................................... *15.36 10.92 10.92 1.16 27.44 27.44 090

50900 ............ A Repair of ureter .................................................. *13.62 9.98 9.98 1.15 24.75 24.75 090

50920 ............ A Closure ureter/skin fistula .................................. *14.33 9.52 9.52 0.99 24.84 24.84 090

50930 ............ A Closure ureter/bowel fistula ............................... *18.72 12.50 12.50 1.22 32.44 32.44 090

50940 ............ A Release of ureter ............................................... *14.51 9.90 9.90 0.95 25.36 25.36 090

50951 ............ A Endoscopy of ureter ........................................... 5.84 1.67 1.67 0.17 7.68 7.68 000

50953 ............ A Endoscopy of ureter ........................................... 6.24 1.66 1.66 0.16 8.06 8.06 000

50955 ............ A Ureter endoscopy & biopsy ................................ 6.75 2.55 2.55 0.25 9.55 9.55 000

50957 ............ A Ureter endoscopy & treatment ........................... 6.79 2.50 2.50 0.25 9.54 9.54 000

50959 ............ A Ureter endoscopy & tracer ................................. 4.40 3.38 3.38 0.29 8.07 8.07 000

50961 ............ A Ureter endoscopy & treatment ........................... 6.05 2.62 2.62 0.26 8.93 8.93 000

50970 ............ A Ureter endoscopy ............................................... 7.14 5.17 5.17 0.52 12.83 12.83 000

50972 ............ A Ureter endoscopy & catheter ............................. 6.89 1.54 1.54 0.16 8.59 8.59 000

50974 ............ A Ureter endoscopy & biopsy ................................ 9.17 7.01 7.01 0.65 16.83 16.83 000

50976 ............ A Ureter endoscopy & treatment ........................... 9.04 6.41 6.41 0.62 16.07 16.07 000

50978 ............ A Ureter endoscopy & tracer ................................. 5.10 4.05 4.05 0.48 9.63 9.63 000

50980 ............ A Ureter endoscopy & treatment ........................... 6.85 3.13 3.13 0.30 10.28 10.28 000

51000 ............ A Drainage of bladder ........................................... 0.78 0.48 0.48 0.05 1.31 1.31 000

51005 ............ A Drainage of bladder ........................................... 1.02 0.46 0.46 0.04 1.52 1.52 000

51010 ............ A Drainage of bladder ........................................... *3.53 0.97 0.97 0.11 4.61 4.61 010

51020 ............ A Incise & treat bladder ......................................... *6.71 6.85 6.85 0.71 14.27 14.27 090

51030 ............ A Incise & treat bladder ......................................... *6.77 4.53 4.53 0.43 11.73 11.73 090

51040 ............ A Incise & drain bladder ........................................ *4.40 #4.84 #4.84 0.75 9.99 9.99 090

51045 ............ A Incise bladder, drain ureter ................................ *6.77 4.96 4.96 0.50 12.23 12.23 090

51050 ............ A Removal of bladder stone .................................. *6.92 7.12 7.12 0.70 14.74 14.74 090

51060 ............ A Removal of ureter stone .................................... *8.85 #9.74 #9.74 1.19 19.78 19.78 090

51065 ............ A Removal of ureter stone .................................... *8.85 7.08 7.08 0.71 16.64 16.64 090

51080 ............ A Drainage of bladder abscess ............................. *5.96 5.18 5.18 0.57 11.71 11.71 090

51500 ............ A Removal of bladder cyst .................................... *10.14 6.86 6.86 1.21 18.21 18.21 090

51520 ............ A Removal of bladder lesion ................................. *9.29 8.53 8.53 0.87 18.69 18.69 090
59151

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

51525 ............ A Removal of bladder lesion ................................. *13.97 10.67 10.67 1.06 25.70 25.70 090

51530 ............ A Removal of bladder lesion ................................. *12.38 9.25 9.25 1.02 22.65 22.65 090

51535 ............ A Repair of ureter lesion ....................................... *12.57 7.68 7.68 1.14 21.39 21.39 090

51550 ............ A Partial removal of bladder .................................. *15.66 10.71 10.71 1.17 27.54 27.54 090

51555 ............ A Partial removal of bladder .................................. *21.23 12.26 12.26 1.31 34.80 34.80 090

51565 ............ A Revise bladder & ureter(s) ................................. *21.62 15.84 15.84 1.67 39.13 39.13 090

51570 ............ A Removal of bladder ............................................ *24.24 15.66 15.66 1.62 41.52 41.52 090

51575 ............ A Removal of bladder & nodes ............................. *30.45 22.87 22.87 2.25 55.57 55.57 090

51580 ............ A Remove bladder; revise tract ............................. *31.08 19.95 19.95 2.04 53.07 53.07 090

51585 ............ A Removal of bladder & nodes ............................. *35.23 25.12 25.12 2.42 62.77 62.77 090

51590 ............ A Remove bladder; revise tract ............................. *32.66 24.52 24.52 2.56 59.74 59.74 090

51595 ............ A Remove bladder; revise tract ............................. *37.14 33.80 33.80 3.34 74.28 74.28 090

51596 ............ A Remove bladder, create pouch .......................... *39.52 34.89 34.89 3.45 77.86 77.86 090

51597 ............ A Removal of pelvic structures .............................. *38.35 30.63 30.63 4.31 73.29 73.29 090

51600 ............ A Injection for bladder x-ray .................................. 0.88 0.28 0.28 0.03 1.19 1.19 000

51605 ............ A Preparation for bladder x-ray ............................. 0.64 0.30 0.30 0.03 0.97 0.97 000

51610 ............ A Injection for bladder x-ray .................................. 1.05 0.27 0.27 0.02 1.34 1.34 000

51700 ............ A Irrigation of bladder ............................................ 0.88 0.22 0.22 0.02 1.12 1.12 000

51705 ............ A Change of bladder tube ..................................... *1.02 0.38 0.38 0.04 1.44 1.44 010

51710 ............ A Change of bladder tube ..................................... *1.49 0.57 0.57 0.06 2.12 2.12 010

51715 ............ A Endoscopic injection/implant .............................. 3.74 2.65 2.65 0.27 6.66 6.66 000

51720 ............ A Treatment of bladder lesion ............................... 1.96 0.45 0.45 0.05 2.46 2.46 000

51725 ............ A Simple cystometrogram ..................................... 1.51 1.01 1.01 0.11 2.63 2.63 000

51725 TC A Simple cystometrogram ..................................... 0.00 0.38 0.38 0.04 0.42 0.42 000

51725 26 A Simple cystometrogram ..................................... 1.51 0.63 0.63 0.07 2.21 2.21 000

51726 ............ A Complex cystometrogram .................................. 1.71 1.29 1.29 0.13 3.13 3.13 000

51726 TC A Complex cystometrogram .................................. 0.00 0.48 0.48 0.05 0.53 0.53 000

51726 26 A Complex cystometrogram .................................. 1.71 0.81 0.81 0.08 2.60 2.60 000

51736 ............ A Urine flow measurement .................................... 0.61 0.41 0.41 0.04 1.06 1.06 000

51736 TC A Urine flow measurement .................................... 0.00 0.15 0.15 0.01 0.16 0.16 000

51736 26 A Urine flow measurement .................................... 0.61 0.26 0.26 0.03 0.90 0.90 000

51741 ............ A Electro-uroflowmetry, first .................................. 1.14 0.56 0.56 0.06 1.76 1.76 000

51741 TC A Electro-uroflowmetry, first .................................. 0.00 0.21 0.21 0.02 0.23 0.23 000

51741 26 A Electro-uroflowmetry, first .................................. 1.14 0.35 0.35 0.04 1.53 1.53 000

51772 ............ A Urethra pressure profile ..................................... 1.61 0.94 0.94 0.11 2.66 2.66 000

51772 TC A Urethra pressure profile ..................................... 0.00 0.42 0.42 0.05 0.47 0.47 000

51772 26 A Urethra pressure profile ..................................... 1.61 0.52 0.52 0.06 2.19 2.19 000

51784 ............ A Anal/urinary muscle study .................................. 1.53 1.04 1.04 0.11 2.68 2.68 000

51784 TC A Anal/urinary muscle study .................................. 0.00 0.39 0.39 0.04 0.43 0.43 000

51784 26 A Anal/urinary muscle study .................................. 1.53 0.65 0.65 0.07 2.25 2.25 000

51785 ............ A Anal/urinary muscle study .................................. 1.53 1.04 1.04 0.11 2.68 2.68 000

51785 TC A Anal/urinary muscle study .................................. 0.00 0.39 0.39 0.04 0.43 0.43 000

51785 26 A Anal/urinary muscle study .................................. 1.53 0.65 0.65 0.07 2.25 2.25 000

51792 ............ A Urinary reflex study ............................................ 1.10 1.93 1.93 0.20 3.23 3.23 000

51792 TC A Urinary reflex study ............................................ 0.00 1.34 1.34 0.14 1.48 1.48 000

51792 26 A Urinary reflex study ............................................ 1.10 0.59 0.59 0.06 1.75 1.75 000

51795 ............ A Urine voiding pressure study ............................. 1.53 1.44 1.44 0.16 3.13 3.13 000

51795 TC A Urine voiding pressure study ............................. 0.00 0.87 0.87 0.10 0.97 0.97 000

51795 26 A Urine voiding pressure study ............................. 1.53 0.57 0.57 0.06 2.16 2.16 000

51797 ............ A Intraabdominal pressure test ............................. 1.60 0.96 0.96 0.10 2.66 2.66 000

51797 TC A Intraabdominal pressure test ............................. 0.00 0.45 0.45 0.05 0.50 0.50 000

51797 26 A Intraabdominal pressure test ............................. 1.60 0.51 0.51 0.05 2.16 2.16 000

51800 ............ A Revision of bladder/urethra ................................ *17.42 12.02 12.02 1.47 30.91 30.91 090

51820 ............ A Revision of urinary tract ..................................... *17.89 7.39 7.39 1.32 26.60 26.60 090

51840 ............ A Attach bladder/urethra ........................................ *10.71 9.22 9.22 1.26 21.19 21.19 090

51841 ............ A Attach bladder/urethra ........................................ *13.03 11.01 11.01 1.48 25.52 25.52 090

51845 ............ A Repair bladder neck ........................................... *9.73 #10.70 #10.70 1.09 21.52 21.52 090

51860 ............ A Repair of bladder wound .................................... *12.02 7.62 7.62 0.91 20.55 20.55 090

51865 ............ A Repair of bladder wound .................................... *15.04 10.96 10.96 1.27 27.27 27.27 090

51880 ............ A Repair of bladder opening ................................. *7.66 4.96 4.96 0.52 13.14 13.14 090

51900 ............ A Repair bladder/vagina lesion ............................. *12.97 11.65 11.65 1.41 26.03 26.03 090

51920 ............ A Close bladder-uterus fistula ............................... *11.81 7.51 7.51 0.73 20.05 20.05 090

51925 ............ A Hysterectomy/bladder repair .............................. *15.58 10.07 10.07 2.33 27.98 27.98 090

51940 ............ A Correction of bladder defect .............................. *26.81 18.95 18.95 2.22 47.98 47.98 090

51960 ............ A Revision of bladder & bowel .............................. *23.01 21.40 21.40 2.27 46.68 46.68 090

51980 ............ A Construct bladder opening ................................. *11.36 7.46 7.46 0.75 19.57 19.57 090

52000 ............ A Cystoscopy ......................................................... 2.01 1.33 1.33 0.14 3.48 3.48 000

52005 ............ A Cystoscopy & ureter catheter ............................ 2.37 2.20 2.20 0.22 4.79 4.79 000

52007 ............ A Cystoscopy and biopsy ...................................... 3.02 2.82 2.82 0.28 6.12 6.12 000

52010 ............ A Cystoscopy & duct catheter ............................... 3.02 1.90 1.90 0.20 5.12 5.12 000

52204 ............ A Cystoscopy ......................................................... 2.37 2.38 2.38 0.24 4.99 4.99 000

52214 ............ A Cystoscopy and treatment ................................. 3.71 2.80 2.80 0.28 6.79 6.79 000

52224 ............ A Cystoscopy and treatment ................................. 3.14 2.90 2.90 0.29 6.33 6.33 000

52234 ............ A Cystoscopy and treatment ................................. 4.63 4.71 4.71 0.45 9.79 9.79 000
59152

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

52235 ............ A Cystoscopy and treatment ................................. 5.45 #6.00 #6.00 0.81 12.26 12.26 000

52240 ............ A Cystoscopy and treatment ................................. 9.72 10.65 10.65 1.04 21.41 21.41 000

52250 ............ A Cystoscopy & radiotracer ................................... 4.50 2.86 2.86 0.29 7.65 7.65 000

52260 ............ A Cystoscopy & treatment ..................................... 3.92 2.11 2.11 0.22 6.25 6.25 000

52265 ............ A Cystoscopy & treatment ..................................... 2.94 1.35 1.35 0.14 4.43 4.43 000

52270 ............ A Cystoscopy & revise urethra .............................. 3.37 3.47 3.47 0.35 7.19 7.19 000

52275 ............ A Cystoscopy & revise urethra .............................. 4.70 3.42 3.42 0.34 8.46 8.46 000

52276 ............ A Cystoscopy and treatment ................................. 5.00 4.58 4.58 0.45 10.03 10.03 000

52277 ............ A Cystoscopy and treatment ................................. 6.17 4.82 4.82 0.47 11.46 11.46 000

52281 ............ A Cystoscopy and treatment ................................. 2.80 2.31 2.31 0.23 5.34 5.34 000

52282 ............ A Cystoscopy, implant stent .................................. 6.40 4.58 4.58 0.45 11.43 11.43 000

52283 ............ A Cystoscopy and treatment ................................. 3.74 1.51 1.51 0.15 5.40 5.40 000

52285 ............ A Cystoscopy and treatment ................................. 3.61 2.94 2.94 0.30 6.85 6.85 000

52290 ............ A Cystoscopy and treatment ................................. 4.59 2.34 2.34 0.24 7.17 7.17 000

52300 ............ A Cystoscopy and treatment ................................. 5.31 3.47 3.47 0.36 9.14 9.14 000

52301 ............ A Cystoscopy and treatment ................................. 5.51 3.47 3.47 0.36 9.34 9.34 000

52305 ............ A Cystoscopy and treatment ................................. 5.31 3.50 3.50 0.35 9.16 9.16 000

52310 ............ A Cystoscopy and treatment ................................. 2.81 2.99 2.99 0.30 6.10 6.10 000

52315 ............ A Cystoscopy and treatment ................................. 5.21 4.07 4.07 0.40 9.68 9.68 000

52317 ............ A Remove bladder stone ....................................... 6.72 6.19 6.19 0.59 13.50 13.50 000

52318 ............ A Remove bladder stone ....................................... 9.19 7.88 7.88 0.77 17.84 17.84 000

52320 ............ A Cystoscopy and treatment ................................. 4.70 4.86 4.86 0.47 10.03 10.03 000

52325 ............ A Cystoscopy, stone removal ................................ 6.16 #6.78 #6.78 0.68 13.62 13.62 000

52327 ............ A Cystoscopy, inject material ................................ 5.19 3.69 3.69 0.36 9.24 9.24 000

52330 ............ A Cystoscopy and treatment ................................. 5.04 3.47 3.47 0.35 8.86 8.86 000

52332 ............ A Cystoscopy and treatment ................................. 2.83 3.21 #3.11 0.32 6.36 6.26 000

52334 ............ A Create passage to kidney .................................. 4.83 3.33 3.33 0.34 8.50 8.50 000

52335 ............ A Endoscopy of urinary tract ................................. 5.86 4.69 4.69 0.45 11.00 11.00 000

52336 ............ A Cystoscopy, stone removal ................................ 6.88 #7.57 #7.57 0.99 15.44 15.44 000

52337 ............ A Cystoscopy, stone removal ................................ 7.97 #8.77 #8.77 1.08 17.82 17.82 000

52338 ............ A Cystoscopy and treatment ................................. 7.34 5.92 5.92 0.57 13.83 13.83 000

52339 ............ A Cystoscopy and treatment ................................. 8.82 5.92 5.92 0.57 15.31 15.31 000

52340 ............ A Cystoscopy and treatment ................................. *9.68 5.15 5.15 0.50 15.33 15.33 090

52450 ............ A Incision of prostate ............................................. *7.64 4.99 4.99 0.49 13.12 13.12 090

52500 ............ A Revision of bladder neck ................................... *8.47 7.44 7.44 0.72 16.63 16.63 090

52510 ............ A Dilation prostatic urethra .................................... *6.72 #7.39 #7.39 0.74 14.85 14.85 090

52601 ............ A Prostatectomy (TURP) ....................................... *12.37 11.87 11.87 1.16 25.40 25.40 090

52606 ............ A Control postop bleeding ..................................... *8.13 3.32 3.32 0.33 11.78 11.78 090

52612 ............ A Prostatectomy, first stage .................................. *7.98 #8.78 #8.78 0.99 17.75 17.75 090

52614 ............ A Prostatectomy, second stage ............................. *6.84 7.09 7.09 0.68 14.61 14.61 090

52620 ............ A Remove residual prostate .................................. *6.61 5.33 5.33 0.51 12.45 12.45 090

52630 ............ A Remove prostate regrowth ................................. *7.26 #7.99 #7.99 1.13 16.38 16.38 090

52640 ............ A Relieve bladder contracture ............................... *6.62 6.43 6.43 0.62 13.67 13.67 090

52647 ............ A Laser surgery of prostate ................................... *10.36 #11.40 #11.40 1.16 22.92 22.92 090

52648 ............ A Laser surgery of prostate ................................... *11.21 11.87 11.87 1.16 24.24 24.24 090

52700 ............ A Drainage of prostate abscess ............................ *6.80 3.30 3.30 0.34 10.44 10.44 090

53000 ............ A Incision of urethra .............................................. *2.28 1.76 1.76 0.17 4.21 4.21 010

53010 ............ A Incision of urethra .............................................. *3.64 3.52 3.52 0.37 7.53 7.53 090

53020 ............ A Incision of urethra .............................................. 1.77 0.82 0.82 0.09 2.68 2.68 000

53025 ............ A Incision of urethra .............................................. 1.13 0.80 0.80 0.08 2.01 2.01 000

53040 ............ A Drainage of urethra abscess .............................. *6.40 1.85 1.85 0.19 8.44 8.44 090

53060 ............ A Drainage of urethra abscess .............................. *2.63 0.51 0.51 0.07 3.21 3.21 010

53080 ............ A Drainage of urinary leakage ............................... *6.29 3.98 3.98 0.45 10.72 10.72 090

53085 ............ A Drainage of urinary leakage ............................... *10.27 6.75 6.75 0.70 17.72 17.72 090

53200 ............ A Biopsy of urethra ................................................ 2.59 1.10 1.10 0.12 3.81 3.81 000

53210 ............ A Removal of urethra ............................................ *12.57 6.64 6.64 0.67 19.88 19.88 090

53215 ............ A Removal of urethra ............................................ *15.58 10.00 10.00 0.96 26.54 26.54 090

53220 ............ A Treatment of urethra lesion ................................ *7.00 4.77 4.77 0.49 12.26 12.26 090

53230 ............ A Removal of urethra lesion .................................. *9.58 7.93 7.93 0.79 18.30 18.30 090

53235 ............ A Removal of urethra lesion .................................. *10.14 5.02 5.02 0.49 15.65 15.65 090

53240 ............ A Surgery for urethra pouch .................................. *6.45 4.33 4.33 0.45 11.23 11.23 090

53250 ............ A Removal of urethra gland .................................. *5.89 4.05 4.05 0.40 10.34 10.34 090

53260 ............ A Treatment of urethra lesion ................................ *2.98 1.12 1.12 0.16 4.26 4.26 010

53265 ............ A Treatment of urethra lesion ................................ *3.12 1.88 1.88 0.22 5.22 5.22 010

53270 ............ A Removal of urethra gland .................................. *3.09 0.84 0.84 0.18 4.11 4.11 010

53275 ............ A Repair of urethra defect ..................................... *4.53 2.37 2.37 0.25 7.15 7.15 010

53400 ............ A Revise urethra, 1st stage ................................... *12.77 7.47 7.47 0.76 21.00 21.00 090

53405 ............ A Revise urethra, 2nd stage .................................. *14.48 10.38 10.38 1.21 26.07 26.07 090

53410 ............ A Reconstruction of urethra ................................... *16.44 8.56 8.56 0.84 25.84 25.84 090

53415 ............ A Reconstruction of urethra ................................... *19.41 11.87 11.87 1.15 32.43 32.43 090

53420 ............ A Reconstruct urethra, stage 1 ............................. *14.08 10.88 10.88 1.05 26.01 26.01 090

53425 ............ A Reconstruct urethra, stage 2 ............................. *15.98 9.25 9.25 0.88 26.11 26.11 090

53430 ............ A Reconstruction of urethra ................................... *16.34 7.16 7.16 0.76 24.26 24.26 090

53440 ............ A Correct bladder function ..................................... *12.34 13.14 13.14 1.39 26.87 26.87 090
59153

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

53442 ............ A Remove perineal prosthesis .............................. *8.27 5.84 5.84 0.67 14.78 14.78 090

53443 ............ A Reconstruction of urethra ................................... *19.89 10.03 10.03 1.07 30.99 30.99 090

53445 ............ A Correct urine flow control ................................... *14.06 #15.47 #15.47 2.03 31.56 31.56 090

53447 ............ A Remove artificial sphincter ................................. *13.17 9.16 9.16 0.89 23.22 23.22 090

53449 ............ A Correct artificial sphincter .................................. *9.70 8.41 8.41 0.82 18.93 18.93 090

53450 ............ A Revision of urethra ............................................. *6.14 2.74 2.74 0.27 9.15 9.15 090

53460 ............ A Revision of urethra ............................................. *7.12 2.44 2.44 0.25 9.81 9.81 090

53502 ............ A Repair of urethra injury ...................................... *7.63 4.97 4.97 0.56 13.16 13.16 090

53505 ............ A Repair of urethra injury ...................................... *7.63 5.18 5.18 0.51 13.32 13.32 090

53510 ............ A Repair of urethra injury ...................................... *10.11 6.98 6.98 0.66 17.75 17.75 090

53515 ............ A Repair of urethra injury ...................................... *13.31 9.03 9.03 0.88 23.22 23.22 090

53520 ............ A Repair of urethra defect ..................................... *8.68 5.89 5.89 0.56 15.13 15.13 090

53600 ............ A Dilate urethra stricture ........................................ 1.21 0.33 0.33 0.03 1.57 1.57 000

53601 ............ A Dilate urethra stricture ........................................ 0.98 0.29 0.29 0.03 1.30 1.30 000

53605 ............ A Dilate urethra stricture ........................................ 1.28 0.46 0.46 0.05 1.79 1.79 000

53620 ............ A Dilate urethra stricture ........................................ 1.62 0.47 0.47 0.05 2.14 2.14 000

53621 ............ A Dilate urethra stricture ........................................ 1.35 0.38 0.38 0.04 1.77 1.77 000

53660 ............ A Dilation of urethra ............................................... 0.71 0.28 0.28 0.03 1.02 1.02 000

53661 ............ A Dilation of urethra ............................................... 0.72 0.25 0.25 0.03 1.00 1.00 000

53665 ............ A Dilation of urethra ............................................... 0.76 0.36 0.36 0.04 1.16 1.16 000

53670 ............ A Insert urinary catheter ........................................ 0.50 0.22 0.22 0.02 0.74 0.74 000

53675 ............ A Insert urinary catheter ........................................ 1.47 0.47 0.47 0.05 1.99 1.99 000

53850 ............ A Prostatic microwave thermotx ............................ *9.45 6.71 6.71 0.66 16.82 16.82 090

53852 ............ A Prostatic rf thermotx ........................................... *9.88 7.01 7.01 0.69 17.58 17.58 090

53899 ............ C Urology surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

54000 ............ A Slitting of prepuce .............................................. *1.54 0.63 0.63 0.07 2.24 2.24 010

54001 ............ A Slitting of prepuce .............................................. *2.19 0.84 0.84 0.09 3.12 3.12 010

54015 ............ A Drain penis lesion .............................................. *5.32 0.83 0.83 0.09 6.24 6.24 010

54050 ............ A Destruction, penis lesion(s) ................................ *1.24 0.38 0.38 0.03 1.65 1.65 010

54055 ............ A Destruction, penis lesion(s) ................................ *1.22 0.61 0.61 0.06 1.89 1.89 010

54056 ............ A Cryosurgery, penis lesion(s) .............................. *1.24 0.53 0.53 0.04 1.81 1.81 010

54057 ............ A Laser surg, penis lesion(s) ................................. *1.24 1.52 #1.36 0.21 2.97 2.81 010

54060 ............ A Excision of penis lesion(s) ................................. *1.93 1.17 1.17 0.12 3.22 3.22 010

54065 ............ A Destruction, penis lesion(s) ................................ *2.42 2.47 2.47 0.25 5.14 5.14 010

54100 ............ A Biopsy of penis ................................................... 1.90 0.65 0.65 0.07 2.62 2.62 000

54105 ............ A Biopsy of penis ................................................... *3.50 1.01 1.01 0.11 4.62 4.62 010

54110 ............ A Treatment of penis lesion .................................. *10.13 6.03 6.03 0.61 16.77 16.77 090

54111 ............ A Treat penis lesion, graft ..................................... *13.57 9.18 9.18 0.97 23.72 23.72 090

54112 ............ A Treat penis lesion, graft ..................................... *15.86 10.84 10.84 1.14 27.84 27.84 090

54115 ............ A Treatment of penis lesion .................................. *6.15 4.18 4.18 0.44 10.77 10.77 090

54120 ............ A Partial removal of penis ..................................... *9.97 6.47 6.47 0.62 17.06 17.06 090

54125 ............ A Removal of penis ............................................... *13.53 11.56 11.56 1.17 26.26 26.26 090

54130 ............ A Remove penis & nodes ...................................... *20.14 14.66 14.66 1.32 36.12 36.12 090

54135 ............ A Remove penis & nodes ...................................... *26.36 17.75 17.75 1.74 45.85 45.85 090

54150 ............ A Circumcision ....................................................... *1.81 0.54 0.54 0.05 2.40 2.40 010

54152 ............ A Circumcision ....................................................... *2.31 1.82 1.82 0.20 4.33 4.33 010

54160 ............ A Circumcision ....................................................... *2.48 1.66 1.66 0.21 4.35 4.35 010

54161 ............ A Circumcision ....................................................... *3.27 2.17 2.17 0.23 5.67 5.67 010

54200 ............ A Treatment of penis lesion .................................. *1.06 0.32 0.32 0.03 1.41 1.41 010

54205 ............ A Treatment of penis lesion .................................. *7.93 5.11 5.11 0.50 13.54 13.54 090

54220 ............ A Treatment of penis lesion .................................. 2.42 1.58 1.58 0.17 4.17 4.17 000

54230 ............ A Prepare penis study ........................................... 1.34 1.34 1.34 0.13 2.81 2.81 000

54231 ............ A Dynamic cavernosometry ................................... 2.04 1.44 1.44 0.14 3.62 3.62 000

54235 ............ A Penile injection ................................................... 1.19 0.43 0.43 0.04 1.66 1.66 000

54240 ............ A Penis study ......................................................... 1.31 0.99 0.99 0.12 2.42 2.42 000

54240 TC A Penis study ......................................................... 0.00 0.48 0.48 0.06 0.54 0.54 000

54240 26 A Penis study ......................................................... 1.31 0.51 0.51 0.06 1.88 1.88 000

54250 ............ A Penis study ......................................................... 2.22 0.80 0.80 0.08 3.10 3.10 000

54250 TC A Penis study ......................................................... 0.00 0.30 0.30 0.03 0.33 0.33 000

54250 26 A Penis study ......................................................... 2.22 0.50 0.50 0.05 2.77 2.77 000

54300 ............ A Revision of penis ................................................ *10.41 6.88 6.88 0.87 18.16 18.16 090

54304 ............ A Revision of penis ................................................ *12.49 8.66 8.66 0.90 22.05 22.05 090

54308 ............ A Reconstruction of urethra ................................... *11.83 5.84 5.84 0.74 18.41 18.41 090

54312 ............ A Reconstruction of urethra ................................... *13.57 9.37 9.37 0.91 23.85 23.85 090

54316 ............ A Reconstruction of urethra ................................... *16.82 11.34 11.34 1.12 29.28 29.28 090

54318 ............ A Reconstruction of urethra ................................... *11.25 7.53 7.53 1.11 19.89 19.89 090

54322 ............ A Reconstruction of urethra ................................... *13.01 7.61 7.61 0.74 21.36 21.36 090

54324 ............ A Reconstruction of urethra ................................... *16.31 10.98 10.98 1.08 28.37 28.37 090

54326 ............ A Reconstruction of urethra ................................... *15.72 10.51 10.51 1.03 27.26 27.26 090

54328 ............ A Revise penis, urethra ......................................... *15.65 10.72 10.72 1.24 27.61 27.61 090

54332 ............ A Revise penis, urethra ......................................... *17.08 12.52 12.52 1.13 30.73 30.73 090

54336 ............ A Revise penis, urethra ......................................... *20.04 18.79 18.79 1.40 40.23 40.23 090

54340 ............ A Secondary urethral surgery ................................ *8.91 6.07 6.07 0.59 15.57 15.57 090

54344 ............ A Secondary urethral surgery ................................ *15.94 16.61 16.61 1.10 33.65 33.65 090
59154

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

54348 ............ A Secondary urethral surgery ................................ *17.15 11.62 11.62 1.14 29.91 29.91 090

54352 ............ A Reconstruct urethra, penis ................................. *24.74 16.18 16.18 1.49 42.41 42.41 090

54360 ............ A Penis plastic surgery .......................................... *11.93 7.02 7.02 0.73 19.68 19.68 090

54380 ............ A Repair penis ....................................................... *13.18 9.42 9.42 0.75 23.35 23.35 090

54385 ............ A Repair penis ....................................................... *15.39 10.46 10.46 0.89 26.74 26.74 090

54390 ............ A Repair penis and bladder ................................... *21.61 13.57 13.57 1.58 36.76 36.76 090

54400 ............ A Insert semi-rigid prosthesis ................................ *8.99 #9.89 #9.89 1.27 20.15 20.15 090

54401 ............ A Insert self-contd prosthesis ................................ *10.28 #11.31 #11.31 1.73 23.32 23.32 090

54402 ............ A Remove penis prosthesis ................................... *9.21 6.00 6.00 0.58 15.79 15.79 090

54405 ............ A Insert multi-comp prosthesis .............................. *13.43 #14.77 #14.77 2.10 30.30 30.30 090

54407 ............ A Remove multi-comp prosthesis .......................... *13.34 11.22 11.22 1.10 25.66 25.66 090

54409 ............ A Revise penis prosthesis ..................................... *12.20 8.97 8.97 0.87 22.04 22.04 090

54420 ............ A Revision of penis ................................................ *11.42 7.74 7.74 0.87 20.03 20.03 090

54430 ............ A Revision of penis ................................................ *10.15 6.99 6.99 0.69 17.83 17.83 090

54435 ............ A Revision of penis ................................................ *6.12 4.15 4.15 0.39 10.66 10.66 090

54440 ............ C Repair of penis ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 090

54450 ............ A Preputial stretching ............................................ 1.12 0.68 0.68 0.07 1.87 1.87 000

54500 ............ A Biopsy of testis ................................................... 1.31 0.44 0.44 0.05 1.80 1.80 000

54505 ............ A Biopsy of testis ................................................... *3.46 1.86 1.86 0.22 5.54 5.54 010

54510 ............ A Removal of testis lesion ..................................... *5.45 3.03 3.03 0.38 8.86 8.86 090

54520 ............ A Removal of testis ............................................... *5.23 5.31 5.31 0.52 11.06 11.06 090

54530 ............ A Removal of testis ............................................... *8.58 7.32 7.32 0.77 16.67 16.67 090

54535 ............ A Extensive testis surgery ..................................... *12.16 8.54 8.54 1.02 21.72 21.72 090

54550 ............ A Exploration for testis .......................................... *7.78 5.25 5.25 0.61 13.64 13.64 090

54560 ............ A Exploration for testis .......................................... *11.13 7.23 7.23 0.81 19.17 19.17 090

54600 ............ A Reduce testis torsion ......................................... *7.01 4.62 4.62 0.48 12.11 12.11 090

54620 ............ A Suspension of testis ........................................... *4.90 3.32 3.32 0.33 8.55 8.55 010

54640 ............ A Suspension of testis ........................................... *6.90 #7.59 #7.59 0.91 15.40 15.40 090

54650 ............ A Orchiopexy (Fowler-Stephens) .......................... *11.45 7.82 7.82 0.91 20.18 20.18 090

54660 ............ A Revision of testis ................................................ *5.11 3.40 3.40 0.34 8.85 8.85 090

54670 ............ A Repair testis injury ............................................. *6.41 4.30 4.30 0.43 11.14 11.14 090

54680 ............ A Relocation of testis(es) ...................................... *12.65 8.19 8.19 0.80 21.64 21.64 090

54700 ............ A Drainage of scrotum ........................................... *3.43 0.90 0.90 0.11 4.44 4.44 010

54800 ............ A Biopsy of epididymis .......................................... 2.33 1.97 1.97 0.19 4.49 4.49 000

54820 ............ A Exploration of epididymis ................................... *5.14 2.62 2.62 0.29 8.05 8.05 090

54830 ............ A Remove epididymis lesion ................................. *5.38 3.51 3.51 0.39 9.28 9.28 090

54840 ............ A Remove epididymis lesion ................................. *5.20 4.84 4.84 0.48 10.52 10.52 090

54860 ............ A Removal of epididymis ....................................... *6.32 5.17 5.17 0.50 11.99 11.99 090

54861 ............ A Removal of epididymis ....................................... *8.90 7.30 7.30 0.72 16.92 16.92 090

54900 ............ A Fusion of spermatic ducts .................................. *13.20 8.95 8.95 0.87 23.02 23.02 090

54901 ............ A Fusion of spermatic ducts .................................. *17.94 12.29 12.29 1.20 31.43 31.43 090

55000 ............ A Drainage of hydrocele ........................................ 1.43 0.40 0.40 0.04 1.87 1.87 000

55040 ............ A Removal of hydrocele ........................................ *5.36 4.88 4.88 0.55 10.79 10.79 090

55041 ............ A Removal of hydroceles ...................................... *7.74 7.47 7.47 0.81 16.02 16.02 090

55060 ............ A Repair of hydrocele ............................................ *5.52 4.13 4.13 0.50 10.15 10.15 090

55100 ............ A Drainage of scrotum abscess ............................ *2.13 0.63 0.63 0.07 2.83 2.83 010

55110 ............ A Explore scrotum ................................................. *5.70 3.48 3.48 0.37 9.55 9.55 090

55120 ............ A Removal of scrotum lesion ................................ *5.09 1.79 1.79 0.21 7.09 7.09 090

55150 ............ A Removal of scrotum ........................................... *7.22 5.45 5.45 0.57 13.24 13.24 090

55175 ............ A Revision of scrotum ........................................... *5.24 4.49 4.49 0.48 10.21 10.21 090

55180 ............ A Revision of scrotum ........................................... *10.72 6.83 6.83 0.82 18.37 18.37 090

55200 ............ A Incision of sperm duct ........................................ *4.24 1.97 1.97 0.20 6.41 6.41 090

55250 ............ A Removal of sperm duct(s) .................................. *3.29 2.63 2.63 0.28 6.20 6.20 090

55300 ............ A Preparation, sperm duct x-ray ........................... 3.51 2.71 2.71 0.27 6.49 6.49 000

55400 ............ A Repair of sperm duct ......................................... *8.49 6.56 6.56 0.62 15.67 15.67 090

55450 ............ A Ligation of sperm duct ....................................... *4.12 2.61 2.61 0.32 7.05 7.05 010

55500 ............ A Removal of hydrocele ........................................ *5.59 4.32 4.32 0.50 10.41 10.41 090

55520 ............ A Removal of sperm cord lesion ........................... *6.03 3.12 3.12 0.51 9.66 9.66 090

55530 ............ A Revise spermatic cord veins .............................. *5.66 5.20 5.20 0.60 11.46 11.46 090

55535 ............ A Revise spermatic cord veins .............................. *6.56 4.40 4.40 0.45 11.41 11.41 090

55540 ............ A Revise hernia & sperm veins ............................. *7.67 4.54 4.54 0.91 13.12 13.12 090

55600 ............ A Incise sperm duct pouch .................................... *6.38 4.31 4.31 0.55 11.24 11.24 090

55605 ............ A Incise sperm duct pouch .................................... *7.96 5.60 5.60 0.59 14.15 14.15 090

55650 ............ A Remove sperm duct pouch ................................ *11.80 7.22 7.22 0.76 19.78 19.78 090

55680 ............ A Remove sperm pouch lesion ............................. *5.19 4.43 4.43 0.38 10.00 10.00 090

55700 ............ A Biopsy of prostate .............................................. 1.57 1.50 1.50 0.15 3.22 3.22 000

55705 ............ A Biopsy of prostate .............................................. *4.57 3.37 3.37 0.34 8.28 8.28 010

55720 ............ A Drainage of prostate abscess ............................ *7.64 3.51 3.51 0.37 11.52 11.52 090

55725 ............ A Drainage of prostate abscess ............................ *8.68 5.62 5.62 0.54 14.84 14.84 090

55801 ............ A Removal of prostate ........................................... *17.80 12.76 12.76 1.44 32.00 32.00 090

55810 ............ A Extensive prostate surgery ................................ *22.58 17.88 17.88 1.77 42.23 42.23 090

55812 ............ A Extensive prostate surgery ................................ *27.51 17.68 17.68 1.94 47.13 47.13 090

55815 ............ A Extensive prostate surgery ................................ *30.46 25.20 25.20 2.42 58.08 58.08 090

55821 ............ A Removal of prostate ........................................... *14.25 13.59 13.59 1.35 29.19 29.19 090
59155

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

55831 ............ A Removal of prostate ........................................... *15.62 14.56 14.56 1.44 31.62 31.62 090

55840 ............ A Extensive prostate surgery ................................ *22.69 16.60 16.60 1.61 40.90 40.90 090

55842 ............ A Extensive prostate surgery ................................ *24.38 19.16 19.16 1.88 45.42 45.42 090

55845 ............ A Extensive prostate surgery ................................ *28.55 25.10 25.10 2.44 56.09 56.09 090

55859 ............ A Percut/needle insert, pros .................................. *12.52 5.89 5.89 0.58 18.99 18.99 090

55860 ............ A Surgical exposure, prostate ............................... *14.45 7.13 7.13 0.70 22.28 22.28 090

55862 ............ A Extensive prostate surgery ................................ *18.39 11.69 11.69 1.20 31.28 31.28 090

55865 ............ A Extensive prostate surgery ................................ *22.87 24.52 24.52 2.39 49.78 49.78 090

55870 ............ A Electroejaculation ............................................... 2.58 1.83 1.83 0.18 4.59 4.59 000

55899 ............ C Genital surgery procedure ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

55970 ............ N Sex transformation, M to F ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

55980 ............ N Sex transformation, F to M ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

56300 ............ A Laparoscopy; diagnostic .................................... *5.10 4.45 4.45 0.93 10.48 10.48 010

56301 ............ A Laparoscopy; tubal cautery ................................ *5.60 4.71 4.71 1.28 11.59 11.59 010

56302 ............ A Laparoscopy; tubal block ................................... *5.60 5.26 5.26 1.32 12.18 12.18 010

56303 ............ A Laparoscopy; excise lesions .............................. *11.79 5.53 5.53 1.16 18.48 18.48 090

56304 ............ A Laparoscopy; lysis .............................................. *11.29 5.60 5.60 1.20 18.09 18.09 090

56305 ............ A Laparoscopy; biopsy .......................................... *5.40 4.90 4.90 0.79 11.09 11.09 010

56306 ............ A Laparoscopy; aspiration ..................................... *5.70 4.87 4.87 1.18 11.75 11.75 010

56307 ............ A Laparoscopy; remove adnexa ............................ *11.05 7.16 7.16 1.60 19.81 19.81 010

56308 ............ A Laparoscopy; hysterectomy ............................... *14.19 9.39 9.39 2.07 25.65 25.65 010

56309 ............ A Laparoscopy; remove myoma ............................ *14.21 4.76 4.76 1.03 20.00 20.00 010

56310 ............ A Laparoscopic enterolysis .................................... *14.44 8.28 8.28 1.75 24.47 24.47 090

56311 ............ A Laparoscopic lymph node biop .......................... *9.25 6.38 6.38 1.47 17.10 17.10 010

56312 ............ A Laparoscopic lymphadenectomy ........................ *12.38 8.56 8.56 0.84 21.78 21.78 010

56313 ............ A Laparoscopic lymphadenectomy ........................ *14.32 10.01 10.01 2.31 26.64 26.64 010

56314 ............ A Lapar; drain lymphocele ..................................... *9.48 6.73 6.73 0.66 16.87 16.87 090

56315 ............ A Laparoscopic appendectomy ............................. *8.70 4.89 4.89 1.01 14.60 14.60 090

56316 ............ A Laparoscopic hernia repair ................................ *6.27 4.51 4.51 0.94 11.72 11.72 090

56317 ............ A Laparoscopic hernia repair ................................ *8.24 5.22 5.22 1.11 14.57 14.57 090

56318 ............ A Laparoscopic orchiectomy ................................. *10.96 7.23 7.23 0.81 19.00 19.00 090

56320 ............ A Laparoscopy, spermatic veins ........................... *6.57 4.40 4.40 0.45 11.42 11.42 090

56322 ............ A Laparoscopy, vagus nerves ............................... *10.15 5.07 5.07 1.18 16.40 16.40 090

56323 ............ A Laparoscopy, vagus nerves ............................... *12.15 6.09 6.09 1.41 19.65 19.65 090

56324 ............ A Laparoscopy, cholecystoenter ........................... *12.58 9.16 9.16 1.93 23.67 23.67 090

56340 ............ A Laparoscopic cholecystectomy .......................... *11.09 7.99 7.99 1.74 20.82 20.82 090

56341 ............ A Laparoscopic cholecystectomy .......................... *11.94 8.43 8.43 1.84 22.21 22.21 090

56342 ............ A Laparoscopic cholecystectomy .......................... *14.23 9.37 9.37 2.00 25.60 25.60 090

56343 ............ A Laparoscopic salpingostomy .............................. *13.74 5.28 5.28 1.11 20.13 20.13 090

56344 ............ A Laparoscopic fimbrioplasty ................................. *12.88 5.11 5.11 1.19 19.18 19.18 090

56345 ............ C Laparoscopic splenectomy ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

56346 ............ A Laparoscopic gastrostomy ................................. *7.73 6.19 6.19 1.19 15.11 15.11 090

56347 ............ C Laparoscopic jejunostomy .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

56348 ............ A Laparo; resect intestine ...................................... *22.04 13.25 13.25 2.78 38.07 38.07 090

56349 ............ A Laparoscopy; fundoplasty .................................. *17.25 11.88 11.88 2.53 31.66 31.66 090

56350 ............ A Hysteroscopy; diagnostic ................................... 3.33 1.99 1.99 0.44 5.76 5.76 000

56351 ............ A Hysteroscopy; biopsy ......................................... 4.75 1.99 1.99 0.44 7.18 7.18 000

56352 ............ A Hysteroscopy; lysis ............................................ 6.17 3.77 3.77 0.85 10.79 10.79 000

56353 ............ A Hysteroscopy; resect septum ............................. 7.00 3.77 3.77 0.85 11.62 11.62 000

56354 ............ A Hysteroscopy; remove myoma .......................... 10.00 4.93 4.93 1.30 16.23 16.23 000

56355 ............ A Hysteroscopy; remove impact ............................ 5.21 1.99 1.99 0.44 7.64 7.64 000

56356 ............ A Hysteroscopy; ablation ....................................... 6.17 4.39 4.39 1.49 12.05 12.05 000

56362 ............ A Laparoscopy w/cholangio ................................... 4.89 2.77 2.77 0.19 7.85 7.85 000

56363 ............ A Laparoscopy w/biopsy ........................................ 5.18 3.93 3.93 0.45 9.56 9.56 000

56399 ............ C Laparoscopy procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

56405 ............ A I & D of vulva/perineum ..................................... *1.44 0.76 0.76 0.15 2.35 2.35 010

56420 ............ A Drainage of gland abscess ................................ *1.39 0.80 0.80 0.13 2.32 2.32 010

56440 ............ A Surgery for vulva lesion ..................................... *2.84 2.63 2.63 0.52 5.99 5.99 010

56441 ............ A Lysis of labial lesion(s) ....................................... *1.97 1.65 1.65 0.30 3.92 3.92 010

56501 ............ A Destruction, vulva lesion(s) ................................ *1.53 0.54 0.54 0.11 2.18 2.18 010

56515 ............ A Destruction, vulva lesion(s) ................................ *1.88 2.36 #2.07 0.66 4.90 4.61 010

56605 ............ A Biopsy of vulva/perineum ................................... 1.10 0.68 0.68 0.15 1.93 1.93 000

56606 ............ A Biopsy of vulva/perineum ................................... 0.55 0.35 0.35 0.08 0.98 0.98 000

56620 ............ A Partial removal of vulva ..................................... *7.47 6.47 6.47 1.40 15.34 15.34 090

56625 ............ A Complete removal of vulva ................................ *8.40 #9.24 #9.24 2.13 19.77 19.77 090

56630 ............ A Extensive vulva surgery ..................................... *12.36 13.46 13.46 3.28 29.10 29.10 090

56631 ............ A Extensive vulva surgery ..................................... *16.20 #17.82 #17.82 4.51 38.53 38.53 090

56632 ............ A Extensive vulva surgery ..................................... *20.29 21.32 21.32 4.51 46.12 46.12 090

56633 ............ A Extensive vulva surgery ..................................... *16.47 15.97 15.97 3.28 35.72 35.72 090

56634 ............ A Extensive vulva surgery ..................................... *17.88 #19.67 #19.67 4.51 42.06 42.06 090

56637 ............ A Extensive vulva surgery ..................................... *21.97 21.42 21.42 4.51 47.90 47.90 090

56640 ............ A Extensive vulva surgery ..................................... *22.17 19.95 19.95 4.36 46.48 46.48 090

56700 ............ A Partial removal of hymen ................................... *2.52 1.82 1.82 0.35 4.69 4.69 010

56720 ............ A Incision of hymen ............................................... 0.68 0.48 0.48 0.11 1.27 1.27 000
59156

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

56740 ............ A Remove vagina gland lesion .............................. *3.76 2.87 2.87 0.55 7.18 7.18 010

56800 ............ A Repair of vagina ................................................. *3.89 2.92 2.92 0.57 7.38 7.38 010

56805 ............ A Repair clitoris ..................................................... *18.86 11.75 11.75 1.37 31.98 31.98 090

56810 ............ A Repair of perineum ............................................ *4.13 2.62 2.62 0.51 7.26 7.26 010

57000 ............ A Exploration of vagina ......................................... *2.97 2.03 2.03 0.35 5.35 5.35 010

57010 ............ A Drainage of pelvic abscess ................................ *6.03 2.65 2.65 0.51 9.19 9.19 090

57020 ............ A Drainage of pelvic fluid ...................................... 1.50 0.65 0.65 0.14 2.29 2.29 000

57061 ............ A Destruction vagina lesion(s) ............................... *1.25 0.82 0.82 0.17 2.24 2.24 010

57065 ............ A Destruction vagina lesion(s) ............................... *2.61 #2.87 #2.87 0.74 6.22 6.22 010

57100 ............ A Biopsy of vagina ................................................. 0.97 0.62 0.62 0.13 1.72 1.72 000

57105 ............ A Biopsy of vagina ................................................. *1.69 1.57 1.57 0.33 3.59 3.59 010

57108 ............ A Partial removal of vagina ................................... *6.36 5.28 5.28 1.10 12.74 12.74 090

57110 ............ A Removal of vagina ............................................. *14.29 7.88 7.88 1.76 23.93 23.93 090

57120 ............ A Closure of vagina ............................................... *7.41 6.99 6.99 1.51 15.91 15.91 090

57130 ............ A Remove vagina lesion ........................................ *2.43 2.62 2.62 0.55 5.60 5.60 010

57135 ............ A Remove vagina lesion ........................................ *2.67 1.93 1.93 0.38 4.98 4.98 010

57150 ............ A Treat vagina infection ......................................... 0.55 0.19 0.19 0.04 0.78 0.78 000

57160 ............ A Insertion of pessary/device ................................ 0.89 0.25 0.25 0.05 1.19 1.19 000

57170 ............ A Fitting of diaphragm/cap .................................... 0.91 0.32 0.32 0.06 1.29 1.29 000

57180 ............ A Treat vaginal bleeding ........................................ *1.58 0.55 0.55 0.11 2.24 2.24 010

57200 ............ A Repair of vagina ................................................. *3.94 2.71 2.71 0.60 7.25 7.25 090

57210 ............ A Repair vagina/perineum ..................................... *5.17 3.27 3.27 0.65 9.09 9.09 090

57220 ............ A Revision of urethra ............................................. *4.31 4.44 4.44 0.80 9.55 9.55 090

57230 ............ A Repair of urethral lesion ..................................... *5.64 3.84 3.84 0.64 10.12 10.12 090

57240 ............ A Repair bladder & vagina .................................... *6.07 #6.68 #6.68 1.60 14.35 14.35 090

57250 ............ A Repair rectum & vagina ..................................... *5.53 #6.08 #6.08 1.69 13.30 13.30 090

57260 ............ A Repair of vagina ................................................. *8.27 8.65 8.65 1.88 18.80 18.80 090

57265 ............ A Extensive repair of vagina ................................. *11.34 9.42 9.42 2.11 22.87 22.87 090

57268 ............ A Repair of bowel bulge ........................................ *6.76 7.02 7.02 1.50 15.28 15.28 090

57270 ............ A Repair of bowel pouch ....................................... *12.11 6.83 6.83 1.44 20.38 20.38 090

57280 ............ A Suspension of vagina ......................................... *15.04 8.53 8.53 1.85 25.42 25.42 090

57282 ............ A Repair of vaginal prolapse ................................. *8.86 8.72 8.72 1.89 19.47 19.47 090

57284 ............ A Repair paravaginal defect .................................. *12.70 8.59 8.59 0.84 22.13 22.13 090

57288 ............ A Repair bladder defect ......................................... *13.02 10.72 10.72 1.36 25.10 25.10 090

57289 ............ A Repair bladder & vagina .................................... *11.58 8.19 8.19 1.13 20.90 20.90 090

57291 ............ A Construction of vagina ....................................... *7.95 5.35 5.35 1.19 14.49 14.49 090

57292 ............ A Construct vagina with graft ................................ *13.09 6.55 6.55 1.38 21.02 21.02 090

57300 ............ A Repair rectum-vagina fistula .............................. *7.61 7.91 7.91 1.66 17.18 17.18 090

57305 ............ A Repair rectum-vagina fistula .............................. *13.77 7.55 7.55 1.56 22.88 22.88 090

57307 ............ A Fistula repair & colostomy ................................. *15.93 6.11 6.11 1.28 23.32 23.32 090

57308 ............ A Fistula repair, transperine .................................. *9.94 7.23 7.23 1.41 18.58 18.58 090

57310 ............ A Repair urethrovaginal lesion .............................. *6.78 4.32 4.32 0.48 11.58 11.58 090

57311 ............ A Repair urethrovaginal lesion .............................. *7.98 5.58 5.58 0.41 13.97 13.97 090

57320 ............ A Repair bladder-vagina lesion ............................. *8.01 #8.81 #8.81 1.35 18.17 18.17 090

57330 ............ A Repair bladder-vagina lesion ............................. *12.35 8.29 8.29 0.81 21.45 21.45 090

57335 ............ A Repair vagina ..................................................... *18.73 6.91 6.91 0.81 26.45 26.45 090

57400 ............ A Dilation of vagina ............................................... 2.27 0.33 0.33 0.06 2.66 2.66 000

57410 ............ A Pelvic examination ............................................. 1.75 0.36 0.36 0.05 2.16 2.16 000

57415 ............ A Removal vaginal foreign body ........................... *2.17 0.36 0.36 0.05 2.58 2.58 010

57452 ............ A Examination of vagina ........................................ 0.99 0.65 0.65 0.14 1.78 1.78 000

57454 ............ A Vagina examination & biopsy ............................ 1.27 1.21 1.21 0.26 2.74 2.74 000

57460 ............ A Cervix excision ................................................... 2.83 2.02 2.02 0.46 5.31 5.31 000

57500 ............ A Biopsy of cervix .................................................. 0.97 0.57 0.57 0.12 1.66 1.66 000

57505 ............ A Endocervical curettage ....................................... *1.14 0.63 0.63 0.13 1.90 1.90 010

57510 ............ A Cauterization of cervix ....................................... *1.90 0.52 0.52 0.09 2.51 2.51 010

57511 ............ A Cryocautery of cervix ......................................... *1.90 0.85 0.85 0.17 2.92 2.92 010

57513 ............ A Laser surgery of cervix ...................................... *1.90 #2.09 #2.09 0.67 4.66 4.66 010

57520 ............ A Conization of cervix ............................................ *4.04 3.45 3.45 0.73 8.22 8.22 090

57522 ............ A Conization of cervix ............................................ *3.36 3.45 3.45 0.73 7.54 7.54 090

57530 ............ A Removal of cervix .............................................. *4.79 3.61 3.61 0.78 9.18 9.18 090

57531 ............ A Removal of cervix, radical .................................. *22.04 17.77 17.77 3.87 43.68 43.68 090

57540 ............ A Removal of residual cervix ................................. *12.22 6.74 6.74 1.51 20.47 20.47 090

57545 ............ A Remove cervix, repair pelvis .............................. *13.03 4.58 4.58 1.03 18.64 18.64 090

57550 ............ A Removal of residual cervix ................................. *5.53 #6.08 #6.08 1.54 13.15 13.15 090

57555 ............ A Remove cervix, repair vagina ............................ *8.95 #9.85 #9.85 2.17 20.97 20.97 090

57556 ............ A Remove cervix, repair bowel ............................. *8.37 #9.21 #9.21 1.92 19.50 19.50 090

57700 ............ A Revision of cervix ............................................... *3.55 2.39 2.39 0.34 6.28 6.28 090

57720 ............ A Revision of cervix ............................................... *4.13 2.76 2.76 0.50 7.39 7.39 090

57800 ............ A Dilation of cervical canal .................................... 0.77 0.48 0.48 0.10 1.35 1.35 000

57820 ............ A D&c of residual cervix ........................................ *1.67 2.08 2.08 0.46 4.21 4.21 010

58100 ............ A Biopsy of uterus lining ........................................ 0.71 0.66 0.66 0.14 1.51 1.51 000

58120 ............ A Dilation and curettage (D&C) ............................. *3.27 2.70 2.70 0.56 6.53 6.53 010

58140 ............ A Removal of uterus lesion ................................... *14.60 8.33 8.33 1.71 24.64 24.64 090

58145 ............ A Removal of uterus lesion ................................... *8.04 8.24 8.24 1.54 17.82 17.82 090
59157

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

58150 ............ A Total hysterectomy ............................................. *15.24 9.57 9.57 2.08 26.89 26.89 090

58152 ............ A Total hysterectomy ............................................. *15.09 11.99 11.99 2.59 29.67 29.67 090

58180 ............ A Partial hysterectomy ........................................... *15.29 9.76 9.76 2.11 27.16 27.16 090

58200 ............ A Extensive hysterectomy ..................................... *21.59 12.98 12.98 2.80 37.37 37.37 090

58210 ............ A Extensive hysterectomy ..................................... *28.85 17.77 17.77 3.87 50.49 50.49 090

58240 ............ A Removal of pelvis contents ................................ *38.39 28.73 28.73 6.15 73.27 73.27 090

58260 ............ A Vaginal hysterectomy ......................................... *12.20 9.39 9.39 2.07 23.66 23.66 090

58262 ............ A Vaginal hysterectomy ......................................... *13.99 9.39 9.39 2.07 25.45 25.45 090

58263 ............ A Vaginal hysterectomy ......................................... *15.28 10.32 10.32 2.22 27.82 27.82 090

58267 ............ A Hysterectomy & vagina repair ............................ *15.00 11.53 11.53 2.46 28.99 28.99 090

58270 ............ A Hysterectomy & vagina repair ............................ *13.48 10.32 10.32 2.22 26.02 26.02 090

58275 ............ A Hysterectomy, revise vagina .............................. *14.98 11.02 11.02 2.32 28.32 28.32 090

58280 ............ A Hysterectomy, revise vagina .............................. *15.41 10.50 10.50 2.30 28.21 28.21 090

58285 ............ A Extensive hysterectomy ..................................... *18.57 11.60 11.60 2.70 32.87 32.87 090

58300 ............ N Insert intrauterine device .................................... +1.01 0.77 0.77 0.13 1.91 1.91 XXX

58301 ............ A Remove intrauterine device ............................... 1.27 0.45 0.45 0.08 1.80 1.80 000

58321 ............ A Artificial insemination ......................................... 0.92 0.71 0.71 0.15 1.78 1.78 000

58322 ............ A Artificial insemination ......................................... 1.10 0.71 0.71 0.15 1.96 1.96 000

58323 ............ A Sperm washing .................................................. 0.23 0.16 0.16 0.04 0.43 0.43 000

58340 ............ A Catheter for hysterography ................................ 0.88 0.57 0.57 0.08 1.53 1.53 000

58345 ............ A Reopen fallopian tube ........................................ *4.66 3.49 3.49 0.41 8.56 8.56 010

58350 ............ A Reopen fallopian tube ........................................ *1.01 0.69 0.69 0.16 1.86 1.86 010

58400 ............ A Suspension of uterus ......................................... *6.36 5.64 5.64 1.16 13.16 13.16 090

58410 ............ A Suspension of uterus ......................................... *12.73 5.53 5.53 0.84 19.10 19.10 090

58520 ............ A Repair of ruptured uterus ................................... *11.92 4.24 4.24 0.99 17.15 17.15 090

58540 ............ A Revision of uterus .............................................. *14.64 6.13 6.13 1.42 22.19 22.19 090

58600 ............ A Division of fallopian tube .................................... *3.84 #4.22 #4.22 1.38 9.44 9.44 090

58605 ............ A Division of fallopian tube .................................... *3.34 #3.67 #3.67 1.01 8.02 8.02 090

58611 ............ A Ligate oviduct(s) ................................................. 0.63 0.47 0.47 0.10 1.20 1.20 ZZZ

58615 ............ A Occlude fallopian tube(s) ................................... *3.90 2.91 2.91 0.35 7.16 7.16 010

58700 ............ A Removal of fallopian tube .................................. *6.49 6.33 6.33 1.31 14.13 14.13 090

58720 ............ A Removal of ovary/tube(s) ................................... *11.36 7.50 7.50 1.63 20.49 20.49 090

58740 ............ A Revise fallopian tube(s) ..................................... *5.83 #6.41 #6.41 1.88 14.12 14.12 090

58750 ............ A Repair oviduct .................................................... *14.84 6.31 6.31 1.46 22.61 22.61 090

58752 ............ A Revise ovarian tube(s) ....................................... *14.84 6.74 6.74 0.93 22.51 22.51 090

58760 ............ A Remove tubal obstruction .................................. *13.13 5.11 5.11 1.19 19.43 19.43 090

58770 ............ A Create new tubal opening .................................. *13.97 5.28 5.28 1.11 20.36 20.36 090

58800 ............ A Drainage of ovarian cyst(s) ................................ *4.14 2.68 2.68 0.53 7.35 7.35 090

58805 ............ A Drainage of ovarian cyst(s) ................................ *5.88 6.38 6.38 1.36 13.62 13.62 090

58820 ............ A Open drain ovary abscess ................................. *4.22 2.76 2.76 0.49 7.47 7.47 090

58822 ............ A Percut drain ovary abscess ............................... *10.13 3.55 3.55 0.81 14.49 14.49 090

58823 ............ A Percut drain pelvic abscess ............................... 3.38 2.56 2.56 0.30 6.24 6.24 000

58825 ............ A Transposition, ovary(s) ....................................... *6.13 4.03 4.03 0.93 11.09 11.09 090

58900 ............ A Biopsy of ovary(s) .............................................. *5.99 5.19 5.19 1.07 12.25 12.25 090

58920 ............ A Partial removal of ovary(s) ................................. *6.78 6.78 6.78 1.41 14.97 14.97 090

58925 ............ A Removal of ovarian cyst(s) ................................ *11.36 6.56 6.56 1.38 19.30 19.30 090

58940 ............ A Removal of ovary(s) ........................................... *7.29 6.49 6.49 1.33 15.11 15.11 090

58943 ............ A Removal of ovary(s) ........................................... *18.43 12.11 12.11 2.63 33.17 33.17 090

58950 ............ A Resect ovarian malignancy ................................ *15.27 11.24 11.24 2.38 28.89 28.89 090

58951 ............ A Resect ovarian malignancy ................................ *21.81 18.34 18.34 3.93 44.08 44.08 090

58952 ............ A Resect ovarian malignancy ................................ *25.01 18.11 18.11 3.92 47.04 47.04 090

58960 ............ A Exploration of abdomen ..................................... *14.65 12.98 12.98 2.95 30.58 30.58 090

58970 ............ A Retrieval of oocyte ............................................. 3.53 2.52 2.52 0.58 6.63 6.63 000

58974 ............ C Transfer of embryo ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 000

58976 ............ A Transfer of embryo ............................................. 3.83 2.73 2.73 0.63 7.19 7.19 000

58999 ............ C Genital surgery procedure ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

59000 ............ A Amniocentesis .................................................... 1.30 0.97 0.97 0.18 2.45 2.45 000

59012 ............ A Fetal cord puncture, prenatal ............................. 3.45 2.62 2.62 0.31 6.38 6.38 000

59015 ............ A Chorion biopsy ................................................... 2.20 1.20 1.20 0.10 3.50 3.50 000

59020 ............ A Fetal contract stress test .................................... 0.66 1.23 1.23 0.29 2.18 2.18 000

59020 TC A Fetal contract stress test .................................... 0.00 0.50 0.50 0.10 0.60 0.60 000

59020 26 A Fetal contract stress test .................................... 0.66 #0.73 #0.73 0.19 1.58 1.58 000

59025 ............ A Fetal non-stress test .......................................... 0.53 0.61 0.61 0.12 1.26 1.26 000

59025 TC A Fetal non-stress test .......................................... 0.00 0.22 0.22 0.04 0.26 0.26 000

59025 26 A Fetal non-stress test .......................................... 0.53 0.39 0.39 0.08 1.00 1.00 000

59030 ............ A Fetal scalp blood sample ................................... 1.99 1.58 1.58 0.21 3.78 3.78 000

59050 ............ A Fetal monitor w/report ........................................ 0.89 0.81 0.81 0.15 1.85 1.85 XXX

59051 ............ A Fetal monitor/interpret only ................................ 0.74 0.81 0.81 0.15 1.70 1.70 XXX

59100 ............ A Remove uterus lesion ........................................ *12.35 4.14 4.14 0.96 17.45 17.45 090

59120 ............ A Treat ectopic pregnancy .................................... *11.49 7.86 7.86 1.50 20.85 20.85 090

59121 ............ A Treat ectopic pregnancy .................................... *11.67 5.38 5.38 1.07 18.12 18.12 090

59130 ............ A Treat ectopic pregnancy .................................... *14.22 5.96 5.96 0.70 20.88 20.88 090

59135 ............ A Treat ectopic pregnancy .................................... *13.88 9.85 9.85 1.15 24.88 24.88 090

59136 ............ A Treat ectopic pregnancy .................................... *13.18 6.22 6.22 1.44 20.84 20.84 090
59158

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

59140 ............ A Treat ectopic pregnancy .................................... *5.46 4.66 4.66 0.29 10.41 10.41 090

59150 ............ A Treat ectopic pregnancy .................................... *6.89 4.53 4.53 1.05 12.47 12.47 090

59151 ............ A Treat ectopic pregnancy .................................... *7.86 8.61 8.61 0.64 17.11 17.11 090

59160 ............ A D&C after delivery .............................................. *2.71 2.93 2.93 0.52 6.16 6.16 010

59200 ............ A Insert cervical dilator .......................................... 0.79 0.54 0.54 0.11 1.44 1.44 000

59300 ............ A Episiotomy or vaginal repair .............................. 2.41 0.99 0.99 0.10 3.50 3.50 000

59320 ............ A Revision of cervix ............................................... 2.48 1.78 1.78 0.41 4.67 4.67 000

59325 ............ A Revision of cervix ............................................... 4.07 2.89 2.89 0.29 7.25 7.25 000

59350 ............ A Repair of uterus ................................................. 4.95 3.54 3.54 0.82 9.31 9.31 000

59400 ............ A Obstetrical care .................................................. 23.06 14.99 14.99 3.47 41.52 41.52 MMM

59409 ............ A Obstetrical care .................................................. 13.50 9.48 9.48 2.20 25.18 25.18 MMM

59410 ............ A Obstetrical care .................................................. 14.78 10.31 10.31 2.39 27.48 27.48 MMM

59412 ............ A Antepartum manipulation ................................... 1.71 1.22 1.22 0.29 3.22 3.22 MMM

59414 ............ A Deliver placenta ................................................. 1.61 1.15 1.15 0.27 3.03 3.03 MMM

59425 ............ A Antepartum care only ......................................... 4.81 2.88 2.88 0.66 8.35 8.35 MMM

59426 ............ A Antepartum care only ......................................... 8.28 4.94 4.94 1.14 14.36 14.36 MMM

59430 ............ A Care after delivery .............................................. 2.13 0.38 0.38 0.07 2.58 2.58 MMM

59510 ............ A Cesarean delivery .............................................. 26.22 16.90 16.90 3.92 47.04 47.04 MMM

59514 ............ A Cesarean delivery only ...................................... 15.97 10.99 10.99 2.55 29.51 29.51 MMM

59515 ............ A Cesarean delivery .............................................. 17.37 11.82 11.82 2.73 31.92 31.92 MMM

59525 ............ A Remove uterus after cesarean .......................... 8.54 3.81 3.81 0.88 13.23 13.23 MMM

59610 ............ A Vbac delivery ...................................................... 24.62 14.99 14.99 3.47 43.08 43.08 MMM

59612 ............ A Vbac delivery only .............................................. 15.06 9.48 9.48 2.20 26.74 26.74 MMM

59614 ............ A Vbac care after delivery ..................................... 16.34 10.31 10.31 2.39 29.04 29.04 MMM

59618 ............ A Attempted vbac delivery ..................................... 27.78 16.90 16.90 3.92 48.60 48.60 MMM

59620 ............ A Attempted vbac delivery only ............................. 17.53 10.99 10.99 2.55 31.07 31.07 MMM

59622 ............ A Attempted vbac after care .................................. 18.93 11.82 11.82 2.73 33.48 33.48 MMM

59812 ............ A Treatment of miscarriage ................................... *3.25 3.61 #3.58 0.77 7.63 7.60 090

59820 ............ A Care of miscarriage ............................................ *4.01 3.75 3.75 0.77 8.53 8.53 090

59821 ............ A Treatment of miscarriage ................................... *4.47 2.72 2.72 0.62 7.81 7.81 090

59830 ............ A Treat uterus infection ......................................... *6.11 4.53 4.53 0.52 11.16 11.16 090

59840 ............ A Abortion .............................................................. *3.01 3.22 3.22 0.69 6.92 6.92 010

59841 ............ A Abortion .............................................................. *5.24 3.75 3.75 0.76 9.75 9.75 010

59850 ............ A Abortion .............................................................. *5.91 4.00 4.00 0.85 10.76 10.76 090

59851 ............ A Abortion .............................................................. *5.93 4.28 4.28 0.88 11.09 11.09 090

59852 ............ A Abortion .............................................................. *8.24 5.51 5.51 1.27 15.02 15.02 090

59855 ............ A Abortion .............................................................. *6.12 4.14 4.14 0.96 11.22 11.22 090

59856 ............ A Abortion .............................................................. *7.48 5.11 5.11 1.19 13.78 13.78 090

59857 ............ A Abortion .............................................................. *9.29 6.22 6.22 1.44 16.95 16.95 090

59866 ............ A Abortion .............................................................. 4.00 2.86 2.86 0.66 7.52 7.52 000

59870 ............ A Evacuate mole of uterus .................................... *4.28 2.91 2.91 0.67 7.86 7.86 090

59871 ............ A Remove cerclage suture .................................... 2.13 1.78 1.78 0.41 4.32 4.32 000

59899 ............ C Maternity care procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

60000 ............ A Drain thyroid/tongue cyst ................................... *1.76 0.60 0.60 0.09 2.45 2.45 010

60001 ............ A Aspirate/inject thyriod cyst ................................. 0.97 1.05 1.05 0.12 2.14 2.14 000

60100 ............ A Biopsy of thyroid ................................................ 0.97 1.05 1.05 0.12 2.14 2.14 000

60200 ............ A Remove thyroid lesion ....................................... *9.55 6.02 6.02 1.04 16.61 16.61 090

60210 ............ A Partial excision thyroid ....................................... *10.88 8.68 8.68 1.65 21.21 21.21 090

60212 ............ A Parital thyroid excision ....................................... *16.03 9.04 9.04 1.74 26.81 26.81 090

60220 ............ A Partial removal of thyroid ................................... *10.53 8.54 8.54 1.61 20.68 20.68 090

60225 ............ A Partial removal of thyroid ................................... *14.19 10.49 10.49 1.92 26.60 26.60 090

60240 ............ A Removal of thyroid ............................................. *16.06 10.58 10.58 1.96 28.60 28.60 090

60252 ............ A Removal of thyroid ............................................. *18.20 13.65 13.65 2.55 34.40 34.40 090

60254 ............ A Extensive thyroid surgery ................................... *23.88 19.21 19.21 3.08 46.17 46.17 090

60260 ............ A Repeat thyroid surgery ....................................... *15.46 3.14 3.14 0.34 18.94 18.94 090

60270 ............ A Removal of thyroid ............................................. *17.94 13.97 13.97 2.54 34.45 34.45 090

60271 ............ A Removal of thyroid ............................................. *14.89 12.14 12.14 2.25 29.28 29.28 090

60280 ............ A Remove thyroid duct lesion ............................... *6.08 #6.69 #6.69 1.11 13.88 13.88 090

60281 ............ A Remove thyroid duct lesion ............................... *8.53 5.04 5.04 0.95 14.52 14.52 090

60500 ............ A Explore parathyroid glands ................................ *16.23 11.36 11.36 2.31 29.90 29.90 090

60502 ............ A Re-explore parathyroids ..................................... *20.35 11.39 11.39 2.33 34.07 34.07 090

60505 ............ A Explore parathyroid glands ................................ *21.49 13.14 13.14 2.56 37.19 37.19 090

60512 ............ A Autotransplant, parathyroid ................................ 4.45 2.32 2.32 0.54 7.31 7.31 ZZZ

60520 ............ A Removal of thymus gland .................................. *16.81 13.54 13.54 2.46 32.81 32.81 090

60521 ............ A Removal thymus gland ...................................... *18.87 13.54 13.54 2.46 34.87 34.87 090

60522 ............ A Removal of thymus gland .................................. *23.09 13.54 13.54 2.46 39.09 39.09 090

60540 ............ A Explore adrenal gland ........................................ *17.03 12.05 12.05 2.08 31.16 31.16 090

60545 ............ A Explore adrenal gland ........................................ *19.88 14.27 14.27 2.34 36.49 36.49 090

60600 ............ A Remove carotid body lesion .............................. *17.93 11.46 11.46 1.88 31.27 31.27 090

60605 ............ A Remove carotid body lesion .............................. *20.24 10.71 10.71 2.21 33.16 33.16 090

60699 ............ C Endocrine surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

61000 ............ A Remove cranial cavity fluid ................................ 1.58 1.07 1.07 0.17 2.82 2.82 000

61001 ............ A Remove cranial cavity fluid ................................ 1.49 0.88 0.88 0.17 2.54 2.54 000

61020 ............ A Remove brain cavity fluid ................................... 1.51 1.26 1.26 0.20 2.97 2.97 000
59159

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

61026 ............ A Injection into brain canal .................................... 1.69 #1.86 #1.86 0.22 3.77 3.77 000

61050 ............ A Remove brain canal fluid ................................... 1.51 1.23 1.23 0.15 2.89 2.89 000

61055 ............ A Injection into brain canal .................................... 2.10 1.88 1.88 0.19 4.17 4.17 000

61070 ............ A Brain canal shunt procedure .............................. 0.89 0.49 0.49 0.03 1.41 1.41 000

61105 ............ A Drill skull for examination ................................... *5.14 #5.65 #5.65 1.24 12.03 12.03 090

61106 ............ A Drill skull for exam/surgery ................................ 4.62 #5.08 #5.08 1.15 10.85 10.85 ZZZ

61107 ............ A Drill skull for implantation ................................... 5.00 #5.50 #5.50 1.26 11.76 11.76 000

61108 ............ A Drill skull for drainage ........................................ *10.19 #11.21 #11.21 2.22 23.62 23.62 090

61120 ............ A Pierce skull for examination ............................... *8.76 5.95 5.95 1.08 15.79 15.79 090

61130 ............ A Pierce skull, exam/surgery ................................. 6.37 4.95 4.95 0.96 12.28 12.28 ZZZ

61140 ............ A Pierce skull for biopsy ........................................ *15.90 14.13 14.13 2.56 32.59 32.59 090

61150 ............ A Pierce skull for drainage .................................... *17.57 14.65 14.65 2.63 34.85 34.85 090

61151 ............ A Pierce skull for drainage .................................... *12.42 2.13 2.13 0.37 14.92 14.92 090

61154 ............ A Pierce skull, remove clot .................................... *14.99 #16.49 #16.49 3.27 34.75 34.75 090

61156 ............ A Pierce skull for drainage .................................... *16.32 16.19 16.19 3.05 35.56 35.56 090

61210 ............ A Pierce skull; implant device ............................... 5.84 6.04 6.04 1.53 13.41 13.41 000

61215 ............ A Insert brain-fluid device ...................................... *4.89 #5.38 #5.38 1.63 11.90 11.90 090

61250 ............ A Pierce skull & explore ........................................ *10.42 8.03 8.03 1.44 19.89 19.89 090

61253 ............ A Pierce skull & explore ........................................ *12.36 9.62 9.62 1.69 23.67 23.67 090

61304 ............ A Open skull for exploration .................................. *21.96 #24.16 #24.16 4.78 50.90 50.90 090

61305 ............ A Open skull for exploration .................................. *26.61 29.11 29.11 5.05 60.77 60.77 090

61312 ............ A Open skull for drainage ...................................... *24.57 24.13 24.13 4.46 53.16 53.16 090

61313 ............ A Open skull for drainage ...................................... *24.93 24.04 24.04 4.38 53.35 53.35 090

61314 ............ A Open skull for drainage ...................................... *24.23 25.62 25.62 4.68 54.53 54.53 090

61315 ............ A Open skull for drainage ...................................... *27.68 24.41 24.41 4.47 56.56 56.56 090

61320 ............ A Open skull for drainage ...................................... *25.62 18.70 18.70 3.41 47.73 47.73 090

61321 ............ A Open skull for drainage ...................................... *28.50 19.83 19.83 3.54 51.87 51.87 090

61330 ............ A Decompress eye socket ..................................... *23.32 12.97 12.97 1.22 37.51 37.51 090

61332 ............ A Explore/biopsy eye socket ................................. *27.28 20.72 20.72 2.76 50.76 50.76 090

61333 ............ A Explore orbit; remove lesion .............................. *27.95 20.46 20.46 3.26 51.67 51.67 090

61334 ............ A Explore orbit; remove object .............................. *18.27 14.65 14.65 1.82 34.74 34.74 090

61340 ............ A Relieve cranial pressure .................................... *18.66 14.80 14.80 2.54 36.00 36.00 090

61343 ............ A Incise skull, pressure relief ................................ *29.77 30.05 30.05 5.28 65.10 65.10 090

61345 ............ A Relieve cranial pressure .................................... *27.20 19.18 19.18 3.45 49.83 49.83 090

61440 ............ A Incise skull for surgery ....................................... *26.63 20.75 20.75 3.00 50.38 50.38 090

61450 ............ A Incise skull for surgery ....................................... *25.95 20.43 20.43 3.43 49.81 49.81 090

61458 ............ A Incise skull for brain wound ............................... *27.29 27.28 27.28 4.87 59.44 59.44 090

61460 ............ A Incise skull for surgery ....................................... *28.39 25.05 25.05 3.98 57.42 57.42 090

61470 ............ A Incise skull for surgery ....................................... *26.06 13.86 13.86 2.53 42.45 42.45 090

61480 ............ A Incise skull for surgery ....................................... *26.49 15.07 15.07 1.78 43.34 43.34 090

61490 ............ A Incise skull for surgery ....................................... *25.66 11.72 11.72 2.16 39.54 39.54 090

61500 ............ A Removal of skull lesion ...................................... *17.92 #19.71 #19.71 3.58 41.21 41.21 090

61501 ............ A Remove infected skull bone ............................... *14.84 #16.32 #16.32 3.33 34.49 34.49 090

61510 ............ A Removal of brain lesion ..................................... *28.45 27.04 27.04 4.90 60.39 60.39 090

61512 ............ A Remove brain lining lesion ................................. *35.09 29.02 29.02 5.28 69.39 69.39 090

61514 ............ A Removal of brain abscess ................................. *25.26 25.52 25.52 4.74 55.52 55.52 090

61516 ............ A Removal of brain lesion ..................................... *24.61 26.48 26.48 4.57 55.66 55.66 090

61518 ............ A Removal of brain lesion ..................................... *37.32 30.02 30.02 5.46 72.80 72.80 090

61519 ............ A Remove brain lining lesion ................................. *41.39 31.22 31.22 5.77 78.38 78.38 090

61520 ............ A Removal of brain lesion ..................................... *54.84 33.85 33.85 5.89 94.58 94.58 090

61521 ............ A Removal of brain lesion ..................................... *44.48 32.97 32.97 5.85 83.30 83.30 090

61522 ............ A Removal of brain abscess ................................. *29.45 19.96 19.96 3.79 53.20 53.20 090

61524 ............ A Removal of brain lesion ..................................... *27.86 27.45 27.45 5.15 60.46 60.46 090

61526 ............ A Removal of brain lesion ..................................... *52.17 34.01 34.01 4.79 90.97 90.97 090

61530 ............ A Removal of brain lesion ..................................... *43.86 34.01 34.01 4.79 82.66 82.66 090

61531 ............ A Implant brain electrodes ..................................... *14.63 14.98 14.98 1.75 31.36 31.36 090

61533 ............ A Implant brain electrodes ..................................... *19.71 17.02 17.02 3.33 40.06 40.06 090

61534 ............ A Removal of brain lesion ..................................... *20.97 6.38 6.38 2.01 29.36 29.36 090

61535 ............ A Remove brain electrodes ................................... *11.63 7.66 7.66 1.25 20.54 20.54 090

61536 ............ A Removal of brain lesion ..................................... *35.52 21.96 21.96 3.99 61.47 61.47 090

61538 ............ A Removal of brain tissue ..................................... *26.81 29.08 29.08 4.97 60.86 60.86 090

61539 ............ A Removal of brain tissue ..................................... *32.08 22.96 22.96 4.07 59.11 59.11 090

61541 ............ A Incision of brain tissue ....................................... *28.85 19.80 19.80 3.78 52.43 52.43 090

61542 ............ A Removal of brain tissue ..................................... *31.02 19.91 19.91 3.90 54.83 54.83 090

61543 ............ A Removal of brain tissue ..................................... *29.22 17.24 17.24 2.49 48.95 48.95 090

61544 ............ A Remove & treat brain lesion .............................. *25.50 #28.05 #28.05 2.11 55.66 55.66 090

61545 ............ A Excision of brain tumor ...................................... *43.80 25.66 25.66 4.80 74.26 74.26 090

61546 ............ A Removal of pituitary gland ................................. *31.30 27.01 27.01 4.78 63.09 63.09 090

61548 ............ A Removal of pituitary gland ................................. *21.53 #23.68 #23.68 4.03 49.24 49.24 090

61550 ............ A Release of skull seams ...................................... *14.65 11.81 11.81 1.11 27.57 27.57 090

61552 ............ A Release of skull seams ...................................... *19.56 13.83 13.83 2.70 36.09 36.09 090

61556 ............ A Incise skull/sutures ............................................. *22.26 15.53 15.53 3.04 40.83 40.83 090

61557 ............ A Incise skull/sutures ............................................. *22.38 15.62 15.62 3.05 41.05 41.05 090

61558 ............ A Excision of skull/sutures ..................................... *25.58 17.74 17.74 3.47 46.79 46.79 090
59160

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

61559 ............ A Excision of skull/sutures ..................................... *32.79 23.01 23.01 4.50 60.30 60.30 090

61563 ............ A Excision of skull tumor ....................................... *26.83 18.81 18.81 3.68 49.32 49.32 090

61564 ............ A Excision of skull tumor ....................................... *33.83 23.73 23.73 4.64 62.20 62.20 090

61570 ............ A Remove brain foreign body ................................ *24.60 16.49 16.49 3.06 44.15 44.15 090

61571 ............ A Incise skull for brain wound ............................... *26.39 18.32 18.32 3.21 47.92 47.92 090

61575 ............ A Skull base/brainstem surgery ............................. *34.36 32.99 32.99 5.05 72.40 72.40 090

61576 ............ A Skull base/brainstem surgery ............................. *52.43 28.23 28.23 3.91 84.57 84.57 090

61580 ............ A Craniofacial approach, skull ............................... *30.35 21.01 21.01 4.10 55.46 55.46 090

61581 ............ A Craniofacial approach, skull ............................... *34.60 23.84 23.84 4.66 63.10 63.10 090

61582 ............ A Craniofacial approach, skull ............................... *31.66 21.65 21.65 4.22 57.53 57.53 090

61583 ............ A Craniofacial approach, skull ............................... *36.21 24.70 24.70 4.83 65.74 65.74 090

61584 ............ A Orbitocranial approach/skull ............................... *34.65 23.91 23.91 4.68 63.24 63.24 090

61585 ............ A Orbitocranial approach/skull ............................... *38.61 26.75 26.75 5.23 70.59 70.59 090

61586 ............ A Resect nasopharynx, skull ................................. *25.10 21.38 21.38 2.32 48.80 48.80 090

61590 ............ A Infratemporal approach/skull .............................. *41.78 29.10 29.10 5.68 76.56 76.56 090

61591 ............ A Infratemporal approach/skull .............................. *43.68 30.52 30.52 5.96 80.16 80.16 090

61592 ............ A Orbitocranial approach/skull ............................... *39.64 27.68 27.68 5.41 72.73 72.73 090

61595 ............ A Transtemporal approach/skull ............................ *29.57 20.44 20.44 4.00 54.01 54.01 090

61596 ............ A Transcochlear approach/skull ............................ *35.63 24.84 24.84 4.86 65.33 65.33 090

61597 ............ A Transcondylar approach/skull ............................ *37.96 26.26 26.26 5.13 69.35 69.35 090

61598 ............ A Transpetrosal approach/skull ............................. *33.41 23.13 23.13 4.52 61.06 61.06 090

61600 ............ A Resect/excise cranial lesion ............................... *25.85 17.74 17.74 3.46 47.05 47.05 090

61601 ............ A Resect/excise cranial lesion ............................... *27.89 19.03 19.03 3.72 50.64 50.64 090

61605 ............ A Resect/excise cranial lesion ............................... *29.33 20.09 20.09 3.93 53.35 53.35 090

61606 ............ A Resect/excise cranial lesion ............................... *38.83 26.90 26.90 5.25 70.98 70.98 090

61607 ............ A Resect/excise cranial lesion ............................... *36.27 25.13 25.13 4.91 66.31 66.31 090

61608 ............ A Resect/excise cranial lesion ............................... *42.10 29.24 29.24 5.71 77.05 77.05 090

61609 ............ A Transect, artery, sinus ....................................... 9.89 7.19 7.19 1.40 18.48 18.48 ZZZ

61610 ............ A Transect, artery, sinus ....................................... 29.67 21.57 21.57 4.21 55.45 55.45 ZZZ

61611 ............ A Transect, artery, sinus ....................................... 7.42 5.39 5.39 1.06 13.87 13.87 ZZZ

61612 ............ A Transect, artery, sinus ....................................... 27.88 20.27 20.27 3.96 52.11 52.11 ZZZ

61613 ............ A Remove aneurysm, sinus .................................. *40.86 28.67 28.67 5.61 75.14 75.14 090

61615 ............ A Resect/excise lesion, skull ................................. *32.07 22.07 22.07 4.31 58.45 58.45 090

61616 ............ A Resect/excise lesion, skull ................................. *43.33 30.03 30.03 5.86 79.22 79.22 090

61618 ............ A Repair dura ........................................................ *16.99 11.35 11.35 2.22 30.56 30.56 090

61619 ............ A Repair dura ........................................................ *20.71 14.19 14.19 2.77 37.67 37.67 090

61624 ............ A Occlusion/embolization cath .............................. 20.15 15.28 15.28 1.79 37.22 37.22 000

61626 ............ A Occlusion/embolization cath .............................. 16.62 12.60 12.60 1.47 30.69 30.69 000

61680 ............ A Intracranial vessel surgery ................................. *30.71 31.06 31.06 5.79 67.56 67.56 090

61682 ............ A Intracranial vessel surgery ................................. *61.57 35.31 35.31 6.36 103.24 103.24 090

61684 ............ A Intracranial vessel surgery ................................. *39.81 29.76 29.76 3.47 73.04 73.04 090

61686 ............ A Intracranial vessel surgery ................................. *64.49 35.98 35.98 4.20 104.67 104.67 090

61690 ............ A Intracranial vessel surgery ................................. *29.31 27.46 27.46 4.09 60.86 60.86 090

61692 ............ A Intracranial vessel surgery ................................. *51.87 28.79 28.79 3.36 84.02 84.02 090

61700 ............ A Inner skull vessel surgery .................................. *50.52 31.69 31.69 5.67 87.88 87.88 090

61702 ............ A Inner skull vessel surgery .................................. *48.41 36.31 36.31 6.61 91.33 91.33 090

61703 ............ A Clamp neck artery .............................................. *17.47 12.21 12.21 2.24 31.92 31.92 090

61705 ............ A Revise circulation to head .................................. *36.20 30.41 30.41 5.25 71.86 71.86 090

61708 ............ A Revise circulation to head .................................. *35.30 25.20 25.20 2.32 62.82 62.82 090

61710 ............ A Revise circulation to head .................................. *29.67 16.63 16.63 1.75 48.05 48.05 090

61711 ............ A Fusion of skull arteries ....................................... *36.33 33.04 33.04 6.20 75.57 75.57 090

61712 ............ A Skull or spine microsurgery ............................... 3.49 #3.84 #3.84 0.93 8.26 8.26 ZZZ

61720 ............ A Incise skull/brain surgery ................................... *16.77 #18.45 #18.45 4.05 39.27 39.27 090

61735 ............ A Incise skull/brain surgery ................................... *20.43 12.96 12.96 1.51 34.90 34.90 090

61750 ............ A Incise skull; brain biopsy .................................... *18.20 13.54 13.54 4.31 36.05 36.05 090

61751 ............ A Brain biopsy with cat scan ................................. *17.62 #19.38 #19.38 4.44 41.44 41.44 090

61760 ............ A Implant brain electrodes ..................................... *22.27 14.98 14.98 1.75 39.00 39.00 090

61770 ............ A Incise skull for treatment .................................... *21.44 19.38 19.38 3.43 44.25 44.25 090

61790 ............ A Treat trigeminal nerve ........................................ *10.86 #11.95 #11.95 3.03 25.84 25.84 090

61791 ............ A Treat trigeminal tract .......................................... *14.61 9.77 9.77 3.16 27.54 27.54 090

61793 ............ A Focus radiation beam ........................................ *17.24 #18.96 #18.96 1.96 38.16 38.16 090

61795 ............ A Brain surgery using computer ............................ 4.04 #4.44 #4.44 1.55 10.03 10.03 000

61850 ............ A Implant neuroelectrodes ..................................... *12.39 11.63 11.63 2.26 26.28 26.28 090

61855 ............ A Implant neuroelectrodes ..................................... *13.39 10.39 10.39 1.47 25.25 25.25 090

61860 ............ A Implant neuroelectrodes ..................................... *20.87 8.14 8.14 1.59 30.60 30.60 090

61865 ............ A Implant neuroelectrodes ..................................... *22.97 15.78 15.78 3.09 41.84 41.84 090

61870 ............ A Implant neuroelectrodes ..................................... *14.94 4.19 4.19 0.82 19.95 19.95 090

61875 ............ A Implant neuroelectrodes ..................................... *15.06 6.69 6.69 1.31 23.06 23.06 090

61880 ............ A Revise/remove neuroelectrode .......................... *6.29 4.79 4.79 0.66 11.74 11.74 090

61885 ............ A Implant neuroreceiver ........................................ *5.85 1.96 1.96 0.29 8.10 8.10 090

61888 ............ A Revise/remove neuroreceiver ............................ *5.07 2.25 2.25 0.44 7.76 7.76 010

62000 ............ A Repair of skull fracture ....................................... *12.53 5.73 5.73 0.95 19.21 19.21 090

62005 ............ A Repair of skull fracture ....................................... *16.17 11.08 11.08 1.97 29.22 29.22 090

62010 ............ A Treatment of head injury .................................... *19.81 19.20 19.20 3.39 42.40 42.40 090
59161

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

62100 ............ A Repair brain fluid leakage .................................. *22.03 21.62 21.62 3.72 47.37 47.37 090

62115 ............ A Reduction of skull defect .................................... *21.66 15.51 15.51 1.82 38.99 38.99 090

62116 ............ A Reduction of skull defect .................................... *23.59 16.98 16.98 1.99 42.56 42.56 090

62117 ............ A Reduction of skull defect .................................... *26.60 19.20 19.20 2.25 48.05 48.05 090

62120 ............ A Repair skull cavity lesion ................................... *23.35 16.90 16.90 1.98 42.23 42.23 090

62121 ............ A Incise skull repair ............................................... *21.58 17.51 17.51 3.41 42.50 42.50 090

62140 ............ A Repair of skull defect ......................................... *13.51 13.43 13.43 2.39 29.33 29.33 090

62141 ............ A Repair of skull defect ......................................... *14.91 #16.40 #16.40 3.28 34.59 34.59 090

62142 ............ A Remove skull plate/flap ...................................... *10.79 #11.87 #11.87 2.64 25.30 25.30 090

62143 ............ A Replace skull plate/flap ...................................... *13.05 9.17 9.17 1.65 23.87 23.87 090

62145 ............ A Repair of skull & brain ....................................... *18.82 13.16 13.16 2.29 34.27 34.27 090

62146 ............ A Repair of skull with graft .................................... *16.12 10.99 10.99 2.15 29.26 29.26 090

62147 ............ A Repair of skull with graft .................................... *19.34 13.17 13.17 2.57 35.08 35.08 090

62180 ............ A Establish brain cavity shunt ............................... *21.06 14.21 14.21 2.70 37.97 37.97 090

62190 ............ A Establish brain cavity shunt ............................... *11.07 #12.18 #12.18 3.21 26.46 26.46 090

62192 ............ A Establish brain cavity shunt ............................... *12.25 #13.48 #13.48 2.74 28.47 28.47 090

62194 ............ A Replace/irrigate catheter .................................... *5.03 1.88 1.88 0.29 7.20 7.20 010

62200 ............ A Establish brain cavity shunt ............................... *18.32 16.95 16.95 3.09 38.36 38.36 090

62201 ............ A Establish brain cavity shunt ............................... *14.86 8.78 8.78 1.72 25.36 25.36 090

62220 ............ A Establish brain cavity shunt ............................... *13.00 #14.30 #14.30 3.12 30.42 30.42 090

62223 ............ A Establish brain cavity shunt ............................... *12.87 #14.16 #14.16 3.02 30.05 30.05 090

62225 ............ A Replace/irrigate catheter .................................... *5.41 4.80 4.80 0.58 10.79 10.79 090

62230 ............ A Replace/revise brain shunt ................................ *10.54 9.83 9.83 1.82 22.19 22.19 090

62256 ............ A Remove brain cavity shunt ................................ *6.60 6.38 6.38 1.17 14.15 14.15 090

62258 ............ A Replace brain cavity shunt ................................. *14.54 14.78 14.78 2.55 31.87 31.87 090

62268 ............ A Drain spinal cord cyst ........................................ 4.74 2.98 2.98 0.36 8.08 8.08 000

62269 ............ A Needle biopsy spinal cord .................................. 5.02 1.75 1.75 0.28 7.05 7.05 000

62270 ............ A Spinal fluid tap, diagnostic ................................. 1.13 0.71 0.71 0.06 1.90 1.90 000

62272 ............ A Drain spinal fluid ................................................ 1.35 1.01 1.01 0.12 2.48 2.48 000

62273 ............ A Treat lumbar spine lesion .................................. 2.15 1.12 1.12 0.26 3.53 3.53 000

62274 ............ A Inject spinal anesthetic ....................................... 1.78 0.74 0.74 0.17 2.69 2.69 000

62275 ............ A Inject spinal anesthetic ....................................... 1.79 0.59 0.59 0.19 2.57 2.57 000

62276 ............ A Inject spinal anesthetic ....................................... 2.04 1.23 1.23 0.23 3.50 3.50 000

62277 ............ A Inject spinal anesthetic ....................................... 2.15 0.84 0.84 0.23 3.22 3.22 000

62278 ............ A Inject spinal anesthetic ....................................... 1.51 0.98 0.98 0.26 2.75 2.75 000

62279 ............ A Inject spinal anesthetic ....................................... 1.58 0.82 0.82 0.24 2.64 2.64 000

62280 ............ A Treat spinal cord lesion ...................................... *2.63 0.71 0.71 0.14 3.48 3.48 010

62281 ............ A Treat spinal cord lesion ...................................... *2.66 0.87 0.87 0.28 3.81 3.81 010

62282 ............ A Treat spinal canal lesion .................................... *2.33 1.70 1.70 0.40 4.43 4.43 010

62284 ............ A Injection for myelogram ...................................... 1.54 1.98 #1.69 0.34 3.86 3.57 000

62287 ............ A Percutaneous diskectomy .................................. *8.08 6.96 6.96 2.65 17.69 17.69 090

62288 ............ A Injection into spinal canal ................................... 1.74 1.12 1.12 0.24 3.10 3.10 000

62289 ............ A Injection into spinal canal ................................... 1.64 1.07 1.07 0.29 3.00 3.00 000

62290 ............ A Inject for spine disk x-ray ................................... 3.00 1.86 1.86 0.24 5.10 5.10 000

62291 ............ A Inject for spine disk x-ray ................................... 2.91 1.78 1.78 0.39 5.08 5.08 000

62292 ............ A Injection into disk lesion ..................................... *7.86 #8.65 #8.65 2.13 18.64 18.64 090

62294 ............ A Injection into spinal artery .................................. *11.83 5.84 5.84 0.68 18.35 18.35 090

62298 ............ A Injection into spinal canal ................................... 2.20 1.04 1.04 0.13 3.37 3.37 000

62350 ............ A Implant spinal catheter ....................................... *6.87 3.49 3.49 1.02 11.38 11.38 090

62351 ............ A Implant spinal catheter ....................................... *10.00 5.16 5.16 1.50 16.66 16.66 090

62355 ............ A Remove spinal canal catheter ........................... *5.45 3.49 3.49 0.68 9.62 9.62 090

62360 ............ A Insert spine infusion device ............................... *2.62 1.12 1.12 0.33 4.07 4.07 090

62361 ............ A Implant spine infusion pump .............................. *5.42 2.68 2.68 0.78 8.88 8.88 090

62362 ............ A Implant spine infusion pump .............................. *7.04 3.51 3.51 1.02 11.57 11.57 090

62365 ............ A Remove spine infusion device ........................... *5.42 3.47 3.47 0.68 9.57 9.57 090

62367 ............ C Analyze spine infusion pump ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

62367 TC C Analyze spine infusion pump ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

62367 26 A Analyze spine infusion pump ............................. 0.48 0.35 0.35 0.07 0.90 0.90 XXX

62368 ............ C Analyze spine infusion pump ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

62368 TC C Analyze spine infusion pump ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

62368 26 A Analyze spine infusion pump ............................. 0.75 0.55 0.55 0.11 1.41 1.41 XXX

63001 ............ A Removal of spinal lamina ................................... *15.82 #17.40 #17.40 3.42 36.64 36.64 090

63003 ............ A Removal of spinal lamina ................................... *15.95 #17.55 #17.55 3.23 36.73 36.73 090

63005 ............ A Removal of spinal lamina ................................... *14.92 #16.41 #16.41 3.10 34.43 34.43 090

63011 ............ A Removal of spinal lamina ................................... *14.52 9.99 9.99 1.87 26.38 26.38 090

63012 ............ A Removal of spinal lamina ................................... *15.40 #16.94 #16.94 3.15 35.49 35.49 090

63015 ............ A Removal of spinal lamina ................................... *19.35 21.23 21.23 4.18 44.76 44.76 090

63016 ............ A Removal of spinal lamina ................................... *19.20 #21.12 #21.12 4.11 44.43 44.43 090

63017 ............ A Removal of spinal lamina ................................... *15.94 #17.53 #17.53 4.00 37.47 37.47 090

63020 ............ A Neck spine disk surgery ..................................... *14.81 16.04 16.04 3.38 34.23 34.23 090

63030 ............ A Low back disk surgery ....................................... *12.00 #13.20 #13.20 2.81 28.01 28.01 090

63035 ............ A Added spinal disk surgery .................................. 3.15 #3.47 #3.47 0.76 7.38 7.38 ZZZ

63040 ............ A Neck spine disk surgery ..................................... *18.81 #20.69 #20.69 4.30 43.80 43.80 090

63042 ............ A Low back disk surgery ....................................... *17.47 #19.22 #19.22 4.38 41.07 41.07 090
59162

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

63045 ............ A Removal of spinal lamina ................................... *16.50 #18.15 #18.15 4.38 39.03 39.03 090

63046 ............ A Removal of spinal lamina ................................... *15.80 #17.38 #17.38 4.58 37.76 37.76 090

63047 ............ A Removal of spinal lamina ................................... *14.61 #16.07 #16.07 4.48 35.16 35.16 090

63048 ............ A Removal of spinal lamina ................................... 3.26 #3.59 #3.59 1.03 7.88 7.88 ZZZ

63055 ............ A Decompress spinal cord .................................... *21.99 23.73 23.73 4.18 49.90 49.90 090

63056 ............ A Decompress spinal cord .................................... *20.36 21.84 21.84 3.76 45.96 45.96 090

63057 ............ A Decompress spinal cord .................................... 5.26 3.84 3.84 0.85 9.95 9.95 ZZZ

63064 ............ A Decompress spinal cord .................................... *24.61 23.83 23.83 4.09 52.53 52.53 090

63066 ............ A Decompress spinal cord .................................... 3.26 2.48 2.48 0.45 6.19 6.19 ZZZ

63075 ............ A Neck spine disk surgery ..................................... *19.41 17.57 17.57 3.21 40.19 40.19 090

63076 ............ A Neck spine disk surgery ..................................... 4.05 #4.46 #4.46 0.97 9.48 9.48 ZZZ

63077 ............ A Spine disk surgery, thorax ................................. *21.44 18.42 18.42 3.17 43.03 43.03 090

63078 ............ A Spine disk surgery, thorax ................................. 3.28 2.61 2.61 0.45 6.34 6.34 ZZZ

63081 ............ A Removal of vertebral body ................................. *23.73 #26.10 #26.10 4.50 54.33 54.33 090

63082 ............ A Removal of vertebral body ................................. 4.37 #4.81 #4.81 1.22 10.40 10.40 ZZZ

63085 ............ A Removal of vertebral body ................................. *26.92 27.39 27.39 4.69 59.00 59.00 090

63086 ............ A Removal of vertebral body ................................. 3.19 #3.51 #3.51 1.07 7.77 7.77 ZZZ

63087 ............ A Removal of vertebral body ................................. *35.57 28.25 28.25 4.85 68.67 68.67 090

63088 ............ A Removal of vertebral body ................................. 4.33 #4.76 #4.76 1.18 10.27 10.27 ZZZ

63090 ............ A Removal of vertebral body ................................. *28.16 29.22 29.22 4.92 62.30 62.30 090

63091 ............ A Removal of vertebral body ................................. 3.03 2.73 2.73 0.46 6.22 6.22 ZZZ

63170 ............ A Incise spinal cord tract(s) ................................... *19.83 18.88 18.88 3.28 41.99 41.99 090

63172 ............ A Drainage of spinal cyst ...................................... *17.66 #19.43 #19.43 4.26 41.35 41.35 090

63173 ............ A Drainage of spinal cyst ...................................... *21.99 15.47 15.47 1.81 39.27 39.27 090

63180 ............ A Revise spinal cord ligaments ............................. *18.27 11.61 11.61 2.05 31.93 31.93 090

63182 ............ A Revise spinal cord ligaments ............................. *20.50 16.44 16.44 2.21 39.15 39.15 090

63185 ............ A Incise spinal column/nerves ............................... *15.04 15.55 15.55 2.93 33.52 33.52 090

63190 ............ A Incise spinal column/nerves ............................... *17.45 #19.20 #19.20 3.91 40.56 40.56 090

63191 ............ A Incise spinal column/nerves ............................... *17.54 13.04 13.04 2.21 32.79 32.79 090

63194 ............ A Incise spinal column & cord ............................... *19.19 13.02 13.02 2.33 34.54 34.54 090

63195 ............ A Incise spinal column & cord ............................... *18.84 13.86 13.86 2.11 34.81 34.81 090

63196 ............ A Incise spinal column & cord ............................... *22.30 15.59 15.59 1.83 39.72 39.72 090

63197 ............ A Incise spinal column & cord ............................... *21.11 14.36 14.36 2.62 38.09 38.09 090

63198 ............ A Incise spinal column & cord ............................... *25.38 16.32 16.32 3.19 44.89 44.89 090

63199 ............ A Incise spinal column & cord ............................... *26.89 21.40 21.40 2.61 50.90 50.90 090

63200 ............ A Release of spinal cord ....................................... *19.18 12.49 12.49 1.83 33.50 33.50 090

63250 ............ A Revise spinal cord vessels ................................ *40.76 27.99 27.99 5.22 73.97 73.97 090

63251 ............ A Revise spinal cord vessels ................................ *41.20 22.74 22.74 4.32 68.26 68.26 090

63252 ............ A Revise spinal cord vessels ................................ *41.19 28.25 28.25 5.52 74.96 74.96 090

63265 ............ A Excise intraspinal lesion ..................................... *21.56 22.01 22.01 3.90 47.47 47.47 090

63266 ............ A Excise intraspinal lesion ..................................... *22.30 #24.53 #24.53 4.43 51.26 51.26 090

63267 ............ A Excise intraspinal lesion ..................................... *17.95 #19.75 #19.75 4.20 41.90 41.90 090

63268 ............ A Excise intraspinal lesion ..................................... *18.52 12.56 12.56 2.46 33.54 33.54 090

63270 ............ A Excise intraspinal lesion ..................................... *26.80 18.14 18.14 3.42 48.36 48.36 090

63271 ............ A Excise intraspinal lesion ..................................... *26.92 26.60 26.60 4.79 58.31 58.31 090

63272 ............ A Excise intraspinal lesion ..................................... *25.32 23.15 23.15 4.26 52.73 52.73 090

63273 ............ A Excise intraspinal lesion ..................................... *24.29 17.56 17.56 3.12 44.97 44.97 090

63275 ............ A Biopsy/excise spinal tumor ................................ *23.68 #26.05 #26.05 5.09 54.82 54.82 090

63276 ............ A Biopsy/excise spinal tumor ................................ *23.45 25.31 25.31 4.62 53.38 53.38 090

63277 ............ A Biopsy/excise spinal tumor ................................ *20.83 #22.91 #22.91 4.25 47.99 47.99 090

63278 ............ A Biopsy/excise spinal tumor ................................ *20.56 #22.62 #22.62 4.32 47.50 47.50 090

63280 ............ A Biopsy/excise spinal tumor ................................ *28.35 28.08 28.08 4.99 61.42 61.42 090

63281 ............ A Biopsy/excise spinal tumor ................................ *28.05 27.67 27.67 4.96 60.68 60.68 090

63282 ............ A Biopsy/excise spinal tumor ................................ *26.39 24.11 24.11 4.44 54.94 54.94 090

63283 ............ A Biopsy/excise spinal tumor ................................ *25.00 18.77 18.77 3.44 47.21 47.21 090

63285 ............ A Biopsy/excise spinal tumor ................................ *36.00 24.49 24.49 4.49 64.98 64.98 090

63286 ............ A Biopsy/excise spinal tumor ................................ *35.63 28.76 28.76 4.92 69.31 69.31 090

63287 ............ A Biopsy/excise spinal tumor ................................ *36.70 25.72 25.72 4.53 66.95 66.95 090

63290 ............ A Biopsy/excise spinal tumor ................................ *37.38 27.16 27.16 4.65 69.19 69.19 090

63300 ............ A Removal of vertebral body ................................. *24.43 17.27 17.27 2.02 43.72 43.72 090

63301 ............ A Removal of vertebral body ................................. *27.60 18.45 18.45 3.58 49.63 49.63 090

63302 ............ A Removal of vertebral body ................................. *27.81 21.36 21.36 3.02 52.19 52.19 090

63303 ............ A Removal of vertebral body ................................. *30.50 18.50 18.50 3.39 52.39 52.39 090

63304 ............ A Removal of vertebral body ................................. *30.33 21.31 21.31 2.49 54.13 54.13 090

63305 ............ A Removal of vertebral body ................................. *32.03 22.49 22.49 3.75 58.27 58.27 090

63306 ............ A Removal of vertebral body ................................. *32.22 22.76 22.76 2.65 57.63 57.63 090

63307 ............ A Removal of vertebral body ................................. *31.63 24.42 24.42 2.98 59.03 59.03 090

63308 ............ A Removal of vertebral body ................................. 5.25 4.05 4.05 0.73 10.03 10.03 ZZZ

63600 ............ A Remove spinal cord lesion ................................. *14.02 10.70 10.70 2.63 27.35 27.35 090

63610 ............ A Stimulation of spinal cord ................................... 8.73 6.73 6.73 2.06 17.52 17.52 000

63615 ............ A Remove lesion of spinal cord ............................ *16.28 11.55 11.55 2.03 29.86 29.86 090

63650 ............ A Implant neuroelectrodes ..................................... *6.74 #7.41 #7.41 2.13 16.28 16.28 090

63655 ............ A Implant neuroelectrodes ..................................... *10.29 #11.32 #11.32 3.64 25.25 25.25 090

63660 ............ A Revise/remove neuroelectrode .......................... *6.16 #6.78 #6.78 1.56 14.50 14.50 090
59163

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

63685 ............ A Implant neuroreceiver ........................................ *7.04 7.40 7.40 1.46 15.90 15.90 090

63688 ............ A Revise/remove neuroreceiver ............................ *5.39 #5.93 #5.93 1.26 12.58 12.58 090

63690 ............ A Analysis of neuroreceiver ................................... 0.45 0.58 #0.50 0.12 1.15 1.07 XXX

63691 ............ A Analysis of neuroreceiver ................................... 0.65 0.41 0.41 0.11 1.17 1.17 XXX

63700 ............ A Repair of spinal herniation ................................. *16.53 11.35 11.35 2.22 30.10 30.10 090

63702 ............ A Repair of spinal herniation ................................. *18.48 12.78 12.78 2.49 33.75 33.75 090

63704 ............ A Repair of spinal herniation ................................. *21.18 14.19 14.19 2.77 38.14 38.14 090

63706 ............ A Repair of spinal herniation ................................. *24.11 16.33 16.33 3.18 43.62 43.62 090

63707 ............ A Repair spinal fluid leakage ................................. *11.26 #12.39 #12.39 2.56 26.21 26.21 090

63709 ............ A Repair spinal fluid leakage ................................. *14.32 #15.75 #15.75 3.30 33.37 33.37 090

63710 ............ A Graft repair of spine defect ................................ *14.07 9.75 9.75 1.58 25.40 25.40 090

63740 ............ A Install spinal shunt ............................................. *11.36 #12.50 #12.50 2.99 26.85 26.85 090

63741 ............ A Install spinal shunt ............................................. *8.25 #9.08 #9.08 2.39 19.72 19.72 090

63744 ............ A Revision of spinal shunt ..................................... *8.10 8.15 8.15 1.68 17.93 17.93 090

63746 ............ A Removal of spinal shunt .................................... *6.43 5.52 5.52 1.08 13.03 13.03 090

64400 ............ A Injection for nerve block ..................................... 1.11 0.48 0.48 0.05 1.64 1.64 000

64402 ............ A Injection for nerve block ..................................... 1.25 0.62 0.62 0.09 1.96 1.96 000

64405 ............ A Injection for nerve block ..................................... 1.32 0.64 0.64 0.07 2.03 2.03 000

64408 ............ A Injection for nerve block ..................................... 1.41 1.04 1.04 0.11 2.56 2.56 000

64410 ............ A Injection for nerve block ..................................... 1.43 0.71 0.71 0.15 2.29 2.29 000

64412 ............ A Injection for nerve block ..................................... 1.18 0.62 0.62 0.08 1.88 1.88 000

64413 ............ A Injection for nerve block ..................................... 1.40 0.74 0.74 0.08 2.22 2.22 000

64415 ............ A Injection for nerve block ..................................... 1.48 0.26 0.26 0.07 1.81 1.81 000

64417 ............ A Injection for nerve block ..................................... 1.44 0.63 0.63 0.15 2.22 2.22 000

64418 ............ A Injection for nerve block ..................................... 1.32 0.85 0.85 0.10 2.27 2.27 000

64420 ............ A Injection for nerve block ..................................... 1.18 0.64 0.64 0.07 1.89 1.89 000

64421 ............ A Injection for nerve block ..................................... 1.68 0.83 0.83 0.17 2.68 2.68 000

64425 ............ A Injection for nerve block ..................................... 1.75 0.57 0.57 0.10 2.42 2.42 000

64430 ............ A Injection for nerve block ..................................... 1.46 0.70 0.70 0.12 2.28 2.28 000

64435 ............ A Injection for nerve block ..................................... 1.45 0.47 0.47 0.09 2.01 2.01 000

64440 ............ A Injection for nerve block ..................................... 1.34 0.79 0.79 0.09 2.22 2.22 000

64441 ............ A Injection for nerve block ..................................... 1.79 1.01 1.01 0.12 2.92 2.92 000

64442 ............ A Injection for nerve block ..................................... 1.41 1.19 1.19 0.16 2.76 2.76 000

64443 ............ A Injection for nerve block ..................................... 0.98 0.63 0.63 0.12 1.73 1.73 ZZZ

64445 ............ A Injection for nerve block ..................................... 1.48 0.49 0.49 0.06 2.03 2.03 000

64450 ............ A Injection for nerve block ..................................... 1.27 0.53 0.53 0.05 1.85 1.85 000

64505 ............ A Injection for nerve block ..................................... 1.36 0.62 0.62 0.06 2.04 2.04 000

64508 ............ A Injection for nerve block ..................................... 1.12 1.04 1.04 0.08 2.24 2.24 000

64510 ............ A Injection for nerve block ..................................... 1.22 0.71 0.71 0.18 2.11 2.11 000

64520 ............ A Injection for nerve block ..................................... 1.35 0.72 0.72 0.17 2.24 2.24 000

64530 ............ A Injection for nerve block ..................................... 1.58 1.17 1.17 0.28 3.03 3.03 000

64550 ............ A Apply neurostimulator ........................................ 0.18 0.44 0.44 0.04 0.66 0.66 000

64553 ............ A Implant neuroelectrodes ..................................... *2.31 1.02 1.02 0.10 3.43 3.43 010

64555 ............ A Implant neuroelectrodes ..................................... *2.27 0.42 0.42 0.10 2.79 2.79 010

64560 ............ A Implant neuroelectrodes ..................................... *2.36 1.45 1.45 0.24 4.05 4.05 010

64565 ............ A Implant neuroelectrodes ..................................... *1.76 0.76 0.76 0.08 2.60 2.60 010

64573 ............ A Implant neuroelectrodes ..................................... *4.43 3.16 3.16 0.61 8.20 8.20 090

64575 ............ A Implant neuroelectrodes ..................................... *4.35 3.07 3.07 0.40 7.82 7.82 090

64577 ............ A Implant neuroelectrodes ..................................... *4.62 2.76 2.76 0.45 7.83 7.83 090

64580 ............ A Implant neuroelectrodes ..................................... *4.12 2.91 2.91 0.20 7.23 7.23 090

64585 ............ A Revise/remove neuroelectrode .......................... *2.06 0.97 0.97 0.09 3.12 3.12 010

64590 ............ A Implant neuroreceiver ........................................ *2.40 1.84 1.84 0.35 4.59 4.59 010

64595 ............ A Revise/remove neuroreceiver ............................ *1.73 1.12 1.12 0.21 3.06 3.06 010

64600 ............ A Injection treatment of nerve ............................... *3.45 1.69 1.69 0.17 5.31 5.31 010

64605 ............ A Injection treatment of nerve ............................... *5.61 1.56 1.56 0.33 7.50 7.50 010

64610 ............ A Injection treatment of nerve ............................... *7.16 7.26 7.26 1.35 15.77 15.77 010

64612 ............ A Destroy nerve, face muscle ............................... *1.96 1.45 1.45 0.17 3.58 3.58 010

64613 ............ A Destroy nerve, spine muscle ............................. *1.96 1.45 1.45 0.17 3.58 3.58 010

64620 ............ A Injection treatment of nerve ............................... *2.84 1.00 1.00 0.19 4.03 4.03 010

64622 ............ A Injection treatment of nerve ............................... *3.00 1.82 1.82 0.35 5.17 5.17 010

64623 ............ A Injection treatment of nerve ............................... 0.99 0.85 0.85 0.17 2.01 2.01 ZZZ

64630 ............ A Injection treatment of nerve ............................... *3.00 1.74 1.74 0.38 5.12 5.12 010

64640 ............ A Injection treatment of nerve ............................... *2.76 0.92 0.92 0.09 3.77 3.77 010

64680 ............ A Injection treatment of nerve ............................... *2.62 1.55 1.55 0.41 4.58 4.58 010

64702 ............ A Revise finger/toe nerve ...................................... *4.23 4.22 4.22 0.70 9.15 9.15 090

64704 ............ A Revise hand/foot nerve ...................................... *4.57 #5.03 #5.03 0.74 10.34 10.34 090

64708 ............ A Revise arm/leg nerve ......................................... *6.12 #6.73 #6.73 1.26 14.11 14.11 090

64712 ............ A Revision of sciatic nerve .................................... *7.75 #8.53 #8.53 1.68 17.96 17.96 090

64713 ............ A Revision of arm nerve(s) .................................... *11.00 9.40 9.40 1.72 22.12 22.12 090

64714 ............ A Revise low back nerve(s) ................................... *10.33 6.13 6.13 1.41 17.87 17.87 090

64716 ............ A Revision of cranial nerve ................................... *6.31 4.83 4.83 0.67 11.81 11.81 090

64718 ............ A Revise ulnar nerve at elbow .............................. *5.99 #6.59 #6.59 1.13 13.71 13.71 090

64719 ............ A Revise ulnar nerve at wrist ................................ *4.85 4.95 4.95 0.85 10.65 10.65 090

64721 ............ A Carpal tunnel surgery ......................................... *4.29 #4.72 #4.72 0.83 9.84 9.84 090
59164

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

64722 ............ A Relieve pressure on nerve(s) ............................. *4.70 #5.17 #5.17 1.11 10.98 10.98 090

64726 ............ A Release foot/toe nerve ....................................... *4.18 0.72 0.72 0.07 4.97 4.97 090

64727 ............ A Internal nerve revision ........................................ 3.10 3.24 3.24 0.55 6.89 6.89 ZZZ

64732 ............ A Incision of brow nerve ........................................ *4.41 4.31 4.31 0.72 9.44 9.44 090

64734 ............ A Incision of cheek nerve ...................................... *4.92 4.61 4.61 0.67 10.20 10.20 090

64736 ............ A Incision of chin nerve ......................................... *4.60 4.46 4.46 0.42 9.48 9.48 090

64738 ............ A Incision of jaw nerve .......................................... *5.73 5.07 5.07 0.61 11.41 11.41 090

64740 ............ A Incision of tongue nerve ..................................... *5.59 5.18 5.18 0.62 11.39 11.39 090

64742 ............ A Incision of facial nerve ....................................... *6.22 5.00 5.00 0.44 11.66 11.66 090

64744 ............ A Incise nerve, back of head ................................. *5.24 #5.76 #5.76 1.10 12.10 12.10 090

64746 ............ A Incise diaphragm nerve ...................................... *5.93 3.77 3.77 0.77 10.47 10.47 090

64752 ............ A Incision of vagus nerve ...................................... *7.06 3.93 3.93 0.85 11.84 11.84 090

64755 ............ A Incision of stomach nerves ................................ *13.52 10.47 10.47 2.27 26.26 26.26 090

64760 ............ A Incision of vagus nerve ...................................... *6.96 6.65 6.65 1.50 15.11 15.11 090

64761 ............ A Incision of pelvis nerve ...................................... *6.41 4.66 4.66 0.50 11.57 11.57 090

64763 ............ A Incise hip/thigh nerve ......................................... *6.93 4.80 4.80 0.92 12.65 12.65 090

64766 ............ A Incise hip/thigh nerve ......................................... *8.67 6.67 6.67 1.20 16.54 16.54 090

64771 ............ A Sever cranial nerve ............................................ *7.35 6.42 6.42 0.73 14.50 14.50 090

64772 ............ A Incision of spinal nerve ...................................... *7.21 6.77 6.77 1.30 15.28 15.28 090

64774 ............ A Remove skin nerve lesion .................................. *5.17 2.74 2.74 0.45 8.36 8.36 090

64776 ............ A Remove digit nerve lesion ................................. *5.12 2.78 2.78 0.41 8.31 8.31 090

64778 ............ A Added digit nerve surgery .................................. 3.11 2.73 2.73 0.43 6.27 6.27 ZZZ

64782 ............ A Remove limb nerve lesion ................................. *6.23 4.70 4.70 0.46 11.39 11.39 090

64783 ............ A Added limb nerve surgery .................................. 3.72 3.26 3.26 0.47 7.45 7.45 ZZZ

64784 ............ A Remove nerve lesion ......................................... *9.82 5.64 5.64 0.96 16.42 16.42 090

64786 ............ A Remove sciatic nerve lesion .............................. *15.46 12.66 12.66 2.14 30.26 30.26 090

64787 ............ A Implant nerve end .............................................. 4.30 3.47 3.47 0.60 8.37 8.37 ZZZ

64788 ............ A Remove skin nerve lesion .................................. *4.61 3.63 3.63 0.50 8.74 8.74 090

64790 ............ A Removal of nerve lesion .................................... *11.31 7.11 7.11 1.22 19.64 19.64 090

64792 ............ A Removal of nerve lesion .................................... *14.92 8.99 8.99 1.66 25.57 25.57 090

64795 ............ A Biopsy of nerve .................................................. 3.01 2.38 2.38 0.39 5.78 5.78 000

64802 ............ A Remove sympathetic nerves .............................. *9.15 5.40 5.40 1.10 15.65 15.65 090

64804 ............ A Remove sympathetic nerves .............................. *14.64 12.77 12.77 2.44 29.85 29.85 090

64809 ............ A Remove sympathetic nerves .............................. *13.67 10.55 10.55 2.04 26.26 26.26 090

64818 ............ A Remove sympathetic nerves .............................. *10.30 8.57 8.57 1.72 20.59 20.59 090

64820 ............ A Remove sympathetic nerves .............................. *10.37 7.27 7.27 1.42 19.06 19.06 090

64830 ............ A Microrepair of nerve ........................................... 3.10 2.01 2.01 0.38 5.49 5.49 ZZZ

64831 ............ A Repair of digit nerve ........................................... *9.44 3.38 3.38 0.56 13.38 13.38 090

64832 ............ A Repair additional nerve ...................................... 5.66 1.40 1.40 0.24 7.30 7.30 ZZZ

64834 ............ A Repair of hand or foot nerve .............................. *10.19 3.50 3.50 0.56 14.25 14.25 090

64835 ............ A Repair of hand or foot nerve .............................. *10.94 5.96 5.96 1.03 17.93 17.93 090

64836 ............ A Repair of hand or foot nerve .............................. *10.94 6.70 6.70 1.22 18.86 18.86 090

64837 ............ A Repair additional nerve ...................................... 6.26 4.45 4.45 0.85 11.56 11.56 ZZZ

64840 ............ A Repair of leg nerve ............................................ *13.02 10.35 10.35 0.53 23.90 23.90 090

64856 ............ A Repair/transpose nerve ...................................... *13.80 8.21 8.21 1.46 23.47 23.47 090

64857 ............ A Repair arm/leg nerve ......................................... *14.49 9.53 9.53 1.54 25.56 25.56 090

64858 ............ A Repair sciatic nerve ........................................... *16.49 10.98 10.98 2.11 29.58 29.58 090

64859 ............ A Additional nerve surgery .................................... 4.26 3.50 3.50 0.58 8.34 8.34 ZZZ

64861 ............ A Repair of arm nerves ......................................... *19.24 13.42 13.42 1.38 34.04 34.04 090

64862 ............ A Repair of low back nerves ................................. *19.44 21.56 21.56 1.61 42.61 42.61 090

64864 ............ A Repair of facial nerve ......................................... *12.55 7.86 7.86 1.16 21.57 21.57 090

64865 ............ A Repair of facial nerve ......................................... *15.24 12.34 12.34 1.50 29.08 29.08 090

64866 ............ A Fusion of facial/other nerve ............................... *15.74 11.19 11.19 1.84 28.77 28.77 090

64868 ............ A Fusion of facial/other nerve ............................... *14.04 11.19 11.19 1.47 26.70 26.70 090

64870 ............ A Fusion of facial/other nerve ............................... *15.99 13.91 13.91 1.70 31.60 31.60 090

64872 ............ A Subsequent repair of nerve ............................... 1.99 1.44 1.44 0.29 3.72 3.72 ZZZ

64874 ............ A Repair & revise nerve ........................................ 2.98 2.17 2.17 0.43 5.58 5.58 ZZZ

64876 ............ A Repair nerve; shorten bone ............................... 3.38 2.46 2.46 0.48 6.32 6.32 ZZZ

64885 ............ A Nerve graft, head or neck .................................. *17.53 12.69 12.69 1.48 31.70 31.70 090

64886 ............ A Nerve graft, head or neck .................................. *20.75 15.13 15.13 1.77 37.65 37.65 090

64890 ............ A Nerve graft, hand or foot .................................... *15.15 12.26 12.26 2.12 29.53 29.53 090

64891 ............ A Nerve graft, hand or foot .................................... *16.14 10.42 10.42 1.73 28.29 28.29 090

64892 ............ A Nerve graft, arm or leg ....................................... *14.65 11.04 11.04 1.69 27.38 27.38 090

64893 ............ A Nerve graft, arm or leg ....................................... *15.60 13.93 13.93 2.27 31.80 31.80 090

64895 ............ A Nerve graft, hand or foot .................................... *19.25 13.16 13.16 2.55 34.96 34.96 090

64896 ............ A Nerve graft, hand or foot .................................... *20.49 17.53 17.53 1.90 39.92 39.92 090

64897 ............ A Nerve graft, arm or leg ....................................... *18.24 12.63 12.63 2.47 33.34 33.34 090

64898 ............ A Nerve graft, arm or leg ....................................... *19.50 14.40 14.40 2.35 36.25 36.25 090

64901 ............ A Additional nerve graft ......................................... 10.22 10.16 10.16 0.87 21.25 21.25 ZZZ

64902 ............ A Additional nerve graft ......................................... 11.83 11.92 11.92 0.99 24.74 24.74 ZZZ

64905 ............ A Nerve pedicle transfer ........................................ *14.02 9.40 9.40 0.70 24.12 24.12 090

64907 ............ A Nerve pedicle transfer ........................................ *18.83 13.02 13.02 2.55 34.40 34.40 090

64999 ............ C Nervous system surgery .................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

65091 ............ A Revise eye ......................................................... *6.46 #7.11 #7.11 0.45 14.02 14.02 090
59165

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

65093 ............ A Revise eye with implant ..................................... *6.87 #7.56 #7.56 0.52 14.95 14.95 090

65101 ............ A Removal of eye .................................................. *7.03 #7.73 #7.73 0.47 15.23 15.23 090

65103 ............ A Remove eye/insert implant ................................ *7.57 #8.33 #8.33 0.50 16.40 16.40 090

65105 ............ A Remove eye/attach implant ............................... *8.49 #9.34 #9.34 0.55 18.38 18.38 090

65110 ............ A Removal of eye .................................................. *13.95 #15.35 #15.35 1.14 30.44 30.44 090

65112 ............ A Remove eye, revise socket ................................ *16.38 12.16 12.16 1.09 29.63 29.63 090

65114 ............ A Remove eye, revise socket ................................ *17.53 13.07 13.07 1.65 32.25 32.25 090

65125 ............ A Revise ocular implant ......................................... *3.12 2.47 2.47 0.13 5.72 5.72 090

65130 ............ A Insert ocular implant ........................................... *7.15 #7.87 #7.87 0.50 15.52 15.52 090

65135 ............ A Insert ocular implant ........................................... *7.33 5.42 5.42 0.35 13.10 13.10 090

65140 ............ A Attach ocular implant ......................................... *8.02 6.22 6.22 0.33 14.57 14.57 090

65150 ............ A Revise ocular implant ......................................... *6.26 #6.89 #6.89 0.56 13.71 13.71 090

65155 ............ A Reinsert ocular implant ...................................... *8.66 #9.53 #9.53 0.90 19.09 19.09 090

65175 ............ A Removal of ocular implant ................................. *6.28 #6.91 #6.91 0.40 13.59 13.59 090

65205 ............ A Remove foreign body from eye ......................... 0.71 0.37 0.37 0.02 1.10 1.10 000

65210 ............ A Remove foreign body from eye ......................... 0.84 0.46 0.46 0.03 1.33 1.33 000

65220 ............ A Remove foreign body from eye ......................... 0.71 0.52 0.52 0.04 1.27 1.27 000

65222 ............ A Remove foreign body from eye ......................... 0.93 0.57 0.57 0.03 1.53 1.53 000

65235 ............ A Remove foreign body from eye ......................... *7.57 5.61 5.61 0.30 13.48 13.48 090

65260 ............ A Remove foreign body from eye ......................... *10.96 8.63 8.63 0.45 20.04 20.04 090

65265 ............ A Remove foreign body from eye ......................... *12.59 10.04 10.04 0.51 23.14 23.14 090

65270 ............ A Repair of eye wound .......................................... *1.90 1.17 1.17 0.07 3.14 3.14 010

65272 ............ A Repair of eye wound .......................................... *3.82 1.64 1.64 0.10 5.56 5.56 090

65273 ............ A Repair of eye wound .......................................... *4.36 3.22 3.22 0.21 7.79 7.79 090

65275 ............ A Repair of eye wound .......................................... *5.34 0.66 0.66 0.04 6.04 6.04 090

65280 ............ A Repair of eye wound .......................................... *7.66 #8.43 #8.43 0.49 16.58 16.58 090

65285 ............ A Repair of eye wound .......................................... *12.90 12.26 12.26 0.64 25.80 25.80 090

65286 ............ A Repair of eye wound .......................................... *5.51 4.79 4.79 0.25 10.55 10.55 090

65290 ............ A Repair of eye socket wound .............................. *5.41 #5.95 #5.95 0.37 11.73 11.73 090

65400 ............ A Removal of eye lesion ....................................... *6.06 6.46 6.46 0.35 12.87 12.87 090

65410 ............ A Biopsy of cornea ................................................ 1.47 1.59 1.59 0.11 3.17 3.17 000

65420 ............ A Removal of eye lesion ....................................... *4.17 4.28 4.28 0.23 8.68 8.68 090

65426 ............ A Removal of eye lesion ....................................... *5.25 #5.78 #5.78 0.38 11.41 11.41 090

65430 ............ A Corneal smear .................................................... 1.47 0.54 0.54 0.03 2.04 2.04 000

65435 ............ A Curette/treat cornea ........................................... 0.92 0.77 0.77 0.04 1.73 1.73 000

65436 ............ A Curette/treat cornea ........................................... *4.19 1.53 1.53 0.08 5.80 5.80 090

65450 ............ A Treatment of corneal lesion ............................... *3.27 3.28 3.28 0.17 6.72 6.72 090

65600 ............ A Revision of cornea ............................................. *3.40 2.62 2.62 0.14 6.16 6.16 090

65710 ............ A Corneal transplant .............................................. *12.35 12.44 12.44 1.13 25.92 25.92 090

65730 ............ A Corneal transplant .............................................. *14.25 15.14 15.14 1.29 30.68 30.68 090

65750 ............ A Corneal transplant .............................................. *15.00 16.10 16.10 1.33 32.43 32.43 090

65755 ............ A Corneal transplant .............................................. *14.89 16.10 16.10 1.39 32.38 32.38 090

65760 ............ N Revision of cornea ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

65765 ............ N Revision of cornea ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

65767 ............ N Corneal tissue transplant ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

65770 ............ A Revise cornea with implant ................................ *17.56 13.81 13.81 0.71 32.08 32.08 090

65771 ............ N Radial keratotomy .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

65772 ............ A Correction of astigmatism .................................. *4.29 #4.72 #4.72 0.31 9.32 9.32 090

65775 ............ A Correction of astigmatism .................................. *5.79 #6.37 #6.37 0.50 12.66 12.66 090

65800 ............ A Drainage of eye .................................................. 1.91 1.72 1.72 0.10 3.73 3.73 000

65805 ............ A Drainage of eye .................................................. 1.91 1.81 1.81 0.10 3.82 3.82 000

65810 ............ A Drainage of eye .................................................. *4.87 #5.36 #5.36 0.30 10.53 10.53 090

65815 ............ A Drainage of eye .................................................. *5.05 4.49 4.49 0.24 9.78 9.78 090

65820 ............ A Relieve inner eye pressure ................................ *8.13 9.54 9.54 0.51 18.18 18.18 090

65850 ............ A Incision of eye .................................................... *10.52 #11.57 #11.57 0.69 22.78 22.78 090

65855 ............ A Laser surgery of eye .......................................... *4.30 6.01 6.01 0.52 10.83 10.83 090

65860 ............ A Incise inner eye adhesions ................................ *3.55 #3.91 #3.91 0.37 7.83 7.83 090

65865 ............ A Incise inner eye adhesions ................................ *5.60 #6.16 #6.16 0.41 12.17 12.17 090

65870 ............ A Incise inner eye adhesions ................................ *6.27 5.86 5.86 0.31 12.44 12.44 090

65875 ............ A Incise inner eye adhesions ................................ *6.54 6.28 6.28 0.34 13.16 13.16 090

65880 ............ A Incise inner eye adhesions ................................ *7.09 6.85 6.85 0.37 14.31 14.31 090

65900 ............ A Remove eye lesion ............................................ *10.93 7.91 7.91 0.92 19.76 19.76 090

65920 ............ A Remove implant from eye .................................. *8.40 8.36 8.36 0.44 17.20 17.20 090

65930 ............ A Remove blood clot from eye .............................. *7.44 7.68 7.68 0.41 15.53 15.53 090

66020 ............ A Injection treatment of eye .................................. *1.59 #1.75 #1.75 0.14 3.48 3.48 010

66030 ............ A Injection treatment of eye .................................. *1.25 0.54 0.54 0.03 1.82 1.82 010

66130 ............ A Remove eye lesion ............................................ *7.69 5.28 5.28 0.28 13.25 13.25 090

66150 ............ A Glaucoma surgery .............................................. *8.30 #9.13 #9.13 0.59 18.02 18.02 090

66155 ............ A Glaucoma surgery .............................................. *8.29 #9.12 #9.12 0.50 17.91 17.91 090

66160 ............ A Glaucoma surgery .............................................. *10.17 10.77 10.77 0.55 21.49 21.49 090

66165 ............ A Glaucoma surgery .............................................. *8.01 #8.81 #8.81 0.57 17.39 17.39 090

66170 ............ A Glaucoma surgery .............................................. *12.16 12.15 12.15 0.63 24.94 24.94 090

66172 ............ A Incision of eye .................................................... *15.04 12.15 12.15 0.63 27.82 27.82 090

66180 ............ A Implant eye shunt ............................................... *14.55 #16.01 #16.01 1.03 31.59 31.59 090
59166

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

66185 ............ A Revise eye shunt ............................................... *8.14 #8.95 #8.95 0.58 17.67 17.67 090

66220 ............ A Repair eye lesion ............................................... *7.77 5.95 5.95 0.34 14.06 14.06 090

66225 ............ A Repair/graft eye lesion ....................................... *11.05 #12.16 #12.16 0.86 24.07 24.07 090

66250 ............ A Follow-up surgery of eye ................................... *5.98 #6.58 #6.58 0.38 12.94 12.94 090

66500 ............ A Incision of iris ..................................................... *3.71 #4.08 #4.08 0.27 8.06 8.06 090

66505 ............ A Incision of iris ..................................................... *4.08 3.27 3.27 0.17 7.52 7.52 090

66600 ............ A Remove iris and lesion ...................................... *8.68 9.36 9.36 0.51 18.55 18.55 090

66605 ............ A Removal of iris ................................................... *12.79 11.87 11.87 0.67 25.33 25.33 090

66625 ............ A Removal of iris ................................................... *5.13 #5.64 #5.64 0.48 11.25 11.25 090

66630 ............ A Removal of iris ................................................... *6.16 #6.78 #6.78 0.45 13.39 13.39 090

66635 ............ A Removal of iris ................................................... *6.25 #6.88 #6.88 0.49 13.62 13.62 090

66680 ............ A Repair iris & ciliary body .................................... *5.44 #5.98 #5.98 0.35 11.77 11.77 090

66682 ............ A Repair iris and ciliary body ................................ *6.21 #6.83 #6.83 0.38 13.42 13.42 090

66700 ............ A Destruction, ciliary body ..................................... *4.78 #5.26 #5.26 0.35 10.39 10.39 090

66710 ............ A Destruction, ciliary body ..................................... *4.78 #5.26 #5.26 0.41 10.45 10.45 090

66720 ............ A Destruction, ciliary body ..................................... *4.78 #5.26 #5.26 0.38 10.42 10.42 090

66740 ............ A Destruction, ciliary body ..................................... *4.78 #5.26 #5.26 0.39 10.43 10.43 090

66761 ............ A Revision of iris .................................................... *4.07 #4.48 #4.48 0.47 9.02 9.02 090

66762 ............ A Revision of iris .................................................... *4.58 #5.04 #5.04 0.55 10.17 10.17 090

66770 ............ A Removal of inner eye lesion .............................. *5.18 #5.70 #5.70 0.45 11.33 11.33 090

66820 ............ A Incision, secondary cataract .............................. *3.89 #4.28 #4.28 0.29 8.46 8.46 090

66821 ............ A After cataract laser surgery ................................ *2.35 #2.59 #2.59 0.37 5.31 5.31 090

66825 ............ A Reposition intraocular lens ................................. *8.23 7.33 7.33 0.38 15.94 15.94 090

66830 ............ A Removal of lens lesion ....................................... *8.20 7.67 7.67 0.40 16.27 16.27 090

66840 ............ A Removal of lens material ................................... *7.91 #8.70 #8.70 0.54 17.15 17.15 090

66850 ............ A Removal of lens material ................................... *9.11 #10.02 #10.02 0.70 19.83 19.83 090

66852 ............ A Removal of lens material ................................... *9.97 #10.97 #10.97 0.90 21.84 21.84 090

66920 ............ A Extraction of lens ............................................... *8.86 #9.75 #9.75 0.60 19.21 19.21 090

66930 ............ A Extraction of lens ............................................... *10.18 10.49 10.49 0.57 21.24 21.24 090

66940 ............ A Extraction of lens ............................................... *8.93 #9.82 #9.82 0.62 19.37 19.37 090

66983 ............ A Remove cataract, insert lens ............................. *8.99 #9.89 #9.89 0.95 19.83 19.83 090

66984 ............ A Remove cataract, insert lens ............................. *10.28 #11.31 #11.31 0.94 22.53 22.53 090

66985 ............ A Insert lens prosthesis ......................................... *8.39 #9.23 #9.23 0.63 18.25 18.25 090

66986 ............ A Exchange lens prosthesis .................................. *12.28 12.20 12.20 0.63 25.11 25.11 090

66999 ............ C Eye surgery procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

67005 ............ A Partial removal of eye fluid ................................ *5.70 #6.27 #6.27 1.13 13.10 13.10 090

67010 ............ A Partial removal of eye fluid ................................ *6.87 #7.56 #7.56 1.04 15.47 15.47 090

67015 ............ A Release of eye fluid ........................................... *6.92 6.45 6.45 0.35 13.72 13.72 090

67025 ............ A Replace eye fluid ............................................... *6.84 6.75 6.75 0.36 13.95 13.95 090

67027 ............ A Implant eye drug system .................................... *10.85 9.04 9.04 0.47 20.36 20.36 090

67028 ............ A Injection eye drug ............................................... 2.52 3.22 #2.77 0.18 5.92 5.47 000

67030 ............ A Incise inner eye strands ..................................... *4.84 #5.32 #5.32 0.50 10.66 10.66 090

67031 ............ A Laser surgery, eye strands ................................ *3.67 #4.04 #4.04 0.75 8.46 8.46 090

67036 ............ A Removal of inner eye fluid ................................. *11.89 #13.08 #13.08 1.49 26.46 26.46 090

67038 ............ A Strip retinal membrane ....................................... *21.24 #23.36 #23.36 1.80 46.40 46.40 090

67039 ............ A Laser treatment of retina .................................... *14.52 #15.97 #15.97 1.68 32.17 32.17 090

67040 ............ A Laser treatment of retina .................................... *17.23 #18.95 #18.95 1.75 37.93 37.93 090

67101 ............ A Repair, detached retina ...................................... *7.53 #8.28 #8.28 0.66 16.47 16.47 090

67105 ............ A Repair, detached retina ...................................... *7.41 9.14 9.14 0.80 17.35 17.35 090

67107 ............ A Repair detached retina ....................................... *14.84 #16.32 #16.32 1.10 32.26 32.26 090

67108 ............ A Repair detached retina ....................................... *20.82 #22.90 #22.90 1.76 45.48 45.48 090

67110 ............ A Repair detached retina ....................................... *8.81 #9.69 #9.69 0.97 19.47 19.47 090

67112 ............ A Re-repair detached retina .................................. *16.86 16.51 16.51 0.86 34.23 34.23 090

67115 ............ A Release, encircling material ............................... *4.99 #5.49 #5.49 0.44 10.92 10.92 090

67120 ............ A Remove eye implant material ............................ *5.98 #6.58 #6.58 0.38 12.94 12.94 090

67121 ............ A Remove eye implant material ............................ *10.67 9.42 9.42 0.49 20.58 20.58 090

67141 ............ A Treatment of retina ............................................. *5.20 #5.72 #5.72 0.48 11.40 11.40 090

67145 ............ A Treatment of retina ............................................. *5.37 6.50 6.50 0.49 12.36 12.36 090

67208 ............ A Treatment of retinal lesion ................................. *6.70 #7.37 #7.37 0.52 14.59 14.59 090

67210 ............ A Treatment of retinal lesion ................................. *10.05 9.02 9.02 0.47 19.54 19.54 090

67218 ............ A Treatment of retinal lesion ................................. *13.52 13.31 13.31 0.70 27.53 27.53 090

67227 ............ A Treatment of retinal lesion ................................. *6.58 #7.24 #7.24 0.51 14.33 14.33 090

67228 ............ A Treatment of retinal lesion ................................. *12.74 9.39 9.39 0.48 22.61 22.61 090

67250 ............ A Reinforce eye wall .............................................. *8.66 6.99 6.99 0.40 16.05 16.05 090

67255 ............ A Reinforce/graft eye wall ..................................... *8.90 #9.79 #9.79 0.87 19.56 19.56 090

67299 ............ C Eye surgery procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

67311 ............ A Revise eye muscle ............................................. *6.65 #7.32 #7.32 0.47 14.44 14.44 090

67312 ............ A Revise two eye muscles .................................... *8.54 #9.39 #9.39 0.53 18.46 18.46 090

67314 ............ A Revise eye muscle ............................................. *7.52 #8.27 #8.27 0.58 16.37 16.37 090

67316 ............ A Revise two eye muscles .................................... *9.66 10.27 10.27 0.67 20.60 20.60 090

67318 ............ A Revise eye muscle(s) ......................................... *7.85 6.21 6.21 0.33 14.39 14.39 090

67320 ............ A Revise eye muscle(s) ......................................... *8.66 #9.53 #9.53 0.69 18.88 18.88 090

67331 ............ A Eye surgery follow-up ........................................ *8.12 #8.93 #8.93 0.54 17.59 17.59 090

67332 ............ A Rerevise eye muscles ........................................ *8.99 #9.89 #9.89 0.58 19.46 19.46 090
59167

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

67334 ............ A Revise eye muscle w/suture .............................. *7.96 6.30 6.30 0.33 14.59 14.59 090

67335 ............ A Eye suture during surgery .................................. 2.49 #2.74 #2.74 0.43 5.66 5.66 ZZZ

67340 ............ A Revise eye muscle ............................................. *9.85 7.88 7.88 0.41 18.14 18.14 090

67343 ............ A Release eye tissue ............................................. *7.35 5.83 5.83 0.31 13.49 13.49 090

67345 ............ A Destroy nerve of eye muscle ............................. *2.96 2.22 2.22 0.26 5.44 5.44 010

67350 ............ A Biopsy eye muscle ............................................. 2.87 2.39 2.39 0.13 5.39 5.39 000

67399 ............ C Eye muscle surgery procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

67400 ............ A Explore/biopsy eye socket ................................. *9.76 #10.74 #10.74 0.62 21.12 21.12 090

67405 ............ A Explore/drain eye socket .................................... *7.93 #8.72 #8.72 0.67 17.32 17.32 090

67412 ............ A Explore/treat eye socket .................................... *9.50 #10.45 #10.45 0.67 20.62 20.62 090

67413 ............ A Explore/treat eye socket .................................... *10.00 8.09 8.09 0.57 18.66 18.66 090

67414 ............ A Explore/decompress eye socket ........................ *11.13 8.39 8.39 0.44 19.96 19.96 090

67415 ............ A Aspiration orbital contents .................................. 1.76 #1.94 #1.94 0.12 3.82 3.82 000

67420 ............ A Explore/treat eye socket .................................... *20.06 16.78 16.78 1.11 37.95 37.95 090

67430 ............ A Explore/treat eye socket .................................... *13.39 10.65 10.65 0.54 24.58 24.58 090

67440 ............ A Explore/drain eye socket .................................... *13.09 #14.40 #14.40 0.97 28.46 28.46 090

67445 ............ A Explore/decompress eye socket ........................ *14.42 11.13 11.13 0.57 26.12 26.12 090

67450 ............ A Explore/biopsy eye socket ................................. *13.51 #14.86 #14.86 0.87 29.24 29.24 090

67500 ............ A Inject/treat eye socket ........................................ 0.79 0.73 0.73 0.06 1.58 1.58 000

67505 ............ A Inject/treat eye socket ........................................ 0.82 1.04 #0.90 0.06 1.92 1.78 000

67515 ............ A Inject/treat eye socket ........................................ 0.61 0.56 0.56 0.03 1.20 1.20 000

67550 ............ A Insert eye socket implant ................................... *10.19 9.62 9.62 0.70 20.51 20.51 090

67560 ............ A Revise eye socket implant ................................. *10.60 8.30 8.30 0.48 19.38 19.38 090

67570 ............ A Decompress optic nerve .................................... *13.58 7.56 7.56 0.39 21.53 21.53 090

67599 ............ C Orbit surgery procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

67700 ............ A Drainage of eyelid abscess ................................ *1.35 0.49 0.49 0.03 1.87 1.87 010

67710 ............ A Incision of eyelid ................................................ *1.02 1.01 1.01 0.06 2.09 2.09 010

67715 ............ A Incision of eyelid fold ......................................... *1.22 #1.34 #1.34 0.09 2.65 2.65 010

67800 ............ A Remove eyelid lesion ......................................... *1.38 0.94 0.94 0.05 2.37 2.37 010

67801 ............ A Remove eyelid lesions ....................................... *1.88 1.39 1.39 0.08 3.35 3.35 010

67805 ............ A Remove eyelid lesions ....................................... *2.22 1.38 1.38 0.08 3.68 3.68 010

67808 ............ A Remove eyelid lesion(s) ..................................... *3.80 2.13 2.13 0.13 6.06 6.06 090

67810 ............ A Biopsy of eyelid .................................................. 1.48 0.81 0.81 0.05 2.34 2.34 000

67820 ............ A Revise eyelashes ............................................... 0.89 0.38 0.38 0.02 1.29 1.29 000

67825 ............ A Revise eyelashes ............................................... *1.38 0.90 0.90 0.05 2.33 2.33 010

67830 ............ A Revise eyelashes ............................................... *1.70 2.12 #1.87 0.17 3.99 3.74 010

67835 ............ A Revise eyelashes ............................................... *5.56 #6.12 #6.12 0.45 12.13 12.13 090

67840 ............ A Remove eyelid lesion ......................................... *2.04 1.22 1.22 0.07 3.33 3.33 010

67850 ............ A Treat eyelid lesion .............................................. *1.69 0.82 0.82 0.05 2.56 2.56 010

67875 ............ A Closure of eyelid by suture ................................ 1.35 1.72 #1.49 0.13 3.20 2.97 000

67880 ............ A Revision of eyelid ............................................... *3.80 3.94 3.94 0.23 7.97 7.97 090

67882 ............ A Revision of eyelid ............................................... *5.07 #5.58 #5.58 0.37 11.02 11.02 090

67900 ............ A Repair brow defect ............................................. *6.14 3.78 3.78 0.20 10.12 10.12 090

67901 ............ A Repair eyelid defect ........................................... *6.97 #7.67 #7.67 0.64 15.28 15.28 090

67902 ............ A Repair eyelid defect ........................................... *7.03 #7.73 #7.73 0.72 15.48 15.48 090

67903 ............ A Repair eyelid defect ........................................... *6.37 #7.01 #7.01 0.73 14.11 14.11 090

67904 ............ A Repair eyelid defect ........................................... *6.26 #6.89 #6.89 0.71 13.86 13.86 090

67906 ............ A Repair eyelid defect ........................................... *6.79 5.46 5.46 0.36 12.61 12.61 090

67908 ............ A Repair eyelid defect ........................................... *5.13 #5.64 #5.64 0.54 11.31 11.31 090

67909 ............ A Revise eyelid defect ........................................... *5.40 #5.94 #5.94 0.48 11.82 11.82 090

67911 ............ A Revise eyelid defect ........................................... *5.27 #5.80 #5.80 0.79 11.86 11.86 090

67914 ............ A Repair eyelid defect ........................................... *3.68 #4.05 #4.05 0.39 8.12 8.12 090

67915 ............ A Repair eyelid defect ........................................... *3.18 1.25 1.25 0.07 4.50 4.50 090

67916 ............ A Repair eyelid defect ........................................... *5.31 #5.84 #5.84 0.38 11.53 11.53 090

67917 ............ A Repair eyelid defect ........................................... *6.02 #6.62 #6.62 0.47 13.11 13.11 090

67921 ............ A Repair eyelid defect ........................................... *3.40 #3.74 #3.74 0.20 7.34 7.34 090

67922 ............ A Repair eyelid defect ........................................... *3.06 1.19 1.19 0.07 4.32 4.32 090

67923 ............ A Repair eyelid defect ........................................... *5.88 #6.47 #6.47 0.38 12.73 12.73 090

67924 ............ A Repair eyelid defect ........................................... *5.79 #6.37 #6.37 0.43 12.59 12.59 090

67930 ............ A Repair eyelid wound .......................................... *3.61 1.27 1.27 0.08 4.96 4.96 010

67935 ............ A Repair eyelid wound .......................................... *6.22 3.79 3.79 0.24 10.25 10.25 090

67938 ............ A Remove eyelid foreign body .............................. *1.33 0.52 0.52 0.03 1.88 1.88 010

67950 ............ A Revision of eyelid ............................................... *5.82 #6.40 #6.40 0.45 12.67 12.67 090

67961 ............ A Revision of eyelid ............................................... *5.69 #6.26 #6.26 0.50 12.45 12.45 090

67966 ............ A Revision of eyelid ............................................... *6.57 #7.23 #7.23 0.66 14.46 14.46 090

67971 ............ A Reconstruction of eyelid ..................................... *9.79 10.68 10.68 0.64 21.11 21.11 090

67973 ............ A Reconstruction of eyelid ..................................... *12.87 13.54 13.54 0.91 27.32 27.32 090

67974 ............ A Reconstruction of eyelid ..................................... *12.84 14.07 14.07 0.87 27.78 27.78 090

67975 ............ A Reconstruction of eyelid ..................................... *9.13 4.15 4.15 0.24 13.52 13.52 090

67999 ............ C Revision of eyelid ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

68020 ............ A Incise/drain eyelid lining ..................................... *1.37 0.51 0.51 0.03 1.91 1.91 010

68040 ............ A Treatment of eyelid lesions ................................ 0.85 0.45 0.45 0.02 1.32 1.32 000

68100 ............ A Biopsy of eyelid lining ........................................ 1.35 0.99 0.99 0.06 2.40 2.40 000

68110 ............ A Remove eyelid lining lesion ............................... *1.77 1.24 1.24 0.07 3.08 3.08 010
59168

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

68115 ............ A Remove eyelid lining lesion ............................... *2.36 1.93 1.93 0.11 4.40 4.40 010

68130 ............ A Remove eyelid lining lesion ............................... *4.93 4.09 4.09 0.22 9.24 9.24 090

68135 ............ A Remove eyelid lining lesion ............................... *1.84 0.74 0.74 0.04 2.62 2.62 010

68200 ............ A Treat eyelid by injection ..................................... 0.49 0.52 0.52 0.03 1.04 1.04 000

68320 ............ A Revise/graft eyelid lining .................................... *5.37 #5.91 #5.91 0.42 11.70 11.70 090

68325 ............ A Revise/graft eyelid lining .................................... *7.36 #8.10 #8.10 0.62 16.08 16.08 090

68326 ............ A Revise/graft eyelid lining .................................... *7.15 #7.87 #7.87 0.49 15.51 15.51 090

68328 ............ A Revise/graft eyelid lining .................................... *8.18 #9.00 #9.00 0.82 18.00 18.00 090

68330 ............ A Revise eyelid lining ............................................ *4.83 #5.31 #5.31 0.35 10.49 10.49 090

68335 ............ A Revise/graft eyelid lining .................................... *7.19 #7.91 #7.91 0.68 15.78 15.78 090

68340 ............ A Separate eyelid adhesions ................................. *4.17 3.14 3.14 0.17 7.48 7.48 090

68360 ............ A Revise eyelid lining ............................................ *4.37 #4.81 #4.81 0.33 9.51 9.51 090

68362 ............ A Revise eyelid lining ............................................ *7.34 8.01 8.01 0.42 15.77 15.77 090

68399 ............ C Eyelid lining surgery ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

68400 ............ A Incise/drain tear gland ........................................ *1.69 1.00 1.00 0.06 2.75 2.75 010

68420 ............ A Incise/drain tear sac ........................................... *2.30 1.02 1.02 0.06 3.38 3.38 010

68440 ............ A Incise tear duct opening ..................................... *0.94 0.76 0.76 0.04 1.74 1.74 010

68500 ............ A Removal of tear gland ........................................ *11.02 7.61 7.61 0.75 19.38 19.38 090

68505 ............ A Partial removal tear gland .................................. *10.94 8.69 8.69 0.49 20.12 20.12 090

68510 ............ A Biopsy of tear gland ........................................... 4.61 3.69 3.69 0.28 8.58 8.58 000

68520 ............ A Removal of tear sac ........................................... *7.51 #8.26 #8.26 0.51 16.28 16.28 090

68525 ............ A Biopsy of tear sac .............................................. 4.43 3.68 3.68 0.23 8.34 8.34 000

68530 ............ A Clearance of tear duct ....................................... *3.66 2.85 2.85 0.17 6.68 6.68 010

68540 ............ A Remove tear gland lesion .................................. *10.60 8.31 8.31 0.50 19.41 19.41 090

68550 ............ A Remove tear gland lesion .................................. *13.26 11.34 11.34 0.74 25.34 25.34 090

68700 ............ A Repair tear ducts ................................................ *6.60 2.69 2.69 0.15 9.44 9.44 090

68705 ............ A Revise tear duct opening ................................... *2.06 1.02 1.02 0.05 3.13 3.13 010

68720 ............ A Create tear sac drain ......................................... *8.96 9.84 9.84 0.74 19.54 19.54 090

68745 ............ A Create tear duct drain ........................................ *8.63 6.56 6.56 0.45 15.64 15.64 090

68750 ............ A Create tear duct drain ........................................ *8.66 #9.53 #9.53 0.83 19.02 19.02 090

68760 ............ A Close tear duct opening ..................................... *1.73 0.92 0.92 0.04 2.69 2.69 010

68761 ............ A Close tear duct opening ..................................... *1.36 0.92 0.92 0.04 2.32 2.32 010

68770 ............ A Close tear system fistula .................................... *7.02 4.24 4.24 0.23 11.49 11.49 090

68801 ............ A Dilate tear duct opening ..................................... *0.94 0.42 0.42 0.02 1.38 1.38 010

68810 ............ A Probe nasolacrimal duct .................................... *1.90 0.55 0.55 0.03 2.48 2.48 010

68811 ............ A Probe nasolacrimal duct .................................... *2.35 1.49 1.49 0.09 3.93 3.93 010

68815 ............ A Probe nasolacrimal duct .................................... *3.20 1.93 1.93 0.10 5.23 5.23 010

68840 ............ A Explore/irrigate tear ducts .................................. *1.25 0.49 0.49 0.03 1.77 1.77 010

68850 ............ A Injection for tear sac x-ray ................................. 0.80 0.51 0.51 0.04 1.35 1.35 000

68899 ............ C Tear duct system surgery .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

69000 ............ A Drain external ear lesion .................................... *1.45 0.35 0.35 0.03 1.83 1.83 010

69005 ............ A Drain external ear lesion .................................... *2.11 1.16 1.16 0.13 3.40 3.40 010

69020 ............ A Drain outer ear canal lesion ............................... *1.48 0.45 0.45 0.04 1.97 1.97 010

69090 ............ N Pierce earlobes .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

69100 ............ A Biopsy of external ear ........................................ 0.81 0.66 0.66 0.07 1.54 1.54 000

69105 ............ A Biopsy of external ear canal .............................. 0.85 0.80 0.80 0.09 1.74 1.74 000

69110 ............ A Partial removal external ear ............................... *3.44 2.63 2.63 0.37 6.44 6.44 090

69120 ............ A Removal of external ear ..................................... *4.05 0.78 0.78 0.07 4.90 4.90 090

69140 ............ A Remove ear canal lesion(s) ............................... *7.97 8.00 8.00 0.88 16.85 16.85 090

69145 ............ A Remove ear canal lesion(s) ............................... *2.62 2.51 2.51 0.28 5.41 5.41 090

69150 ............ A Extensive ear canal surgery .............................. *13.43 10.46 10.46 1.25 25.14 25.14 090

69155 ............ A Extensive ear/neck surgery ................................ *20.80 15.92 15.92 1.61 38.33 38.33 090

69200 ............ A Clear outer ear canal ......................................... 0.77 0.42 0.42 0.04 1.23 1.23 000

69205 ............ A Clear outer ear canal ......................................... *1.20 1.07 1.07 0.11 2.38 2.38 010

69210 ............ A Remove impacted ear wax ................................ 0.61 0.23 0.23 0.02 0.86 0.86 000

69220 ............ A Clean out mastoid cavity .................................... 0.83 0.50 0.50 0.05 1.38 1.38 000

69222 ............ A Clean out mastoid cavity .................................... *1.40 0.74 0.74 0.08 2.22 2.22 010

69300 ............ R Revise external ear ............................................ 6.36 5.30 5.30 0.28 11.94 11.94 YYY

69310 ............ A Rebuild outer ear canal ...................................... *10.79 9.84 9.84 1.08 21.71 21.71 090

69320 ............ A Rebuild outer ear canal ...................................... *16.96 14.65 14.65 1.66 33.27 33.27 090

69399 ............ C Outer ear surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

69400 ............ A Inflate middle ear canal ...................................... 0.83 0.45 0.45 0.05 1.33 1.33 000

69401 ............ A Inflate middle ear canal ...................................... 0.63 0.25 0.25 0.03 0.91 0.91 000

69405 ............ A Catheterize middle ear canal ............................. *2.63 0.48 0.48 0.04 3.15 3.15 010

69410 ............ A Inset middle ear baffle ....................................... 0.33 0.60 0.60 0.07 1.00 1.00 000

69420 ............ A Incision of eardrum ............................................ *1.33 0.69 0.69 0.08 2.10 2.10 010

69421 ............ A Incision of eardrum ............................................ *1.73 1.14 1.14 0.13 3.00 3.00 010

69424 ............ A Remove ventilating tube .................................... 0.85 0.60 0.60 0.06 1.51 1.51 000

69433 ............ A Create eardrum opening .................................... *1.52 1.33 1.33 0.15 3.00 3.00 010

69436 ............ A Create eardrum opening .................................... *1.96 2.13 2.13 0.23 4.32 4.32 010

69440 ............ A Exploration of middle ear ................................... *7.57 #8.33 #8.33 0.93 16.83 16.83 090

69450 ............ A Eardrum revision ................................................ *5.57 #6.13 #6.13 1.15 12.85 12.85 090

69501 ............ A Mastoidectomy ................................................... *9.07 #9.98 #9.98 1.17 20.22 20.22 090

69502 ............ A Mastoidectomy ................................................... *12.38 13.36 13.36 1.45 27.19 27.19 090
59169

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

69505 ............ A Remove mastoid structures ............................... *12.99 #14.29 #14.29 1.79 29.07 29.07 090

69511 ............ A Extensive mastoid surgery ................................. *13.52 #14.87 #14.87 1.84 30.23 30.23 090

69530 ............ A Extensive mastoid surgery ................................. *19.19 16.71 16.71 1.72 37.62 37.62 090

69535 ............ A Remove part of temporal bone .......................... *36.14 25.27 25.27 2.85 64.26 64.26 090

69540 ............ A Remove ear lesion ............................................. *1.20 1.27 1.27 0.14 2.61 2.61 010

69550 ............ A Remove ear lesion ............................................. *10.99 #12.09 #12.09 2.00 25.08 25.08 090

69552 ............ A Remove ear lesion ............................................. *19.46 16.73 16.73 1.86 38.05 38.05 090

69554 ............ A Remove ear lesion ............................................. *33.16 22.87 22.87 2.63 58.66 58.66 090

69601 ............ A Mastoid surgery revision .................................... *13.24 14.02 14.02 1.55 28.81 28.81 090

69602 ............ A Mastoid surgery revision .................................... *13.58 #14.94 #14.94 1.75 30.27 30.27 090

69603 ............ A Mastoid surgery revision .................................... *14.02 #15.42 #15.42 1.88 31.32 31.32 090

69604 ............ A Mastoid surgery revision .................................... *14.02 #15.42 #15.42 2.70 32.14 32.14 090

69605 ............ A Mastoid surgery revision .................................... *18.49 14.95 14.95 1.86 35.30 35.30 090

69610 ............ A Repair of eardrum .............................................. *4.43 0.93 0.93 0.10 5.46 5.46 010

69620 ............ A Repair of eardrum .............................................. *5.89 #6.48 #6.48 1.16 13.53 13.53 090

69631 ............ A Repair eardrum structures ................................. *9.86 #10.85 #10.85 1.61 22.32 22.32 090

69632 ............ A Rebuild eardrum structures ................................ *12.75 #14.03 #14.03 1.73 28.51 28.51 090

69633 ............ A Rebuild eardrum structures ................................ *12.10 #13.31 #13.31 1.78 27.19 27.19 090

69635 ............ A Repair eardrum structures ................................. *13.33 #14.66 #14.66 1.91 29.90 29.90 090

69636 ............ A Rebuild eardrum structures ................................ *15.22 #16.74 #16.74 2.11 34.07 34.07 090

69637 ............ A Rebuild eardrum structures ................................ *15.11 #16.62 #16.62 2.22 33.95 33.95 090

69641 ............ A Revise middle ear & mastoid ............................. *12.71 #13.98 #13.98 1.87 28.56 28.56 090

69642 ............ A Revise middle ear & mastoid ............................. *16.84 #18.52 #18.52 2.21 37.57 37.57 090

69643 ............ A Revise middle ear & mastoid ............................. *15.32 #16.85 #16.85 2.51 34.68 34.68 090

69644 ............ A Revise middle ear & mastoid ............................. *16.97 #18.67 #18.67 2.70 38.34 38.34 090

69645 ............ A Revise middle ear & mastoid ............................. *16.38 #18.02 #18.02 2.51 36.91 36.91 090

69646 ............ A Revise middle ear & mastoid ............................. *17.99 #19.79 #19.79 2.40 40.18 40.18 090

69650 ............ A Release middle ear bone ................................... *9.66 #10.63 #10.63 1.33 21.62 21.62 090

69660 ............ A Revise middle ear bone ..................................... *11.90 #13.09 #13.09 1.82 26.81 26.81 090

69661 ............ A Revise middle ear bone ..................................... *15.74 #17.31 #17.31 1.93 34.98 34.98 090

69662 ............ A Revise middle ear bone ..................................... *15.44 #16.98 #16.98 1.94 34.36 34.36 090

69666 ............ A Repair middle ear structures .............................. *9.75 #10.73 #10.73 1.77 22.25 22.25 090

69667 ............ A Repair middle ear structures .............................. *9.76 #10.74 #10.74 1.66 22.16 22.16 090

69670 ............ A Remove mastoid air cells ................................... *11.51 10.18 10.18 1.08 22.77 22.77 090

69676 ............ A Remove middle ear nerve .................................. *9.52 8.53 8.53 0.86 18.91 18.91 090

69700 ............ A Close mastoid fistula .......................................... *8.23 7.86 7.86 0.84 16.93 16.93 090

69710 ............ N Implant/replace hearing aid ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

69711 ............ A Remove/repair hearing aid ................................. *10.44 8.44 8.44 0.44 19.32 19.32 090

69720 ............ A Release facial nerve .......................................... *14.38 #15.82 #15.82 2.27 32.47 32.47 090

69725 ............ A Release facial nerve .......................................... *25.38 14.65 14.65 1.51 41.54 41.54 090

69740 ............ A Repair facial nerve ............................................. *15.96 11.83 11.83 1.69 29.48 29.48 090

69745 ............ A Repair facial nerve ............................................. *16.69 15.95 15.95 1.53 34.17 34.17 090

69799 ............ C Middle ear surgery procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

69801 ............ A Incise inner ear .................................................. *8.56 #9.42 #9.42 1.84 19.82 19.82 090

69802 ............ A Incise inner ear .................................................. *13.10 11.24 11.24 1.22 25.56 25.56 090

69805 ............ A Explore inner ear ................................................ *13.82 13.14 13.14 2.00 28.96 28.96 090

69806 ............ A Explore inner ear ................................................ *12.35 #13.59 #13.59 2.54 28.48 28.48 090

69820 ............ A Establish inner ear window ................................ *10.34 8.85 8.85 1.00 20.19 20.19 090

69840 ............ A Revise inner ear window .................................... *10.26 8.49 8.49 0.51 19.26 19.26 090

69905 ............ A Remove inner ear .............................................. *11.10 #12.21 #12.21 2.07 25.38 25.38 090

69910 ............ A Remove inner ear & mastoid ............................. *13.63 #14.99 #14.99 2.34 30.96 30.96 090

69915 ............ A Incise inner ear nerve ........................................ *21.23 17.71 17.71 2.02 40.96 40.96 090

69930 ............ A Implant cochlear device ..................................... *16.81 #18.49 #18.49 3.34 38.64 38.64 090

69949 ............ C Inner ear surgery procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

69950 ............ A Incise inner ear nerve ........................................ *25.64 17.99 17.99 2.31 45.94 45.94 090

69955 ............ A Release facial nerve .......................................... *27.04 20.28 20.28 2.25 49.57 49.57 090

69960 ............ A Release inner ear canal ..................................... *27.04 17.85 17.85 1.93 46.82 46.82 090

69970 ............ A Remove inner ear lesion .................................... *30.04 19.69 19.69 2.26 51.99 51.99 090

69979 ............ C Temporal bone surgery ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

70010 ............ A Contrast x-ray of brain ....................................... 1.19 4.65 4.65 0.34 6.18 6.18 XXX

70010 TC A Contrast x-ray of brain ....................................... 0.00 4.13 4.13 0.26 4.39 4.39 XXX

70010 26 A Contrast x-ray of brain ....................................... 1.19 0.52 0.52 0.08 1.79 1.79 XXX

70015 ............ A Contrast x-ray of brain ....................................... 1.19 1.81 1.81 0.17 3.17 3.17 XXX

70015 TC A Contrast x-ray of brain ....................................... 0.00 1.29 1.29 0.09 1.38 1.38 XXX

70015 26 A Contrast x-ray of brain ....................................... 1.19 0.52 0.52 0.08 1.79 1.79 XXX

70030 ............ A X-ray eye for foreign body ................................. 0.17 0.48 0.48 0.04 0.69 0.69 XXX

70030 TC A X-ray eye for foreign body ................................. 0.00 0.40 0.40 0.03 0.43 0.43 XXX

70030 26 A X-ray eye for foreign body ................................. 0.17 0.08 0.08 0.01 0.26 0.26 XXX

70100 ............ A X-ray exam of jaw .............................................. 0.18 0.59 0.59 0.04 0.81 0.81 XXX

70100 TC A X-ray exam of jaw .............................................. 0.00 0.50 0.50 0.03 0.53 0.53 XXX

70100 26 A X-ray exam of jaw .............................................. 0.18 0.09 0.09 0.01 0.28 0.28 XXX

70110 ............ A X-ray exam of jaw .............................................. 0.25 0.71 0.71 0.06 1.02 1.02 XXX

70110 TC A X-ray exam of jaw .............................................. 0.00 0.59 0.59 0.04 0.63 0.63 XXX

70110 26 A X-ray exam of jaw .............................................. 0.25 0.12 0.12 0.02 0.39 0.39 XXX
59170

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

70120 ............ A X-ray exam of mastoids ..................................... 0.18 0.68 0.68 0.05 0.91 0.91 XXX

70120 TC A X-ray exam of mastoids ..................................... 0.00 0.59 0.59 0.04 0.63 0.63 XXX

70120 26 A X-ray exam of mastoids ..................................... 0.18 0.09 0.09 0.01 0.28 0.28 XXX

70130 ............ A X-ray exam of mastoids ..................................... 0.34 0.91 0.91 0.07 1.32 1.32 XXX

70130 TC A X-ray exam of mastoids ..................................... 0.00 0.75 0.75 0.05 0.80 0.80 XXX

70130 26 A X-ray exam of mastoids ..................................... 0.34 0.16 0.16 0.02 0.52 0.52 XXX

70134 ............ A X-ray exam of middle ear .................................. 0.34 0.86 0.86 0.07 1.27 1.27 XXX

70134 TC A X-ray exam of middle ear .................................. 0.00 0.70 0.70 0.05 0.75 0.75 XXX

70134 26 A X-ray exam of middle ear .................................. 0.34 0.16 0.16 0.02 0.52 0.52 XXX

70140 ............ A X-ray exam of facial bones ................................ 0.19 0.68 0.68 0.05 0.92 0.92 XXX

70140 TC A X-ray exam of facial bones ................................ 0.00 0.59 0.59 0.04 0.63 0.63 XXX

70140 26 A X-ray exam of facial bones ................................ 0.19 0.09 0.09 0.01 0.29 0.29 XXX

70150 ............ A X-ray exam of facial bones ................................ 0.26 0.87 0.87 0.07 1.20 1.20 XXX

70150 TC A X-ray exam of facial bones ................................ 0.00 0.75 0.75 0.05 0.80 0.80 XXX

70150 26 A X-ray exam of facial bones ................................ 0.26 0.12 0.12 0.02 0.40 0.40 XXX

70160 ............ A X-ray exam of nasal bones ................................ 0.17 0.58 0.58 0.04 0.79 0.79 XXX

70160 TC A X-ray exam of nasal bones ................................ 0.00 0.50 0.50 0.03 0.53 0.53 XXX

70160 26 A X-ray exam of nasal bones ................................ 0.17 0.08 0.08 0.01 0.26 0.26 XXX

70170 ............ A X-ray exam of tear duct ..................................... 0.30 1.04 1.04 0.08 1.42 1.42 XXX

70170 TC A X-ray exam of tear duct ..................................... 0.00 0.90 0.90 0.06 0.96 0.96 XXX

70170 26 A X-ray exam of tear duct ..................................... 0.30 0.14 0.14 0.02 0.46 0.46 XXX

70190 ............ A X-ray exam of eye sockets ................................ 0.21 0.69 0.69 0.05 0.95 0.95 XXX

70190 TC A X-ray exam of eye sockets ................................ 0.00 0.59 0.59 0.04 0.63 0.63 XXX

70190 26 A X-ray exam of eye sockets ................................ 0.21 0.10 0.10 0.01 0.32 0.32 XXX

70200 ............ A X-ray exam of eye sockets ................................ 0.28 0.88 0.88 0.07 1.23 1.23 XXX

70200 TC A X-ray exam of eye sockets ................................ 0.00 0.75 0.75 0.05 0.80 0.80 XXX

70200 26 A X-ray exam of eye sockets ................................ 0.28 0.13 0.13 0.02 0.43 0.43 XXX

70210 ............ A X-ray exam of sinuses ....................................... 0.17 0.67 0.67 0.05 0.89 0.89 XXX

70210 TC A X-ray exam of sinuses ....................................... 0.00 0.59 0.59 0.04 0.63 0.63 XXX

70210 26 A X-ray exam of sinuses ....................................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX

70220 ............ A X-ray exam of sinuses ....................................... 0.25 0.87 0.87 0.07 1.19 1.19 XXX

70220 TC A X-ray exam of sinuses ....................................... 0.00 0.75 0.75 0.05 0.80 0.80 XXX

70220 26 A X-ray exam of sinuses ....................................... 0.25 0.12 0.12 0.02 0.39 0.39 XXX

70240 ............ A X-ray exam pituitary saddle ............................... 0.19 0.49 0.49 0.04 0.72 0.72 XXX

70240 TC A X-ray exam pituitary saddle ............................... 0.00 0.40 0.40 0.03 0.43 0.43 XXX

70240 26 A X-ray exam pituitary saddle ............................... 0.19 0.09 0.09 0.01 0.29 0.29 XXX

70250 ............ A X-ray exam of skull ............................................ 0.24 0.70 0.70 0.06 1.00 1.00 XXX

70250 TC A X-ray exam of skull ............................................ 0.00 0.59 0.59 0.04 0.63 0.63 XXX

70250 26 A X-ray exam of skull ............................................ 0.24 0.11 0.11 0.02 0.37 0.37 XXX

70260 ............ A X-ray exam of skull ............................................ 0.34 1.01 1.01 0.08 1.43 1.43 XXX

70260 TC A X-ray exam of skull ............................................ 0.00 0.85 0.85 0.06 0.91 0.91 XXX

70260 26 A X-ray exam of skull ............................................ 0.34 0.16 0.16 0.02 0.52 0.52 XXX

70300 ............ A X-ray exam of teeth ........................................... 0.10 0.30 0.30 0.03 0.43 0.43 XXX

70300 TC A X-ray exam of teeth ........................................... 0.00 0.25 0.25 0.02 0.27 0.27 XXX

70300 26 A X-ray exam of teeth ........................................... 0.10 0.05 0.05 0.01 0.16 0.16 XXX

70310 ............ A X-ray exam of teeth ........................................... 0.16 0.47 0.47 0.04 0.67 0.67 XXX

70310 TC A X-ray exam of teeth ........................................... 0.00 0.40 0.40 0.03 0.43 0.43 XXX

70310 26 A X-ray exam of teeth ........................................... 0.16 0.07 0.07 0.01 0.24 0.24 XXX

70320 ............ A Full mouth x-ray of teeth .................................... 0.22 0.85 0.85 0.07 1.14 1.14 XXX

70320 TC A Full mouth x-ray of teeth .................................... 0.00 0.75 0.75 0.05 0.80 0.80 XXX

70320 26 A Full mouth x-ray of teeth .................................... 0.22 0.10 0.10 0.02 0.34 0.34 XXX

70328 ............ A X-ray exam of jaw joint ...................................... 0.18 0.56 0.56 0.04 0.78 0.78 XXX

70328 TC A X-ray exam of jaw joint ...................................... 0.00 0.47 0.47 0.03 0.50 0.50 XXX

70328 26 A X-ray exam of jaw joint ...................................... 0.18 0.09 0.09 0.01 0.28 0.28 XXX

70330 ............ A X-ray exam of jaw joints .................................... 0.24 0.91 0.91 0.07 1.22 1.22 XXX

70330 TC A X-ray exam of jaw joints .................................... 0.00 0.80 0.80 0.05 0.85 0.85 XXX

70330 26 A X-ray exam of jaw joints .................................... 0.24 0.11 0.11 0.02 0.37 0.37 XXX

70332 ............ A X-ray exam of jaw joint ...................................... 0.54 2.25 2.25 0.17 2.96 2.96 XXX

70332 TC A X-ray exam of jaw joint ...................................... 0.00 2.00 2.00 0.13 2.13 2.13 XXX

70332 26 A X-ray exam of jaw joint ...................................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

70336 ............ A Magnetic image jaw joint ................................... 1.48 11.11 11.11 0.73 13.32 13.32 XXX

70336 TC A Magnetic image jaw joint ................................... 0.00 10.68 10.68 0.67 11.35 11.35 XXX

70336 26 A Magnetic image jaw joint ................................... 1.48 0.43 0.43 0.06 1.97 1.97 XXX

70350 ............ A X-ray head for orthodontia ................................. 0.17 0.44 0.44 0.03 0.64 0.64 XXX

70350 TC A X-ray head for orthodontia ................................. 0.00 0.36 0.36 0.02 0.38 0.38 XXX

70350 26 A X-ray head for orthodontia ................................. 0.17 0.08 0.08 0.01 0.26 0.26 XXX

70355 ............ A Panoramic x-ray of jaws .................................... 0.20 0.63 0.63 0.05 0.88 0.88 XXX

70355 TC A Panoramic x-ray of jaws .................................... 0.00 0.54 0.54 0.04 0.58 0.58 XXX

70355 26 A Panoramic x-ray of jaws .................................... 0.20 0.09 0.09 0.01 0.30 0.30 XXX

70360 ............ A X-ray exam of neck ............................................ 0.17 0.48 0.48 0.04 0.69 0.69 XXX

70360 TC A X-ray exam of neck ............................................ 0.00 0.40 0.40 0.03 0.43 0.43 XXX

70360 26 A X-ray exam of neck ............................................ 0.17 0.08 0.08 0.01 0.26 0.26 XXX

70370 ............ A Throat x-ray & fluoroscopy ................................. 0.32 1.39 1.39 0.10 1.81 1.81 XXX

70370 TC A Throat x-ray & fluoroscopy ................................. 0.00 1.24 1.24 0.08 1.32 1.32 XXX
59171

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

70370 26 A Throat x-ray & fluoroscopy ................................. 0.32 0.15 0.15 0.02 0.49 0.49 XXX

70371 ............ A Speech evaluation, complex .............................. 0.84 2.38 2.38 0.19 3.41 3.41 XXX

70371 TC A Speech evaluation, complex .............................. 0.00 2.00 2.00 0.13 2.13 2.13 XXX

70371 26 A Speech evaluation, complex .............................. 0.84 0.38 0.38 0.06 1.28 1.28 XXX

70373 ............ A Contrast x-ray of larynx ...................................... 0.44 1.90 1.90 0.14 2.48 2.48 XXX

70373 TC A Contrast x-ray of larynx ...................................... 0.00 1.70 1.70 0.11 1.81 1.81 XXX

70373 26 A Contrast x-ray of larynx ...................................... 0.44 0.20 0.20 0.03 0.67 0.67 XXX

70380 ............ A X-ray exam of salivary gland ............................. 0.17 0.72 0.72 0.05 0.94 0.94 XXX

70380 TC A X-ray exam of salivary gland ............................. 0.00 0.64 0.64 0.04 0.68 0.68 XXX

70380 26 A X-ray exam of salivary gland ............................. 0.17 0.08 0.08 0.01 0.26 0.26 XXX

70390 ............ A X-ray exam of salivary duct ............................... 0.38 1.87 1.87 0.14 2.39 2.39 XXX

70390 TC A X-ray exam of salivary duct ............................... 0.00 1.70 1.70 0.11 1.81 1.81 XXX

70390 26 A X-ray exam of salivary duct ............................... 0.38 0.17 0.17 0.03 0.58 0.58 XXX

70450 ............ A CAT scan of head or brain ................................ 0.85 4.88 4.88 0.35 6.08 6.08 XXX

70450 TC A CAT scan of head or brain ................................ 0.00 4.50 4.50 0.29 4.79 4.79 XXX

70450 26 A CAT scan of head or brain ................................ 0.85 0.38 0.38 0.06 1.29 1.29 XXX

70460 ............ A Contrast CAT scan of head ............................... 1.13 5.89 5.89 0.43 7.45 7.45 XXX

70460 TC A Contrast CAT scan of head ............................... 0.00 5.39 5.39 0.35 5.74 5.74 XXX

70460 26 A Contrast CAT scan of head ............................... 1.13 0.50 0.50 0.08 1.71 1.71 XXX

70470 ............ A Contrast CAT scans of head ............................. 1.27 7.30 7.30 0.52 9.09 9.09 XXX

70470 TC A Contrast CAT scans of head ............................. 0.00 6.74 6.74 0.43 7.17 7.17 XXX

70470 26 A Contrast CAT scans of head ............................. 1.27 0.56 0.56 0.09 1.92 1.92 XXX

70480 ............ A CAT scan of skull ............................................... 1.28 5.07 5.07 0.38 6.73 6.73 XXX

70480 TC A CAT scan of skull ............................................... 0.00 4.50 4.50 0.29 4.79 4.79 XXX

70480 26 A CAT scan of skull ............................................... 1.28 0.57 0.57 0.09 1.94 1.94 XXX

70481 ............ A Contrast CAT scan of skull ................................ 1.38 6.00 6.00 0.44 7.82 7.82 XXX

70481 TC A Contrast CAT scan of skull ................................ 0.00 5.39 5.39 0.35 5.74 5.74 XXX

70481 26 A Contrast CAT scan of skull ................................ 1.38 0.61 0.61 0.09 2.08 2.08 XXX

70482 ............ A Contrast CAT scans of skull .............................. 1.45 7.38 7.38 0.53 9.36 9.36 XXX

70482 TC A Contrast CAT scans of skull .............................. 0.00 6.74 6.74 0.43 7.17 7.17 XXX

70482 26 A Contrast CAT scans of skull .............................. 1.45 0.64 0.64 0.10 2.19 2.19 XXX

70486 ............ A CAT scan of face, jaw ........................................ 1.14 5.00 5.00 0.37 6.51 6.51 XXX

70486 TC A CAT scan of face, jaw ........................................ 0.00 4.50 4.50 0.29 4.79 4.79 XXX

70486 26 A CAT scan of face, jaw ........................................ 1.14 0.50 0.50 0.08 1.72 1.72 XXX

70487 ............ A Contrast CAT scan, face/jaw ............................. 1.30 5.96 5.96 0.44 7.70 7.70 XXX

70487 TC A Contrast CAT scan, face/jaw ............................. 0.00 5.39 5.39 0.35 5.74 5.74 XXX

70487 26 A Contrast CAT scan, face/jaw ............................. 1.30 0.57 0.57 0.09 1.96 1.96 XXX

70488 ............ A Contrast CAT scans face/jaw ............................ 1.42 7.37 7.37 0.53 9.32 9.32 XXX

70488 TC A Contrast CAT scans face/jaw ............................ 0.00 6.74 6.74 0.43 7.17 7.17 XXX

70488 26 A Contrast CAT scans face/jaw ............................ 1.42 0.63 0.63 0.10 2.15 2.15 XXX

70490 ............ A CAT scan of neck tissue .................................... 1.28 5.07 5.07 0.38 6.73 6.73 XXX

70490 TC A CAT scan of neck tissue .................................... 0.00 4.50 4.50 0.29 4.79 4.79 XXX

70490 26 A CAT scan of neck tissue .................................... 1.28 0.57 0.57 0.09 1.94 1.94 XXX

70491 ............ A Contrast CAT of neck tissue .............................. 1.38 6.00 6.00 0.44 7.82 7.82 XXX

70491 TC A Contrast CAT of neck tissue .............................. 0.00 5.39 5.39 0.35 5.74 5.74 XXX

70491 26 A Contrast CAT of neck tissue .............................. 1.38 0.61 0.61 0.09 2.08 2.08 XXX

70492 ............ A Contrast CAT of neck tissue .............................. 1.45 7.38 7.38 0.53 9.36 9.36 XXX

70492 TC A Contrast CAT of neck tissue .............................. 0.00 6.74 6.74 0.43 7.17 7.17 XXX

70492 26 A Contrast CAT of neck tissue .............................. 1.45 0.64 0.64 0.10 2.19 2.19 XXX

70540 ............ A Magnetic image, face, neck ............................... 1.48 11.34 11.34 0.77 13.59 13.59 XXX

70540 TC A Magnetic image, face, neck ............................... 0.00 10.68 10.68 0.67 11.35 11.35 XXX

70540 26 A Magnetic image, face, neck ............................... 1.48 0.66 0.66 0.10 2.24 2.24 XXX

70541 ............ R Magnetic image, head (MRA) ............................ 1.81 11.34 11.34 0.77 13.92 13.92 XXX

70541 TC R Magnetic image, head (MRA) ............................ 0.00 10.68 10.68 0.67 11.35 11.35 XXX

70541 26 R Magnetic image, head (MRA) ............................ 1.81 0.66 0.66 0.10 2.57 2.57 XXX

70551 ............ A Magnetic image, brain (MRI) ............................. 1.48 11.34 11.34 0.77 13.59 13.59 XXX

70551 TC A Magnetic image, brain (MRI) ............................. 0.00 10.68 10.68 0.67 11.35 11.35 XXX

70551 26 A Magnetic image, brain (MRI) ............................. 1.48 0.66 0.66 0.10 2.24 2.24 XXX

70552 ............ A Magnetic image, brain (MRI) ............................. 1.78 13.61 13.61 0.93 16.32 16.32 XXX

70552 TC A Magnetic image, brain (MRI) ............................. 0.00 12.81 12.81 0.81 13.62 13.62 XXX

70552 26 A Magnetic image, brain (MRI) ............................. 1.78 0.80 0.80 0.12 2.70 2.70 XXX

70553 ............ A Magnetic image, brain ........................................ 2.36 24.79 24.79 1.65 28.80 28.80 XXX

70553 TC A Magnetic image, brain ........................................ 0.00 23.72 23.72 1.49 25.21 25.21 XXX

70553 26 A Magnetic image, brain ........................................ 2.36 1.07 1.07 0.16 3.59 3.59 XXX

71010 ............ A Chest x-ray ......................................................... 0.18 0.53 0.53 0.04 0.75 0.75 XXX

71010 TC A Chest x-ray ......................................................... 0.00 0.45 0.45 0.03 0.48 0.48 XXX

71010 26 A Chest x-ray ......................................................... 0.18 0.08 0.08 0.01 0.27 0.27 XXX

71015 ............ A X-ray exam of chest ........................................... 0.21 0.60 0.60 0.04 0.85 0.85 XXX

71015 TC A X-ray exam of chest ........................................... 0.00 0.50 0.50 0.03 0.53 0.53 XXX

71015 26 A X-ray exam of chest ........................................... 0.21 0.10 0.10 0.01 0.32 0.32 XXX

71020 ............ A Chest x-ray ......................................................... 0.22 0.69 0.69 0.05 0.96 0.96 XXX

71020 TC A Chest x-ray ......................................................... 0.00 0.59 0.59 0.04 0.63 0.63 XXX

71020 26 A Chest x-ray ......................................................... 0.22 0.10 0.10 0.01 0.33 0.33 XXX

71021 ............ A Chest x-ray ......................................................... 0.27 0.82 0.82 0.07 1.16 1.16 XXX
59172

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

71021 TC A Chest x-ray ......................................................... 0.00 0.70 0.70 0.05 0.75 0.75 XXX

71021 26 A Chest x-ray ......................................................... 0.27 0.12 0.12 0.02 0.41 0.41 XXX

71022 ............ A Chest x-ray ......................................................... 0.31 0.84 0.84 0.07 1.22 1.22 XXX

71022 TC A Chest x-ray ......................................................... 0.00 0.70 0.70 0.05 0.75 0.75 XXX

71022 26 A Chest x-ray ......................................................... 0.31 0.14 0.14 0.02 0.47 0.47 XXX

71023 ............ A Chest x-ray and fluoroscopy .............................. 0.38 0.92 0.92 0.08 1.38 1.38 XXX

71023 TC A Chest x-ray and fluoroscopy .............................. 0.00 0.75 0.75 0.05 0.80 0.80 XXX

71023 26 A Chest x-ray and fluoroscopy .............................. 0.38 0.17 0.17 0.03 0.58 0.58 XXX

71030 ............ A Chest x-ray ......................................................... 0.31 0.89 0.89 0.07 1.27 1.27 XXX

71030 TC A Chest x-ray ......................................................... 0.00 0.75 0.75 0.05 0.80 0.80 XXX

71030 26 A Chest x-ray ......................................................... 0.31 0.14 0.14 0.02 0.47 0.47 XXX

71034 ............ A Chest x-ray & fluoroscopy .................................. 0.46 1.58 1.58 0.12 2.16 2.16 XXX

71034 TC A Chest x-ray & fluoroscopy .................................. 0.00 1.37 1.37 0.09 1.46 1.46 XXX

71034 26 A Chest x-ray & fluoroscopy .................................. 0.46 0.21 0.21 0.03 0.70 0.70 XXX

71035 ............ A Chest x-ray ......................................................... 0.18 0.58 0.58 0.04 0.80 0.80 XXX

71035 TC A Chest x-ray ......................................................... 0.00 0.50 0.50 0.03 0.53 0.53 XXX

71035 26 A Chest x-ray ......................................................... 0.18 0.08 0.08 0.01 0.27 0.27 XXX

71036 ............ A X-ray guidance for biopsy .................................. 0.54 1.75 1.75 0.14 2.43 2.43 XXX

71036 TC A X-ray guidance for biopsy .................................. 0.00 1.50 1.50 0.10 1.60 1.60 XXX

71036 26 A X-ray guidance for biopsy .................................. 0.54 0.25 0.25 0.04 0.83 0.83 XXX

71038 ............ A X-ray guidance for biopsy .................................. 0.54 1.85 1.85 0.15 2.54 2.54 XXX

71038 TC A X-ray guidance for biopsy .................................. 0.00 1.60 1.60 0.11 1.71 1.71 XXX

71038 26 A X-ray guidance for biopsy .................................. 0.54 0.25 0.25 0.04 0.83 0.83 XXX

71040 ............ A Contrast x-ray of bronchi ................................... 0.58 1.66 1.66 0.13 2.37 2.37 XXX

71040 TC A Contrast x-ray of bronchi ................................... 0.00 1.39 1.39 0.09 1.48 1.48 XXX

71040 26 A Contrast x-ray of bronchi ................................... 0.58 0.27 0.27 0.04 0.89 0.89 XXX

71060 ............ A Contrast x-ray of bronchi ................................... 0.74 2.44 2.44 0.19 3.37 3.37 XXX

71060 TC A Contrast x-ray of bronchi ................................... 0.00 2.10 2.10 0.14 2.24 2.24 XXX

71060 26 A Contrast x-ray of bronchi ................................... 0.74 0.34 0.34 0.05 1.13 1.13 XXX

71090 ............ A X-ray & pacemaker insertion ............................. 0.54 1.85 1.85 0.15 2.54 2.54 XXX

71090 TC A X-ray & pacemaker insertion ............................. 0.00 1.60 1.60 0.11 1.71 1.71 XXX

71090 26 A X-ray & pacemaker insertion ............................. 0.54 0.25 0.25 0.04 0.83 0.83 XXX

71100 ............ A X-ray exam of ribs .............................................. 0.22 0.64 0.64 0.06 0.92 0.92 XXX

71100 TC A X-ray exam of ribs .............................................. 0.00 0.54 0.54 0.04 0.58 0.58 XXX

71100 26 A X-ray exam of ribs .............................................. 0.22 0.10 0.10 0.02 0.34 0.34 XXX

71101 ............ A X-ray exam of ribs, chest ................................... 0.27 0.77 0.77 0.06 1.10 1.10 XXX

71101 TC A X-ray exam of ribs, chest ................................... 0.00 0.64 0.64 0.04 0.68 0.68 XXX

71101 26 A X-ray exam of ribs, chest ................................... 0.27 0.13 0.13 0.02 0.42 0.42 XXX

71110 ............ A X-ray exam of ribs .............................................. 0.27 0.88 0.88 0.07 1.22 1.22 XXX

71110 TC A X-ray exam of ribs .............................................. 0.00 0.75 0.75 0.05 0.80 0.80 XXX

71110 26 A X-ray exam of ribs .............................................. 0.27 0.13 0.13 0.02 0.42 0.42 XXX

71111 ............ A X-ray exam of ribs, chest ................................... 0.32 1.00 1.00 0.08 1.40 1.40 XXX

71111 TC A X-ray exam of ribs, chest ................................... 0.00 0.85 0.85 0.06 0.91 0.91 XXX

71111 26 A X-ray exam of ribs, chest ................................... 0.32 0.15 0.15 0.02 0.49 0.49 XXX

71120 ............ A X-ray exam of breastbone ................................. 0.20 0.71 0.71 0.05 0.96 0.96 XXX

71120 TC A X-ray exam of breastbone ................................. 0.00 0.62 0.62 0.04 0.66 0.66 XXX

71120 26 A X-ray exam of breastbone ................................. 0.20 0.09 0.09 0.01 0.30 0.30 XXX

71130 ............ A X-ray exam of breastbone ................................. 0.22 0.77 0.77 0.05 1.04 1.04 XXX

71130 TC A X-ray exam of breastbone ................................. 0.00 0.67 0.67 0.04 0.71 0.71 XXX

71130 26 A X-ray exam of breastbone ................................. 0.22 0.10 0.10 0.01 0.33 0.33 XXX

71250 ............ A Cat scan of chest ............................................... 1.16 6.14 6.14 0.44 7.74 7.74 XXX

71250 TC A Cat scan of chest ............................................... 0.00 5.63 5.63 0.36 5.99 5.99 XXX

71250 26 A Cat scan of chest ............................................... 1.16 0.51 0.51 0.08 1.75 1.75 XXX

71260 ............ A Contrast CAT scan of chest ............................... 1.24 7.29 7.29 0.51 9.04 9.04 XXX

71260 TC A Contrast CAT scan of chest ............................... 0.00 6.74 6.74 0.43 7.17 7.17 XXX

71260 26 A Contrast CAT scan of chest ............................... 1.24 0.55 0.55 0.08 1.87 1.87 XXX

71270 ............ A Contrast CAT scans of chest ............................. 1.38 9.04 9.04 0.61 11.03 11.03 XXX

71270 TC A Contrast CAT scans of chest ............................. 0.00 8.43 8.43 0.52 8.95 8.95 XXX

71270 26 A Contrast CAT scans of chest ............................. 1.38 0.61 0.61 0.09 2.08 2.08 XXX

71550 ............ A Magnetic image, chest ....................................... 1.60 11.40 11.40 0.78 13.78 13.78 XXX

71550 TC A Magnetic image, chest ....................................... 0.00 10.68 10.68 0.67 11.35 11.35 XXX

71550 26 A Magnetic image, chest ....................................... 1.60 0.72 0.72 0.11 2.43 2.43 XXX

71555 ............ N Magnetic imaging/chest (MRA) .......................... +1.81 11.40 11.40 0.78 13.99 13.99 XXX

71555 TC N Magnetic imaging/chest (MRA) .......................... +0.00 10.68 10.68 0.67 11.35 11.35 XXX

71555 26 N Magnetic imaging/chest (MRA) .......................... +1.81 0.72 0.72 0.11 2.64 2.64 XXX

72010 ............ A X-ray exam of spine ........................................... 0.45 1.18 1.18 0.09 1.72 1.72 XXX

72010 TC A X-ray exam of spine ........................................... 0.00 0.98 0.98 0.06 1.04 1.04 XXX

72010 26 A X-ray exam of spine ........................................... 0.45 0.20 0.20 0.03 0.68 0.68 XXX

72020 ............ A X-ray exam of spine ........................................... 0.15 0.47 0.47 0.04 0.66 0.66 XXX

72020 TC A X-ray exam of spine ........................................... 0.00 0.40 0.40 0.03 0.43 0.43 XXX

72020 26 A X-ray exam of spine ........................................... 0.15 0.07 0.07 0.01 0.23 0.23 XXX

72040 ............ A X-ray exam of neck spine .................................. 0.22 0.67 0.67 0.05 0.94 0.94 XXX

72040 TC A X-ray exam of neck spine .................................. 0.00 0.57 0.57 0.04 0.61 0.61 XXX

72040 26 A X-ray exam of neck spine .................................. 0.22 0.10 0.10 0.01 0.33 0.33 XXX
59173

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

72050 ............ A X-ray exam of neck spine .................................. 0.31 0.99 0.99 0.08 1.38 1.38 XXX

72050 TC A X-ray exam of neck spine .................................. 0.00 0.85 0.85 0.06 0.91 0.91 XXX

72050 26 A X-ray exam of neck spine .................................. 0.31 0.14 0.14 0.02 0.47 0.47 XXX

72052 ............ A X-ray exam of neck spine .................................. 0.36 1.25 1.25 0.09 1.70 1.70 XXX

72052 TC A X-ray exam of neck spine .................................. 0.00 1.08 1.08 0.07 1.15 1.15 XXX

72052 26 A X-ray exam of neck spine .................................. 0.36 0.17 0.17 0.02 0.55 0.55 XXX

72069 ............ A X-ray exam of trunk spine .................................. 0.22 0.57 0.57 0.04 0.83 0.83 XXX

72069 TC A X-ray exam of trunk spine .................................. 0.00 0.47 0.47 0.03 0.50 0.50 XXX

72069 26 A X-ray exam of trunk spine .................................. 0.22 0.10 0.10 0.01 0.33 0.33 XXX

72070 ............ A X-ray exam of thorax spine ................................ 0.22 0.72 0.72 0.05 0.99 0.99 XXX

72070 TC A X-ray exam of thorax spine ................................ 0.00 0.62 0.62 0.04 0.66 0.66 XXX

72070 26 A X-ray exam of thorax spine ................................ 0.22 0.10 0.10 0.01 0.33 0.33 XXX

72072 ............ A X-ray exam of thoracic spine ............................. 0.22 0.80 0.80 0.06 1.08 1.08 XXX

72072 TC A X-ray exam of thoracic spine ............................. 0.00 0.70 0.70 0.05 0.75 0.75 XXX

72072 26 A X-ray exam of thoracic spine ............................. 0.22 0.10 0.10 0.01 0.33 0.33 XXX

72074 ............ A X-ray exam of thoracic spine ............................. 0.22 0.97 0.97 0.07 1.26 1.26 XXX

72074 TC A X-ray exam of thoracic spine ............................. 0.00 0.87 0.87 0.06 0.93 0.93 XXX

72074 26 A X-ray exam of thoracic spine ............................. 0.22 0.10 0.10 0.01 0.33 0.33 XXX

72080 ............ A X-ray exam of trunk spine .................................. 0.22 0.74 0.74 0.05 1.01 1.01 XXX

72080 TC A X-ray exam of trunk spine .................................. 0.00 0.64 0.64 0.04 0.68 0.68 XXX

72080 26 A X-ray exam of trunk spine .................................. 0.22 0.10 0.10 0.01 0.33 0.33 XXX

72090 ............ A X-ray exam of trunk spine .................................. 0.28 0.77 0.77 0.06 1.11 1.11 XXX

72090 TC A X-ray exam of trunk spine .................................. 0.00 0.64 0.64 0.04 0.68 0.68 XXX

72090 26 A X-ray exam of trunk spine .................................. 0.28 0.13 0.13 0.02 0.43 0.43 XXX

72100 ............ A X-ray exam of lower spine ................................. 0.22 0.74 0.74 0.05 1.01 1.01 XXX

72100 TC A X-ray exam of lower spine ................................. 0.00 0.64 0.64 0.04 0.68 0.68 XXX

72100 26 A X-ray exam of lower spine ................................. 0.22 0.10 0.10 0.01 0.33 0.33 XXX

72110 ............ A X-ray exam of lower spine ................................. 0.31 1.01 1.01 0.08 1.40 1.40 XXX

72110 TC A X-ray exam of lower spine ................................. 0.00 0.87 0.87 0.06 0.93 0.93 XXX

72110 26 A X-ray exam of lower spine ................................. 0.31 0.14 0.14 0.02 0.47 0.47 XXX

72114 ............ A X-ray exam of lower spine ................................. 0.36 1.30 1.30 0.09 1.75 1.75 XXX

72114 TC A X-ray exam of lower spine ................................. 0.00 1.13 1.13 0.07 1.20 1.20 XXX

72114 26 A X-ray exam of lower spine ................................. 0.36 0.17 0.17 0.02 0.55 0.55 XXX

72120 ............ A X-ray exam of lower spine ................................. 0.22 0.95 0.95 0.07 1.24 1.24 XXX

72120 TC A X-ray exam of lower spine ................................. 0.00 0.85 0.85 0.06 0.91 0.91 XXX

72120 26 A X-ray exam of lower spine ................................. 0.22 0.10 0.10 0.01 0.33 0.33 XXX

72125 ............ A CAT scan of neck spine ..................................... 1.16 6.14 6.14 0.44 7.74 7.74 XXX

72125 TC A CAT scan of neck spine ..................................... 0.00 5.63 5.63 0.36 5.99 5.99 XXX

72125 26 A CAT scan of neck spine ..................................... 1.16 0.51 0.51 0.08 1.75 1.75 XXX

72126 ............ A Contrast CAT scan of neck ................................ 1.22 7.27 7.27 0.51 9.00 9.00 XXX

72126 TC A Contrast CAT scan of neck ................................ 0.00 6.74 6.74 0.43 7.17 7.17 XXX

72126 26 A Contrast CAT scan of neck ................................ 1.22 0.53 0.53 0.08 1.83 1.83 XXX

72127 ............ A Contrast CAT scans of neck .............................. 1.27 8.99 8.99 0.61 10.87 10.87 XXX

72127 TC A Contrast CAT scans of neck .............................. 0.00 8.43 8.43 0.52 8.95 8.95 XXX

72127 26 A Contrast CAT scans of neck .............................. 1.27 0.56 0.56 0.09 1.92 1.92 XXX

72128 ............ A CAT scan of thorax spine .................................. 1.16 6.14 6.14 0.44 7.74 7.74 XXX

72128 TC A CAT scan of thorax spine .................................. 0.00 5.63 5.63 0.36 5.99 5.99 XXX

72128 26 A CAT scan of thorax spine .................................. 1.16 0.51 0.51 0.08 1.75 1.75 XXX

72129 ............ A Contrast CAT scan of thorax ............................. 1.22 7.27 7.27 0.51 9.00 9.00 XXX

72129 TC A Contrast CAT scan of thorax ............................. 0.00 6.74 6.74 0.43 7.17 7.17 XXX

72129 26 A Contrast CAT scan of thorax ............................. 1.22 0.53 0.53 0.08 1.83 1.83 XXX

72130 ............ A Contrast CAT scans of thorax ........................... 1.27 8.99 8.99 0.61 10.87 10.87 XXX

72130 TC A Contrast CAT scans of thorax ........................... 0.00 8.43 8.43 0.52 8.95 8.95 XXX

72130 26 A Contrast CAT scans of thorax ........................... 1.27 0.56 0.56 0.09 1.92 1.92 XXX

72131 ............ A CAT scan of lower spine .................................... 1.16 6.14 6.14 0.44 7.74 7.74 XXX

72131 TC A CAT scan of lower spine .................................... 0.00 5.63 5.63 0.36 5.99 5.99 XXX

72131 26 A CAT scan of lower spine .................................... 1.16 0.51 0.51 0.08 1.75 1.75 XXX

72132 ............ A Contrast CAT of lower spine .............................. 1.22 7.27 7.27 0.51 9.00 9.00 XXX

72132 TC A Contrast CAT of lower spine .............................. 0.00 6.74 6.74 0.43 7.17 7.17 XXX

72132 26 A Contrast CAT of lower spine .............................. 1.22 0.53 0.53 0.08 1.83 1.83 XXX

72133 ............ A Contrast CAT scans, low spine ......................... 1.27 8.99 8.99 0.61 10.87 10.87 XXX

72133 TC A Contrast CAT scans, low spine ......................... 0.00 8.43 8.43 0.52 8.95 8.95 XXX

72133 26 A Contrast CAT scans, low spine ......................... 1.27 0.56 0.56 0.09 1.92 1.92 XXX

72141 ............ A Magnetic image, neck spine .............................. 1.60 11.40 11.40 0.78 13.78 13.78 XXX

72141 TC A Magnetic image, neck spine .............................. 0.00 10.68 10.68 0.67 11.35 11.35 XXX

72141 26 A Magnetic image, neck spine .............................. 1.60 0.72 0.72 0.11 2.43 2.43 XXX

72142 ............ A Magnetic image, neck spine .............................. 1.92 13.67 13.67 0.94 16.53 16.53 XXX

72142 TC A Magnetic image, neck spine .............................. 0.00 12.81 12.81 0.81 13.62 13.62 XXX

72142 26 A Magnetic image, neck spine .............................. 1.92 0.86 0.86 0.13 2.91 2.91 XXX

72146 ............ A Magnetic image, chest spine ............................. 1.60 12.58 12.58 0.85 15.03 15.03 XXX

72146 TC A Magnetic image, chest spine ............................. 0.00 11.86 11.86 0.74 12.60 12.60 XXX

72146 26 A Magnetic image, chest spine ............................. 1.60 0.72 0.72 0.11 2.43 2.43 XXX

72147 ............ A Magnetic image, chest spine ............................. 1.92 13.67 13.67 0.94 16.53 16.53 XXX

72147 TC A Magnetic image, chest spine ............................. 0.00 12.81 12.81 0.81 13.62 13.62 XXX
59174

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

72147 26 A Magnetic image, chest spine ............................. 1.92 0.86 0.86 0.13 2.91 2.91 XXX

72148 ............ A Magnetic image, lumbar spine ........................... 1.48 12.52 12.52 0.84 14.84 14.84 XXX

72148 TC A Magnetic image, lumbar spine ........................... 0.00 11.86 11.86 0.74 12.60 12.60 XXX

72148 26 A Magnetic image, lumbar spine ........................... 1.48 0.66 0.66 0.10 2.24 2.24 XXX

72149 ............ A Magnetic image, lumbar spine ........................... 1.78 13.61 13.61 0.93 16.32 16.32 XXX

72149 TC A Magnetic image, lumbar spine ........................... 0.00 12.81 12.81 0.81 13.62 13.62 XXX

72149 26 A Magnetic image, lumbar spine ........................... 1.78 0.80 0.80 0.12 2.70 2.70 XXX

72156 ............ A Magnetic image, neck spine .............................. 2.57 24.87 24.87 1.66 29.10 29.10 XXX

72156 TC A Magnetic image, neck spine .............................. 0.00 23.72 23.72 1.49 25.21 25.21 XXX

72156 26 A Magnetic image, neck spine .............................. 2.57 1.15 1.15 0.17 3.89 3.89 XXX

72157 ............ A Magnetic image, chest spine ............................. 2.57 24.87 24.87 1.66 29.10 29.10 XXX

72157 TC A Magnetic image, chest spine ............................. 0.00 23.72 23.72 1.49 25.21 25.21 XXX

72157 26 A Magnetic image, chest spine ............................. 2.57 1.15 1.15 0.17 3.89 3.89 XXX

72158 ............ A Magnetic image, lumbar spine ........................... 2.36 24.79 24.79 1.65 28.80 28.80 XXX

72158 TC A Magnetic image, lumbar spine ........................... 0.00 23.72 23.72 1.49 25.21 25.21 XXX

72158 26 A Magnetic image, lumbar spine ........................... 2.36 1.07 1.07 0.16 3.59 3.59 XXX

72159 ............ N Magnetic imaging/spine (MRA) .......................... +1.80 12.52 12.52 0.84 15.16 15.16 XXX

72159 TC N Magnetic imaging/spine (MRA) .......................... +0.00 11.86 11.86 0.74 12.60 12.60 XXX

72159 26 N Magnetic imaging/spine (MRA) .......................... +1.80 0.66 0.66 0.10 2.56 2.56 XXX

72170 ............ A X-ray exam of pelvis .......................................... 0.17 0.57 0.57 0.04 0.78 0.78 XXX

72170 TC A X-ray exam of pelvis .......................................... 0.00 0.50 0.50 0.03 0.53 0.53 XXX

72170 26 A X-ray exam of pelvis .......................................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX

72190 ............ A X-ray exam of pelvis .......................................... 0.21 0.74 0.74 0.05 1.00 1.00 XXX

72190 TC A X-ray exam of pelvis .......................................... 0.00 0.64 0.64 0.04 0.68 0.68 XXX

72190 26 A X-ray exam of pelvis .......................................... 0.21 0.10 0.10 0.01 0.32 0.32 XXX

72192 ............ A CAT scan of pelvis ............................................. 1.09 6.11 6.11 0.43 7.63 7.63 XXX

72192 TC A CAT scan of pelvis ............................................. 0.00 5.63 5.63 0.36 5.99 5.99 XXX

72192 26 A CAT scan of pelvis ............................................. 1.09 0.48 0.48 0.07 1.64 1.64 XXX

72193 ............ A Contrast CAT scan of pelvis .............................. 1.16 7.03 7.03 0.49 8.68 8.68 XXX

72193 TC A Contrast CAT scan of pelvis .............................. 0.00 6.52 6.52 0.41 6.93 6.93 XXX

72193 26 A Contrast CAT scan of pelvis .............................. 1.16 0.51 0.51 0.08 1.75 1.75 XXX

72194 ............ A Contrast CAT scans of pelvis ............................ 1.22 8.62 8.62 0.58 10.42 10.42 XXX

72194 TC A Contrast CAT scans of pelvis ............................ 0.00 8.09 8.09 0.50 8.59 8.59 XXX

72194 26 A Contrast CAT scans of pelvis ............................ 1.22 0.53 0.53 0.08 1.83 1.83 XXX

72196 ............ A Magnetic image, pelvis ...................................... 1.60 11.40 11.40 0.78 13.78 13.78 XXX

72196 TC A Magnetic image, pelvis ...................................... 0.00 10.68 10.68 0.67 11.35 11.35 XXX

72196 26 A Magnetic image, pelvis ...................................... 1.60 0.72 0.72 0.11 2.43 2.43 XXX

72198 ............ N Magnetic imaging/pelvis(MRA) .......................... +1.80 11.40 11.40 0.78 13.98 13.98 XXX

72198 TC N Magnetic imaging/pelvis(MRA) .......................... +0.00 10.68 10.68 0.67 11.35 11.35 XXX

72198 26 N Magnetic imaging/pelvis(MRA) .......................... +1.80 0.72 0.72 0.11 2.63 2.63 XXX

72200 ............ A X-ray exam sacroiliac joints ............................... 0.17 0.58 0.58 0.04 0.79 0.79 XXX

72200 TC A X-ray exam sacroiliac joints ............................... 0.00 0.50 0.50 0.03 0.53 0.53 XXX

72200 26 A X-ray exam sacroiliac joints ............................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX

72202 ............ A X-ray exam sacroiliac joints ............................... 0.19 0.68 0.68 0.05 0.92 0.92 XXX

72202 TC A X-ray exam sacroiliac joints ............................... 0.00 0.59 0.59 0.04 0.63 0.63 XXX

72202 26 A X-ray exam sacroiliac joints ............................... 0.19 0.09 0.09 0.01 0.29 0.29 XXX

72220 ............ A X-ray exam of tailbone ....................................... 0.17 0.62 0.62 0.05 0.84 0.84 XXX

72220 TC A X-ray exam of tailbone ....................................... 0.00 0.54 0.54 0.04 0.58 0.58 XXX

72220 26 A X-ray exam of tailbone ....................................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX

72240 ............ A Contrast x-ray of neck spine .............................. 0.91 4.93 4.93 0.35 6.19 6.19 XXX

72240 TC A Contrast x-ray of neck spine .............................. 0.00 4.52 4.52 0.29 4.81 4.81 XXX

72240 26 A Contrast x-ray of neck spine .............................. 0.91 0.41 0.41 0.06 1.38 1.38 XXX

72255 ............ A Contrast x-ray thorax spine ................................ 0.91 4.54 4.54 0.32 5.77 5.77 XXX

72255 TC A Contrast x-ray thorax spine ................................ 0.00 4.13 4.13 0.26 4.39 4.39 XXX

72255 26 A Contrast x-ray thorax spine ................................ 0.91 0.41 0.41 0.06 1.38 1.38 XXX

72265 ............ A Contrast x-ray lower spine ................................. 0.83 4.26 4.26 0.31 5.40 5.40 XXX

72265 TC A Contrast x-ray lower spine ................................. 0.00 3.88 3.88 0.25 4.13 4.13 XXX

72265 26 A Contrast x-ray lower spine ................................. 0.83 0.38 0.38 0.06 1.27 1.27 XXX

72270 ............ A Contrast x-ray of spine ....................................... 1.33 6.40 6.40 0.46 8.19 8.19 XXX

72270 TC A Contrast x-ray of spine ....................................... 0.00 5.81 5.81 0.37 6.18 6.18 XXX

72270 26 A Contrast x-ray of spine ....................................... 1.33 0.59 0.59 0.09 2.01 2.01 XXX

72285 ............ A X-ray of neck spine disk .................................... 0.83 8.37 8.37 0.56 9.76 9.76 XXX

72285 TC A X-ray of neck spine disk .................................... 0.00 7.99 7.99 0.50 8.49 8.49 XXX

72285 26 A X-ray of neck spine disk .................................... 0.83 0.38 0.38 0.06 1.27 1.27 XXX

72295 ............ A X-ray of lower spine disk ................................... 0.83 7.87 7.87 0.52 9.22 9.22 XXX

72295 TC A X-ray of lower spine disk ................................... 0.00 7.49 7.49 0.46 7.95 7.95 XXX

72295 26 A X-ray of lower spine disk ................................... 0.83 0.38 0.38 0.06 1.27 1.27 XXX

73000 ............ A X-ray exam of collarbone ................................... 0.16 0.57 0.57 0.04 0.77 0.77 XXX

73000 TC A X-ray exam of collarbone ................................... 0.00 0.50 0.50 0.03 0.53 0.53 XXX

73000 26 A X-ray exam of collarbone ................................... 0.16 0.07 0.07 0.01 0.24 0.24 XXX

73010 ............ A X-ray exam of shoulder blade ............................ 0.17 0.58 0.58 0.04 0.79 0.79 XXX

73010 TC A X-ray exam of shoulder blade ............................ 0.00 0.50 0.50 0.03 0.53 0.53 XXX

73010 26 A X-ray exam of shoulder blade ............................ 0.17 0.08 0.08 0.01 0.26 0.26 XXX

73020 ............ A X-ray exam of shoulder ...................................... 0.15 0.52 0.52 0.04 0.71 0.71 XXX
59175

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

73020 TC A X-ray exam of shoulder ...................................... 0.00 0.45 0.45 0.03 0.48 0.48 XXX

73020 26 A X-ray exam of shoulder ...................................... 0.15 0.07 0.07 0.01 0.23 0.23 XXX

73030 ............ A X-ray exam of shoulder ...................................... 0.18 0.62 0.62 0.05 0.85 0.85 XXX

73030 TC A X-ray exam of shoulder ...................................... 0.00 0.54 0.54 0.04 0.58 0.58 XXX

73030 26 A X-ray exam of shoulder ...................................... 0.18 0.08 0.08 0.01 0.27 0.27 XXX

73040 ............ A Contrast x-ray of shoulder ................................. 0.54 2.25 2.25 0.17 2.96 2.96 XXX

73040 TC A Contrast x-ray of shoulder ................................. 0.00 2.00 2.00 0.13 2.13 2.13 XXX

73040 26 A Contrast x-ray of shoulder ................................. 0.54 0.25 0.25 0.04 0.83 0.83 XXX

73050 ............ A X-ray exam of shoulders .................................... 0.20 0.73 0.73 0.05 0.98 0.98 XXX

73050 TC A X-ray exam of shoulders .................................... 0.00 0.64 0.64 0.04 0.68 0.68 XXX

73050 26 A X-ray exam of shoulders .................................... 0.20 0.09 0.09 0.01 0.30 0.30 XXX

73060 ............ A X-ray exam of humerus ..................................... 0.17 0.62 0.62 0.05 0.84 0.84 XXX

73060 TC A X-ray exam of humerus ..................................... 0.00 0.54 0.54 0.04 0.58 0.58 XXX

73060 26 A X-ray exam of humerus ..................................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX

73070 ............ A X-ray exam of elbow .......................................... 0.15 0.57 0.57 0.04 0.76 0.76 XXX

73070 TC A X-ray exam of elbow .......................................... 0.00 0.50 0.50 0.03 0.53 0.53 XXX

73070 26 A X-ray exam of elbow .......................................... 0.15 0.07 0.07 0.01 0.23 0.23 XXX

73080 ............ A X-ray exam of elbow .......................................... 0.17 0.62 0.62 0.05 0.84 0.84 XXX

73080 TC A X-ray exam of elbow .......................................... 0.00 0.54 0.54 0.04 0.58 0.58 XXX

73080 26 A X-ray exam of elbow .......................................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX

73085 ............ A Contrast x-ray of elbow ...................................... 0.54 2.25 2.25 0.17 2.96 2.96 XXX

73085 TC A Contrast x-ray of elbow ...................................... 0.00 2.00 2.00 0.13 2.13 2.13 XXX

73085 26 A Contrast x-ray of elbow ...................................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

73090 ............ A X-ray exam of forearm ....................................... 0.16 0.57 0.57 0.04 0.77 0.77 XXX

73090 TC A X-ray exam of forearm ....................................... 0.00 0.50 0.50 0.03 0.53 0.53 XXX

73090 26 A X-ray exam of forearm ....................................... 0.16 0.07 0.07 0.01 0.24 0.24 XXX

73092 ............ A X-ray exam of arm, infant .................................. 0.16 0.54 0.54 0.04 0.74 0.74 XXX

73092 TC A X-ray exam of arm, infant .................................. 0.00 0.47 0.47 0.03 0.50 0.50 XXX

73092 26 A X-ray exam of arm, infant .................................. 0.16 0.07 0.07 0.01 0.24 0.24 XXX

73100 ............ A X-ray exam of wrist ............................................ 0.16 0.54 0.54 0.04 0.74 0.74 XXX

73100 TC A X-ray exam of wrist ............................................ 0.00 0.47 0.47 0.03 0.50 0.50 XXX

73100 26 A X-ray exam of wrist ............................................ 0.16 0.07 0.07 0.01 0.24 0.24 XXX

73110 ............ A X-ray exam of wrist ............................................ 0.17 0.59 0.59 0.04 0.80 0.80 XXX

73110 TC A X-ray exam of wrist ............................................ 0.00 0.51 0.51 0.03 0.54 0.54 XXX

73110 26 A X-ray exam of wrist ............................................ 0.17 0.08 0.08 0.01 0.26 0.26 XXX

73115 ............ A Contrast x-ray of wrist ........................................ 0.54 1.75 1.75 0.14 2.43 2.43 XXX

73115 TC A Contrast x-ray of wrist ........................................ 0.00 1.50 1.50 0.10 1.60 1.60 XXX

73115 26 A Contrast x-ray of wrist ........................................ 0.54 0.25 0.25 0.04 0.83 0.83 XXX

73120 ............ A X-ray exam of hand ........................................... 0.16 0.54 0.54 0.04 0.74 0.74 XXX

73120 TC A X-ray exam of hand ........................................... 0.00 0.47 0.47 0.03 0.50 0.50 XXX

73120 26 A X-ray exam of hand ........................................... 0.16 0.07 0.07 0.01 0.24 0.24 XXX

73130 ............ A X-ray exam of hand ........................................... 0.17 0.59 0.59 0.04 0.80 0.80 XXX

73130 TC A X-ray exam of hand ........................................... 0.00 0.51 0.51 0.03 0.54 0.54 XXX

73130 26 A X-ray exam of hand ........................................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX

73140 ............ A X-ray exam of finger(s) ...................................... 0.13 0.46 0.46 0.04 0.63 0.63 XXX

73140 TC A X-ray exam of finger(s) ...................................... 0.00 0.40 0.40 0.03 0.43 0.43 XXX

73140 26 A X-ray exam of finger(s) ...................................... 0.13 0.06 0.06 0.01 0.20 0.20 XXX

73200 ............ A CAT scan of arm ................................................ 1.09 5.21 5.21 0.37 6.67 6.67 XXX

73200 TC A CAT scan of arm ................................................ 0.00 4.73 4.73 0.30 5.03 5.03 XXX

73200 26 A CAT scan of arm ................................................ 1.09 0.48 0.48 0.07 1.64 1.64 XXX

73201 ............ A Contrast CAT scan of arm ................................. 1.16 6.14 6.14 0.44 7.74 7.74 XXX

73201 TC A Contrast CAT scan of arm ................................. 0.00 5.63 5.63 0.36 5.99 5.99 XXX

73201 26 A Contrast CAT scan of arm ................................. 1.16 0.51 0.51 0.08 1.75 1.75 XXX

73202 ............ A Contrast CAT scans of arm ............................... 1.22 7.61 7.61 0.53 9.36 9.36 XXX

73202 TC A Contrast CAT scans of arm ............................... 0.00 7.08 7.08 0.45 7.53 7.53 XXX

73202 26 A Contrast CAT scans of arm ............................... 1.22 0.53 0.53 0.08 1.83 1.83 XXX

73220 ............ A Magnetic image, arm, hand ............................... 1.48 11.34 11.34 0.77 13.59 13.59 XXX

73220 TC A Magnetic image, arm, hand ............................... 0.00 10.68 10.68 0.67 11.35 11.35 XXX

73220 26 A Magnetic image, arm, hand ............................... 1.48 0.66 0.66 0.10 2.24 2.24 XXX

73221 ............ A Magnetic image, joint of arm ............................. 1.48 11.11 11.11 0.73 13.32 13.32 XXX

73221 TC A Magnetic image, joint of arm ............................. 0.00 10.68 10.68 0.67 11.35 11.35 XXX

73221 26 A Magnetic image, joint of arm ............................. 1.48 0.43 0.43 0.06 1.97 1.97 XXX

73225 ............ N Magnetic imaging/upper (MRA) ......................... +1.73 11.34 11.34 0.77 13.84 13.84 XXX

73225 TC N Magnetic imaging/upper (MRA) ......................... +0.00 10.68 10.68 0.67 11.35 11.35 XXX

73225 26 N Magnetic imaging/upper (MRA) ......................... +1.73 0.66 0.66 0.10 2.49 2.49 XXX

73500 ............ A X-ray exam of hip ............................................... 0.17 0.53 0.53 0.04 0.74 0.74 XXX

73500 TC A X-ray exam of hip ............................................... 0.00 0.45 0.45 0.03 0.48 0.48 XXX

73500 26 A X-ray exam of hip ............................................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX

73510 ............ A X-ray exam of hip ............................................... 0.21 0.64 0.64 0.05 0.90 0.90 XXX

73510 TC A X-ray exam of hip ............................................... 0.00 0.54 0.54 0.04 0.58 0.58 XXX

73510 26 A X-ray exam of hip ............................................... 0.21 0.10 0.10 0.01 0.32 0.32 XXX

73520 ............ A X-ray exam of hips ............................................. 0.26 0.76 0.76 0.06 1.08 1.08 XXX

73520 TC A X-ray exam of hips ............................................. 0.00 0.64 0.64 0.04 0.68 0.68 XXX

73520 26 A X-ray exam of hips ............................................. 0.26 0.12 0.12 0.02 0.40 0.40 XXX
59176

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

73525 ............ A Contrast x-ray of hip .......................................... 0.54 2.25 2.25 0.17 2.96 2.96 XXX

73525 TC A Contrast x-ray of hip .......................................... 0.00 2.00 2.00 0.13 2.13 2.13 XXX

73525 26 A Contrast x-ray of hip .......................................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

73530 ............ A X-ray exam of hip ............................................... 0.29 0.63 0.63 0.05 0.97 0.97 XXX

73530 TC A X-ray exam of hip ............................................... 0.00 0.50 0.50 0.03 0.53 0.53 XXX

73530 26 A X-ray exam of hip ............................................... 0.29 0.13 0.13 0.02 0.44 0.44 XXX

73540 ............ A X-ray exam of pelvis & hips ............................... 0.20 0.64 0.64 0.05 0.89 0.89 XXX

73540 TC A X-ray exam of pelvis & hips ............................... 0.00 0.54 0.54 0.04 0.58 0.58 XXX

73540 26 A X-ray exam of pelvis & hips ............................... 0.20 0.10 0.10 0.01 0.31 0.31 XXX

73550 ............ A X-ray exam of thigh ............................................ 0.17 0.62 0.62 0.05 0.84 0.84 XXX

73550 TC A X-ray exam of thigh ............................................ 0.00 0.54 0.54 0.04 0.58 0.58 XXX

73550 26 A X-ray exam of thigh ............................................ 0.17 0.08 0.08 0.01 0.26 0.26 XXX

73560 ............ A X-ray exam of knee ............................................ 0.17 0.57 0.57 0.04 0.78 0.78 XXX

73560 TC A X-ray exam of knee ............................................ 0.00 0.50 0.50 0.03 0.53 0.53 XXX

73560 26 A X-ray exam of knee ............................................ 0.17 0.07 0.07 0.01 0.25 0.25 XXX

73562 ............ A X-ray exam of knee ............................................ 0.18 0.63 0.63 0.05 0.86 0.86 XXX

73562 TC A X-ray exam of knee ............................................ 0.00 0.54 0.54 0.04 0.58 0.58 XXX

73562 26 A X-ray exam of knee ............................................ 0.18 0.09 0.09 0.01 0.28 0.28 XXX

73564 ............ A X-ray exam of knee ............................................ 0.22 0.69 0.69 0.06 0.97 0.97 XXX

73564 TC A X-ray exam of knee ............................................ 0.00 0.59 0.59 0.04 0.63 0.63 XXX

73564 26 A X-ray exam of knee ............................................ 0.22 0.10 0.10 0.02 0.34 0.34 XXX

73565 ............ A X-ray exam of knee ............................................ 0.17 0.54 0.54 0.04 0.75 0.75 XXX

73565 TC A X-ray exam of knee ............................................ 0.00 0.47 0.47 0.03 0.50 0.50 XXX

73565 26 A X-ray exam of knee ............................................ 0.17 0.07 0.07 0.01 0.25 0.25 XXX

73580 ............ A Contrast x-ray of knee joint ................................ 0.54 2.75 2.75 0.21 3.50 3.50 XXX

73580 TC A Contrast x-ray of knee joint ................................ 0.00 2.50 2.50 0.17 2.67 2.67 XXX

73580 26 A Contrast x-ray of knee joint ................................ 0.54 0.25 0.25 0.04 0.83 0.83 XXX

73590 ............ A X-ray exam of lower leg ..................................... 0.17 0.57 0.57 0.04 0.78 0.78 XXX

73590 TC A X-ray exam of lower leg ..................................... 0.00 0.50 0.50 0.03 0.53 0.53 XXX

73590 26 A X-ray exam of lower leg ..................................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX

73592 ............ A X-ray exam of leg, infant .................................... 0.16 0.54 0.54 0.04 0.74 0.74 XXX

73592 TC A X-ray exam of leg, infant .................................... 0.00 0.47 0.47 0.03 0.50 0.50 XXX

73592 26 A X-ray exam of leg, infant .................................... 0.16 0.07 0.07 0.01 0.24 0.24 XXX

73600 ............ A X-ray exam of ankle ........................................... 0.16 0.54 0.54 0.04 0.74 0.74 XXX

73600 TC A X-ray exam of ankle ........................................... 0.00 0.47 0.47 0.03 0.50 0.50 XXX

73600 26 A X-ray exam of ankle ........................................... 0.16 0.07 0.07 0.01 0.24 0.24 XXX

73610 ............ A X-ray exam of ankle ........................................... 0.17 0.59 0.59 0.04 0.80 0.80 XXX

73610 TC A X-ray exam of ankle ........................................... 0.00 0.51 0.51 0.03 0.54 0.54 XXX

73610 26 A X-ray exam of ankle ........................................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX

73615 ............ A Contrast x-ray of ankle ....................................... 0.54 2.25 2.25 0.17 2.96 2.96 XXX

73615 TC A Contrast x-ray of ankle ....................................... 0.00 2.00 2.00 0.13 2.13 2.13 XXX

73615 26 A Contrast x-ray of ankle ....................................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

73620 ............ A X-ray exam of foot ............................................. 0.16 0.54 0.54 0.04 0.74 0.74 XXX

73620 TC A X-ray exam of foot ............................................. 0.00 0.47 0.47 0.03 0.50 0.50 XXX

73620 26 A X-ray exam of foot ............................................. 0.16 0.07 0.07 0.01 0.24 0.24 XXX

73630 ............ A X-ray exam of foot ............................................. 0.17 0.59 0.59 0.04 0.80 0.80 XXX

73630 TC A X-ray exam of foot ............................................. 0.00 0.51 0.51 0.03 0.54 0.54 XXX

73630 26 A X-ray exam of foot ............................................. 0.17 0.08 0.08 0.01 0.26 0.26 XXX

73650 ............ A X-ray exam of heel ............................................. 0.16 0.52 0.52 0.04 0.72 0.72 XXX

73650 TC A X-ray exam of heel ............................................. 0.00 0.45 0.45 0.03 0.48 0.48 XXX

73650 26 A X-ray exam of heel ............................................. 0.16 0.07 0.07 0.01 0.24 0.24 XXX

73660 ............ A X-ray exam of toe(s) .......................................... 0.13 0.46 0.46 0.04 0.63 0.63 XXX

73660 TC A X-ray exam of toe(s) .......................................... 0.00 0.40 0.40 0.03 0.43 0.43 XXX

73660 26 A X-ray exam of toe(s) .......................................... 0.13 0.06 0.06 0.01 0.20 0.20 XXX

73700 ............ A CAT scan of leg ................................................. 1.09 5.21 5.21 0.37 6.67 6.67 XXX

73700 TC A CAT scan of leg ................................................. 0.00 4.73 4.73 0.30 5.03 5.03 XXX

73700 26 A CAT scan of leg ................................................. 1.09 0.48 0.48 0.07 1.64 1.64 XXX

73701 ............ A Contrast CAT scan of leg .................................. 1.16 6.14 6.14 0.44 7.74 7.74 XXX

73701 TC A Contrast CAT scan of leg .................................. 0.00 5.63 5.63 0.36 5.99 5.99 XXX

73701 26 A Contrast CAT scan of leg .................................. 1.16 0.51 0.51 0.08 1.75 1.75 XXX

73702 ............ A Contrast CAT scans of leg ................................. 1.22 7.61 7.61 0.53 9.36 9.36 XXX

73702 TC A Contrast CAT scans of leg ................................. 0.00 7.08 7.08 0.45 7.53 7.53 XXX

73702 26 A Contrast CAT scans of leg ................................. 1.22 0.53 0.53 0.08 1.83 1.83 XXX

73720 ............ A Magnetic image, leg, foot ................................... 1.48 11.34 11.34 0.77 13.59 13.59 XXX

73720 TC A Magnetic image, leg, foot ................................... 0.00 10.68 10.68 0.67 11.35 11.35 XXX

73720 26 A Magnetic image, leg, foot ................................... 1.48 0.66 0.66 0.10 2.24 2.24 XXX

73721 ............ A Magnetic image, joint of leg ............................... 1.48 11.11 11.11 0.73 13.32 13.32 XXX

73721 TC A Magnetic image, joint of leg ............................... 0.00 10.68 10.68 0.67 11.35 11.35 XXX

73721 26 A Magnetic image, joint of leg ............................... 1.48 0.43 0.43 0.06 1.97 1.97 XXX

73725 ............ R Magnetic imaging/lower (MRA) .......................... 1.82 11.34 11.34 0.77 13.93 13.93 XXX

73725 TC R Magnetic imaging/lower (MRA) .......................... 0.00 10.68 10.68 0.67 11.35 11.35 XXX

73725 26 R Magnetic imaging/lower (MRA) .......................... 1.82 0.66 0.66 0.10 2.58 2.58 XXX

74000 ............ A X-ray exam of abdomen .................................... 0.18 0.58 0.58 0.04 0.80 0.80 XXX

74000 TC A X-ray exam of abdomen .................................... 0.00 0.50 0.50 0.03 0.53 0.53 XXX
59177

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

74000 26 A X-ray exam of abdomen .................................... 0.18 0.08 0.08 0.01 0.27 0.27 XXX

74010 ............ A X-ray exam of abdomen .................................... 0.23 0.65 0.65 0.06 0.94 0.94 XXX

74010 TC A X-ray exam of abdomen .................................... 0.00 0.54 0.54 0.04 0.58 0.58 XXX

74010 26 A X-ray exam of abdomen .................................... 0.23 0.11 0.11 0.02 0.36 0.36 XXX

74020 ............ A X-ray exam of abdomen .................................... 0.27 0.72 0.72 0.06 1.05 1.05 XXX

74020 TC A X-ray exam of abdomen .................................... 0.00 0.59 0.59 0.04 0.63 0.63 XXX

74020 26 A X-ray exam of abdomen .................................... 0.27 0.13 0.13 0.02 0.42 0.42 XXX

74022 ............ A X-ray exam series, abdomen ............................. 0.32 0.85 0.85 0.07 1.24 1.24 XXX

74022 TC A X-ray exam series, abdomen ............................. 0.00 0.70 0.70 0.05 0.75 0.75 XXX

74022 26 A X-ray exam series, abdomen ............................. 0.32 0.15 0.15 0.02 0.49 0.49 XXX

74150 ............ A CAT scan of abdomen ....................................... 1.19 5.91 5.91 0.43 7.53 7.53 XXX

74150 TC A CAT scan of abdomen ....................................... 0.00 5.39 5.39 0.35 5.74 5.74 XXX

74150 26 A CAT scan of abdomen ....................................... 1.19 0.52 0.52 0.08 1.79 1.79 XXX

74160 ............ A Contrast CAT scan of abdomen ........................ 1.27 7.08 7.08 0.50 8.85 8.85 XXX

74160 TC A Contrast CAT scan of abdomen ........................ 0.00 6.52 6.52 0.41 6.93 6.93 XXX

74160 26 A Contrast CAT scan of abdomen ........................ 1.27 0.56 0.56 0.09 1.92 1.92 XXX

74170 ............ A Contrast CAT scans, abdomen .......................... 1.40 8.71 8.71 0.60 10.71 10.71 XXX

74170 TC A Contrast CAT scans, abdomen .......................... 0.00 8.09 8.09 0.50 8.59 8.59 XXX

74170 26 A Contrast CAT scans, abdomen .......................... 1.40 0.62 0.62 0.10 2.12 2.12 XXX

74181 ............ A Magnetic image, abdomen (MRI) ...................... 1.60 11.40 11.40 0.78 13.78 13.78 XXX

74181 TC A Magnetic image, abdomen (MRI) ...................... 0.00 10.68 10.68 0.67 11.35 11.35 XXX

74181 26 A Magnetic image, abdomen (MRI) ...................... 1.60 0.72 0.72 0.11 2.43 2.43 XXX

74185 ............ N Magnetic image/abdomen (MRA) ...................... +1.80 11.40 11.40 0.78 13.98 13.98 XXX

74185 TC N Magnetic image/abdomen (MRA) ...................... +0.00 10.68 10.68 0.67 11.35 11.35 XXX

74185 26 N Magnetic image/abdomen (MRA) ...................... +1.80 0.72 0.72 0.11 2.63 2.63 XXX

74190 ............ A X-ray exam of peritoneum ................................. 0.48 1.37 1.37 0.10 1.95 1.95 XXX

74190 TC A X-ray exam of peritoneum ................................. 0.00 1.24 1.24 0.08 1.32 1.32 XXX

74190 26 A X-ray exam of peritoneum ................................. 0.48 0.13 0.13 0.02 0.63 0.63 XXX

74210 ............ A Contrast x-ray exam of throat ............................ 0.36 1.29 1.29 0.09 1.74 1.74 XXX

74210 TC A Contrast x-ray exam of throat ............................ 0.00 1.13 1.13 0.07 1.20 1.20 XXX

74210 26 A Contrast x-ray exam of throat ............................ 0.36 0.16 0.16 0.02 0.54 0.54 XXX

74220 ............ A Contrast x-ray exam,esophagus ........................ 0.46 1.34 1.34 0.10 1.90 1.90 XXX

74220 TC A Contrast x-ray exam,esophagus ........................ 0.00 1.13 1.13 0.07 1.20 1.20 XXX

74220 26 A Contrast x-ray exam,esophagus ........................ 0.46 0.21 0.21 0.03 0.70 0.70 XXX

74230 ............ A Cinema x-ray throat/esophagus ......................... 0.53 1.49 1.49 0.12 2.14 2.14 XXX

74230 TC A Cinema x-ray throat/esophagus ......................... 0.00 1.24 1.24 0.08 1.32 1.32 XXX

74230 26 A Cinema x-ray throat/esophagus ......................... 0.53 0.25 0.25 0.04 0.82 0.82 XXX

74235 ............ A Remove esophagus obstruction ........................ 1.19 3.02 3.02 0.25 4.46 4.46 XXX

74235 TC A Remove esophagus obstruction ........................ 0.00 2.50 2.50 0.17 2.67 2.67 XXX

74235 26 A Remove esophagus obstruction ........................ 1.19 0.52 0.52 0.08 1.79 1.79 XXX

74240 ............ A X-ray exam upper GI tract ................................. 0.69 1.71 1.71 0.14 2.54 2.54 XXX

74240 TC A X-ray exam upper GI tract ................................. 0.00 1.39 1.39 0.09 1.48 1.48 XXX

74240 26 A X-ray exam upper GI tract ................................. 0.69 0.32 0.32 0.05 1.06 1.06 XXX

74241 ............ A X-ray exam upper GI tract ................................. 0.69 1.74 1.74 0.14 2.57 2.57 XXX

74241 TC A X-ray exam upper GI tract ................................. 0.00 1.42 1.42 0.09 1.51 1.51 XXX

74241 26 A X-ray exam upper GI tract ................................. 0.69 0.32 0.32 0.05 1.06 1.06 XXX

74245 ............ A X-ray exam upper GI tract ................................. 0.91 2.68 2.68 0.21 3.80 3.80 XXX

74245 TC A X-ray exam upper GI tract ................................. 0.00 2.27 2.27 0.15 2.42 2.42 XXX

74245 26 A X-ray exam upper GI tract ................................. 0.91 0.41 0.41 0.06 1.38 1.38 XXX

74246 ............ A Contrast x-ray upper GI tract ............................. 0.69 1.89 1.89 0.15 2.73 2.73 XXX

74246 TC A Contrast x-ray upper GI tract ............................. 0.00 1.57 1.57 0.10 1.67 1.67 XXX

74246 26 A Contrast x-ray upper GI tract ............................. 0.69 0.32 0.32 0.05 1.06 1.06 XXX

74247 ............ A Contrast x-ray upper GI tract ............................. 0.69 1.92 1.92 0.16 2.77 2.77 XXX

74247 TC A Contrast x-ray upper GI tract ............................. 0.00 1.60 1.60 0.11 1.71 1.71 XXX

74247 26 A Contrast x-ray upper GI tract ............................. 0.69 0.32 0.32 0.05 1.06 1.06 XXX

74249 ............ A Contrast x-ray upper GI tract ............................. 0.91 2.86 2.86 0.22 3.99 3.99 XXX

74249 TC A Contrast x-ray upper GI tract ............................. 0.00 2.45 2.45 0.16 2.61 2.61 XXX

74249 26 A Contrast x-ray upper GI tract ............................. 0.91 0.41 0.41 0.06 1.38 1.38 XXX

74250 ............ A X-ray exam of small bowel ................................ 0.47 1.45 1.45 0.11 2.03 2.03 XXX

74250 TC A X-ray exam of small bowel ................................ 0.00 1.24 1.24 0.08 1.32 1.32 XXX

74250 26 A X-ray exam of small bowel ................................ 0.47 0.21 0.21 0.03 0.71 0.71 XXX

74251 ............ A X-ray exam of small bowel ................................ 0.69 1.45 1.45 0.11 2.25 2.25 XXX

74251 TC A X-ray exam of small bowel ................................ 0.00 1.24 1.24 0.08 1.32 1.32 XXX

74251 26 A X-ray exam of small bowel ................................ 0.69 0.21 0.21 0.03 0.93 0.93 XXX

74260 ............ A X-ray exam of small bowel ................................ 0.50 1.65 1.65 0.12 2.27 2.27 XXX

74260 TC A X-ray exam of small bowel ................................ 0.00 1.42 1.42 0.09 1.51 1.51 XXX

74260 26 A X-ray exam of small bowel ................................ 0.50 0.23 0.23 0.03 0.76 0.76 XXX

74270 ............ A Contrast x-ray exam of colon ............................. 0.69 1.94 1.94 0.16 2.79 2.79 XXX

74270 TC A Contrast x-ray exam of colon ............................. 0.00 1.62 1.62 0.11 1.73 1.73 XXX

74270 26 A Contrast x-ray exam of colon ............................. 0.69 0.32 0.32 0.05 1.06 1.06 XXX

74280 ............ A Contrast x-ray exam of colon ............................. 0.99 2.58 2.58 0.21 3.78 3.78 XXX

74280 TC A Contrast x-ray exam of colon ............................. 0.00 2.13 2.13 0.14 2.27 2.27 XXX

74280 26 A Contrast x-ray exam of colon ............................. 0.99 0.45 0.45 0.07 1.51 1.51 XXX

74283 ............ A Contrast x-ray exam of colon ............................. 2.02 3.34 3.34 0.30 5.66 5.66 XXX
59178

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

74283 TC A Contrast x-ray exam of colon ............................. 0.00 2.44 2.44 0.16 2.60 2.60 XXX

74283 26 A Contrast x-ray exam of colon ............................. 2.02 0.90 0.90 0.14 3.06 3.06 XXX

74290 ............ A Contrast x-ray, gallbladder ................................. 0.32 0.85 0.85 0.07 1.24 1.24 XXX

74290 TC A Contrast x-ray, gallbladder ................................. 0.00 0.70 0.70 0.05 0.75 0.75 XXX

74290 26 A Contrast x-ray, gallbladder ................................. 0.32 0.15 0.15 0.02 0.49 0.49 XXX

74291 ............ A Contrast x-rays, gallbladder ............................... 0.20 0.49 0.49 0.04 0.73 0.73 XXX

74291 TC A Contrast x-rays, gallbladder ............................... 0.00 0.40 0.40 0.03 0.43 0.43 XXX

74291 26 A Contrast x-rays, gallbladder ............................... 0.20 0.09 0.09 0.01 0.30 0.30 XXX

74300 ............ C X-ray bile ducts, pancreas ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

74300 TC C X-ray bile ducts, pancreas ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

74300 26 A X-ray bile ducts, pancreas ................................. 0.36 0.17 0.17 0.02 0.55 0.55 XXX

74301 ............ C Additional x-rays at surgery ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

74301 TC C Additional x-rays at surgery ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

74301 26 A Additional x-rays at surgery ............................... 0.21 0.10 0.10 0.01 0.32 0.32 XXX

74305 ............ A X-ray bile ducts, pancreas ................................. 0.42 0.94 0.94 0.08 1.44 1.44 XXX

74305 TC A X-ray bile ducts, pancreas ................................. 0.00 0.75 0.75 0.05 0.80 0.80 XXX

74305 26 A X-ray bile ducts, pancreas ................................. 0.42 0.19 0.19 0.03 0.64 0.64 XXX

74320 ............ A Contrast x-ray of bile ducts ................................ 0.54 3.25 3.25 0.23 4.02 4.02 XXX

74320 TC A Contrast x-ray of bile ducts ................................ 0.00 3.00 3.00 0.19 3.19 3.19 XXX

74320 26 A Contrast x-ray of bile ducts ................................ 0.54 0.25 0.25 0.04 0.83 0.83 XXX

74327 ............ A X-ray for bile stone removal ............................... 0.70 2.00 2.00 0.16 2.86 2.86 XXX

74327 TC A X-ray for bile stone removal ............................... 0.00 1.68 1.68 0.11 1.79 1.79 XXX

74327 26 A X-ray for bile stone removal ............................... 0.70 0.32 0.32 0.05 1.07 1.07 XXX

74328 ............ A X-ray for bile duct endoscopy ............................ 0.70 3.32 3.32 0.24 4.26 4.26 XXX

74328 TC A X-ray for bile duct endoscopy ............................ 0.00 3.00 3.00 0.19 3.19 3.19 XXX

74328 26 A X-ray for bile duct endoscopy ............................ 0.70 0.32 0.32 0.05 1.07 1.07 XXX

74329 ............ A X-ray for pancreas endoscopy ........................... 0.70 3.32 3.32 0.24 4.26 4.26 XXX

74329 TC A X-ray for pancreas endoscopy ........................... 0.00 3.00 3.00 0.19 3.19 3.19 XXX

74329 26 A X-ray for pancreas endoscopy ........................... 0.70 0.32 0.32 0.05 1.07 1.07 XXX

74330 ............ A X-ray, bile/pancreas endoscopy ......................... 0.90 3.32 3.32 0.24 4.46 4.46 XXX

74330 TC A X-ray, bile/pancreas endoscopy ......................... 0.00 3.00 3.00 0.19 3.19 3.19 XXX

74330 26 A X-ray, bile/pancreas endoscopy ......................... 0.90 0.32 0.32 0.05 1.27 1.27 XXX

74340 ............ A X-ray guide for GI tube ...................................... 0.54 2.75 2.75 0.21 3.50 3.50 XXX

74340 TC A X-ray guide for GI tube ...................................... 0.00 2.50 2.50 0.17 2.67 2.67 XXX

74340 26 A X-ray guide for GI tube ...................................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

74350 ............ A X-ray guide, stomach tube ................................. 0.76 3.35 3.35 0.24 4.35 4.35 XXX

74350 TC A X-ray guide, stomach tube ................................. 0.00 3.00 3.00 0.19 3.19 3.19 XXX

74350 26 A X-ray guide, stomach tube ................................. 0.76 0.35 0.35 0.05 1.16 1.16 XXX

74355 ............ A X-ray guide, intestinal tube ................................ 0.76 2.85 2.85 0.22 3.83 3.83 XXX

74355 TC A X-ray guide, intestinal tube ................................ 0.00 2.50 2.50 0.17 2.67 2.67 XXX

74355 26 A X-ray guide, intestinal tube ................................ 0.76 0.35 0.35 0.05 1.16 1.16 XXX

74360 ............ A X-ray guide, GI dilation ...................................... 0.54 3.25 3.25 0.23 4.02 4.02 XXX

74360 TC A X-ray guide, GI dilation ...................................... 0.00 3.00 3.00 0.19 3.19 3.19 XXX

74360 26 A X-ray guide, GI dilation ...................................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

74363 ............ A X-ray, bile duct dilation ...................................... 0.88 6.21 6.21 0.43 7.52 7.52 XXX

74363 TC A X-ray, bile duct dilation ...................................... 0.00 5.81 5.81 0.37 6.18 6.18 XXX

74363 26 A X-ray, bile duct dilation ...................................... 0.88 0.40 0.40 0.06 1.34 1.34 XXX

74400 ............ A Contrast x-ray urinary tract ................................ 0.49 1.82 1.82 0.14 2.45 2.45 XXX

74400 TC A Contrast x-ray urinary tract ................................ 0.00 1.60 1.60 0.11 1.71 1.71 XXX

74400 26 A Contrast x-ray urinary tract ................................ 0.49 0.22 0.22 0.03 0.74 0.74 XXX

74405 ............ A Contrast x-ray urinary tract ................................ 0.49 2.11 2.11 0.16 2.76 2.76 XXX

74405 TC A Contrast x-ray urinary tract ................................ 0.00 1.89 1.89 0.13 2.02 2.02 XXX

74405 26 A Contrast x-ray urinary tract ................................ 0.49 0.22 0.22 0.03 0.74 0.74 XXX

74410 ............ A Contrast x-ray urinary tract ................................ 0.49 2.08 2.08 0.15 2.72 2.72 XXX

74410 TC A Contrast x-ray urinary tract ................................ 0.00 1.86 1.86 0.12 1.98 1.98 XXX

74410 26 A Contrast x-ray urinary tract ................................ 0.49 0.22 0.22 0.03 0.74 0.74 XXX

74415 ............ A Contrast x-ray urinary tract ................................ 0.49 2.24 2.24 0.16 2.89 2.89 XXX

74415 TC A Contrast x-ray urinary tract ................................ 0.00 2.02 2.02 0.13 2.15 2.15 XXX

74415 26 A Contrast x-ray urinary tract ................................ 0.49 0.22 0.22 0.03 0.74 0.74 XXX

74420 ............ A Contrast x-ray urinary tract ................................ 0.36 2.66 2.66 0.19 3.21 3.21 XXX

74420 TC A Contrast x-ray urinary tract ................................ 0.00 2.50 2.50 0.17 2.67 2.67 XXX

74420 26 A Contrast x-ray urinary tract ................................ 0.36 0.16 0.16 0.02 0.54 0.54 XXX

74425 ............ A Contrast x-ray urinary tract ................................ 0.36 1.40 1.40 0.10 1.86 1.86 XXX

74425 TC A Contrast x-ray urinary tract ................................ 0.00 1.24 1.24 0.08 1.32 1.32 XXX

74425 26 A Contrast x-ray urinary tract ................................ 0.36 0.16 0.16 0.02 0.54 0.54 XXX

74430 ............ A Contrast x-ray of bladder ................................... 0.32 1.15 1.15 0.09 1.56 1.56 XXX

74430 TC A Contrast x-ray of bladder ................................... 0.00 1.00 1.00 0.07 1.07 1.07 XXX

74430 26 A Contrast x-ray of bladder ................................... 0.32 0.15 0.15 0.02 0.49 0.49 XXX

74440 ............ A X-ray exam male genital tract ............................ 0.38 1.25 1.25 0.10 1.73 1.73 XXX

74440 TC A X-ray exam male genital tract ............................ 0.00 1.08 1.08 0.07 1.15 1.15 XXX

74440 26 A X-ray exam male genital tract ............................ 0.38 0.17 0.17 0.03 0.58 0.58 XXX

74445 ............ A X-ray exam of penis ........................................... 1.14 1.58 1.58 0.15 2.87 2.87 XXX

74445 TC A X-ray exam of penis ........................................... 0.00 1.08 1.08 0.07 1.15 1.15 XXX

74445 26 A X-ray exam of penis ........................................... 1.14 0.50 0.50 0.08 1.72 1.72 XXX
59179

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

74450 ............ A X-ray exam urethra/bladder ............................... 0.33 1.54 1.54 0.11 1.98 1.98 XXX

74450 TC A X-ray exam urethra/bladder ............................... 0.00 1.39 1.39 0.09 1.48 1.48 XXX

74450 26 A X-ray exam urethra/bladder ............................... 0.33 0.15 0.15 0.02 0.50 0.50 XXX

74455 ............ A X-ray exam urethra/bladder ............................... 0.33 1.65 1.65 0.12 2.10 2.10 XXX

74455 TC A X-ray exam urethra/bladder ............................... 0.00 1.50 1.50 0.10 1.60 1.60 XXX

74455 26 A X-ray exam urethra/bladder ............................... 0.33 0.15 0.15 0.02 0.50 0.50 XXX

74470 ............ A X-ray exam of kidney lesion .............................. 0.54 1.44 1.44 0.12 2.10 2.10 XXX

74470 TC A X-ray exam of kidney lesion .............................. 0.00 1.19 1.19 0.08 1.27 1.27 XXX

74470 26 A X-ray exam of kidney lesion .............................. 0.54 0.25 0.25 0.04 0.83 0.83 XXX

74475 ............ A X-ray control catheter insert ............................... 0.54 4.13 4.13 0.29 4.96 4.96 XXX

74475 TC A X-ray control catheter insert ............................... 0.00 3.88 3.88 0.25 4.13 4.13 XXX

74475 26 A X-ray control catheter insert ............................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

74480 ............ A X-ray control catheter insert ............................... 0.54 4.13 4.13 0.29 4.96 4.96 XXX

74480 TC A X-ray control catheter insert ............................... 0.00 3.88 3.88 0.25 4.13 4.13 XXX

74480 26 A X-ray control catheter insert ............................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

74485 ............ A X-ray guide, GU dilation ..................................... 0.54 3.25 3.25 0.23 4.02 4.02 XXX

74485 TC A X-ray guide, GU dilation ..................................... 0.00 3.00 3.00 0.19 3.19 3.19 XXX

74485 26 A X-ray guide, GU dilation ..................................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

74710 ............ A X-ray measurement of pelvis ............................. 0.34 1.16 1.16 0.09 1.59 1.59 XXX

74710 TC A X-ray measurement of pelvis ............................. 0.00 1.00 1.00 0.07 1.07 1.07 XXX

74710 26 A X-ray measurement of pelvis ............................. 0.34 0.16 0.16 0.02 0.52 0.52 XXX

74740 ............ A X-ray female genital tract ................................... 0.38 1.41 1.41 0.11 1.90 1.90 XXX

74740 TC A X-ray female genital tract ................................... 0.00 1.24 1.24 0.08 1.32 1.32 XXX

74740 26 A X-ray female genital tract ................................... 0.38 0.17 0.17 0.03 0.58 0.58 XXX

74742 ............ A X-ray fallopian tube ............................................ 0.61 3.25 3.25 0.23 4.09 4.09 XXX

74742 TC A X-ray fallopian tube ............................................ 0.00 3.00 3.00 0.19 3.19 3.19 XXX

74742 26 A X-ray fallopian tube ............................................ 0.61 0.25 0.25 0.04 0.90 0.90 XXX

74775 ............ A X-ray exam of perineum .................................... 0.62 1.68 1.68 0.13 2.43 2.43 XXX

74775 TC A X-ray exam of perineum .................................... 0.00 1.39 1.39 0.09 1.48 1.48 XXX

74775 26 A X-ray exam of perineum .................................... 0.62 0.29 0.29 0.04 0.95 0.95 XXX

75552 ............ A Magnetic image, myocardium ............................ 1.60 11.40 11.40 0.78 13.78 13.78 XXX

75552 TC A Magnetic image, myocardium ............................ 0.00 10.68 10.68 0.67 11.35 11.35 XXX

75552 26 A Magnetic image, myocardium ............................ 1.60 0.72 0.72 0.11 2.43 2.43 XXX

75553 ............ A Magnetic image, myocardium ............................ 2.00 11.40 11.40 0.78 14.18 14.18 XXX

75553 TC A Magnetic image, myocardium ............................ 0.00 10.68 10.68 0.67 11.35 11.35 XXX

75553 26 A Magnetic image, myocardium ............................ 2.00 0.72 0.72 0.11 2.83 2.83 XXX

75554 ............ A Cardiac MRI/function .......................................... 1.83 11.40 11.40 0.78 14.01 14.01 XXX

75554 TC A Cardiac MRI/function .......................................... 0.00 10.68 10.68 0.67 11.35 11.35 XXX

75554 26 A Cardiac MRI/function .......................................... 1.83 0.72 0.72 0.11 2.66 2.66 XXX

75555 ............ A Cardiac MRI/limited study .................................. 1.74 11.40 11.40 0.78 13.92 13.92 XXX

75555 TC A Cardiac MRI/limited study .................................. 0.00 10.68 10.68 0.67 11.35 11.35 XXX

75555 26 A Cardiac MRI/limited study .................................. 1.74 0.72 0.72 0.11 2.57 2.57 XXX

75556 ............ N Cardiac MRI/flow mapping ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

75600 ............ A Contrast x-ray exam of aorta ............................. 0.49 12.23 12.23 0.78 13.50 13.50 XXX

75600 TC A Contrast x-ray exam of aorta ............................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75600 26 A Contrast x-ray exam of aorta ............................. 0.49 0.22 0.22 0.03 0.74 0.74 XXX

75605 ............ A Contrast x-ray exam of aorta ............................. 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75605 TC A Contrast x-ray exam of aorta ............................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75605 26 A Contrast x-ray exam of aorta ............................. 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75625 ............ A Contrast x-ray exam of aorta ............................. 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75625 TC A Contrast x-ray exam of aorta ............................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75625 26 A Contrast x-ray exam of aorta ............................. 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75630 ............ A X-ray aorta, leg arteries ..................................... 1.79 13.09 13.09 0.88 15.76 15.76 XXX

75630 TC A X-ray aorta, leg arteries ..................................... 0.00 12.51 12.51 0.79 13.30 13.30 XXX

75630 26 A X-ray aorta, leg arteries ..................................... 1.79 0.58 0.58 0.09 2.46 2.46 XXX

75650 ............ A Artery x-rays, head & neck ................................ 1.49 12.67 12.67 0.85 15.01 15.01 XXX

75650 TC A Artery x-rays, head & neck ................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75650 26 A Artery x-rays, head & neck ................................ 1.49 0.66 0.66 0.10 2.25 2.25 XXX

75658 ............ A X-ray exam of arm arteries ................................ 1.31 12.59 12.59 0.84 14.74 14.74 XXX

75658 TC A X-ray exam of arm arteries ................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75658 26 A X-ray exam of arm arteries ................................ 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75660 ............ A Artery x-rays, head & neck ................................ 1.31 12.59 12.59 0.84 14.74 14.74 XXX

75660 TC A Artery x-rays, head & neck ................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75660 26 A Artery x-rays, head & neck ................................ 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75662 ............ A Artery x-rays, head & neck ................................ 1.66 12.75 12.75 0.86 15.27 15.27 XXX

75662 TC A Artery x-rays, head & neck ................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75662 26 A Artery x-rays, head & neck ................................ 1.66 0.74 0.74 0.11 2.51 2.51 XXX

75665 ............ A Artery x-rays, head & neck ................................ 1.31 12.59 12.59 0.84 14.74 14.74 XXX

75665 TC A Artery x-rays, head & neck ................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75665 26 A Artery x-rays, head & neck ................................ 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75671 ............ A Artery x-rays, head & neck ................................ 1.66 12.75 12.75 0.86 15.27 15.27 XXX

75671 TC A Artery x-rays, head & neck ................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75671 26 A Artery x-rays, head & neck ................................ 1.66 0.74 0.74 0.11 2.51 2.51 XXX

75676 ............ A Artery x-rays, neck ............................................. 1.31 12.59 12.59 0.84 14.74 14.74 XXX
59180

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

75676 TC A Artery x-rays, neck ............................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75676 26 A Artery x-rays, neck ............................................. 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75680 ............ A Artery x-rays, neck ............................................. 1.66 12.75 12.75 0.86 15.27 15.27 XXX

75680 TC A Artery x-rays, neck ............................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75680 26 A Artery x-rays, neck ............................................. 1.66 0.74 0.74 0.11 2.51 2.51 XXX

75685 ............ A Artery x-rays, spine ............................................ 1.31 12.59 12.59 0.84 14.74 14.74 XXX

75685 TC A Artery x-rays, spine ............................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75685 26 A Artery x-rays, spine ............................................ 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75705 ............ A Artery x-rays, spine ............................................ 2.18 12.99 12.99 0.90 16.07 16.07 XXX

75705 TC A Artery x-rays, spine ............................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75705 26 A Artery x-rays, spine ............................................ 2.18 0.98 0.98 0.15 3.31 3.31 XXX

75710 ............ A Artery x-rays, arm/leg ......................................... 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75710 TC A Artery x-rays, arm/leg ......................................... 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75710 26 A Artery x-rays, arm/leg ......................................... 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75716 ............ A Artery x-rays, arms/legs ..................................... 1.31 12.59 12.59 0.84 14.74 14.74 XXX

75716 TC A Artery x-rays, arms/legs ..................................... 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75716 26 A Artery x-rays, arms/legs ..................................... 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75722 ............ A Artery x-rays, kidney .......................................... 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75722 TC A Artery x-rays, kidney .......................................... 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75722 26 A Artery x-rays, kidney .......................................... 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75724 ............ A Artery x-rays, kidneys ........................................ 1.49 12.67 12.67 0.85 15.01 15.01 XXX

75724 TC A Artery x-rays, kidneys ........................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75724 26 A Artery x-rays, kidneys ........................................ 1.49 0.66 0.66 0.10 2.25 2.25 XXX

75726 ............ A Artery x-rays, abdomen ...................................... 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75726 TC A Artery x-rays, abdomen ...................................... 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75726 26 A Artery x-rays, abdomen ...................................... 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75731 ............ A Artery x-rays, adrenal gland ............................... 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75731 TC A Artery x-rays, adrenal gland ............................... 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75731 26 A Artery x-rays, adrenal gland ............................... 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75733 ............ A Artery x-rays, adrenal glands ............................. 1.31 12.59 12.59 0.84 14.74 14.74 XXX

75733 TC A Artery x-rays, adrenal glands ............................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75733 26 A Artery x-rays, adrenal glands ............................. 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75736 ............ A Artery x-rays, pelvis ........................................... 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75736 TC A Artery x-rays, pelvis ........................................... 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75736 26 A Artery x-rays, pelvis ........................................... 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75741 ............ A Artery x-rays, lung .............................................. 1.31 12.59 12.59 0.84 14.74 14.74 XXX

75741 TC A Artery x-rays, lung .............................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75741 26 A Artery x-rays, lung .............................................. 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75743 ............ A Artery x-rays, lungs ............................................ 1.66 12.75 12.75 0.86 15.27 15.27 XXX

75743 TC A Artery x-rays, lungs ............................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75743 26 A Artery x-rays, lungs ............................................ 1.66 0.74 0.74 0.11 2.51 2.51 XXX

75746 ............ A Artery x-rays, lung .............................................. 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75746 TC A Artery x-rays, lung .............................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75746 26 A Artery x-rays, lung .............................................. 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75756 ............ A Artery x-rays, chest ............................................ 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75756 TC A Artery x-rays, chest ............................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75756 26 A Artery x-rays, chest ............................................ 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75774 ............ A Artery x-ray, each vessel ................................... 0.36 12.17 12.17 0.77 13.30 13.30 XXX

75774 TC A Artery x-ray, each vessel ................................... 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75774 26 A Artery x-ray, each vessel ................................... 0.36 0.16 0.16 0.02 0.54 0.54 XXX

75790 ............ A Visualize A–V shunt ........................................... 1.84 2.12 2.12 0.21 4.17 4.17 XXX

75790 TC A Visualize A–V shunt ........................................... 0.00 1.29 1.29 0.09 1.38 1.38 XXX

75790 26 A Visualize A–V shunt ........................................... 1.84 0.83 0.83 0.12 2.79 2.79 XXX

75801 ............ A Lymph vessel x-ray, arm/leg .............................. 0.81 5.53 5.53 0.38 6.72 6.72 XXX

75801 TC A Lymph vessel x-ray, arm/leg .............................. 0.00 5.16 5.16 0.33 5.49 5.49 XXX

75801 26 A Lymph vessel x-ray, arm/leg .............................. 0.81 0.37 0.37 0.05 1.23 1.23 XXX

75803 ............ A Lymph vessel x-ray, arms/legs .......................... 1.17 5.67 5.67 0.41 7.25 7.25 XXX

75803 TC A Lymph vessel x-ray,arms/legs ........................... 0.00 5.16 5.16 0.33 5.49 5.49 XXX

75803 26 A Lymph vessel x-ray,arms/legs ........................... 1.17 0.51 0.51 0.08 1.76 1.76 XXX

75805 ............ A Lymph vessel x-ray, trunk .................................. 0.81 6.18 6.18 0.42 7.41 7.41 XXX

75805 TC A Lymph vessel x-ray, trunk .................................. 0.00 5.81 5.81 0.37 6.18 6.18 XXX

75805 26 A Lymph vessel x-ray, trunk .................................. 0.81 0.37 0.37 0.05 1.23 1.23 XXX

75807 ............ A Lymph vessel x-ray, trunk .................................. 1.17 6.32 6.32 0.45 7.94 7.94 XXX

75807 TC A Lymph vessel x-ray, trunk .................................. 0.00 5.81 5.81 0.37 6.18 6.18 XXX

75807 26 A Lymph vessel x-ray, trunk .................................. 1.17 0.51 0.51 0.08 1.76 1.76 XXX

75809 ............ A Nonvascular shunt, x-ray ................................... 0.47 0.94 0.94 0.08 1.49 1.49 XXX

75809 TC A Nonvascular shunt, x-ray ................................... 0.00 0.75 0.75 0.05 0.80 0.80 XXX

75809 26 A Nonvascular shunt, x-ray ................................... 0.47 0.19 0.19 0.03 0.69 0.69 XXX

75810 ............ A Vein x-ray, spleen/liver ....................................... 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75810 TC A Vein x-ray, spleen/liver ....................................... 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75810 26 A Vein x-ray, spleen/liver ....................................... 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75820 ............ A Vein x-ray, arm/leg ............................................. 0.70 1.22 1.22 0.11 2.03 2.03 XXX

75820 TC A Vein x-ray, arm/leg ............................................. 0.00 0.90 0.90 0.06 0.96 0.96 XXX

75820 26 A Vein x-ray, arm/leg ............................................. 0.70 0.32 0.32 0.05 1.07 1.07 XXX
59181

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

75822 ............ A Vein x-ray, arms/legs ......................................... 1.06 1.88 1.88 0.16 3.10 3.10 XXX

75822 TC A Vein x-ray, arms/legs ......................................... 0.00 1.41 1.41 0.09 1.50 1.50 XXX

75822 26 A Vein x-ray, arms/legs ......................................... 1.06 0.47 0.47 0.07 1.60 1.60 XXX

75825 ............ A Vein x-ray, trunk ................................................. 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75825 TC A Vein x-ray, trunk ................................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75825 26 A Vein x-ray, trunk ................................................. 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75827 ............ A Vein x-ray, chest ................................................ 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75827 TC A Vein x-ray, chest ................................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75827 26 A Vein x-ray, chest ................................................ 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75831 ............ A Vein x-ray, kidney .............................................. 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75831 TC A Vein x-ray, kidney .............................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75831 26 A Vein x-ray, kidney .............................................. 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75833 ............ A Vein x-ray, kidneys ............................................. 1.49 12.67 12.67 0.85 15.01 15.01 XXX

75833 TC A Vein x-ray, kidneys ............................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75833 26 A Vein x-ray, kidneys ............................................. 1.49 0.66 0.66 0.10 2.25 2.25 XXX

75840 ............ A Vein x-ray, adrenal gland ................................... 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75840 TC A Vein x-ray, adrenal gland ................................... 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75840 26 A Vein x-ray, adrenal gland ................................... 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75842 ............ A Vein x-ray, adrenal glands ................................. 1.49 12.67 12.67 0.85 15.01 15.01 XXX

75842 TC A Vein x-ray, adrenal glands ................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75842 26 A Vein x-ray, adrenal glands ................................. 1.49 0.66 0.66 0.10 2.25 2.25 XXX

75860 ............ A Vein x-ray, neck ................................................. 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75860 TC A Vein x-ray, neck ................................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75860 26 A Vein x-ray, neck ................................................. 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75870 ............ A Vein x-ray, skull .................................................. 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75870 TC A Vein x-ray, skull .................................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75870 26 A Vein x-ray, skull .................................................. 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75872 ............ A Vein x-ray, skull .................................................. 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75872 TC A Vein x-ray, skull .................................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75872 26 A Vein x-ray, skull .................................................. 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75880 ............ A Vein x-ray, eye socket ....................................... 0.70 1.22 1.22 0.11 2.03 2.03 XXX

75880 TC A Vein x-ray, eye socket ....................................... 0.00 0.90 0.90 0.06 0.96 0.96 XXX

75880 26 A Vein x-ray, eye socket ....................................... 0.70 0.32 0.32 0.05 1.07 1.07 XXX

75885 ............ A Vein x-ray, liver .................................................. 1.44 12.65 12.65 0.85 14.94 14.94 XXX

75885 TC A Vein x-ray, liver .................................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75885 26 A Vein x-ray, liver .................................................. 1.44 0.64 0.64 0.10 2.18 2.18 XXX

75887 ............ A Vein x-ray, liver .................................................. 1.44 12.65 12.65 0.85 14.94 14.94 XXX

75887 TC A Vein x-ray, liver .................................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75887 26 A Vein x-ray, liver .................................................. 1.44 0.64 0.64 0.10 2.18 2.18 XXX

75889 ............ A Vein x-ray, liver .................................................. 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75889 TC A Vein x-ray, liver .................................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75889 26 A Vein x-ray, liver .................................................. 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75891 ............ A Vein x-ray, liver .................................................. 1.14 12.51 12.51 0.83 14.48 14.48 XXX

75891 TC A Vein x-ray, liver .................................................. 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75891 26 A Vein x-ray, liver .................................................. 1.14 0.50 0.50 0.08 1.72 1.72 XXX

75893 ............ A Venous sampling by catheter ............................ 0.54 12.26 12.26 0.79 13.59 13.59 XXX

75893 TC A Venous sampling by catheter ............................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75893 26 A Venous sampling by catheter ............................ 0.54 0.25 0.25 0.04 0.83 0.83 XXX

75894 ............ A Xrays, transcatheter therapy .............................. 1.31 23.58 23.58 1.53 26.42 26.42 XXX

75894 TC A Xrays, transcatheter therapy .............................. 0.00 23.00 23.00 1.44 24.44 24.44 XXX

75894 26 A Xrays, transcatheter therapy .............................. 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75896 ............ A Xrays, transcatheter therapy .............................. 1.31 20.58 20.58 1.34 23.23 23.23 XXX

75896 TC A Xrays, transcatheter therapy .............................. 0.00 20.00 20.00 1.25 21.25 21.25 XXX

75896 26 A Xrays, transcatheter therapy .............................. 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75898 ............ A Follow-up angiogram .......................................... 1.65 1.74 1.74 0.18 3.57 3.57 XXX

75898 TC A Follow-up angiogram .......................................... 0.00 1.00 1.00 0.07 1.07 1.07 XXX

75898 26 A Follow-up angiogram .......................................... 1.65 0.74 0.74 0.11 2.50 2.50 XXX

75900 ............ A Arterial catheter exchange ................................. 0.49 20.22 20.22 1.29 22.00 22.00 XXX

75900 TC A Arterial catheter exchange ................................. 0.00 19.99 19.99 1.26 21.25 21.25 XXX

75900 26 A Arterial catheter exchange ................................. 0.49 0.23 0.23 0.03 0.75 0.75 XXX

75940 ............ A X-ray placement, vein filter ................................ 0.54 12.26 12.26 0.79 13.59 13.59 XXX

75940 TC A X-ray placement, vein filter ................................ 0.00 12.01 12.01 0.75 12.76 12.76 XXX

75940 26 A X-ray placement, vein filter ................................ 0.54 0.25 0.25 0.04 0.83 0.83 XXX

75945 ............ A Intravascular us .................................................. 0.40 4.57 4.57 0.31 5.28 5.28 XXX

75945 TC A Intravascular us .................................................. 0.00 4.35 4.35 0.28 4.63 4.63 XXX

75945 26 A Intravascular us .................................................. 0.40 0.22 0.22 0.03 0.65 0.65 XXX

75946 ............ A Intravascular us .................................................. 0.40 2.40 2.40 0.17 2.97 2.97 XXX

75946 TC A Intravascular us .................................................. 0.00 2.18 2.18 0.14 2.32 2.32 XXX

75946 26 A Intravascular us .................................................. 0.40 0.22 0.22 0.03 0.65 0.65 XXX

75960 ............ A Transcatheter intro, stent ................................... 0.82 14.57 14.57 0.94 16.33 16.33 XXX

75960 TC A Transcatheter intro, stent ................................... 0.00 14.20 14.20 0.88 15.08 15.08 XXX

75960 26 A Transcatheter intro, stent ................................... 0.82 0.37 0.37 0.06 1.25 1.25 XXX

75961 ............ A Retrieval, broken catheter .................................. 4.25 11.91 11.91 0.90 17.06 17.06 XXX

75961 TC A Retrieval, broken catheter .................................. 0.00 10.01 10.01 0.62 10.63 10.63 XXX
59182

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

75961 26 A Retrieval, broken catheter .................................. 4.25 1.90 1.90 0.28 6.43 6.43 XXX

75962 ............ A Repair arterial blockage ..................................... 0.54 15.25 15.25 0.98 16.77 16.77 XXX

75962 TC A Repair arterial blockage ..................................... 0.00 15.00 15.00 0.94 15.94 15.94 XXX

75962 26 A Repair arterial blockage ..................................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

75964 ............ A Repair artery blockage, each ............................. 0.36 8.16 8.16 0.52 9.04 9.04 XXX

75964 TC A Repair artery blockage, each ............................. 0.00 8.00 8.00 0.50 8.50 8.50 XXX

75964 26 A Repair artery blockage, each ............................. 0.36 0.16 0.16 0.02 0.54 0.54 XXX

75966 ............ A Repair arterial blockage ..................................... 1.31 15.58 15.58 1.03 17.92 17.92 XXX

75966 TC A Repair arterial blockage ..................................... 0.00 15.00 15.00 0.94 15.94 15.94 XXX

75966 26 A Repair arterial blockage ..................................... 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75968 ............ A Repair artery blockage, each ............................. 0.36 8.16 8.16 0.52 9.04 9.04 XXX

75968 TC A Repair artery blockage, each ............................. 0.00 8.00 8.00 0.50 8.50 8.50 XXX

75968 26 A Repair artery blockage, each ............................. 0.36 0.16 0.16 0.02 0.54 0.54 XXX

75970 ............ A Vascular biopsy .................................................. 0.83 11.38 11.38 0.75 12.96 12.96 XXX

75970 TC A Vascular biopsy .................................................. 0.00 11.00 11.00 0.69 11.69 11.69 XXX

75970 26 A Vascular biopsy .................................................. 0.83 0.38 0.38 0.06 1.27 1.27 XXX

75978 ............ A Repair venous blockage .................................... 0.54 15.48 15.48 0.98 17.00 17.00 XXX

75978 TC A Repair venous blockage .................................... 0.00 15.00 15.00 0.94 15.94 15.94 XXX

75978 26 A Repair venous blockage .................................... 0.54 0.48 0.48 0.04 1.06 1.06 XXX

75980 ............ A Contrast x-ray exam bile duct ............................ 1.44 5.80 5.80 0.43 7.67 7.67 XXX

75980 TC A Contrast x-ray exam bile duct ............................ 0.00 5.16 5.16 0.33 5.49 5.49 XXX

75980 26 A Contrast x-ray exam bile duct ............................ 1.44 0.64 0.64 0.10 2.18 2.18 XXX

75982 ............ A Contrast x-ray exam bile duct ............................ 1.44 6.45 6.45 0.47 8.36 8.36 XXX

75982 TC A Contrast x-ray exam bile duct ............................ 0.00 5.81 5.81 0.37 6.18 6.18 XXX

75982 26 A Contrast x-ray exam bile duct ............................ 1.44 0.64 0.64 0.10 2.18 2.18 XXX

75984 ............ A X-ray control catheter change ............................ 0.72 2.19 2.19 0.17 3.08 3.08 XXX

75984 TC A X-ray control catheter change ............................ 0.00 1.86 1.86 0.12 1.98 1.98 XXX

75984 26 A X-ray control catheter change ............................ 0.72 0.33 0.33 0.05 1.10 1.10 XXX

75989 ............ A Abscess drainage under x-ray ........................... 1.19 3.52 3.52 0.27 4.98 4.98 XXX

75989 TC A Abscess drainage under x-ray ........................... 0.00 3.00 3.00 0.19 3.19 3.19 XXX

75989 26 A Abscess drainage under x-ray ........................... 1.19 0.52 0.52 0.08 1.79 1.79 XXX

75992 ............ A Atherectomy, x-ray exam ................................... 0.54 15.25 15.25 0.98 16.77 16.77 XXX

75992 TC A Atherectomy, x-ray exam ................................... 0.00 15.00 15.00 0.94 15.94 15.94 XXX

75992 26 A Atherectomy, x-ray exam ................................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

75993 ............ A Atherectomy, x-ray exam ................................... 0.36 8.16 8.16 0.52 9.04 9.04 XXX

75993 TC A Atherectomy, x-ray exam ................................... 0.00 8.00 8.00 0.50 8.50 8.50 XXX

75993 26 A Atherectomy, x-ray exam ................................... 0.36 0.16 0.16 0.02 0.54 0.54 XXX

75994 ............ A Atherectomy, x-ray exam ................................... 1.31 15.58 15.58 1.03 17.92 17.92 XXX

75994 TC A Atherectomy, x-ray exam ................................... 0.00 15.00 15.00 0.94 15.94 15.94 XXX

75994 26 A Atherectomy, x-ray exam ................................... 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75995 ............ A Atherectomy, x-ray exam ................................... 1.31 15.58 15.58 1.03 17.92 17.92 XXX

75995 TC A Atherectomy, x-ray exam ................................... 0.00 15.00 15.00 0.94 15.94 15.94 XXX

75995 26 A Atherectomy, x-ray exam ................................... 1.31 0.58 0.58 0.09 1.98 1.98 XXX

75996 ............ A Atherectomy, x-ray exam ................................... 0.36 8.16 8.16 0.52 9.04 9.04 XXX

75996 TC A Atherectomy, x-ray exam ................................... 0.00 8.00 8.00 0.50 8.50 8.50 XXX

75996 26 A Atherectomy, x-ray exam ................................... 0.36 0.16 0.16 0.02 0.54 0.54 XXX

76000 ............ A Fluoroscope examination ................................... 0.17 1.31 1.31 0.09 1.57 1.57 XXX

76000 TC A Fluoroscope examination ................................... 0.00 1.24 1.24 0.08 1.32 1.32 XXX

76000 26 A Fluoroscope examination ................................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX

76001 ............ A Fluoroscope exam, extensive ............................ 0.67 2.81 2.81 0.22 3.70 3.70 XXX

76001 TC A Fluoroscope exam, extensive ............................ 0.00 2.50 2.50 0.17 2.67 2.67 XXX

76001 26 A Fluoroscope exam, extensive ............................ 0.67 0.31 0.31 0.05 1.03 1.03 XXX

76003 ............ A Needle localization by x-ray ............................... 0.54 1.49 1.49 0.12 2.15 2.15 XXX

76003 TC A Needle localization by x-ray ............................... 0.00 1.24 1.24 0.08 1.32 1.32 XXX

76003 26 A Needle localization by x-ray ............................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

76010 ............ A X-ray, nose to rectum ........................................ 0.18 0.58 0.58 0.04 0.80 0.80 XXX

76010 TC A X-ray, nose to rectum ........................................ 0.00 0.50 0.50 0.03 0.53 0.53 XXX

76010 26 A X-ray, nose to rectum ........................................ 0.18 0.08 0.08 0.01 0.27 0.27 XXX

76020 ............ A X-rays for bone age ........................................... 0.19 0.59 0.59 0.04 0.82 0.82 XXX

76020 TC A X-rays for bone age ........................................... 0.00 0.50 0.50 0.03 0.53 0.53 XXX

76020 26 A X-rays for bone age ........................................... 0.19 0.09 0.09 0.01 0.29 0.29 XXX

76040 ............ A X-rays, bone evaluation ..................................... 0.27 0.88 0.88 0.07 1.22 1.22 XXX

76040 TC A X-rays, bone evaluation ..................................... 0.00 0.75 0.75 0.05 0.80 0.80 XXX

76040 26 A X-rays, bone evaluation ..................................... 0.27 0.13 0.13 0.02 0.42 0.42 XXX

76061 ............ A X-rays, bone survey ........................................... 0.45 1.15 1.15 0.09 1.69 1.69 XXX

76061 TC A X-rays, bone survey ........................................... 0.00 0.95 0.95 0.06 1.01 1.01 XXX

76061 26 A X-rays, bone survey ........................................... 0.45 0.20 0.20 0.03 0.68 0.68 XXX

76062 ............ A X-rays, bone survey ........................................... 0.54 1.62 1.62 0.13 2.29 2.29 XXX

76062 TC A X-rays, bone survey ........................................... 0.00 1.37 1.37 0.09 1.46 1.46 XXX

76062 26 A X-rays, bone survey ........................................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

76065 ............ A X-rays, bone evaluation ..................................... 0.28 0.83 0.83 0.07 1.18 1.18 XXX

76065 TC A X-rays, bone evaluation ..................................... 0.00 0.70 0.70 0.05 0.75 0.75 XXX

76065 26 A X-rays, bone evaluation ..................................... 0.28 0.13 0.13 0.02 0.43 0.43 XXX

76066 ............ A Joint(s) survey, single film ................................. 0.31 1.20 1.20 0.09 1.60 1.60 XXX
59183

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

76066 TC A Joint(s) survey, single film ................................. 0.00 1.06 1.06 0.07 1.13 1.13 XXX

76066 26 A Joint(s) survey, single film ................................. 0.31 0.14 0.14 0.02 0.47 0.47 XXX

76070 ............ A CT scan, bone density study ............................. 0.25 2.93 2.93 0.20 3.38 3.38 XXX

76070 TC A CT scan, bone density study ............................. 0.00 2.81 2.81 0.18 2.99 2.99 XXX

76070 26 A CT scan, bone density study ............................. 0.25 0.12 0.12 0.02 0.39 0.39 XXX

76075 ............ A Dual energy x-ray study ..................................... 0.30 3.07 3.07 0.21 3.58 3.58 XXX

76075 TC A Dual energy x-ray study ..................................... 0.00 2.95 2.95 0.19 3.14 3.14 XXX

76075 26 A Dual energy x-ray study ..................................... 0.30 0.12 0.12 0.02 0.44 0.44 XXX

76076 ............ A Dual energy x-ray study ..................................... 0.22 1.54 1.54 0.12 1.88 1.88 XXX

76076 TC A Dual energy x-ray study ..................................... 0.00 1.44 1.44 0.10 1.54 1.54 XXX

76076 26 A Dual energy x-ray study ..................................... 0.22 0.10 0.10 0.02 0.34 0.34 XXX

76078 ............ A Photodensitometry ............................................. 0.20 0.82 0.82 0.07 1.09 1.09 XXX

76078 TC A Photodensitometry ............................................. 0.00 0.72 0.72 0.05 0.77 0.77 XXX

76078 26 A Photodensitometry ............................................. 0.20 0.10 0.10 0.02 0.32 0.32 XXX

76080 ............ A X-ray exam of fistula .......................................... 0.54 1.25 1.25 0.11 1.90 1.90 XXX

76080 TC A X-ray exam of fistula .......................................... 0.00 1.00 1.00 0.07 1.07 1.07 XXX

76080 26 A X-ray exam of fistula .......................................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

76086 ............ A X-ray of mammary duct ..................................... 0.36 2.67 2.67 0.19 3.22 3.22 XXX

76086 TC A X-ray of mammary duct ..................................... 0.00 2.50 2.50 0.17 2.67 2.67 XXX

76086 26 A X-ray of mammary duct ..................................... 0.36 0.17 0.17 0.02 0.55 0.55 XXX

76088 ............ A X-ray of mammary ducts .................................... 0.45 3.69 3.69 0.25 4.39 4.39 XXX

76088 TC A X-ray of mammary ducts .................................... 0.00 3.49 3.49 0.22 3.71 3.71 XXX

76088 26 A X-ray of mammary ducts .................................... 0.45 0.20 0.20 0.03 0.68 0.68 XXX

76090 ............ A Mammogram, one breast ................................... 0.58 1.12 1.12 0.09 1.79 1.79 XXX

76090 TC A Mammogram, one breast ................................... 0.00 1.00 1.00 0.07 1.07 1.07 XXX

76090 26 A Mammogram, one breast ................................... 0.58 0.12 0.12 0.02 0.72 0.72 XXX

76091 ............ A Mammogram, both breasts ................................ 0.69 1.42 1.42 0.11 2.22 2.22 XXX

76091 TC A Mammogram, both breasts ................................ 0.00 1.24 1.24 0.08 1.32 1.32 XXX

76091 26 A Mammogram, both breasts ................................ 0.69 0.18 0.18 0.03 0.90 0.90 XXX

76092 ............ X Mammogram, screening .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

76093 ............ A Magnetic image, breast ...................................... 1.63 17.52 17.52 1.16 20.31 20.31 XXX

76093 TC A Magnetic image, breast ...................................... 0.00 16.80 16.80 1.05 17.85 17.85 XXX

76093 26 A Magnetic image, breast ...................................... 1.63 0.72 0.72 0.11 2.46 2.46 XXX

76094 ............ A Magnetic image, both breasts ............................ 1.63 23.51 23.51 1.53 26.67 26.67 XXX

76094 TC A Magnetic image, both breasts ............................ 0.00 22.79 22.79 1.42 24.21 24.21 XXX

76094 26 A Magnetic image, both breasts ............................ 1.63 0.72 0.72 0.11 2.46 2.46 XXX

76095 ............ A Stereotactic breast biopsy .................................. 1.59 7.54 7.54 0.54 9.67 9.67 XXX

76095 TC A Stereotactic breast biopsy .................................. 0.00 6.83 6.83 0.43 7.26 7.26 XXX

76095 26 A Stereotactic breast biopsy .................................. 1.59 0.71 0.71 0.11 2.41 2.41 XXX

76096 ............ A X-ray of needle wire, breast ............................... 0.56 1.50 1.50 0.12 2.18 2.18 XXX

76096 TC A X-ray of needle wire, breast ............................... 0.00 1.24 1.24 0.08 1.32 1.32 XXX

76096 26 A X-ray of needle wire, breast ............................... 0.56 0.26 0.26 0.04 0.86 0.86 XXX

76098 ............ A X-ray exam, breast specimen ............................ 0.16 0.47 0.47 0.04 0.67 0.67 XXX

76098 TC A X-ray exam, breast specimen ............................ 0.00 0.40 0.40 0.03 0.43 0.43 XXX

76098 26 A X-ray exam, breast specimen ............................ 0.16 0.07 0.07 0.01 0.24 0.24 XXX

76100 ............ A X-ray exam of body section ............................... 0.58 1.46 1.46 0.12 2.16 2.16 XXX

76100 TC A X-ray exam of body section ............................... 0.00 1.19 1.19 0.08 1.27 1.27 XXX

76100 26 A X-ray exam of body section ............................... 0.58 0.27 0.27 0.04 0.89 0.89 XXX

76101 ............ A Complex body section x-ray .............................. 0.58 1.62 1.62 0.13 2.33 2.33 XXX

76101 TC A Complex body section x-ray .............................. 0.00 1.35 1.35 0.09 1.44 1.44 XXX

76101 26 A Complex body section x-ray .............................. 0.58 0.27 0.27 0.04 0.89 0.89 XXX

76102 ............ A Complex body section x-rays ............................. 0.58 1.92 1.92 0.15 2.65 2.65 XXX

76102 TC A Complex body section x-rays ............................. 0.00 1.65 1.65 0.11 1.76 1.76 XXX

76102 26 A Complex body section x-rays ............................. 0.58 0.27 0.27 0.04 0.89 0.89 XXX

76120 ............ A Cinematic x-rays ................................................ 0.38 1.17 1.17 0.10 1.65 1.65 XXX

76120 TC A Cinematic x-rays ................................................ 0.00 1.00 1.00 0.07 1.07 1.07 XXX

76120 26 A Cinematic x-rays ................................................ 0.38 0.17 0.17 0.03 0.58 0.58 XXX

76125 ............ A Cinematic x-rays ................................................ 0.27 0.87 0.87 0.07 1.21 1.21 XXX

76125 TC A Cinematic x-rays ................................................ 0.00 0.75 0.75 0.05 0.80 0.80 XXX

76125 26 A Cinematic x-rays ................................................ 0.27 0.12 0.12 0.02 0.41 0.41 XXX

76140 ............ I X-ray consultation .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

76150 ............ A X-ray exam, dry process .................................... 0.00 0.40 0.40 0.03 0.43 0.43 XXX

76350 ............ C Special x-ray contrast study ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

76355 ............ A CAT scan for localization ................................... 1.21 8.40 8.40 0.57 10.18 10.18 XXX

76355 TC A CAT scan for localization ................................... 0.00 7.87 7.87 0.49 8.36 8.36 XXX

76355 26 A CAT scan for localization ................................... 1.21 0.53 0.53 0.08 1.82 1.82 XXX

76360 ............ A CAT scan for needle biopsy .............................. 1.16 8.37 8.37 0.57 10.10 10.10 XXX

76360 TC A CAT scan for needle biopsy .............................. 0.00 7.87 7.87 0.49 8.36 8.36 XXX

76360 26 A CAT scan for needle biopsy .............................. 1.16 0.50 0.50 0.08 1.74 1.74 XXX

76365 ............ A CAT scan for cyst aspiration .............................. 1.16 8.37 8.37 0.57 10.10 10.10 XXX

76365 TC A CAT scan for cyst aspiration .............................. 0.00 7.87 7.87 0.49 8.36 8.36 XXX

76365 26 A CAT scan for cyst aspiration .............................. 1.16 0.50 0.50 0.08 1.74 1.74 XXX

76370 ............ A CAT scan for therapy guide ............................... 0.85 3.19 3.19 0.24 4.28 4.28 XXX

76370 TC A CAT scan for therapy guide ............................... 0.00 2.81 2.81 0.18 2.99 2.99 XXX
59184

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

76370 26 A CAT scan for therapy guide ............................... 0.85 0.38 0.38 0.06 1.29 1.29 XXX

76375 ............ A 3d/holograph reconstr add-on ............................ 0.16 3.44 3.44 0.22 3.82 3.82 XXX

76375 TC A 3d/holograph reconstr add-on ............................ 0.00 3.37 3.37 0.21 3.58 3.58 XXX

76375 26 A 3d/holograph reconstr add-on ............................ 0.16 0.07 0.07 0.01 0.24 0.24 XXX

76380 ............ A CAT scan follow-up study .................................. 0.98 3.78 3.78 0.28 5.04 5.04 XXX

76380 TC A CAT scan follow-up study .................................. 0.00 3.34 3.34 0.21 3.55 3.55 XXX

76380 26 A CAT scan follow-up study .................................. 0.98 0.44 0.44 0.07 1.49 1.49 XXX

76390 ............ A Mr spectroscopy ................................................. 1.40 11.34 11.34 0.77 13.51 13.51 XXX

76390 TC A Mr spectroscopy ................................................. 0.00 10.68 10.68 0.67 11.35 11.35 XXX

76390 26 A Mr spectroscopy ................................................. 1.40 0.66 0.66 0.10 2.16 2.16 XXX

76400 ............ A Magnetic image, bone marrow .......................... 1.60 11.40 11.40 0.78 13.78 13.78 XXX

76400 TC A Magnetic image, bone marrow .......................... 0.00 10.68 10.68 0.67 11.35 11.35 XXX

76400 26 A Magnetic image, bone marrow .......................... 1.60 0.72 0.72 0.11 2.43 2.43 XXX

76499 ............ C Radiographic procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

76499 TC C Radiographic procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

76499 26 C Radiographic procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

76506 ............ A Echo exam of head ............................................ 0.63 1.64 1.64 0.13 2.40 2.40 XXX

76506 TC A Echo exam of head ............................................ 0.00 1.35 1.35 0.09 1.44 1.44 XXX

76506 26 A Echo exam of head ............................................ 0.63 0.29 0.29 0.04 0.96 0.96 XXX

76511 ............ A Echo exam of eye .............................................. 0.94 1.44 1.44 0.12 2.50 2.50 XXX

76511 TC A Echo exam of eye .............................................. 0.00 1.19 1.19 0.08 1.27 1.27 XXX

76511 26 A Echo exam of eye .............................................. 0.94 0.25 0.25 0.04 1.23 1.23 XXX

76512 ............ A Echo exam of eye .............................................. 0.66 1.75 1.75 0.15 2.56 2.56 XXX

76512 TC A Echo exam of eye .............................................. 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76512 26 A Echo exam of eye .............................................. 0.66 0.30 0.30 0.05 1.01 1.01 XXX

76513 ............ A Echo exam of eye, water bath ........................... 0.66 1.75 1.75 0.15 2.56 2.56 XXX

76513 TC A Echo exam of eye, water bath ........................... 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76513 26 A Echo exam of eye, water bath ........................... 0.66 0.30 0.30 0.05 1.01 1.01 XXX

76516 ............ A Echo exam of eye .............................................. 0.54 1.44 1.44 0.12 2.10 2.10 XXX

76516 TC A Echo exam of eye .............................................. 0.00 1.19 1.19 0.08 1.27 1.27 XXX

76516 26 A Echo exam of eye .............................................. 0.54 0.25 0.25 0.04 0.83 0.83 XXX

76519 ............ A Echo exam of eye .............................................. 0.54 1.44 1.44 0.12 2.10 2.10 XXX

76519 TC A Echo exam of eye .............................................. 0.00 1.19 1.19 0.08 1.27 1.27 XXX

76519 26 A Echo exam of eye .............................................. 0.54 0.25 0.25 0.04 0.83 0.83 XXX

76529 ............ A Echo exam of eye .............................................. 0.57 1.56 1.56 0.13 2.26 2.26 XXX

76529 TC A Echo exam of eye .............................................. 0.00 1.30 1.30 0.09 1.39 1.39 XXX

76529 26 A Echo exam of eye .............................................. 0.57 0.26 0.26 0.04 0.87 0.87 XXX

76536 ............ A Echo exam of head and neck ............................ 0.56 1.61 1.61 0.13 2.30 2.30 XXX

76536 TC A Echo exam of head and neck ............................ 0.00 1.35 1.35 0.09 1.44 1.44 XXX

76536 26 A Echo exam of head and neck ............................ 0.56 0.26 0.26 0.04 0.86 0.86 XXX

76604 ............ A Echo exam of chest ........................................... 0.55 1.50 1.50 0.12 2.17 2.17 XXX

76604 TC A Echo exam of chest ........................................... 0.00 1.24 1.24 0.08 1.32 1.32 XXX

76604 26 A Echo exam of chest ........................................... 0.55 0.26 0.26 0.04 0.85 0.85 XXX

76645 ............ A Echo exam of breast .......................................... 0.54 1.25 1.25 0.11 1.90 1.90 XXX

76645 TC A Echo exam of breast .......................................... 0.00 1.00 1.00 0.07 1.07 1.07 XXX

76645 26 A Echo exam of breast .......................................... 0.54 0.25 0.25 0.04 0.83 0.83 XXX

76700 ............ A Echo exam of abdomen ..................................... 0.81 2.25 2.25 0.17 3.23 3.23 XXX

76700 TC A Echo exam of abdomen ..................................... 0.00 1.88 1.88 0.12 2.00 2.00 XXX

76700 26 A Echo exam of abdomen ..................................... 0.81 0.37 0.37 0.05 1.23 1.23 XXX

76705 ............ A Echo exam of abdomen ..................................... 0.59 1.62 1.62 0.13 2.34 2.34 XXX

76705 TC A Echo exam of abdomen ..................................... 0.00 1.35 1.35 0.09 1.44 1.44 XXX

76705 26 A Echo exam of abdomen ..................................... 0.59 0.27 0.27 0.04 0.90 0.90 XXX

76770 ............ A Echo exam abdomen back wall ......................... 0.74 2.22 2.22 0.17 3.13 3.13 XXX

76770 TC A Echo exam abdomen back wall ......................... 0.00 1.88 1.88 0.12 2.00 2.00 XXX

76770 26 A Echo exam abdomen back wall ......................... 0.74 0.34 0.34 0.05 1.13 1.13 XXX

76775 ............ A Echo exam abdomen back wall ......................... 0.58 1.62 1.62 0.13 2.33 2.33 XXX

76775 TC A Echo exam abdomen back wall ......................... 0.00 1.35 1.35 0.09 1.44 1.44 XXX

76775 26 A Echo exam abdomen back wall ......................... 0.58 0.27 0.27 0.04 0.89 0.89 XXX

76778 ............ A Echo exam kidney transplant ............................. 0.74 2.22 2.22 0.17 3.13 3.13 XXX

76778 TC A Echo exam kidney transplant ............................. 0.00 1.88 1.88 0.12 2.00 2.00 XXX

76778 26 A Echo exam kidney transplant ............................. 0.74 0.34 0.34 0.05 1.13 1.13 XXX

76800 ............ A Echo exam spinal canal ..................................... 1.13 1.85 1.85 0.17 3.15 3.15 XXX

76800 TC A Echo exam spinal canal ..................................... 0.00 1.35 1.35 0.09 1.44 1.44 XXX

76800 26 A Echo exam spinal canal ..................................... 1.13 0.50 0.50 0.08 1.71 1.71 XXX

76805 ............ A Echo exam of pregnant uterus .......................... 0.99 2.45 2.45 0.20 3.64 3.64 XXX

76805 TC A Echo exam of pregnant uterus .......................... 0.00 2.00 2.00 0.13 2.13 2.13 XXX

76805 26 A Echo exam of pregnant uterus .......................... 0.99 0.45 0.45 0.07 1.51 1.51 XXX

76810 ............ A Echo exam of pregnant uterus .......................... 1.97 4.88 4.88 0.38 7.23 7.23 XXX

76810 TC A Echo exam of pregnant uterus .......................... 0.00 4.00 4.00 0.25 4.25 4.25 XXX

76810 26 A Echo exam of pregnant uterus .......................... 1.97 0.88 0.88 0.13 2.98 2.98 XXX

76815 ............ A Echo exam of pregnant uterus .......................... 0.65 1.65 1.65 0.13 2.43 2.43 XXX

76815 TC A Echo exam of pregnant uterus .......................... 0.00 1.35 1.35 0.09 1.44 1.44 XXX

76815 26 A Echo exam of pregnant uterus .......................... 0.65 0.30 0.30 0.04 0.99 0.99 XXX

76816 ............ A Echo exam followup or repeat ........................... 0.57 1.32 1.32 0.11 2.00 2.00 XXX
59185

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

76816 TC A Echo exam followup or repeat ........................... 0.00 1.06 1.06 0.07 1.13 1.13 XXX

76816 26 A Echo exam followup or repeat ........................... 0.57 0.26 0.26 0.04 0.87 0.87 XXX

76818 ............ A Fetal biophysical profile ..................................... 0.77 1.89 1.89 0.15 2.81 2.81 XXX

76818 TC A Fetal biophysical profile ..................................... 0.00 1.54 1.54 0.10 1.64 1.64 XXX

76818 26 A Fetal biophysical profile ..................................... 0.77 0.35 0.35 0.05 1.17 1.17 XXX

76825 ............ A Echo exam of fetal heart .................................... 1.67 2.23 2.23 0.17 4.07 4.07 XXX

76825 TC A Echo exam of fetal heart .................................... 0.00 1.88 1.88 0.12 2.00 2.00 XXX

76825 26 A Echo exam of fetal heart .................................... 1.67 0.35 0.35 0.05 2.07 2.07 XXX

76826 ............ A Echo exam of fetal heart .................................... 0.83 1.35 1.35 0.10 2.28 2.28 XXX

76826 TC A Echo exam of fetal heart .................................... 0.00 0.67 0.67 0.05 0.72 0.72 XXX

76826 26 A Echo exam of fetal heart .................................... 0.83 0.68 0.68 0.05 1.56 1.56 XXX

76827 ............ A Echo exam of fetal heart .................................... 0.58 2.28 2.28 0.18 3.04 3.04 XXX

76827 TC A Echo exam of fetal heart .................................... 0.00 1.64 1.64 0.13 1.77 1.77 XXX

76827 26 A Echo exam of fetal heart .................................... 0.58 #0.64 #0.64 0.05 1.27 1.27 XXX

76828 ............ A Echo exam of fetal heart .................................... 0.56 1.34 1.34 0.11 2.01 2.01 XXX

76828 TC A Echo exam of fetal heart .................................... 0.00 1.06 1.06 0.09 1.15 1.15 XXX

76828 26 A Echo exam of fetal heart .................................... 0.56 0.28 0.28 0.02 0.86 0.86 XXX

76830 ............ A Echo exam, transvaginal .................................... 0.69 1.77 1.77 0.15 2.61 2.61 XXX

76830 TC A Echo exam, transvaginal .................................... 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76830 26 A Echo exam, transvaginal .................................... 0.69 0.32 0.32 0.05 1.06 1.06 XXX

76831 ............ A Echo exam, uterus ............................................. 0.72 1.77 1.77 0.15 2.64 2.64 XXX

76831 TC A Echo exam, uterus ............................................. 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76831 26 A Echo exam, uterus ............................................. 0.72 0.32 0.32 0.05 1.09 1.09 XXX

76856 ............ A Echo exam of pelvis ........................................... 0.69 1.77 1.77 0.15 2.61 2.61 XXX

76856 TC A Echo exam of pelvis ........................................... 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76856 26 A Echo exam of pelvis ........................................... 0.69 0.32 0.32 0.05 1.06 1.06 XXX

76857 ............ A Echo exam of pelvis ........................................... 0.38 1.17 1.17 0.10 1.65 1.65 XXX

76857 TC A Echo exam of pelvis ........................................... 0.00 1.00 1.00 0.07 1.07 1.07 XXX

76857 26 A Echo exam of pelvis ........................................... 0.38 0.17 0.17 0.03 0.58 0.58 XXX

76870 ............ A Echo exam of scrotum ....................................... 0.64 1.74 1.74 0.14 2.52 2.52 XXX

76870 TC A Echo exam of scrotum ....................................... 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76870 26 A Echo exam of scrotum ....................................... 0.64 0.29 0.29 0.04 0.97 0.97 XXX

76872 ............ A Echo exam, transrectal ...................................... 0.69 1.77 1.77 0.15 2.61 2.61 XXX

76872 TC A Echo exam, transrectal ...................................... 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76872 26 A Echo exam, transrectal ...................................... 0.69 0.32 0.32 0.05 1.06 1.06 XXX

76880 ............ A Echo exam of extremity ..................................... 0.59 1.62 1.62 0.13 2.34 2.34 XXX

76880 TC A Echo exam of extremity ..................................... 0.00 1.35 1.35 0.09 1.44 1.44 XXX

76880 26 A Echo exam of extremity ..................................... 0.59 0.27 0.27 0.04 0.90 0.90 XXX

76885 ............ A Echo exam, infant hips ...................................... 0.74 1.77 1.77 0.15 2.66 2.66 XXX

76885 TC A Echo exam, infant hips ...................................... 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76885 26 A Echo exam, infant hips ...................................... 0.74 0.32 0.32 0.05 1.11 1.11 XXX

76886 ............ A Echo exam, infant hips ...................................... 0.62 1.62 1.62 0.13 2.37 2.37 XXX

76886 TC A Echo exam, infant hips ...................................... 0.00 1.35 1.35 0.09 1.44 1.44 XXX

76886 26 A Echo exam, infant hips ...................................... 0.62 0.27 0.27 0.04 0.93 0.93 XXX

76930 ............ A Echo guide for heart sac tap ............................. 0.67 1.76 1.76 0.15 2.58 2.58 XXX

76930 TC A Echo guide for heart sac tap ............................. 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76930 26 A Echo guide for heart sac tap ............................. 0.67 0.31 0.31 0.05 1.03 1.03 XXX

76932 ............ A Echo guide for heart biopsy ............................... 0.67 1.76 1.76 0.15 2.58 2.58 XXX

76932 TC A Echo guide for heart biopsy ............................... 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76932 26 A Echo guide for heart biopsy ............................... 0.67 0.31 0.31 0.05 1.03 1.03 XXX

76934 ............ A Echo guide for chest tap .................................... 0.67 1.76 1.76 0.15 2.58 2.58 XXX

76934 TC A Echo guide for chest tap .................................... 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76934 26 A Echo guide for chest tap .................................... 0.67 0.31 0.31 0.05 1.03 1.03 XXX

76936 ............ A Echo guide for artery repair ............................... 1.99 7.24 7.24 0.48 9.71 9.71 XXX

76936 TC A Echo guide for artery repair ............................... 0.00 6.00 6.00 0.38 6.38 6.38 XXX

76936 26 A Echo guide for artery repair ............................... 1.99 1.24 1.24 0.10 3.33 3.33 XXX

76938 ............ A Echo exam for drainage ..................................... 0.67 1.76 1.76 0.15 2.58 2.58 XXX

76938 TC A Echo exam for drainage ..................................... 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76938 26 A Echo exam for drainage ..................................... 0.67 0.31 0.31 0.05 1.03 1.03 XXX

76941 ............ A Echo guide for transfusion ................................. 1.34 2.07 2.07 0.19 3.60 3.60 XXX

76941 TC A Echo guide for transfusion ................................. 0.00 1.46 1.46 0.09 1.55 1.55 XXX

76941 26 A Echo guide for transfusion ................................. 1.34 0.61 0.61 0.10 2.05 2.05 XXX

76942 ............ A Echo guide for biopsy ........................................ 0.67 1.76 1.76 0.15 2.58 2.58 XXX

76942 TC A Echo guide for biopsy ........................................ 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76942 26 A Echo guide for biopsy ........................................ 0.67 0.31 0.31 0.05 1.03 1.03 XXX

76945 ............ A Echo guide, villus sampling ............................... 0.67 2.07 2.07 0.19 2.93 2.93 XXX

76945 TC A Echo guide, villus sampling ............................... 0.00 1.46 1.46 0.09 1.55 1.55 XXX

76945 26 A Echo guide, villus sampling ............................... 0.67 0.61 0.61 0.10 1.38 1.38 XXX

76946 ............ A Echo guide for amniocentesis ............................ 0.38 1.62 1.62 0.13 2.13 2.13 XXX

76946 TC A Echo guide for amniocentesis ............................ 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76946 26 A Echo guide for amniocentesis ............................ 0.38 0.17 0.17 0.03 0.58 0.58 XXX

76948 ............ A Echo guide, ova aspiration ................................ 0.38 1.62 1.62 0.13 2.13 2.13 XXX

76948 TC A Echo guide, ova aspiration ................................ 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76948 26 A Echo guide, ova aspiration ................................ 0.38 0.17 0.17 0.03 0.58 0.58 XXX
59186

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

76950 ............ A Echo guidance radiotherapy .............................. 0.58 1.51 1.51 0.12 2.21 2.21 XXX

76950 TC A Echo guidance radiotherapy .............................. 0.00 1.24 1.24 0.08 1.32 1.32 XXX

76950 26 A Echo guidance radiotherapy .............................. 0.58 0.27 0.27 0.04 0.89 0.89 XXX

76960 ............ A Echo guidance radiotherapy .............................. 0.58 1.51 1.51 0.12 2.21 2.21 XXX

76960 TC A Echo guidance radiotherapy .............................. 0.00 1.24 1.24 0.08 1.32 1.32 XXX

76960 26 A Echo guidance radiotherapy .............................. 0.58 0.27 0.27 0.04 0.89 0.89 XXX

76965 ............ A Echo guidance radiotherapy .............................. 1.34 6.78 6.78 0.52 8.64 8.64 XXX

76965 TC A Echo guidance radiotherapy .............................. 0.00 5.31 5.31 0.33 5.64 5.64 XXX

76965 26 A Echo guidance radiotherapy .............................. 1.34 #1.47 #1.47 0.19 3.00 3.00 XXX

76970 ............ A Ultrasound exam follow-up ................................ 0.40 1.18 1.18 0.10 1.68 1.68 XXX

76970 TC A Ultrasound exam follow-up ................................ 0.00 1.00 1.00 0.07 1.07 1.07 XXX

76970 26 A Ultrasound exam follow-up ................................ 0.40 0.18 0.18 0.03 0.61 0.61 XXX

76975 ............ A GI endoscopic ultrasound .................................. 0.81 1.79 1.79 0.15 2.75 2.75 XXX

76975 TC A GI endoscopic ultrasound .................................. 0.00 1.45 1.45 0.10 1.55 1.55 XXX

76975 26 A GI endoscopic ultrasound .................................. 0.81 0.34 0.34 0.05 1.20 1.20 XXX

76986 ............ A Echo exam at surgery ........................................ 1.20 3.03 3.03 0.25 4.48 4.48 XXX

76986 TC A Echo exam at surgery ........................................ 0.00 2.50 2.50 0.17 2.67 2.67 XXX

76986 26 A Echo exam at surgery ........................................ 1.20 0.53 0.53 0.08 1.81 1.81 XXX

76999 ............ C Echo examination procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

76999 TC C Echo examination procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

76999 26 C Echo examination procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

77261 ............ A Radiation therapy planning ................................ 1.39 0.62 0.62 0.09 2.10 2.10 XXX

77262 ............ A Radiation therapy planning ................................ 2.11 0.94 0.94 0.14 3.19 3.19 XXX

77263 ............ A Radiation therapy planning ................................ 3.14 1.40 1.40 0.20 4.74 4.74 XXX

77280 ............ A Set radiation therapy field .................................. 0.70 3.63 3.63 0.26 4.59 4.59 XXX

77280 TC A Set radiation therapy field .................................. 0.00 3.31 3.31 0.21 3.52 3.52 XXX

77280 26 A Set radiation therapy field .................................. 0.70 0.32 0.32 0.05 1.07 1.07 XXX

77285 ............ A Set radiation therapy field .................................. 1.05 5.77 5.77 0.41 7.23 7.23 XXX

77285 TC A Set radiation therapy field .................................. 0.00 5.31 5.31 0.34 5.65 5.65 XXX

77285 26 A Set radiation therapy field .................................. 1.05 0.46 0.46 0.07 1.58 1.58 XXX

77290 ............ A Set radiation therapy field .................................. 1.56 6.90 6.90 0.50 8.96 8.96 XXX

77290 TC A Set radiation therapy field .................................. 0.00 6.20 6.20 0.39 6.59 6.59 XXX

77290 26 A Set radiation therapy field .................................. 1.56 0.70 0.70 0.11 2.37 2.37 XXX

77295 ............ A Set radiation therapy field .................................. 4.57 28.68 28.68 1.93 35.18 35.18 XXX

77295 TC A Set radiation therapy field .................................. 0.00 26.62 26.62 1.70 28.32 28.32 XXX

77295 26 A Set radiation therapy field .................................. 4.57 2.06 2.06 0.23 6.86 6.86 XXX

77299 ............ C Radiation therapy planning ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

77299 TC C Radiation therapy planning ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

77299 26 C Radiation therapy planning ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

77300 ............ A Radiation therapy dose plan .............................. 0.62 1.56 1.56 0.12 2.30 2.30 XXX

77300 TC A Radiation therapy dose plan .............................. 0.00 1.28 1.28 0.08 1.36 1.36 XXX

77300 26 A Radiation therapy dose plan .............................. 0.62 0.28 0.28 0.04 0.94 0.94 XXX

77305 ............ A Radiation therapy dose plan .............................. 0.70 2.09 2.09 0.17 2.96 2.96 XXX

77305 TC A Radiation therapy dose plan .............................. 0.00 1.77 1.77 0.12 1.89 1.89 XXX

77305 26 A Radiation therapy dose plan .............................. 0.70 0.32 0.32 0.05 1.07 1.07 XXX

77310 ............ A Radiation therapy dose plan .............................. 1.05 2.68 2.68 0.22 3.95 3.95 XXX

77310 TC A Radiation therapy dose plan .............................. 0.00 2.22 2.22 0.15 2.37 2.37 XXX

77310 26 A Radiation therapy dose plan .............................. 1.05 0.46 0.46 0.07 1.58 1.58 XXX

77315 ............ A Radiation therapy dose plan .............................. 1.56 3.23 3.23 0.28 5.07 5.07 XXX

77315 TC A Radiation therapy dose plan .............................. 0.00 2.53 2.53 0.17 2.70 2.70 XXX

77315 26 A Radiation therapy dose plan .............................. 1.56 0.70 0.70 0.11 2.37 2.37 XXX

77321 ............ A Radiation therapy port plan ................................ 0.95 4.28 4.28 0.30 5.53 5.53 XXX

77321 TC A Radiation therapy port plan ................................ 0.00 3.85 3.85 0.24 4.09 4.09 XXX

77321 26 A Radiation therapy port plan ................................ 0.95 0.43 0.43 0.06 1.44 1.44 XXX

77326 ............ A Radiation therapy dose plan .............................. 0.93 2.67 2.67 0.21 3.81 3.81 XXX

77326 TC A Radiation therapy dose plan .............................. 0.00 2.25 2.25 0.15 2.40 2.40 XXX

77326 26 A Radiation therapy dose plan .............................. 0.93 0.42 0.42 0.06 1.41 1.41 XXX

77327 ............ A Radiation therapy dose plan .............................. 1.39 3.93 3.93 0.30 5.62 5.62 XXX

77327 TC A Radiation therapy dose plan .............................. 0.00 3.31 3.31 0.21 3.52 3.52 XXX

77327 26 A Radiation therapy dose plan .............................. 1.39 0.62 0.62 0.09 2.10 2.10 XXX

77328 ............ A Radiation therapy dose plan .............................. 2.09 5.66 5.66 0.44 8.19 8.19 XXX

77328 TC A Radiation therapy dose plan .............................. 0.00 4.73 4.73 0.30 5.03 5.03 XXX

77328 26 A Radiation therapy dose plan .............................. 2.09 0.93 0.93 0.14 3.16 3.16 XXX

77331 ............ A Special radiation dosimetry ................................ 0.87 0.87 0.87 0.09 1.83 1.83 XXX

77331 TC A Special radiation dosimetry ................................ 0.00 0.48 0.48 0.03 0.51 0.51 XXX

77331 26 A Special radiation dosimetry ................................ 0.87 0.39 0.39 0.06 1.32 1.32 XXX

77332 ............ A Radiation treatment aid(s) .................................. 0.54 1.53 1.53 0.12 2.19 2.19 XXX

77332 TC A Radiation treatment aid(s) .................................. 0.00 1.28 1.28 0.08 1.36 1.36 XXX

77332 26 A Radiation treatment aid(s) .................................. 0.54 0.25 0.25 0.04 0.83 0.83 XXX

77333 ............ A Radiation treatment aid(s) .................................. 0.84 2.19 2.19 0.18 3.21 3.21 XXX

77333 TC A Radiation treatment aid(s) .................................. 0.00 1.81 1.81 0.12 1.93 1.93 XXX

77333 26 A Radiation treatment aid(s) .................................. 0.84 0.38 0.38 0.06 1.28 1.28 XXX

77334 ............ A Radiation treatment aid(s) .................................. 1.24 3.64 3.64 0.27 5.15 5.15 XXX

77334 TC A Radiation treatment aid(s) .................................. 0.00 3.10 3.10 0.19 3.29 3.29 XXX
59187

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

77334 26 A Radiation treatment aid(s) .................................. 1.24 0.54 0.54 0.08 1.86 1.86 XXX

77336 ............ A Radiation physics consult .................................. 0.00 2.84 2.84 0.18 3.02 3.02 XXX

77370 ............ A Radiation physics consult .................................. 0.00 3.33 3.33 0.21 3.54 3.54 XXX

77399 ............ C External radiation dosimetry .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

77399 TC C External radiation dosimetry .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

77399 26 C External radiation dosimetry .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

77401 ............ A Radiation treatment delivery .............................. 0.00 1.69 1.69 0.11 1.80 1.80 XXX

77402 ............ A Radiation treatment delivery .............................. 0.00 1.69 1.69 0.11 1.80 1.80 XXX

77403 ............ A Radiation treatment delivery .............................. 0.00 1.69 1.69 0.11 1.80 1.80 XXX

77404 ............ A Radiation treatment delivery .............................. 0.00 1.69 1.69 0.11 1.80 1.80 XXX

77406 ............ A Radiation treatment delivery .............................. 0.00 1.69 1.69 0.11 1.80 1.80 XXX

77407 ............ A Radiation treatment delivery .............................. 0.00 1.99 1.99 0.13 2.12 2.12 XXX

77408 ............ A Radiation treatment delivery .............................. 0.00 1.99 1.99 0.13 2.12 2.12 XXX

77409 ............ A Radiation treatment delivery .............................. 0.00 1.99 1.99 0.13 2.12 2.12 XXX

77411 ............ A Radiation treatment delivery .............................. 0.00 1.99 1.99 0.13 2.12 2.12 XXX

77412 ............ A Radiation treatment delivery .............................. 0.00 2.22 2.22 0.15 2.37 2.37 XXX

77413 ............ A Radiation treatment delivery .............................. 0.00 2.22 2.22 0.15 2.37 2.37 XXX

77414 ............ A Radiation treatment delivery .............................. 0.00 2.22 2.22 0.15 2.37 2.37 XXX

77416 ............ A Radiation treatment delivery .............................. 0.00 2.22 2.22 0.15 2.37 2.37 XXX

77417 ............ A Radiology port film(s) ......................................... 0.00 0.56 0.56 0.04 0.60 0.60 XXX

77419 ............ A Weekly radiation therapy ................................... 3.60 1.61 1.61 0.23 5.44 5.44 XXX

77420 ............ A Weekly radiation therapy ................................... 1.61 0.72 0.72 0.11 2.44 2.44 XXX

77425 ............ A Weekly radiation therapy ................................... 2.44 1.10 1.10 0.17 3.71 3.71 XXX

77430 ............ A Weekly radiation therapy ................................... 3.60 1.61 1.61 0.23 5.44 5.44 XXX

77431 ............ A Radiation therapy management ......................... 1.81 0.81 0.81 0.12 2.74 2.74 XXX

77432 ............ A Stereotactic radiation trmt .................................. 7.93 4.94 4.94 0.40 13.27 13.27 XXX

77470 ............ A Special radiation treatment ................................ 2.09 11.55 11.55 0.80 14.44 14.44 XXX

77470 TC A Special radiation treatment ................................ 0.00 10.62 10.62 0.66 11.28 11.28 XXX

77470 26 A Special radiation treatment ................................ 2.09 0.93 0.93 0.14 3.16 3.16 XXX

77499 ............ C Radiation therapy management ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

77499 TC C Radiation therapy management ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

77499 26 C Radiation therapy management ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

77600 ............ R Hyperthermia treatment ..................................... 1.56 3.60 3.60 0.29 5.45 5.45 ZZZ

77600 TC R Hyperthermia treatment ..................................... 0.00 2.90 2.90 0.18 3.08 3.08 ZZZ

77600 26 R Hyperthermia treatment ..................................... 1.56 0.70 0.70 0.11 2.37 2.37 ZZZ

77605 ............ R Hyperthermia treatment ..................................... 2.09 4.80 4.80 0.39 7.28 7.28 ZZZ

77605 TC R Hyperthermia treatment ..................................... 0.00 3.87 3.87 0.25 4.12 4.12 ZZZ

77605 26 R Hyperthermia treatment ..................................... 2.09 0.93 0.93 0.14 3.16 3.16 ZZZ

77610 ............ R Hyperthermia treatment ..................................... 1.56 3.60 3.60 0.29 5.45 5.45 ZZZ

77610 TC R Hyperthermia treatment ..................................... 0.00 2.90 2.90 0.18 3.08 3.08 ZZZ

77610 26 R Hyperthermia treatment ..................................... 1.56 0.70 0.70 0.11 2.37 2.37 ZZZ

77615 ............ R Hyperthermia treatment ..................................... 2.09 4.80 4.80 0.39 7.28 7.28 ZZZ

77615 TC R Hyperthermia treatment ..................................... 0.00 3.87 3.87 0.25 4.12 4.12 ZZZ

77615 26 R Hyperthermia treatment ..................................... 2.09 0.93 0.93 0.14 3.16 3.16 ZZZ

77620 ............ R Hyperthermia treatment ..................................... 1.56 3.60 3.60 0.29 5.45 5.45 ZZZ

77620 TC R Hyperthermia treatment ..................................... 0.00 2.90 2.90 0.18 3.08 3.08 ZZZ

77620 26 R Hyperthermia treatment ..................................... 1.56 0.70 0.70 0.11 2.37 2.37 ZZZ

77750 ............ A Infuse radioactive materials ............................... *4.91 3.32 3.32 0.38 8.61 8.61 090

77750 TC A Infuse radioactive materials ............................... 0.00 1.27 1.27 0.08 1.35 1.35 090

77750 26 A Infuse radioactive materials ............................... *4.91 2.05 2.05 0.30 7.26 7.26 090

77761 ............ A Radioelement application ................................... *3.81 3.98 3.98 0.39 8.18 8.18 090

77761 TC A Radioelement application ................................... 0.00 2.39 2.39 0.16 2.55 2.55 090

77761 26 A Radioelement application ................................... *3.81 1.59 1.59 0.23 5.63 5.63 090

77762 ............ A Radioelement application ................................... *5.72 5.83 5.83 0.57 12.12 12.12 090

77762 TC A Radioelement application ................................... 0.00 3.44 3.44 0.22 3.66 3.66 090

77762 26 A Radioelement application ................................... *5.72 2.39 2.39 0.35 8.46 8.46 090

77763 ............ A Radioelement application ................................... *8.57 7.86 7.86 0.77 17.20 17.20 090

77763 TC A Radioelement application ................................... 0.00 4.28 4.28 0.27 4.55 4.55 090

77763 26 A Radioelement application ................................... *8.57 3.58 3.58 0.50 12.65 12.65 090

77776 ............ A Radioelement application ................................... 4.66 4.16 4.16 0.45 9.27 9.27 XXX

77776 TC A Radioelement application ................................... 0.00 2.07 2.07 0.14 2.21 2.21 XXX

77776 26 A Radioelement application ................................... 4.66 2.09 2.09 0.31 7.06 7.06 XXX

77777 ............ A Radioelement application ................................... *7.48 7.17 7.17 0.71 15.36 15.36 090

77777 TC A Radioelement application ................................... 0.00 4.04 4.04 0.26 4.30 4.30 090

77777 26 A Radioelement application ................................... *7.48 3.13 3.13 0.45 11.06 11.06 090

77778 ............ A Radioelement application ................................... *11.19 9.58 9.58 0.98 21.75 21.75 090

77778 TC A Radioelement application ................................... 0.00 4.89 4.89 0.31 5.20 5.20 090

77778 26 A Radioelement application ................................... *11.19 4.69 4.69 0.67 16.55 16.55 090

77781 ............ A High intensity brachytherapy .............................. *1.66 20.04 20.04 1.32 23.02 23.02 090

77781 TC A High intensity brachytherapy .............................. 0.00 19.35 19.35 1.21 20.56 20.56 090

77781 26 A High intensity brachytherapy .............................. *1.66 0.69 0.69 0.11 2.46 2.46 090

77782 ............ A High intensity brachytherapy .............................. *2.49 20.40 20.40 1.37 24.26 24.26 090

77782 TC A High intensity brachytherapy .............................. 0.00 19.35 19.35 1.21 20.56 20.56 090

77782 26 A High intensity brachytherapy .............................. *2.49 1.05 1.05 0.16 3.70 3.70 090
59188

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

77783 ............ A High intensity brachytherapy .............................. *3.73 20.90 20.90 1.44 26.07 26.07 090

77783 TC A High intensity brachytherapy .............................. 0.00 19.35 19.35 1.21 20.56 20.56 090

77783 26 A High intensity brachytherapy .............................. *3.73 1.55 1.55 0.23 5.51 5.51 090

77784 ............ A High intensity brachytherapy .............................. *5.61 21.69 21.69 1.56 28.86 28.86 090

77784 TC A High intensity brachytherapy .............................. 0.00 19.35 19.35 1.21 20.56 20.56 090

77784 26 A High intensity brachytherapy .............................. *5.61 2.34 2.34 0.35 8.30 8.30 090

77789 ............ A Radioelement application ................................... *1.12 0.89 0.89 0.10 2.11 2.11 090

77789 TC A Radioelement application ................................... 0.00 0.43 0.43 0.03 0.46 0.46 090

77789 26 A Radioelement application ................................... *1.12 0.46 0.46 0.07 1.65 1.65 090

77790 ............ A Radioelement handling ...................................... 1.05 0.94 0.94 0.10 2.09 2.09 XXX

77790 TC A Radioelement handling ...................................... 0.00 0.48 0.48 0.03 0.51 0.51 XXX

77790 26 A Radioelement handling ...................................... 1.05 0.46 0.46 0.07 1.58 1.58 XXX

77799 ............ C Radium/radioisotope therapy ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

77799 TC C Radium/radioisotope therapy ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

77799 26 C Radium/radioisotope therapy ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78000 ............ A Thyroid, single uptake ........................................ 0.19 1.01 1.01 0.07 1.27 1.27 XXX

78000 TC A Thyroid, single uptake ........................................ 0.00 0.92 0.92 0.06 0.98 0.98 XXX

78000 26 A Thyroid, single uptake ........................................ 0.19 0.09 0.09 0.01 0.29 0.29 XXX

78001 ............ A Thyroid, multiple uptakes ................................... 0.26 1.36 1.36 0.10 1.72 1.72 XXX

78001 TC A Thyroid, multiple uptakes ................................... 0.00 1.24 1.24 0.08 1.32 1.32 XXX

78001 26 A Thyroid, multiple uptakes ................................... 0.26 0.12 0.12 0.02 0.40 0.40 XXX

78003 ............ A Thyroid suppress/stimul ..................................... 0.33 1.07 1.07 0.08 1.48 1.48 XXX

78003 TC A Thyroid suppress/stimul ..................................... 0.00 0.92 0.92 0.06 0.98 0.98 XXX

78003 26 A Thyroid suppress/stimul ..................................... 0.33 0.15 0.15 0.02 0.50 0.50 XXX

78006 ............ A Thyroid, imaging with uptake ............................. 0.49 2.49 2.49 0.18 3.16 3.16 XXX

78006 TC A Thyroid, imaging with uptake ............................. 0.00 2.27 2.27 0.15 2.42 2.42 XXX

78006 26 A Thyroid, imaging with uptake ............................. 0.49 0.22 0.22 0.03 0.74 0.74 XXX

78007 ............ A Thyroid, image, mult uptakes ............................. 0.50 2.68 2.68 0.19 3.37 3.37 XXX

78007 TC A Thyroid, image, mult uptakes ............................. 0.00 2.45 2.45 0.16 2.61 2.61 XXX

78007 26 A Thyroid, image, mult uptakes ............................. 0.50 0.23 0.23 0.03 0.76 0.76 XXX

78010 ............ A Thyroid imaging .................................................. 0.39 1.90 1.90 0.14 2.43 2.43 XXX

78010 TC A Thyroid imaging .................................................. 0.00 1.73 1.73 0.11 1.84 1.84 XXX

78010 26 A Thyroid imaging .................................................. 0.39 0.17 0.17 0.03 0.59 0.59 XXX

78011 ............ A Thyroid imaging with flow .................................. 0.45 2.50 2.50 0.18 3.13 3.13 XXX

78011 TC A Thyroid imaging with flow .................................. 0.00 2.29 2.29 0.15 2.44 2.44 XXX

78011 26 A Thyroid imaging with flow .................................. 0.45 0.21 0.21 0.03 0.69 0.69 XXX

78015 ............ A Thyroid met imaging .......................................... 0.67 2.76 2.76 0.21 3.64 3.64 XXX

78015 TC A Thyroid met imaging .......................................... 0.00 2.45 2.45 0.16 2.61 2.61 XXX

78015 26 A Thyroid met imaging .......................................... 0.67 0.31 0.31 0.05 1.03 1.03 XXX

78016 ............ A Thyroid met imaging/studies .............................. 0.82 3.70 3.70 0.27 4.79 4.79 XXX

78016 TC A Thyroid met imaging/studies .............................. 0.00 3.32 3.32 0.21 3.53 3.53 XXX

78016 26 A Thyroid met imaging/studies .............................. 0.82 0.38 0.38 0.06 1.26 1.26 XXX

78017 ............ A Thyroid met imaging, mult ................................. 0.87 3.94 3.94 0.28 5.09 5.09 XXX

78017 TC A Thyroid met imaging, mult ................................. 0.00 3.55 3.55 0.22 3.77 3.77 XXX

78017 26 A Thyroid met imaging, mult ................................. 0.87 0.39 0.39 0.06 1.32 1.32 XXX

78018 ............ A Thyroid, met imaging, body ............................... 0.95 5.60 5.60 0.39 6.94 6.94 XXX

78018 TC A Thyroid, met imaging, body ............................... 0.00 5.17 5.17 0.33 5.50 5.50 XXX

78018 26 A Thyroid, met imaging, body ............................... 0.95 0.43 0.43 0.06 1.44 1.44 XXX

78070 ............ A Parathyroid nuclear imaging .............................. 0.82 1.96 1.96 0.15 2.93 2.93 XXX

78070 TC A Parathyroid nuclear imaging .............................. 0.00 1.73 1.73 0.11 1.84 1.84 XXX

78070 26 A Parathyroid nuclear imaging .............................. 0.82 0.23 0.23 0.04 1.09 1.09 XXX

78075 ............ A Adrenal nuclear imaging .................................... 0.74 5.51 5.51 0.38 6.63 6.63 XXX

78075 TC A Adrenal nuclear imaging .................................... 0.00 5.17 5.17 0.33 5.50 5.50 XXX

78075 26 A Adrenal nuclear imaging .................................... 0.74 0.34 0.34 0.05 1.13 1.13 XXX

78099 ............ C Endocrine nuclear procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78099 TC C Endocrine nuclear procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78099 26 C Endocrine nuclear procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78102 ............ A Bone marrow imaging, ltd .................................. 0.55 2.19 2.19 0.17 2.91 2.91 XXX

78102 TC A Bone marrow imaging, ltd .................................. 0.00 1.94 1.94 0.13 2.07 2.07 XXX

78102 26 A Bone marrow imaging, ltd .................................. 0.55 0.25 0.25 0.04 0.84 0.84 XXX

78103 ............ A Bone marrow imaging, mult ............................... 0.75 3.36 3.36 0.24 4.35 4.35 XXX

78103 TC A Bone marrow imaging, mult ............................... 0.00 3.02 3.02 0.19 3.21 3.21 XXX

78103 26 A Bone marrow imaging, mult ............................... 0.75 0.34 0.34 0.05 1.14 1.14 XXX

78104 ............ A Bone marrow imaging, body .............................. 0.80 4.25 4.25 0.30 5.35 5.35 XXX

78104 TC A Bone marrow imaging, body .............................. 0.00 3.88 3.88 0.25 4.13 4.13 XXX

78104 26 A Bone marrow imaging, body .............................. 0.80 0.37 0.37 0.05 1.22 1.22 XXX

78110 ............ A Plasma volume, single ....................................... 0.19 0.99 0.99 0.07 1.25 1.25 XXX

78110 TC A Plasma volume, single ....................................... 0.00 0.90 0.90 0.06 0.96 0.96 XXX

78110 26 A Plasma volume, single ....................................... 0.19 0.09 0.09 0.01 0.29 0.29 XXX

78111 ............ A Plasma volume, multiple .................................... 0.22 2.55 2.55 0.18 2.95 2.95 XXX

78111 TC A Plasma volume, multiple .................................... 0.00 2.45 2.45 0.16 2.61 2.61 XXX

78111 26 A Plasma volume, multiple .................................... 0.22 0.10 0.10 0.02 0.34 0.34 XXX

78120 ............ A Red cell mass, single ......................................... 0.23 1.76 1.76 0.13 2.12 2.12 XXX

78120 TC A Red cell mass, single ......................................... 0.00 1.65 1.65 0.11 1.76 1.76 XXX
59189

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

78120 26 A Red cell mass, single ......................................... 0.23 0.11 0.11 0.02 0.36 0.36 XXX

78121 ............ A Red cell mass, multiple ...................................... 0.32 2.92 2.92 0.19 3.43 3.43 XXX

78121 TC A Red cell mass, multiple ...................................... 0.00 2.77 2.77 0.17 2.94 2.94 XXX

78121 26 A Red cell mass, multiple ...................................... 0.32 0.15 0.15 0.02 0.49 0.49 XXX

78122 ............ A Blood volume ..................................................... 0.45 4.59 4.59 0.31 5.35 5.35 XXX

78122 TC A Blood volume ..................................................... 0.00 4.39 4.39 0.28 4.67 4.67 XXX

78122 26 A Blood volume ..................................................... 0.45 0.20 0.20 0.03 0.68 0.68 XXX

78130 ............ A Red cell survival study ....................................... 0.61 3.00 3.00 0.21 3.82 3.82 XXX

78130 TC A Red cell survival study ....................................... 0.00 2.72 2.72 0.17 2.89 2.89 XXX

78130 26 A Red cell survival study ....................................... 0.61 0.28 0.28 0.04 0.93 0.93 XXX

78135 ............ A Red cell survival kinetics .................................... 0.64 4.93 4.93 0.34 5.91 5.91 XXX

78135 TC A Red cell survival kinetics .................................... 0.00 4.64 4.64 0.30 4.94 4.94 XXX

78135 26 A Red cell survival kinetics .................................... 0.64 0.29 0.29 0.04 0.97 0.97 XXX

78140 ............ A Red cell sequestration ....................................... 0.61 4.03 4.03 0.28 4.92 4.92 XXX

78140 TC A Red cell sequestration ....................................... 0.00 3.75 3.75 0.24 3.99 3.99 XXX

78140 26 A Red cell sequestration ....................................... 0.61 0.28 0.28 0.04 0.93 0.93 XXX

78160 ............ A Plasma iron turnover .......................................... 0.33 3.64 3.64 0.24 4.21 4.21 XXX

78160 TC A Plasma iron turnover .......................................... 0.00 3.49 3.49 0.22 3.71 3.71 XXX

78160 26 A Plasma iron turnover .......................................... 0.33 0.15 0.15 0.02 0.50 0.50 XXX

78162 ............ A Iron absorption exam ......................................... 0.45 3.25 3.25 0.22 3.92 3.92 XXX

78162 TC A Iron absorption exam ......................................... 0.00 3.05 3.05 0.19 3.24 3.24 XXX

78162 26 A Iron absorption exam ......................................... 0.45 0.20 0.20 0.03 0.68 0.68 XXX

78170 ............ A Red cell iron utilization ....................................... 0.41 5.24 5.24 0.35 6.00 6.00 XXX

78170 TC A Red cell iron utilization ....................................... 0.00 5.06 5.06 0.32 5.38 5.38 XXX

78170 26 A Red cell iron utilization ....................................... 0.41 0.18 0.18 0.03 0.62 0.62 XXX

78172 ............ C Total body iron estimation .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78172 TC C Total body iron estimation .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78172 26 A Total body iron estimation .................................. 0.53 0.25 0.25 0.04 0.82 0.82 XXX

78185 ............ A Spleen imaging .................................................. 0.40 2.43 2.43 0.18 3.01 3.01 XXX

78185 TC A Spleen imaging .................................................. 0.00 2.25 2.25 0.15 2.40 2.40 XXX

78185 26 A Spleen imaging .................................................. 0.40 0.18 0.18 0.03 0.61 0.61 XXX

78190 ............ A Platelet survival, kinetics .................................... 1.09 5.93 5.93 0.42 7.44 7.44 XXX

78190 TC A Platelet survival, kinetics .................................... 0.00 5.45 5.45 0.35 5.80 5.80 XXX

78190 26 A Platelet survival, kinetics .................................... 1.09 0.48 0.48 0.07 1.64 1.64 XXX

78191 ............ A Platelet survival .................................................. 0.61 7.27 7.27 0.48 8.36 8.36 XXX

78191 TC A Platelet survival .................................................. 0.00 6.99 6.99 0.44 7.43 7.43 XXX

78191 26 A Platelet survival .................................................. 0.61 0.28 0.28 0.04 0.93 0.93 XXX

78195 ............ A Lymph system imaging ...................................... 1.20 4.20 4.20 0.30 5.70 5.70 XXX

78195 TC A Lymph system imaging ...................................... 0.00 3.88 3.88 0.25 4.13 4.13 XXX

78195 26 A Lymph system imaging ...................................... 1.20 0.32 0.32 0.05 1.57 1.57 XXX

78199 ............ C Blood/lymph nuclear exam ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78199 TC C Blood/lymph nuclear exam ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78199 26 C Blood/lymph nuclear exam ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78201 ............ A Liver imaging ...................................................... 0.44 2.44 2.44 0.18 3.06 3.06 XXX

78201 TC A Liver imaging ...................................................... 0.00 2.25 2.25 0.15 2.40 2.40 XXX

78201 26 A Liver imaging ...................................................... 0.44 0.19 0.19 0.03 0.66 0.66 XXX

78202 ............ A Liver imaging with flow ....................................... 0.51 2.98 2.98 0.21 3.70 3.70 XXX

78202 TC A Liver imaging with flow ....................................... 0.00 2.75 2.75 0.17 2.92 2.92 XXX

78202 26 A Liver imaging with flow ....................................... 0.51 0.23 0.23 0.04 0.78 0.78 XXX

78205 ............ A Liver imaging (3D) .............................................. 0.71 5.96 5.96 0.41 7.08 7.08 XXX

78205 TC A Liver imaging (3D) .............................................. 0.00 5.63 5.63 0.36 5.99 5.99 XXX

78205 26 A Liver imaging (3D) .............................................. 0.71 0.33 0.33 0.05 1.09 1.09 XXX

78215 ............ A Liver and spleen imaging ................................... 0.49 3.02 3.02 0.20 3.71 3.71 XXX

78215 TC A Liver and spleen imaging ................................... 0.00 2.80 2.80 0.17 2.97 2.97 XXX

78215 26 A Liver and spleen imaging ................................... 0.49 0.22 0.22 0.03 0.74 0.74 XXX

78216 ............ A Liver & spleen image, flow ................................. 0.57 3.58 3.58 0.25 4.40 4.40 XXX

78216 TC A Liver & spleen image, flow ................................. 0.00 3.32 3.32 0.21 3.53 3.53 XXX

78216 26 A Liver & spleen image, flow ................................. 0.57 0.26 0.26 0.04 0.87 0.87 XXX

78220 ............ A Liver function study ............................................ 0.49 3.77 3.77 0.25 4.51 4.51 XXX

78220 TC A Liver function study ............................................ 0.00 3.55 3.55 0.22 3.77 3.77 XXX

78220 26 A Liver function study ............................................ 0.49 0.22 0.22 0.03 0.74 0.74 XXX

78223 ............ A Hepatobiliary imaging ......................................... 0.84 3.87 3.87 0.28 4.99 4.99 XXX

78223 TC A Hepatobiliary imaging ......................................... 0.00 3.49 3.49 0.22 3.71 3.71 XXX

78223 26 A Hepatobiliary imaging ......................................... 0.84 0.38 0.38 0.06 1.28 1.28 XXX

78230 ............ A Salivary gland imaging ....................................... 0.45 2.28 2.28 0.17 2.90 2.90 XXX

78230 TC A Salivary gland imaging ....................................... 0.00 2.07 2.07 0.14 2.21 2.21 XXX

78230 26 A Salivary gland imaging ....................................... 0.45 0.21 0.21 0.03 0.69 0.69 XXX

78231 ............ A Serial salivary imaging ....................................... 0.52 3.26 3.26 0.23 4.01 4.01 XXX

78231 TC A Serial salivary imaging ....................................... 0.00 3.02 3.02 0.19 3.21 3.21 XXX

78231 26 A Serial salivary imaging ....................................... 0.52 0.24 0.24 0.04 0.80 0.80 XXX

78232 ............ A Salivary gland function exam ............................. 0.47 3.59 3.59 0.24 4.30 4.30 XXX

78232 TC A Salivary gland function exam ............................. 0.00 3.37 3.37 0.21 3.58 3.58 XXX

78232 26 A Salivary gland function exam ............................. 0.47 0.22 0.22 0.03 0.72 0.72 XXX

78258 ............ A Esophageal motility study .................................. 0.74 3.09 3.09 0.22 4.05 4.05 XXX
59190

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

78258 TC A Esophageal motility study .................................. 0.00 2.75 2.75 0.17 2.92 2.92 XXX

78258 26 A Esophageal motility study .................................. 0.74 0.34 0.34 0.05 1.13 1.13 XXX

78261 ............ A Gastric mucosa imaging .................................... 0.69 4.23 4.23 0.30 5.22 5.22 XXX

78261 TC A Gastric mucosa imaging .................................... 0.00 3.91 3.91 0.25 4.16 4.16 XXX

78261 26 A Gastric mucosa imaging .................................... 0.69 0.32 0.32 0.05 1.06 1.06 XXX

78262 ............ A Gastroesophageal reflux exam .......................... 0.68 4.36 4.36 0.31 5.35 5.35 XXX

78262 TC A Gastroesophageal reflux exam .......................... 0.00 4.05 4.05 0.26 4.31 4.31 XXX

78262 26 A Gastroesophageal reflux exam .......................... 0.68 0.31 0.31 0.05 1.04 1.04 XXX

78264 ............ A Gastric emptying study ...................................... 0.78 4.29 4.29 0.30 5.37 5.37 XXX

78264 TC A Gastric emptying study ...................................... 0.00 3.93 3.93 0.25 4.18 4.18 XXX

78264 26 A Gastric emptying study ...................................... 0.78 0.36 0.36 0.05 1.19 1.19 XXX

78270 ............ A Vit B–12 absorption exam .................................. 0.20 1.57 1.57 0.11 1.88 1.88 XXX

78270 TC A Vit B–12 absorption exam .................................. 0.00 1.47 1.47 0.10 1.57 1.57 XXX

78270 26 A Vit B–12 absorption exam .................................. 0.20 0.10 0.10 0.01 0.31 0.31 XXX

78271 ............ A Vit B–12 absorp exam, IF .................................. 0.20 1.67 1.67 0.11 1.98 1.98 XXX

78271 TC A Vit B–12 absorp exam, IF .................................. 0.00 1.57 1.57 0.10 1.67 1.67 XXX

78271 26 A Vit B–12 absorp exam, IF .................................. 0.20 0.10 0.10 0.01 0.31 0.31 XXX

78272 ............ A Vit B–12 absorp, combined ................................ 0.27 2.34 2.34 0.17 2.78 2.78 XXX

78272 TC A Vit B–12 absorp, combined ................................ 0.00 2.21 2.21 0.15 2.36 2.36 XXX

78272 26 A Vit B–12 absorp, combined ................................ 0.27 0.13 0.13 0.02 0.42 0.42 XXX

78278 ............ A Acute GI blood loss imaging .............................. 0.99 5.09 5.09 0.37 6.45 6.45 XXX

78278 TC A Acute GI blood loss imaging .............................. 0.00 4.64 4.64 0.30 4.94 4.94 XXX

78278 26 A Acute GI blood loss imaging .............................. 0.99 0.45 0.45 0.07 1.51 1.51 XXX

78282 ............ C GI protein loss exam .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78282 TC C GI protein loss exam .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78282 26 A GI protein loss exam .......................................... 0.38 0.17 0.17 0.03 0.58 0.58 XXX

78290 ............ A Meckel’s divert exam ......................................... 0.68 3.21 3.21 0.23 4.12 4.12 XXX

78290 TC A Meckel’s divert exam ......................................... 0.00 2.90 2.90 0.18 3.08 3.08 XXX

78290 26 A Meckel’s divert exam ......................................... 0.68 0.31 0.31 0.05 1.04 1.04 XXX

78291 ............ A Leveen/shunt patency exam .............................. 0.88 3.31 3.31 0.24 4.43 4.43 XXX

78291 TC A Leveen/shunt patency exam .............................. 0.00 2.92 2.92 0.18 3.10 3.10 XXX

78291 26 A Leveen/shunt patency exam .............................. 0.88 0.39 0.39 0.06 1.33 1.33 XXX

78299 ............ C GI nuclear procedure ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78299 TC C GI nuclear procedure ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78299 26 C GI nuclear procedure ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78300 ............ A Bone imaging, limited area ................................ 0.62 2.66 2.66 0.20 3.48 3.48 XXX

78300 TC A Bone imaging, limited area ................................ 0.00 2.37 2.37 0.16 2.53 2.53 XXX

78300 26 A Bone imaging, limited area ................................ 0.62 0.29 0.29 0.04 0.95 0.95 XXX

78305 ............ A Bone imaging, multiple areas ............................ 0.83 3.87 3.87 0.28 4.98 4.98 XXX

78305 TC A Bone imaging, multiple areas ............................ 0.00 3.49 3.49 0.22 3.71 3.71 XXX

78305 26 A Bone imaging, multiple areas ............................ 0.83 0.38 0.38 0.06 1.27 1.27 XXX

78306 ............ A Bone imaging, whole body ................................. 0.86 4.46 4.46 0.32 5.64 5.64 XXX

78306 TC A Bone imaging, whole body ................................. 0.00 4.07 4.07 0.26 4.33 4.33 XXX

78306 26 A Bone imaging, whole body ................................. 0.86 0.39 0.39 0.06 1.31 1.31 XXX

78315 ............ A Bone imaging, 3 phase ...................................... 1.02 5.00 5.00 0.36 6.38 6.38 XXX

78315 TC A Bone imaging, 3 phase ...................................... 0.00 4.55 4.55 0.29 4.84 4.84 XXX

78315 26 A Bone imaging, 3 phase ...................................... 1.02 0.45 0.45 0.07 1.54 1.54 XXX

78320 ............ A Bone imaging (3D) ............................................. 1.04 6.09 6.09 0.43 7.56 7.56 XXX

78320 TC A Bone imaging (3D) ............................................. 0.00 5.63 5.63 0.36 5.99 5.99 XXX

78320 26 A Bone imaging (3D) ............................................. 1.04 0.46 0.46 0.07 1.57 1.57 XXX

78350 ............ A Bone mineral, single photon .............................. 0.22 0.82 0.82 0.07 1.11 1.11 XXX

78350 TC A Bone mineral, single photon .............................. 0.00 0.72 0.72 0.05 0.77 0.77 XXX

78350 26 A Bone mineral, single photon .............................. 0.22 0.10 0.10 0.02 0.34 0.34 XXX

78351 ............ N Bone mineral, dual photon ................................. +0.30 0.19 0.19 0.02 0.51 0.51 XXX

78399 ............ C Musculoskeletal nuclear exam ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78399 TC C Musculoskeletal nuclear exam ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78399 26 C Musculoskeletal nuclear exam ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78414 ............ C Non-imaging heart function ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78414 TC C Non-imaging heart function ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78414 26 A Non-imaging heart function ................................ 0.45 0.20 0.20 0.03 0.68 0.68 XXX

78428 ............ A Cardiac shunt imaging ....................................... 0.78 2.51 2.51 0.19 3.48 3.48 XXX

78428 TC A Cardiac shunt imaging ....................................... 0.00 2.15 2.15 0.14 2.29 2.29 XXX

78428 26 A Cardiac shunt imaging ....................................... 0.78 0.36 0.36 0.05 1.19 1.19 XXX

78445 ............ A Vascular flow imaging ........................................ 0.49 2.01 2.01 0.15 2.65 2.65 XXX

78445 TC A Vascular flow imaging ........................................ 0.00 1.77 1.77 0.11 1.88 1.88 XXX

78445 26 A Vascular flow imaging ........................................ 0.49 0.24 0.24 0.04 0.77 0.77 XXX

78455 ............ A Venous thrombosis study ................................... 0.73 4.13 4.13 0.29 5.15 5.15 XXX

78455 TC A Venous thrombosis study ................................... 0.00 3.80 3.80 0.24 4.04 4.04 XXX

78455 26 A Venous thrombosis study ................................... 0.73 0.33 0.33 0.05 1.11 1.11 XXX

78457 ............ A Venous thrombosis imaging ............................... 0.77 2.88 2.88 0.22 3.87 3.87 XXX

78457 TC A Venous thrombosis imaging ............................... 0.00 2.53 2.53 0.17 2.70 2.70 XXX

78457 26 A Venous thrombosis imaging ............................... 0.77 0.35 0.35 0.05 1.17 1.17 XXX

78458 ............ A Ven thrombosis images, bilat ............................. 0.90 4.23 4.23 0.30 5.43 5.43 XXX

78458 TC A Ven thrombosis images, bilat ............................. 0.00 3.83 3.83 0.24 4.07 4.07 XXX
59191

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

78458 26 A Ven thrombosis images, bilat ............................. 0.90 0.40 0.40 0.06 1.36 1.36 XXX

78459 ............ I Heart muscle imaging (PET) .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78459 TC I Heart muscle imaging (PET) .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78459 26 I Heart muscle imaging (PET) .............................. +1.88 1.34 1.34 0.10 3.32 3.32 XXX

78460 ............ A Heart muscle blood single ................................. 0.86 2.64 2.64 0.21 3.71 3.71 XXX

78460 TC A Heart muscle blood single ................................. 0.00 2.25 2.25 0.15 2.40 2.40 XXX

78460 26 A Heart muscle blood single ................................. 0.86 0.39 0.39 0.06 1.31 1.31 XXX

78461 ............ A Heart muscle blood multiple .............................. 1.23 5.04 5.04 0.37 6.64 6.64 XXX

78461 TC A Heart muscle blood multiple .............................. 0.00 4.50 4.50 0.29 4.79 4.79 XXX

78461 26 A Heart muscle blood multiple .............................. 1.23 0.54 0.54 0.08 1.85 1.85 XXX

78464 ............ A Heart image (3D) single ..................................... 1.09 7.22 7.22 0.50 8.81 8.81 XXX

78464 TC A Heart image (3D) single ..................................... 0.00 6.74 6.74 0.43 7.17 7.17 XXX

78464 26 A Heart image (3D) single ..................................... 1.09 0.48 0.48 0.07 1.64 1.64 XXX

78465 ............ A Heart image (3D) multiple .................................. 1.46 11.89 11.89 0.80 14.15 14.15 XXX

78465 TC A Heart image (3D) multiple .................................. 0.00 11.24 11.24 0.70 11.94 11.94 XXX

78465 26 A Heart image (3D) multiple .................................. 1.46 0.65 0.65 0.10 2.21 2.21 XXX

78466 ............ A Heart infarct image ............................................. 0.69 2.82 2.82 0.22 3.73 3.73 XXX

78466 TC A Heart infarct image ............................................. 0.00 2.50 2.50 0.17 2.67 2.67 XXX

78466 26 A Heart infarct image ............................................. 0.69 0.32 0.32 0.05 1.06 1.06 XXX

78468 ............ A Heart infarct image, EF ...................................... 0.80 3.85 3.85 0.27 4.92 4.92 XXX

78468 TC A Heart infarct image, EF ...................................... 0.00 3.49 3.49 0.22 3.71 3.71 XXX

78468 26 A Heart infarct image, EF ...................................... 0.80 0.36 0.36 0.05 1.21 1.21 XXX

78469 ............ A Heart infarct image (3D) .................................... 0.92 5.39 5.39 0.38 6.69 6.69 XXX

78469 TC A Heart infarct image (3D) .................................... 0.00 4.98 4.98 0.32 5.30 5.30 XXX

78469 26 A Heart infarct image (3D) .................................... 0.92 0.41 0.41 0.06 1.39 1.39 XXX

78472 ............ A Gated heart, resting ........................................... 0.98 5.69 5.69 0.41 7.08 7.08 XXX

78472 TC A Gated heart, resting ........................................... 0.00 5.25 5.25 0.34 5.59 5.59 XXX

78472 26 A Gated heart, resting ........................................... 0.98 0.44 0.44 0.07 1.49 1.49 XXX

78473 ............ A Gated heart, multiple .......................................... 1.47 8.52 8.52 0.59 10.58 10.58 XXX

78473 TC A Gated heart, multiple .......................................... 0.00 7.87 7.87 0.49 8.36 8.36 XXX

78473 26 A Gated heart, multiple .......................................... 1.47 0.65 0.65 0.10 2.22 2.22 XXX

78478 ............ A Heart wall motion (add-on) ................................ 0.62 1.76 1.76 0.14 2.52 2.52 XXX

78478 TC A Heart wall motion (add-on) ................................ 0.00 1.48 1.48 0.10 1.58 1.58 XXX

78478 26 A Heart wall motion (add-on) ................................ 0.62 0.28 0.28 0.04 0.94 0.94 XXX

78480 ............ A Heart function, (add-on) ..................................... 0.62 1.76 1.76 0.14 2.52 2.52 XXX

78480 TC A Heart function, (add-on) ..................................... 0.00 1.48 1.48 0.10 1.58 1.58 XXX

78480 26 A Heart function, (add-on) ..................................... 0.62 0.28 0.28 0.04 0.94 0.94 XXX

78481 ............ A Heart first pass single ........................................ 0.98 5.42 5.42 0.39 6.79 6.79 XXX

78481 TC A Heart first pass single ........................................ 0.00 4.98 4.98 0.32 5.30 5.30 XXX

78481 26 A Heart first pass single ........................................ 0.98 0.44 0.44 0.07 1.49 1.49 XXX

78483 ............ A Heart first pass multiple ..................................... 1.47 8.15 8.15 0.57 10.19 10.19 XXX

78483 TC A Heart first pass multiple ..................................... 0.00 7.50 7.50 0.47 7.97 7.97 XXX

78483 26 A Heart first pass multiple ..................................... 1.47 0.65 0.65 0.10 2.22 2.22 XXX

78491 ............ I Heart image (pet) single .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78491 TC I Heart image (pet) single .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78491 26 I Heart image (pet) single .................................... +1.50 1.34 1.34 0.10 2.94 2.94 XXX

78492 ............ I Heart image (pet) multiple ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78492 TC I Heart image (pet) multiple ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78492 26 I Heart image (pet) multiple ................................. +1.87 1.34 1.34 0.10 3.31 3.31 XXX

78499 ............ C Cardiovascular nuclear exam ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78499 TC C Cardiovascular nuclear exam ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78499 26 C Cardiovascular nuclear exam ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78580 ............ A Lung perfusion imaging ...................................... 0.74 3.61 3.61 0.26 4.61 4.61 XXX

78580 TC A Lung perfusion imaging ...................................... 0.00 3.27 3.27 0.21 3.48 3.48 XXX

78580 26 A Lung perfusion imaging ...................................... 0.74 0.34 0.34 0.05 1.13 1.13 XXX

78584 ............ A Lung V/Q image single breath ........................... 0.99 3.50 3.50 0.26 4.75 4.75 XXX

78584 TC A Lung V/Q image single breath ........................... 0.00 3.05 3.05 0.19 3.24 3.24 XXX

78584 26 A Lung V/Q image single breath ........................... 0.99 0.45 0.45 0.07 1.51 1.51 XXX

78585 ............ A Lung V/Q imaging .............................................. 1.09 5.85 5.85 0.41 7.35 7.35 XXX

78585 TC A Lung V/Q imaging .............................................. 0.00 5.37 5.37 0.34 5.71 5.71 XXX

78585 26 A Lung V/Q imaging .............................................. 1.09 0.48 0.48 0.07 1.64 1.64 XXX

78586 ............ A Aerosol lung image, single ................................. 0.40 2.65 2.65 0.19 3.24 3.24 XXX

78586 TC A Aerosol lung image, single ................................. 0.00 2.47 2.47 0.16 2.63 2.63 XXX

78586 26 A Aerosol lung image, single ................................. 0.40 0.18 0.18 0.03 0.61 0.61 XXX

78587 ............ A Aerosol lung image, multiple .............................. 0.49 2.89 2.89 0.20 3.58 3.58 XXX

78587 TC A Aerosol lung image, multiple .............................. 0.00 2.67 2.67 0.17 2.84 2.84 XXX

78587 26 A Aerosol lung image, multiple .............................. 0.49 0.22 0.22 0.03 0.74 0.74 XXX

78591 ............ A Vent image, 1 breath, 1 proj .............................. 0.40 2.90 2.90 0.20 3.50 3.50 XXX

78591 TC A Vent image, 1 breath, 1 proj .............................. 0.00 2.72 2.72 0.17 2.89 2.89 XXX

78591 26 A Vent image, 1 breath, 1 proj .............................. 0.40 0.18 0.18 0.03 0.61 0.61 XXX

78593 ............ A Vent image, 1 proj, gas ...................................... 0.49 3.51 3.51 0.24 4.24 4.24 XXX

78593 TC A Vent image, 1 proj, gas ...................................... 0.00 3.29 3.29 0.21 3.50 3.50 XXX

78593 26 A Vent image, 1 proj, gas ...................................... 0.49 0.22 0.22 0.03 0.74 0.74 XXX

78594 ............ A Vent image, mult proj, gas ................................. 0.53 5.00 5.00 0.34 5.87 5.87 XXX
59192

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

78594 TC A Vent image, mult proj, gas ................................. 0.00 4.75 4.75 0.30 5.05 5.05 XXX

78594 26 A Vent image, mult proj, gas ................................. 0.53 0.25 0.25 0.04 0.82 0.82 XXX

78596 ............ A Lung differential function .................................... 1.27 7.30 7.30 0.52 9.09 9.09 XXX

78596 TC A Lung differential function .................................... 0.00 6.74 6.74 0.43 7.17 7.17 XXX

78596 26 A Lung differential function .................................... 1.27 0.56 0.56 0.09 1.92 1.92 XXX

78599 ............ C Respiratory nuclear exam .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78599 TC C Respiratory nuclear exam .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78599 26 C Respiratory nuclear exam .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78600 ............ A Brain imaging, ltd static ...................................... 0.44 2.95 2.95 0.20 3.59 3.59 XXX

78600 TC A Brain imaging, ltd static ...................................... 0.00 2.75 2.75 0.17 2.92 2.92 XXX

78600 26 A Brain imaging, ltd static ...................................... 0.44 0.20 0.20 0.03 0.67 0.67 XXX

78601 ............ A Brain ltd imaging & flow ..................................... 0.51 3.48 3.48 0.24 4.23 4.23 XXX

78601 TC A Brain ltd imaging & flow ..................................... 0.00 3.24 3.24 0.20 3.44 3.44 XXX

78601 26 A Brain ltd imaging & flow ..................................... 0.51 0.24 0.24 0.04 0.79 0.79 XXX

78605 ............ A Brain imaging, complete .................................... 0.53 3.49 3.49 0.24 4.26 4.26 XXX

78605 TC A Brain imaging, complete .................................... 0.00 3.24 3.24 0.20 3.44 3.44 XXX

78605 26 A Brain imaging, complete .................................... 0.53 0.25 0.25 0.04 0.82 0.82 XXX

78606 ............ A Brain imaging comp & flow ................................ 0.64 3.98 3.98 0.27 4.89 4.89 XXX

78606 TC A Brain imaging comp & flow ................................ 0.00 3.69 3.69 0.23 3.92 3.92 XXX

78606 26 A Brain imaging comp & flow ................................ 0.64 0.29 0.29 0.04 0.97 0.97 XXX

78607 ............ A Brain imaging (3D) ............................................. 1.23 6.79 6.79 0.47 8.49 8.49 XXX

78607 TC A Brain imaging (3D) ............................................. 0.00 6.25 6.25 0.39 6.64 6.64 XXX

78607 26 A Brain imaging (3D) ............................................. 1.23 0.54 0.54 0.08 1.85 1.85 XXX

78608 ............ N Brain imaging (PET) ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78609 ............ N Brain imaging (PET) ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78610 ............ A Brain flow imaging only ...................................... 0.30 1.64 1.64 0.12 2.06 2.06 XXX

78610 TC A Brain flow imaging only ...................................... 0.00 1.50 1.50 0.10 1.60 1.60 XXX

78610 26 A Brain flow imaging only ...................................... 0.30 0.14 0.14 0.02 0.46 0.46 XXX

78615 ............ A Cerebral blood flow imaging .............................. 0.42 3.86 3.86 0.26 4.54 4.54 XXX

78615 TC A Cerebral blood flow imaging .............................. 0.00 3.67 3.67 0.23 3.90 3.90 XXX

78615 26 A Cerebral blood flow imaging .............................. 0.42 0.19 0.19 0.03 0.64 0.64 XXX

78630 ............ A Cerebrospinal fluid scan .................................... 0.68 5.11 5.11 0.36 6.15 6.15 XXX

78630 TC A Cerebrospinal fluid scan .................................... 0.00 4.80 4.80 0.31 5.11 5.11 XXX

78630 26 A Cerebrospinal fluid scan .................................... 0.68 0.31 0.31 0.05 1.04 1.04 XXX

78635 ............ A CSF ventriculography ......................................... 0.61 2.70 2.70 0.20 3.51 3.51 XXX

78635 TC A CSF ventriculography ......................................... 0.00 2.42 2.42 0.16 2.58 2.58 XXX

78635 26 A CSF ventriculography ......................................... 0.61 0.28 0.28 0.04 0.93 0.93 XXX

78645 ............ A CSF shunt evaluation ......................................... 0.57 3.53 3.53 0.25 4.35 4.35 XXX

78645 TC A CSF shunt evaluation ......................................... 0.00 3.27 3.27 0.21 3.48 3.48 XXX

78645 26 A CSF shunt evaluation ......................................... 0.57 0.26 0.26 0.04 0.87 0.87 XXX

78647 ............ A Cerebrospinal fluid scan .................................... 0.90 6.04 6.04 0.42 7.36 7.36 XXX

78647 TC A Cerebrospinal fluid scan .................................... 0.00 5.63 5.63 0.36 5.99 5.99 XXX

78647 26 A Cerebrospinal fluid scan .................................... 0.90 0.41 0.41 0.06 1.37 1.37 XXX

78650 ............ A CSF leakage imaging ......................................... 0.61 4.70 4.70 0.32 5.63 5.63 XXX

78650 TC A CSF leakage imaging ......................................... 0.00 4.42 4.42 0.28 4.70 4.70 XXX

78650 26 A CSF leakage imaging ......................................... 0.61 0.28 0.28 0.04 0.93 0.93 XXX

78660 ............ A Nuclear exam of tear flow .................................. 0.53 2.27 2.27 0.17 2.97 2.97 XXX

78660 TC A Nuclear exam of tear flow .................................. 0.00 2.02 2.02 0.13 2.15 2.15 XXX

78660 26 A Nuclear exam of tear flow .................................. 0.53 0.25 0.25 0.04 0.82 0.82 XXX

78699 ............ C Nervous system nuclear exam .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78699 TC C Nervous system nuclear exam .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78699 26 C Nervous system nuclear exam .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78700 ............ A Kidney imaging, static ........................................ 0.45 3.10 3.10 0.21 3.76 3.76 XXX

78700 TC A Kidney imaging, static ........................................ 0.00 2.90 2.90 0.18 3.08 3.08 XXX

78700 26 A Kidney imaging, static ........................................ 0.45 0.20 0.20 0.03 0.68 0.68 XXX

78701 ............ A Kidney imaging with flow ................................... 0.49 3.61 3.61 0.24 4.34 4.34 XXX

78701 TC A Kidney imaging with flow ................................... 0.00 3.39 3.39 0.21 3.60 3.60 XXX

78701 26 A Kidney imaging with flow ................................... 0.49 0.22 0.22 0.03 0.74 0.74 XXX

78704 ............ A Imaging renogram .............................................. 0.74 4.11 4.11 0.29 5.14 5.14 XXX

78704 TC A Imaging renogram .............................................. 0.00 3.77 3.77 0.24 4.01 4.01 XXX

78704 26 A Imaging renogram .............................................. 0.74 0.34 0.34 0.05 1.13 1.13 XXX

78707 ............ A Kidney flow & function image ............................ 0.96 4.68 4.68 0.33 5.97 5.97 XXX

78707 TC A Kidney flow & function image ............................ 0.00 4.26 4.26 0.27 4.53 4.53 XXX

78707 26 A Kidney flow & function image ............................ 0.96 0.42 0.42 0.06 1.44 1.44 XXX

78708 ............ A Kidney flow & function image ............................ 1.21 4.68 4.68 0.33 6.22 6.22 XXX

78708 TC A Kidney flow & function image ............................ 0.00 4.26 4.26 0.27 4.53 4.53 XXX

78708 26 A Kidney flow & function image ............................ 1.21 0.42 0.42 0.06 1.69 1.69 XXX

78709 ............ A Kidney flow & function image ............................ 1.41 4.68 4.68 0.33 6.42 6.42 XXX

78709 TC A Kidney flow & function image ............................ 0.00 4.26 4.26 0.27 4.53 4.53 XXX

78709 26 A Kidney flow & function image ............................ 1.41 0.42 0.42 0.06 1.89 1.89 XXX

78710 ............ A Kidney imaging (3D) .......................................... 0.66 5.93 5.93 0.41 7.00 7.00 XXX

78710 TC A Kidney imaging (3D) .......................................... 0.00 5.63 5.63 0.36 5.99 5.99 XXX

78710 26 A Kidney imaging (3D) .......................................... 0.66 0.30 0.30 0.05 1.01 1.01 XXX

78715 ............ A Renal vascular flow exam .................................. 0.30 1.64 1.64 0.12 2.06 2.06 XXX
59193

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

78715 TC A Renal vascular flow exam .................................. 0.00 1.50 1.50 0.10 1.60 1.60 XXX

78715 26 A Renal vascular flow exam .................................. 0.30 0.14 0.14 0.02 0.46 0.46 XXX

78725 ............ A Kidney function study ......................................... 0.38 1.87 1.87 0.14 2.39 2.39 XXX

78725 TC A Kidney function study ......................................... 0.00 1.70 1.70 0.11 1.81 1.81 XXX

78725 26 A Kidney function study ......................................... 0.38 0.17 0.17 0.03 0.58 0.58 XXX

78726 ............ D Kidney function w/intervent ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78726 TC D Kidney function w/intervent ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78726 26 D Kidney function w/intervent ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78727 ............ D Kidney transplant evaluation .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78727 TC D Kidney transplant evaluation .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78727 26 D Kidney transplant evaluation .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78730 ............ A Urinary bladder retention ................................... 0.36 1.55 1.55 0.11 2.02 2.02 XXX

78730 TC A Urinary bladder retention ................................... 0.00 1.39 1.39 0.09 1.48 1.48 XXX

78730 26 A Urinary bladder retention ................................... 0.36 0.16 0.16 0.02 0.54 0.54 XXX

78740 ............ A Ureteral reflux study ........................................... 0.57 2.28 2.28 0.17 3.02 3.02 XXX

78740 TC A Ureteral reflux study ........................................... 0.00 2.02 2.02 0.13 2.15 2.15 XXX

78740 26 A Ureteral reflux study ........................................... 0.57 0.26 0.26 0.04 0.87 0.87 XXX

78760 ............ A Testicular imaging .............................................. 0.66 2.85 2.85 0.21 3.72 3.72 XXX

78760 TC A Testicular imaging .............................................. 0.00 2.55 2.55 0.17 2.72 2.72 XXX

78760 26 A Testicular imaging .............................................. 0.66 0.30 0.30 0.04 1.00 1.00 XXX

78761 ............ A Testicular imaging & flow ................................... 0.71 3.38 3.38 0.24 4.33 4.33 XXX

78761 TC A Testicular imaging & flow ................................... 0.00 3.05 3.05 0.19 3.24 3.24 XXX

78761 26 A Testicular imaging & flow ................................... 0.71 0.33 0.33 0.05 1.09 1.09 XXX

78799 ............ C Genitourinary nuclear exam ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78799 TC C Genitourinary nuclear exam ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78799 26 C Genitourinary nuclear exam ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78800 ............ A Tumor imaging, limited area .............................. 0.66 3.54 3.54 0.24 4.44 4.44 XXX

78800 TC A Tumor imaging, limited area .............................. 0.00 3.24 3.24 0.20 3.44 3.44 XXX

78800 26 A Tumor imaging, limited area .............................. 0.66 0.30 0.30 0.04 1.00 1.00 XXX

78801 ............ A Tumor imaging, mult areas ................................ 0.79 4.39 4.39 0.31 5.49 5.49 XXX

78801 TC A Tumor imaging, mult areas ................................ 0.00 4.03 4.03 0.26 4.29 4.29 XXX

78801 26 A Tumor imaging, mult areas ................................ 0.79 0.36 0.36 0.05 1.20 1.20 XXX

78802 ............ A Tumor imaging, whole body ............................... 0.86 5.66 5.66 0.40 6.92 6.92 XXX

78802 TC A Tumor imaging, whole body ............................... 0.00 5.27 5.27 0.34 5.61 5.61 XXX

78802 26 A Tumor imaging, whole body ............................... 0.86 0.39 0.39 0.06 1.31 1.31 XXX

78803 ............ A Tumor imaging (3D) ........................................... 1.09 6.73 6.73 0.46 8.28 8.28 XXX

78803 TC A Tumor imaging (3D) ........................................... 0.00 6.25 6.25 0.39 6.64 6.64 XXX

78803 26 A Tumor imaging (3D) ........................................... 1.09 0.48 0.48 0.07 1.64 1.64 XXX

78805 ............ A Abscess imaging, ltd area .................................. 0.73 3.57 3.57 0.25 4.55 4.55 XXX

78805 TC A Abscess imaging, ltd area .................................. 0.00 3.24 3.24 0.20 3.44 3.44 XXX

78805 26 A Abscess imaging, ltd area .................................. 0.73 0.33 0.33 0.05 1.11 1.11 XXX

78806 ............ A Abscess imaging, whole body ........................... 0.86 6.51 6.51 0.45 7.82 7.82 XXX

78806 TC A Abscess imaging, whole body ........................... 0.00 6.13 6.13 0.39 6.52 6.52 XXX

78806 26 A Abscess imaging, whole body ........................... 0.86 0.38 0.38 0.06 1.30 1.30 XXX

78807 ............ A Nuclear localization/abscess .............................. 1.09 6.73 6.73 0.46 8.28 8.28 XXX

78807 TC A Nuclear localization/abscess .............................. 0.00 6.25 6.25 0.39 6.64 6.64 XXX

78807 26 A Nuclear localization/abscess .............................. 1.09 0.48 0.48 0.07 1.64 1.64 XXX

78810 ............ N Tumor imaging (PET) ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78810 TC N Tumor imaging (PET) ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78810 26 N Tumor imaging (PET) ......................................... +1.93 1.37 1.37 0.10 3.40 3.40 XXX

78890 ............ B Nuclear medicine data proc ............................... +0.05 1.26 1.26 0.08 1.39 1.39 XXX

78890 TC B Nuclear medicine data proc ............................... +0.00 1.24 1.24 0.08 1.32 1.32 XXX

78890 26 B Nuclear medicine data proc ............................... +0.05 0.02 0.02 0.00 0.07 0.07 XXX

78891 ............ B Nuclear med data proc ...................................... +0.10 2.55 2.55 0.18 2.83 2.83 XXX

78891 TC B Nuclear med data proc ...................................... +0.00 2.50 2.50 0.17 2.67 2.67 XXX

78891 26 B Nuclear med data proc ...................................... +0.10 0.05 0.05 0.01 0.16 0.16 XXX

78990 ............ I Provide diag radionuclide(s) .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78999 ............ C Nuclear diagnostic exam .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78999 TC C Nuclear diagnostic exam .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

78999 26 C Nuclear diagnostic exam .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

79000 ............ A Intial hyperthyroid therapy .................................. 1.80 3.31 3.31 0.29 5.40 5.40 XXX

79000 TC A Intial hyperthyroid therapy .................................. 0.00 2.50 2.50 0.17 2.67 2.67 XXX

79000 26 A Intial hyperthyroid therapy .................................. 1.80 0.81 0.81 0.12 2.73 2.73 XXX

79001 ............ A Repeat hyperthyroid therapy .............................. 1.05 1.70 1.70 0.15 2.90 2.90 XXX

79001 TC A Repeat hyperthyroid therapy .............................. 0.00 1.24 1.24 0.08 1.32 1.32 XXX

79001 26 A Repeat hyperthyroid therapy .............................. 1.05 0.46 0.46 0.07 1.58 1.58 XXX

79020 ............ A Thyroid ablation .................................................. 1.81 3.31 3.31 0.29 5.41 5.41 XXX

79020 TC A Thyroid ablation .................................................. 0.00 2.50 2.50 0.17 2.67 2.67 XXX

79020 26 A Thyroid ablation .................................................. 1.81 0.81 0.81 0.12 2.74 2.74 XXX

79030 ............ A Thyroid ablation, carcinoma ............................... 2.10 3.44 3.44 0.31 5.85 5.85 XXX

79030 TC A Thyroid ablation, carcinoma ............................... 0.00 2.50 2.50 0.17 2.67 2.67 XXX

79030 26 A Thyroid ablation, carcinoma ............................... 2.10 0.94 0.94 0.14 3.18 3.18 XXX

79035 ............ A Thyroid metastatic therapy ................................. 2.52 3.63 3.63 0.34 6.49 6.49 XXX

79035 TC A Thyroid metastatic therapy ................................. 0.00 2.50 2.50 0.17 2.67 2.67 XXX
59194

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

79035 26 A Thyroid metastatic therapy ................................. 2.52 1.13 1.13 0.17 3.82 3.82 XXX

79100 ............ A Hematopoetic nuclear therapy ........................... 1.32 3.08 3.08 0.26 4.66 4.66 XXX

79100 TC A Hematopoetic nuclear therapy ........................... 0.00 2.50 2.50 0.17 2.67 2.67 XXX

79100 26 A Hematopoetic nuclear therapy ........................... 1.32 0.58 0.58 0.09 1.99 1.99 XXX

79200 ............ A Intracavitary nuc treatment ................................ 1.99 3.39 3.39 0.31 5.69 5.69 XXX

79200 TC A Intracavitary nuc treatment ................................ 0.00 2.50 2.50 0.17 2.67 2.67 XXX

79200 26 A Intracavitary nuc treatment ................................ 1.99 0.89 0.89 0.14 3.02 3.02 XXX

79300 ............ C Interstitial nuclear therapy .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

79300 TC C Interstitial nuclear therapy .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

79300 26 A Interstitial nuclear therapy .................................. 1.60 0.71 0.71 0.11 2.42 2.42 XXX

79400 ............ A Nonhemato nuclear therapy ............................... 1.96 3.37 3.37 0.30 5.63 5.63 XXX

79400 TC A Nonhemato nuclear therapy ............................... 0.00 2.50 2.50 0.17 2.67 2.67 XXX

79400 26 A Nonhemato nuclear therapy ............................... 1.96 0.87 0.87 0.13 2.96 2.96 XXX

79420 ............ C Intravascular nuc therapy ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

79420 TC C Intravascular nuc therapy ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

79420 26 A Intravascular nuc therapy ................................... 1.51 0.67 0.67 0.10 2.28 2.28 XXX

79440 ............ A Nuclear joint therapy .......................................... 1.99 3.39 3.39 0.31 5.69 5.69 XXX

79440 TC A Nuclear joint therapy .......................................... 0.00 2.50 2.50 0.17 2.67 2.67 XXX

79440 26 A Nuclear joint therapy .......................................... 1.99 0.89 0.89 0.14 3.02 3.02 XXX

79900 ............ C Provide ther radiopharm(s) ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

79999 ............ C Nuclear medicine therapy .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

79999 TC C Nuclear medicine therapy .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

79999 26 C Nuclear medicine therapy .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80002 ............ D 1–2 clinical chem tests ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80003 ............ D 3 clinical chemistry tests .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80004 ............ D 124 clinical chemistry tests ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80005 ............ D 5 clinical chemistry tests .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80006 ............ D 6 clinical chemistry tests .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80007 ............ D 7 clinical chemistry tests .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80008 ............ D 8 clinical chemistry tests .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80009 ............ D 129 clinical chemistry tests ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80010 ............ D 110 clinical chemistry tests ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80011 ............ D 11 clinical chemistry tests .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80012 ............ D 12 clinical chemistry tests .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80016 ............ D 13–16 blood/urine tests ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80018 ............ D 112/317–18 blood/urine tests ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80019 ............ D 12/31/9719 blood/urine tests .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80049 ............ X Metabolic panel, basic ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80050 ............ N General health panel .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80051 ............ X Electrolyte panel ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80054 ............ X Comprehen metabolic panel .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80055 ............ I Obstetric panel ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80058 ............ X Hepatic function panel ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80059 ............ X Hepatitis panel ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80061 ............ X Lipid panel .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80072 ............ X Arthritis panel ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80090 ............ X Torch antibody panel ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80091 ............ X Thyroid panel ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80092 ............ X Thyroid panel w/TSH ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80100 ............ X Drug screen ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80101 ............ X Drug screen ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80102 ............ X Drug confirmation ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80103 ............ X Drug analysis, tissue prep ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80150 ............ X Assay of amikacin .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80152 ............ X Assay of amitriptyline ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80154 ............ X Assay of benzodiazepines ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80156 ............ X Assay carbamazepine ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80158 ............ X Assay of cyclosporine ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80160 ............ X Assay of desipramine ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80162 ............ X Assay for digoxin ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80164 ............ X Assay, dipropylacetic acid .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80166 ............ X Assay of doxepin ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80168 ............ X Assay of ethosuximide ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80170 ............ X Gentamicin ......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80172 ............ X Assay for gold .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80174 ............ X Assay of imipramine ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80176 ............ X Assay for lidocaine ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80178 ............ X Assay for lithium ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80182 ............ X Assay for nortriptyline ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80184 ............ X Assay for phenobarbital ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80185 ............ X Assay for phenytoin ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80186 ............ X Assay for phenytoin, free ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80188 ............ X Assay for primidone ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80190 ............ X Assay for procainamide ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59195

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

80192 ............ X Assay for procainamide ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80194 ............ X Assay for quinidine ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80196 ............ X Assay for salicylate ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80197 ............ X Assay for tacrolimus ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80198 ............ X Assay for theophylline ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80200 ............ X Assay for tobramycin ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80201 ............ X Assay for topiramate .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80202 ............ X Assay for vancomycin ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80299 ............ X Quantitative assay, drug .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80400 ............ X Acth stimulation panel ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80402 ............ X Acth stimulation panel ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80406 ............ X Acth stimulation panel ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80408 ............ X Aldosterone suppression eval ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80410 ............ X Calcitonin stimul panel ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80412 ............ X CRH stimulation panel ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80414 ............ X Testosterone response ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80415 ............ X Estradiol response panel ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80416 ............ X Renin stimulation panel ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80417 ............ X Renin stimulation panel ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80418 ............ X Pituitary evaluation panel ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80420 ............ X Dexamethasone panel ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80422 ............ X Glucagon tolerance panel .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80424 ............ X Glucagon tolerance panel .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80426 ............ X Gonadotropin hormone panel ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80428 ............ X Growth hormone panel ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80430 ............ X Growth hormone panel ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80432 ............ X Insulin suppression panel .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80434 ............ X Insulin tolerance panel ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80435 ............ X Insulin tolerance panel ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80436 ............ X Metyrapone panel .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80438 ............ X TRH stimulation panel ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80439 ............ X TRH stimulation panel ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80440 ............ X TRH stimulation panel ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

80500 ............ A Lab pathology consultation ................................ 0.37 0.20 0.20 0.01 0.58 0.58 XXX

80502 ............ A Lab pathology consultation ................................ 1.33 0.33 0.33 0.02 1.68 1.68 XXX

81000 ............ X Urinalysis, nonauto, w/scope ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

81001 ............ X Urinalysis, auto, w/scope ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

81002 ............ X Urinalysis nonauto w/o scope ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

81003 ............ X Urinalysis, auto, w/o scope ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

81005 ............ X Urinalysis ............................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

81007 ............ X Urine screen for bacteria ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

81015 ............ X Microscopic exam of urine ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

81020 ............ X Urinalysis, glass test .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

81025 ............ X Urine pregnancy test .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

81050 ............ X Urinalysis, volume measure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

81099 ............ X Urinalysis test procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82000 ............ X Assay blood acetaldehyde ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82003 ............ X Assay acetaminophen ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82009 ............ X Test for acetone/ketones ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82010 ............ X Acetone assay .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82013 ............ X Acetylcholinesterase assay ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82024 ............ X ACTH .................................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82030 ............ X ADP & AMP ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82040 ............ X Assay serum albumin ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82042 ............ X Assay urine albumin ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82043 ............ X Microalbumin, quantitative ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82044 ............ X Microalbumin, semiquant ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82055 ............ X Assay ethanol ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82075 ............ X Assay breath ethanol ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82085 ............ X Assay of aldolase ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82088 ............ X Aldosterone ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82101 ............ X Assay of urine alkaloids ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82103 ............ X Alpha-1-antitrypsin, total .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82104 ............ X Alpha-1-antitrypsin, pheno ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82105 ............ X Alpha-fetoprotein, serum .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82106 ............ X Alpha-fetoprotein; amniotic ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82108 ............ X Assay, aluminum ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82128 ............ X Test for amino acids .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82130 ............ X Amino acids analysis ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82131 ............ X Amino acids ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82135 ............ X Assay, aminolevulinic acid ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82140 ............ X Assay of ammonia ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82143 ............ X Amniotic fluid scan ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82145 ............ X Assay of amphetamines ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59196

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

82150 ............ X Assay of amylase ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82154 ............ X Androstanediol glucuronide ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82157 ............ X Assay of androstenedione ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82160 ............ X Androsterone assay ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82163 ............ X Assay of angiotensin II ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82164 ............ X Angiotensin I enzyme test .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82172 ............ X Apolipoprotein .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82175 ............ X Assay of arsenic ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82180 ............ X Assay of ascorbic acid ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82190 ............ X Atomic absorption .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82205 ............ X Assay of barbiturates ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82232 ............ X Beta-2 protein ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82239 ............ X Bile acids, total ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82240 ............ X Bile acids, cholylglycine ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82250 ............ X Assay bilirubin .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82251 ............ X Assay bilirubin .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82252 ............ X Fecal bilirubin test .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82270 ............ X Test feces for blood ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82273 ............ X Test for blood, other source ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82286 ............ X Assay of bradykinin ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82300 ............ X Assay cadmium .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82306 ............ X Assay of vitamin D ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82307 ............ X Assay of vitamin D ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82308 ............ X Assay of calcitonin ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82310 ............ X Assay calcium .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82330 ............ X Assay calcium .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82331 ............ X Calcium infusion test .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82340 ............ X Assay calcium in urine ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82355 ............ X Calculus (stone) analysis ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82360 ............ X Calculus (stone) assay ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82365 ............ X Calculus (stone) assay ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82370 ............ X X-ray assay, calculus (stone) ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82374 ............ X Assay blood carbon dioxide ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82375 ............ X Assay blood carbon monoxide ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82376 ............ X Test for carbon monoxide .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82378 ............ X Carcinoembryonic antigen ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82380 ............ X Assay carotene .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82382 ............ X Assay urine catecholamines .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82383 ............ X Assay blood catecholamines ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82384 ............ X Assay three catecholamines .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82387 ............ X Cathepsin-D ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82390 ............ X Assay ceruloplasmin .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82397 ............ X Chemiluminescent assay ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82415 ............ X Assay chloramphenicol ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82435 ............ X Assay blood chloride .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82436 ............ X Assay urine chloride ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82438 ............ X Assay other fluid chlorides ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82441 ............ X Test for chlorohydrocarbons .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82465 ............ X Assay serum cholesterol .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82480 ............ X Assay serum cholinesterase .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82482 ............ X Assay rbc cholinesterase ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82485 ............ X Assay chondroitin sulfate ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82486 ............ X Gas/liquid chromatography ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82487 ............ X Paper chromatography ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82488 ............ X Paper chromatography ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82489 ............ X Thin layer chromatography ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82491 ............ X Chromotography, quantitative ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82495 ............ X Assay chromium ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82507 ............ X Assay citrate ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82520 ............ X Assay for cocaine ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82523 ............ X Collagen crosslinks ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82525 ............ X Assay copper ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82528 ............ X Assay corticosterone .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82530 ............ X Cortisol, free ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82533 ............ X Total cortisol ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82540 ............ X Assay creatine .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82550 ............ X Assay CK (CPK) ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82552 ............ X Assay CPK in blood ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82553 ............ X Creatine, MB fraction ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82554 ............ X Creatine, isoforms .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82565 ............ X Assay creatinine ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82570 ............ X Assay urine creatinine ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82575 ............ X Creatinine clearance test ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82585 ............ X Assay cryofibrinogen .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59197

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

82595 ............ X Assay cryoglobulin ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82600 ............ X Assay cyanide .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82607 ............ X Vitamin B–12 ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82608 ............ X B–12 binding capacity ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82615 ............ X Test for urine cystines ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82626 ............ X Dehydroepiandrosterone .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82627 ............ X Dehydroepiandrosterone .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82633 ............ X Desoxycorticosterone ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82634 ............ X Deoxycortisol ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82638 ............ X Assay dibucaine number .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82646 ............ X Assay of dihydrocodeinone ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82649 ............ X Assay of dihydromorphinone ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82651 ............ X Dihydrotestosterone assay ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82652 ............ X Assay, dihydroxyvitamin D ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82654 ............ X Assay of dimethadione ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82664 ............ X Electrophoretic test ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82666 ............ X Epiandrosterone assay ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82668 ............ X Erythropoietin ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82670 ............ X Estradiol ............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82671 ............ X Estrogens assay ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82672 ............ X Estrogen assay .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82677 ............ X Estriol ................................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82679 ............ X Estrone ............................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82690 ............ X Ethchlorvynol ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82693 ............ X Ethylene glycol ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82696 ............ X Etiocholanolone .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82705 ............ X Fats/lipids, feces, qualitativ ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82710 ............ X Fats/lipids, feces, quantitati ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82715 ............ X Fecal fat assay ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82725 ............ X Assay blood fatty acids ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82728 ............ X Assay ferritin ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82735 ............ X Assay fluoride ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82742 ............ X Assay of flurazepam .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82746 ............ X Blood folic acid serum ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82747 ............ X Folic acid, RBC .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82757 ............ X Assay semen fructose ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82759 ............ X RBC galactokinase assay .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82760 ............ X Assay galactose ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82775 ............ X Assay galactose transferase .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82776 ............ X Galactose transferase test ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82784 ............ X Assay gammaglobulin IgM ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82785 ............ X Assay, gammaglobulin IgE ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82787 ............ X IgG1, 2, 3 and 4 ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82800 ............ X Blood pH ............................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82803 ............ X Blood gases: pH, pO2 & pCO2 ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82805 ............ X Blood gases W/02 saturation ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82810 ............ X Blood gases, O2 sat only ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82820 ............ X Hemoglobin-oxygen affinity ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82926 ............ X Assay gastric acid .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82928 ............ X Assay gastric acid .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82938 ............ X Gastrin test ......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82941 ............ X Assay of gastrin ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82943 ............ X Assay of glucagon .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82946 ............ X Glucagon tolerance test ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82947 ............ X Assay quantitative, glucose ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82948 ............ X Reagent strip/blood glucose .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82950 ............ X Glucose test ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82951 ............ X Glucose tolerance test (GTT) ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82952 ............ X GTT-added samples .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82953 ............ X Glucose-tolbutamide test ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82955 ............ X Assay G6PD enzyme ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82960 ............ X Test for G6PD enzyme ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82962 ............ X Glucose blood test ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82963 ............ X Glucosidase assay ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82965 ............ X Assay GDH enzyme ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82975 ............ X Assay glutamine ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82977 ............ X Assay of GGT .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82978 ............ X Glutathione assay .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82979 ............ X Assay RBC glutathione enzyme ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82980 ............ X Assay of glutethimide ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

82985 ............ X Glycated protein ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83001 ............ X Gonadotropin (FSH) ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83002 ............ X Gonadotropin (LH) ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83003 ............ X Assay growth hormone (HGH) ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59198

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

83008 ............ X Assay guanosine ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83010 ............ X Quant assay haptoglobin ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83012 ............ X Assay haptoglobins ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83015 ............ X Heavy metal screen ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83018 ............ X Quantitative screen, metals ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83019 ............ X Breath isotope test ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83020 ............ X Assay hemoglobin .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83020 26 A Assay hemoglobin .............................................. 0.37 0.20 0.20 0.01 0.58 0.58 XXX

83026 ............ X Hemoglobin, copper sulfate ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83030 ............ X Fetal hemoglobin assay ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83033 ............ X Fetal fecal hemoglobin assay ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83036 ............ X Glycated hemoglobin test .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83045 ............ X Blood methemoglobin test ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83050 ............ X Blood methemoglobin assay .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83051 ............ X Assay plasma hemoglobin ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83055 ............ X Blood sulfhemoglobin test .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83060 ............ X Blood sulfhemoglobin assay .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83065 ............ X Hemoglobin heat assay ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83068 ............ X Hemoglobin stability screen ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83069 ............ X Assay urine hemoglobin ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83070 ............ X Qualt assay hemosiderin ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83071 ............ X Quant assay of hemosiderin .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83088 ............ X Assay histamine ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83150 ............ X Assay for HVA .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83491 ............ X Assay of corticosteroids ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83497 ............ X Assay 5-HIAA ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83498 ............ X Assay of progesterone ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83499 ............ X Assay of progesterone ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83500 ............ X Assay free hydroxyproline .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83505 ............ X Assay total hydroxyproline ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83516 ............ X Immunoassay, nonantibody ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83518 ............ X Immunoassay, dipstick ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83519 ............ X Immunoassay nonantibody ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83520 ............ X Immunoassay, RIA ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83525 ............ X Assay of insulin .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83527 ............ X Assay of insulin .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83528 ............ X Assay intrinsic factor .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83540 ............ X Assay iron .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83550 ............ X Iron binding test ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83570 ............ X Assay IDH enzyme ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83582 ............ X Assay ketogenic steroids ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83586 ............ X Assay 17-(17-KS)ketosteroids ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83593 ............ X Fractionation ketosteroids .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83605 ............ X Lactic acid assay ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83615 ............ X Lactate (LD) (LDH) enzyme ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83625 ............ X Assay LDH enzymes .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83632 ............ X Placental lactogen .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83633 ............ X Test urine for lactose ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83634 ............ X Assay urine for lactose ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83655 ............ X Assay for lead .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83661 ............ X Assay L/S ratio ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83662 ............ X L/S ratio, foam stability ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83670 ............ X Assay LAP enzyme ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83690 ............ X Assay lipase ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83715 ............ X Assay blood lipoproteins .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83717 ............ X Assay blood lipoproteins .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83718 ............ X Blood lipoprotein assay ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83719 ............ X Blood lipoprotein assay ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83721 ............ X Blood lipoprotein assay ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83727 ............ X LRH hormone assay .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83735 ............ X Assay magnesium .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83775 ............ X Assay of md enzyme ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83785 ............ X Assay of manganese ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83805 ............ X Assay of meprobamate ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83825 ............ X Assay mercury ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83835 ............ X Assay metanephrines ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83840 ............ X Assay methadone .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83857 ............ X Assay methemalbumin ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83858 ............ X Assay methsuximide .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83864 ............ X Mucopolysaccharides ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83866 ............ X Mucopolysaccharides screen ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83872 ............ X Assay synovial fluid mucin ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83873 ............ X Assay, CSF protein ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83874 ............ X Myoglobin ........................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59199

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

83883 ............ X Nephelometry, not specified .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83885 ............ X Assay for nickel .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83887 ............ X Assay nicotine .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83890 ............ X Molecular diagnostics ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83892 ............ X Molecular diagnostics ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83894 ............ X Molecular diagnostics ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83896 ............ X Molecular diagnostics ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83898 ............ X Molecular diagnostics ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83902 ............ X Molecular diagnostics ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83912 ............ X Genetic examination .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83912 26 A Genetic examination .......................................... 0.37 0.20 0.20 0.01 0.58 0.58 XXX

83915 ............ X Assay nucleotidase ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83916 ............ X Oligoclonal bands ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83918 ............ X Assay organic acids ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83925 ............ X Opiates ............................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83930 ............ X Assay blood osmolality ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83935 ............ X Assay urine osmolality ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83937 ............ X Assay for osteocalcin ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83945 ............ X Assay oxalate ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83970 ............ X Assay of parathormone ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83986 ............ X Assay body fluid acidity ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

83992 ............ X Assay for phencyclidine ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84022 ............ X Assay of phenothiazine ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84030 ............ X Assay blood PKU ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84035 ............ X Assay phenylketones ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84060 ............ X Assay acid phosphatase .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84061 ............ X Phosphatase, forensic exam .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84066 ............ X Assay prostate phosphatase .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84075 ............ X Assay alkaline phosphatase .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84078 ............ X Assay alkaline phosphatase .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84080 ............ X Assay alkaline phosphatases ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84081 ............ X Amniotic fluid enzyme test ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84085 ............ X Assay RBC PG6D enzyme ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84087 ............ X Assay phosphohexose enzymes ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84100 ............ X Assay phosphorus .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84105 ............ X Assay urine phosphorus .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84106 ............ X Test for porphobilinogen .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84110 ............ X Assay porphobilinogen ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84119 ............ X Test urine for porphyrins .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84120 ............ X Assay urine porphyrins ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84126 ............ X Assay feces porphyrins ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84127 ............ X Porphyrins, feces ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84132 ............ X Assay serum potassium ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84133 ............ X Assay urine potassium ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84134 ............ X Prealbumin ......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84135 ............ X Assay pregnanediol ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84138 ............ X Assay pregnanetriol ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84140 ............ X Assay for pregnenolone ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84143 ............ X Assay/17-hydroxypregnenolone ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84144 ............ X Assay progesterone ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84146 ............ X Assay for prolactin ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84150 ............ X Assay of prostaglandin ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84153 ............ X Prostate specific antigen .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84155 ............ X Assay protein ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84160 ............ X Assay serum protein .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84165 ............ X Assay serum proteins ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84165 26 A Assay serum proteins ........................................ 0.37 0.20 0.20 0.01 0.58 0.58 XXX

84181 ............ X Western blot test ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84181 26 A Western blot test ................................................ 0.37 0.20 0.20 0.01 0.58 0.58 XXX

84182 ............ X Protein, western blot test ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84182 26 A Protein, western blot test ................................... 0.37 0.20 0.20 0.01 0.58 0.58 XXX

84202 ............ X Assay RBC protoporphyrin ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84203 ............ X Test RBC protoporphyrin ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84206 ............ X Assay of proinsulin ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84207 ............ X Assay vitamin B–6 ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84210 ............ X Assay pyruvate ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84220 ............ X Assay pyruvate kinase ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84228 ............ X Assay quinine ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84233 ............ X Assay estrogen .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84234 ............ X Assay progesterone ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84235 ............ X Assay endocrine hormone ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84238 ............ X Assay non-endocrine receptor ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84244 ............ X Assay of renin .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84252 ............ X Assay vitamin B–2 ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59200

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

84255 ............ X Assay selenium .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84260 ............ X Assay serotonin .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84270 ............ X Sex hormone globulin (SHBG) .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84275 ............ X Assay sialic acid ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84285 ............ X Assay silica ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84295 ............ X Assay serum sodium .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84300 ............ X Assay urine sodium ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84305 ............ X Somatomedin ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84307 ............ X Somatostatin ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84311 ............ X Spectrophotometry ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84315 ............ X Body fluid specific gravity .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84375 ............ X Chromatogram assay, sugars ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84392 ............ X Assay urine sulfate ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84402 ............ X Testosterone ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84403 ............ X Assay total testosterone ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84425 ............ X Assay vitamin B–1 ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84430 ............ X Assay thiocyanate .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84432 ............ X Thyroglobulin ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84436 ............ X Assay, total thyroxine ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84437 ............ X Assay neonatal thyroxine ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84439 ............ X Assay, free thyroxine ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84442 ............ X Thyroid activity (TBG) assay .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84443 ............ X Assay thyroid stim hormone .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84445 ............ X Thyroid immunoglobulins TSI ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84446 ............ X Assay vitamin E ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84449 ............ X Assay for transcortin .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84450 ............ X Transferase (AST) (SGOT) ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84460 ............ X Alanine amino (ALT) (SGPT) ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84466 ............ X Transferrin .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84478 ............ X Assay triglycerides ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84479 ............ X Assay thyroid (t–3 or t–4) .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84480 ............ X Assay triiodothyronine (t–3) ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84481 ............ X Free assay (FT–3) ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84482 ............ X T3 reverse .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84484 ............ X Troponin, quant .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84485 ............ X Assay duodenal fluid trypsin .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84488 ............ X Test feces for trypsin ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84490 ............ X Assay feces for trypsin ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84510 ............ X Assay tyrosine .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84512 ............ X Troponin, qual .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84520 ............ X Assay urea nitrogen ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84525 ............ X Urea nitrogen semi-quant .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84540 ............ X Assay urine urea-N ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84545 ............ X Urea-N clearance test ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84550 ............ X Assay blood uric acid ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84560 ............ X Assay urine uric acid .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84577 ............ X Assay feces urobilinogen ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84578 ............ X Test urine urobilinogen ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84580 ............ X Assay urine urobilinogen .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84583 ............ X Assay urine urobilinogen .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84585 ............ X Assay urine VMA ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84586 ............ X VIP assay ........................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84588 ............ X Assay vasopressin ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84590 ............ X Assay vitamin-A ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84597 ............ X Assay vitamin-K ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84600 ............ X Assay for volatiles .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84620 ............ X Xylose tolerance test .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84630 ............ X Assay zinc .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84681 ............ X Assay C-peptide ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84702 ............ X Chorionic gonadotropin test ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84703 ............ X Chorionic gonadotropin assay ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84830 ............ X Ovulation tests ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

84999 ............ X Clinical chemistry test ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85002 ............ X Bleeding time test .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85007 ............ X Differential WBC count ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85008 ............ X Nondifferential WBC count ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85009 ............ X Differential WBC count ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85013 ............ X Hematocrit .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85014 ............ X Hematocrit .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85018 ............ X Hemoglobin ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85021 ............ X Automated hemogram ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85022 ............ X Automated hemogram ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85023 ............ X Automated hemogram ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85024 ............ X Automated hemogram ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59201

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

85025 ............ X Automated hemogram ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85027 ............ X Automated hemogram ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85029 ............ X Automated hemogram ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85030 ............ X Automated hemogram ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85031 ............ X Manual hemogram, complete cbc ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85041 ............ X Red blood cell (RBC) count ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85044 ............ X Reticulocyte count .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85045 ............ X Reticulocyte count .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85048 ............ X White blood cell (WBC) count ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85060 ............ A Blood smear interpretation ................................. 0.45 0.22 0.22 0.02 0.69 0.69 XXX

85095 ............ A Bone marrow aspiration ..................................... 1.08 0.67 0.67 0.05 1.80 1.80 XXX

85097 ............ A Bone marrow interpretation ................................ 0.94 0.48 0.48 0.04 1.46 1.46 XXX

85102 ............ A Bone marrow biopsy .......................................... 1.37 0.80 0.80 0.05 2.22 2.22 XXX

85130 ............ X Chromogenic substrate assay ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85170 ............ X Blood clot retraction ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85175 ............ X Blood clot lysis time ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85210 ............ X Blood clot factor II test ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85220 ............ X Blood clot factor V test ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85230 ............ X Blood clot factor VII test ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85240 ............ X Blood clot factor VIII test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85244 ............ X Blood clot factor VIII test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85245 ............ X Blood clot factor VIII test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85246 ............ X Blood clot factor VIII test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85247 ............ X Blood clot factor VIII test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85250 ............ X Blood clot factor IX test ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85260 ............ X Blood clot factor X test ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85270 ............ X Blood clot factor XI test ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85280 ............ X Blood clot factor XII test ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85290 ............ X Blood clot factor XIII test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85291 ............ X Blood clot factor XIII test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85292 ............ X Blood clot factor assay ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85293 ............ X Blood clot factor assay ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85300 ............ X Antithrombin III test ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85301 ............ X Antithrombin III test ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85302 ............ X Blood clot inhibitor antigen ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85303 ............ X Blood clot inhibitor test ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85305 ............ X Blood clot inhibitor assay ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85306 ............ X Blood clot inhibitor test ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85335 ............ X Factor inhibitor test ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85337 ............ X Thrombomodulin ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85345 ............ X Coagulation time ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85347 ............ X Coagulation time ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85348 ............ X Coagulation time ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85360 ............ X Euglobulin lysis .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85362 ............ X Fibrin degradation products ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85366 ............ X Fibrinogen test ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85370 ............ X Fibrinogen test ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85378 ............ X Fibrin degradation .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85379 ............ X Fibrin degradation .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85384 ............ X Fibrinogen .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85385 ............ X Fibrinogen .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85390 ............ X Fibrinolysins screen ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85390 26 A Fibrinolysins screen ........................................... 0.37 0.20 0.20 0.01 0.58 0.58 XXX

85400 ............ X Fibrinolytic plasmin ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85410 ............ X Fibrinolytic antiplasmin ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85415 ............ X Fibrinolytic plasminogen ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85420 ............ X Fibrinolytic plasminogen ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85421 ............ X Fibrinolytic plasminogen ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85441 ............ X Heinz bodies; direct ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85445 ............ X Heinz bodies; induced ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85460 ............ X Hemoglobin, fetal ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85461 ............ X Hemoglobin, fetal ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85475 ............ X Hemolysin ........................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85520 ............ X Heparin assay .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85525 ............ X Heparin ............................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85530 ............ X Heparin-protamine tolerance .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85535 ............ X Iron stain, blood cells ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85540 ............ X Wbc alkaline phosphatase ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85547 ............ X RBC mechanical fragility .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85549 ............ X Muramidase ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85555 ............ X RBC osmotic fragility .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85557 ............ X RBC osmotic fragility .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85576 ............ X Blood platelet aggregation ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85576 26 A Blood platelet aggregation ................................. 0.37 0.20 0.20 0.01 0.58 0.58 XXX
59202

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

85585 ............ X Blood platelet estimation .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85590 ............ X Platelet manual count ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85595 ............ X Platelet count, automated .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85597 ............ X Platelet neutralization ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85610 ............ X Prothrombin time ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85611 ............ X Prothrombin test ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85612 ............ X Viper venom prothrombin time ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85613 ............ X Russell viper venom, diluted .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85635 ............ X Reptilase test ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85651 ............ X Rbc sed rate, nonauto ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85652 ............ X Rbc sed rate, auto ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85660 ............ X RBC sickle cell test ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85670 ............ X Thrombin time, plasma ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85675 ............ X Thrombin time, titer ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85705 ............ X Thromboplastin inhibition ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85730 ............ X Thromboplastin time, partial ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85732 ............ X Thromboplastin time, partial ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85810 ............ X Blood viscosity examination ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

85999 ............ X Hematology procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86000 ............ X Agglutinins; febrile .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86003 ............ X Allergen specific IgE .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86005 ............ X Allergen specific IgE .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86021 ............ X WBC antibody identification ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86022 ............ X Platelet antibodies .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86023 ............ X Immunoglobulin assay ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86038 ............ X Antinuclear antibodies ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86039 ............ X Antinuclear antibodies (ANA) ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86060 ............ X Antistreptolysin O titer ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86063 ............ X Antistreptolysin O screen ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86077 ............ A Physician blood bank service ............................ 0.94 0.30 0.30 0.02 1.26 1.26 XXX

86078 ............ A Physician blood bank service ............................ 0.94 0.34 0.34 0.02 1.30 1.30 XXX

86079 ............ A Physician blood bank service ............................ 0.94 0.33 0.33 0.02 1.29 1.29 XXX

86140 ............ X C-reactive protein ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86147 ............ X Cardiolipin antibody ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86148 ............ X Phospholipid antibody ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86155 ............ X Chemotaxis assay .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86156 ............ X Cold agglutinin screen ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86157 ............ X Cold agglutinin, titer ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86160 ............ X Complement, antigen ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86161 ............ X Complement/function activity ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86162 ............ X Complement, total (CH50) ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86171 ............ X Complement fixation, each ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86185 ............ X Counterimmunoelectrophoresis ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86215 ............ X Deoxyribonuclease, antibody ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86225 ............ X DNA antibody ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86226 ............ X DNA antibody, single strand .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86235 ............ X Nuclear antigen antibody ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86243 ............ X Fc receptor ......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86255 ............ X Fluorescent antibody; screen ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86255 26 A Fluorescent antibody; screen ............................. 0.37 0.20 0.20 0.01 0.58 0.58 XXX

86256 ............ X Fluorescent antibody; titer .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86256 26 A Fluorescent antibody; titer .................................. 0.37 0.20 0.20 0.01 0.58 0.58 XXX

86277 ............ X Growth hormone antibody .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86280 ............ X Hemagglutination inhibition ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86287 ............ D 12/Hepatitis B (HBsAg) ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86289 ............ D Hepatitis BC antibody test ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86290 ............ D 12/Hepatitis BC antibody test ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86291 ............ D Hepatitis BS antibody test .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86293 ............ D Hepatitis Be antibody test .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86295 ............ D 12/Hepatitis Be antibody test ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86296 ............ D Hepatitis A antibody test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86299 ............ D Hepatitis A antibody test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86302 ............ D Hepatitis C antibody ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86303 ............ D Hepatitis C antibody ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86306 ............ D Hepatitis, delta agent ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86308 ............ X Heterophile antibodies ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86309 ............ X Heterophile antibodies ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86310 ............ X Heterophile antibodies ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86311 ............ D 12/31/97HIV antigen test ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86313 ............ D Immunoassay, infectious agent ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86315 ............ D Immunoassay, infectious agent ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86316 ............ X Immunoassay, tumor antigen ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86317 ............ X Immunoassay, infectious agent ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86318 ............ X Immunoassay, infectious agent ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59203

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

86320 ............ X Serum immunoelectrophoresis .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86320 26 A Serum immunoelectrophoresis .......................... 0.37 0.20 0.20 0.01 0.58 0.58 XXX

86325 ............ X Other immunoelectrophoresis ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86325 26 A Other immunoelectrophoresis ............................ 0.37 0.20 0.20 0.01 0.58 0.58 XXX

86327 ............ X Immunoelectrophoresis assay ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86327 26 A Immunoelectrophoresis assay ........................... 0.42 0.20 0.20 0.01 0.63 0.63 XXX

86329 ............ X Immunodiffusion ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86331 ............ X Immunodiffusion ouchterlony ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86332 ............ X Immune complex assay ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86334 ............ X Immunofixation procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86334 26 A Immunofixation procedure .................................. 0.37 0.20 0.20 0.01 0.58 0.58 XXX

86337 ............ X Insulin antibodies ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86340 ............ X Intrinsic factor antibody ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86341 ............ X Islet cell antibody ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86343 ............ X Leukocyte histamine release ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86344 ............ X Leukocyte phagocytosis ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86353 ............ X Lymphocyte transformation ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86359 ............ X T cells, total count .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86360 ............ X T cell absolute count/ratio .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86361 ............ X T cell absolute count .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86376 ............ X Microsomal antibody .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86378 ............ X Migration inhibitory factor ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86382 ............ X Neutralization test, viral ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86384 ............ X Nitroblue tetrazolium dye ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86403 ............ X Particle agglutination test ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86406 ............ X Particle agglutination test ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86430 ............ X Rheumatoid factor test ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86431 ............ X Rheumatoid factor, quant ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86485 ............ C Skin test, candida ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86490 ............ A Coccidioidomycosis skin test ............................. 0.00 0.28 0.28 0.02 0.30 0.30 XXX

86510 ............ A Histoplasmosis skin test ..................................... 0.00 0.30 0.30 0.02 0.32 0.32 XXX

86580 ............ A TB intradermal test ............................................. 0.00 0.24 0.24 0.02 0.26 0.26 XXX

86585 ............ A TB tine test ......................................................... 0.00 0.19 0.19 0.01 0.20 0.20 XXX

86586 ............ C Skin test, unlisted ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86588 ............ X Streptocollus, direct screen ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86590 ............ X Streptokinase, antibody ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86592 ............ X Blood serology, qualitative ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86593 ............ X Blood serology, quantitative ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86602 ............ X Antinomyces antibody ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86603 ............ X Adenovirus, antibody .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86606 ............ X Aspergillus antibody ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86609 ............ X Bacterium, antibody ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86612 ............ X Blastomyces, antibody ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86615 ............ X Bordetella antibody ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86617 ............ X Lyme disease antibody ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86618 ............ X Lyme disease antibody ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86619 ............ X Borrelia antibody ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86622 ............ X Brucella, antibody ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86625 ............ X Campylobacter, antibody ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86628 ............ X Candida, antibody .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86631 ............ X Chlamydia, antibody ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86632 ............ X Chlamydia, IgM, antibody .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86635 ............ X Coccidioides, antibody ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86638 ............ X Q fever antibody ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86641 ............ X Cryptococcus antibody ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86644 ............ X CMV antibody ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86645 ............ X CMV antibody, IgM ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86648 ............ X Diphtheria antibody ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86651 ............ X Encephalitis antibody ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86652 ............ X Encephalitis antibody ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86653 ............ X Encephalitis, antibody ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86654 ............ X Encephalitis, antibody ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86658 ............ X Enterovirus, antibody ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86663 ............ X Epstein-barr antibody ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86664 ............ X Epstein-barr antibody ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86665 ............ X Epstein-barr, antibody ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86668 ............ X Francisella tularensis ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86671 ............ X Fungus, antibody ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86674 ............ X Giardia lamblia ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86677 ............ X Helicobacter pylori .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86682 ............ X Helminth, antibody ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86684 ............ X Hemophilus influenza ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86687 ............ X HTLV I ................................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86688 ............ X HTLV–II .............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59204

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

86689 ............ X HTLV/HIV confirmatory test ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86692 ............ X Hepatitis, delta agent ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86694 ............ X Herpes simplex test ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86695 ............ X Herpes simplex test ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86698 ............ X Histoplasma ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86701 ............ X HIV–1 ................................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86702 ............ X HIV–2 ................................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86703 ............ X HIV–1/HIV–2, single assay ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86704 ............ X Hep b core ab test, igg & m .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86705 ............ X Hep b core ab test, igm ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86706 ............ X Hepatitis b surface ab test ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86707 ............ X Hepatitis be ab test ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86708 ............ X Hep a ab test, igg & m ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86709 ............ X Hep a ab test, igm ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86710 ............ X Influenza virus .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86713 ............ X Legionella ........................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86717 ............ X Leishmania ......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86720 ............ X Leptospira ........................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86723 ............ X Listeria monocytogenes ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86727 ............ X Lymph choriomeningitis ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86729 ............ X Lympho venereum ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86732 ............ X Mucormycosis .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86735 ............ X Mumps ................................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86738 ............ X Mycoplasma ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86741 ............ X Neisseria meningitidis ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86744 ............ X Nocardia ............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86747 ............ X Parvovirus .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86750 ............ X Malaria ................................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86753 ............ X Protozoa, not elsewhere .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86756 ............ X Respiratory virus ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86759 ............ X Rotavirus ............................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86762 ............ X Rubella ............................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86765 ............ X Rubeola .............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86768 ............ X Salmonella .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86771 ............ X Shigella ............................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86774 ............ X Tetanus .............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86777 ............ X Toxoplasma ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86778 ............ X Toxoplasma, IgM ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86781 ............ X Treponema pallidum confirm ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86784 ............ X Trichinella ........................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86787 ............ X Varicella-zoster ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86790 ............ X Virus, not specified ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86793 ............ X Yersinia .............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86800 ............ X Thyroglobulin antibody ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86803 ............ X Hepatitis c ab test .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86804 ............ X Hep c ab test, confirm ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86805 ............ X Lymphocytotoxicity assay .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86806 ............ X Lymphocytotoxicity assay .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86807 ............ X Cytotoxic antibody screening ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86808 ............ X Cytotoxic antibody screening ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86812 ............ X HLA typing, A, B, or C ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86813 ............ X HLA typing, A, B, or C ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86816 ............ X HLA typing, DR/DQ ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86817 ............ X HLA typing, DR/DQ ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86821 ............ X Lymphocyte culture, mixed ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86822 ............ X Lymphocyte culture, primed ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86849 ............ X Immunology procedure ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86850 ............ X RBC antibody screen ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86860 ............ X RBC antibody elution ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86870 ............ X RBC antibody identification ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86880 ............ X Coombs test ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86885 ............ X Coombs test ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86886 ............ X Coombs test ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86890 ............ X Autologous blood process .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86891 ............ X Autologous blood, op salvage ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86900 ............ X Blood typing, ABO .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86901 ............ X Blood typing, Rh (D) .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86903 ............ X Blood typing, antigen screen ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86904 ............ X Blood typing, patient serum ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86905 ............ X Blood typing, RBC antigens ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86906 ............ X Blood typing, Rh phenotype ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86910 ............ N Blood typing, paternity test ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86911 ............ N Blood typing, antigen system ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86915 ............ X Bone marrow ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59205

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

86920 ............ X Compatibility test ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86921 ............ X Compatibility test ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86922 ............ X Compatibility test ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86927 ............ X Plasma, fresh frozen .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86930 ............ X Frozen blood prep .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86931 ............ X Frozen blood thaw ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86932 ............ X Frozen blood, freeze/thaw ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86940 ............ X Hemolysins/agglutinins auto .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86941 ............ X Hemolysins/agglutinins ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86945 ............ X Blood product/irradiation .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86950 ............ X Leukacyte transfusion ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86965 ............ X Pooling blood platelets ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86970 ............ X RBC pretreatment .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86971 ............ X RBC pretreatment .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86972 ............ X RBC pretreatment .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86975 ............ X RBC pretreatment, serum .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86976 ............ X RBC pretreatment, serum .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86977 ............ X RBC pretreatment, serum .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86978 ............ X RBC pretreatment, serum .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86985 ............ X Split blood or products ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

86999 ............ X Transfusion procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87001 ............ X Small animal inoculation .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87003 ............ X Small animal inoculation .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87015 ............ X Specimen concentration ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87040 ............ X Blood culture for bacteria ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87045 ............ X Stool culture for bacteria .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87060 ............ X Nose/throat culture,bacteria ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87070 ............ X Culture specimen, bacteria ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87072 ............ X Culture of specimen by kit ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87075 ............ X Culture specimen, bacteria ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87076 ............ X Bacteria identification ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87081 ............ X Bacteria culture screen ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87082 ............ X Culture of specimen by kit ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87083 ............ X Culture of specimen by kit ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87084 ............ X Culture of specimen by kit ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87085 ............ X Culture of specimen by kit ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87086 ............ X Urine culture, colony count ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87087 ............ X Urine bacteria culture ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87088 ............ X Urine bacteria culture ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87101 ............ X Skin fungus culture ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87102 ............ X Fungus isolation culture ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87103 ............ X Blood fungus culture .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87106 ............ X Fungus identification .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87109 ............ X Mycoplasma culture ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87110 ............ X Culture, chlamydia ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87116 ............ X Mycobacteria culture .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87117 ............ X Mycobacteria culture .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87118 ............ X Mycobacteria identification ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87140 ............ X Culture typing, fluorescent ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87143 ............ X Culture typing, GLC method .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87145 ............ X Culture typing, phage method ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87147 ............ X Culture typing, serologic .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87151 ............ X Culture typing, serologic .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87155 ............ X Culture typing, precipitin .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87158 ............ X Culture typing, added method ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87163 ............ X Special microbiology culture .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87164 ............ X Dark field examination ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87164 26 A Dark field examination ....................................... 0.37 0.20 0.20 0.01 0.58 0.58 XXX

87166 ............ X Dark field examination ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87174 ............ X Endotoxin, bacterial ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87175 ............ X Assay, endotoxin, bacterial ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87176 ............ X Endotoxin, bacterial ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87177 ............ X Ova and parasites smears ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87178 ............ D Microbe identification ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87179 ............ D Microbe identification ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87181 ............ X Antibiotic sensitivity, each .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87184 ............ X Antibiotic sensitivity, each .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87186 ............ X Antibiotic sensitivity, MIC ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87187 ............ X Antibiotic sensitivity, MBC .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87188 ............ X Antibiotic sensitivity, each .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87190 ............ X TB antibiotic sensitivity ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87192 ............ X Antibiotic sensitivity, each .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87197 ............ X Bactericidal level, serum .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87205 ............ X Smear, stain & interpret ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59206

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

87206 ............ X Smear, stain & interpret ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87207 ............ X Smear, stain & interpret ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87207 26 A Smear, stain & interpret ..................................... 0.37 0.20 0.20 0.01 0.58 0.58 XXX

87208 ............ X Smear, stain & interpret ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87210 ............ X Smear, stain & interpret ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87211 ............ X Smear, stain & interpret ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87220 ............ X Tissue exam for fungi ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87230 ............ X Assay, toxin or antitoxin ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87250 ............ X Virus inoculation for test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87252 ............ X Virus inoculation for test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87253 ............ X Virus inoculation for test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87260 ............ X Adenovirus ag, dfa ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87265 ............ X Pertussis ag, dfa ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87270 ............ X Chylmd trach ag, dfa .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87272 ............ X Cryptosporidum ag, dfa ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87274 ............ X Herpes simplex ag, dfa ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87276 ............ X Influenza ag, dfa ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87278 ............ X Legion pneumo ag, dfa ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87280 ............ X Resp syncytial ag, dfa ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87285 ............ X Trepon pallidum ag, dfa ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87290 ............ X Varicella ag, dfa ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87299 ............ X Ag detection nos, dfa ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87301 ............ X Adenovirus ag, eia ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87320 ............ X Chylmd trach ag, eia .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87324 ............ X Clostridium ag, eia ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87328 ............ X Cryptospor ag, eia .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87332 ............ X Cytomegalovirus ag, eia .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87335 ............ X E coli 0157 ag, eia ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87340 ............ X Hepatitis b surface ag, eia ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87350 ............ X Hepatitis b ag, eia .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87380 ............ X Hepatitis delta ag, eia ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87385 ............ X Histoplasma capsul ag, eia ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87390 ............ X HIV-1 ag, eia ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87391 ............ X HIV-2 ag, eia ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87420 ............ X Resp syncytial ag, eia ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87425 ............ X Rotavirus ag, eia ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87430 ............ X Strep a ag, eia ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87449 ............ X Ag detect nos, eia, mult ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87450 ............ X Ag detect nos, eia, single .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87470 ............ X Bartonella, dna, dir probe .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87471 ............ X Bartonella, dna, amp probe ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87472 ............ X Bartonella, dna, quant ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87475 ............ X Lyme dis, dna, dir probe .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87476 ............ X Lyme dis, dna, amp probe ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87477 ............ X Lyme dis, dna, quant ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87480 ............ X Candida, dna, dir probe ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87481 ............ X Candida, dna, amp probe .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87482 ............ X Candida, dna, quant ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87485 ............ X Chylmd pneum, dna, dir probe .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87486 ............ X Chylmd pneum, dna, amp probe ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87487 ............ X Chylmd pneum, dna, quant ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87490 ............ X Chylmd trach, dna, dir probe ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87491 ............ X Chylmd trach, dna, amp probe .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87492 ............ X Chylmd trach, dna, quant ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87495 ............ X Cytomeg, dna, dir probe .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87496 ............ X Cytomeg, dna, amp probe ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87497 ............ X Cytomeg, dna, quant .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87510 ............ X Gardner vag, dna, dir probe .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87511 ............ X Gardner vag, dna, amp probe ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87512 ............ X Gardner vag, dna, quant .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87515 ............ X Hepatitis b, dna, dir probe ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87516 ............ X Hepatitis b, dna, amp probe .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87517 ............ X Hepatitis b, dna, quant ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87520 ............ X Hepatitis c, rna, dir probe .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87521 ............ X Hepatitis c, rna, amp probe ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87522 ............ X Hepatitis c, rna, quant ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87525 ............ X Hepatitis g , dna, dir probe ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87526 ............ X Hepatitis g, dna, amp probe .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87527 ............ X Hepatitis g, dna, quant ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87528 ............ X Hsv, dna, dir probe ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87529 ............ X Hsv, dna, amp probe ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87530 ............ X Hsv, dna, quant .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87531 ............ X Hhv–6, dna, dir probe ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87532 ............ X Hhv–6, dna, amp probe ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59207

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

87533 ............ X Hhv–6, dna, quant .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87534 ............ X Hiv–1, dna, dir probe ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87535 ............ X Hiv–1, dna, amp probe ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87536 ............ X Hiv–1, dna, quant ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87537 ............ X Hiv–2, dna, dir probe ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87538 ............ X Hiv–2, dna, amp probe ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87539 ............ X Hiv–2, dna, quant ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87540 ............ X Legion pneumo, dna, dir prob ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87541 ............ X Legion pneumo, dna, amp prob ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87542 ............ X Legion pneumo, dna, quant ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87550 ............ X Mycobacteria, dna, dir probe ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87551 ............ X Mycobacteria, dna, amp probe .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87552 ............ X Mycobacteria, dna, quant ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87555 ............ X M. tuberculo, dna, dir probe ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87556 ............ X M. tuberculo, dna, amp probe ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87557 ............ X M. tuberculo, dna, quant .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87560 ............ X M. avium-intra, dna, dir prob .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87561 ............ X M. avium-intra, dna, amp prob ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87562 ............ X M. avium-intra, dna, quant ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87580 ............ X M. pneumon, dna, dir probe .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87581 ............ X M. pneumon, dna, amp probe ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87582 ............ X M. pneumon, dna, quant .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87590 ............ X N. gonorrhoeae, dna, dir prob ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87591 ............ X N. gonorrhoeae, dna, amp prob ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87592 ............ X N. gonorrhoeae, dna, quant ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87620 ............ X Hpv, dna, dir probe ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87621 ............ X Hpv, dna, amp probe ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87622 ............ X Hpv, dna, quant .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87650 ............ X Strep a, dna, dir probe ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87651 ............ X Strep a, dna, amp probe .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87652 ............ X Strep a, dna, quant ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87797 ............ X Detect agent nos, dna, dir ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87798 ............ X Detect agent nos, dna, amp .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87799 ............ X Detect agent nos, dna, quant ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87810 ............ X Chylmd trach assay w/optic ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87850 ............ X N. gonorrhoeae assay w/optic ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87880 ............ X Strep a assay w/optic ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87899 ............ X Agent nos assay w/optic .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

87999 ............ X Microbiology procedure ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88000 ............ N Autopsy (necropsy), gross ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88005 ............ N Autopsy (necropsy), gross ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88007 ............ N Autopsy (necropsy), gross ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88012 ............ N Autopsy (necropsy), gross ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88014 ............ N Autopsy (necropsy), gross ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88016 ............ N Autopsy (necropsy), gross ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88020 ............ N Autopsy (necropsy), complete ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88025 ............ N Autopsy (necropsy), complete ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88027 ............ N Autopsy (necropsy), complete ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88028 ............ N Autopsy (necropsy), complete ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88029 ............ N Autopsy (necropsy), complete ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88036 ............ N Limited autopsy .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88037 ............ N Limited autopsy .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88040 ............ N Forensic autopsy (necropsy) .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88045 ............ N Coroner’s autopsy (necropsy) ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88099 ............ N Necropsy (autopsy) procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88104 ............ A Cytopathology, fluids .......................................... 0.56 0.44 0.44 0.04 1.04 1.04 XXX

88104 TC A Cytopathology, fluids .......................................... 0.00 0.21 0.21 0.02 0.23 0.23 XXX

88104 26 A Cytopathology, fluids .......................................... 0.56 0.23 0.23 0.02 0.81 0.81 XXX

88106 ............ A Cytopathology, fluids .......................................... 0.56 0.37 0.37 0.03 0.96 0.96 XXX

88106 TC A Cytopathology, fluids .......................................... 0.00 0.17 0.17 0.02 0.19 0.19 XXX

88106 26 A Cytopathology, fluids .......................................... 0.56 0.20 0.20 0.01 0.77 0.77 XXX

88107 ............ A Cytopathology, fluids .......................................... 0.76 0.47 0.47 0.04 1.27 1.27 XXX

88107 TC A Cytopathology, fluids .......................................... 0.00 0.23 0.23 0.02 0.25 0.25 XXX

88107 26 A Cytopathology, fluids .......................................... 0.76 0.24 0.24 0.02 1.02 1.02 XXX

88108 ............ A Cytopath, concentrate tech ................................ 0.56 0.47 0.47 0.04 1.07 1.07 XXX

88108 TC A Cytopath, concentrate tech ................................ 0.00 0.23 0.23 0.02 0.25 0.25 XXX

88108 26 A Cytopath, concentrate tech ................................ 0.56 0.24 0.24 0.02 0.82 0.82 XXX

88125 ............ A Forensic cytopathology ...................................... 0.26 0.11 0.11 0.00 0.37 0.37 XXX

88125 TC A Forensic cytopathology ...................................... 0.00 0.04 0.04 0.00 0.04 0.04 XXX

88125 26 A Forensic cytopathology ...................................... 0.26 0.07 0.07 0.00 0.33 0.33 XXX

88130 ............ X Sex chromatin identification ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88140 ............ X Sex chromatin identification ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88141 ............ A Cytopath cerv/vag interpret ................................ 0.42 0.32 0.32 0.04 0.78 0.78 XXX

88142 ............ X Cytopath cerv/vag thin layer .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59208

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

88150 ............ X Cytopath cerv/vag .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88151 ............ D Cytopathology interpretation .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88151 26 D Cytopathology interpretation .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88152 ............ X Cytopath cerv/vag auto ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88155 ............ X Cytopath cerv/vag index .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88156 ............ X Cytopath cerv/vag tbs ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88157 ............ D 1TBS smear (bethesda system) ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88157 26 D 1TBS smear (bethesda system) ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88158 ............ X Cytopath cerv/vag tbs auto ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88160 ............ A Cytopath smear, other source ........................... 0.50 0.33 0.33 0.03 0.86 0.86 XXX

88160 TC A Cytopath smear, other source ........................... 0.00 0.16 0.16 0.02 0.18 0.18 XXX

88160 26 A Cytopath smear, other source ........................... 0.50 0.17 0.17 0.01 0.68 0.68 XXX

88161 ............ A Cytopath smear, other source ........................... 0.50 0.39 0.39 0.03 0.92 0.92 XXX

88161 TC A Cytopath smear, other source ........................... 0.00 0.19 0.19 0.02 0.21 0.21 XXX

88161 26 A Cytopath smear, other source ........................... 0.50 0.20 0.20 0.01 0.71 0.71 XXX

88162 ............ A Cytopath smear, other source ........................... 0.76 0.79 0.79 0.05 1.60 1.60 XXX

88162 TC A Cytopath smear, other source ........................... 0.00 0.38 0.38 0.02 0.40 0.40 XXX

88162 26 A Cytopath smear, other source ........................... 0.76 0.41 0.41 0.03 1.20 1.20 XXX

88170 ............ A Fine needle aspiration ........................................ 1.27 0.99 0.99 0.09 2.35 2.35 XXX

88170 TC A Fine needle aspiration ........................................ 0.00 0.47 0.47 0.04 0.51 0.51 XXX

88170 26 A Fine needle aspiration ........................................ 1.27 0.52 0.52 0.05 1.84 1.84 XXX

88171 ............ A Fine needle aspiration ........................................ 1.27 1.35 1.35 0.09 2.71 2.71 XXX

88171 TC A Fine needle aspiration ........................................ 0.00 0.64 0.64 0.04 0.68 0.68 XXX

88171 26 A Fine needle aspiration ........................................ 1.27 0.71 0.71 0.05 2.03 2.03 XXX

88172 ............ A Evaluation of smear ........................................... 0.60 0.71 0.71 0.05 1.36 1.36 XXX

88172 TC A Evaluation of smear ........................................... 0.00 0.35 0.35 0.02 0.37 0.37 XXX

88172 26 A Evaluation of smear ........................................... 0.60 0.36 0.36 0.03 0.99 0.99 XXX

88173 ............ A Interpretation of smear ....................................... 1.39 0.87 0.87 0.05 2.31 2.31 XXX

88173 TC A Interpretation of smear ....................................... 0.00 0.42 0.42 0.02 0.44 0.44 XXX

88173 26 A Interpretation of smear ....................................... 1.39 0.45 0.45 0.03 1.87 1.87 XXX

88180 ............ A Cell marker study ............................................... 0.36 0.33 0.33 0.03 0.72 0.72 XXX

88180 TC A Cell marker study ............................................... 0.00 0.16 0.16 0.02 0.18 0.18 XXX

88180 26 A Cell marker study ............................................... 0.36 0.17 0.17 0.01 0.54 0.54 XXX

88182 ............ A Cell marker study ............................................... 0.77 0.89 0.89 0.07 1.73 1.73 XXX

88182 TC A Cell marker study ............................................... 0.00 0.44 0.44 0.04 0.48 0.48 XXX

88182 26 A Cell marker study ............................................... 0.77 0.45 0.45 0.03 1.25 1.25 XXX

88199 ............ C Cytopathology procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88199 TC C Cytopathology procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88199 26 C Cytopathology procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88230 ............ X Tissue culture, lymphocyte ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88233 ............ X Tissue culture, skin/biopsy ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88235 ............ X Tissue culture, placenta ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88237 ............ X Tissue culture, bone marrow ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88239 ............ X Tissue culture, other .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88245 ............ X Chromosome analysis ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88248 ............ X Chromosome analysis ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88250 ............ X Chromosome analysis ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88260 ............ X Chromosome analysis: 5 cells ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88261 ............ X Chromosome analysis: 5 cells ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88262 ............ X Chromosome count: 15–20 cells ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88263 ............ X Chromosome analysis: 45 cells ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88267 ............ X Chromosome analysis: placenta ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88269 ............ X Chromosome analysis: amniotic ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88280 ............ X Chromosome karyotype study ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88283 ............ X Chromosome banding study .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88285 ............ X Chromosome count: additional .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88289 ............ X Chromosome study: additional .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88299 ............ C Cytogenetic study ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88300 ............ A Surg path, gross ................................................. 0.08 0.20 0.20 0.01 0.29 0.29 XXX

88300 TC A Surg path, gross ................................................. 0.00 0.10 0.10 0.00 0.10 0.10 XXX

88300 26 A Surg path, gross ................................................. 0.08 0.10 0.10 0.01 0.19 0.19 XXX

88302 ............ A Tissue exam by pathologist ............................... 0.13 0.40 0.40 0.04 0.57 0.57 XXX

88302 TC A Tissue exam by pathologist ............................... 0.00 0.23 0.23 0.02 0.25 0.25 XXX

88302 26 A Tissue exam by pathologist ............................... 0.13 0.17 0.17 0.02 0.32 0.32 XXX

88304 ............ A Tissue exam by pathologist ............................... 0.22 0.57 0.57 0.04 0.83 0.83 XXX

88304 TC A Tissue exam by pathologist ............................... 0.00 0.33 0.33 0.02 0.35 0.35 XXX

88304 26 A Tissue exam by pathologist ............................... 0.22 #0.24 #0.24 0.02 0.48 0.48 XXX

88305 ............ A Tissue exam by pathologist ............................... 0.75 1.03 1.03 0.08 1.86 1.86 XXX

88305 TC A Tissue exam by pathologist ............................... 0.00 0.50 0.50 0.04 0.54 0.54 XXX

88305 26 A Tissue exam by pathologist ............................... 0.75 0.53 0.53 0.04 1.32 1.32 XXX

88307 ............ A Tissue exam by pathologist ............................... 1.59 1.52 1.52 0.12 3.23 3.23 XXX

88307 TC A Tissue exam by pathologist ............................... 0.00 0.74 0.74 0.06 0.80 0.80 XXX

88307 26 A Tissue exam by pathologist ............................... 1.59 0.78 0.78 0.06 2.43 2.43 XXX

88309 ............ A Tissue exam by pathologist ............................... 2.28 1.92 1.92 0.13 4.33 4.33 XXX
59209

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

88309 TC A Tissue exam by pathologist ............................... 0.00 0.93 0.93 0.06 0.99 0.99 XXX

88309 26 A Tissue exam by pathologist ............................... 2.28 0.99 0.99 0.07 3.34 3.34 XXX

88311 ............ A Decalcify tissue .................................................. 0.24 0.21 0.21 0.01 0.46 0.46 XXX

88311 TC A Decalcify tissue .................................................. 0.00 0.10 0.10 0.00 0.10 0.10 XXX

88311 26 A Decalcify tissue .................................................. 0.24 0.11 0.11 0.01 0.36 0.36 XXX

88312 ............ A Special stains ..................................................... 0.54 0.26 0.26 0.01 0.81 0.81 XXX

88312 TC A Special stains ..................................................... 0.00 0.12 0.12 0.00 0.12 0.12 XXX

88312 26 A Special stains ..................................................... 0.54 0.14 0.14 0.01 0.69 0.69 XXX

88313 ............ A Special stains ..................................................... 0.24 0.21 0.21 0.01 0.46 0.46 XXX

88313 TC A Special stains ..................................................... 0.00 0.10 0.10 0.00 0.10 0.10 XXX

88313 26 A Special stains ..................................................... 0.24 0.11 0.11 0.01 0.36 0.36 XXX

88314 ............ A Histochemical stain ............................................ 0.45 0.62 0.62 0.04 1.11 1.11 XXX

88314 TC A Histochemical stain ............................................ 0.00 0.27 0.27 0.02 0.29 0.29 XXX

88314 26 A Histochemical stain ............................................ 0.45 0.35 0.35 0.02 0.82 0.82 XXX

88318 ............ A Chemical histochemistry .................................... 0.42 0.24 0.24 0.01 0.67 0.67 XXX

88318 TC A Chemical histochemistry .................................... 0.00 0.12 0.12 0.00 0.12 0.12 XXX

88318 26 A Chemical histochemistry .................................... 0.42 0.12 0.12 0.01 0.55 0.55 XXX

88319 ............ A Enzyme histochemistry ...................................... 0.53 0.49 0.49 0.04 1.06 1.06 XXX

88319 TC A Enzyme histochemistry ...................................... 0.00 0.23 0.23 0.02 0.25 0.25 XXX

88319 26 A Enzyme histochemistry ...................................... 0.53 0.26 0.26 0.02 0.81 0.81 XXX

88321 ............ A Microslide consultation ....................................... 1.30 0.41 0.41 0.03 1.74 1.74 XXX

88323 ............ A Microslide consultation ....................................... 1.35 0.72 0.72 0.05 2.12 2.12 XXX

88323 TC A Microslide consultation ....................................... 0.00 0.33 0.33 0.02 0.35 0.35 XXX

88323 26 A Microslide consultation ....................................... 1.35 0.39 0.39 0.03 1.77 1.77 XXX

88325 ............ A Comprehensive review of data .......................... 2.22 0.47 0.47 0.04 2.73 2.73 XXX

88329 ............ A Pathology consult in surgery .............................. 0.67 0.37 0.37 0.03 1.07 1.07 XXX

88331 ............ A Pathology consult in surgery .............................. 1.19 1.10 1.10 0.08 2.37 2.37 XXX

88331 TC A Pathology consult in surgery .............................. 0.00 0.54 0.54 0.04 0.58 0.58 XXX

88331 26 A Pathology consult in surgery .............................. 1.19 0.56 0.56 0.04 1.79 1.79 XXX

88332 ............ A Pathology consult in surgery .............................. 0.59 0.56 0.56 0.04 1.19 1.19 XXX

88332 TC A Pathology consult in surgery .............................. 0.00 0.27 0.27 0.02 0.29 0.29 XXX

88332 26 A Pathology consult in surgery .............................. 0.59 0.29 0.29 0.02 0.90 0.90 XXX

88342 ............ A Immunocytochemistry ........................................ 0.85 0.64 0.64 0.04 1.53 1.53 XXX

88342 TC A Immunocytochemistry ........................................ 0.00 0.31 0.31 0.02 0.33 0.33 XXX

88342 26 A Immunocytochemistry ........................................ 0.85 0.33 0.33 0.02 1.20 1.20 XXX

88346 ............ A Immunofluorescent study ................................... 0.86 0.58 0.58 0.04 1.48 1.48 XXX

88346 TC A Immunofluorescent study ................................... 0.00 0.27 0.27 0.02 0.29 0.29 XXX

88346 26 A Immunofluorescent study ................................... 0.86 0.31 0.31 0.02 1.19 1.19 XXX

88347 ............ A Immunofluorescent study ................................... 0.86 0.42 0.42 0.04 1.32 1.32 XXX

88347 TC A Immunofluorescent study ................................... 0.00 0.27 0.27 0.02 0.29 0.29 XXX

88347 26 A Immunofluorescent study ................................... 0.86 0.15 0.15 0.02 1.03 1.03 XXX

88348 ............ A Electron microscopy ........................................... 1.51 2.28 2.28 0.16 3.95 3.95 XXX

88348 TC A Electron microscopy ........................................... 0.00 1.09 1.09 0.08 1.17 1.17 XXX

88348 26 A Electron microscopy ........................................... 1.51 1.19 1.19 0.08 2.78 2.78 XXX

88349 ............ A Scanning electron microscopy ........................... 0.76 1.55 1.55 0.12 2.43 2.43 XXX

88349 TC A Scanning electron microscopy ........................... 0.00 0.76 0.76 0.06 0.82 0.82 XXX

88349 26 A Scanning electron microscopy ........................... 0.76 0.79 0.79 0.06 1.61 1.61 XXX

88355 ............ A Analysis, skeletal muscle ................................... 1.85 1.74 1.74 0.13 3.72 3.72 XXX

88355 TC A Analysis, skeletal muscle ................................... 0.00 0.82 0.82 0.06 0.88 0.88 XXX

88355 26 A Analysis, skeletal muscle ................................... 1.85 0.92 0.92 0.07 2.84 2.84 XXX

88356 ............ A Analysis, nerve ................................................... 3.02 2.66 2.66 0.18 5.86 5.86 XXX

88356 TC A Analysis, nerve ................................................... 0.00 1.27 1.27 0.08 1.35 1.35 XXX

88356 26 A Analysis, nerve ................................................... 3.02 1.39 1.39 0.10 4.51 4.51 XXX

88358 ............ A Analysis, tumor ................................................... 2.82 2.32 2.32 0.16 5.30 5.30 XXX

88358 TC A Analysis, tumor ................................................... 0.00 1.16 1.16 0.08 1.24 1.24 XXX

88358 26 A Analysis, tumor ................................................... 2.82 1.16 1.16 0.08 4.06 4.06 XXX

88362 ............ A Nerve teasing preparations ................................ 2.17 1.97 1.97 0.13 4.27 4.27 XXX

88362 TC A Nerve teasing preparations ................................ 0.00 0.97 0.97 0.06 1.03 1.03 XXX

88362 26 A Nerve teasing preparations ................................ 2.17 1.00 1.00 0.07 3.24 3.24 XXX

88365 ............ A Tissue hybridization ........................................... 0.93 0.75 0.75 0.05 1.73 1.73 XXX

88365 TC A Tissue hybridization ........................................... 0.00 0.37 0.37 0.02 0.39 0.39 XXX

88365 26 A Tissue hybridization ........................................... 0.93 0.38 0.38 0.03 1.34 1.34 XXX

88371 ............ X Protein, western blot tissue ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88371 26 A Protein, western blot tissue ................................ 0.37 0.20 0.20 0.01 0.58 0.58 XXX

88372 ............ X Protein analysis w/probe .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88372 26 A Protein analysis w/probe .................................... 0.37 0.20 0.20 0.01 0.58 0.58 XXX

88399 ............ C Surgical pathology procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88399 TC C Surgical pathology procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

88399 26 C Surgical pathology procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89050 ............ X Body fluid cell count ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89051 ............ X Body fluid cell count ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89060 ............ X Exam, synovial fluid crystals .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89060 26 A Exam, synovial fluid crystals .............................. 0.37 0.20 0.20 0.01 0.58 0.58 XXX

89100 ............ A Sample intestinal contents ................................. 0.60 0.42 0.42 0.03 1.05 1.05 XXX
59210

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

89105 ............ A Sample intestinal contents ................................. 0.50 0.39 0.39 0.03 0.92 0.92 XXX

89125 ............ X Specimen fat stain ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89130 ............ A Sample stomach contents .................................. 0.45 0.41 0.41 0.03 0.89 0.89 XXX

89132 ............ A Sample stomach contents .................................. 0.19 0.19 0.19 0.02 0.40 0.40 XXX

89135 ............ A Sample stomach contents .................................. 0.79 0.58 0.58 0.04 1.41 1.41 XXX

89136 ............ A Sample stomach contents .................................. 0.21 0.22 0.22 0.02 0.45 0.45 XXX

89140 ............ A Sample stomach contents .................................. 0.94 0.81 0.81 0.07 1.82 1.82 XXX

89141 ............ A Sample stomach contents .................................. 0.85 0.73 0.73 0.06 1.64 1.64 XXX

89160 ............ X Exam feces for meat fibers ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89190 ............ X Nasal smear for eosinophils .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89250 ............ X Fertilization of oocyte ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89251 ............ X Culture oocyte w/embryos ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89252 ............ X Assist oocyte fertilization .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89253 ............ X Embryo hatching ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89254 ............ X Oocyte identification ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89255 ............ X Prepare embryo for transfer ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89256 ............ X Prepare cryopreserved embryo ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89257 ............ X Sperm identification ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89258 ............ X Cryopreservation, embryo .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89259 ............ X Cryopreservation, sperm .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89260 ............ X Sperm isolation, simple ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89261 ............ X Sperm isolation, complex ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89300 ............ X Semen analysis .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89310 ............ X Semen analysis .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89320 ............ X Semen analysis .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89325 ............ X Sperm antibody test ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89329 ............ X Sperm evaluation test ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89330 ............ X Evaluation, cervical mucus ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89350 ............ A Sputum specimen collection .............................. 0.00 0.39 0.39 0.03 0.42 0.42 XXX

89355 ............ X Exam feces for starch ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89360 ............ A Collect sweat for test ......................................... 0.00 0.43 0.43 0.03 0.46 0.46 XXX

89365 ............ X Water load test ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89399 ............ C Pathology lab procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89399 TC C Pathology lab procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

89399 26 C Pathology lab procedure .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90700 ............ E DTaP immunization ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90701 ............ E DTP immunization .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90702 ............ E DT immunization ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90703 ............ E Tetanus immunization ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90704 ............ E Mumps immunization ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90705 ............ E Measles immunization ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90706 ............ E Rubella immunization ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90707 ............ E MMR virus immunization .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90708 ............ E Measles-rubella immunization ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90709 ............ E Rubella & mumps immunization ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90710 ............ E Combined vaccine .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90711 ............ E Combined vaccine .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90712 ............ E Oral poliovirus immunization .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90713 ............ E Poliomyelitis immunization ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90714 ............ E Typhoid immunization ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90716 ............ E Chicken pox vaccine .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90717 ............ E Yellow fever immunization ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90718 ............ E Td immunization ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90719 ............ E Diphtheria immunization ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90720 ............ E DTP/HIB vaccine ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90721 ............ E Dtap/hib vaccine ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90724 ............ X Influenza immunization ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90725 ............ E Cholera immunization ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90726 ............ E Rabies immunization .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90727 ............ E Plague immunization .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90728 ............ E BCG immunization ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90730 ............ E Hepatitis A vaccine ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90732 ............ X Pneumococcal immunization ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90733 ............ E Meningococcal immunization ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90735 ............ E Encephalitis virus vaccine .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90737 ............ E Influenza B immunization ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90741 ............ E Passive immunization, ISG ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90742 ............ E Special passive immunization ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90744 ............ X Hepatitis B vaccine, under 11 ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90745 ............ X Hepatitis B vaccine, 11–19 ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90746 ............ X Hepatitis B vaccine, over 20 .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90747 ............ X Hepatitis B vaccine, ill pat .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90748 ............ X Hepatitis b/hib vaccine ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90749 ............ C Immunization procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59211

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

90780 ............ A IV infusion therapy, 1 hour ................................. 0.00 1.06 1.06 0.08 1.14 1.14 XXX

90781 ............ A IV infusion, additional hour ................................ 0.00 0.53 0.53 0.04 0.57 0.57 XXX

90782 ............ T Injection (SC)/(IM) .............................................. 0.00 0.10 0.10 0.01 0.11 0.11 XXX

90783 ............ T Injection (IA) ....................................................... 0.00 0.39 0.39 0.03 0.42 0.42 XXX

90784 ............ T Injection (IV) ....................................................... 0.00 0.45 0.45 0.04 0.49 0.49 XXX

90788 ............ T Injection of antibiotic .......................................... 0.00 0.11 0.11 0.01 0.12 0.12 XXX

90799 ............ C Therapeutic/diag injection .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90801 ............ A Psy dx interview ................................................. 2.80 0.67 0.67 0.09 3.56 3.56 XXX

90802 ............ A Intac psy dx interview ........................................ 3.01 0.38 0.38 0.05 3.44 3.44 XXX

90804 ............ A Psytx, office (20–30) .......................................... 1.11 0.35 0.35 0.05 1.51 1.51 XXX

90805 ............ A Psytx, office (20–30) w/e&m .............................. 1.47 0.35 0.35 0.05 1.87 1.87 XXX

90806 ............ A Psytx, office (45–50) .......................................... 1.73 0.54 0.54 0.08 2.35 2.35 XXX

90807 ............ A Psytx, office (45–50) w/e&m .............................. 2.00 0.54 0.54 0.08 2.62 2.62 XXX

90808 ............ A Psytx, office (75–80) .......................................... 2.76 1.05 1.05 0.15 3.96 3.96 XXX

90809 ............ A Psytx, office (75–80) w/e&m .............................. 3.15 1.05 1.05 0.15 4.35 4.35 XXX

90810 ............ A Intac psytx, office (20–30) .................................. 1.19 0.59 0.59 0.09 1.87 1.87 XXX

90811 ............ A Intac psytx, off 20–30 w/e&m ............................ 1.58 0.59 0.59 0.09 2.26 2.26 XXX

90812 ............ A Intac psytx, office (45–50) .................................. 1.86 0.59 0.59 0.09 2.54 2.54 XXX

90813 ............ A Intac psytx, off 45–50 w/e&m ............................ 2.15 0.59 0.59 0.09 2.83 2.83 XXX

90814 ............ A Intac psytx, office (75–80) .................................. 2.97 0.59 0.59 0.09 3.65 3.65 XXX

90815 ............ A Intac psytx, off 75–80 w/e&m ............................ 3.39 0.59 0.59 0.09 4.07 4.07 XXX

90816 ............ A Psytx, hosp (20–30) ........................................... 1.24 0.35 0.35 0.05 1.64 1.64 XXX

90817 ............ A Psytx, hosp (20–30) w/e&m ............................... 1.65 0.35 0.35 0.05 2.05 2.05 XXX

90818 ............ A Psytx, hosp (45–50) ........................................... 1.94 0.54 0.54 0.08 2.56 2.56 XXX

90819 ............ A Psytx, hosp (45–50) w/e&m ............................... 2.24 0.54 0.54 0.08 2.86 2.86 XXX

90820 ............ D Diagnostic interview ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90821 ............ A Psytx, hosp (75–80) ........................................... 3.09 1.05 1.05 0.15 4.29 4.29 XXX

90822 ............ A Psytx, hosp (75–80) w/e&m ............................... 3.53 1.05 1.05 0.15 4.73 4.73 XXX

90823 ............ A Intac psytx, hosp (20–30) .................................. 1.33 0.59 0.59 0.09 2.01 2.01 XXX

90824 ............ A Intac psytx, hsp 20–30 w/e&m ........................... 1.77 0.59 0.59 0.09 2.45 2.45 XXX

90825 ............ D 1Evaluation of tests/records ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90826 ............ A Intac psytx, hosp (45–50) .................................. 2.08 0.59 0.59 0.09 2.76 2.76 XXX

90827 ............ A Intac psytx, hsp 45–50 w/e&m ........................... 2.41 0.59 0.59 0.09 3.09 3.09 XXX

90828 ............ A Intac psytx, hosp (75–80) .................................. 3.32 0.59 0.59 0.09 4.00 4.00 XXX

90829 ............ A Intac psytx, hsp 75–80 w/e&m ........................... 3.80 0.59 0.59 0.09 4.48 4.48 XXX

90835 ............ D Special interview ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90841 ............ D Psychotherapy .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90842 ............ D Psychotherapy, 75–80 min. ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90843 ............ D Psychotherapy, 20–30 min. ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90844 ............ D Psychotherapy, 45–50 min. ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90845 ............ A Psychoanalysis ................................................... 1.79 0.41 0.41 0.05 2.25 2.25 XXX

90846 ............ R Family psytx w/o patient .................................... 1.83 0.62 0.62 0.08 2.53 2.53 XXX

90847 ............ R Family psytx w/patient ........................................ 2.21 0.58 0.58 0.08 2.87 2.87 XXX

90849 ............ R Multiple family group psytx ................................ 0.59 0.26 0.26 0.03 0.88 0.88 XXX

90853 ............ A Group psychotherapy ......................................... 0.59 0.26 0.26 0.03 0.88 0.88 XXX

90855 ............ D 12/3 Individual psychotherapy ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90857 ............ A Intac group psytx ................................................ 0.63 0.15 0.15 0.02 0.80 0.80 XXX

90862 ............ A Medication management .................................... 0.95 0.37 0.37 0.05 1.37 1.37 XXX

90865 ............ A Narcosynthesis ................................................... 2.84 0.50 0.50 0.07 3.41 3.41 XXX

90870 ............ A Electroconvulsive therapy .................................. 1.88 0.55 0.55 0.08 2.51 2.51 000

90871 ............ A Electroconvulsive therapy .................................. 2.72 0.83 0.83 0.13 3.68 3.68 000

90875 ............ N Psychophysiological therapy .............................. 1.20 0.00 0.00 0.00 1.20 1.20 XXX

90876 ............ N Psychophysiological therapy .............................. 1.90 0.00 0.00 0.00 1.90 1.90 XXX

90880 ............ A Hypnotherapy ..................................................... 2.19 0.64 0.64 0.07 2.90 2.90 XXX

90882 ............ N Environmental manipulation ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90885 ............ B Psy evaluation of records .................................. +0.97 0.31 0.31 0.04 1.32 1.32 XXX

90887 ............ B Consultation with family ..................................... +1.48 0.33 0.33 0.04 1.85 1.85 XXX

90889 ............ B Preparation of report .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90899 ............ C Psychiatric service/therapy ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90901 ............ A Biofeedback, any method .................................. 0.41 0.97 0.97 0.07 1.45 1.45 000

90911 ............ A Biofeedback peri/uro/rectal ................................ 0.89 1.13 1.13 0.27 2.29 2.29 000

90918 ............ A ESRD related services, month ........................... 11.18 2.19 2.19 0.14 13.51 13.51 XXX

90919 ............ A ESRD related services, month ........................... 8.54 2.19 2.19 0.14 10.87 10.87 XXX

90920 ............ A ESRD related services, month ........................... 7.27 2.19 2.19 0.14 9.60 9.60 XXX

90921 ............ A ESRD related services, month ........................... 4.47 2.19 2.19 0.14 6.80 6.80 XXX

90922 ............ A ESRD related services, day ............................... 0.37 0.07 0.07 0.01 0.45 0.45 XXX

90923 ............ A Esrd related services, day ................................. 0.28 0.07 0.07 0.01 0.36 0.36 XXX

90924 ............ A Esrd related services, day ................................. 0.24 0.07 0.07 0.01 0.32 0.32 XXX

90925 ............ A Esrd related services, day ................................. 0.15 0.07 0.07 0.01 0.23 0.23 XXX

90935 ............ A Hemodialysis, one evaluation ............................ 1.22 #1.34 #1.34 0.10 2.66 2.66 000

90937 ............ A Hemodialysis, repeated eval. ............................. 2.11 #2.32 #2.32 0.18 4.61 4.61 000

90945 ............ A Dialysis, one evaluation ..................................... 1.28 1.27 1.27 0.08 2.63 2.63 000

90947 ............ A Dialysis, repeated eval. ...................................... 2.16 2.09 2.09 0.14 4.39 4.39 000

90989 ............ X Dialysis training/complete .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59212

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

90993 ............ X Dialysis training/incomplete ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90997 ............ A Hemoperfusion ................................................... 1.84 #2.02 #2.02 0.16 4.02 4.02 000

90999 ............ C Dialysis procedure .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

91000 ............ A Esophageal intubation ........................................ 0.73 0.66 0.66 0.06 1.45 1.45 000

91000 TC A Esophageal intubation ........................................ 0.00 0.07 0.07 0.01 0.08 0.08 000

91000 26 A Esophageal intubation ........................................ 0.73 0.59 0.59 0.05 1.37 1.37 000

91010 ............ A Esophagus motility study ................................... 1.25 2.16 2.16 0.17 3.58 3.58 000

91010 TC A Esophagus motility study ................................... 0.00 0.78 0.78 0.06 0.84 0.84 000

91010 26 A Esophagus motility study ................................... 1.25 #1.38 #1.38 0.11 2.74 2.74 000

91011 ............ A Esophagus motility study ................................... 1.50 2.63 2.63 0.18 4.31 4.31 000

91011 TC A Esophagus motility study ................................... 0.00 0.98 0.98 0.07 1.05 1.05 000

91011 26 A Esophagus motility study ................................... 1.50 #1.65 #1.65 0.11 3.26 3.26 000

91012 ............ A Esophagus motility study ................................... 1.46 2.71 2.71 0.23 4.40 4.40 000

91012 TC A Esophagus motility study ................................... 0.00 1.10 1.10 0.08 1.18 1.18 000

91012 26 A Esophagus motility study ................................... 1.46 #1.61 #1.61 0.15 3.22 3.22 000

91020 ............ A Gastric motility .................................................... 1.44 2.31 2.31 0.18 3.93 3.93 000

91020 TC A Gastric motility .................................................... 0.00 0.73 0.73 0.06 0.79 0.79 000

91020 26 A Gastric motility .................................................... 1.44 #1.58 #1.58 0.12 3.14 3.14 000

91030 ............ A Acid perfusion of esophagus ............................. 0.91 0.56 0.56 0.05 1.52 1.52 000

91030 TC A Acid perfusion of esophagus ............................. 0.00 0.21 0.21 0.02 0.23 0.23 000

91030 26 A Acid perfusion of esophagus ............................. 0.91 0.35 0.35 0.03 1.29 1.29 000

91032 ............ A Esophagus, acid reflux test ................................ 1.21 1.96 1.96 0.16 3.33 3.33 000

91032 TC A Esophagus, acid reflux test ................................ 0.00 0.71 0.71 0.06 0.77 0.77 000

91032 26 A Esophagus, acid reflux test ................................ 1.21 1.25 1.25 0.10 2.56 2.56 000

91033 ............ A Prolonged acid reflux test .................................. 1.30 2.71 2.71 0.25 4.26 4.26 000

91033 TC A Prolonged acid reflux test .................................. 0.00 1.28 1.28 0.11 1.39 1.39 000

91033 26 A Prolonged acid reflux test .................................. 1.30 #1.43 #1.43 0.14 2.87 2.87 000

91052 ............ A Gastric analysis test ........................................... 0.79 0.82 0.82 0.07 1.68 1.68 000

91052 TC A Gastric analysis test ........................................... 0.00 0.32 0.32 0.03 0.35 0.35 000

91052 26 A Gastric analysis test ........................................... 0.79 0.50 0.50 0.04 1.33 1.33 000

91055 ............ A Gastric intubation for smear ............................... 0.94 0.80 0.80 0.06 1.80 1.80 000

91055 TC A Gastric intubation for smear ............................... 0.00 0.29 0.29 0.02 0.31 0.31 000

91055 26 A Gastric intubation for smear ............................... 0.94 0.51 0.51 0.04 1.49 1.49 000

91060 ............ A Gastric saline load test ...................................... 0.45 0.71 0.71 0.06 1.22 1.22 000

91060 TC A Gastric saline load test ...................................... 0.00 0.21 0.21 0.02 0.23 0.23 000

91060 26 A Gastric saline load test ...................................... 0.45 0.50 0.50 0.04 0.99 0.99 000

91065 ............ A Breath hydrogen test .......................................... 0.20 0.56 0.56 0.05 0.81 0.81 000

91065 TC A Breath hydrogen test .......................................... 0.00 0.34 0.34 0.02 0.36 0.36 000

91065 26 A Breath hydrogen test .......................................... 0.20 #0.22 #0.22 0.03 0.45 0.45 000

91100 ............ A Pass intestine bleeding tube .............................. 1.08 0.56 0.56 0.05 1.69 1.69 000

91105 ............ A Gastric intubation treatment ............................... 0.37 #0.41 #0.41 0.04 0.82 0.82 000

91122 ............ A Anal pressure record .......................................... 1.77 1.73 1.73 0.22 3.72 3.72 000

91122 TC A Anal pressure record .......................................... 0.00 0.67 0.67 0.09 0.76 0.76 000

91122 26 A Anal pressure record .......................................... 1.77 1.06 1.06 0.13 2.96 2.96 000

91299 ............ C Gastroenterology procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

91299 TC C Gastroenterology procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

91299 26 C Gastroenterology procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92002 ............ A Eye exam, new patient ...................................... 0.88 0.49 0.49 0.02 1.39 1.39 XXX

92004 ............ A Eye exam, new patient ...................................... 1.67 0.57 0.57 0.02 2.26 2.26 XXX

92012 ............ A Eye exam established pt .................................... 0.67 0.44 0.44 0.02 1.13 1.13 XXX

92014 ............ A Eye exam & treatment ....................................... 1.10 0.54 0.54 0.02 1.66 1.66 XXX

92015 ............ N Refraction ........................................................... +0.38 0.32 0.32 0.02 0.72 0.72 XXX

92018 ............ A New eye exam & treatment ............................... 1.51 0.47 0.47 0.03 2.01 2.01 XXX

92019 ............ A Eye exam & treatment ....................................... 1.31 0.47 0.47 0.03 1.81 1.81 XXX

92020 ............ A Special eye evaluation ....................................... 0.37 0.29 0.29 0.01 0.67 0.67 XXX

92060 ............ A Special eye evaluation ....................................... 0.69 0.39 0.39 0.02 1.10 1.10 XXX

92060 TC A Special eye evaluation ....................................... 0.00 0.18 0.18 0.01 0.19 0.19 XXX

92060 26 A Special eye evaluation ....................................... 0.69 0.21 0.21 0.01 0.91 0.91 XXX

92065 ............ A Orthoptic/pleoptic training .................................. 0.37 0.36 0.36 0.01 0.74 0.74 XXX

92065 TC A Orthoptic/pleoptic training .................................. 0.00 0.16 0.16 0.00 0.16 0.16 XXX

92065 26 A Orthoptic/pleoptic training .................................. 0.37 0.20 0.20 0.01 0.58 0.58 XXX

92070 ............ A Fitting of contact lens ......................................... 0.70 1.20 1.20 0.06 1.96 1.96 XXX

92081 ............ A Visual field examination(s) ................................. 0.36 0.32 0.32 0.01 0.69 0.69 XXX

92081 TC A Visual field examination(s) ................................. 0.00 0.15 0.15 0.00 0.15 0.15 XXX

92081 26 A Visual field examination(s) ................................. 0.36 0.17 0.17 0.01 0.54 0.54 XXX

92082 ............ A Visual field examination(s) ................................. 0.44 0.49 0.49 0.02 0.95 0.95 XXX

92082 TC A Visual field examination(s) ................................. 0.00 0.19 0.19 0.01 0.20 0.20 XXX

92082 26 A Visual field examination(s) ................................. 0.44 0.30 0.30 0.01 0.75 0.75 XXX

92083 ............ A Visual field examination(s) ................................. 0.50 0.83 0.83 0.04 1.37 1.37 XXX

92083 TC A Visual field examination(s) ................................. 0.00 0.28 0.28 0.01 0.29 0.29 XXX

92083 26 A Visual field examination(s) ................................. 0.50 0.55 0.55 0.03 1.08 1.08 XXX

92100 ............ A Serial tonometry exam(s) ................................... 0.92 0.25 0.25 0.01 1.18 1.18 XXX

92120 ............ A Tonography & eye evaluation ............................ 0.81 0.31 0.31 0.02 1.14 1.14 XXX

92130 ............ A Water provocation tonography ........................... 0.81 0.49 0.49 0.02 1.32 1.32 XXX
59213

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

92140 ............ A Glaucoma provocative tests ............................... 0.50 0.30 0.30 0.01 0.81 0.81 XXX

92225 ............ A Special eye exam, initial .................................... 0.38 0.45 0.45 0.02 0.85 0.85 XXX

92226 ............ A Special eye exam, subsequent .......................... 0.33 0.40 0.40 0.02 0.75 0.75 XXX

92230 ............ A Eye exam with photos ........................................ 0.60 0.69 0.69 0.04 1.33 1.33 XXX

92235 ............ A Eye exam with photos ........................................ 0.81 1.58 1.58 0.09 2.48 2.48 XXX

92235 TC A Eye exam with photos ........................................ 0.00 0.99 0.99 0.06 1.05 1.05 XXX

92235 26 A Eye exam with photos ........................................ 0.81 0.59 0.59 0.03 1.43 1.43 XXX

92240 ............ A Icg angiography .................................................. 1.10 1.58 1.58 0.09 2.77 2.77 XXX

92240 TC A Icg angiography .................................................. 0.00 0.99 0.99 0.06 1.05 1.05 XXX

92240 26 A Icg angiography .................................................. 1.10 0.59 0.59 0.03 1.72 1.72 XXX

92250 ............ A Eye exam with photos ........................................ 0.44 0.42 0.42 0.02 0.88 0.88 XXX

92250 TC A Eye exam with photos ........................................ 0.00 0.17 0.17 0.01 0.18 0.18 XXX

92250 26 A Eye exam with photos ........................................ 0.44 0.25 0.25 0.01 0.70 0.70 XXX

92260 ............ A Ophthalmoscopy/dynamometry .......................... 0.20 0.54 0.54 0.03 0.77 0.77 XXX

92265 ............ A Eye muscle evaluation ....................................... 0.81 0.29 0.29 0.02 1.12 1.12 XXX

92265 TC A Eye muscle evaluation ....................................... 0.00 0.22 0.22 0.02 0.24 0.24 XXX

92265 26 A Eye muscle evaluation ....................................... 0.81 0.07 0.07 0.00 0.88 0.88 XXX

92270 ............ A Electro-oculography ........................................... 0.81 0.67 0.67 0.05 1.53 1.53 XXX

92270 TC A Electro-oculography ........................................... 0.00 0.30 0.30 0.02 0.32 0.32 XXX

92270 26 A Electro-oculography ........................................... 0.81 0.37 0.37 0.03 1.21 1.21 XXX

92275 ............ A Electroretinography ............................................ 1.01 0.90 0.90 0.05 1.96 1.96 XXX

92275 TC A Electroretinography ............................................ 0.00 0.39 0.39 0.02 0.41 0.41 XXX

92275 26 A Electroretinography ............................................ 1.01 0.51 0.51 0.03 1.55 1.55 XXX

92283 ............ A Color vision examination .................................... 0.17 0.29 0.29 0.01 0.47 0.47 XXX

92283 TC A Color vision examination .................................... 0.00 0.12 0.12 0.00 0.12 0.12 XXX

92283 26 A Color vision examination .................................... 0.17 0.17 0.17 0.01 0.35 0.35 XXX

92284 ............ A Dark adaptation eye exam ................................. 0.24 0.45 0.45 0.02 0.71 0.71 XXX

92284 TC A Dark adaptation eye exam ................................. 0.00 0.17 0.17 0.01 0.18 0.18 XXX

92284 26 A Dark adaptation eye exam ................................. 0.24 0.28 0.28 0.01 0.53 0.53 XXX

92285 ............ A Eye photography ................................................ 0.20 0.29 0.29 0.01 0.50 0.50 XXX

92285 TC A Eye photography ................................................ 0.00 0.11 0.11 0.00 0.11 0.11 XXX

92285 26 A Eye photography ................................................ 0.20 0.18 0.18 0.01 0.39 0.39 XXX

92286 ............ A Internal eye photography ................................... 0.66 1.22 1.22 0.07 1.95 1.95 XXX

92286 TC A Internal eye photography ................................... 0.00 0.39 0.39 0.02 0.41 0.41 XXX

92286 26 A Internal eye photography ................................... 0.66 0.83 0.83 0.05 1.54 1.54 XXX

92287 ............ A Internal eye photography ................................... 0.81 1.52 1.52 0.08 2.41 2.41 XXX

92310 ............ N Contact lens fitting ............................................. +1.17 #1.29 #1.29 0.00 2.46 2.46 XXX

92311 ............ A Contact lens fitting ............................................. 1.08 0.90 0.90 0.03 2.01 2.01 XXX

92312 ............ A Contact lens fitting ............................................. 1.26 1.16 1.16 0.03 2.45 2.45 XXX

92313 ............ A Contact lens fitting ............................................. 0.92 0.88 0.88 0.03 1.83 1.83 XXX

92314 ............ N Prescription of contact lens ................................ +0.69 #0.76 #0.76 0.00 1.45 1.45 XXX

92315 ............ A Prescription of contact lens ................................ 0.45 0.66 0.66 0.03 1.14 1.14 XXX

92316 ............ A Prescription of contact lens ................................ 0.68 0.95 0.95 0.04 1.67 1.67 XXX

92317 ............ A Prescription of contact lens ................................ 0.45 0.39 0.39 0.02 0.86 0.86 XXX

92325 ............ A Modification of contact lens ............................... 0.00 0.38 0.38 0.01 0.39 0.39 XXX

92326 ............ A Replacement of contact lens ............................. 0.00 1.56 1.56 0.06 1.62 1.62 XXX

92330 ............ A Fitting of artificial eye ......................................... 1.08 1.13 1.13 0.09 2.30 2.30 XXX

92335 ............ A Fitting of artificial eye ......................................... 0.45 1.97 1.97 0.11 2.53 2.53 XXX

92340 ............ N Fitting of spectacles ........................................... +0.37 0.42 #0.41 0.00 0.79 0.78 XXX

92341 ............ N Fitting of spectacles ........................................... +0.47 0.53 #0.52 0.00 1.00 0.99 XXX

92342 ............ N Fitting of spectacles ........................................... +0.53 0.60 #0.58 0.00 1.13 1.11 XXX

92352 ............ B Special spectacles fitting .................................... +0.37 0.30 0.30 0.01 0.68 0.68 XXX

92353 ............ B Special spectacles fitting .................................... +0.50 0.40 0.40 0.01 0.91 0.91 XXX

92354 ............ B Special spectacles fitting .................................... +0.00 8.44 8.44 0.10 8.54 8.54 XXX

92355 ............ B Special spectacles fitting .................................... +0.00 4.13 4.13 0.01 4.14 4.14 XXX

92358 ............ B Eye prosthesis service ....................................... +0.00 0.92 0.92 0.05 0.97 0.97 XXX

92370 ............ N Repair & adjust spectacles ................................ +0.32 0.36 #0.35 0.00 0.68 0.67 XXX

92371 ............ B Repair & adjust spectacles ................................ +0.00 0.59 0.59 0.02 0.61 0.61 XXX

92390 ............ N Supply of spectacles .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92391 ............ N Supply of contact lenses .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92392 ............ I Supply of low vision aids ................................... +0.00 3.85 3.85 0.02 3.87 3.87 XXX

92393 ............ I Supply of artificial eye ........................................ +0.00 11.96 11.96 0.67 12.63 12.63 XXX

92395 ............ I Supply of spectacles .......................................... +0.00 1.31 1.31 0.10 1.41 1.41 XXX

92396 ............ I Supply of contact lenses .................................... +0.00 2.19 2.19 0.08 2.27 2.27 XXX

92499 ............ C Eye service or procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92499 TC C Eye service or procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92499 26 C Eye service or procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92502 ............ A Ear and throat examination ................................ 1.51 1.12 1.12 0.12 2.75 2.75 000

92504 ............ A Ear microscopy examination .............................. 0.18 0.26 0.26 0.02 0.46 0.46 XXX

92506 ............ A Speech & hearing evaluation ............................. 0.86 0.52 0.52 0.05 1.43 1.43 XXX

92507 ............ A Speech/hearing therapy ..................................... 0.52 0.33 0.33 0.03 0.88 0.88 XXX

92508 ............ A Speech/hearing therapy ..................................... 0.26 0.18 0.18 0.02 0.46 0.46 XXX

92510 ............ A Rehab for ear implant ........................................ 1.50 1.36 1.36 0.15 3.01 3.01 XXX

92511 ............ A Nasopharyngoscopy ........................................... 0.84 0.85 0.85 0.09 1.78 1.78 000
59214

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

92512 ............ A Nasal function studies ........................................ 0.55 0.47 0.47 0.05 1.07 1.07 XXX

92516 ............ A Facial nerve function test ................................... 0.43 0.39 0.39 0.04 0.86 0.86 XXX

92520 ............ A Laryngeal function studies ................................. 0.76 0.53 0.53 0.05 1.34 1.34 XXX

92525 ............ A Oral function evaluation ..................................... 1.50 1.02 1.02 0.11 2.63 2.63 XXX

92526 ............ A Oral function therapy .......................................... 0.55 0.47 0.47 0.05 1.07 1.07 XXX

92531 ............ B Spontaneous nystagmus study .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92532 ............ B Positional nystagmus study ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92533 ............ B Caloric vestibular test ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92534 ............ B Optokinetic nystagmus ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92541 ............ A Spontaneous nystagmus test ............................. 0.40 0.67 0.67 0.07 1.14 1.14 XXX

92541 TC A Spontaneous nystagmus test ............................. 0.00 0.22 0.22 0.02 0.24 0.24 XXX

92541 26 A Spontaneous nystagmus test ............................. 0.40 0.45 0.45 0.05 0.90 0.90 XXX

92542 ............ A Positional nystagmus test .................................. 0.33 0.61 0.61 0.07 1.01 1.01 XXX

92542 TC A Positional nystagmus test .................................. 0.00 0.25 0.25 0.03 0.28 0.28 XXX

92542 26 A Positional nystagmus test .................................. 0.33 0.36 0.36 0.04 0.73 0.73 XXX

92543 ............ A Caloric vestibular test ......................................... 0.38 0.82 0.82 0.09 1.29 1.29 XXX

92543 TC A Caloric vestibular test ......................................... 0.00 0.40 0.40 0.04 0.44 0.44 XXX

92543 26 A Caloric vestibular test ......................................... 0.38 0.42 0.42 0.05 0.85 0.85 XXX

92544 ............ A Optokinetic nystagmus test ................................ 0.26 0.47 0.47 0.05 0.78 0.78 XXX

92544 TC A Optokinetic nystagmus test ................................ 0.00 0.20 0.20 0.02 0.22 0.22 XXX

92544 26 A Optokinetic nystagmus test ................................ 0.26 0.27 0.27 0.03 0.56 0.56 XXX

92545 ............ A Oscillating tracking test ...................................... 0.23 0.40 0.40 0.04 0.67 0.67 XXX

92545 TC A Oscillating tracking test ...................................... 0.00 0.20 0.20 0.02 0.22 0.22 XXX

92545 26 A Oscillating tracking test ...................................... 0.23 0.20 0.20 0.02 0.45 0.45 XXX

92546 ............ A Sinusoidal rotational test .................................... 0.29 0.53 0.53 0.05 0.87 0.87 XXX

92546 TC A Sinusoidal rotational test .................................... 0.00 0.23 0.23 0.02 0.25 0.25 XXX

92546 26 A Sinusoidal rotational test .................................... 0.29 0.30 0.30 0.03 0.62 0.62 XXX

92547 ............ A Supplemental electrical test ............................... 0.00 0.53 0.53 0.06 0.59 0.59 XXX

92548 ............ A Posturography .................................................... 0.50 1.85 1.85 0.19 2.54 2.54 XXX

92548 TC A Posturography .................................................... 0.00 1.40 1.40 0.14 1.54 1.54 XXX

92548 26 A Posturography .................................................... 0.50 0.45 0.45 0.05 1.00 1.00 XXX

92551 ............ N Pure tone hearing test, air ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92552 ............ A Pure tone audiometry, air .................................. 0.00 0.42 0.42 0.04 0.46 0.46 XXX

92553 ............ A Audiometry, air & bone ...................................... 0.00 0.63 0.63 0.07 0.70 0.70 XXX

92555 ............ A Speech threshold audiometry ............................ 0.00 0.36 0.36 0.04 0.40 0.40 XXX

92556 ............ A Speech audiometry, complete ........................... 0.00 0.54 0.54 0.06 0.60 0.60 XXX

92557 ............ A Comprehensive hearing test .............................. 0.00 1.13 1.13 0.13 1.26 1.26 XXX

92559 ............ N Group audiometric testing .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92560 ............ N Bekesy audiometry, screen ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92561 ............ A Bekesy audiometry, diagnosis ........................... 0.00 0.68 0.68 0.07 0.75 0.75 XXX

92562 ............ A Loudness balance test ....................................... 0.00 0.39 0.39 0.04 0.43 0.43 XXX

92563 ............ A Tone decay hearing test .................................... 0.00 0.36 0.36 0.04 0.40 0.40 XXX

92564 ............ A Sisi hearing test ................................................. 0.00 0.45 0.45 0.05 0.50 0.50 XXX

92565 ............ A Stenger test, pure tone ...................................... 0.00 0.38 0.38 0.04 0.42 0.42 XXX

92567 ............ A Tympanometry ................................................... 0.00 0.50 0.50 0.06 0.56 0.56 XXX

92568 ............ A Acoustic reflex testing ........................................ 0.00 0.36 0.36 0.04 0.40 0.40 XXX

92569 ............ A Acoustic reflex decay test .................................. 0.00 0.39 0.39 0.04 0.43 0.43 XXX

92571 ............ A Filtered speech hearing test .............................. 0.00 0.37 0.37 0.04 0.41 0.41 XXX

92572 ............ A Staggered spondaic word test ........................... 0.00 0.08 0.08 0.01 0.09 0.09 XXX

92573 ............ A Lombard test ...................................................... 0.00 0.33 0.33 0.04 0.37 0.37 XXX

92575 ............ A Sensorineural acuity test .................................... 0.00 0.29 0.29 0.03 0.32 0.32 XXX

92576 ............ A Synthetic sentence test ...................................... 0.00 0.42 0.42 0.05 0.47 0.47 XXX

92577 ............ A Stenger test, speech .......................................... 0.00 0.68 0.68 0.08 0.76 0.76 XXX

92579 ............ A Visual audiometry (vra) ...................................... 0.00 0.69 0.69 0.07 0.76 0.76 XXX

92582 ............ A Conditioning play audiometry ............................. 0.00 0.69 0.69 0.07 0.76 0.76 XXX

92583 ............ A Select picture audiometry .................................. 0.00 0.85 0.85 0.09 0.94 0.94 XXX

92584 ............ A Electrocochleography ......................................... 0.00 2.36 2.36 0.25 2.61 2.61 XXX

92585 ............ A Auditory evoked potential ................................... 0.50 3.25 3.25 0.31 4.06 4.06 XXX

92585 TC A Auditory evoked potential ................................... 0.00 1.76 1.76 0.17 1.93 1.93 XXX

92585 26 A Auditory evoked potential ................................... 0.50 1.49 1.49 0.14 2.13 2.13 XXX

92587 ............ A Evoked auditory test .......................................... 0.13 1.35 1.35 0.13 1.61 1.61 XXX

92587 TC A Evoked auditory test .......................................... 0.00 1.24 1.24 0.12 1.36 1.36 XXX

92587 26 A Evoked auditory test .......................................... 0.13 0.11 0.11 0.01 0.25 0.25 XXX

92588 ............ A Evoked auditory test .......................................... 0.36 1.70 1.70 0.16 2.22 2.22 XXX

92588 TC A Evoked auditory test .......................................... 0.00 1.40 1.40 0.14 1.54 1.54 XXX

92588 26 A Evoked auditory test .......................................... 0.36 0.30 0.30 0.02 0.68 0.68 XXX

92589 ............ A Auditory function test(s) ..................................... 0.00 0.51 0.51 0.06 0.57 0.57 XXX

92590 ............ N Hearing aid exam, one ear ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92591 ............ N Hearing aid exam, both ears ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92592 ............ N Hearing aid check, one ear ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92593 ............ N Hearing aid check, both ears ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92594 ............ N Electro hearing aid test, one .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92595 ............ N Electro hearing aid test, both ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92596 ............ A Ear protector evaluation ..................................... 0.00 0.56 0.56 0.06 0.62 0.62 XXX
59215

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

92597 ............ A Oral speech device eval .................................... 1.35 1.01 1.01 0.11 2.47 2.47 XXX

92598 ............ A Modify oral speech device ................................. 0.99 0.66 0.66 0.07 1.72 1.72 XXX

92599 ............ C ENT procedure/service ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92599 TC C ENT procedure/service ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92599 26 C ENT procedure/service ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

92950 ............ A Heart/lung resuscitation (CPR) .......................... 3.80 2.27 2.27 0.17 6.24 6.24 000

92953 ............ A Temporary external pacing ................................ 0.23 #0.25 #0.25 0.15 0.63 0.63 000

92960 ............ A Heart electroconversion ..................................... 2.25 1.88 1.88 0.16 4.29 4.29 000

92970 ............ A Cardioassist, internal .......................................... 3.52 3.47 3.47 0.41 7.40 7.40 000

92971 ............ A Cardioassist, external ......................................... 1.77 1.11 1.11 0.08 2.96 2.96 000

92975 ............ A Dissolve clot, heart vessel ................................. 7.25 5.71 5.71 0.42 13.38 13.38 000

92977 ............ A Dissolve clot, heart vessel ................................. 0.00 7.68 7.68 0.54 8.22 8.22 XXX

92978 ............ A Intravas us, heart (add-on) ................................ 1.80 5.41 5.41 0.36 7.57 7.57 ZZZ

92978 TC A Intravas us, heart (add-on) ................................ 0.00 4.35 4.35 0.28 4.63 4.63 ZZZ

92978 26 A Intravas us, heart (add-on) ................................ 1.80 1.06 1.06 0.08 2.94 2.94 ZZZ

92979 ............ A Intravas us, heart (add-on) ................................ 1.44 3.03 3.03 0.20 4.67 4.67 ZZZ

92979 TC A Intravas us, heart (add-on) ................................ 0.00 2.18 2.18 0.14 2.32 2.32 ZZZ

92979 26 A Intravas us, heart (add-on) ................................ 1.44 0.85 0.85 0.06 2.35 2.35 ZZZ

92980 ............ A Insert intracoronary stent ................................... 14.84 #16.32 #16.32 1.22 32.38 32.38 000

92981 ............ A Insert intracoronary stent ................................... 4.17 #4.59 #4.59 0.44 9.20 9.20 ZZZ

92982 ............ A Coronary artery dilation ...................................... 10.98 #12.08 #12.08 1.22 24.28 24.28 000

92984 ............ A Coronary artery dilation ...................................... 2.97 #3.27 #3.27 0.44 6.68 6.68 ZZZ

92986 ............ A Revision of aortic valve ...................................... *21.80 12.04 12.04 0.90 34.74 34.74 090

92987 ............ A Revision of mitral valve ...................................... *22.70 12.20 12.20 0.91 35.81 35.81 090

92990 ............ A Revision of pulmonary valve .............................. *17.34 9.59 9.59 0.71 27.64 27.64 090

92992 ............ C Revision of heart chamber ................................. 0.00 0.00 0.00 0.00 0.00 0.00 090

92993 ............ C Revision of heart chamber ................................. 0.00 0.00 0.00 0.00 0.00 0.00 090

92995 ............ A Coronary atherectomy ........................................ 12.09 #13.30 #13.30 1.22 26.61 26.61 000

92996 ............ A Coronary atherectomy ........................................ 3.26 #3.59 #3.59 0.44 7.29 7.29 ZZZ

92997 ............ A Pul art balloon repair, perc ................................ 12.00 #13.20 #13.20 1.22 26.42 26.42 000

92998 ............ A Pul art balloon repair, perc ................................ 6.00 3.80 3.80 0.44 10.24 10.24 ZZZ

93000 ............ A Electrocardiogram, complete ............................. 0.17 0.59 0.59 0.04 0.80 0.80 XXX

93005 ............ A Electrocardiogram, tracing ................................. 0.00 0.43 0.43 0.03 0.46 0.46 XXX

93010 ............ A Electrocardiogram report .................................... 0.17 0.16 0.16 0.01 0.34 0.34 XXX

93012 ............ A Transmission of ecg ........................................... 0.00 2.25 2.25 0.22 2.47 2.47 XXX

93014 ............ A Report on transmitted ecg ................................. 0.52 0.40 0.40 0.05 0.97 0.97 XXX

93015 ............ A Cardiovascular stress test .................................. 0.75 2.32 2.32 0.18 3.25 3.25 XXX

93016 ............ A Cardiovascular stress test .................................. 0.45 0.39 0.39 0.03 0.87 0.87 XXX

93017 ............ A Cardiovascular stress test .................................. 0.00 1.60 1.60 0.12 1.72 1.72 XXX

93018 ............ A Cardiovascular stress test .................................. 0.30 #0.33 #0.33 0.03 0.66 0.66 XXX

93024 ............ A Cardiac drug stress test ..................................... 1.17 2.36 2.36 0.23 3.76 3.76 XXX

93024 TC A Cardiac drug stress test ..................................... 0.00 1.07 1.07 0.09 1.16 1.16 XXX

93024 26 A Cardiac drug stress test ..................................... 1.17 #1.29 #1.29 0.14 2.60 2.60 XXX

93040 ............ A Rhythm ECG with report .................................... 0.16 0.26 0.26 0.02 0.44 0.44 XXX

93041 ............ A Rhythm ECG, tracing ......................................... 0.00 0.14 0.14 0.01 0.15 0.15 XXX

93042 ............ A Rhythm ECG, report .......................................... 0.16 0.12 0.12 0.01 0.29 0.29 XXX

93224 ............ A ECG monitor/report, 24 hrs ................................ 0.52 3.83 3.83 0.31 4.66 4.66 XXX

93225 ............ A ECG monitor/record, 24 hrs ............................... 0.00 1.18 1.18 0.09 1.27 1.27 XXX

93226 ............ A ECG monitor/report, 24 hrs ................................ 0.00 2.08 2.08 0.16 2.24 2.24 XXX

93227 ............ A ECG monitor/review, 24 hrs ............................... 0.52 #0.57 #0.57 0.06 1.15 1.15 XXX

93230 ............ A ECG monitor/report, 24 hrs ................................ 0.52 4.09 4.09 0.34 4.95 4.95 XXX

93231 ............ A ECG monitor/record, 24 hrs ............................... 0.00 1.45 1.45 0.11 1.56 1.56 XXX

93232 ............ A ECG monitor/report, 24 hrs ................................ 0.00 2.07 2.07 0.15 2.22 2.22 XXX

93233 ............ A ECG monitor/review, 24 hrs ............................... 0.52 #0.57 #0.57 0.08 1.17 1.17 XXX

93235 ............ A ECG monitor/report, 24 hrs ................................ 0.45 3.00 3.00 0.23 3.68 3.68 XXX

93236 ............ A ECG monitor/report, 24 hrs ................................ 0.00 2.50 2.50 0.17 2.67 2.67 XXX

93237 ............ A ECG monitor/review, 24 hrs ............................... 0.45 #0.50 #0.50 0.06 1.01 1.01 XXX

93268 ............ A ECG record/review ............................................. 0.52 3.83 3.83 0.36 4.71 4.71 XXX

93270 ............ A ECG recording ................................................... 0.00 1.18 1.18 0.09 1.27 1.27 XXX

93271 ............ A ECG/monitoring and anaylsis ............................ 0.00 2.25 2.25 0.22 2.47 2.47 XXX

93272 ............ A ECG/review, interpret only ................................. 0.52 0.40 0.40 0.05 0.97 0.97 XXX

93278 ............ A ECG/signal-averaged ......................................... 0.25 1.38 1.38 0.18 1.81 1.81 XXX

93278 TC A ECG/signal-averaged ......................................... 0.00 1.10 1.10 0.12 1.22 1.22 XXX

93278 26 A ECG/signal-averaged ......................................... 0.25 #0.28 #0.28 0.06 0.59 0.59 XXX

93303 ............ A Echo transthoracic ............................................. 1.30 4.68 4.68 0.36 6.34 6.34 XXX

93303 TC A Echo transthoracic ............................................. 0.00 3.68 3.68 0.27 3.95 3.95 XXX

93303 26 A Echo transthoracic ............................................. 1.30 1.00 1.00 0.09 2.39 2.39 XXX

93304 ............ A Echo transthoracic ............................................. 0.75 2.53 2.53 0.19 3.47 3.47 XXX

93304 TC A Echo transthoracic ............................................. 0.00 1.85 1.85 0.14 1.99 1.99 XXX

93304 26 A Echo transthoracic ............................................. 0.75 0.68 0.68 0.05 1.48 1.48 XXX

93307 ............ A Echo exam of heart ............................................ 0.92 4.68 4.68 0.36 5.96 5.96 XXX

93307 TC A Echo exam of heart ............................................ 0.00 3.68 3.68 0.27 3.95 3.95 XXX

93307 26 A Echo exam of heart ............................................ 0.92 1.00 1.00 0.09 2.01 2.01 XXX

93308 ............ A Echo exam of heart ............................................ 0.53 2.43 2.43 0.19 3.15 3.15 XXX
59216

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

93308 TC A Echo exam of heart ............................................ 0.00 1.85 1.85 0.14 1.99 1.99 XXX

93308 26 A Echo exam of heart ............................................ 0.53 #0.58 #0.58 0.05 1.16 1.16 XXX

93312 ............ A Echo transesophageal ....................................... 2.20 4.95 4.95 0.45 7.60 7.60 XXX

93312 TC A Echo transesophageal ....................................... 0.00 3.60 3.60 0.33 3.93 3.93 XXX

93312 26 A Echo transesophageal ....................................... 2.20 1.35 1.35 0.12 3.67 3.67 XXX

93313 ............ A Echo transesophageal ....................................... 0.95 0.67 0.67 0.06 1.68 1.68 XXX

93314 ............ A Echo transesophageal ....................................... 1.25 4.27 4.27 0.39 5.91 5.91 XXX

93314 TC A Echo transesophageal ....................................... 0.00 3.60 3.60 0.33 3.93 3.93 XXX

93314 26 A Echo transesophageal ....................................... 1.25 0.67 0.67 0.06 1.98 1.98 XXX

93315 ............ A Echo transesophageal ....................................... 2.78 4.95 4.95 0.45 8.18 8.18 XXX

93315 TC A Echo transesophageal ....................................... 0.00 3.60 3.60 0.33 3.93 3.93 XXX

93315 26 A Echo transesophageal ....................................... 2.78 1.35 1.35 0.12 4.25 4.25 XXX

93316 ............ A Echo transesophageal ....................................... 0.95 0.67 0.67 0.06 1.68 1.68 XXX

93317 ............ A Echo transesophageal ....................................... 1.83 4.27 4.27 0.39 6.49 6.49 XXX

93317 TC A Echo transesophageal ....................................... 0.00 3.60 3.60 0.33 3.93 3.93 XXX

93317 26 A Echo transesophageal ....................................... 1.83 0.67 0.67 0.06 2.56 2.56 XXX

93320 ............ A Doppler echo exam, heart ................................. 0.38 2.05 2.05 0.18 2.61 2.61 ZZZ

93320 TC A Doppler echo exam, heart ................................. 0.00 1.63 1.63 0.13 1.76 1.76 ZZZ

93320 26 A Doppler echo exam, heart ................................. 0.38 #0.42 #0.42 0.05 0.85 0.85 ZZZ

93321 ............ A Doppler echo exam, heart ................................. 0.15 1.23 1.23 0.11 1.49 1.49 ZZZ

93321 TC A Doppler echo exam, heart ................................. 0.00 1.06 1.06 0.09 1.15 1.15 ZZZ

93321 26 A Doppler echo exam, heart ................................. 0.15 #0.17 #0.17 0.02 0.34 0.34 ZZZ

93325 ............ A Doppler color flow .............................................. 0.07 2.80 2.80 0.25 3.12 3.12 ZZZ

93325 TC A Doppler color flow .............................................. 0.00 2.76 2.76 0.24 3.00 3.00 ZZZ

93325 26 A Doppler color flow .............................................. 0.07 0.04 0.04 0.01 0.12 0.12 ZZZ

93350 ............ A Echo transthoracic ............................................. 0.78 2.54 2.54 0.24 3.56 3.56 XXX

93350 TC A Echo transthoracic ............................................. 0.00 1.68 1.68 0.14 1.82 1.82 XXX

93350 26 A Echo transthoracic ............................................. 0.78 #0.86 #0.86 0.10 1.74 1.74 XXX

93501 ............ A Right heart catheterization ................................. 3.02 19.43 19.43 1.54 23.99 23.99 000

93501 TC A Right heart catheterization ................................. 0.00 16.11 16.11 1.20 17.31 17.31 000

93501 26 A Right heart catheterization ................................. 3.02 #3.32 #3.32 0.34 6.68 6.68 000

93503 ............ A Insert/place heart catheter ................................. 2.91 2.37 2.37 0.36 5.64 5.64 000

93505 ............ A Biopsy of heart lining ......................................... 4.38 4.92 4.92 0.46 9.76 9.76 000

93505 TC A Biopsy of heart lining ......................................... 0.00 1.89 1.89 0.18 2.07 2.07 000

93505 26 A Biopsy of heart lining ......................................... 4.38 3.03 3.03 0.28 7.69 7.69 000

93508 ............ A Cath placement, angiography ............................ 4.10 14.79 14.79 0.98 19.87 19.87 000

93508 TC A Cath placement, angiography ............................ 0.00 12.01 12.01 0.75 12.76 12.76 000

93508 26 A Cath placement, angiography ............................ 4.10 2.78 2.78 0.23 7.11 7.11 000

93510 ............ A Left heart catheterization ................................... 4.33 38.28 38.28 2.86 45.47 45.47 000

93510 TC A Left heart catheterization ................................... 0.00 35.22 35.22 2.63 37.85 37.85 000

93510 26 A Left heart catheterization ................................... 4.33 3.06 3.06 0.23 7.62 7.62 000

93511 ............ A Left heart catheterization ................................... 5.03 36.91 36.91 2.76 44.70 44.70 000

93511 TC A Left heart catheterization ................................... 0.00 34.29 34.29 2.56 36.85 36.85 000

93511 26 A Left heart catheterization ................................... 5.03 2.62 2.62 0.20 7.85 7.85 000

93514 ............ A Left heart catheterization ................................... 7.05 38.84 38.84 2.94 48.83 48.83 000

93514 TC A Left heart catheterization ................................... 0.00 34.29 34.29 2.56 36.85 36.85 000

93514 26 A Left heart catheterization ................................... 7.05 4.55 4.55 0.38 11.98 11.98 000

93524 ............ A Left heart catheterization ................................... 6.95 49.45 49.45 3.69 60.09 60.09 000

93524 TC A Left heart catheterization ................................... 0.00 44.80 44.80 3.35 48.15 48.15 000

93524 26 A Left heart catheterization ................................... 6.95 4.65 4.65 0.34 11.94 11.94 000

93526 ............ A Rt & Lt heart catheters ....................................... 5.99 51.48 51.48 3.83 61.30 61.30 000

93526 TC A Rt & Lt heart catheters ....................................... 0.00 46.03 46.03 3.44 49.47 49.47 000

93526 26 A Rt & Lt heart catheters ....................................... 5.99 5.45 5.45 0.39 11.83 11.83 000

93527 ............ A Rt & Lt heart catheters ....................................... 7.28 51.94 51.94 3.85 63.07 63.07 000

93527 TC A Rt & Lt heart catheters ....................................... 0.00 44.80 44.80 3.35 48.15 48.15 000

93527 26 A Rt & Lt heart catheters ....................................... 7.28 7.14 7.14 0.50 14.92 14.92 000

93528 ............ A Rt & Lt heart catheters ....................................... 9.00 49.23 49.23 3.68 61.91 61.91 000

93528 TC A Rt & Lt heart catheters ....................................... 0.00 44.80 44.80 3.35 48.15 48.15 000

93528 26 A Rt & Lt heart catheters ....................................... 9.00 4.43 4.43 0.33 13.76 13.76 000

93529 ............ A Rt, Lt heart catheterization ................................. 4.80 47.73 47.73 3.57 56.10 56.10 000

93529 TC A Rt, Lt heart catheterization ................................. 0.00 44.80 44.80 3.35 48.15 48.15 000

93529 26 A Rt, Lt heart catheterization ................................. 4.80 2.93 2.93 0.22 7.95 7.95 000

93530 ............ A Rt heart cath, congenital .................................... 4.23 19.72 19.72 1.54 25.49 25.49 000

93530 TC A Rt heart cath, congenital .................................... 0.00 16.11 16.11 1.20 17.31 17.31 000

93530 26 A Rt heart cath, congenital .................................... 4.23 3.61 3.61 0.34 8.18 8.18 000

93531 ............ A R & l heart cath, congenital ............................... 8.35 51.48 51.48 3.83 63.66 63.66 000

93531 TC A R & l heart cath, congenital ............................... 0.00 46.03 46.03 3.44 49.47 49.47 000

93531 26 A R & l heart cath, congenital ............................... 8.35 5.45 5.45 0.39 14.19 14.19 000

93532 ............ A R & l heart cath, congenital ............................... 10.00 51.94 51.94 3.85 65.79 65.79 000

93532 TC A R & l heart cath, congenital ............................... 0.00 44.80 44.80 3.35 48.15 48.15 000

93532 26 A R & l heart cath, congenital ............................... 10.00 7.14 7.14 0.50 17.64 17.64 000

93533 ............ A R & l heart cath, congenital ............................... 6.70 47.73 47.73 3.57 58.00 58.00 000

93533 TC A R & l heart cath, congenital ............................... 0.00 44.80 44.80 3.35 48.15 48.15 000

93533 26 A R & l heart cath, congenital ............................... 6.70 2.93 2.93 0.22 9.85 9.85 000
59217

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

93536 ............ A Insert circulation assi ......................................... 4.85 #5.34 #5.34 0.71 10.90 10.90 000

93539 ............ A Injection, cardiac cath ........................................ 0.40 0.88 #0.44 0.20 1.48 1.04 000

93540 ............ A Injection, cardiac cath ........................................ 0.43 0.88 #0.47 0.20 1.51 1.10 000

93541 ............ A Injection for lung angiogram .............................. 0.29 #0.32 #0.32 0.16 0.77 0.77 000

93542 ............ A Injection for heart x-rays .................................... 0.29 #0.32 #0.32 0.16 0.77 0.77 000

93543 ............ A Injection for heart x-rays .................................... 0.29 0.57 #0.32 0.11 0.97 0.72 000

93544 ............ A Injection for aortography .................................... 0.25 0.57 #0.28 0.11 0.93 0.64 000

93545 ............ A Injection for coronary x-rays .............................. 0.40 #0.44 #0.44 0.24 1.08 1.08 000

93555 ............ A Imaging, cardiac cath ......................................... 0.81 6.25 6.25 0.42 7.48 7.48 XXX

93555 TC A Imaging, cardiac cath ......................................... 0.00 5.98 5.98 0.38 6.36 6.36 XXX

93555 26 A Imaging, cardiac cath ......................................... 0.81 0.27 0.27 0.04 1.12 1.12 XXX

93556 ............ A Imaging, cardiac cath ......................................... 0.83 9.88 9.88 0.65 11.36 11.36 XXX

93556 TC A Imaging, cardiac cath ......................................... 0.00 9.43 9.43 0.58 10.01 10.01 XXX

93556 26 A Imaging, cardiac cath ......................................... 0.83 0.45 0.45 0.07 1.35 1.35 XXX

93561 ............ A Cardiac output measurement ............................. 0.50 1.05 1.05 0.16 1.71 1.71 000

93561 TC A Cardiac output measurement ............................. 0.00 0.50 0.50 0.07 0.57 0.57 000

93561 26 A Cardiac output measurement ............................. 0.50 #0.55 #0.55 0.09 1.14 1.14 000

93562 ............ A Cardiac output measurement ............................. 0.16 0.48 0.48 0.10 0.74 0.74 000

93562 TC A Cardiac output measurement ............................. 0.00 0.30 0.30 0.04 0.34 0.34 000

93562 26 A Cardiac output measurement ............................. 0.16 #0.18 #0.18 0.06 0.40 0.40 000

93600 ............ A Bundle of His recording ..................................... 2.12 4.19 4.19 0.38 6.69 6.69 000

93600 TC A Bundle of His recording ..................................... 0.00 1.86 1.86 0.14 2.00 2.00 000

93600 26 A Bundle of His recording ..................................... 2.12 #2.33 #2.33 0.24 4.69 4.69 000

93602 ............ A Intra-atrial recording ........................................... 2.12 2.83 2.83 0.22 5.17 5.17 000

93602 TC A Intra-atrial recording ........................................... 0.00 1.06 1.06 0.08 1.14 1.14 000

93602 26 A Intra-atrial recording ........................................... 2.12 1.77 1.77 0.14 4.03 4.03 000

93603 ............ A Right ventricular recording ................................. 2.12 3.79 3.79 0.28 6.19 6.19 000

93603 TC A Right ventricular recording ................................. 0.00 1.60 1.60 0.12 1.72 1.72 000

93603 26 A Right ventricular recording ................................. 2.12 2.19 2.19 0.16 4.47 4.47 000

93607 ............ A Right ventricular recording ................................. 3.26 3.63 3.63 0.28 7.17 7.17 000

93607 TC A Right ventricular recording ................................. 0.00 1.42 1.42 0.11 1.53 1.53 000

93607 26 A Right ventricular recording ................................. 3.26 2.21 2.21 0.17 5.64 5.64 000

93609 ............ A Mapping of tachycardia ...................................... 10.07 6.43 6.43 0.47 16.97 16.97 000

93609 TC A Mapping of tachycardia ...................................... 0.00 2.59 2.59 0.19 2.78 2.78 000

93609 26 A Mapping of tachycardia ...................................... 10.07 3.84 3.84 0.28 14.19 14.19 000

93610 ............ A Intra-atrial pacing ............................................... 3.02 3.60 3.60 0.27 6.89 6.89 000

93610 TC A Intra-atrial pacing ............................................... 0.00 1.29 1.29 0.10 1.39 1.39 000

93610 26 A Intra-atrial pacing ............................................... 3.02 2.31 2.31 0.17 5.50 5.50 000

93612 ............ A Intraventricular pacing ........................................ 3.02 3.88 3.88 0.29 7.19 7.19 000

93612 TC A Intraventricular pacing ........................................ 0.00 1.54 1.54 0.12 1.66 1.66 000

93612 26 A Intraventricular pacing ........................................ 3.02 2.34 2.34 0.17 5.53 5.53 000

93615 ............ A Esophageal recording ........................................ 0.99 0.65 0.65 0.04 1.68 1.68 000

93615 TC A Esophageal recording ........................................ 0.00 0.30 0.30 0.02 0.32 0.32 000

93615 26 A Esophageal recording ........................................ 0.99 0.35 0.35 0.02 1.36 1.36 000

93616 ............ A Esophageal recording ........................................ 1.49 1.66 1.66 0.10 3.25 3.25 000

93616 TC A Esophageal recording ........................................ 0.00 0.30 0.30 0.02 0.32 0.32 000

93616 26 A Esophageal recording ........................................ 1.49 1.36 1.36 0.08 2.93 2.93 000

93618 ............ A Heart rhythm pacing ........................................... 4.26 8.47 8.47 0.72 13.45 13.45 000

93618 TC A Heart rhythm pacing ........................................... 0.00 3.78 3.78 0.28 4.06 4.06 000

93618 26 A Heart rhythm pacing ........................................... 4.26 #4.69 #4.69 0.44 9.39 9.39 000

93619 ............ A Electrophysiology evaluation .............................. 7.32 15.39 15.39 1.40 24.11 24.11 000

93619 TC A Electrophysiology evaluation .............................. 0.00 7.34 7.34 0.54 7.88 7.88 000

93619 26 A Electrophysiology evaluation .............................. 7.32 #8.05 #8.05 0.86 16.23 16.23 000

93620 ............ A Electrophysiology evaluation .............................. 11.59 21.29 21.29 1.55 34.43 34.43 000

93620 TC A Electrophysiology evaluation .............................. 0.00 8.54 8.54 0.60 9.14 9.14 000

93620 26 A Electrophysiology evaluation .............................. 11.59 #12.75 #12.75 0.95 25.29 25.29 000

93621 ............ C Electrophysiology evaluation .............................. 0.00 0.00 0.00 0.00 0.00 0.00 000

93621 TC C Electrophysiology evaluation .............................. 0.00 0.00 0.00 0.00 0.00 0.00 000

93621 26 A Electrophysiology evaluation .............................. 12.66 #13.93 #13.93 1.11 27.70 27.70 000

93622 ............ C Electrophysiology evaluation .............................. 0.00 0.00 0.00 0.00 0.00 0.00 000

93622 TC C Electrophysiology evaluation .............................. 0.00 0.00 0.00 0.00 0.00 0.00 000

93622 26 A Electrophysiology evaluation .............................. 12.74 #14.01 #14.01 1.07 27.82 27.82 000

93623 ............ C Stimulation, pacing heart ................................... 0.00 0.00 0.00 0.00 0.00 0.00 000

93623 TC C Stimulation, pacing heart ................................... 0.00 0.00 0.00 0.00 0.00 0.00 000

93623 26 A Stimulation, pacing heart ................................... 2.85 2.78 2.78 0.20 5.83 5.83 000

93624 ............ A Electrophysiologic study ..................................... 4.81 4.88 4.88 0.35 10.04 10.04 000

93624 TC A Electrophysiologic study ..................................... 0.00 1.89 1.89 0.14 2.03 2.03 000

93624 26 A Electrophysiologic study ..................................... 4.81 2.99 2.99 0.21 8.01 8.01 000

93631 ............ A Heart pacing, mapping ....................................... 7.60 11.62 11.62 1.37 20.59 20.59 000

93631 TC A Heart pacing, mapping ....................................... 0.00 5.86 5.86 0.70 6.56 6.56 000

93631 26 A Heart pacing, mapping ....................................... 7.60 5.76 5.76 0.67 14.03 14.03 000

93640 ............ A Evaluation heart device ...................................... 3.52 10.71 10.71 1.09 15.32 15.32 000

93640 TC A Evaluation heart device ...................................... 0.00 6.84 6.84 0.48 7.32 7.32 000

93640 26 A Evaluation heart device ...................................... 3.52 #3.87 #3.87 0.61 8.00 8.00 000
59218

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

93641 ............ A Electrophysiology evaluation .............................. 5.93 13.36 13.36 1.09 20.38 20.38 000

93641 TC A Electrophysiology evaluation .............................. 0.00 6.84 6.84 0.48 7.32 7.32 000

93641 26 A Electrophysiology evaluation .............................. 5.93 #6.52 #6.52 0.61 13.06 13.06 000

93642 ............ A Electrophysiology evaluation .............................. 4.89 12.22 12.22 1.09 18.20 18.20 000

93642 TC A Electrophysiology evaluation .............................. 0.00 6.84 6.84 0.48 7.32 7.32 000

93642 26 A Electrophysiology evaluation .............................. 4.89 #5.38 #5.38 0.61 10.88 10.88 000

93650 ............ A Ablate heart dysrhythm focus ............................ 10.51 #11.56 #11.56 1.34 23.41 23.41 000

93651 ............ A Ablate heart dysrhythm focus ............................ 16.25 17.83 17.83 1.34 35.42 35.42 000

93652 ............ A Ablate heart dysrhythm focus ............................ 17.68 17.83 17.83 1.34 36.85 36.85 000

93660 ............ C Tilt table evaluation ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 000

93660 TC C Tilt table evaluation ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 000

93660 26 A Tilt table evaluation ............................................ 1.89 1.44 1.44 0.17 3.50 3.50 000

93720 ............ A Total body plethysmography .............................. 0.17 0.89 0.86 0.10 1.16 1.13 XXX

93721 ............ A Plethysmography tracing .................................... 0.00 0.67 0.67 0.07 0.74 0.74 XXX

93722 ............ A Plethysmography report ..................................... 0.17 0.22 #0.19 0.03 0.42 0.39 XXX

93724 ............ A Analyze pacemaker system ............................... 4.89 6.66 6.66 0.50 12.05 12.05 000

93724 TC A Analyze pacemaker system ............................... 0.00 3.78 3.78 0.28 4.06 4.06 000

93724 26 A Analyze pacemaker system ............................... 4.89 2.88 2.88 0.22 7.99 7.99 000

93731 ............ A Analyze pacemaker system ............................... 0.45 0.79 0.79 0.07 1.31 1.31 XXX

93731 TC A Analyze pacemaker system ............................... 0.00 0.47 0.47 0.04 0.51 0.51 XXX

93731 26 A Analyze pacemaker system ............................... 0.45 0.32 0.32 0.03 0.80 0.80 XXX

93732 ............ A Analyze pacemaker system ............................... 0.92 0.91 0.91 0.08 1.91 1.91 XXX

93732 TC A Analyze pacemaker system ............................... 0.00 0.49 0.49 0.04 0.53 0.53 XXX

93732 26 A Analyze pacemaker system ............................... 0.92 0.42 0.42 0.04 1.38 1.38 XXX

93733 ............ A Telephone analysis, pacemaker ........................ 0.17 0.88 0.88 0.08 1.13 1.13 XXX

93733 TC A Telephone analysis, pacemaker ........................ 0.00 0.69 0.69 0.06 0.75 0.75 XXX

93733 26 A Telephone analysis, pacemaker ........................ 0.17 #0.19 #0.19 0.02 0.38 0.38 XXX

93734 ............ A Analyze pacemaker system ............................... 0.38 0.64 0.64 0.06 1.08 1.08 XXX

93734 TC A Analyze pacemaker system ............................... 0.00 0.33 0.33 0.03 0.36 0.36 XXX

93734 26 A Analyze pacemaker system ............................... 0.38 0.31 0.31 0.03 0.72 0.72 XXX

93735 ............ A Analyze pacemaker system ............................... 0.74 0.85 0.85 0.08 1.67 1.67 XXX

93735 TC A Analyze pacemaker system ............................... 0.00 0.42 0.42 0.04 0.46 0.46 XXX

93735 26 A Analyze pacemaker system ............................... 0.74 0.43 0.43 0.04 1.21 1.21 XXX

93736 ............ A Telephone analysis, pacemaker ........................ 0.15 0.77 0.77 0.09 1.01 1.01 XXX

93736 TC A Telephone analysis, pacemaker ........................ 0.00 0.60 0.60 0.06 0.66 0.66 XXX

93736 26 A Telephone analysis, pacemaker ........................ 0.15 #0.17 #0.17 0.03 0.35 0.35 XXX

93737 ............ A Analyze cardio/defibrillator ................................. 0.45 0.74 0.74 0.06 1.25 1.25 XXX

93737 TC A Analyze cardio/defibrillator ................................. 0.00 0.47 0.47 0.04 0.51 0.51 XXX

93737 26 A Analyze cardio/defibrillator ................................. 0.45 0.27 0.27 0.02 0.74 0.74 XXX

93738 ............ A Analyze cardio/defibrillator ................................. 0.92 0.88 0.88 0.07 1.87 1.87 XXX

93738 TC ...... A Analyze cardio/defibrillator ................................. 0.00 0.49 0.49 0.04 0.53 0.53 XXX

93738 26 A Analyze cardio/defibrillator ................................. 0.92 0.39 0.39 0.03 1.34 1.34 XXX

93740 ............ A Temperature gradient studies ............................ 0.16 0.45 0.45 0.04 0.65 0.65 XXX

93740 TC A Temperature gradient studies ............................ 0.00 0.15 0.15 0.01 0.16 0.16 XXX

93740 26 A Temperature gradient studies ............................ 0.16 0.30 0.30 0.03 0.49 0.49 XXX

93760 ............ N Cephalic thermogram ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

93762 ............ N Peripheral thermogram ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

93770 ............ A Measure venous pressure ................................. 0.16 0.20 0.20 0.02 0.38 0.38 XXX

93770 TC A Measure venous pressure ................................. 0.00 0.03 0.03 0.00 0.03 0.03 XXX

93770 26 A Measure venous pressure ................................. 0.16 0.17 0.17 0.02 0.35 0.35 XXX

93784 ............ N Ambulatory BP monitoring ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

93786 ............ N Ambulatory BP recording ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

93788 ............ N Ambulatory BP analysis ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

93790 ............ N Review/report BP recording ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

93797 ............ A Cardiac rehab ..................................................... 0.18 #0.20 #0.20 0.02 0.40 0.40 000

93798 ............ A Cardiac rehab/monitor ........................................ 0.28 0.47 0.47 0.04 0.79 0.79 000

93799 ............ C Cardiovascular procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

93799 TC C Cardiovascular procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

93799 26 C Cardiovascular procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

93875 ............ A Extracranial study ............................................... 0.22 1.29 1.29 0.18 1.69 1.69 XXX

93875 TC A Extracranial study ............................................... 0.00 1.05 1.05 0.12 1.17 1.17 XXX

93875 26 A Extracranial study ............................................... 0.22 #0.24 #0.24 0.06 0.52 0.52 XXX

93880 ............ A Extracranial study ............................................... 0.60 3.94 3.94 0.44 4.98 4.98 XXX

93880 TC A Extracranial study ............................................... 0.00 3.55 3.55 0.40 3.95 3.95 XXX

93880 26 A Extracranial study ............................................... 0.60 0.39 0.39 0.04 1.03 1.03 XXX

93882 ............ A Extracranial study ............................................... 0.40 2.62 2.62 0.29 3.31 3.31 XXX

93882 TC A Extracranial study ............................................... 0.00 2.36 2.36 0.26 2.62 2.62 XXX

93882 26 A Extracranial study ............................................... 0.40 0.26 0.26 0.03 0.69 0.69 XXX

93886 ............ A Intracranial study ................................................ 0.94 4.44 4.44 0.50 5.88 5.88 XXX

93886 TC A Intracranial study ................................................ 0.00 4.02 4.02 0.45 4.47 4.47 XXX

93886 26 A Intracranial study ................................................ 0.94 0.42 0.42 0.05 1.41 1.41 XXX

93888 ............ A Intracranial study ................................................ 0.62 2.96 2.96 0.34 3.92 3.92 XXX

93888 TC A Intracranial study ................................................ 0.00 2.68 2.68 0.31 2.99 2.99 XXX

93888 26 A Intracranial study ................................................ 0.62 0.28 0.28 0.03 0.93 0.93 XXX
59219

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

93922 ............ A Extremity study ................................................... 0.25 1.38 1.38 0.19 1.82 1.82 XXX

93922 TC A Extremity study ................................................... 0.00 1.10 1.10 0.14 1.24 1.24 XXX

93922 26 A Extremity study ................................................... 0.25 0.28 0.28 0.05 0.58 0.58 XXX

93923 ............ A Extremity study ................................................... 0.45 2.58 2.58 0.35 3.38 3.38 XXX

93923 TC A Extremity study ................................................... 0.00 2.08 2.08 0.26 2.34 2.34 XXX

93923 26 A Extremity study ................................................... 0.45 #0.50 #0.50 0.09 1.04 1.04 XXX

93924 ............ A Extremity study ................................................... 0.50 2.81 2.81 0.39 3.70 3.70 XXX

93924 TC A Extremity study ................................................... 0.00 2.26 2.26 0.29 2.55 2.55 XXX

93924 26 A Extremity study ................................................... 0.50 #0.55 #0.55 0.10 1.15 1.15 XXX

93925 ............ A Lower extremity study ........................................ 0.58 3.96 3.96 0.44 4.98 4.98 XXX

93925 TC A Lower extremity study ........................................ 0.00 3.57 3.57 0.40 3.97 3.97 XXX

93925 26 A Lower extremity study ........................................ 0.58 0.39 0.39 0.04 1.01 1.01 XXX

93926 ............ A Lower extremity study ........................................ 0.39 2.64 2.64 0.30 3.33 3.33 XXX

93926 TC A Lower extremity study ........................................ 0.00 2.38 2.38 0.27 2.65 2.65 XXX

93926 26 A Lower extremity study ........................................ 0.39 0.26 0.26 0.03 0.68 0.68 XXX

93930 ............ A Upper extremity study ........................................ 0.46 4.18 4.18 0.47 5.11 5.11 XXX

93930 TC A Upper extremity study ........................................ 0.00 3.79 3.79 0.42 4.21 4.21 XXX

93930 26 A Upper extremity study ........................................ 0.46 0.39 0.39 0.05 0.90 0.90 XXX

93931 ............ A Upper extremity study ........................................ 0.31 2.78 2.78 0.31 3.40 3.40 XXX

93931 TC A Upper extremity study ........................................ 0.00 2.52 2.52 0.28 2.80 2.80 XXX

93931 26 A Upper extremity study ........................................ 0.31 0.26 0.26 0.03 0.60 0.60 XXX

93965 ............ A Extremity study ................................................... 0.35 1.43 1.43 0.19 1.97 1.97 XXX

93965 TC A Extremity study ................................................... 0.00 1.04 1.04 0.13 1.17 1.17 XXX

93965 26 A Extremity study ................................................... 0.35 #0.39 #0.39 0.06 0.80 0.80 XXX

93970 ............ A Extremity study ................................................... 0.68 4.33 4.33 0.51 5.52 5.52 XXX

93970 TC A Extremity study ................................................... 0.00 3.93 3.93 0.46 4.39 4.39 XXX

93970 26 A Extremity study ................................................... 0.68 0.40 0.40 0.05 1.13 1.13 XXX

93971 ............ A Extremity study ................................................... 0.45 2.89 2.89 0.34 3.68 3.68 XXX

93971 TC A Extremity study ................................................... 0.00 2.62 2.62 0.31 2.93 2.93 XXX

93971 26 A Extremity study ................................................... 0.45 0.27 0.27 0.03 0.75 0.75 XXX

93975 ............ A Vascular study .................................................... 1.80 4.90 4.90 0.55 7.25 7.25 XXX

93975 TC A Vascular study .................................................... 0.00 4.48 4.48 0.50 4.98 4.98 XXX

93975 26 A Vascular study .................................................... 1.80 0.42 0.42 0.05 2.27 2.27 XXX

93976 ............ A Vascular study .................................................... 1.21 3.27 3.27 0.37 4.85 4.85 XXX

93976 TC A Vascular study .................................................... 0.00 2.99 2.99 0.34 3.33 3.33 XXX

93976 26 A Vascular study .................................................... 1.21 0.28 0.28 0.03 1.52 1.52 XXX

93978 ............ A Vascular study .................................................... 0.65 4.06 4.06 0.47 5.18 5.18 XXX

93978 TC A Vascular study .................................................... 0.00 3.67 3.67 0.42 4.09 4.09 XXX

93978 26 A Vascular study .................................................... 0.65 0.39 0.39 0.05 1.09 1.09 XXX

93979 ............ A Vascular study .................................................... 0.44 2.70 2.70 0.31 3.45 3.45 XXX

93979 TC A Vascular study .................................................... 0.00 2.44 2.44 0.28 2.72 2.72 XXX

93979 26 A Vascular study .................................................... 0.44 0.26 0.26 0.03 0.73 0.73 XXX

93980 ............ A Penile vascular study ......................................... 1.25 4.15 4.15 0.45 5.85 5.85 XXX

93980 TC A Penile vascular study ......................................... 0.00 3.33 3.33 0.38 3.71 3.71 XXX

93980 26 A Penile vascular study ......................................... 1.25 0.82 0.82 0.07 2.14 2.14 XXX

93981 ............ A Penile vascular study ......................................... 0.44 3.47 3.47 0.39 4.30 4.30 XXX

93981 TC A Penile vascular study ......................................... 0.00 3.07 3.07 0.36 3.43 3.43 XXX

93981 26 A Penile vascular study ......................................... 0.44 0.40 0.40 0.03 0.87 0.87 XXX

93990 ............ A Doppler flow testing ........................................... 0.25 2.57 2.57 0.29 3.11 3.11 XXX

93990 TC A Doppler flow testing ........................................... 0.00 2.38 2.38 0.27 2.65 2.65 XXX

93990 26 A Doppler flow testing ........................................... 0.25 0.19 0.19 0.02 0.46 0.46 XXX

94010 ............ A Breathing capacity test ....................................... 0.17 0.68 0.68 0.05 0.90 0.90 XXX

94010 TC A Breathing capacity test ....................................... 0.00 0.40 0.40 0.03 0.43 0.43 XXX

94010 26 A Breathing capacity test ....................................... 0.17 0.28 0.28 0.02 0.47 0.47 XXX

94060 ............ A Evaluation of wheezing ...................................... 0.31 1.23 1.23 0.09 1.63 1.63 XXX

94060 TC A Evaluation of wheezing ...................................... 0.00 0.89 0.89 0.06 0.95 0.95 XXX

94060 26 A Evaluation of wheezing ...................................... 0.31 #0.34 #0.34 0.03 0.68 0.68 XXX

94070 ............ A Evaluation of wheezing ...................................... 0.60 1.77 1.77 0.13 2.50 2.50 XXX

94070 TC A Evaluation of wheezing ...................................... 0.00 1.39 1.39 0.10 1.49 1.49 XXX

94070 26 A Evaluation of wheezing ...................................... 0.60 0.38 0.38 0.03 1.01 1.01 XXX

94150 ............ B Vital capacity test ............................................... +0.07 0.16 0.16 0.02 0.25 0.25 XXX

94150 TC B Vital capacity test ............................................... +0.00 0.08 0.08 0.01 0.09 0.09 XXX

94150 26 B Vital capacity test ............................................... +0.07 #0.08 #0.08 0.01 0.16 0.16 XXX

94200 ............ A Lung function test (MBC/MVV) .......................... 0.11 0.36 0.36 0.03 0.50 0.50 XXX

94200 TC A Lung function test (MBC/MVV) .......................... 0.00 0.24 0.24 0.02 0.26 0.26 XXX

94200 26 A Lung function test (MBC/MVV) .......................... 0.11 #0.12 #0.12 0.01 0.24 0.24 XXX

94240 ............ A Residual lung capacity ....................................... 0.26 0.88 0.88 0.07 1.21 1.21 XXX

94240 TC A Residual lung capacity ....................................... 0.00 0.65 0.65 0.05 0.70 0.70 XXX

94240 26 A Residual lung capacity ....................................... 0.26 0.23 0.23 0.02 0.51 0.51 XXX

94250 ............ A Expired gas collection ........................................ 0.11 0.25 0.25 0.02 0.38 0.38 XXX

94250 TC A Expired gas collection ........................................ 0.00 0.13 0.13 0.01 0.14 0.14 XXX

94250 26 A Expired gas collection ........................................ 0.11 #0.12 #0.12 0.01 0.24 0.24 XXX

94260 ............ A Thoracic gas volume .......................................... 0.13 0.66 0.66 0.06 0.85 0.85 XXX

94260 TC A Thoracic gas volume .......................................... 0.00 0.52 0.52 0.04 0.56 0.56 XXX
59220

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

94260 26 A Thoracic gas volume .......................................... 0.13 #0.14 #0.14 0.02 0.29 0.29 XXX

94350 ............ A Lung nitrogen washout curve ............................. 0.26 0.73 0.73 0.05 1.04 1.04 XXX

94350 TC A Lung nitrogen washout curve ............................. 0.00 0.52 0.52 0.04 0.56 0.56 XXX

94350 26 A Lung nitrogen washout curve ............................. 0.26 0.21 0.21 0.01 0.48 0.48 XXX

94360 ............ A Measure airflow resistance ................................ 0.26 1.11 1.11 0.07 1.44 1.44 XXX

94360 TC A Measure airflow resistance ................................ 0.00 0.92 0.92 0.06 0.98 0.98 XXX

94360 26 A Measure airflow resistance ................................ 0.26 0.19 0.19 0.01 0.46 0.46 XXX

94370 ............ A Breath airway closing volume ............................ 0.26 0.40 0.40 0.03 0.69 0.69 XXX

94370 TC A Breath airway closing volume ............................ 0.00 0.26 0.26 0.02 0.28 0.28 XXX

94370 26 A Breath airway closing volume ............................ 0.26 0.14 0.14 0.01 0.41 0.41 XXX

94375 ............ A Respiratory flow volume loop ............................. 0.31 0.67 0.67 0.04 1.02 1.02 XXX

94375 TC A Respiratory flow volume loop ............................. 0.00 0.46 0.46 0.03 0.49 0.49 XXX

94375 26 A Respiratory flow volume loop ............................. 0.31 0.21 0.21 0.01 0.53 0.53 XXX

94400 ............ A CO2 breathing response curve .......................... 0.40 0.77 0.77 0.19 1.36 1.36 XXX

94400 TC A CO2 breathing response curve .......................... 0.00 0.30 0.30 0.06 0.36 0.36 XXX

94400 26 A CO2 breathing response curve .......................... 0.40 0.47 0.47 0.13 1.00 1.00 XXX

94450 ............ A Hypoxia response curve .................................... 0.40 0.61 0.61 0.05 1.06 1.06 XXX

94450 TC A Hypoxia response curve .................................... 0.00 0.37 0.37 0.03 0.40 0.40 XXX

94450 26 A Hypoxia response curve .................................... 0.40 0.24 0.24 0.02 0.66 0.66 XXX

94620 ............ A Pulmonary stress testing .................................... 0.88 2.05 2.05 0.15 3.08 3.08 XXX

94620 TC A Pulmonary stress testing .................................... 0.00 1.35 1.35 0.10 1.45 1.45 XXX

94620 26 A Pulmonary stress testing .................................... 0.88 0.70 0.70 0.05 1.63 1.63 XXX

94640 ............ A Airway inhalation treatment ................................ 0.00 0.39 0.39 0.03 0.42 0.42 XXX

94642 ............ C Aerosol inhalation treatment .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

94650 ............ A Pressure breathing (IPPB) ................................. 0.00 0.37 0.37 0.03 0.40 0.40 XXX

94651 ............ A Pressure breathing (IPPB) ................................. 0.00 0.36 0.36 0.03 0.39 0.39 XXX

94652 ............ A Pressure breathing (IPPB) ................................. 0.00 0.41 0.41 0.08 0.49 0.49 XXX

94656 ............ A Initial ventilator mgmt ......................................... 1.22 1.13 1.13 0.12 2.47 2.47 XXX

94657 ............ A Cont. ventilator ................................................... 0.83 0.62 0.62 0.05 1.50 1.50 XXX

94660 ............ A Pos airway pressure, CPAP .............................. 0.76 0.71 0.71 0.06 1.53 1.53 XXX

94662 ............ A Neg pressure ventilation, cnp ............................ 0.76 0.30 0.30 0.02 1.08 1.08 XXX

94664 ............ A Aerosol or vapor inhalations .............................. 0.00 0.50 0.50 0.04 0.54 0.54 XXX

94665 ............ A Aerosol or vapor inhalations .............................. 0.00 0.46 0.46 0.05 0.51 0.51 XXX

94667 ............ A Chest wall manipulation ..................................... 0.00 0.55 0.55 0.05 0.60 0.60 XXX

94668 ............ A Chest wall manipulation ..................................... 0.00 0.34 0.34 0.03 0.37 0.37 XXX

94680 ............ A Exhaled air analysis: O2 .................................... 0.26 0.78 0.78 0.10 1.14 1.14 XXX

94680 TC A Exhaled air analysis: O2 .................................... 0.00 0.49 0.49 0.07 0.56 0.56 XXX

94680 26 A Exhaled air analysis: O2 .................................... 0.26 #0.29 #0.29 0.03 0.58 0.58 XXX

94681 ............ A Exhaled air analysis: O2, CO2 .......................... 0.20 1.54 1.54 0.17 1.91 1.91 XXX

94681 TC A Exhaled air analysis: O2, CO2 .......................... 0.00 1.32 1.32 0.13 1.45 1.45 XXX

94681 26 A Exhaled air analysis: O2, CO2 .......................... 0.20 #0.22 #0.22 0.04 0.46 0.46 XXX

94690 ............ A Exhaled air analysis ........................................... 0.07 0.56 0.56 0.04 0.67 0.67 XXX

94690 TC A Exhaled air analysis ........................................... 0.00 0.51 0.51 0.04 0.55 0.55 XXX

94690 26 A Exhaled air analysis ........................................... 0.07 0.05 0.05 0.00 0.12 0.12 XXX

94720 ............ A Monoxide diffusing capacity ............................... 0.26 1.03 1.03 0.08 1.37 1.37 XXX

94720 TC A Monoxide diffusing capacity ............................... 0.00 0.80 0.80 0.06 0.86 0.86 XXX

94720 26 A Monoxide diffusing capacity ............................... 0.26 0.23 0.23 0.02 0.51 0.51 XXX

94725 ............ A Membrane diffusion capacity ............................. 0.26 1.84 1.84 0.14 2.24 2.24 XXX

94725 TC A Membrane diffusion capacity ............................. 0.00 1.66 1.66 0.13 1.79 1.79 XXX

94725 26 A Membrane diffusion capacity ............................. 0.26 0.18 0.18 0.01 0.45 0.45 XXX

94750 ............ A Pulmonary compliance study ............................. 0.23 0.80 0.80 0.06 1.09 1.09 XXX

94750 TC A Pulmonary compliance study ............................. 0.00 0.55 0.55 0.04 0.59 0.59 XXX

94750 26 A Pulmonary compliance study ............................. 0.23 #0.25 #0.25 0.02 0.50 0.50 XXX

94760 ............ A Measure blood oxygen level .............................. 0.00 0.25 0.25 0.02 0.27 0.27 XXX

94761 ............ A Measure blood oxygen level .............................. 0.00 0.64 0.64 0.06 0.70 0.70 XXX

94762 ............ A Measure blood oxygen level .............................. 0.00 1.08 1.08 0.10 1.18 1.18 XXX

94770 ............ A Exhaled carbon dioxide test ............................... 0.15 0.40 0.40 0.11 0.66 0.66 XXX

94770 TC A Exhaled carbon dioxide test ............................... 0.00 0.29 0.29 0.08 0.37 0.37 XXX

94770 26 A Exhaled carbon dioxide test ............................... 0.15 0.11 0.11 0.03 0.29 0.29 XXX

94772 ............ C Breath recording, infant ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

94772 TC C Breath recording, infant ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

94772 26 C Breath recording, infant ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

94799 ............ C Pulmonary service/procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

94799 TC C Pulmonary service/procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

94799 26 C Pulmonary service/procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

95004 ............ A Allergy skin tests ................................................ 0.00 0.09 0.09 0.01 0.10 0.10 XXX

95010 ............ A Sensitivity skin tests ........................................... 0.15 0.11 0.11 0.01 0.27 0.27 XXX

95015 ............ A Sensitivity skin tests ........................................... 0.15 0.11 0.11 0.01 0.27 0.27 XXX

95024 ............ A Allergy skin tests ................................................ 0.00 0.14 0.14 0.01 0.15 0.15 XXX

95027 ............ A Skin end point titration ....................................... 0.00 0.14 0.14 0.01 0.15 0.15 XXX

95028 ............ A Allergy skin tests ................................................ 0.00 0.22 0.22 0.01 0.23 0.23 XXX

95044 ............ A Allergy patch tests .............................................. 0.00 0.19 0.19 0.01 0.20 0.20 XXX

95052 ............ A Photo patch test ................................................. 0.00 0.24 0.24 0.01 0.25 0.25 XXX

95056 ............ A Photosensitivity tests .......................................... 0.00 0.17 0.17 0.01 0.18 0.18 XXX
59221

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

95060 ............ A Eye allergy tests ................................................. 0.00 0.33 0.33 0.02 0.35 0.35 XXX

95065 ............ A Nose allergy test ................................................ 0.00 0.19 0.19 0.01 0.20 0.20 XXX

95070 ............ A Bronchial allergy tests ........................................ 0.00 2.17 2.17 0.02 2.19 2.19 XXX

95071 ............ A Bronchial allergy tests ........................................ 0.00 2.78 2.78 0.02 2.80 2.80 XXX

95075 ............ A Ingestion challenge test ..................................... 0.95 1.97 1.97 0.02 2.94 2.94 XXX

95078 ............ A Provocative testing ............................................. 0.00 0.24 0.24 0.02 0.26 0.26 XXX

95115 ............ A Immunotherapy, one injection ............................ 0.00 0.37 0.37 0.02 0.39 0.39 000

95117 ............ A Immunotherapy injections .................................. 0.00 0.48 0.48 0.02 0.50 0.50 000

95120 ............ I Immunotherapy, one injection ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

95125 ............ I Immunotherapy, many antigens ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

95130 ............ I Immunotherapy, insect venom ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

95131 ............ I Immunotherapy, insect venoms ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

95132 ............ I Immunotherapy, insect venoms ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

95133 ............ I Immunotherapy, insect venoms ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

95134 ............ I Immunotherapy, insect venoms ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

95144 ............ A Antigen therapy services .................................... 0.06 0.13 0.13 0.01 0.20 0.20 000

95145 ............ A Antigen therapy services .................................... 0.06 0.34 0.34 0.03 0.43 0.43 000

95146 ............ A Antigen therapy services .................................... 0.06 0.61 0.61 0.03 0.70 0.70 000

95147 ............ A Antigen therapy services .................................... 0.06 0.91 0.91 0.03 1.00 1.00 000

95148 ............ A Antigen therapy services .................................... 0.06 0.91 0.91 0.03 1.00 1.00 000

95149 ............ A Antigen therapy services .................................... 0.06 1.14 1.14 0.03 1.23 1.23 000

95165 ............ A Antigen therapy services .................................... 0.06 0.10 0.10 0.01 0.17 0.17 000

95170 ............ A Antigen therapy services .................................... 0.06 0.35 0.35 0.03 0.44 0.44 000

95180 ............ A Rapid desensitization ......................................... 2.01 0.14 0.14 0.01 2.16 2.16 000

95199 ............ C Allergy immunology services ............................. 0.00 0.00 0.00 0.00 0.00 0.00 000

95805 ............ A Multiple sleep latency test .................................. 1.88 5.51 5.51 0.45 7.84 7.84 XXX

95805 TC A Multiple sleep latency test .................................. 0.00 4.95 4.95 0.38 5.33 5.33 XXX

95805 26 A Multiple sleep latency test .................................. 1.88 0.56 0.56 0.07 2.51 2.51 XXX

95806 ............ A Sleep study, unattended .................................... 1.66 7.18 6.56 0.55 9.39 8.77 XXX

95806 TC A Sleep study, unattended .................................... 0.00 4.73 4.73 0.36 5.09 5.09 XXX

95806 26 A Sleep study, unattended .................................... 1.66 2.45 #1.83 0.19 4.30 3.68 XXX

95807 ............ A Sleep study, attended ........................................ 1.66 8.13 8.13 0.67 10.46 10.46 XXX

95807 TC A Sleep study, attended ........................................ 0.00 6.30 6.30 0.48 6.78 6.78 XXX

95807 26 A Sleep study, attended ........................................ 1.66 #1.83 #1.83 0.19 3.68 3.68 XXX

95808 ............ A Polysomnography, 1–3 ...................................... 2.65 8.75 8.75 0.67 12.07 12.07 XXX

95808 TC A Polysomnography, 1–3 ...................................... 0.00 6.30 6.30 0.48 6.78 6.78 XXX

95808 26 A Polysomnography, 1–3 ...................................... 2.65 2.45 2.45 0.19 5.29 5.29 XXX

95810 ............ A Polysomnography, 4 or more ............................. 3.53 8.75 8.75 0.67 12.95 12.95 XXX

95810 TC A Polysomnography, 4 or more ............................. 0.00 6.30 6.30 0.48 6.78 6.78 XXX

95810 26 A Polysomnography, 4 or more ............................. 3.53 2.45 2.45 0.19 6.17 6.17 XXX

95811 ............ A Polysomnography w/cpap .................................. 3.80 9.19 9.19 0.70 13.69 13.69 XXX

95811 TC A Polysomnography w/cpap .................................. 0.00 6.62 6.62 0.50 7.12 7.12 XXX

95811 26 A Polysomnography w/cpap .................................. 3.80 2.57 2.57 0.20 6.57 6.57 XXX

95812 ............ A Electroencephalogram (EEG) ............................ 1.08 1.85 1.85 0.15 3.08 3.08 XXX

95812 TC A Electroencephalogram (EEG) ............................ 0.00 1.35 1.35 0.11 1.46 1.46 XXX

95812 26 A Electroencephalogram (EEG) ............................ 1.08 0.50 0.50 0.04 1.62 1.62 XXX

95813 ............ A Electroencephalogram (EEG) ............................ 1.73 1.85 1.85 0.15 3.73 3.73 XXX

95813 TC A Electroencephalogram (EEG) ............................ 0.00 1.35 1.35 0.11 1.46 1.46 XXX

95813 26 A Electroencephalogram (EEG) ............................ 1.73 0.50 0.50 0.04 2.27 2.27 XXX

95816 ............ A Electroencephalogram (EEG) ............................ 1.08 1.54 1.54 0.13 2.75 2.75 XXX

95816 TC A Electroencephalogram (EEG) ............................ 0.00 1.26 1.26 0.10 1.36 1.36 XXX

95816 26 A Electroencephalogram (EEG) ............................ 1.08 0.28 0.28 0.03 1.39 1.39 XXX

95819 ............ A Electroencephalogram (EEG) ............................ 1.08 1.80 1.80 0.14 3.02 3.02 XXX

95819 TC A Electroencephalogram (EEG) ............................ 0.00 1.30 1.30 0.10 1.40 1.40 XXX

95819 26 A Electroencephalogram (EEG) ............................ 1.08 0.50 0.50 0.04 1.62 1.62 XXX

95822 ............ A Sleep electroencephalogram ............................. 1.08 2.28 2.28 0.18 3.54 3.54 XXX

95822 TC A Sleep electroencephalogram ............................. 0.00 1.72 1.72 0.14 1.86 1.86 XXX

95822 26 A Sleep electroencephalogram ............................. 1.08 0.56 0.56 0.04 1.68 1.68 XXX

95824 ............ A Electroencephalography ..................................... 0.74 0.98 0.98 0.07 1.79 1.79 XXX

95824 TC A Electroencephalography ..................................... 0.00 0.40 0.40 0.03 0.43 0.43 XXX

95824 26 A Electroencephalography ..................................... 0.74 0.58 0.58 0.04 1.36 1.36 XXX

95827 ............ A Night electroencephalogram .............................. 1.08 3.06 3.06 0.24 4.38 4.38 XXX

95827 TC A Night electroencephalogram .............................. 0.00 2.18 2.18 0.17 2.35 2.35 XXX

95827 26 A Night electroencephalogram .............................. 1.08 0.88 0.88 0.07 2.03 2.03 XXX

95829 ............ A Surgery electrocorticogram ................................ 6.21 0.59 0.59 0.05 6.85 6.85 XXX

95829 TC A Surgery electrocorticogram ................................ 0.00 0.14 0.14 0.02 0.16 0.16 XXX

95829 26 A Surgery electrocorticogram ................................ 6.21 0.45 0.45 0.03 6.69 6.69 XXX

95830 ............ A Insert electrodes for EEG .................................. 1.70 0.78 0.78 0.07 2.55 2.55 XXX

95831 ............ A Limb muscle testing, manual ............................. 0.28 0.29 0.29 0.03 0.60 0.60 XXX

95832 ............ A Hand muscle testing, manual ............................ 0.29 0.25 0.25 0.02 0.56 0.56 XXX

95833 ............ A Body muscle testing, manual ............................. 0.47 0.38 0.38 0.05 0.90 0.90 XXX

95834 ............ A Body muscle testing, manual ............................. 0.60 0.61 0.61 0.06 1.27 1.27 XXX

95851 ............ A Range of motion measurements ........................ 0.16 0.24 0.24 0.02 0.42 0.42 XXX

95852 ............ A Range of motion measurements ........................ 0.11 0.15 0.15 0.02 0.28 0.28 XXX
59222

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

95857 ............ A Tensilon test ....................................................... 0.53 0.50 0.50 0.04 1.07 1.07 XXX

95858 ............ A Tensilon test & myogram ................................... 1.56 1.02 1.02 0.09 2.67 2.67 XXX

95858 TC A Tensilon test & myogram ................................... 0.00 0.38 0.38 0.04 0.42 0.42 XXX

95858 26 A Tensilon test & myogram ................................... 1.56 0.64 0.64 0.05 2.25 2.25 XXX

95860 ............ A Muscle test, one limb ......................................... 0.96 1.09 1.09 0.09 2.14 2.14 XXX

95860 TC A Muscle test, one limb ......................................... 0.00 0.36 0.36 0.03 0.39 0.39 XXX

95860 26 A Muscle test, one limb ......................................... 0.96 0.73 0.73 0.06 1.75 1.75 XXX

95861 ............ A Muscle test, two limbs ........................................ 1.54 1.97 1.97 0.16 3.67 3.67 XXX

95861 TC A Muscle test, two limbs ........................................ 0.00 0.70 0.70 0.06 0.76 0.76 XXX

95861 26 A Muscle test, two limbs ........................................ 1.54 1.27 1.27 0.10 2.91 2.91 XXX

95863 ............ A Muscle test, 3 limbs ........................................... 1.87 2.30 2.30 0.18 4.35 4.35 XXX

95863 TC A Muscle test, 3 limbs ........................................... 0.00 0.89 0.89 0.07 0.96 0.96 XXX

95863 26 A Muscle test, 3 limbs ........................................... 1.87 1.41 1.41 0.11 3.39 3.39 XXX

95864 ............ A Muscle test, 4 limbs ........................................... 1.99 3.45 3.45 0.27 5.71 5.71 XXX

95864 TC A Muscle test, 4 limbs ........................................... 0.00 1.70 1.70 0.13 1.83 1.83 XXX

95864 26 A Muscle test, 4 limbs ........................................... 1.99 1.75 1.75 0.14 3.88 3.88 XXX

95867 ............ A Muscle test, head or neck .................................. 0.79 1.13 1.13 0.09 2.01 2.01 XXX

95867 TC A Muscle test, head or neck .................................. 0.00 0.55 0.55 0.04 0.59 0.59 XXX

95867 26 A Muscle test, head or neck .................................. 0.79 0.58 0.58 0.05 1.42 1.42 XXX

95868 ............ A Muscle test, head or neck .................................. 1.18 1.92 1.92 0.15 3.25 3.25 XXX

95868 TC A Muscle test, head or neck .................................. 0.00 0.66 0.66 0.05 0.71 0.71 XXX

95868 26 A Muscle test, head or neck .................................. 1.18 1.26 1.26 0.10 2.54 2.54 XXX

95869 ............ A Muscle test, thor paraspinal ............................... 0.37 0.53 0.53 0.05 0.95 0.95 XXX

95869 TC A Muscle test, thor paraspinal ............................... 0.00 0.20 0.20 0.02 0.22 0.22 XXX

95869 26 A Muscle test, thor paraspinal ............................... 0.37 0.33 0.33 0.03 0.73 0.73 XXX

95870 ............ A Muscle test, non-paraspinal ............................... 0.37 0.53 0.53 0.05 0.95 0.95 XXX

95870 TC A Muscle test, non-paraspinal ............................... 0.00 0.20 0.20 0.02 0.22 0.22 XXX

95870 26 A Muscle test, non-paraspinal ............................... 0.37 0.33 0.33 0.03 0.73 0.73 XXX

95872 ............ A Muscle test, one fiber ......................................... 1.50 1.25 1.25 0.11 2.86 2.86 XXX

95872 TC A Muscle test, one fiber ......................................... 0.00 0.57 0.57 0.05 0.62 0.62 XXX

95872 26 A Muscle test, one fiber ......................................... 1.50 0.68 0.68 0.06 2.24 2.24 XXX

95875 ............ A Limb exercise test .............................................. 1.34 0.60 0.60 0.10 2.04 2.04 XXX

95875 TC A Limb exercise test .............................................. 0.00 0.38 0.38 0.06 0.44 0.44 XXX

95875 26 A Limb exercise test .............................................. 1.34 0.22 0.22 0.04 1.60 1.60 XXX

95900 ............ A Motor nerve conduction test .............................. 0.42 0.62 0.62 0.05 1.09 1.09 XXX

95900 TC A Motor nerve conduction test .............................. 0.00 0.27 0.27 0.02 0.29 0.29 XXX

95900 26 A Motor nerve conduction test .............................. 0.42 0.35 0.35 0.03 0.80 0.80 XXX

95903 ............ A Motor nerve conduction test .............................. 0.60 0.59 0.59 0.05 1.24 1.24 XXX

95903 TC A Motor nerve conduction test .............................. 0.00 0.24 0.24 0.02 0.26 0.26 XXX

95903 26 A Motor nerve conduction test .............................. 0.60 0.35 0.35 0.03 0.98 0.98 XXX

95904 ............ A Sense nerve conduction test ............................. 0.34 0.55 0.55 0.05 0.94 0.94 XXX

95904 TC A Sense nerve conduction test ............................. 0.00 0.21 0.21 0.02 0.23 0.23 XXX

95904 26 A Sense nerve conduction test ............................. 0.34 0.34 0.34 0.03 0.71 0.71 XXX

95920 ............ A Intraoperative nerve testing ............................... 2.11 2.67 2.67 0.20 4.98 4.98 XXX

95920 TC A Intraoperative nerve testing ............................... 0.00 1.24 1.24 0.08 1.32 1.32 XXX

95920 26 A Intraoperative nerve testing ............................... 2.11 1.43 1.43 0.12 3.66 3.66 XXX

95921 ............ A Autonomic nervous func test ............................. 0.90 0.68 0.68 0.05 1.63 1.63 XXX

95921 TC A Autonomic nervous func test ............................. 0.00 0.36 0.36 0.03 0.39 0.39 XXX

95921 26 A Autonomic nervous func test ............................. 0.90 0.32 0.32 0.02 1.24 1.24 XXX

95922 ............ A Autonomic nervous func test ............................. 0.96 0.70 0.70 0.06 1.72 1.72 XXX

95922 TC A Autonomic nervous func test ............................. 0.00 0.36 0.36 0.03 0.39 0.39 XXX

95922 26 A Autonomic nervous func test ............................. 0.96 0.34 0.34 0.03 1.33 1.33 XXX

95923 ............ A Autonomic nervous func test ............................. 0.90 0.68 0.68 0.05 1.63 1.63 XXX

95923 TC A Autonomic nervous func test ............................. 0.00 0.36 0.36 0.03 0.39 0.39 XXX

95923 26 A Autonomic nervous func test ............................. 0.90 0.32 0.32 0.02 1.24 1.24 XXX

95925 ............ A Somatosensory testing ....................................... 0.54 1.51 1.51 0.12 2.17 2.17 XXX

95925 TC A Somatosensory testing ....................................... 0.00 0.87 0.87 0.07 0.94 0.94 XXX

95925 26 A Somatosensory testing ....................................... 0.54 0.64 0.64 0.05 1.23 1.23 XXX

95926 ............ A Somatosensory testing ....................................... 0.54 1.51 1.51 0.12 2.17 2.17 XXX

95926 TC A Somatosensory testing ....................................... 0.00 0.87 0.87 0.07 0.94 0.94 XXX

95926 26 A Somatosensory testing ....................................... 0.54 0.64 0.64 0.05 1.23 1.23 XXX

95927 ............ A Somatosensory testing ....................................... 0.54 1.51 1.51 0.12 2.17 2.17 XXX

95927 TC A Somatosensory testing ....................................... 0.00 0.87 0.87 0.07 0.94 0.94 XXX

95927 26 A Somatosensory testing ....................................... 0.54 0.64 0.64 0.05 1.23 1.23 XXX

95930 ............ A Visual evoked potential test ............................... 0.35 0.83 0.83 0.05 1.23 1.23 XXX

95930 TC A Visual evoked potential test ............................... 0.00 0.25 0.25 0.01 0.26 0.26 XXX

95930 26 A Visual evoked potential test ............................... 0.35 0.58 0.58 0.04 0.97 0.97 XXX

95933 ............ A Blink reflex test ................................................... 0.59 1.25 1.25 0.10 1.94 1.94 XXX

95933 TC A Blink reflex test ................................................... 0.00 0.75 0.75 0.06 0.81 0.81 XXX

95933 26 A Blink reflex test ................................................... 0.59 0.50 0.50 0.04 1.13 1.13 XXX

95934 ............ A h reflex test ........................................................ 0.51 0.54 0.54 0.05 1.10 1.10 XXX

95934 TC A h reflex test ........................................................ 0.00 0.20 0.20 0.02 0.22 0.22 XXX

95934 26 A h reflex test ........................................................ 0.51 0.34 0.34 0.03 0.88 0.88 XXX

95936 ............ A h reflex test ........................................................ 0.55 0.54 0.54 0.05 1.14 1.14 XXX
59223

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

95936 TC A h reflex test ........................................................ 0.00 0.20 0.20 0.02 0.22 0.22 XXX

95936 26 A h reflex test ........................................................ 0.55 0.34 0.34 0.03 0.92 0.92 XXX

95937 ............ A Neuromuscular junction test .............................. 0.65 0.77 0.77 0.07 1.49 1.49 XXX

95937 TC A Neuromuscular junction test .............................. 0.00 0.32 0.32 0.03 0.35 0.35 XXX

95937 26 A Neuromuscular junction test .............................. 0.65 0.45 0.45 0.04 1.14 1.14 XXX

95950 ............ A Ambulatory eeg monitoring ................................ 1.51 7.25 7.25 0.60 9.36 9.36 XXX

95950 TC A Ambulatory eeg monitoring ................................ 0.00 6.04 6.04 0.50 6.54 6.54 XXX

95950 26 A Ambulatory eeg monitoring ................................ 1.51 1.21 1.21 0.10 2.82 2.82 XXX

95951 ............ A EEG monitoring/videorecord .............................. 6.00 8.83 8.83 0.64 15.47 15.47 XXX

95951 TC A EEG monitoring/videorecord .............................. 0.00 7.33 7.33 0.53 7.86 7.86 XXX

95951 26 A EEG monitoring/videorecord .............................. 6.00 1.50 1.50 0.11 7.61 7.61 XXX

95953 ............ A EEG monitoring/computer .................................. 3.08 7.25 7.25 0.60 10.93 10.93 XXX

95953 TC A EEG monitoring/computer .................................. 0.00 6.04 6.04 0.50 6.54 6.54 XXX

95953 26 A EEG monitoring/computer .................................. 3.08 1.21 1.21 0.10 4.39 4.39 XXX

95954 ............ A EEG monitoring/giving drugs ............................. 2.45 2.32 2.32 0.28 5.05 5.05 XXX

95954 TC A EEG monitoring/giving drugs ............................. 0.00 0.45 0.45 0.06 0.51 0.51 XXX

95954 26 A EEG monitoring/giving drugs ............................. 2.45 1.87 1.87 0.22 4.54 4.54 XXX

95955 ............ A EEG during surgery ........................................... 1.01 2.90 2.90 0.30 4.21 4.21 XXX

95955 TC A EEG during surgery ........................................... 0.00 1.87 1.87 0.19 2.06 2.06 XXX

95955 26 A EEG during surgery ........................................... 1.01 1.03 1.03 0.11 2.15 2.15 XXX

95956 ............ A EEG monitoring/cable/radio ............................... 3.08 7.54 7.54 0.61 11.23 11.23 XXX

95956 TC A EEG monitoring/cable/radio ............................... 0.00 6.04 6.04 0.50 6.54 6.54 XXX

95956 26 A EEG monitoring/cable/radio ............................... 3.08 1.50 1.50 0.11 4.69 4.69 XXX

95957 ............ A EEG digital analysis ........................................... 1.98 2.25 2.25 0.18 4.41 4.41 XXX

95957 TC A EEG digital analysis ........................................... 0.00 1.62 1.62 0.13 1.75 1.75 XXX

95957 26 A EEG digital analysis ........................................... 1.98 0.63 0.63 0.05 2.66 2.66 XXX

95958 ............ A EEG monitoring/function test ............................. 4.25 4.89 4.89 0.52 9.66 9.66 XXX

95958 TC A EEG monitoring/function test ............................. 0.00 1.66 1.66 0.14 1.80 1.80 XXX

95958 26 A EEG monitoring/function test ............................. 4.25 3.23 3.23 0.38 7.86 7.86 XXX

95961 ............ A Electrode stimulation, brain ................................ 2.97 2.67 2.67 0.20 5.84 5.84 XXX

95961 TC A Electrode stimulation, brain ................................ 0.00 1.24 1.24 0.08 1.32 1.32 XXX

95961 26 A Electrode stimulation, brain ................................ 2.97 1.43 1.43 0.12 4.52 4.52 XXX

95962 ............ A Electrode stimulation, brain ................................ 3.21 2.67 2.67 0.20 6.08 6.08 XXX

95962 TC A Electrode stimulation, brain ................................ 0.00 1.24 1.24 0.08 1.32 1.32 XXX

95962 26 A Electrode stimulation, brain ................................ 3.21 1.43 1.43 0.12 4.76 4.76 XXX

95999 ............ C Neurological procedure ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

96100 ............ A Psychological testing .......................................... 0.00 1.68 1.68 0.20 1.88 1.88 XXX

96105 ............ A Assessment of aphasia ...................................... 0.00 1.68 1.68 0.20 1.88 1.88 XXX

96110 ............ C Developmental test, lim ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

96111 ............ A Developmental test, extend ............................... 0.00 1.68 1.68 0.20 1.88 1.88 XXX

96115 ............ A Neurobehavior status exam ............................... 0.00 1.68 1.68 0.20 1.88 1.88 XXX

96117 ............ A Neuropsych test battery ..................................... 0.00 1.68 1.68 0.20 1.88 1.88 XXX

96400 ............ A Chemotherapy, (SC)/(IM) ................................... 0.00 0.13 0.13 0.01 0.14 0.14 XXX

96405 ............ A Intralesional chemo admin ................................. 0.52 0.38 0.38 0.03 0.93 0.93 000

96406 ............ A Intralesional chemo admin ................................. 0.80 0.56 0.56 0.04 1.40 1.40 000

96408 ............ A Chemotherapy, push technique ......................... 0.00 0.92 0.92 0.06 0.98 0.98 XXX

96410 ............ A Chemotherapy, infusion method ........................ 0.00 1.47 1.47 0.09 1.56 1.56 XXX

96412 ............ A Chemotherapy, infusion method ........................ 0.00 1.10 1.10 0.08 1.18 1.18 XXX

96414 ............ A Chemotherapy, infusion method ........................ 0.00 1.27 1.27 0.09 1.36 1.36 XXX

96420 ............ A Chemotherapy, push technique ......................... 0.00 1.19 1.19 0.09 1.28 1.28 XXX

96422 ............ A Chemotherapy, infusion method ........................ 0.00 1.17 1.17 0.09 1.26 1.26 XXX

96423 ............ A Chemotherapy, infusion method ........................ 0.00 0.46 0.46 0.03 0.49 0.49 XXX

96425 ............ A Chemotherapy, infusion method ........................ 0.00 1.36 1.36 0.09 1.45 1.45 XXX

96440 ............ A Chemotherapy, intracavitary .............................. 2.37 0.81 0.81 0.06 3.24 3.24 000

96445 ............ A Chemotherapy, intracavitary .............................. 2.20 0.98 0.98 0.09 3.27 3.27 000

96450 ............ A Chemotherapy, into CNS ................................... 1.89 0.87 0.87 0.06 2.82 2.82 000

96520 ............ A Pump refilling, maintenance ............................... 0.00 0.85 0.85 0.06 0.91 0.91 XXX

96530 ............ A Pump refilling, maintenance ............................... 0.00 1.01 1.01 0.07 1.08 1.08 XXX

96542 ............ A Chemotherapy injection ..................................... 1.42 1.09 1.09 0.13 2.64 2.64 XXX

96545 ............ B Provide chemotherapy agent ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

96549 ............ C Chemotherapy, unspecified ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

96900 ............ A Ultraviolet light therapy ...................................... 0.00 0.38 0.38 0.03 0.41 0.41 XXX

96902 ............ B Trichogram ......................................................... +0.41 0.29 0.29 0.02 0.72 0.72 XXX

96910 ............ A Photochemotherapy with UV–B ......................... 0.00 0.55 0.55 0.04 0.59 0.59 XXX

96912 ............ A Photochemotherapy with UV–A ......................... 0.00 0.63 0.63 0.05 0.68 0.68 XXX

96913 ............ A Photochemotherapy, UV–A or B ........................ 0.00 1.29 1.29 0.10 1.39 1.39 XXX

96999 ............ C Dermatological procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

97001 ............ A Pt evaluation ...................................................... 1.20 0.35 0.35 0.11 1.66 1.66 XXX

97002 ............ A Pt re-evaluation .................................................. 0.60 0.04 0.04 0.01 0.65 0.65 XXX

97003 ............ A Ot evaluation ...................................................... 1.20 0.35 0.35 0.11 1.66 1.66 XXX

97004 ............ A Ot re-evaluation .................................................. 0.60 0.04 0.04 0.01 0.65 0.65 XXX

97010 ............ B Hot or cold packs therapy .................................. +0.06 0.21 0.21 0.02 0.29 0.29 XXX

97012 ............ A Mechanical traction therapy ............................... 0.25 0.19 0.19 0.02 0.46 0.46 XXX

97014 ............ A Electric stimulation therapy ................................ 0.18 0.20 0.20 0.02 0.40 0.40 XXX
59224

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

97016 ............ A Vasopneumatic device therapy .......................... 0.18 0.25 0.25 0.02 0.45 0.45 XXX

97018 ............ A Paraffin bath therapy .......................................... 0.06 0.24 0.24 0.03 0.33 0.33 XXX

97020 ............ A Microwave therapy ............................................. 0.06 0.20 0.20 0.02 0.28 0.28 XXX

97022 ............ A Whirlpool therapy ............................................... 0.17 0.19 0.19 0.02 0.38 0.38 XXX

97024 ............ A Diathermy treatment ........................................... 0.06 0.21 0.21 0.02 0.29 0.29 XXX

97026 ............ A Infrared therapy .................................................. 0.06 0.19 0.19 0.02 0.27 0.27 XXX

97028 ............ A Ultraviolet therapy .............................................. 0.08 0.19 0.19 0.01 0.28 0.28 XXX

97032 ............ A Electrical stimulation .......................................... 0.25 0.14 0.14 0.01 0.40 0.40 XXX

97033 ............ A Electric current therapy ...................................... 0.26 0.14 0.14 0.02 0.42 0.42 XXX

97034 ............ A Contrast bath therapy ........................................ 0.21 0.10 0.10 0.01 0.32 0.32 XXX

97035 ............ A Ultrasound therapy ............................................. 0.21 0.11 0.11 0.01 0.33 0.33 XXX

97036 ............ A Hydrotherapy ...................................................... 0.28 0.21 0.21 0.02 0.51 0.51 XXX

97039 ............ A Physical therapy treatment ................................ 0.20 0.24 0.24 0.03 0.47 0.47 XXX

97110 ............ A Therapeutic exercises ........................................ 0.45 0.13 0.13 0.02 0.60 0.60 XXX

97112 ............ A Neuromuscular reeducation ............................... 0.45 0.13 0.13 0.01 0.59 0.59 XXX

97113 ............ A Aquatic therapy/exercises .................................. 0.44 0.20 0.20 0.02 0.66 0.66 XXX

97116 ............ A Gait training therapy ........................................... 0.40 0.11 0.11 0.01 0.52 0.52 XXX

97122 ............ A Manual traction therapy ..................................... 0.42 0.11 0.11 0.01 0.54 0.54 XXX

97124 ............ A Massage therapy ................................................ 0.35 0.11 0.11 0.01 0.47 0.47 XXX

97139 ............ A Physical medicine procedure ............................. 0.21 0.16 0.16 0.02 0.39 0.39 XXX

97150 ............ A Group therapeutic procedures ........................... 0.27 0.20 0.20 0.02 0.49 0.49 XXX

97250 ............ A Myofascial release ............................................. 0.45 0.35 0.35 0.04 0.84 0.84 000

97260 ............ A Regional manipulation ........................................ 0.19 0.20 0.20 0.02 0.41 0.41 000

97261 ............ A Supplemental manipulations .............................. 0.12 0.11 0.11 0.01 0.24 0.24 000

97265 ............ A Joint mobilization ................................................ 0.45 0.35 0.35 0.04 0.84 0.84 XXX

97504 ............ A Orthotic training .................................................. 0.45 0.14 0.14 0.02 0.61 0.61 XXX

97520 ............ A Prosthetic training .............................................. 0.45 0.15 0.15 0.02 0.62 0.62 XXX

97530 ............ A Therapeutic activities ......................................... 0.44 0.17 0.17 0.02 0.63 0.63 XXX

97535 ............ A Self care mngment training ................................ 0.45 0.17 0.17 0.02 0.64 0.64 XXX

97537 ............ A Community/work reintegration ........................... 0.45 0.17 0.17 0.02 0.64 0.64 XXX

97542 ............ A Wheelchair mngement training .......................... 0.25 0.17 0.17 0.02 0.44 0.44 XXX

97545 ............ R Work hardening .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

97546 ............ R Work hardening .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

97703 ............ A Prosthetic checkout ............................................ 0.25 0.18 0.18 0.03 0.46 0.46 XXX

97750 ............ A Physical performance test .................................. 0.45 0.24 0.24 0.03 0.72 0.72 XXX

97770 ............ A Cognitive skills development .............................. 0.44 0.28 0.28 0.03 0.75 0.75 XXX

97780 ............ N Acupuncture w/o stim ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

97781 ............ N Acupuncture w/stim ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

97799 ............ C Physical medicine procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

98925 ............ A Osteopathic manipulation ................................... 0.45 0.25 0.25 0.02 0.72 0.72 000

98926 ............ A Osteopathic manipulation ................................... 0.65 0.40 0.40 0.03 1.08 1.08 000

98927 ............ A Osteopathic manipulation ................................... 0.87 0.38 0.38 0.03 1.28 1.28 000

98928 ............ A Osteopathic manipulation ................................... 1.03 0.42 0.42 0.04 1.49 1.49 000

98929 ............ A Osteopathic manipulation ................................... 1.19 0.39 0.39 0.03 1.61 1.61 000

98940 ............ A Chiropractic manipulation ................................... 0.45 0.29 0.29 0.01 0.75 0.75 000

98941 ............ A Chiropractic manipulation ................................... 0.65 0.29 0.29 0.01 0.95 0.95 000

98942 ............ A Chiropractic manipulation ................................... 0.87 0.29 0.29 0.01 1.17 1.17 000

98943 ............ N Chiropractic manipulation ................................... +0.40 0.29 0.29 0.01 0.70 0.70 XXX

99000 ............ B Specimen handling ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99001 ............ B Specimen handling ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99002 ............ B Device handling .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99024 ............ B Post-op follow-up visit ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99025 ............ B Initial surgical evaluation .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99050 ............ B Medical services after hrs .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99052 ............ B Medical services at night ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99054 ............ B Medical services, unusual hrs ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99056 ............ B Non-office medical services ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99058 ............ B Office emergency care ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99070 ............ B Special supplies ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99071 ............ B Patient education materials ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99075 ............ N Medical testimony .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99078 ............ B Group health education ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99080 ............ B Special reports or forms ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99082 ............ C Unusual physician travel .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99090 ............ B Computer data analysis ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99100 ............ B Special anesthesia service ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99116 ............ B Anesthesia with hypothermia ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99135 ............ B Special anesthesia procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99140 ............ B Emergency anesthesia ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99141 ............ B Sedation, iv/im or inhalant ................................. +0.80 0.83 0.83 0.05 1.68 1.68 XXX

99142 ............ B Sedation, oral/rectal/nasal .................................. +0.60 0.62 0.62 0.04 1.26 1.26 XXX

99175 ............ A Induction of vomiting .......................................... 0.00 1.33 1.33 0.10 1.43 1.43 XXX

99183 ............ A Hyperbaric oxygen therapy ................................ 2.34 1.67 1.67 0.11 4.12 4.12 XXX

99185 ............ A Regional hypothermia ........................................ 0.00 0.61 0.61 0.04 0.65 0.65 XXX
59225

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

99186 ............ A Total body hypothermia ..................................... 0.00 1.70 1.70 0.52 2.22 2.22 XXX

99190 ............ X Special pump services ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99191 ............ X Special pump services ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99192 ............ X Special pump services ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99195 ............ A Phlebotomy ........................................................ 0.00 0.42 0.42 0.03 0.45 0.45 XXX

99199 ............ C Special service or report .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99201 ............ A Office/outpatient visit, new ................................. 0.45 0.42 0.37 0.04 0.91 0.86 XXX

99202 ............ A Office/outpatient visit, new ................................. 0.88 0.51 0.45 0.05 1.44 1.38 XXX

99203 ............ A Office/outpatient visit, new ................................. 1.34 0.59 0.52 0.06 1.99 1.92 XXX

99204 ............ A Office/outpatient visit, new ................................. 2.00 0.88 0.78 0.08 2.96 2.86 XXX

99205 ............ A Office/outpatient visit, new ................................. 2.67 0.96 0.85 0.09 3.72 3.61 XXX

99211 ............ A Office/outpatient visit, est ................................... 0.17 0.21 0.19 0.02 0.40 0.38 XXX

99212 ............ A Office/outpatient visit, est ................................... 0.45 0.32 0.28 0.02 0.79 0.75 XXX

99213 ............ A Office/outpatient visit, est ................................... 0.67 0.43 0.38 0.03 1.13 1.08 XXX

99214 ............ A Office/outpatient visit, est ................................... 1.10 0.57 0.50 0.04 1.71 1.64 XXX

99215 ............ A Office/outpatient visit, est ................................... 1.77 0.86 0.76 0.07 2.70 2.60 XXX

99217 ............ A Observation care discharge ............................... 1.28 0.52 0.52 0.04 1.84 1.84 XXX

99218 ............ A Observation care ................................................ 1.28 0.68 0.68 0.06 2.02 2.02 XXX

99219 ............ A Observation care ................................................ 2.14 1.05 1.05 0.09 3.28 3.28 XXX

99220 ............ A Observation care ................................................ 2.99 1.14 1.14 0.09 4.22 4.22 XXX

99221 ............ A Initial hospital care ............................................. 1.28 0.67 0.67 0.06 2.01 2.01 XXX

99222 ............ A Initial hospital care ............................................. 2.14 1.04 1.04 0.09 3.27 3.27 XXX

99223 ............ A Initial hospital care ............................................. 2.99 1.13 1.13 0.08 4.20 4.20 XXX

99231 ............ A Subsequent hospital care .................................. 0.64 0.38 0.38 0.03 1.05 1.05 XXX

99232 ............ A Subsequent hospital care .................................. 1.06 0.45 0.45 0.04 1.55 1.55 XXX

99233 ............ A Subsequent hospital care .................................. 1.51 0.60 0.60 0.05 2.16 2.16 XXX

99234 ............ A Observ/hosp same date ..................................... 2.56 0.68 0.68 0.06 3.30 3.30 XXX

99235 ............ A Observ/hosp same date ..................................... 3.42 1.05 1.05 0.09 4.56 4.56 XXX

99236 ............ A Observ/hosp same date ..................................... 4.27 1.14 1.14 0.09 5.50 5.50 XXX

99238 ............ A Hospital discharge day ....................................... 1.28 0.51 0.51 0.04 1.83 1.83 XXX

99239 ............ A Hospital discharge day ....................................... 1.75 0.51 0.51 0.04 2.30 2.30 XXX

99241 ............ A Office consultation .............................................. 0.64 0.64 0.64 0.08 1.36 1.36 XXX

99242 ............ A Office consultation .............................................. 1.29 0.77 0.77 0.09 2.15 2.15 XXX

99243 ............ A Office consultation .............................................. 1.72 0.97 0.97 0.10 2.79 2.79 XXX

99244 ............ A Office consultation .............................................. 2.58 1.23 1.23 0.11 3.92 3.92 XXX

99245 ............ A Office consultation .............................................. 3.43 1.69 1.69 0.16 5.28 5.28 XXX

99251 ............ A Initial inpatient consult ........................................ 0.66 0.67 0.67 0.08 1.41 1.41 XXX

99252 ............ A Initial inpatient consult ........................................ 1.32 0.76 0.76 0.09 2.17 2.17 XXX

99253 ............ A Initial inpatient consult ........................................ 1.82 0.95 0.95 0.10 2.87 2.87 XXX

99254 ............ A Initial inpatient consult ........................................ 2.64 1.20 1.20 0.11 3.95 3.95 XXX

99255 ............ A Initial inpatient consult ........................................ 3.65 1.57 1.57 0.14 5.36 5.36 XXX

99261 ............ A Follow-up inpatient consult ................................ 0.42 0.33 0.33 0.03 0.78 0.78 XXX

99262 ............ A Follow-up inpatient consult ................................ 0.85 0.46 0.46 0.04 1.35 1.35 XXX

99263 ............ A Follow-up inpatient consult ................................ 1.27 0.67 0.67 0.04 1.98 1.98 XXX

99271 ............ A Confirmatory consultation .................................. 0.45 0.58 0.58 0.07 1.10 1.10 XXX

99272 ............ A Confirmatory consultation .................................. 0.84 0.71 0.71 0.09 1.64 1.64 XXX

99273 ............ A Confirmatory consultation .................................. 1.19 1.02 1.02 0.11 2.32 2.32 XXX

99274 ............ A Confirmatory consultation .................................. 1.73 1.22 1.22 0.11 3.06 3.06 XXX

99275 ............ A Confirmatory consultation .................................. 2.31 1.74 1.74 0.17 4.22 4.22 XXX

99281 ............ A Emergency dept visit .......................................... 0.33 0.28 0.28 0.01 0.62 0.62 XXX

99282 ............ A Emergency dept visit .......................................... 0.55 0.38 0.38 0.03 0.96 0.96 XXX

99283 ............ A Emergency dept visit .......................................... 1.24 0.49 0.49 0.04 1.77 1.77 XXX

99284 ............ A Emergency dept visit .......................................... 1.95 0.70 0.70 0.06 2.71 2.71 XXX

99285 ............ A Emergency dept visit .......................................... 3.06 1.13 1.13 0.08 4.27 4.27 XXX

99288 ............ B Direct advanced life support .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99291 ............ A Critical care, first hour ........................................ 4.00 1.43 1.43 0.11 5.54 5.54 XXX

99292 ............ A Critical care, addl 30 min ................................... 2.00 0.63 0.63 0.04 2.67 2.67 XXX

99295 ............ A Neonatal critical care ......................................... 16.00 5.08 5.08 1.55 22.63 22.63 XXX

99296 ............ A Neonatal critical care ......................................... 8.00 2.46 2.46 0.77 11.23 11.23 XXX

99297 ............ A Neonatal critical care ......................................... 4.00 1.23 1.23 0.38 5.61 5.61 XXX

99301 ............ A Nursing facility care ............................................ 1.20 0.45 0.45 0.03 1.68 1.68 XXX

99302 ............ A Nursing facility care ............................................ 1.61 0.50 0.50 0.04 2.15 2.15 XXX

99303 ............ A Nursing facility care ............................................ 2.01 0.95 0.95 0.07 3.03 3.03 XXX

99311 ............ A Nursing facility care, subseq .............................. 0.60 0.34 0.34 0.03 0.97 0.97 XXX

99312 ............ A Nursing facility care, subseq .............................. 1.00 0.41 0.41 0.03 1.44 1.44 XXX

99313 ............ A Nursing facility care, subseq .............................. 1.42 0.46 0.46 0.04 1.92 1.92 XXX

99315 ............ A Nursing fac discharge day ................................. 1.13 0.51 0.51 0.04 1.68 1.68 XXX

99316 ............ A Nursing fac discharge day ................................. 1.50 0.51 0.51 0.04 2.05 2.05 XXX

99321 ............ A Rest home visit, new patient .............................. 0.71 0.37 0.37 0.03 1.11 1.11 XXX

99322 ............ A Rest home visit, new patient .............................. 1.01 0.51 0.51 0.05 1.57 1.57 XXX

99323 ............ A Rest home visit, new patient .............................. 1.28 0.73 0.73 0.06 2.07 2.07 XXX

99331 ............ A Rest home visit, estab pat ................................. 0.60 0.28 0.28 0.02 0.90 0.90 XXX

99332 ............ A Rest home visit, estab pat ................................. 0.80 0.36 0.36 0.03 1.19 1.19 XXX

99333 ............ A Rest home visit, estab pat ................................. 1.00 0.44 0.44 0.02 1.46 1.46 XXX
59226

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

99341 ............ A Home visit, new patient ...................................... 1.01 0.53 0.53 0.05 1.59 1.59 XXX

99342 ............ A Home visit, new patient ...................................... 1.52 0.60 0.60 0.05 2.17 2.17 XXX

99343 ............ A Home visit, new patient ...................................... 2.27 0.77 0.77 0.06 3.10 3.10 XXX

99344 ............ A Home visit, new patient ...................................... 3.03 0.85 0.85 0.09 3.97 3.97 XXX

99345 ............ A Home visit, new patient ...................................... 3.79 0.85 0.85 0.09 4.73 4.73 XXX

99347 ............ A Home visit, estab patient ................................... 0.76 0.45 0.45 0.04 1.25 1.25 XXX

99348 ............ A Home visit, estab patient ................................... 1.26 0.53 0.53 0.04 1.83 1.83 XXX

99349 ............ A Home visit, estab patient ................................... 2.02 0.61 0.61 0.05 2.68 2.68 XXX

99350 ............ A Home visit, estab patient ................................... 3.03 0.76 0.76 0.07 3.86 3.86 XXX

99351 ............ D Home visit, estab patient ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99352 ............ D Home visit, estab patient ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99353 ............ D 12/Home visit, estab patient .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99354 ............ A Prolonged service, office .................................... 1.77 0.76 0.76 0.07 2.60 2.60 XXX

99355 ............ A Prolonged service, office .................................... 1.77 0.76 0.76 0.07 2.60 2.60 XXX

99356 ............ A Prolonged service, inpatient ............................... 1.71 0.85 0.85 0.08 2.64 2.64 XXX

99357 ............ A Prolonged service, inpatient ............................... 1.71 0.85 0.85 0.08 2.64 2.64 XXX

99358 ............ B Prolonged serv, w/o contact .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99359 ............ B Prolonged serv, w/o contact .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99360 ............ X Physician standby services ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99361 ............ B Physician/team conference ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99362 ............ B Physician/team conference ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99371 ............ B Physician phone consultation ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99372 ............ B Physician phone consultation ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99373 ............ B Physician phone consultation ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99374 ............ B Home health care supervision ........................... +1.10 0.51 0.51 0.04 1.65 1.65 XXX

99375 ............ A Home health care supervision ........................... 1.73 0.51 0.51 0.04 2.28 2.28 XXX

99376 ............ D 1Care plan oversight/over 60 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99377 ............ B Hospice care supervision ................................... +1.10 0.51 0.51 0.04 1.65 1.65 XXX

99378 ............ A Hospice care supervision ................................... 1.73 0.51 0.51 0.04 2.28 2.28 XXX

99379 ............ B Nursing fac care supervision ............................. +1.10 0.51 0.51 0.04 1.65 1.65 XXX

99380 ............ B Nursing fac care supervision ............................. +1.73 0.51 0.51 0.04 2.28 2.28 XXX

99381 ............ N Preventive visit, new, infant ............................... +1.19 1.23 1.23 0.08 2.50 2.50 XXX

99382 ............ N Preventive visit, new, age 1–4 ........................... +1.36 1.41 1.41 0.09 2.86 2.86 XXX

99383 ............ N Preventive visit, new, age 5–11 ......................... +1.36 1.41 1.41 0.09 2.86 2.86 XXX

99384 ............ N Preventive visit, new, 12–17 .............................. +1.53 1.59 1.59 0.10 3.22 3.22 XXX

99385 ............ N Preventive visit, new, 18–39 .............................. +1.53 1.40 1.40 0.09 3.02 3.02 XXX

99386 ............ N Preventive visit, new, 40–64 .............................. +1.88 1.72 1.72 0.10 3.70 3.70 XXX

99387 ............ N Preventive visit, new, 65 & over ........................ +2.06 1.88 1.88 0.11 4.05 4.05 XXX

99391 ............ N Preventive visit, est, infant ................................. +1.02 1.06 1.06 0.07 2.15 2.15 XXX

99392 ............ N Preventive visit, est, age 1–4 ............................. +1.19 1.23 1.23 0.08 2.50 2.50 XXX

99393 ............ N Preventive visit, est, age 5–11 ........................... +1.19 1.23 1.23 0.08 2.50 2.50 XXX

99394 ............ N Preventive visit, est, 12–17 ................................ +1.36 1.41 1.41 0.09 2.86 2.86 XXX

99395 ............ N Preventive visit, est, 18–39 ................................ +1.36 1.25 1.25 0.08 2.69 2.69 XXX

99396 ............ N Preventive visit, est, 40–64 ................................ +1.53 1.40 1.40 0.09 3.02 3.02 XXX

99397 ............ N Preventive visit, est, 65 & over .......................... +1.71 1.56 1.56 0.10 3.37 3.37 XXX

99401 ............ N Preventive counseling, indiv .............................. +0.48 0.45 0.45 0.03 0.96 0.96 XXX

99402 ............ N Preventive counseling, indiv .............................. +0.98 0.89 0.89 0.05 1.92 1.92 XXX

99403 ............ N Preventive counseling, indiv .............................. +1.46 1.34 1.34 0.08 2.88 2.88 XXX

99404 ............ N Preventive counseling, indiv .............................. +1.95 1.78 1.78 0.11 3.84 3.84 XXX

99411 ............ N Preventive counseling, group ............................. +0.15 0.14 0.14 0.01 0.30 0.30 XXX

99412 ............ N Preventive counseling, group ............................. +0.25 0.23 0.23 0.01 0.49 0.49 XXX

99420 ............ N Health risk assessment test ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99429 ............ N Unlisted preventive service ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99431 ............ A Initial care, normal newborn ............................... 1.17 1.21 1.21 0.08 2.46 2.46 XXX

99432 ............ A Newborn care not in hospital ............................. 1.26 1.31 1.31 0.08 2.65 2.65 XXX

99433 ............ A Normal newborn care, hospital .......................... 0.62 0.64 0.64 0.04 1.30 1.30 XXX

99435 ............ A Hospital NB discharge day ................................ 1.50 1.55 1.55 0.10 3.15 3.15 XXX

99436 ............ A Attendance, birth ................................................ 1.50 1.55 1.55 0.10 3.15 3.15 XXX

99440 ............ A Newborn resuscitation ........................................ 2.93 3.04 3.04 0.19 6.16 6.16 XXX

99450 ............ N Life/disability evaluation ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99455 ............ R Disability examination ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99456 ............ R Disability examination ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99499 ............ C Unlisted E/M service .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0021 ............ I Outside state ambulance serv ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0030 ............ X Air ambulance service ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0040 ............ X Helicopter ambulance service ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0050 ............ X Water amb service emergency .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0080 ............ I Noninterest escort in non er .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0090 ............ I Interest escort in non er ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0100 ............ I Nonemergency transport taxi ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0110 ............ I Nonemergency transport bus ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0120 ............ I Noner transport mini-bus ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0130 ............ I Noner transport wheelch van ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0140 ............ I Nonemergency transport air .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59227

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

A0160 ............ I Noner transport case worker ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0170 ............ I Noner transport parking fees ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0180 ............ I Noner transport lodgng recip ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0190 ............ I Noner transport meals recip .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0200 ............ I Noner transport lodgng escrt ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0210 ............ I Noner transport meals escort ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0225 ............ X Neonatal emergency transport ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0300 ............ X Ambulance basic non-emer all .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0302 ............ X Ambulance basic emergeny all .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0304 ............ X Amb adv non-er no serv all ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0306 ............ X Amb adv non-er spec serv all ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0308 ............ X Amb adv er no spec serv all .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0310 ............ X Amb adv er spec serv all ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0320 ............ X Amb basic non-er + supplies ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0322 ............ X Amb basic emerg + supplies ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0324 ............ X Adv non-er serv sep mileage ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0326 ............ X Adv non-er no serv sep mile .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0328 ............ X Adv er no serv sep mileage ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0330 ............ X Adv er spec serv sep mile ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0340 ............ X Amb basic non-er + mileage .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0342 ............ X Ambul basic emer + mileage ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0344 ............ X Amb adv non-er no serv +mile .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0346 ............ X Amb adv non-er serv + mile .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0348 ............ X Adv emer no spec serv + mile ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0350 ............ X Adv emer spec serv + mileage .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0360 ............ X Basic non-er sep mile & supp ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0362 ............ X Basic emer sep mile & supply ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0364 ............ X Adv non-er no serv sep mi & su ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0366 ............ X Adv non-er serv sep mil & supp ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0368 ............ X Adv er no serv sep mile & supp ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0370 ............ X Adv er spec serv sep mi & supp ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0380 ............ X Basic life support mileage .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0382 ............ X Basic support routine suppls .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0384 ............ X Bls defibrillation supplies .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0390 ............ X Advanced life support mileag ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0392 ............ X Als defibrillation supplies .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0394 ............ X Als IV drug therapy supplies .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0396 ............ X Als esophageal intub suppls .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0398 ............ X Als routine disposble suppls .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0420 ............ X Ambulance waiting 1/2 hr .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0422 ............ X Ambulance 02 life sustaining ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0424 ............ X Extra ambulance attendant ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0888 ............ N Noncovered ambulance mileage ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A0999 ............ X Unlisted ambulance service ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A2000 ............ D Chiropractor manip of spine ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4206 ............ P 1 CC sterile syringe & needle ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4207 ............ P 2 CC sterile syringe & needle ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4208 ............ P 3 CC sterile syringe & needle ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4209 ............ P 5+ CC sterile syringe & needle .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4210 ............ N Nonneedle injection device ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4211 ............ P Supp for self-adm injections .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4212 ............ P Non coring needle or stylet ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4213 ............ P 20+ CC syringe only .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4214 ............ P 30 CC sterile water/saline .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4215 ............ P Sterile needle ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4220 ............ P Infusion pump refill kit ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4221 ............ X Maint drug infus cath per wk ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4222 ............ X Drug infusion pump supplies ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4230 ............ N Infus insulin pump non needle ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4231 ............ N Infusion insulin pump needle ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4232 ............ N Syringe w/needle insulin 3cc ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4244 ............ P Alcohol or peroxide per pint ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4245 ............ P Alcohol wipes per box ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4246 ............ P Betadine/phisohex solution ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4247 ............ P Betadine/iodine swabs/wipes ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4250 ............ N Urine reagent strips/tablets ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4253 ............ P Blood glucose/reagent strips .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4254 ............ X Battery for glucose monitor ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4255 ............ X Glucose monitor platforms ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4256 ............ P Calibrator solution/chips ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4258 ............ P Lancet device each ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4259 ............ P Lancets per box ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4260 ............ N Levonorgestrel implant ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4262 ............ B Temporary tear duct plug ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59228

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

A4263 ............ A Permanent tear duct plug .................................. 0.00 0.95 0.95 0.00 0.95 0.95 XXX

A4265 ............ P Paraffin ............................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4270 ............ B Disposable endoscope sheath ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4300 ............ A Cath impl vasc access portal ............................. 0.00 0.95 0.95 0.00 0.95 0.95 XXX

A4301 ............ P Implantable access syst perc ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4305 ............ P Drug delivery system >=50 ML .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4306 ............ P Drug delivery system <=5 ML ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4310 ............ P Insert tray w/o bag/cath ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4311 ............ P Catheter w/o bag 2-way latex ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4312 ............ P Cath w/o bag 2-way silicone .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4313 ............ P Catheter w/bag 3-way ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4314 ............ P Cath w/drainage 2-way latex ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4315 ............ P Cath w/drainage 2-way silcne ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4316 ............ P Cath w/drainage 3-way ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4320 ............ P Irrigation tray ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4321 ............ X Cath therapeutic irrig agent ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4322 ............ P Irrigation syringe ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4323 ............ P Saline irrigation solution ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4326 ............ P Male external catheter ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4327 ............ P Fem urinary collect dev cup ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4328 ............ P Fem urinary collect pouch .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4329 ............ P External catheter start set .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4330 ............ P Stool collection pouch ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4335 ............ P Incontinence supply ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4338 ............ P Indwelling catheter latex .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4340 ............ P Indwelling catheter special ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4344 ............ P Cath indw foley 2 way silicn .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4346 ............ P Cath indw foley 3 way ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4347 ............ P Male external catheter ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4351 ............ P Straight tip urine catheter ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4352 ............ P Coude tip urinary catheter ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4353 ............ X Intermittent urinary cath ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4354 ............ P Cath insertion tray w/bag ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4355 ............ P Bladder irrigation tubing ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4356 ............ P Ext ureth clmp or compr dvc .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4357 ............ P Bedside drainage bag ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4358 ............ P Urinary leg bag ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4359 ............ P Urinary suspensory w/o leg b ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4361 ............ P Ostomy face plate .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4362 ............ P Solid skin barrier ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4363 ............ P Liquid skin barrier ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4364 ............ P Ostomy/cath adhesive ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4365 ............ X Ostomy adhesive remover wipe ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4367 ............ P Ostomy belt ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4368 ............ X Ostomy filter ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4397 ............ P Irrigation supply sleeve ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4398 ............ P Ostomy irrigation bag ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4399 ............ P Ostomy irrig cone/cath w brs ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4400 ............ P Ostomy irrigation set .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4402 ............ P Lubricant per ounce ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4404 ............ P Ostomy ring each ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4421 ............ P Ostomy supply misc ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4454 ............ P Tape all types all sizes ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4455 ............ P Adhesive remover per ounce ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4460 ............ P Elastic compression bandage ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4462 ............ X Abdmnl drssng holder/binder ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4465 ............ P Non-elastic extremity binder .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4470 ............ P Gravlee jet washer ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4480 ............ P Vabra aspirator ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4481 ............ X Tracheostoma filter ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4490 ............ N Above knee surgical stocking ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4495 ............ N Thigh length surg stocking ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4500 ............ N Below knee surgical stocking ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4510 ............ N Full length surg stocking .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4550 ............ A Surgical trays ..................................................... 0.00 0.95 0.95 0.00 0.95 0.95 XXX

A4554 ............ N Disposable underpads ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4556 ............ P Electrodes .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4557 ............ P Lead wires .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4558 ............ P Conductive paste or gel ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4560 ............ X Pessary .............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4565 ............ X Slings .................................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4570 ............ X Splint .................................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4572 ............ X Rib belt ............................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4575 ............ N Hyperbaric o2 chamber disps ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59229

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

A4580 ............ X Cast supplies (plaster) ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4590 ............ X Special casting material ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4595 ............ X TENS suppl 2 lead per month ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4611 ............ X Heavy duty battery ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4612 ............ X Battery cables .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4613 ............ X Battery charger ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4615 ............ X Cannula nasal .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4616 ............ X Tubing (oxygen) per foot .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4617 ............ X Mouth piece ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4618 ............ X Breathing circuits ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4619 ............ X Face tent ............................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4620 ............ X Variable concentration mask .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4621 ............ X Tracheotomy mask or collar .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4622 ............ X Tracheostomy or larngectomy ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4623 ............ X Tracheostomy inner cannula .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4624 ............ X Tracheal suction tube ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4625 ............ X Trach care kit for new trach ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4626 ............ X Tracheostomy cleaning brush ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4627 ............ N Spacer bag/reservoir .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4628 ............ X Oropharyngeal suction cath ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4629 ............ X Tracheostomy care kit ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4630 ............ X Repl bat t.e.n.s. own by pt ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4631 ............ X Wheelchair battery ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4635 ............ X Underarm crutch pad ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4636 ............ X Handgrip for cane etc ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4637 ............ X Repl tip cane/crutch/walker ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4640 ............ X Alternating pressure pad .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4641 ............ E Diagnostic imaging agent ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4642 ............ E Satumomab pendetide per dose ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4643 ............ E High dose contrast MRI ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4644 ............ E Contrast 100–199 MGs iodine ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4645 ............ E Contrast 200–299 MGs iodine ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4646 ............ E Contrast 300–399 MGs iodine ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4647 ............ B Supp- paramagnetic contr mat .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4649 ............ P Surgical supplies ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4650 ............ X Supp esrd centrifuge .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4655 ............ X Esrd syringe/needle ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4660 ............ X Esrd blood pressure device ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4663 ............ X Esrd blood pressure cuff .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4670 ............ N Auto blood pressure monitor .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4680 ............ X Activated carbon filters ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4690 ............ X Dialyzers ............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4700 ............ X Standard dialysate solution ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4705 ............ X Bicarb dialysate solution .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4712 ............ X Sterile water ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4714 ............ X Treated water for dialysis ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4730 ............ X Fistula cannulation set dial ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4735 ............ X Local/topical anesthetics .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4740 ............ X Esrd shunt accessory ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4750 ............ X Arterial or venous tubing .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4755 ............ X Arterial and venous tubing ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4760 ............ X Standard testing solution ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4765 ............ X Dialysate concentrate ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4770 ............ X Blood testing supplies ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4771 ............ X Blood clotting time tube ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4772 ............ X Dextrostick/glucose strips .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4773 ............ X Hemostix ............................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4774 ............ X Ammonia test paper ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4780 ............ X Esrd sterilizing agent .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4790 ............ X Esrd cleansing agents ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4800 ............ X Heparin/antidote dialysis .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4820 ............ X Supplies hemodialysis kit ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4850 ............ X Rubber tipped hemostats ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4860 ............ X Disposable catheter caps ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4870 ............ X Plumbing/electrical work .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4880 ............ X Water storage tanks ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4890 ............ R Contracts/repair/maintenance ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4900 ............ X Capd supply kit .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4901 ............ X Ccpd supply kit ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4905 ............ X Ipd supply kit ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4910 ............ X Esrd nonmedical supplies .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4912 ............ X Gomco drain bottle ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4913 ............ X Esrd supply ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4914 ............ X Preparation kit .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59230

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

A4918 ............ X Venous pressure clamp ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4919 ............ X Supp dialysis dialyzer holde .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4920 ............ X Harvard pressure clamp ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4921 ............ X Measuring cylinder ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4927 ............ X Gloves ................................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5051 ............ P Pouch clsd w barr attached ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5052 ............ P Clsd ostomy pouch w/o barr .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5053 ............ P Clsd ostomy pouch faceplate ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5054 ............ P Clsd ostomy pouch w/flange .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5055 ............ P Stoma cap .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5061 ............ P Pouch drainable w barrier at .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5062 ............ P Drnble ostomy pouch w/o barr ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5063 ............ P Drain ostomy pouch w/flange ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5064 ............ I Drain ostomy pouch w/fceplte ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5065 ............ I Drain ostomy pouch on fcplte ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5071 ............ P Urinary pouch w/barrier ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5072 ............ P Urinary pouch w/o barrier .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5073 ............ P Urinary pouch on barr w/flng ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5074 ............ I Urinary pouch w/faceplate ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5075 ............ I Urinary pouch on faceplate ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5081 ............ P Continent stoma plug ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5082 ............ P Continent stoma catheter ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5093 ............ P Ostomy accessory convex inse ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5102 ............ P Bedside drain btl w/wo tube ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5105 ............ P Urinary suspensory ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5112 ............ P Urinary leg bag ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5113 ............ P Latex leg strap ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5114 ............ P Foam/fabric leg strap ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5119 ............ P Skin barrier wipes box pr 50 .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5121 ............ P Solid skin barrier 6x6 ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5122 ............ P Solid skin barrier 8x8 ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5123 ............ P Skin barrier with flange ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5126 ............ P Adhesive disc/foam pad ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5131 ............ P Appliance cleaner ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5149 ............ P Incontinence/ostomy supply ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5500 ............ X Diab shoe for density insert ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5501 ............ X Diabetic custom molded shoe ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5502 ............ X Diabetic shoe density insert ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5503 ............ X Diabetic shoe w/roller/rockr ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5504 ............ X Diabetic shoe with wedge .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5505 ............ X Diab shoe w/metatarsal bar ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5506 ............ X Diabetic shoe w/off set heel ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A5507 ............ X Modification diabetic shoe .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6020 ............ P Collagen dressing cover ea ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6025 ............ I Silicone gel sheet, each ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6154 ............ P Wound pouch each ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6196 ............ P Alginate dressing <=16 sq in ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6197 ............ P Alginate drsg ≤16 <=48 sq in ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6198 ............ P alginate dressing > 48 sq in ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6199 ............ P Alginate drsg wound filler ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6203 ............ P Composite drsg <=16 sq in ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6204 ............ P Composite drsg >16<=48 sq in .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6205 ............ P Composite drsg >48 sq in .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6206 ............ P Contact layer <=16 sq in .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6207 ............ P Contact layer >16<=48 sq in .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6208 ............ P Contact layer >48 sq in ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6209 ............ P Foam drsg <=16 sq in w/o bdr .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6210 ............ P Foam drg >16<=48 sq in w/o b ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6211 ............ P Foam drg >48 sq in w/o brdr ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6212 ............ P Foam drg <=16 sq in w/border .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6213 ............ P Foam drg >16<=48 sq in w/bdr ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6214 ............ P Foam drg >48 sq in w/border ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6215 ............ P Foam dressing wound filler ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6216 ............ P Non-sterile gauze <=16 sq in ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6217 ............ P Non-sterile gauze >16<=48 sq ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6218 ............ P Non-sterile gauze >48 sq in ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6219 ............ P Gauze <=16 sq in w/border ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6220 ............ P Gauze >16 <=48 sq in w/bordr .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6221 ............ P Gauze >48 sq in w/border ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6222 ............ P Gauze <=16 in no w/sal w/o b ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6223 ............ P Gauze >16 <=48 no w/sal w/o b ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6224 ............ P Gauze >48 in no w/sal w/o b ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6228 ............ P Gauze <=16 sq in water/sal ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6229 ............ P Gauze >16 <=48 sq in watr/sal .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59231

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

A6230 ............ P Gauze >48 sq in water/salne ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6234 ............ P Hydrocolld drg <=16 w/o bdr ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6235 ............ P Hydrocolld drg >16 <=48 w/o b ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6236 ............ P Hydrocolld drg >48 in w/o b ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6237 ............ P Hydrocolld drg <=16 in w/bdr ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6238 ............ P Hydrocolld drg >16<=48 w/bdr ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6239 ............ P Hydrocolld drg >48 in w/bdr ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6240 ............ P Hydrocolld drg filler paste .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6241 ............ P Hydrocolloid drg filler dry ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6242 ............ P Hydrogel drg <=16 in w/o bdr ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6243 ............ P Hydrogel drg >16<=48 w/o bdr .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6244 ............ P Hydrogel drg >48 in w/o bdr .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6245 ............ P Hydrogel drg <=16 in w/bdr ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6246 ............ P Hydrogel drg >≤16 <=48 in w/b ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6247 ............ P Hydrogel drg >48 sq in w/b ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6248 ............ P Hydrogel drsg gel filler ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6250 ............ P Skin seal protect moisturizr ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6251 ............ P Absorpt drg <=16 sq in w/o b ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6252 ............ P Absorpt drg >16 <=48 w/o bdr ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6253 ............ P Absorpt drg >48 sq in w/o b .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6254 ............ P Absorpt drg <=16 sq in w/bdr ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6255 ............ P Absorpt drg >16<=48 in w/bdr ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6256 ............ P Absorpt drg >48 sq in w/bdr .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6257 ............ P Transparent film <= 16 sq in .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6258 ............ P Transparent film >16<=48 in .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6259 ............ P Transparent film >48 sq in ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6260 ............ P Wound cleanser any type/size ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6261 ............ P Wound filler gel/paste/oz .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6262 ............ P Wound filler dry form/gram ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6263 ............ P Non-sterile elastic gauze/yd ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6264 ............ P Non-sterile no elastic gauze .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6265 ............ P Tape per 18 sq inches ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6266 ............ P Impreg gauze no h20/sal/yard ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6402 ............ P Sterile gauze <=16 sq in .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6403 ............ P Sterile gauze >16 <=48 sq in ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6404 ............ P Sterile gauze >48 sq in ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6405 ............ P Sterile elastic gauze/yd ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A6406 ............ P Sterile non-elastic gauze/yd ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A9150 ............ E Misc/exper non-prescript dru ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A9160 ............ N Podiatrist non-covered servi .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A9170 ............ N Chiropractor non-covered ser ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A9190 ............ N Misc/expe personal comfort i ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A9270 ............ N Non-covered item or service .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A9300 ............ N Exercise equipment ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A9500 ............ E Technetium TC 99m sestamibi .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A9502 ............ X Technetium TC99M tetrofosmin ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A9503 ............ E Technetium TC 99m medronate ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A9505 ............ E Thallous chloride TL 201/mci ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A9600 ............ X Strontium-89 chloride ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0120 ............ N Periodic oral evaluation ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0140 ............ N Limit oral eval problm focus ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0150 ............ R Comprehensve oral evaluation .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D0160 ............ N Extensv oral eval prob focus ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0210 ............ I Intraor complete film series ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0220 ............ I Intraoral periapical first f .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0230 ............ I Intraoral periapical ea add ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0240 ............ R Intraoral occlusal film ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D0250 ............ R Extraoral first film ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D0260 ............ R Extraoral ea additional film ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D0270 ............ R Dental bitewing single film ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D0272 ............ R Dental bitewings two films ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D0274 ............ R Dental bitewings four films ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D0290 ............ I Dental film skull/facial bon ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0310 ............ I Dental saliography ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0320 ............ I Dental tmj arthrogram incl i ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0321 ............ I Dental other tmj films ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0322 ............ I Dental tomographic survey ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0330 ............ I Dental panoramic film ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0340 ............ I Dental cephalometric film ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0415 ............ N Bacteriologic study ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0425 ............ N Caries susceptibility test .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0460 ............ R Pulp vitality test .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D0470 ............ N Diagnostic casts ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D0471 ............ R Diagnostic photographs ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
59232

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

D0501 ............ R Histopathologic examinations ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D0502 ............ R Other oral pathology procedu ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D0999 ............ R Unspecified diagnostic proce ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D1110 ............ N Dental prophylaxis adult ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D1120 ............ N Dental prophylaxis child ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D1201 ............ N Topical fluor w prophy child ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D1203 ............ N Topical fluor w/o prophy chi ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D1204 ............ N Topical fluor w/o prophy adu ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D1205 ............ N Topical fluoride w/ prophy a ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D1310 ............ N Nutri counsel-control caries ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D1320 ............ N Tobacco counseling ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D1330 ............ N Oral hygiene instruction ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D1351 ............ N Dental sealant per tooth ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D1510 ............ R Space maintainer fxd unilat ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D1515 ............ R Fixed bilat space maintainer .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D1520 ............ R Remove unilat space maintainer ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D1525 ............ R Remove bilat space maintainer ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D1550 ............ R Recement space maintainer .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D2110 ............ N Amalgam one surface primary ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2120 ............ N Amalgam two surfaces primary ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2130 ............ N Amalgam three surfaces primary ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2131 ............ N Amalgam four/more surf primary ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2140 ............ N Amalgam one surface permanent ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2150 ............ N Amalgam two surfaces permanent .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2160 ............ N Amalgam three surfaces permanent .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2161 ............ N Amalgam 4 or > surfaces permanent ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2210 ............ N Silicate cement per restorat ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2330 ............ N Resin one surface-anterior ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2331 ............ N Resin two surfaces-anterior ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2332 ............ N Resin three surfaces-anterior ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2335 ............ N Resin 4/> surf or w incis an ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2336 ............ N Composite resin crown ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2380 ............ N Resin one surf poster primary ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2381 ............ N Resin two surf poster primary ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2382 ............ N Resin three/more surf post p ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2385 ............ N Resin one surf poster permanent ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2386 ............ N Resin two surf poster permanent ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2387 ............ N Resin three/more surf post p ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2410 ............ N Dental gold foil one surfaces ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2420 ............ N Dental gold foil two surfaces .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2430 ............ N Dental gold foil three surfaces ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2510 ............ N Dental inlay metallic 1 surface ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2520 ............ N Dental inlay metallic 2 surfaces ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2530 ............ N Dental inlay metl 3/more sur .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2543 ............ N Dental onlay metallic 3 surf ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2544 ............ N Dental onlay metl 4/more sur ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2610 ............ N Inlay porcelain/ceramic 1 su .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2620 ............ N Inlay porcelain/ceramic 2 su .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2630 ............ N Dental onlay porc 3/more sur ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2642 ............ N Dental onlay porcelin 2 surf ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2643 ............ N Dental onlay porcelin 3 surf ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2644 ............ N Dental onlay porc 4/more sur ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2650 ............ N Inlay composite/resin one su ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2651 ............ N Inlay composite/resin two su .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2652 ............ N Dental inlay resin 3/mre sur ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2662 ............ N Dental onlay resin 2 surfaces ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2663 ............ N Dental onlay resin 3 surfaces ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2664 ............ N Dental onlay resin 4/mre sur .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2710 ............ N Crown resin laboratory ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2720 ............ N Crown resin w/high noble me ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2721 ............ N Crown resin w/base metal ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2722 ............ N Crown resin w/noble metal ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2740 ............ N Crown porcelain/ceramic subs ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2750 ............ N Crown porcelain w/h noble m ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2751 ............ N Crown porcelain fused base m .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2752 ............ N Crown porcelain w/noble met ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2790 ............ N Crown full cast high noble m ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2791 ............ N Crown full cast base metal ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2792 ............ N Crown full cast noble metal ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2810 ............ N Crown 3/4 cast metallic ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2910 ............ N Dental recement inlay ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2920 ............ N Dental recement crown ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2930 ............ N Prefab stnlss steel crwn pri ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2931 ............ N Prefab stnlss steel crown pe .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59233

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

D2932 ............ N Prefabricated resin crown .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2933 ............ N Prefab stainless steel crown .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2940 ............ N Dental sedative filling ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2950 ............ N Core build-up incl any pins ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2951 ............ N Tooth pin retention ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2952 ............ N Post and core cast + crown ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2954 ............ N Prefab post/core + crown ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2955 ............ N Post removal ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2960 ............ N Laminate labial veneer ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2961 ............ N Lab labial veneer resin ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2962 ............ N Lab labial veneer porcelain ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2970 ............ R Temporary—fractured tooth ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D2980 ............ N Crown repair ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D2999 ............ R Dental unspec restorative pr .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D3110 ............ N Pulp cap direct ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3120 ............ N Pulp cap indirect ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3220 ............ N Therapeutic pulpotomy ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3230 ............ N Pulpal therapy anterior prim ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3240 ............ N Pulpal therapy posterior prim ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3310 ............ N Anterior ............................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3320 ............ N Root canal therapy 2 canals .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3330 ............ N Root canal therapy 3 canals .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3346 ............ N Retreat root canal anterior ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3347 ............ N Retreat root canal bicuspid ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3348 ............ N Retreat root canal molar .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3351 ............ N Apexification/recalc initial ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3352 ............ N Apexification/recalc interim ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3353 ............ N Apexification/recalc final ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3410 ............ N Apicoect/perirad surg anter ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3421 ............ N Root surgery bicuspid ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3425 ............ N Root surgery molar ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3426 ............ N Root surgery ea add root ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3430 ............ N Retrograde filling ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3450 ............ N Root amputation ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3460 ............ R Endodontic endosseous implant ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D3470 ............ N Intentional replantation ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3910 ............ N Isolation-tooth w rubb dam ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3920 ............ N Tooth splitting ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3950 ............ N Canal prep/fitting of dowel ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3960 ............ N Bleaching of discolored tooth ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D3999 ............ R Endodontic procedure ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D4210 ............ I Gingivectomy/plasty per quad ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4211 ............ I Gingivectomy/plasty per tooth ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4220 ............ N Gingival curettage per quadr ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4240 ............ N Gingival flap proc w/planing ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4249 ............ N Crown lengthen hard tissue ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4250 ............ R Mucogingival surg per quadra ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D4260 ............ R Osseous surgery per quadrant .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D4263 ............ R Bone replce graft first site .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D4264 ............ R Bone replce graft each add ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D4266 ............ N Guided tiss regen resorble ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4267 ............ N Guided tiss regen nonresorb ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4270 ............ R Pedicle soft tissue graft pr ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D4271 ............ R Free soft tissue graft proc .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D4273 ............ R Subepithelial tissue graft .................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D4274 ............ N Distal/proximal wedge proc ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4320 ............ N Provision splnt intracoronal ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4321 ............ N Provisional splint extracoro ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4341 ............ N Periodontal scaling & root .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4355 ............ R Full mouth debridement ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D4381 ............ R Localized chemo delivery ................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D4910 ............ N Periodontal maint procedures ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4920 ............ N Unscheduled dressing change ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D4999 ............ N Unspecified periodontal proc ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5110 ............ N Dentures complete maxillary .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5120 ............ N Dentures complete mandible ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5130 ............ N Dentures immediat maxillary .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5140 ............ N Dentures immediat mandible ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5211 ............ N Dentures maxill part resin .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5212 ............ N Dentures mand part resin .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5213 ............ N Dentures maxill part metal ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5214 ............ N Dentures mandibl part metal .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5281 ............ N Removable partial denture ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5410 ............ N Dentures adjust cmplt maxil ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59234

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

D5411 ............ N Dentures adjust cmplt mand .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5421 ............ N Dentures adjust part maxill ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5422 ............ N Dentures adjust part mandbl .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5510 ............ N Dentur repr broken compl bas ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5520 ............ N Replace denture teeth complt ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5610 ............ N Dentures repair resin base ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5620 ............ N Rep part denture cast frame .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5630 ............ N Rep partial denture clasp ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5640 ............ N Replace part denture teeth ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5650 ............ N Add tooth to partial denture ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5660 ............ N Add clasp to partial denture ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5710 ............ N Dentures rebase cmplt maxil ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5711 ............ N Dentures rebase cmplt mand ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5720 ............ N Dentures rebase part maxill ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5721 ............ N Dentures rebase part mandbl ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5730 ............ N Denture reln cmplt maxil ch ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5731 ............ N Denture reln cmplt mand chr ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5740 ............ N Denture reln part maxil chr ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5741 ............ N Denture reln part mand chr ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5750 ............ N Denture reln cmplt max lab ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5751 ............ N Denture reln cmplt mand lab ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5760 ............ N Denture reln part maxil lab ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5761 ............ N Denture reln part mand lab ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5810 ............ N Denture interm cmplt maxill ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5811 ............ N Denture interm cmplt mandbl ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5820 ............ N Denture interm part maxill .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5821 ............ N Denture interm part mandbl ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5850 ............ N Denture tiss conditn maxill ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5851 ............ N Denture tiss condtin mandbl .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5860 ............ N Overdenture complete ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5861 ............ N Overdenture partial ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5862 ............ N Precision attachment .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5899 ............ N Removable prosthodontic proc .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5911 ............ R Facial moulage sectional ................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D5912 ............ R Facial moulage complete ................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D5913 ............ I Nasal prosthesis ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5914 ............ I Auricular prosthesis ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5915 ............ I Orbital prosthesis ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5916 ............ I Ocular prosthesis ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5919 ............ I Facial prosthesis ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5922 ............ I Nasal septal prosthesis ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5923 ............ I Ocular prosthesis interim ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5924 ............ I Cranial prosthesis .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5925 ............ I Facial augmentation implant .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5926 ............ I Replacement nasal prosthesis ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5927 ............ I Auricular replacement ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5928 ............ I Orbital replacement ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5929 ............ I Facial replacement ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5931 ............ I Surgical obturator ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5932 ............ I Postsurgical obturator ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5933 ............ I Refitting of obturator .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5934 ............ I Mandibular flange prosthesis ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5935 ............ I Mandibular denture prosth ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5936 ............ I Temp obturator prosthesis ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5937 ............ I Trismus appliance .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5951 ............ R Feeding aid ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D5952 ............ I Pediatric speech aid ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5953 ............ I Adult speech aid ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5954 ............ I Superimposed prosthesis ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5955 ............ I Palatal lift prosthesis .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5958 ............ I Intraoral con def inter plt .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5959 ............ I Intraoral con def mod palat ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5960 ............ I Modify speech aid prosthesis ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5982 ............ I Surgical stent ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5983 ............ R Radiation applicator ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D5984 ............ R Radiation shield .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D5985 ............ R Radiation cone locator ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D5986 ............ N Fluoride applicator .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5987 ............ R Commissure splint .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D5988 ............ I Surgical splint ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D5999 ............ I Maxillofacial prosthesis ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6010 ............ I Odontics endosteal implant ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6020 ............ I Odontics abutment placement ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6040 ............ I Odontics eposteal implant .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59235

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

D6050 ............ I Odontics transosteal implnt ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6055 ............ I Implant connecting bar ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6080 ............ I Implant maintenance .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6090 ............ I Repair implant .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6095 ............ I Odontics repr abutment ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6100 ............ I Removal of implant ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6199 ............ I Implant procedure .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6210 ............ N Prosthodont high noble metal ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6211 ............ N Bridge base metal cast ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6212 ............ N Bridge noble metal cast ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6240 ............ N Bridge porcelain high noble ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6241 ............ N Bridge porcelain base metal .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6242 ............ N Bridge porcelain nobel metal ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6250 ............ N Bridge resin w/high noble .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6251 ............ N Bridge resin base metal ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6252 ............ N Bridge resin w/noble metal ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6520 ............ N Dental retainer two surfaces .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6530 ............ N Retainer metallic 3+ surface .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6543 ............ N Dental retainr onlay 3 surf ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6544 ............ N Dental retainr onlay 4/more ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6545 ............ N Dental retainr cast metl ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6720 ............ N Retain crown resin w hi nble ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6721 ............ N Crown resin w/base metal ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6722 ............ N Crown resin w/noble metal ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6750 ............ N Crown porcelain high noble ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6751 ............ N Crown porcelain base metal .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6752 ............ N Crown porcelain noble metal ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6780 ............ N Crown 3/4 high noble metal ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6790 ............ N Crown full high noble metal ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6791 ............ N Crown full base metal cast ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6792 ............ N Crown full noble metal cast ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6920 ............ R Dental connector bar .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D6930 ............ N Dental recement bridge ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6940 ............ N Stress breaker .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6950 ............ N Precision attachment .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6970 ............ N Post & core plus retainer ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6971 ............ N Cast post bridge retainer ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6972 ............ N Prefab post & core plus reta .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6973 ............ N Core build up for retainer ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6975 ............ N Coping metal ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6980 ............ N Bridge repair ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D6999 ............ N Fixed prosthodontic proc .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7110 ............ R Oral surgery single tooth .................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D7120 ............ R Each add tooth extraction .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D7130 ............ R Tooth root removal ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D7210 ............ R Rem imp tooth w mucoper flp ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D7220 ............ R Impact tooth remov soft tiss ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D7230 ............ R Impact tooth remov part bony ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D7240 ............ R Impact tooth remov comp bony ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D7241 ............ R Impact tooth rem bony w/comp ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D7250 ............ R Tooth root removal ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D7260 ............ R Oral antral fistula closure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D7270 ............ N Tooth reimplantation .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7272 ............ N Tooth transplantation ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7280 ............ N Exposure impact tooth orthod ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7281 ............ N Exposure tooth aid eruption ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7285 ............ I Biopsy of oral tissue hard .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7286 ............ I Biopsy of oral tissue soft .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7290 ............ N Repositioning of teeth ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7291 ............ R Transseptal fiberotomy ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D7310 ............ I Alveoplasty w/extraction ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7320 ............ I Alveoplasty w/o extraction ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7340 ............ I Vestibuloplasty ridge extens .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7350 ............ I Vestibuloplasty exten graft ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7410 ............ I Rad exc lesion up to 1.25 cm ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7420 ............ I Lesion >1.25 cm ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7430 ............ I Exc benign tumor to 1.25 cm ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7431 ............ I Benign tumor exc >1.25 cm ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7440 ............ I Malig tumor exc to 1.25 cm ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7441 ............ I Malig tumor >1.25 cm ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7450 ............ I Rem odontogen cyst to 1.25cm ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7451 ............ I Rem odontogen cyst >1.25 cm .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7460 ............ I Rem nonodonto cyst to 1.25cm ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7461 ............ I Rem nonodonto cyst >1.25 cm .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59236

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

D7465 ............ I Lesion destruction .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7470 ............ I Rem exostosis maxilla/mandib .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7480 ............ I Partial ostectomy ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7490 ............ I Mandible resection ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7510 ............ I I&d absc intraoral soft tiss ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7520 ............ I I&d abscess extraoral ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7530 ............ I Removal fb skin/areolar tiss ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7540 ............ I Removal of fb reaction ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7550 ............ I Removal of sloughed off bone ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7560 ............ I Maxillary sinusotomy .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7610 ............ I Maxilla open reduct simple ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7620 ............ I Clsd reduct simpl maxilla fx ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7630 ............ I Open red simpl mandible fx ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7640 ............ I Clsd red simpl mandible fx ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7650 ............ I Open red simp malar/zygom fx .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7660 ............ I Clsd red simp malar/zygom fx ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7670 ............ I Open red simple alveolus fx .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7680 ............ I Reduct simple facial bone fx .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7710 ............ I Maxilla open reduct compound .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7720 ............ I Clsd reduct compd maxilla fx ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7730 ............ I Open reduct compd mandble fx ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7740 ............ I Clsd reduct compd mandble fx .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7750 ............ I Open red comp malar/zygma fx ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7760 ............ I Clsd red comp malar/zygma fx .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7770 ............ I Open reduc compd alveolus fx .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7780 ............ I Reduct compnd facial bone fx ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7810 ............ I Tmj open reduct-dislocation ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7820 ............ I Closed tmp manipulation ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7830 ............ I Tmj manipulation under anest ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7840 ............ I Removal of tmj condyle ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7850 ............ I Tmj meniscectomy ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7852 ............ I Tmj repair of joint disc ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7854 ............ I Tmj excisn of joint membrane ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7856 ............ I Tmj cutting of a muscle ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7858 ............ I Tmj reconstruction .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7860 ............ I Tmj cutting into joint ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7865 ............ I Tmj reshaping components ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7870 ............ I Tmj aspiration joint fluid ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7872 ............ I Tmj diagnostic arthroscopy ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7873 ............ I Tmj arthroscopy lysis adhesn ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7874 ............ I Tmj arthroscopy disc reposit .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7875 ............ I Tmj arthroscopy synovectomy ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7876 ............ I Tmj arthroscopy discectomy .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7877 ............ I Tmj arthroscopy debridement ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7880 ............ I Occlusal orthotic appliance ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7899 ............ I Tmj unspecified therapy ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7910 ............ I Dent sutur recent wnd to 5cm ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7911 ............ I Dental suture wound to 5 cm ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7912 ............ I Suture complicate wnd >5 cm ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7920 ............ I Dental skin graft ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7940 ............ R Reshaping bone orthognathic ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D7941 ............ I Bone cutting ramus closed ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7942 ............ I Bone cutting ramus open ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7943 ............ I Cutting ramus open w/graft ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7944 ............ I Bone cutting segmented .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7945 ............ I Bone cutting body mandible .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7946 ............ I Reconstruction maxilla total ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7947 ............ I Reconstruct maxilla segment ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7948 ............ I Reconstruct midface no graft ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7949 ............ I Reconstruct midface w/graft .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7950 ............ I Mandible graft .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7955 ............ I Repair maxillofacial defects ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7960 ............ I Frenulectomy/frenulotomy .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7970 ............ I Excision hyperplastic tissue ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7971 ............ I Excision pericoronal gingiva .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7980 ............ I Sialolithotomy ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7981 ............ I Excision of salivary gland .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7982 ............ I Sialodochoplasty ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7983 ............ I Closure of salivary fistula ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7990 ............ I Emergency tracheotomy .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7991 ............ I Dental coronoidectomy ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7995 ............ I Synthetic graft facial bones ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7996 ............ I Implant mandible for augment ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D7999 ............ I Oral surgery procedure ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59237

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

D8010 ............ N Limited dental tx primary .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8020 ............ N Limited dental tx transition ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8030 ............ N Limited dental tx adolescent .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8040 ............ N Limited dental tx adult ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8050 ............ N Intercep dental tx primary .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8060 ............ N Intercep dental tx transitn .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8070 ............ N Compre dental tx transition ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8080 ............ N Compre dental tx adolescent ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8090 ............ N Compre dental tx adult ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8210 ............ N Orthodontic rem appliance tx ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8220 ............ N Fixed appliance therapy habt ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8660 ............ N Preorthodontic tx visit ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8670 ............ N Periodic orthodontc tx visit ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8680 ............ N Orthodontic retention .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8690 ............ N Orthodontic treatment ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D8999 ............ N Orthodontic procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9110 ............ R Tx dental pain minor proc .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D9210 ............ I Dent anesthesia w/o surgery ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9211 ............ I Regional block anesthesia ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9212 ............ I Trigeminal block anesthesia .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9215 ............ I Local anesthesia ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9220 ............ I General anesthesia ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9221 ............ I General anesthesia ea ad 15m ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9230 ............ R Analgesia ............................................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D9240 ............ I Intravenous sedation .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9310 ............ I Dental consultation ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9410 ............ I Dental house call ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9420 ............ I Hospital call ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9430 ............ I Office visit during hours ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9440 ............ I Office visit after hours ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9610 ............ I Dent therapeutic drug inject ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9630 ............ R Other drugs/medicaments .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D9910 ............ N Dent appl desensitizing med .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9920 ............ N Behavior management ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9930 ............ R Treatment of complications ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D9940 ............ R Dental occlusal guard ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D9941 ............ N Fabrication athletic guard ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9950 ............ R Occlusion analysis ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D9951 ............ R Limited occlusal adjustment ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D9952 ............ R Complete occlusal adjustment ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY

D9970 ............ N Enamel microabrasion ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

D9999 ............ I Adjunctive procedure ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0001 ............ X Drawing blood for specimen .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0002 ............ A Temporary urinary catheter ................................ 0.50 0.70 0.70 0.02 1.22 1.22 000

G0004 ............ A ECG transm phys review & int .......................... 0.52 7.31 7.31 0.65 8.48 8.48 XXX

G0005 ............ A ECG 24 hour recording ...................................... 0.00 1.18 1.18 0.09 1.27 1.27 XXX

G0006 ............ A ECG transmission & analysis ............................ 0.00 5.73 5.73 0.51 6.24 6.24 XXX

G0007 ............ A ECG phy review & interpret ............................... 0.52 0.40 0.40 0.05 0.97 0.97 XXX

G0008 ............ X Admin influenza virus vac .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0009 ............ X Admin pneumococcal vaccine ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0010 ............ X Admin hepatitis b vaccine .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0015 ............ A Post symptom ECG tracing ............................... 0.00 5.73 5.73 0.51 6.24 6.24 XXX

G0016 ............ A Post symptom ECG md review .......................... 0.52 0.40 0.40 0.05 0.97 0.97 XXX

G0025 ............ A Collagen skin test kit .......................................... 0.00 0.95 0.95 0.00 0.95 0.95 XXX

G0026 ............ X Fecal leukocyte examination .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0027 ............ X Semen analysis .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0030 ............ C PET imaging prev PET single ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0030 TC C PET imaging prev PET single ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0030 26 A PET imaging prev PET single ............................ 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0031 ............ C PET imaging prev PET multple ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0031 TC C PET imaging prev PET multple ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0031 26 A PET imaging prev PET multple ......................... 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0032 ............ C PET follow SPECT 78464 singl ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0032 TC C PET follow SPECT 78464 singl ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0032 26 A PET follow SPECT 78464 singl ......................... 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0033 ............ C PET follow SPECT 78464 mult .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0033 TC C PET follow SPECT 78464 mult .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0033 26 A PET follow SPECT 78464 mult .......................... 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0034 ............ C PET follow SPECT 76865 singl ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0034 TC C PET follow SPECT 76865 singl ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0034 26 A PET follow SPECT 76865 singl ......................... 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0035 ............ C PET follow SPECT 78465 mult .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0035 TC C PET follow SPECT 78465 mult .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0035 26 A PET follow SPECT 78465 mult .......................... 1.87 0.65 0.65 0.10 2.62 2.62 XXX
59238

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

G0036 ............ C PET follow cornry angio sing ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0036 TC C PET follow cornry angio sing ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0036 26 A PET follow cornry angio sing ............................. 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0037 ............ C PET follow cornry angio mult ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0037 TC C PET follow cornry angio mult ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0037 26 A PET follow cornry angio mult ............................. 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0038 ............ C PET follow myocard perf sing ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0038 TC C PET follow myocard perf sing ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0038 26 A PET follow myocard perf sing ............................ 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0039 ............ C PET follow myocard perf mult ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0039 TC C PET follow myocard perf mult ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0039 26 A PET follow myocard perf mult ............................ 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0040 ............ C PET follow stress echo singl .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0040 TC C PET follow stress echo singl .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0040 26 A PET follow stress echo singl .............................. 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0041 ............ C PET follow stress echo mult .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0041 TC C PET follow stress echo mult .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0041 26 A PET follow stress echo mult .............................. 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0042 ............ C PET follow ventriculogm sing ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0042 TC C PET follow ventriculogm sing ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0042 26 A PET follow ventriculogm sing ............................. 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0043 ............ C PET follow ventriculogm mult ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0043 TC C PET follow ventriculogm mult ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0043 26 A PET follow ventriculogm mult ............................ 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0044 ............ C PET following rest ECG singl ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0044 TC C PET following rest ECG singl ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0044 26 A PET following rest ECG singl ............................ 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0045 ............ C PET following rest ECG mult ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0045 TC C PET following rest ECG mult ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0045 26 A PET following rest ECG mult ............................. 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0046 ............ C PET follow stress ECG singl .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0046 TC C PET follow stress ECG singl .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0046 26 A PET follow stress ECG singl .............................. 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0047 ............ C PET follow stress ECG mult .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0047 TC C PET follow stress ECG mult .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0047 26 A PET follow stress ECG mult .............................. 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0050 ............ A Residual urine by ultrasound ............................. 0.00 0.81 0.81 0.05 0.86 0.86 XXX

G0051 ............ D Destroy benign/premal lesion ............................ *0.00 0.00 0.00 0.00 0.00 0.00 010

G0052 ............ D Destruction of added lesions ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ

G0053 ............ D Destruction of added lesions ............................. *0.00 0.00 0.00 0.00 0.00 0.00 010

G0058 ............ D Auto multichannel 20 tests ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0059 ............ D Auto multichannel 21 tests ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0060 ............ D Auto multichannel 22 tests ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0062 ............ D peripheral bone densitometry ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0062 TC D peripheral bone densitometry ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0062 26 D peripheral bone densitometry ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0063 ............ D central bone densitometry .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0063 TC D central bone densitometry .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0063 26 D central bone densitometry .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0064 ............ D care plan oversight, hme hlth ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0065 ............ D care plan oversight, hospice .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0066 ............ D care plan oversight nurs fac .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0071 ............ D Psychotherapy, office, no E/M ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0072 ............ D Psychotherapy, office, wth E/M ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0073 ............ D Psychotherapy, office, no E/M ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0074 ............ D Psychotherapy, office, wth E/M ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0075 ............ D Psychotherapy, office, no E/M ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0076 ............ D Psychotherapy, office, wth E/M ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0077 ............ D Psychotherapy, office, no E/M ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0078 ............ D Psychotherapy, office, wth E/M ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0079 ............ D Psychotherapy, office, no E/M ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0080 ............ D Psychotherapy, office, wth E/M ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0081 ............ D Psychotherapy, office, no E/M ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0082 ............ D Psychotherapy, office, wth E/M ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0083 ............ D Psychotherapy, inpt, no E/M .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0084 ............ D Psychotherapy, inpt, with E/M ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0085 ............ D Psychotherapy, inpt, no E/M .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0086 ............ D Psychotherapy, inpt, with E/M ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0087 ............ D Psychotherapy, inpt, no E/M .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0088 ............ D Psychotherapy, inpt, with E/M ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0089 ............ D Psychotherapy, inpt, no E/M .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0090 ............ D Psychotherapy, inpt, with E/M ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0091 ............ D Psychotherapy, inpt, no E/M .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0092 ............ D Psychotherapy, inpt, with E/M ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59239

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

G0093 ............ D Psychotherapy, inpt, no E/M .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0094 ............ D Psychotherapy, inpt, with E/M ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0100 ............ D HIV-1, viral load, quant ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0101 ............ A CA screen; pelvic/breast exam .......................... 0.45 0.28 0.28 0.02 0.75 0.75 XXX

G0104 ............ A CA screen; flexi sigmoidscope ........................... 0.96 1.23 #1.06 0.12 2.31 2.14 000

G0105 ............ A Colorectal scrn; hi risk ind ................................. 3.70 4.13 #4.07 0.39 8.22 8.16 000

G0106 ............ A Colon CA screen; barium enema ...................... 0.99 2.58 2.58 0.21 3.78 3.78 XXX

G0106 TC A Colon CA screen; barium enema ...................... 0.00 2.13 2.13 0.14 2.27 2.27 XXX

G0106 26 A Colon CA screen; barium enema ...................... 0.99 0.45 0.45 0.07 1.51 1.51 XXX

G0107 ............ X CA screen; fecal blood test ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0110 ............ R Nett pulm-rehab educ; ind ................................. 0.90 0.26 0.26 0.04 1.20 1.20 XXX

G0111 ............ R Nett pulm-rehab educ; group ............................. 0.27 0.20 0.20 0.02 0.49 0.49 XXX

G0112 ............ R Nett; nutrition guid, initial ................................... 1.72 0.97 0.97 0.10 2.79 2.79 XXX

G0113 ............ R Nett; nutrition guid, subseqnt ............................. 1.29 0.77 0.77 0.09 2.15 2.15 XXX

G0114 ............ R Nett; psychosocial consult ................................. 1.20 0.35 0.35 0.11 1.66 1.66 XXX

G0115 ............ R Nett; psychological testing ................................. 1.20 0.35 0.35 0.11 1.66 1.66 XXX

G0116 ............ A Nett; psychosocial counsel ................................ 1.11 0.35 0.35 0.05 1.51 1.51 XXX

G0120 ............ A Colon ca scrn; barium enema ............................ 0.99 2.58 2.58 0.21 3.78 3.78 XXX

G0120 TC A Colon ca scrn; barium enema ............................ 0.00 2.13 2.13 0.14 2.27 2.27 XXX

G0120 26 A Colon ca scrn; barium enema ............................ 0.99 0.45 0.45 0.07 1.51 1.51 XXX

G0121 ............ N Colon ca scrn; barium enema ............................ +3.70 4.13 #4.07 0.39 8.22 8.16 XXX

G0122 ............ N Colon ca scrn; barium enema ............................ +0.99 2.58 2.58 0.21 3.78 3.78 XXX

G0122 TC N Colon ca scrn; barium enema ............................ +0.00 2.13 2.13 0.14 2.27 2.27 XXX

G0122 26 N Colon ca scrn; barium enema ............................ +0.99 0.45 0.45 0.07 1.51 1.51 XXX

H5300 ............ D Occupational therapy ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0120 ............ E Tetracyclin injection ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0150 ............ E Injection adenosine 6 MG .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0170 ............ E Adrenalin epinephrin inject ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0190 ............ E Inj biperiden lactate/5 mg ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0205 ............ E Alglucerase injection .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0207 ............ E Amifostine ........................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0210 ............ E Methyldopate hcl injection .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0256 ............ E Alpha 1-proteinase 500 MG ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0270 ............ E Alprostadil for injection ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0280 ............ E Aminophyllin 250 MG inj .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0290 ............ E Ampicillin 500 MG inj ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0295 ............ E Ampicillin sodium per 1.5 gm ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0300 ............ E Amobarbital 125 MG inj ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0330 ............ E Succinycholine chloride inj ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0340 ............ E Nandrolon phenpropionate inj ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0350 ............ E Injection anistreplase 30 u ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0360 ............ E Hydralazine hcl injection .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0380 ............ E Inj metaraminol bitartrate ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0390 ............ E Chloroquine injection .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0400 ............ E Inj trimethaphan camsylate ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0460 ............ E Atropine sulfate injection .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0470 ............ E Dimecaprol injection ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0475 ............ E Baclofen 10 MG injection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0500 ............ E Dicyclomine injection .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0510 ............ E Benzquinamide injection .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0515 ............ E Inj benztropine mesylate .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0520 ............ E Bethanechol chloride inject ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0530 ............ E Penicillin g benzathine inj .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0540 ............ E Penicillin g benzathine inj .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0550 ............ E Penicillin g benzathine inj .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0560 ............ E Penicillin g benzathine inj .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0570 ............ E Penicillin g benzathine inj .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0580 ............ E Penicillin g benzathine inj .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0585 ............ E Botulinum toxin a per unit .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0590 ............ E Ethylnorepinephrine hcl inj ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0600 ............ E Edetate calcium disodium inj ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0610 ............ E Calcium gluconate injection ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0620 ............ E Calcium glycer & lact/10 ML .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0630 ............ E Calcitonin salmon injection ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0635 ............ E Calcitriol injection ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0640 ............ E Leucovorin calcium injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0670 ............ E Inj mepivacaine HCL/10 ml ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0690 ............ E Cefazolin sodium injection ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0694 ............ E Cefoxitin sodium injection .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0695 ............ E Cefonocid sodium injection ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0696 ............ E Ceftriaxone sodium injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0697 ............ E Sterile cefuroxime injection ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0698 ............ E Cefotaxime sodium injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0702 ............ E Betamethasone acet&sod phosp ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59240

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

J0704 ............ E Betamethasone sod phosp/4 MG ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0710 ............ E Cephapirin sodium injection ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0713 ............ E Inj ceftazidime per 500 mg ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0715 ............ E Ceftizoxime sodium / 500 MG ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0720 ............ E Chloramphenicol sodium injec ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0725 ............ E Chorionic gonadotropin/1000u ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0730 ............ E Chlorpheniramin maleate inj .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0735 ............ E Clonidine hydrochloride ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0740 ............ E Cidofovir injection ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0743 ............ E Cilastatin sodium injection ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0745 ............ E Inj codeine phosphate /30 MG ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0760 ............ E Colchicine injection ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0770 ............ E Colistimethate sodium inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0780 ............ E Prochlorperazine injection .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0800 ............ E Corticotropin injection ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0810 ............ E Cortisone injection .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0835 ............ E Inj cosyntropin per 0.25 MG .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0850 ............ E Cytomegalovirus imm IV /vial ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0895 ............ E Deferoxamine mesylate inj ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0900 ............ E Testosterone enanthate inj ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0945 ............ E Brompheniramine maleate inj ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J0970 ............ E Estradiol valerate injection ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1000 ............ E Depo-estradiol cypionate inj ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1020 ............ E Methylprednisolone 20 MG inj ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1030 ............ E Methylprednisolone 40 MG inj ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1040 ............ E Methylprednisolone 80 MG inj ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1050 ............ E Medroxyprogesterone inj .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1055 ............ N Medrxyprogester acetate inj ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1060 ............ E Testosterone cypionate 1 ML ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1070 ............ E Testosterone cypionat 100 MG .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1080 ............ E Testosterone cypionat 200 MG .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1090 ............ E Testosterone cypionate 50 MG .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1095 ............ E Inj dexamethasone acetate ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1100 ............ E Dexamethosone sodium phos ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1110 ............ E Inj dihydroergotamine mesylt ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1120 ............ E Acetazolamid sodium injectio ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1160 ............ E Digoxin injection ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1165 ............ E Phenytoin sodium injection ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1170 ............ E Hydromorphone injection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1180 ............ E Dyphylline injection ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1190 ............ E Dexrazoxane HCl injection ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1200 ............ E Diphenhydramine hcl injectio ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1205 ............ E Chlorothiazide sodium inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1212 ............ E Dimethyl sulfoxide 50% 50 ML .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1230 ............ E Methadone injection ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1240 ............ E Dimenhydrinate injection .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1245 ............ E Dipyridamole injection ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1250 ............ E Inj dobutamine HCL/250 mg .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1320 ............ E Amitriptyline injection ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1325 ............ E Epoprostenol injection ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1330 ............ E Ergonovine maleate injection ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1362 ............ E Erythromycin glucep / 250 MG .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1364 ............ E Erythro lactobionate /500 MG ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1380 ............ E Estradiol valerate 10 MG inj .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1390 ............ E Estradiol valerate 20 MG inj .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1410 ............ E Inj estrogen conjugate 25 MG ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1435 ............ E Injection estrone per 1 MG ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1436 ............ E Etidronate disodium inj ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1440 ............ E Filgrastim 300 mcg injeciton .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1441 ............ E Filgrastim 480 mcg injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1455 ............ E Foscarnet sodium injection ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1460 ............ E Gamma globulin 1 CC inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1470 ............ E Gamma globulin 2 CC inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1480 ............ E Gamma globulin 3 CC inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1490 ............ E Gamma globulin 4 CC inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1500 ............ E Gamma globulin 5 CC inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1510 ............ E Gamma globulin 6 CC inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1520 ............ E Gamma globulin 7 CC inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1530 ............ E Gamma globulin 8 CC inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1540 ............ E Gamma globulin 9 CC inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1550 ............ E Gamma globulin 10 CC inj ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1560 ............ E Gamma globulin >10 CC inj ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1561 ............ E Immune globulin 500 mg ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1562 ............ E Immune globulin 5 gms ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59241

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

J1565 ............ E RSV-ivig ............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1570 ............ E Ganciclovir sodium injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1580 ............ E Garamycin gentamicin inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1600 ............ E Gold sodium thiomaleate inj .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1610 ............ E Glucagon hydrochloride/1 MG ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1620 ............ E Gonadorelin hydroch/ 100 mcg .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1625 ............ D Granisetron hydrochlor/1 MG ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1626 ............ E Granisetron HCl injection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1630 ............ E Haloperidol injection ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1631 ............ E Haloperidol decanoate inj .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1642 ............ E Inj heparin sodium per 10 u ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1644 ............ E Inj heparin sodium per 1000u ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1645 ............ E Dalteparin sodium .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1650 ............ E Inj enoxaparin sodium 30 mg ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1670 ............ E Tetanus immune globulin inj .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1690 ............ E Prednisolone tebutate inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1700 ............ E Hydrocortisone acetate inj ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1710 ............ E Hydrocortisone sodium ph inj ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1720 ............ E Hydrocortisone sodium succ i ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1730 ............ E Diazoxide injection ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1739 ............ E Hydroxyprogesterone cap 125 ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1741 ............ E Hydroxyprogesterone cap 250 ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1742 ............ E Ibutilide fumarate injection ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1760 ............ E Iron dextran 2 CC inj .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1770 ............ E Iron dextran 5 CC inj .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1780 ............ E Iron dextran 10 CC inj ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1785 ............ E Injection imiglucerase /unit ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1790 ............ E Droperidol injection ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1800 ............ E Propranolol injection ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1810 ............ E Droperidol/fentanyl inj ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1820 ............ E Insulin injection ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1825 ............ E Interferon beta-1a ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1830 ............ E Interferon beta-1b/.25 MG .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1840 ............ E Kanamycin sulfate 500 MG inj ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1850 ............ E Kanamycin sulfate 75 MG inj ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1885 ............ E Ketorolac tromethamine inj ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1890 ............ E Cephalothin sodium injection ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1910 ............ E Kutapressin injection .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1930 ............ E Propiomazine injection ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1940 ............ E Furosemide injection .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1950 ............ E Leuprolide acetate/3.75 MG ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1955 ............ E Inj levocarnitine per 1 gm .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1960 ............ E Levorphanol tartrate inj ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1970 ............ E Methotrimeprazine injection ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1980 ............ E Hyoscyamine sulfate inj ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J1990 ............ E Chlordiazepoxide injection ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2000 ............ E Lidocaine injection .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2010 ............ E Lincomycin injection ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2060 ............ E Lorazepam injection ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2150 ............ E Mannitol injection ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2175 ............ E Meperidine hydrochl/100 MG ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2180 ............ E Meperidine/promethazine inj .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2210 ............ E Methylergonovin maleate inj .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2240 ............ E Metocurine iodide injection ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2250 ............ E Inj midazolam hydrochloride .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2260 ............ E Inj milrinone lactate/5 ML ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2270 ............ E Morphine sulfate injection .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2275 ............ E Morphine sulfate injection .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2300 ............ E Inj nalbuphine hydrochloride .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2310 ............ E Inj naloxone hydrochloride ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2320 ............ E Nandrolone decanoate 50 MG ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2321 ............ E Nandrolone decanoate 100 MG ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2322 ............ E Nandrolone decanoate 200 MG ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2330 ............ E Thiothixene injection .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2350 ............ E Niacinamide/niacin injection ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2360 ............ E Orphenadrine injection ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2370 ............ E Phenylephrine hcl injection ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2400 ............ E Chloroprocaine hcl injection ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2405 ............ E Ondansetron hcl injection .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2410 ............ E Oxymorphone hcl injection ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2430 ............ E Pamidronate disodium/30 MG ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2440 ............ E Papaverin hcl injection ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2460 ............ E Oxytetracycline injection .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2480 ............ E Hydrochlorides of opium inj ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59242

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

J2510 ............ E Penicillin g procaine inj ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2512 ............ E Inj pentagastrin per 2 ML ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2515 ............ E Pentobarbital sodium inj ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2540 ............ E Penicillin g potassium inj .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2545 ............ E Pentamidine isethionte/300mg ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2550 ............ E Promethazine hcl injection ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2560 ............ E Phenobarbital sodium inj .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2590 ............ E Oxytocin injection ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2597 ............ E Inj desmopressin acetate ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2640 ............ E Prednisolone sodium ph inj ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2650 ............ E Prednisolone acetate inj ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2670 ............ E Totazoline hcl injection ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2675 ............ E Inj progesterone per 50 MG ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2680 ............ E Fluphenazine decanoate 25 MG ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2690 ............ E Procainamide hcl injection ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2700 ............ E Oxacillin sodium injection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2710 ............ E Neostigmine methylslfte inj ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2720 ............ E Inj protamine sulfate/10 MG ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2725 ............ E Inj protirelin per 250 mcg ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2730 ............ E Pralidoxime chloride inj ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2760 ............ E Phentolaine mesylate inj .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2765 ............ E Metoclopramide hcl injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2790 ............ E Rho d immune globulin inj ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2800 ............ E Methocarbamol injection .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2810 ............ E Inj theophylline per 40 MG ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2820 ............ E Sargramostim injection ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2860 ............ E Secobarbital sodium inj ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2910 ............ E Aurothioglucose injection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2912 ............ E Sodium chloride injection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2920 ............ E Methylprednisolone injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2930 ............ E Methylprednisolone injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2950 ............ E Promazine hcl injection ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2970 ............ E Methicillin sodium injection ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2995 ............ E Inj streptokinase/250000 IU ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J2996 ............ E Alteplase recombinant inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3000 ............ E Streptomycin injection ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3005 ............ D Strontium-89 chloride/10 ML .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3010 ............ E Fentanyl citrate injection .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3030 ............ E Sumatriptan succinate/6 MG .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3070 ............ E Pentazocine hcl injeciton ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3080 ............ E Chlorprothixene injection .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3105 ............ E Terbutaline sulfate inj ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3120 ............ E Testosterone enanthate inj ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3130 ............ E Testosterone enanthate inj ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3140 ............ E Testosterone suspension inj .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3150 ............ E Testosteron propionate inj ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3230 ............ E Chlorpromazine hcl injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3240 ............ E Thyrotropin injection ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3250 ............ E Trimethobenzamide hcl inj ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3260 ............ E Tobramycin sulfate injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3265 ............ E Injection torsemide 10 mg/ml ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3270 ............ E Imipramine hcl injection ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3280 ............ E Thiethylperazine maleate inj .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3301 ............ E Triamcinolone acetonide inj ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3302 ............ E Triamcinolone diacetate inj ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3303 ............ E Triamcinolone hexacetonl inj ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3305 ............ E Inj trimetrexate glucoronate ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3310 ............ E Perphenazine injeciton ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3320 ............ E Spectinomycn di-hcl inj ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3350 ............ E Urea injection ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3360 ............ E Diazepam injection ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3364 ............ E Urokinase 5000 IU injection ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3365 ............ E Urokinase 250,000 IU inj ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3370 ............ R Vancomycin hcl injection .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3390 ............ E Methoxamine injection ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3400 ............ E Triflupromazine hcl inj ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3410 ............ E Hydroxyzine hcl injection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3420 ............ E Vitamin b12 injection .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3430 ............ E Vitamin k phytonadione inj ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3450 ............ E Mephentermine sulfate inj .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3470 ............ E Hyaluronidase injection ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3475 ............ E Inj magnesium sulfate ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3480 ............ E Inj potassium chloride ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3490 ............ E Drugs unclassified injection ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59243

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

J3520 ............ N Edetate disodium per 150 mg ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3530 ............ E Nasal vaccine inhalation .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3535 ............ N Metered dose inhaler drug ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J3570 ............ N Laetrile amygdalin vit B17 .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7030 ............ E Normal saline solution infus ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7040 ............ E Normal saline solution infus ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7042 ............ E 5% dextrose/normal saline ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7050 ............ E Normal saline solution infus ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7051 ............ E Sterile saline/water ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7060 ............ E 5% dextrose/water ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7070 ............ E D5w infusion ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7100 ............ E Dextran 40 infusion ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7110 ............ E Dextran 75 infusion ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7120 ............ E Ringers lactate infusion ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7130 ............ E Hypertonic saline solution .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7190 ............ X Factor viii ............................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7191 ............ X Factor VIII (porcine) ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7192 ............ X Factor viii recombinant ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7194 ............ X Factor ix complex ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7196 ............ X Othr hemophilia clot factors ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7197 ............ X Antithrombin iii injection ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7300 ............ N Intraut copper contraceptive .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7310 ............ E Ganciclovir long act implant ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7500 ............ X Azathiop po tab 50mg 100s ea .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7501 ............ X Azathioprine parenteral ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7503 ............ X Cyclosporine parenteral ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7504 ............ X Lymphocyte immune globulin ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7505 ............ X Monoclonal antibodies ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7506 ............ X Prednisone oral .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7507 ............ E Tacrolimus oral per 1 MG .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7508 ............ E Tacrolimus oral per 5 MG .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7509 ............ X Methylprednisolone oral ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7510 ............ X Prednisolone oral per 5 mg ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7599 ............ X Immunosuppressive drug noc ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7610 ............ E Acetylcysteine 10% injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7615 ............ E Acetylcysteine 20% injection .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7620 ............ E Albuterol sulfate .083%/ml ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7625 ............ E Albuterol sulfate .5% inj ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7627 ............ E Bitolterolmesylate inhal sol ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7630 ............ E Cromolyn sodium injeciton ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7640 ............ E Epinephrine injection .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7645 ............ E Ipratropium bromide .02%/ml ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7650 ............ E Isoetharine hcl .1% inj ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7651 ............ E Isoetharine hcl .125% inj .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7652 ............ E Isoetharine hcl .167% inj .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7653 ............ E Isoetharine hcl .2%/ inj ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7654 ............ E Isoetharine hcl .25% inj ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7655 ............ E Isoetharine hcl 1% inj ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7660 ............ E Isoproterenol hcl .5% inj .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7665 ............ E Isoproterenol hcl 1% inj ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7670 ............ E Metaproterenol sulfate .4% ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7672 ............ E Metaproterenol sulfate .6% ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7675 ............ E Metaproterenol sulfate 5% ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7699 ............ E Inhalation solution for DME ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J7799 ............ E Non-inhalation drug for DME ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J8499 ............ N Oral prescrip drug non chemo ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J8530 ............ E Cyclophosphamide oral 25 MG ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J8560 ............ E Etoposide oral 50 MG ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J8600 ............ E Melphalan oral 2 MG ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J8610 ............ E Methotrexate oral 2.5 MG .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J8999 ............ E Oral prescription drug chemo ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9000 ............ E Doxorubic hcl 10 MG vl chemo ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9015 ............ E Aldesleukin/single use vial ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9020 ............ E Asparaginase injection ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9031 ............ E Bcg live intravesical vac ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9040 ............ E Bleomycin sulfate injection ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9045 ............ E Carboplatin injection ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9050 ............ E Carmus bischl nitro inj ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9060 ............ E Cisplatin 10 MG injection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9062 ............ E Cisplatin 50 MG injection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9065 ............ E Inj cladribine per 1 MG ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9070 ............ E Cyclophosphamide 100 MG inj .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9080 ............ E Cyclophosphamide 200 MG inj .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9090 ............ E Cyclophosphamide 500 MG inj .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59244

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

J9091 ............ E Cyclophosphamide 1.0 grm inj .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9092 ............ E Cyclophosphamide 2.0 grm inj .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9093 ............ E Cyclophosphamide lyophilized ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9094 ............ E Cyclophosphamide lyophilized ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9095 ............ E Cyclophosphamide lyophilized ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9096 ............ E Cyclophosphamide lyophilized ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9097 ............ E Cyclophosphamide lyophilized ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9100 ............ E Cytarabine hcl 100 MG inj ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9110 ............ E Cytarabine hcl 500 MG inj ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9120 ............ E Dactinomycin actinomycin d .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9130 ............ E Dacarbazine 10 MG inj ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9140 ............ E Dacarbazine 200 MG inj .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9150 ............ E Daunorubicin ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9165 ............ E Diethylstilbestrol injection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9170 ............ E Docetaxel ........................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9181 ............ E Etoposide 10 MG inj .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9182 ............ E Etoposide 100 MG inj ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9185 ............ E Fludarabine phosphate inj .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9190 ............ E Fluorouracil injection .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9200 ............ E Floxuridine injection ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9201 ............ E Gemcitabine HCl ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9202 ............ E Goserelin acetate implant .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9206 ............ E Irinotecan injection ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9208 ............ E Ifosfomide injection ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9209 ............ E Mesna injection .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9211 ............ E Idarubicin hcl injection ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9213 ............ E Interferon alfa-2a inj ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9214 ............ E Interferon alfa-2b inj ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9215 ............ E Interferon alfa-n3 inj ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9216 ............ E Interferon gamma 1-b inj .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9217 ............ E Leuprolide acetate suspnsion ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9218 ............ E Leuprolide acetate injection ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9230 ............ E Mechlorethamine hcl inj ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9245 ............ E Inj melphalan hydrochl 50 MG ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9250 ............ E Methotrexate sodium inj ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9260 ............ E Methotrexate sodium inj ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9265 ............ E Paclitaxel injection .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9266 ............ E Pegaspargase/singl dose vial ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9268 ............ E Pentostatin injection ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9270 ............ E Plicamycin (mithramycin) inj .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9280 ............ E Mitomycin 5 MG inj ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9290 ............ E Mitomycin 20 MG inj .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9291 ............ E Mitomycin 40 MG inj .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9293 ............ E Mitoxantrone hydrochl/5 MG .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9320 ............ E Streptozocin injection ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9340 ............ E Thiotepa injection ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9350 ............ E Topotecan .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9360 ............ E Vinblastine sulfate inj ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9370 ............ E Vincristine sulfate 1 MG inj ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9375 ............ E Vincristine sulfate 2 MG inj ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9380 ............ E Vincristine sulfate 5 MG inj ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9390 ............ E Vinorelbine tartrate/10 mg .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9600 ............ E Porfimer sodium ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

J9999 ............ E Chemotherapy drug ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

M0005 ............ D Off visit 2/more modalities ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

M0006 ............ D One phys therapy modality ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

M0007 ............ D Combined phys ther mod & tx ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

M0008 ............ D Combined phys ther mod & tx ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

M0064 ............ A Visit for drug monitoring ..................................... 0.37 0.19 0.19 0.03 0.59 0.59 XXX

M0075 ............ N Cellular therapy .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

M0076 ............ N Prolotherapy ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

M0100 ............ N Intragastric hypothermia ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

M0101 ............ G Foot care hygienic/pm ........................................ 0.43 0.35 0.35 0.03 0.81 0.81 XXX

M0300 ............ N IV chelationtherapy ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

M0301 ............ N Fabric wrapping of aneurysm ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

M0302 ............ N Assessment of cardiac output ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P2028 ............ X Cephalin floculation test ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P2029 ............ X Congo red blood test ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P2031 ............ N Hair analysis ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P2033 ............ X Blood thymol turbidity ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P2038 ............ X Blood mucoprotein ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P3000 ............ X Screen pap by tech w md supv ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P3001 ............ X Screening pap smear by phys ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P3001 26 A Screening pap smear by phys ........................... 0.42 0.32 0.32 0.04 0.78 0.78 XXX
59245

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

P7001 ............ I Culture bacterial urine ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9010 ............ E Whole blood for transfusion ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9011 ............ E Blood split unit .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9012 ............ E Cryoprecipitate each unit ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9013 ............ E Unit/s blood fibrinogen ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9014 ............ E Gamma globulin 1 ML ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9015 ............ E Rh immune globulin 1 ML .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9016 ............ E Leukocyte poor blood, unit ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9017 ............ E One donor fresh frozn plasma ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9018 ............ E Plasma protein fract, unit ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9019 ............ E Platelet concentrate unit .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9020 ............ E Plaelet rich plasma unit ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9021 ............ E Red blood cells unit ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9022 ............ E Washed red blood cells unit .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9603 ............ X One-way allow prorated miles ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9604 ............ X One-way allow prorated trip ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9610 ............ X Urine specimen collect singl .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

P9615 ............ X Urine specimen collect mult ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0034 ............ X Admin of influenza vaccine ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0035 ............ A Cardiokymography ............................................. 0.17 0.49 0.49 0.04 0.70 0.70 XXX

Q0035 TC A Cardiokymography ............................................. 0.00 0.37 0.37 0.03 0.40 0.40 XXX

Q0035 26 A Cardiokymography ............................................. 0.17 0.12 0.12 0.01 0.30 0.30 XXX

Q0068 ............ A Extracorpeal plasmapheresis ............................. 1.67 1.27 1.27 0.16 3.10 3.10 000

Q0091 ............ A Obtaining screen pap smear .............................. 0.37 0.28 0.28 0.03 0.68 0.68 XXX

Q0092 ............ A Set up port x-ray equipment .............................. 0.00 0.30 0.30 0.01 0.31 0.31 XXX

Q0103 ............ D Physical therapy evaluation ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0104 ............ D Phys therapy re-evaluation ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0109 ............ D Occupational therapy eval ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0110 ............ D Occupational therap re-eval ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0111 ............ X Wet mounts/w preparations ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0112 ............ X Potassium hydroxide preps ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0113 ............ X Pinworm examinations ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0114 ............ X Fern test ............................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0115 ............ X Post-coital mucous exam ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0132 ............ X Dispensing fee DME neb drug ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0136 ............ X Non esrd epoetin alpha inj ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0144 ............ N Azithromycin dihydrate, oral ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0156 ............ X Human albumin 5% ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0157 ............ X Human albumin 25% .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q0158 ............ D Combined hib & hep B vaccine ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9920 ............ E Epoetin with hct <=20 ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9921 ............ E Epoetin with hct =21 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9922 ............ E Epoetin with hct =22 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9923 ............ E Epoetin with hct =23 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9924 ............ E Epoetin with hct =24 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9925 ............ E Epoetin with hct =25 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9926 ............ E Epoetin with hct =26 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9927 ............ E Epoetin with hct =27 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9928 ............ E Epoetin with hct =28 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9929 ............ E Epoetin with hct =29 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9930 ............ E Epoetin with hct =30 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9931 ............ E Epoetin with hct =31 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9932 ............ E Epoetin with hct =32 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9933 ............ E Epoetin with hct =33 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9934 ............ E Epoetin with hct =34 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9935 ............ E Epoetin with hct =35 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9936 ............ E Epoetin with hct =36 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9937 ............ E Epoetin with hct =37 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9938 ............ E Epoetin with hct =38 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9939 ............ E Epoetin with hct =39 .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Q9940 ............ E Epoetin with hct >=40 ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

R0070 ............ C Transport portable x-ray ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

R0075 ............ C Transport port x-ray multipl ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

R0076 ............ C Transport portable EKG ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2020 ............ X Vision svcs frames purchases ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2025 ............ N Eyeglasses delux frames ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2100 ............ X Lens spher single plano 4.00 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2101 ............ X Single visn sphere 4.12–7.00 ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2102 ............ X Singl visn sphere 7.12–20.00 ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2103 ............ X Spherocylindr 4.00–0.12–2.00d ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2104 ............ X Spherocylindr 4.00d/2.12–4d ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2105 ............ X Spherocylinder 4.00d/4.25–6d ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2106 ............ X Spherocylinder 4.00d/>6.00d ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2107 ............ X Spherocylinder 4.25d/12–2d .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
59246

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

V2108 ............ X Spherocylinder 4.25d/2.12–4d ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2109 ............ X Spherocylinder 4.25d/4.25–6d ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2110 ............ X Spherocylinder 4.25d/over 6d ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2111 ............ X Spherocylindr 7.25d/.25–2.25 ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2112 ............ X Spherocylindr 7.25d/2.25–4d ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2113 ............ X Spherocylindr 7.25d/4.25–6d ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2114 ............ X Spherocylinder over 12.00d ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2115 ............ X Lens lenticular bifocal ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2116 ............ X Nonaspheric lens bifocal .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2117 ............ X Aspheric lens bifocal .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2118 ............ X Lens aniseikonic single ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2199 ............ X Lens single vision not oth c ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2200 ............ X Lens spher bifoc plano 4.00d ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2201 ............ X Lens sphere bifocal 4.12–7.0 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2202 ............ X Lens sphere bifocal 7.12–20. ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2203 ............ X Lens sphcyl bifocal 4.00d/.1 .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2204 ............ X Lens sphcy bifocal 4.00d/2.1 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2205 ............ X Lens sphcy bifocal 4.00d/4.2 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2206 ............ X Lens sphcy bifocal 4.00d/ove ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2207 ............ X Lens sphcy bifocal 4.25–7d/. ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2208 ............ X Lens sphcy bifocal 4.25–7/2. ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2209 ............ X Lens sphcy bifocal 4.25–7/4. ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2210 ............ X Lens sphcy bifocal 4.25–7/ov ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2211 ............ X Lens sphcy bifo 7.25–12/.25– ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2212 ............ X Lens sphcyl bifo 7.25–12/2.2 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2213 ............ X Lens sphcyl bifo 7.25–12/4.2 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2214 ............ X Lens sphcyl bifocal over 12. .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2215 ............ X Lens lenticular bifocal ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2216 ............ X Lens lenticular nonaspheric ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2217 ............ X Lens lenticular aspheric bif ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2218 ............ X Lens aniseikonic bifocal ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2219 ............ X Lens bifocal seg width over ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2220 ............ X Lens bifocal add over 3.25d .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2299 ............ X Lens bifocal speciality ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2300 ............ X Lens sphere trifocal 4.00d ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2301 ............ X Lens sphere trifocal 4.12–7. .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2302 ............ X Lens sphere trifocal 7.12–20 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2303 ............ X Lens sphcy trifocal 4.0/.12– ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2304 ............ X Lens sphcy trifocal 4.0/2.25 ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2305 ............ X Lens sphcy trifocal 4.0/4.25 ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2306 ............ X Lens sphcyl trifocal 4.00/>6 ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2307 ............ X Lens sphcy trifocal 4.25–7/. ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2308 ............ X Lens sphc trifocal 4.25–7/2. ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2309 ............ X Lens sphc trifocal 4.25–7/4. ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2310 ............ X Lens sphc trifocal 4.25–7/>6 .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2311 ............ X Lens sphc trifo 7.25–12/.25– ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2312 ............ X Lens sphc trifo 7.25–12/2.25 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2313 ............ X Lens sphc trifo 7.25–12/4.25 ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2314 ............ X Lens sphcyl trifocal over 12 ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2315 ............ X Lens lenticular trifocal ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2316 ............ X Lens lenticular nonaspheric ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2317 ............ X Lens lenticular aspheric tri ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2318 ............ X Lens aniseikonic trifocal ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2319 ............ X Lens trifocal seg width >28 ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2320 ............ X Lens trifocal add over 3.25d .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2399 ............ X Lens trifocal speciality ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2410 ............ X Lens variab asphericity sing .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2430 ............ X Lens variable asphericity bi ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2499 ............ X Variable asphericity lens .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2500 ............ X Contact lens pmma spherical ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2501 ............ X Cntct lens pmma-toric/prism .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2502 ............ X Contact lens pmma bifocal ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2503 ............ X Cntct lens pmma color vision ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2510 ............ X Cntct gas permeable sphericl ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2511 ............ X Cntct toric prism ballast ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2512 ............ X Cntct lens gas permbl bifocl .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2513 ............ X Contact lens extended wear .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2520 ............ P Contact lens hydrophilic ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2521 ............ X Cntct lens hydrophilic toric ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2522 ............ X Cntct lens hydrophil bifocl .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2523 ............ X Cntct lens hydrophil extend ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2530 ............ X Contact lens gas impermeable .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2531 ............ X Contact lens gas permeable .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2599 ............ X Contact lens/es other type ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59247

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

V2600 ............ X Hand held low vision aids .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2610 ............ X Single lens spectacle mount .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2615 ............ X Telescop/othr compound lens ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2623 ............ X Plastic eye prosth custom .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2624 ............ X Polishing artifical eye ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2625 ............ X Enlargemnt of eye prosthesis ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2626 ............ X Reduction of eye prosthesis .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2627 ............ X Scleral cover shell .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2628 ............ X Fabrication & fitting ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2629 ............ X Prosthetic eye other type ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2630 ............ X Anter chamber intraocul lens ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2631 ............ X Iris support intraoclr lens .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2632 ............ X Post chmbr intraocular lens ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2700 ............ X Balance lens ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2710 ............ X Glass/plastic slab off prism ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2715 ............ X Prism lens/es ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2718 ............ X Fresnell prism press-on lens .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2730 ............ X Special base curve ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2740 ............ X Rose tint plastic .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2741 ............ X Non-rose tint plastic ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2742 ............ X Rose tint glass ................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2743 ............ X Non-rose tint glass ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2744 ............ X Tint photochromatic lens/es ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2750 ............ X Anti-reflective coating ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2755 ............ X UV lens/es .......................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2760 ............ X Scratch resistant coating .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2770 ............ X Occluder lens/es ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2780 ............ X Oversize lens/es ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2781 ............ X Progressive lens per lens .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2785 ............ X Corneal tissue processing .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V2799 ............ X Miscellaneous vision service .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5008 ............ N Hearing screening .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5010 ............ N Assessment for hearing aid ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5011 ............ N Hearing aid fitting/checking ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5014 ............ N Hearing aid repair/modifying .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5020 ............ N Conformity evaluation ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5030 ............ N Body-worn hearing aid air .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5040 ............ N Body-worn hearing aid bone .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5050 ............ N Body-worn hearing aid in ear ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5060 ............ N Behind ear hearing aid ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5070 ............ N Glasses air conduction ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5080 ............ N Glasses bone conduction ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5090 ............ N Hearing aid dispensing fee ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5100 ............ N Body-worn bilat hearing aid ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5110 ............ N Hearing aid dispensing fee ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5120 ............ N Body-worn binaur hearing aid ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5130 ............ N In ear binaural hearing aid ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5140 ............ N Behind ear binaur hearing aid ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5150 ............ N Glasses binaural hearing aid ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5160 ............ N Dispensing fee binaural ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5170 ............ N Within ear cros hearing aid ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5180 ............ N Behind ear cros hearing aid ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5190 ............ N Glasses cros hearing aid ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5200 ............ N Cros hearing aid dispens fee ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5210 ............ N In ear bicros hearing aid .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5220 ............ N Behind ear bicros hearing aid ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5230 ............ N Glasses bicros hearing aid ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5240 ............ N Dispensing fee bicros ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5299 ............ R Hearing service .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5336 ............ N Repair communication device ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5362 ............ R Speech screening .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5363 ............ R Language screening ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

V5364 ............ R Dysphagia screening .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

Addendum C—Codes With Interim

Relative Value Units

Addendum C lists the codes for which

interim RVUs have been established.

Because these RVUs are interim, public

comments on these codes will be

considered if they are received by 5

p.m., December 30, 1997. Any revisions

to the interim RVUs will be announced

in a document to be published in 1998

that provides our analysis of and

responses to public comments. These

revisions will apply to services

furnished beginning January 1, 1999.

Addendum C contains the following

information:
59248

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

1. CPT/HCPCS code. This is either a

CPT or alphanumeric HCPCS code for

the service in question. CPT codes are

listed first, followed by alphanumeric

HCPCS codes.

2. Modifier. A modifier is shown if

there is TC (modifier TC) and a PC

(modifier -26) for the service. If there is

a PC and a TC for the service,

Addendum C contains three entries for

the code: one for the global values (both

professional and technical); one for

modifier -26 (PC); and one for modifier

TC. The global service is not designated

by a modifier, and physicians must bill

using the code without a modifier if the

physician furnishes both the PCs and

the TCs of the service.

3. Status indicator. This indicator

shows whether the CPT/HCPCS code is

in the fee schedule and whether it is

separately payable if the service is

covered. See Addendum B for a

description of the status indicators.

4. Description of the code. This is an

abbreviated version of the narrative

description of the code.

5. Physician work RVUs. These are the

interim RVUs for the physician work for

this service.

6. Practice expense RVUs. These are

the interim RVUs for the practice

expense for the service.

7. Malpractice expense RVUs. These

are the interim RVUs for the malpractice

expense for the service.

8. Total RVUs. This is the sum of the

work, practice expense, and malpractice

expense RVUs.

9. Global period. This indicator shows

the number of days in the global period

for the code (0, 10, or 90 days). See

Addendum B for explanations of the

alpha codes.

ADDENDUM C.—CODES WITH INTERIM RVUS

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

11055 ............ R Trim skin lesion .................................................. 0.27 0.19 0.19 0.01 0.47 0.47 000

11056 ............ R Trim 2 to 4 skin lesions ...................................... 0.39 0.26 0.26 0.02 0.67 0.67 000

11057 ............ R Trim over 4 skin lesions ..................................... 0.50 0.21 0.21 0.02 0.73 0.73 000

11200 ............ A Removal of skin tags ......................................... *0.77 0.43 0.43 0.04 1.24 1.24 010

11201 ............ A Removal of added skin tags .............................. 0.29 0.17 0.17 0.02 0.48 0.48 ZZZ

11719 ............ R Trim nail(s) ......................................................... 0.06 0.18 #0.07 0.01 0.25 0.14 000

17000 ............ A Destroy benign/premal lesion ............................ *0.60 0.42 0.42 0.03 1.05 1.05 010

17003 ............ A Destroy 2–14 lesions ......................................... 0.15 0.13 0.13 0.01 0.29 0.29 ZZZ

17004 ............ A Destroy 15 & more lesions ................................ *2.79 2.25 2.25 0.20 5.24 5.24 010

17110 ............ A Destruct lesion, 1–14 ......................................... *0.65 0.40 0.40 0.03 1.08 1.08 010

17111 ............ A Destruct lesion, 15 or more ............................... *0.92 0.60 0.60 0.05 1.57 1.57 010

17200 ............ D 1Electrocautery of skin tags ............................... *0.00 0.00 0.00 0.00 0.00 0.00 010

17340 ............ A Cryotherapy of skin ............................................ *0.76 0.28 0.28 0.02 1.06 1.06 010

19020 ............ A Incision of breast lesion ..................................... *3.57 1.40 1.40 0.28 5.25 5.25 090

19316 ............ A Suspension of breast ......................................... *10.69 #11.76 #11.76 2.43 24.88 24.88 090

19357 ............ A Breast reconstruction ......................................... *18.16 12.15 12.15 2.37 32.68 32.68 090

19361 ............ A Breast reconstruction ......................................... *19.26 20.13 20.13 3.88 43.27 43.27 090

19366 ............ A Breast reconstruction ......................................... *21.28 16.40 16.40 3.18 40.86 40.86 090

20102 ............ A Explore wound, abdomen .................................. *3.94 1.92 1.92 0.45 6.31 6.31 010

20103 ............ A Explore wound, extremity ................................... *5.30 2.59 2.59 0.60 8.49 8.49 010

20664 ............ A Halo brace application ....................................... *8.06 3.82 3.82 0.65 12.53 12.53 090

20962 ............ A Other bone graft, microvasc .............................. *39.27 26.90 26.90 5.26 71.43 71.43 090

21010 ............ A Incision of jaw joint ............................................. *10.14 10.24 10.24 0.93 21.31 21.31 090

21015 ............ A Resection of facial tumor ................................... *5.29 #5.82 #5.82 1.13 12.24 12.24 090

21026 ............ A Excision of facial bone(s) ................................... *4.85 3.14 3.14 0.28 8.27 8.27 090

21029 ............ A Contour of face bone lesion ............................... *7.71 #8.48 #8.48 0.78 16.97 16.97 090

21030 ............ A Removal of face bone lesion ............................. *6.46 3.35 3.35 0.29 10.10 10.10 090

21032 ............ A Remove exostosis, maxilla ................................ *3.24 3.88 3.88 0.35 7.47 7.47 090

21034 ............ A Removal of face bone lesion ............................. *16.17 6.98 6.98 0.89 24.04 24.04 090

21040 ............ A Removal of jaw bone lesion ............................... *2.11 2.76 2.76 0.24 5.11 5.11 090

21044 ............ A Removal of jaw bone lesion ............................... *11.86 9.55 9.55 1.11 22.52 22.52 090

21045 ............ A Extensive jaw surgery ........................................ *16.17 13.83 13.83 1.58 31.58 31.58 090

21050 ............ A Removal of jaw joint ........................................... *10.77 #11.85 #11.85 1.08 23.70 23.70 090

21060 ............ A Remove jaw joint cartilage ................................. *10.23 #11.25 #11.25 1.04 22.52 22.52 090

21070 ............ A Remove coronoid process ................................. *8.20 6.81 6.81 0.82 15.83 15.83 090

21076 ............ A Prepare face/oral prosthesis .............................. *13.42 #14.76 #14.76 1.35 29.53 29.53 010

21077 ............ A Prepare face/oral prosthesis .............................. *33.75 #37.13 #37.13 3.39 74.27 74.27 090

21079 ............ A Prepare face/oral prosthesis .............................. *22.34 27.93 27.93 2.25 52.52 52.52 090

21080 ............ A Prepare face/oral prosthesis .............................. *25.10 31.38 31.38 2.52 59.00 59.00 090

21081 ............ A Prepare face/oral prosthesis .............................. *22.88 28.59 28.59 2.30 53.77 53.77 090

21082 ............ A Prepare face/oral prosthesis .............................. *20.87 #22.96 #22.96 2.10 45.93 45.93 090

21083 ............ A Prepare face/oral prosthesis .............................. *19.30 24.13 24.13 1.94 45.37 45.37 090

21084 ............ A Prepare face/oral prosthesis .............................. *22.51 28.14 28.14 2.28 52.93 52.93 090

21085 ............ A Prepare face/oral prosthesis .............................. *9.00 #9.90 #9.90 0.90 19.80 19.80 010

21086 ............ A Prepare face/oral prosthesis .............................. *24.92 31.15 31.15 2.51 58.58 58.58 090

21087 ............ A Prepare face/oral prosthesis .............................. *24.92 #27.41 #27.41 2.51 54.84 54.84 090

21100 ............ A Maxillofacial fixation ........................................... *4.22 1.06 1.06 0.11 5.39 5.39 090

21110 ............ A Interdental fixation .............................................. *5.21 5.53 5.53 0.46 11.20 11.20 090

21141 ............ A Reconstruct midface, lefort ................................ *18.10 14.34 14.34 1.68 34.12 34.12 090

21142 ............ A Reconstruct midface, lefort ................................ *18.81 14.84 14.84 1.74 35.39 35.39 090

21143 ............ A Reconstruct midface, lefort ................................ *19.58 15.40 15.40 1.81 36.79 36.79 090

21208 ............ A Augmentation of facial bones ............................ *10.23 #11.25 #11.25 1.07 22.55 22.55 090

21209 ............ A Reduction of facial bones .................................. *6.72 4.59 4.59 0.76 12.07 12.07 090

21210 ............ A Face bone graft .................................................. *10.23 #11.25 #11.25 1.29 22.77 22.77 090

21215 ............ A Lower jaw bone graft ......................................... *10.77 #11.85 #11.85 1.42 24.04 24.04 090
59249

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

21230 ............ A Rib cartilage graft ............................................... *10.77 10.37 10.37 1.69 22.83 22.83 090

21235 ............ A Ear cartilage graft ............................................... *6.72 #7.39 #7.39 1.09 15.20 15.20 090

21242 ............ A Reconstruction of jaw joint ................................. *12.95 #14.25 #14.25 2.25 29.45 29.45 090

21244 ............ A Reconstruction of lower jaw ............................... *11.86 #13.05 #13.05 1.93 26.84 26.84 090

21245 ............ A Reconstruction of jaw ......................................... *11.86 11.47 11.47 1.31 24.64 24.64 090

21246 ............ A Reconstruction of jaw ......................................... *12.47 8.83 8.83 1.04 22.34 22.34 090

21247 ............ A Reconstruct lower jaw bone ............................... *22.63 #24.89 #24.89 2.27 49.79 49.79 090

21255 ............ A Reconstruct lower jaw bone ............................... *16.72 #18.39 #18.39 1.68 36.79 36.79 090

21256 ............ A Reconstruction of orbit ....................................... *16.19 #17.81 #17.81 1.63 35.63 35.63 090

21260 ............ A Revise eye sockets ............................................ *16.52 #18.17 #18.17 1.66 36.35 36.35 090

21261 ............ A Revise eye sockets ............................................ *31.49 17.78 17.78 1.65 50.92 50.92 090

21263 ............ A Revise eye sockets ............................................ *28.42 #31.26 #31.26 2.86 62.54 62.54 090

21267 ............ A Revise eye sockets ............................................ *18.90 14.61 14.61 2.13 35.64 35.64 090

21268 ............ A Revise eye sockets ............................................ *24.48 15.35 15.35 3.13 42.96 42.96 090

21270 ............ A Augmentation cheek bone ................................. *10.23 9.60 9.60 1.41 21.24 21.24 090

21275 ............ A Revision orbitofacial bones ................................ *11.24 8.95 8.95 1.26 21.45 21.45 090

21280 ............ A Revision of eyelid ............................................... *6.03 #6.63 #6.63 0.61 13.27 13.27 090

21282 ............ A Revision of eyelid ............................................... *3.49 #3.84 #3.84 0.79 8.12 8.12 090

21295 ............ A Revision of jaw muscle/bone ............................. *1.53 0.96 0.96 0.13 2.62 2.62 090

21296 ............ A Revision of jaw muscle/bone ............................. *4.25 3.62 3.62 0.22 8.09 8.09 090

21325 ............ A Repair of nose fracture ...................................... *3.77 4.09 4.09 0.52 8.38 8.38 090

21330 ............ A Repair of nose fracture ...................................... *5.38 #5.92 #5.92 0.86 12.16 12.16 090

21335 ............ A Repair of nose fracture ...................................... *8.61 #9.47 #9.47 1.56 19.64 19.64 090

21336 ............ A Repair nasal septal fracture ............................... *5.72 4.09 4.09 0.52 10.33 10.33 090

21337 ............ A Repair nasal septal fracture ............................... *2.70 2.82 2.82 0.38 5.90 5.90 090

21338 ............ A Repair nasoethmoid fracture .............................. *6.46 5.01 5.01 0.66 12.13 12.13 090

21339 ............ A Repair nasoethmoid fracture .............................. *8.09 7.09 7.09 0.70 15.88 15.88 090

21340 ............ A Repair of nose fracture ...................................... *10.77 8.91 8.91 1.04 20.72 20.72 090

21343 ............ A Repair of sinus fracture ...................................... *12.95 9.17 9.17 1.08 23.20 23.20 090

21344 ............ A Repair of sinus fracture ...................................... *19.72 9.17 9.17 1.08 29.97 29.97 090

21345 ............ A Repair of nose/jaw fracture ................................ *8.16 7.90 7.90 0.81 16.87 16.87 090

21346 ............ A Repair of nose/jaw fracture ................................ *10.61 9.40 9.40 1.04 21.05 21.05 090

21347 ............ A Repair of nose/jaw fracture ................................ *12.69 10.36 10.36 1.36 24.41 24.41 090

21348 ............ A Repair of nose/jaw fracture ................................ *16.69 11.34 11.34 2.22 30.25 30.25 090

21355 ............ A Repair cheek bone fracture ............................... *3.77 1.56 1.56 0.17 5.50 5.50 010

21356 ............ A Repair cheek bone fracture ............................... *4.15 #4.57 #4.57 0.89 9.61 9.61 010

21360 ............ A Repair cheek bone fracture ............................... *6.46 #7.11 #7.11 0.89 14.46 14.46 090

21366 ............ A Repair cheek bone fracture ............................... *17.77 12.08 12.08 2.36 32.21 32.21 090

21385 ............ A Repair eye socket fracture ................................. *9.16 9.59 9.59 1.13 19.88 19.88 090

21386 ............ A Repair eye socket fracture ................................. *9.16 9.07 9.07 1.25 19.48 19.48 090

21387 ............ A Repair eye socket fracture ................................. *9.70 7.45 7.45 0.96 18.11 18.11 090

21390 ............ A Repair eye socket fracture ................................. *10.13 #11.14 #11.14 1.37 22.64 22.64 090

21395 ............ A Repair eye socket fracture ................................. *12.68 9.63 9.63 1.37 23.68 23.68 090

21400 ............ A Treat eye socket fracture ................................... *1.40 1.67 #1.54 0.17 3.24 3.11 090

21401 ............ A Repair eye socket fracture ................................. *3.26 2.58 2.58 0.32 6.16 6.16 090

21406 ............ A Repair eye socket fracture ................................. *7.01 5.21 5.21 0.74 12.96 12.96 090

21407 ............ A Repair eye socket fracture ................................. *8.61 7.09 7.09 0.78 16.48 16.48 090

21408 ............ A Repair eye socket fracture ................................. *12.38 8.49 8.49 0.99 21.86 21.86 090

21421 ............ A Treat mouth roof fracture ................................... *5.14 6.14 #5.65 0.62 11.90 11.41 090

21422 ............ A Repair mouth roof fracture ................................. *8.32 #9.15 #9.15 1.19 18.66 18.66 090

21423 ............ A Repair mouth roof fracture ................................. *10.40 9.80 9.80 1.19 21.39 21.39 090

21431 ............ A Treat craniofacial fracture .................................. *7.05 6.02 6.02 0.71 13.78 13.78 090

21432 ............ A Repair craniofacial fracture ................................ *8.61 6.76 6.76 0.84 16.21 16.21 090

21433 ............ A Repair craniofacial fracture ................................ *25.35 17.96 17.96 2.10 45.41 45.41 090

21435 ............ A Repair craniofacial fracture ................................ *17.25 13.25 13.25 1.88 32.38 32.38 090

21436 ............ A Repair craniofacial fracture ................................ *28.04 14.65 14.65 2.08 44.77 44.77 090

21440 ............ A Repair dental ridge fracture ............................... *2.70 3.07 #2.97 0.28 6.05 5.95 090

21445 ............ A Repair dental ridge fracture ............................... *5.38 6.11 #5.92 0.56 12.05 11.86 090

21450 ............ A Treat lower jaw fracture ..................................... *2.97 2.84 2.84 0.26 6.07 6.07 090

21451 ............ A Treat lower jaw fracture ..................................... *4.87 5.83 #5.36 0.74 11.44 10.97 090

21452 ............ A Treat lower jaw fracture ..................................... *1.98 1.39 1.39 0.17 3.54 3.54 090

21453 ............ A Treat lower jaw fracture ..................................... *5.54 6.64 #6.09 0.55 12.73 12.18 090

21454 ............ A Treat lower jaw fracture ..................................... *6.46 #7.11 #7.11 1.42 14.99 14.99 090

21461 ............ A Repair lower jaw fracture ................................... *8.09 #8.90 #8.90 1.30 18.29 18.29 090

21462 ............ A Repair lower jaw fracture ................................... *9.79 #10.77 #10.77 1.34 21.90 21.90 090

21465 ............ A Repair lower jaw fracture ................................... *11.91 8.44 8.44 0.99 21.34 21.34 090

21485 ............ A Reset dislocated jaw .......................................... *3.99 2.19 2.19 0.20 6.38 6.38 090

21490 ............ A Repair dislocated jaw ......................................... *11.86 6.31 6.31 0.52 18.69 18.69 090

21493 ............ A Treat hyoid bone fracture ................................... *1.27 1.52 #1.40 0.13 2.92 2.80 090

21494 ............ A Repair hyoid bone fracture ................................ *6.28 7.52 7.52 0.63 14.43 14.43 090

21495 ............ A Repair hyoid bone fracture ................................ *5.69 4.82 4.82 0.51 11.02 11.02 090

21497 ............ A Interdental wiring ................................................ *3.86 3.97 3.97 0.38 8.21 8.21 090

21740 ............ A Reconstruction of sternum ................................. *16.50 8.99 8.99 1.64 27.13 27.13 090

21750 ............ A Repair of sternum separation ............................ *10.77 7.33 7.33 1.43 19.53 19.53 090
59250

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

22505 ............ A Manipulation of spine ......................................... *1.87 1.31 1.31 0.17 3.35 3.35 010

22818 ............ A Kyphectomy, 1–2 segments ............................... *31.83 28.25 28.25 4.85 64.93 64.93 090

22819 ............ A Kyphectomy, 3 & more segment ....................... *36.44 28.25 28.25 4.85 69.54 69.54 090

23616 ............ A Repair humerus fracture .................................... *21.27 22.32 22.32 3.54 47.13 47.13 090

24006 ............ A Release elbow joint ............................................ *9.31 7.14 7.14 1.17 17.62 17.62 090

24516 ............ A Repair humerus fracture .................................... *11.65 9.65 9.65 1.54 22.84 22.84 090

24546 ............ A Repair humerus fracture .................................... *15.69 9.97 9.97 1.59 27.25 27.25 090

25337 ............ A Reconstruct ulna/radioulnar ............................... *10.17 8.60 8.60 1.45 20.22 20.22 090

25520 ............ A Repair fracture of radius .................................... *6.26 5.74 5.74 0.94 12.94 12.94 090

25525 ............ A Repair fracture of radius .................................... *12.24 11.15 11.15 1.83 25.22 25.22 090

25526 ............ A Repair fracture of radius .................................... *12.98 11.85 11.85 1.94 26.77 26.77 090

25574 ............ A Treat fracture radius & ulna ............................... *7.01 #7.71 #7.71 1.73 16.45 16.45 090

26546 ............ A Repair non-union hand ...................................... *8.92 8.11 8.11 1.33 18.36 18.36 090

26608 ............ A Treat metacarpal fracture ................................... *5.36 3.55 3.55 0.57 9.48 9.48 090

27193 ............ A Treat pelvic ring fracture .................................... *5.56 2.41 2.41 0.39 8.36 8.36 090

27194 ............ A Treat pelvic ring fracture .................................... *9.65 3.90 3.90 0.50 14.05 14.05 090

27215 ............ A Pelvic fracture(s) treatment ................................ *10.05 #11.06 #11.06 2.33 23.44 23.44 090

27216 ............ A Treat pelvic ring fracture .................................... *15.19 4.30 4.30 0.66 20.15 20.15 090

27217 ............ A Treat pelvic ring fracture .................................... *14.11 14.55 14.55 2.33 30.99 30.99 090

27218 ............ A Treat pelvic ring fracture .................................... *20.15 14.55 14.55 2.33 37.03 37.03 090

27226 ............ A Treat hip wall fracture ........................................ *14.91 15.78 15.78 2.52 33.21 33.21 090

27245 ............ A Repair of thigh fracture ...................................... *20.31 16.30 16.30 2.62 39.23 39.23 090

27496 ............ A Decompression of thigh/knee ............................ *6.11 4.53 4.53 0.74 11.38 11.38 090

27497 ............ A Decompression of thigh/knee ............................ *7.17 5.55 5.55 0.91 13.63 13.63 090

27498 ............ A Decompression of thigh/knee ............................ *7.99 6.32 6.32 1.04 15.35 15.35 090

27499 ............ A Decompression of thigh/knee ............................ *9.00 7.28 7.28 1.19 17.47 17.47 090

27501 ............ A Treatment of thigh fracture ................................ *5.92 5.41 5.41 0.82 12.15 12.15 090

27503 ............ A Treatment of thigh fracture ................................ *10.58 7.67 7.67 1.21 19.46 19.46 090

27507 ............ A Treatment of thigh fracture ................................ *13.99 #15.39 #15.39 2.56 31.94 31.94 090

27509 ............ A Treatment of thigh fracture ................................ *7.71 4.22 4.22 0.65 12.58 12.58 090

27511 ............ A Treatment of thigh fracture ................................ *13.64 #15.00 #15.00 2.56 31.20 31.20 090

27535 ............ A Treatment of knee fracture ................................ *11.50 11.69 11.69 1.88 25.07 25.07 090

27558 ............ A Repair of knee dislocation ................................. *17.72 14.60 14.60 2.43 34.75 34.75 090

27759 ............ A Repair of tibia fracture ....................................... *13.76 13.74 13.74 2.22 29.72 29.72 090

27824 ............ A Treat lower leg fracture ...................................... *2.89 3.47 #3.18 0.55 6.91 6.62 090

27825 ............ A Treat lower leg fracture ...................................... *6.19 6.51 6.51 1.06 13.76 13.76 090

27826 ............ A Treat lower leg fracture ...................................... *8.54 #9.39 #9.39 1.88 19.81 19.81 090

27829 ............ A Treat lower leg joint ........................................... *5.49 #6.04 #6.04 1.37 12.90 12.90 090

27892 ............ A Decompression of leg ........................................ *7.39 3.39 3.39 0.64 11.42 11.42 090

27893 ............ A Decompression of leg ........................................ *7.35 3.38 3.38 0.67 11.40 11.40 090

28470 ............ A Treat metatarsal fracture .................................... *1.99 1.80 1.80 0.23 4.02 4.02 090

28475 ............ A Treat metatarsal fracture .................................... *2.97 2.34 2.34 0.30 5.61 5.61 090

28531 ............ A Treat sesamoid bone fracture ............................ *2.35 1.91 1.91 0.32 4.58 4.58 090

28576 ............ A Treat foot dislocation .......................................... *4.17 2.77 2.77 0.42 7.36 7.36 090

29800 ............ A Jaw arthroscopy/surgery .................................... *6.43 4.01 4.01 0.46 10.90 10.90 090

29804 ............ A Jaw arthroscopy/surgery .................................... *8.14 #8.95 #8.95 1.46 18.55 18.55 090

29850 ............ A Knee arthroscopy/surgery .................................. *8.19 #9.01 #9.01 1.74 18.94 18.94 090

29851 ............ A Knee arthroscopy/surgery .................................. *13.10 10.95 10.95 1.74 25.79 25.79 090

29855 ............ A Tibial arthroscopy/surgery .................................. *10.62 #11.68 #11.68 1.88 24.18 24.18 090

29856 ............ A Tibial arthroscopy/surgery .................................. *14.14 11.69 11.69 1.88 27.71 27.71 090

29860 ............ A Hip arthroscopy, dx ............................................ *8.05 4.84 4.84 0.76 13.65 13.65 090

29861 ............ A Hip arthroscopy/surgery ..................................... *9.15 9.38 9.38 1.73 20.26 20.26 090

29862 ............ A Hip arthroscopy/surgery ..................................... *9.90 10.07 10.07 2.32 22.29 22.29 090

29863 ............ A Hip arthroscopy/surgery ..................................... *9.90 8.72 8.72 1.73 20.35 20.35 090

29891 ............ A Ankle arthroscopy/surgery ................................. *8.40 8.86 8.86 1.77 19.03 19.03 090

29892 ............ A Ankle arthroscopy/surgery ................................. *9.00 8.86 8.86 1.77 19.63 19.63 090

29893 ............ A Scope, plantar fasciotomy .................................. *5.22 5.20 5.20 0.46 10.88 10.88 090

30460 ............ A Revision of nose ................................................ *9.96 8.58 8.58 0.93 19.47 19.47 090

30462 ............ A Revision of nose ................................................ *19.57 17.16 17.16 1.87 38.60 38.60 090

30801 ............ A Cauterization inner nose .................................... *1.09 0.47 0.47 0.05 1.61 1.61 010

30802 ............ A Cauterization inner nose .................................... *2.03 0.94 0.94 0.11 3.08 3.08 010

32201 ............ A Percut drainage, lung lesion .............................. 4.00 3.03 3.03 0.35 7.38 7.38 000

33496 ............ A Repair, prosth valve clot .................................... *27.25 #29.98 #29.98 5.33 62.56 62.56 090

33501 ............ A Repair heart vessel fistula ................................. *17.78 14.14 14.14 2.51 34.43 34.43 090

33514 ............ A CABG, vein, five ................................................. *35.00 #38.50 #38.50 7.23 80.73 80.73 090

33516 ............ A CABG, vein, six+ ................................................ *37.40 #41.14 #41.14 7.74 86.28 86.28 090

33517 ............ A CABG, artery-vein, single .................................. *2.57 #2.83 #2.83 0.50 5.90 5.90 090

33518 ............ A CABG, artery-vein, two ...................................... *4.85 #5.34 #5.34 1.02 11.21 11.21 090

33519 ............ A CABG, artery-vein, three .................................... *7.12 #7.83 #7.83 1.52 16.47 16.47 090

33521 ............ A CABG, artery-vein, four ...................................... *9.40 #10.34 #10.34 2.03 21.77 21.77 090

33522 ............ A CABG, artery-vein, five ...................................... *11.67 #12.84 #12.84 2.54 27.05 27.05 090

33523 ............ A CABG, artery-vein, six+ ..................................... *13.95 #15.35 #15.35 3.05 32.35 32.35 090

33533 ............ A CABG, arterial, single ........................................ *25.83 #28.41 #28.41 5.36 59.60 59.60 090

33534 ............ A CABG, arterial, two ............................................ *28.82 #31.70 #31.70 6.03 66.55 66.55 090
59251

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

33535 ............ A CABG, arterial, three .......................................... *31.81 #34.99 #34.99 6.70 73.50 73.50 090

33536 ............ A CABG, arterial, four+ .......................................... *34.79 #38.27 #38.27 7.37 80.43 80.43 090

33800 ............ A Aortic suspension ............................................... *16.24 14.14 14.14 2.51 32.89 32.89 090

34151 ............ A Removal of artery clot ........................................ *16.86 11.96 11.96 2.39 31.21 31.21 090

35400 ............ A Angioscopy ......................................................... 3.00 2.27 2.27 0.27 5.54 5.54 ZZZ

35691 ............ A Arterial transposition .......................................... *18.05 19.62 19.62 3.81 41.48 41.48 090

35693 ............ A Arterial transposition .......................................... *15.36 9.40 9.40 1.91 26.67 26.67 090

35694 ............ A Arterial transposition .......................................... *19.16 9.33 9.33 2.17 30.66 30.66 090

35695 ............ A Arterial transposition .......................................... *19.16 9.33 9.33 2.17 30.66 30.66 090

36470 ............ A Injection therapy of vein ..................................... *1.09 0.27 0.27 0.04 1.40 1.40 010

36530 ............ R Insertion of infusion pump .................................. *6.20 4.82 4.82 1.02 12.04 12.04 010

36531 ............ R Revision of infusion pump .................................. *4.87 4.37 4.37 0.27 9.51 9.51 010

36532 ............ R Removal of infusion pump ................................. *3.30 1.77 1.77 0.37 5.44 5.44 010

36534 ............ A Revision of access port ...................................... *2.80 #3.08 #3.08 0.21 6.09 6.09 010

36535 ............ A Removal of access port ..................................... *2.27 1.81 1.81 0.38 4.46 4.46 010

36834 ............ A Repair A–V aneurysm ........................................ *9.93 7.80 7.80 1.66 19.39 19.39 090

37195 ............ A Thrombolytic therapy, stroke .............................. 0.00 7.68 7.68 0.54 8.22 8.22 XXX

37250 ............ A Intravascular us .................................................. 2.10 1.14 1.14 0.13 3.37 3.37 ZZZ

37251 ............ A Intravascular us .................................................. 1.60 0.87 0.87 0.10 2.57 2.57 ZZZ

40800 ............ A Drainage of mouth lesion ................................... *1.17 0.74 0.74 0.07 1.98 1.98 010

40801 ............ A Drainage of mouth lesion ................................... *2.53 1.70 1.70 0.16 4.39 4.39 010

40804 ............ A Removal foreign body, mouth ............................ *1.24 0.58 0.58 0.06 1.88 1.88 010

40805 ............ A Removal foreign body, mouth ............................ *2.69 2.50 2.50 0.30 5.49 5.49 010

40808 ............ A Biopsy of mouth lesion ....................................... *0.96 0.76 0.76 0.08 1.80 1.80 010

40810 ............ A Excision of mouth lesion .................................... *1.31 1.18 1.18 0.11 2.60 2.60 010

40812 ............ A Excise/repair mouth lesion ................................. *2.31 1.50 1.50 0.14 3.95 3.95 010

40814 ............ A Excise/repair mouth lesion ................................. *3.42 3.23 3.23 0.32 6.97 6.97 090

40816 ............ A Excision of mouth lesion .................................... *3.67 3.22 3.22 0.33 7.22 7.22 090

40818 ............ A Excise oral mucosa for graft .............................. *2.41 2.25 2.25 0.20 4.86 4.86 090

40819 ............ A Excise lip or cheek fold ...................................... *2.41 1.23 1.23 0.14 3.78 3.78 090

40820 ............ A Treatment of mouth lesion ................................. *1.28 0.53 0.53 0.06 1.87 1.87 010

40830 ............ A Repair mouth laceration ..................................... *1.76 0.67 0.67 0.07 2.50 2.50 010

40831 ............ A Repair mouth laceration ..................................... *2.46 1.94 1.94 0.21 4.61 4.61 010

41800 ............ A Drainage of gum lesion ...................................... *1.17 0.69 0.69 0.07 1.93 1.93 010

41805 ............ A Removal foreign body, gum ............................... *1.24 0.84 0.84 0.08 2.16 2.16 010

41806 ............ A Removal foreign body, jawbone ........................ *2.69 1.64 1.64 0.15 4.48 4.48 010

41822 ............ R Excision of gum lesion ....................................... *2.31 3.03 3.03 0.25 5.59 5.59 010

41823 ............ R Excision of gum lesion ....................................... *3.30 #3.63 #3.63 0.34 7.27 7.27 090

41825 ............ A Excision of gum lesion ....................................... *1.31 1.49 1.49 0.14 2.94 2.94 010

41826 ............ A Excision of gum lesion ....................................... *2.31 2.07 2.07 0.18 4.56 4.56 010

41827 ............ A Excision of gum lesion ....................................... *3.42 #3.76 #3.76 0.38 7.56 7.56 090

41828 ............ R Excision of gum lesion ....................................... *3.09 4.07 4.07 0.33 7.49 7.49 010

41830 ............ R Removal of gum tissue ...................................... *3.35 #3.69 #3.69 0.36 7.40 7.40 010

41872 ............ R Repair gum ......................................................... *2.59 #2.85 #2.85 0.27 5.71 5.71 090

41874 ............ R Repair tooth socket ............................................ *3.09 #3.40 #3.40 0.32 6.81 6.81 090

43360 ............ A Gastrointestinal repair ........................................ *28.78 21.36 21.36 4.19 54.33 54.33 090

43361 ............ A Gastrointestinal repair ........................................ *32.65 25.27 25.27 4.77 62.69 62.69 090

44626 ............ A Repair bowel opening ........................................ *22.59 11.37 11.37 2.40 36.36 36.36 090

44700 ............ A Suspend bowel w/prosthesis ............................. *14.35 11.37 11.37 2.40 28.12 28.12 090

44901 ............ A Drain, app abscess, perc ................................... 3.38 2.56 2.56 0.30 6.24 6.24 000

45119 ............ A Remove, rectum w/reservoir .............................. *26.21 16.06 16.06 3.36 45.63 45.63 090

45900 ............ A Reduction of rectal prolapse .............................. *1.83 0.58 0.58 0.11 2.52 2.52 010

45905 ............ A Dilation of anal sphincter ................................... *1.61 0.71 0.71 0.12 2.44 2.44 010

45910 ............ A Dilation of rectal narrowing ................................ *1.96 0.87 0.87 0.13 2.96 2.96 010

46715 ............ A Repair of anovaginal fistula ............................... *7.46 3.51 3.51 0.82 11.79 11.79 090

46746 ............ A Repair, cloacal anomaly ..................................... *36.74 24.26 24.26 2.37 63.37 63.37 090

47011 ............ A Percut drain, liver lesion .................................... 3.70 2.80 2.80 0.33 6.83 6.83 000

47511 ............ A Insert bile duct drain .......................................... *10.50 2.87 2.87 0.25 13.62 13.62 090

47716 ............ A Fusion of bile duct cyst ...................................... *13.83 6.56 6.56 1.53 21.92 21.92 090

48001 ............ A Placement of drain, pancreas ............................ *18.83 8.13 8.13 1.89 28.85 28.85 090

48005 ............ A Resect/debride pancreas ................................... *22.40 9.19 9.19 2.14 33.73 33.73 090

48146 ............ A Pancreatectomy ................................................. *23.91 16.49 16.49 1.92 42.32 42.32 090

48154 ............ A Pancreatectomy ................................................. *39.95 22.54 22.54 4.75 67.24 67.24 090

48511 ............ A Drain pancreatic pseudocyst .............................. 4.00 3.03 3.03 0.35 7.38 7.38 000

48556 ............ A Removal, allograft pancreas .............................. *15.71 7.26 7.26 1.69 24.66 24.66 090

49021 ............ A Drain abdominal abscess ................................... *3.38 #3.72 #3.72 0.91 8.01 8.01 000

49041 ............ A Percut drain abdom abscess ............................. 4.00 3.03 3.03 0.35 7.38 7.38 000

49061 ............ A Percutdrain retroper abscess ............................. 3.70 2.80 2.80 0.33 6.83 6.83 000

49062 ............ A Drain to peritoneal cavity ................................... *11.36 8.07 8.07 0.79 20.22 20.22 090

49423 ............ A Exchange drainage cath .................................... 1.46 1.10 1.10 0.13 2.69 2.69 000

49424 ............ A Assess cyst, contrast inj .................................... 0.76 0.57 0.57 0.07 1.40 1.40 000

49507 ............ A Repair, inguinal hernia ....................................... *8.17 5.04 5.04 1.08 14.29 14.29 090

50021 ............ A Percut drain renal abscess ................................ 3.38 2.56 2.56 0.30 6.24 6.24 000

50727 ............ A Revise ureter ...................................................... *8.18 5.37 5.37 0.51 14.06 14.06 090
59252

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

50728 ............ A Revise ureter ...................................................... *12.02 7.90 7.90 0.77 20.69 20.69 090

50782 ............ A Reimplant ureter in bladder ............................... *19.54 13.78 13.78 1.46 34.78 34.78 090

50783 ............ A Reimplant ureter in bladder ............................... *20.55 13.78 13.78 1.46 35.79 35.79 090

52282 ............ A Cystoscopy, implant stent .................................. 6.40 4.58 4.58 0.45 11.43 11.43 000

52450 ............ A Incision of prostate ............................................. *7.64 4.99 4.99 0.49 13.12 13.12 090

53850 ............ A Prostatic microwave thermotx ............................ *9.45 6.71 6.71 0.66 16.82 16.82 090

53852 ............ A Prostatic rf thermotx ........................................... *9.88 7.01 7.01 0.69 17.58 17.58 090

54401 ............ A Insert self-contd prosthesis ................................ *10.28 #11.31 #11.31 1.73 23.32 23.32 090

56300 ............ A Laparoscopy; diagnostic .................................... *5.10 4.45 4.45 0.93 10.48 10.48 010

56301 ............ A Laparoscopy; tubal cautery ................................ *5.60 4.71 4.71 1.28 11.59 11.59 010

56302 ............ A Laparoscopy; tubal block ................................... *5.60 5.26 5.26 1.32 12.18 12.18 010

56303 ............ A Laparoscopy; excise lesions .............................. *11.79 5.53 5.53 1.16 18.48 18.48 090

56304 ............ A Laparoscopy; lysis .............................................. *11.29 5.60 5.60 1.20 18.09 18.09 090

56305 ............ A Laparoscopy; biopsy .......................................... *5.40 4.90 4.90 0.79 11.09 11.09 010

56306 ............ A Laparoscopy; aspiration ..................................... *5.70 4.87 4.87 1.18 11.75 11.75 010

56310 ............ A Laparoscopic enterolysis .................................... *14.44 8.28 8.28 1.75 24.47 24.47 090

56314 ............ A Lapar; drain lymphocele ..................................... *9.48 6.73 6.73 0.66 16.87 16.87 090

56318 ............ A Laparoscopic orchiectomy ................................. *10.96 7.23 7.23 0.81 19.00 19.00 090

56322 ............ A Laparoscopy, vagus nerves ............................... *10.15 5.07 5.07 1.18 16.40 16.40 090

56323 ............ A Laparoscopy, vagus nerves ............................... *12.15 6.09 6.09 1.41 19.65 19.65 090

56324 ............ A Laparoscopy, cholecystoenter ........................... *12.58 9.16 9.16 1.93 23.67 23.67 090

56342 ............ A Laparoscopic cholecystectomy .......................... *14.23 9.37 9.37 2.00 25.60 25.60 090

56343 ............ A Laparoscopic salpingostomy .............................. *13.74 5.28 5.28 1.11 20.13 20.13 090

56344 ............ A Laparoscopic fimbrioplasty ................................. *12.88 5.11 5.11 1.19 19.18 19.18 090

56345 ............ C Laparoscopic splenectomy ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

56346 ............ A Laparoscopic gastrostomy ................................. *7.73 6.19 6.19 1.19 15.11 15.11 090

56347 ............ C Laparoscopic jejunostomy .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

56348 ............ A Laparo; resect intestine ...................................... *22.04 13.25 13.25 2.78 38.07 38.07 090

56349 ............ A Laparoscopy; fundoplasty .................................. *17.25 11.88 11.88 2.53 31.66 31.66 090

56350 ............ A Hysteroscopy; diagnostic ................................... 3.33 1.99 1.99 0.44 5.76 5.76 000

56351 ............ A Hysteroscopy; biopsy ......................................... 4.75 1.99 1.99 0.44 7.18 7.18 000

56352 ............ A Hysteroscopy; lysis ............................................ 6.17 3.77 3.77 0.85 10.79 10.79 000

56353 ............ A Hysteroscopy; resect septum ............................. 7.00 3.77 3.77 0.85 11.62 11.62 000

56354 ............ A Hysteroscopy; remove myoma .......................... 10.00 4.93 4.93 1.30 16.23 16.23 000

56355 ............ A Hysteroscopy; remove impact ............................ 5.21 1.99 1.99 0.44 7.64 7.64 000

56356 ............ A Hysteroscopy; ablation ....................................... 6.17 4.39 4.39 1.49 12.05 12.05 000

56631 ............ A Extensive vulva surgery ..................................... *16.20 #17.82 #17.82 4.51 38.53 38.53 090

56634 ............ A Extensive vulva surgery ..................................... *17.88 #19.67 #19.67 4.51 42.06 42.06 090

56637 ............ A Extensive vulva surgery ..................................... *21.97 21.42 21.42 4.51 47.90 47.90 090

56810 ............ A Repair of perineum ............................................ *4.13 2.62 2.62 0.51 7.26 7.26 010

57308 ............ A Fistula repair, transperine .................................. *9.94 7.23 7.23 1.41 18.58 18.58 090

57510 ............ A Cauterization of cervix ....................................... *1.90 0.52 0.52 0.09 2.51 2.51 010

57531 ............ A Removal of cervix, radical .................................. *22.04 17.77 17.77 3.87 43.68 43.68 090

58262 ............ A Vaginal hysterectomy ......................................... *13.99 9.39 9.39 2.07 25.45 25.45 090

58263 ............ A Vaginal hysterectomy ......................................... *15.28 10.32 10.32 2.22 27.82 27.82 090

58345 ............ A Reopen fallopian tube ........................................ *4.66 3.49 3.49 0.41 8.56 8.56 010

58823 ............ A Percut drain pelvic abscess ............................... 3.38 2.56 2.56 0.30 6.24 6.24 000

58825 ............ A Transposition, ovary(s) ....................................... *6.13 4.03 4.03 0.93 11.09 11.09 090

59150 ............ A Treat ectopic pregnancy .................................... *6.89 4.53 4.53 1.05 12.47 12.47 090

59151 ............ A Treat ectopic pregnancy .................................... *7.86 8.61 8.61 0.64 17.11 17.11 090

59871 ............ A Remove cerclage suture .................................... 2.13 1.78 1.78 0.41 4.32 4.32 000

60271 ............ A Removal of thyroid ............................................. *14.89 12.14 12.14 2.25 29.28 29.28 090

61760 ............ A Implant brain electrodes ..................................... *22.27 14.98 14.98 1.75 39.00 39.00 090

62280 ............ A Treat spinal cord lesion ...................................... *2.63 0.71 0.71 0.14 3.48 3.48 010

62281 ............ A Treat spinal cord lesion ...................................... *2.66 0.87 0.87 0.28 3.81 3.81 010

62282 ............ A Treat spinal canal lesion .................................... *2.33 1.70 1.70 0.40 4.43 4.43 010

64612 ............ A Destroy nerve, face muscle ............................... *1.96 1.45 1.45 0.17 3.58 3.58 010

64613 ............ A Destroy nerve, spine muscle ............................. *1.96 1.45 1.45 0.17 3.58 3.58 010

64716 ............ A Revision of cranial nerve ................................... *6.31 4.83 4.83 0.67 11.81 11.81 090

64755 ............ A Incision of stomach nerves ................................ *13.52 10.47 10.47 2.27 26.26 26.26 090

64885 ............ A Nerve graft, head or neck .................................. *17.53 12.69 12.69 1.48 31.70 31.70 090

64886 ............ A Nerve graft, head or neck .................................. *20.75 15.13 15.13 1.77 37.65 37.65 090

65860 ............ A Incise inner eye adhesions ................................ *3.55 #3.91 #3.91 0.37 7.83 7.83 090

66700 ............ A Destruction, ciliary body ..................................... *4.78 #5.26 #5.26 0.35 10.39 10.39 090

66710 ............ A Destruction, ciliary body ..................................... *4.78 #5.26 #5.26 0.41 10.45 10.45 090

66740 ............ A Destruction, ciliary body ..................................... *4.78 #5.26 #5.26 0.39 10.43 10.43 090

67027 ............ A Implant eye drug system .................................... *10.85 9.04 9.04 0.47 20.36 20.36 090

67414 ............ A Explore/decompress eye socke ......................... *11.13 8.39 8.39 0.44 19.96 19.96 090

67445 ............ A Explore/decompress eye socke ......................... *14.42 11.13 11.13 0.57 26.12 26.12 090

67570 ............ A Decompress optic nerve .................................... *13.58 7.56 7.56 0.39 21.53 21.53 090

68761 ............ A Close tear duct opening ..................................... *1.36 0.92 0.92 0.04 2.32 2.32 010

69205 ............ A Clear outer ear canal ......................................... *1.20 1.07 1.07 0.11 2.38 2.38 010

75945 26 A Intravascular us .................................................. 0.40 0.22 0.22 0.03 0.65 0.65 XXX

75946 26 A Intravascular us .................................................. 0.40 0.22 0.22 0.03 0.65 0.65 XXX
59253

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

76076 26 A Dual energy x-ray study ..................................... 0.22 0.10 0.10 0.02 0.34 0.34 XXX

76078 26 A Photodensitometry ............................................. 0.20 0.10 0.10 0.02 0.32 0.32 XXX

76390 26 A Mr spectroscopy ................................................. 1.40 0.66 0.66 0.10 2.16 2.16 XXX

76831 26 A Echo exam, uterus ............................................. 0.72 0.32 0.32 0.05 1.09 1.09 XXX

76885 26 A Echo exam, infant hips ...................................... 0.74 0.32 0.32 0.05 1.11 1.11 XXX

76886 26 A Echo exam, infant hips ...................................... 0.62 0.27 0.27 0.04 0.93 0.93 XXX

77750 ............ A Infuse radioactive materials ............................... *4.91 3.32 3.32 0.38 8.61 8.61 090

77750 26 A Infuse radioactive materials ............................... *4.91 2.05 2.05 0.30 7.26 7.26 090

77761 ............ A Radioelement application ................................... *3.81 3.98 3.98 0.39 8.18 8.18 090

77761 26 A Radioelement application ................................... *3.81 1.59 1.59 0.23 5.63 5.63 090

77762 ............ A Radioelement application ................................... *5.72 5.83 5.83 0.57 12.12 12.12 090

77762 26 A Radioelement application ................................... *5.72 2.39 2.39 0.35 8.46 8.46 090

77763 ............ A Radioelement application ................................... *8.57 7.86 7.86 0.77 17.20 17.20 090

77763 26 A Radioelement application ................................... *8.57 3.58 3.58 0.50 12.65 12.65 090

77777 ............ A Radioelement application ................................... *7.48 7.17 7.17 0.71 15.36 15.36 090

77777 26 A Radioelement application ................................... *7.48 3.13 3.13 0.45 11.06 11.06 090

77778 ............ A Radioelement application ................................... *11.19 9.58 9.58 0.98 21.75 21.75 090

77778 26 A Radioelement application ................................... *11.19 4.69 4.69 0.67 16.55 16.55 090

77781 ............ A High intensity brachytherapy .............................. *1.66 20.04 20.04 1.32 23.02 23.02 090

77781 26 A High intensity brachytherapy .............................. *1.66 0.69 0.69 0.11 2.46 2.46 090

77782 ............ A High intensity brachytherapy .............................. *2.49 20.40 20.40 1.37 24.26 24.26 090

77782 26 A High intensity brachytherapy .............................. *2.49 1.05 1.05 0.16 3.70 3.70 090

77783 ............ A High intensity brachytherapy .............................. *3.73 20.90 20.90 1.44 26.07 26.07 090

77783 26 A High intensity brachytherapy .............................. *3.73 1.55 1.55 0.23 5.51 5.51 090

77784 ............ A High intensity brachytherapy .............................. *5.61 21.69 21.69 1.56 28.86 28.86 090

77784 26 A High intensity brachytherapy .............................. *5.61 2.34 2.34 0.35 8.30 8.30 090

77789 ............ A Radioelement application ................................... *1.12 0.89 0.89 0.10 2.11 2.11 090

77789 26 A Radioelement application ................................... *1.12 0.46 0.46 0.07 1.65 1.65 090

78491 26 I Heart image (pet) single .................................... +1.50 1.34 1.34 0.10 2.94 2.94 XXX

78492 26 I Heart image (pet) multiple ................................. +1.87 1.34 1.34 0.10 3.31 3.31 XXX

78707 26 A Kidney flow & function image ............................ 0.96 0.42 0.42 0.06 1.44 1.44 XXX

78708 26 A Kidney flow & function image ............................ 1.21 0.42 0.42 0.06 1.69 1.69 XXX

78709 26 A Kidney flow & function image ............................ 1.41 0.42 0.42 0.06 1.89 1.89 XXX

88141 ............ A Cytopath cerv/vag interpret ................................ 0.42 0.32 0.32 0.04 0.78 0.78 XXX

88152 ............ X Cytopath cerv/vag auto ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

90802 ............ A Intac psy dx interview ........................................ 3.01 0.38 0.38 0.05 3.44 3.44 XXX

90804 ............ A Psytx, office (20–30) .......................................... 1.11 0.35 0.35 0.05 1.51 1.51 XXX

90805 ............ A Psytx, office (20–30) w/e&m .............................. 1.47 0.35 0.35 0.05 1.87 1.87 XXX

90806 ............ A Psytx, office (45–50) .......................................... 1.73 0.54 0.54 0.08 2.35 2.35 XXX

90807 ............ A Psytx, office (45–50) w/e&m .............................. 2.00 0.54 0.54 0.08 2.62 2.62 XXX

90808 ............ A Psytx, office (75–80) .......................................... 2.76 1.05 1.05 0.15 3.96 3.96 XXX

90809 ............ A Psytx, office (75–80) w/e&m .............................. 3.15 1.05 1.05 0.15 4.35 4.35 XXX

90810 ............ A Intac psytx, office (20–30) .................................. 1.19 0.59 0.59 0.09 1.87 1.87 XXX

90811 ............ A Intac psytx, off 20–30 w/e&m ............................ 1.58 0.59 0.59 0.09 2.26 2.26 XXX

90812 ............ A Intac psytx, office (45–50) .................................. 1.86 0.59 0.59 0.09 2.54 2.54 XXX

90813 ............ A Intac psytx, off 45–50 w/e&m ............................ 2.15 0.59 0.59 0.09 2.83 2.83 XXX

90814 ............ A Intac psytx, office (75–80) .................................. 2.97 0.59 0.59 0.09 3.65 3.65 XXX

90815 ............ A Intac psytx, off 75–80 w/e&m ............................ 3.39 0.59 0.59 0.09 4.07 4.07 XXX

90816 ............ A Psytx, hosp (20–30) ........................................... 1.24 0.35 0.35 0.05 1.64 1.64 XXX

90817 ............ A Psytx, hosp (20–30) w/e&m ............................... 1.65 0.35 0.35 0.05 2.05 2.05 XXX

90818 ............ A Psytx, hosp (45–50) ........................................... 1.94 0.54 0.54 0.08 2.56 2.56 XXX

90819 ............ A Psytx, hosp (45–50) w/e&m ............................... 2.24 0.54 0.54 0.08 2.86 2.86 XXX

90821 ............ A Psytx, hosp (75–80) ........................................... 3.09 1.05 1.05 0.15 4.29 4.29 XXX

90822 ............ A Psytx, hosp (75–80) w/e&m ............................... 3.53 1.05 1.05 0.15 4.73 4.73 XXX

90823 ............ A Intac psytx, hosp (20–30) .................................. 1.33 0.59 0.59 0.09 2.01 2.01 XXX

90824 ............ A Intac psytx, hsp 20–30 w/e&m ........................... 1.77 0.59 0.59 0.09 2.45 2.45 XXX

90826 ............ A Intac psytx, hosp (45–50) .................................. 2.08 0.59 0.59 0.09 2.76 2.76 XXX

90827 ............ A Intac psytx, hsp 45–50 w/e&m ........................... 2.41 0.59 0.59 0.09 3.09 3.09 XXX

90828 ............ A Intac psytx, hosp (75–80) .................................. 3.32 0.59 0.59 0.09 4.00 4.00 XXX

90829 ............ A Intac psytx, hsp 75–80 w/e&m ........................... 3.80 0.59 0.59 0.09 4.48 4.48 XXX

90865 ............ A Narcosynthesis ................................................... 2.84 0.50 0.50 0.07 3.41 3.41 XXX

90875 ............ N Psychophysiological therapy .............................. 1.20 0.00 0.00 0.00 1.20 1.20 XXX

90876 ............ N Psychophysiological therapy .............................. 1.90 0.00 0.00 0.00 1.90 1.90 XXX

90885 ............ B Psy evaluation of records .................................. +0.97 0.31 0.31 0.04 1.32 1.32 XXX

92986 ............ A Revision of aortic valve ...................................... *21.80 12.04 12.04 0.90 34.74 34.74 090

92987 ............ A Revision of mitral valve ...................................... *22.70 12.20 12.20 0.91 35.81 35.81 090

92990 ............ A Revision of pulmonary valve .............................. *17.34 9.59 9.59 0.71 27.64 27.64 090

92997 ............ A Pul art balloon repair, perc ................................ 12.00 #13.20 #13.20 1.22 26.42 26.42 000

92998 ............ A Pul art balloon repair, perc ................................ 6.00 3.80 3.80 0.44 10.24 10.24 ZZZ

93508 26 A Cath placement, angiography ............................ 4.10 2.78 2.78 0.23 7.11 7.11 000

93530 26 A Rt heart cath, congenital .................................... 4.23 3.61 3.61 0.34 8.18 8.18 000

93531 26 A R & l heart cath, congenital ............................... 8.35 5.45 5.45 0.39 14.19 14.19 000

93532 26 A R & l heart cath, congenital ............................... 10.00 7.14 7.14 0.50 17.64 17.64 000

93533 26 A R & l heart cath, congenital ............................... 6.70 2.93 2.93 0.22 9.85 9.85 000
59254

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not used for Medicare payment. 4 * Work RVUs increased in global surgical package.

Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

5 # Indicates reduction of Practice Expense RVUs as result of 110% PE reduction.

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

95806 26 A Sleep study, unattended .................................... 1.66 2.45 #1.83 0.19 4.30 3.68 XXX

95811 26 A Polysomnography w/cpap .................................. 3.80 2.57 2.57 0.20 6.57 6.57 XXX

95870 26 A Muscle test, non-paraspinal ............................... 0.37 0.33 0.33 0.03 0.73 0.73 XXX

95921 26 A Autonomic nervous func test ............................. 0.90 0.32 0.32 0.02 1.24 1.24 XXX

95922 26 A Autonomic nervous func test ............................. 0.96 0.34 0.34 0.03 1.33 1.33 XXX

95923 26 A Autonomic nervous func test ............................. 0.90 0.32 0.32 0.02 1.24 1.24 XXX

96902 ............ B Trichogram ......................................................... +0.41 0.29 0.29 0.02 0.72 0.72 XXX

97001 ............ A Pt evaluation ...................................................... 1.20 0.35 0.35 0.11 1.66 1.66 XXX

97002 ............ A Pt re-evaluation .................................................. 0.60 0.04 0.04 0.01 0.65 0.65 XXX

97003 ............ A Ot evaluation ...................................................... 1.20 0.35 0.35 0.11 1.66 1.66 XXX

97004 ............ A Ot re-evaluation .................................................. 0.60 0.04 0.04 0.01 0.65 0.65 XXX

97780 ............ N Acupuncture w/o stim ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

97781 ............ N Acupuncture w/stim ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

99141 ............ B Sedation, iv/im or inhalant ................................. +0.80 0.83 0.83 0.05 1.68 1.68 XXX

99142 ............ B Sedation, oral/rectal/nasal .................................. +0.60 0.62 0.62 0.04 1.26 1.26 XXX

99234 ............ A Observ/hosp same date ..................................... 2.56 0.68 0.68 0.06 3.30 3.30 XXX

99235 ............ A Observ/hosp same date ..................................... 3.42 1.05 1.05 0.09 4.56 4.56 XXX

99236 ............ A Observ/hosp same date ..................................... 4.27 1.14 1.14 0.09 5.50 5.50 XXX

99301 ............ A Nursing facility care ............................................ 1.20 0.45 0.45 0.03 1.68 1.68 XXX

99302 ............ A Nursing facility care ............................................ 1.61 0.50 0.50 0.04 2.15 2.15 XXX

99303 ............ A Nursing facility care ............................................ 2.01 0.95 0.95 0.07 3.03 3.03 XXX

99311 ............ A Nursing facility care, subseq .............................. 0.60 0.34 0.34 0.03 0.97 0.97 XXX

99312 ............ A Nursing facility care, subseq .............................. 1.00 0.41 0.41 0.03 1.44 1.44 XXX

99313 ............ A Nursing facility care, subseq .............................. 1.42 0.46 0.46 0.04 1.92 1.92 XXX

99315 ............ A Nursing fac discharge day ................................. 1.13 0.51 0.51 0.04 1.68 1.68 XXX

99316 ............ A Nursing fac discharge day ................................. 1.50 0.51 0.51 0.04 2.05 2.05 XXX

99341 ............ A Home visit, new patient ...................................... 1.01 0.53 0.53 0.05 1.59 1.59 XXX

99342 ............ A Home visit, new patient ...................................... 1.52 0.60 0.60 0.05 2.17 2.17 XXX

99343 ............ A Home visit, new patient ...................................... 2.27 0.77 0.77 0.06 3.10 3.10 XXX

99344 ............ A Home visit, new patient ...................................... 3.03 0.85 0.85 0.09 3.97 3.97 XXX

99345 ............ A Home visit, new patient ...................................... 3.79 0.85 0.85 0.09 4.73 4.73 XXX

99347 ............ A Home visit, estab patient ................................... 0.76 0.45 0.45 0.04 1.25 1.25 XXX

99348 ............ A Home visit, estab patient ................................... 1.26 0.53 0.53 0.04 1.83 1.83 XXX

99349 ............ A Home visit, estab patient ................................... 2.02 0.61 0.61 0.05 2.68 2.68 XXX

99350 ............ A Home visit, estab patient ................................... 3.03 0.76 0.76 0.07 3.86 3.86 XXX

99374 ............ B Home health care supervision ........................... +1.10 0.51 0.51 0.04 1.65 1.65 XXX

99375 ............ A Home health care supervision ........................... 1.73 0.51 0.51 0.04 2.28 2.28 XXX

99377 ............ B Hospice care supervision ................................... +1.10 0.51 0.51 0.04 1.65 1.65 XXX

99378 ............ A Hospice care supervision ................................... 1.73 0.51 0.51 0.04 2.28 2.28 XXX

99379 ............ B Nursing fac care supervision ............................. +1.10 0.51 0.51 0.04 1.65 1.65 XXX

99380 ............ B Nursing fac care supervision ............................. +1.73 0.51 0.51 0.04 2.28 2.28 XXX

99436 ............ A Attendance, birth ................................................ 1.50 1.55 1.55 0.10 3.15 3.15 XXX

G0030 26 A PET imaging prev PET single ............................ 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0031 26 A PET imaging prev PET multple ......................... 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0032 26 A PET follow SPECT 78464 singl ......................... 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0033 26 A PET follow SPECT 78464 mult .......................... 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0034 26 A PET follow SPECT 76865 singl ......................... 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0035 26 A PET follow SPECT 78465 mult .......................... 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0036 26 A PET follow cornry angio sing ............................. 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0037 26 A PET follow cornry angio mult ............................. 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0038 26 A PET follow myocard perf sing ............................ 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0039 26 A PET follow myocard perf mult ............................ 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0040 26 A PET follow stress echo singl .............................. 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0041 26 A PET follow stress echo mult .............................. 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0042 26 A PET follow ventriculogm sing ............................. 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0043 26 A PET follow ventriculogm mult ............................ 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0044 26 A PET following rest ECG singl ............................ 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0045 26 A PET following rest ECG mult ............................. 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0046 26 A PET follow stress ECG singl .............................. 1.50 0.48 0.48 0.07 2.05 2.05 XXX

G0047 26 A PET follow stress ECG mult .............................. 1.87 0.65 0.65 0.10 2.62 2.62 XXX

G0051 ............ D Destroy benign/premal lesion ............................ *0.00 0.00 0.00 0.00 0.00 0.00 010

G0101 ............ A CA screen;pelvic/breast exam ........................... 0.45 0.28 0.28 0.02 0.75 0.75 XXX

G0104 ............ A CA screen;flexi sigmoidscope ............................ 0.96 1.23 #1.06 0.12 2.31 2.14 000

G0105 ............ A Colorectal scrn; hi risk ind ................................. 3.70 4.13 #4.07 0.39 8.22 8.16 000

G0106 26 A Colon CA screen;barium enema ........................ 0.99 0.45 0.45 0.07 1.51 1.51 XXX

G0107 ............ X CA screen; fecal blood test ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0110 ............ R Nett pulm-rehab educ; ind ................................. 0.90 0.26 0.26 0.04 1.20 1.20 XXX

G0111 ............ R Nett pulm-rehab educ; group ............................. 0.27 0.20 0.20 0.02 0.49 0.49 XXX

G0112 ............ R Nett;nutrition guid, initial ..................................... 1.72 0.97 0.97 0.10 2.79 2.79 XXX

G0113 ............ R Nett;nutrition guid, subseqnt .............................. 1.29 0.77 0.77 0.09 2.15 2.15 XXX

G0114 ............ R Nett; psychosocial consult ................................. 1.20 0.35 0.35 0.11 1.66 1.66 XXX

G0115 ............ R Nett; psychological testing ................................. 1.20 0.35 0.35 0.11 1.66 1.66 XXX

G0116 ............ A Nett; psychosocial counsel ................................ 1.11 0.35 0.35 0.05 1.51 1.51 XXX

G0120 26 A Colon ca scrn; barium enema ............................ 0.99 0.45 0.45 0.07 1.51 1.51 XXX
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59255

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3 4

Nonfacility

practice

expense

RVUs 5

Facility

practice

expense

RVUs 5

Malpractice

RVUs

Nonfacility

total

Facility

total Global

G0121 ............ N Colon ca scrn; barium enema ............................ +3.70 4.13 #4.07 0.39 8.22 8.16 XXX

G0122 26 N Colon ca scrn; barium enema ............................ +0.99 0.45 0.45 0.07 1.51 1.51 XXX

ADDENDUM D.—1999 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY

Carrier

No.

Locality

No. Locality name Work Practiceexpense

Malpractice

00510 00 ALABAMA ......................................................................................................................................................... 0.978 0.872 0.876

00831 01 ALASKA ............................................................................................................................................................ 1.063 1.173 1.533

00832 00 ARIZONA .......................................................................................................................................................... 0.995 0.971 1.189

00520 13 ARKANSAS ...................................................................................................................................................... 0.953 0.855 0.403

02050 26 ANAHEIM/SANTA ANA, CA ............................................................................................................................. 1.036 1.191 0.846

02050 18 LOS ANGELES, CA ......................................................................................................................................... 1.055 1.199 0.846

31140 03 MARIN/NAPA/SOLANO, CA ............................................................................................................................ 1.014 1.161 0.667

31140 07 OAKLAND/BERKLEY, CA ................................................................................................................................ 1.040 1.196 0.667

31140 05 SAN FRANCISCO, CA ..................................................................................................................................... 1.067 1.299 0.667

31140 06 SAN MATEO, CA ............................................................................................................................................. 1.047 1.274 0.667

31140 09 SANTA CLARA, CA .......................................................................................................................................... 1.062 1.262 0.667

02050 17 VENTURA, CA .................................................................................................................................................. 1.027 1.131 0.717

02050 99 REST OF STATE* ............................................................................................................................................ 1.008 1.043 0.698

31140 99 REST OF STATE* ............................................................................................................................................ 1.008 1.043 0.698

00824 01 COLORADO ..................................................................................................................................................... 0.987 0.970 0.795

10230 00 CONNECTICUT ................................................................................................................................................ 1.049 1.172 1.052

00570 01 DELAWARE ...................................................................................................................................................... 1.019 1.028 0.860

00580 01 DC + MD/VA SUBURBS .................................................................................................................................. 1.050 1.161 1.032

00590 03 FORT LAUDERDALE, FL ................................................................................................................................. 0.996 1.026 1.783

00590 04 MIAMI, FL ......................................................................................................................................................... 1.015 1.077 2.350

00590 99 REST OF STATE ............................................................................................................................................. 0.975 0.948 1.327

00511 01 ATLANTA, GA .................................................................................................................................................. 1.006 1.034 0.951

00511 99 REST OF STATE ............................................................................................................................................. 0.970 0.900 0.951

00833 01 HAWAII/GUAM ................................................................................................................................................. 0.998 1.183 0.954

05130 00 IDAHO ............................................................................................................................................................... 0.960 0.892 0.566

00621 16 CHICAGO, IL .................................................................................................................................................... 1.027 1.088 1.693

00621 12 EAST ST. LOUIS, IL ......................................................................................................................................... 0.988 0.931 1.487

00621 15 SUBURBAN CHICAGO, IL ............................................................................................................................... 1.006 1.067 1.365

00621 99 REST OF STATE ............................................................................................................................................. 0.963 0.886 0.990

00630 00 INDIANA ........................................................................................................................................................... 0.981 0.917 0.408

00640 00 IOWA ................................................................................................................................................................ 0.958 0.882 0.648

00650 00 KANSAS* .......................................................................................................................................................... 0.963 0.898 0.890

00740 04 KANSAS* .......................................................................................................................................................... 0.963 0.898 0.890

00660 00 KENTUCKY ...................................................................................................................................................... 0.970 0.874 0.807

00528 01 NEW ORLEANS, LA ......................................................................................................................................... 0.998 0.950 1.153

00528 99 REST OF STATE ............................................................................................................................................. 0.969 0.881 1.031

31142 03 SOUTHERN MAINE ......................................................................................................................................... 0.979 1.030 0.708

31142 99 REST OF STATE ............................................................................................................................................. 0.961 0.924 0.708

00901 01 BALTIMORE/SURR. CNTYS, MD .................................................................................................................... 1.019 1.039 1.098

00901 99 REST OF STATE ............................................................................................................................................. 0.985 0.986 0.866

31143 01 METROPOLITAN BOSTON ............................................................................................................................. 1.039 1.196 0.713

31143 99 REST OF STATE ............................................................................................................................................. 1.010 1.093 0.713

00623 01 DETROIT, MI .................................................................................................................................................... 1.042 1.022 3.069

00623 99 REST OF STATE ............................................................................................................................................. 0.996 0.939 1.828

10240 00 MINNESOTA ..................................................................................................................................................... 0.989 0.967 0.507

10250 00 MISSISSIPPI ..................................................................................................................................................... 0.957 0.846 0.721

00740 02 METROPOLITAN KANSAS CITY, MO ............................................................................................................ 0.988 0.949 1.196

11260 01 METROPOLITAN ST. LOUIS, MO ................................................................................................................... 0.994 0.943 1.198

00740 99 REST OF STATE* ............................................................................................................................................ 0.945 0.828 1.165

11260 99 REST OF STATE* ............................................................................................................................................ 0.945 0.828 1.165

00751 01 MONTANA ........................................................................................................................................................ 0.951 0.877 0.732

00655 00 NEBRASKA ...................................................................................................................................................... 0.949 0.873 0.443

00834 00 NEVADA ........................................................................................................................................................... 1.005 1.032 0.997

31144 40 NEW HAMPSHIRE ........................................................................................................................................... 0.988 1.033 1.013

00860 01 NORTHERN NJ ................................................................................................................................................ 1.057 1.191 0.795

00860 99 REST OF STATE ............................................................................................................................................. 1.028 1.094 0.795

00521 05 NEW MEXICO .................................................................................................................................................. 0.973 0.910 0.716

00803 01 MANHATTAN, NY ............................................................................................................................................ 1.093 1.353 1.654

00803 02 NYC SUBURBS/LONG I., NY .......................................................................................................................... 1.067 1.233 1.932

00803 03 POUGHKPSIE/N NYC SUBURBS, NY ............................................................................................................ 1.010 1.084 1.326

14330 04 QUEENS, NY .................................................................................................................................................... 1.057 1.234 1.839

00801 99 REST OF STATE ............................................................................................................................................. 0.999 0.959 0.793

05535 00 NORTH CAROLINA .......................................................................................................................................... 0.970 0.924 0.497

00820 01 NORTH DAKOTA ............................................................................................................................................. 0.950 0.877 0.656

16360 00 OHIO ................................................................................................................................................................. 0.990 0.939 1.074
59256 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

ADDENDUM D.—1999 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY—Continued

Carrier

No.

Locality

No. Locality name Work Practiceexpense

Malpractice

00522 00 OKLAHOMA ...................................................................................................................................................... 0.969 0.882 0.451

00835 01 PORTLAND, OR ............................................................................................................................................... 0.996 1.021 0.587

00835 99 REST OF STATE ............................................................................................................................................. 0.961 0.938 0.587

00865 01 METROPOLITAN PHILADELPHIA, PA ............................................................................................................ 1.024 1.089 1.207

00865 99 REST OF STATE ............................................................................................................................................. 0.989 0.931 0.637

00973 20 PUERTO RICO ................................................................................................................................................. 0.882 0.729 0.359

00870 01 RHODE ISLAND ............................................................................................................................................... 1.018 1.069 1.189

00880 01 SOUTH CAROLINA .......................................................................................................................................... 0.975 0.905 0.280

00820 02 SOUTH DAKOTA ............................................................................................................................................. 0.935 0.873 0.435

05440 35 TENNESSEE .................................................................................................................................................... 0.975 0.899 0.552

00900 31 AUSTIN, TX ...................................................................................................................................................... 0.986 1.000 0.849

00900 20 BEAUMONT, TX ............................................................................................................................................... 0.992 0.899 1.386

00900 09 BRAZORIA, TX ................................................................................................................................................. 0.992 0.977 1.386

00900 11 DALLAS, TX ..................................................................................................................................................... 1.010 1.016 0.930

00900 28 FORT WORTH, TX ........................................................................................................................................... 0.987 0.971 0.930

00900 15 GALVESTON, TX ............................................................................................................................................. 0.988 0.970 1.386

00900 18 HOUSTON, TX ................................................................................................................................................. 1.020 1.007 1.418

00900 99 REST OF STATE ............................................................................................................................................. 0.966 0.888 0.871

00910 09 UTAH ................................................................................................................................................................ 0.977 0.909 0.594

31145 50 VERMONT ........................................................................................................................................................ 0.973 0.984 0.548

00973 50 VIRGIN ISLANDS ............................................................................................................................................. 0.965 1.034 1.032

10490 00 VIRGINIA .......................................................................................................................................................... 0.985 0.941 0.557

00836 02 SEATTLE (KING CNTY), WA ........................................................................................................................... 1.005 1.080 0.742

00836 99 REST OF STATE ............................................................................................................................................. 0.982 0.976 0.742

16510 16 WEST VIRGINIA ............................................................................................................................................... 0.963 0.853 1.106

00951 00 WISCONSIN ..................................................................................................................................................... 0.981 0.933 0.841

00825 21 WYOMING ........................................................................................................................................................ 0.967 0.895 0.705

*Payment locality is serviced by two carriers.

Note: Work GPCI is the 1/4 work GPCI required by Section 1848(e)(1)(A)(iii) of the Social Security Act. GPCIs rescaled by the following factors to assure budget

neutrality: Work = 1.00027; Practice expense = 1.00057; Malpractice = 1.03174.

ADDENDUM E.—1998 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY

Carrier

No.

Locality

No. Locality name Work Practiceexpense

Malpractice

00510 00 ALABAMA .......................................................................................................................................................... 0.979 0.871 0.902

00831 01 ALASKA ............................................................................................................................................................. 1.064 1.164 1.575

00832 00 ARIZONA ........................................................................................................................................................... 0.996 0.964 1.255

00520 13 ARKANSAS ....................................................................................................................................................... 0.954 0.854 0.415

02050 26 ANAHEIM/SANTA ANA, CA .............................................................................................................................. 1.037 1.198 0.799

02050 18 LOS ANGELES, CA .......................................................................................................................................... 1.056 1.203 0.799

31140 03 MARIN/NAPA/SOLANO, CA ............................................................................................................................. 1.015 1.171 0.632

31140 07 OAKLAND/BERKLEY, CA ................................................................................................................................. 1.041 1.206 0.632

31140 05 SAN FRANCISCO, CA ...................................................................................................................................... 1.068 1.315 0.632

31140 06 SAN MATEO, CA .............................................................................................................................................. 1.048 1.287 0.632

31140 09 SANTA CLARA, CA ........................................................................................................................................... 1.063 1.276 0.632

02050 17 VENTURA, CA ................................................................................................................................................... 1.028 1.162 0.702

02050 99 REST OF STATE* ............................................................................................................................................. 1.009 1.046 0.663

31140 99 REST OF STATE* ............................................................................................................................................. 1.009 1.046 0.663

00824 01 COLORADO ...................................................................................................................................................... 0.988 0.961 0.811

10230 00 CONNECTICUT ................................................................................................................................................. 1.050 1.182 1.027

00570 01 DELAWARE ....................................................................................................................................................... 1.020 1.030 0.826

00580 01 DC + MD/VA SUBURBS ................................................................................................................................... 1.051 1.177 1.006

00590 03 FORT LAUDERDALE, FL .................................................................................................................................. 0.997 1.031 1.825

00590 04 MIAMI, FL .......................................................................................................................................................... 1.016 1.082 2.403

00590 99 REST OF STATE .............................................................................................................................................. 0.976 0.946 1.372

00511 01 ATLANTA, GA ................................................................................................................................................... 1.007 1.032 0.927

00511 99 REST OF STATE .............................................................................................................................................. 0.971 0.896 0.927

00833 01 HAWAII/GUAM .................................................................................................................................................. 0.999 1.202 0.938

05130 00 IDAHO ................................................................................................................................................................ 0.961 0.887 0.577

00621 16 CHICAGO, IL ..................................................................................................................................................... 1.028 1.084 1.538

00621 12 EAST ST. LOUIS, IL .......................................................................................................................................... 0.988 0.930 1.345

00621 15 SUBURBAN CHICAGO, IL ................................................................................................................................ 1.007 1.080 1.262

00621 99 REST OF STATE .............................................................................................................................................. 0.964 0.885 0.906

00630 00 INDIANA ............................................................................................................................................................ 0.982 0.917 0.382

00640 00 IOWA ................................................................................................................................................................. 0.959 0.880 0.664

00650 00 KANSAS* ........................................................................................................................................................... 0.964 0.895 1.041

00740 04 KANSAS* ........................................................................................................................................................... 0.964 0.895 1.041

00660 00 KENTUCKY ....................................................................................................................................................... 0.971 0.871 0.813

00528 01 NEW ORLEANS, LA .......................................................................................................................................... 0.999 0.948 1.075

00528 99 REST OF STATE .............................................................................................................................................. 0.969 0.876 0.972

31142 03 SOUTHERN MAINE .......................................................................................................................................... 0.980 1.032 0.734

31142 99 REST OF STATE .............................................................................................................................................. 0.962 0.925 0.734

00901 01 BALTIMORE/SURR. CNTYS, MD ..................................................................................................................... 1.020 1.038 1.107

00901 99 REST OF STATE .............................................................................................................................................. 0.984 0.969 0.864
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59257

ADDENDUM E.—1998 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY—Continued

Carrier

No.

Locality

No. Locality name Work Practiceexpense

Malpractice

31143 01 METROPOLITAN BOSTON .............................................................................................................................. 1.040 1.205 0.846

31143 99 REST OF STATE .............................................................................................................................................. 1.011 1.089 0.846

00623 01 DETROIT, MI ..................................................................................................................................................... 1.043 1.030 3.060

00623 99 REST OF STATE .............................................................................................................................................. 0.997 0.937 1.836

10240 00 MINNESOTA ...................................................................................................................................................... 0.990 0.966 0.551

10250 00 MISSISSIPPI ...................................................................................................................................................... 0.957 0.845 0.724

00740 02 METROPOLITAN KANSAS CITY, MO ............................................................................................................. 0.989 0.949 1.202

11260 01 METROPOLITAN ST. LOUIS, MO .................................................................................................................... 0.995 0.944 1.203

00740 99 REST OF STATE* ............................................................................................................................................. 0.946 0.831 1.162

11260 99 REST OF STATE* ............................................................................................................................................. 0.946 0.831 1.162

00751 01 MONTANA ......................................................................................................................................................... 0.952 0.871 0.744

00655 00 NEBRASKA ....................................................................................................................................................... 0.950 0.873 0.444

00834 00 NEVADA ............................................................................................................................................................ 1.006 1.030 0.942

31144 40 NEW HAMPSHIRE ............................................................................................................................................ 0.988 1.034 0.965

00860 01 NORTHERN NJ ................................................................................................................................................. 1.058 1.203 0.779

00860 99 REST OF STATE .............................................................................................................................................. 1.029 1.104 0.779

00521 05 NEW MEXICO ................................................................................................................................................... 0.974 0.907 0.754

00803 01 MANHATTAN, NY ............................................................................................................................................. 1.094 1.356 1.600

00803 02 NYC SUBURBS/LONG I., NY ........................................................................................................................... 1.068 1.234 1.846

00803 03 POUGHKPSIE/N NYC SUBURBS, NY ............................................................................................................. 1.011 1.083 1.272

14330 04 QUEENS, NY ..................................................................................................................................................... 1.058 1.237 1.763

00801 99 REST OF STATE .............................................................................................................................................. 1.000 0.957 0.807

05535 00 NORTH CAROLINA ........................................................................................................................................... 0.971 0.921 0.466

00820 01 NORTH DAKOTA .............................................................................................................................................. 0.951 0.869 0.637

16360 00 OHIO .................................................................................................................................................................. 0.991 0.940 1.062

00522 00 OKLAHOMA ....................................................................................................................................................... 0.969 0.881 0.437

00835 01 PORTLAND, OR ................................................................................................................................................ 0.997 1.011 0.612

00835 99 REST OF STATE .............................................................................................................................................. 0.962 0.934 0.612

00865 01 METROPOLITAN PHILADELPHIA, PA ............................................................................................................. 1.025 1.090 1.261

00865 99 REST OF STATE .............................................................................................................................................. 0.990 0.928 0.687

00973 20 PUERTO RICO .................................................................................................................................................. 0.883 0.734 0.314

00870 01 RHODE ISLAND ................................................................................................................................................ 1.019 1.072 1.379

00880 01 SOUTH CAROLINA ........................................................................................................................................... 0.976 0.902 0.321

00820 02 SOUTH DAKOTA .............................................................................................................................................. 0.936 0.865 0.439

05440 35 TENNESSEE ..................................................................................................................................................... 0.976 0.899 0.538

00900 31 AUSTIN, TX ....................................................................................................................................................... 0.987 0.993 0.838

00900 20 BEAUMONT, TX ................................................................................................................................................ 0.993 0.896 1.407

00900 09 BRAZORIA, TX .................................................................................................................................................. 0.993 0.972 1.407

00900 11 DALLAS, TX ...................................................................................................................................................... 1.011 1.014 0.912

00900 28 FORT WORTH, TX ............................................................................................................................................ 0.988 0.972 0.912

00900 15 GALVESTON, TX .............................................................................................................................................. 0.989 0.968 1.407

00900 18 HOUSTON, TX .................................................................................................................................................. 1.021 1.006 1.423

00900 99 REST OF STATE .............................................................................................................................................. 0.966 0.884 0.855

00910 09 UTAH ................................................................................................................................................................. 0.978 0.900 0.619

31145 50 VERMONT ......................................................................................................................................................... 0.974 0.986 0.500

00973 50 VIRGIN ISLANDS .............................................................................................................................................. 0.966 1.006 1.028

10490 00 VIRGINIA ........................................................................................................................................................... 0.986 0.940 0.538

00836 02 SEATTLE (KING CNTY), WA ............................................................................................................................ 1.006 1.079 0.745

00836 99 REST OF STATE .............................................................................................................................................. 0.983 0.969 0.745

16510 16 WEST VIRGINIA ................................................................................................................................................ 0.964 0.852 1.055

00951 00 WISCONSIN ...................................................................................................................................................... 0.982 0.930 1.001

00825 21 WYOMING ......................................................................................................................................................... 0.968 0.888 0.758

*Payment locality is serviced by two carriers.

Note: Work GPCI is the 1/4 work GPCI required by Section 1848(e)(1)(A)(iii) of the Social Security Act. GPCIs rescaled by the following factors to assure budget

neutrality: Work = 1.00027; Practice expense = 1.00057; Malpractice = 1.03174.

ADDENDUM F.—1999 VERSUS 1997 GEOGRAPHIC ADJUSTMENT FACTOR (GAF) BY 1998 FEE SCHEDULE AREA

Carrier

No.

Locality

No. Locality name 1999GAF

1997

GAF Difference Percentdifference

00973 50 VIRGIN ISLANDS .......................................................................................................... 0.997 0.974 0.023 2.4

00621 16 CHICAGO, IL ................................................................................................................. 1.084 1.066 0.018 1.7

00901 99 REST OF MARYLAND .................................................................................................. 0.980 0.964 0.016 1.7

00621 12 EAST ST. LOUIS, IL ...................................................................................................... 0.989 0.974 0.015 1.5

00528 99 REST OF LOUISIANA ................................................................................................... 0.936 0.926 0.010 1.1

00621 99 REST OF ILLINOIS ....................................................................................................... 0.933 0.924 0.009 1.0

00528 01 NEW ORLEANS, LA ...................................................................................................... 0.986 0.977 0.009 0.9

00820 01 NORTH DAKOTA .......................................................................................................... 0.906 0.898 0.008 0.9

00803 02 NYC SUBURBS/LONG I., NY ....................................................................................... 1.177 1.170 0.007 0.6

00834 00 NEVADA ........................................................................................................................ 1.016 1.010 0.006 0.6

00803 03 POUGHKPSIE/N NYC SUBURBS, NY ......................................................................... 1.056 1.050 0.006 0.6

00835 01 PORTLAND, OR ............................................................................................................ 0.987 0.981 0.006 0.6

00820 02 SOUTH DAKOTA .......................................................................................................... 0.886 0.880 0.006 0.7

00900 31 AUSTIN, TX ................................................................................................................... 0.985 0.979 0.006 0.6

16510 16 WEST VIRGINIA ............................................................................................................ 0.925 0.919 0.006 0.7
59258 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

ADDENDUM F.—1999 VERSUS 1997 GEOGRAPHIC ADJUSTMENT FACTOR (GAF) BY 1998 FEE SCHEDULE AREA—

Continued

Carrier

No.

Locality

No. Locality name 1999GAF

1997

GAF Difference Percentdifference

00824 01 COLORADO .................................................................................................................. 0.971 0.966 0.005 0.5

00900 99 REST OF TEXAS .......................................................................................................... 0.929 0.924 0.005 0.5

00910 09 UTAH ............................................................................................................................. 0.931 0.926 0.005 0.5

00836 99 REST OF WASHINGTON ............................................................................................. 0.968 0.963 0.005 0.5

31144 40 NEW HAMPSHIRE ........................................................................................................ 1.008 1.003 0.005 0.5

00511 01 ATLANTA, GA ............................................................................................................... 1.015 1.011 0.004 0.4

00511 99 REST OF GEORGIA ..................................................................................................... 0.940 0.936 0.004 0.4

05535 00 NORTH CAROLINA ....................................................................................................... 0.928 0.924 0.004 0.4

14330 04 QUEENS, NY ................................................................................................................. 1.167 1.163 0.004 0.3

00900 11 DALLAS, TX .................................................................................................................. 1.009 1.006 0.003 0.3

00751 01 MONTANA ..................................................................................................................... 0.910 0.907 0.003 0.3

00831 01 ALASKA ......................................................................................................................... 1.131 1.128 0.003 0.3

05130 00 IDAHO ............................................................................................................................ 0.913 0.911 0.002 0.2

00630 00 INDIANA ........................................................................................................................ 0.927 0.925 0.002 0.2

00660 00 KENTUCKY ................................................................................................................... 0.923 0.921 0.002 0.2

00803 01 MANHATTAN, NY ......................................................................................................... 1.227 1.225 0.002 0.2

00900 09 BRAZORIA, TX .............................................................................................................. 1.005 1.003 0.002 0.2

10490 00 VIRGINIA ....................................................................................................................... 0.946 0.944 0.002 0.2

31145 50 VERMONT ..................................................................................................................... 0.957 0.955 0.002 0.2

02050 18 LOS ANGELES .............................................................................................................. 1.104 1.103 0.001 0.1

10250 00 MISSISSIPPI .................................................................................................................. 0.900 0.899 0.001 0.1

00835 99 REST OF OREGON ...................................................................................................... 0.934 0.933 0.001 0.1

05440 35 TENNESSEE ................................................................................................................. 0.924 0.923 0.001 0.1

00590 03 FORT WORTH, TX ........................................................................................................ 0.978 0.977 0.001 0.1

00570 01 DELAWARE ................................................................................................................... 1.015 1.015 0.000 0.0

00640 00 IOWA ............................................................................................................................. 0.912 0.912 0.000 0.0

00623 99 REST OF MICHIGAN .................................................................................................... 1.013 1.013 0.000 0.0

00655 00 NEBRASKA ................................................................................................................... 0.894 0.894 0.000 0.0

16360 00 OHIO .............................................................................................................................. 0.973 0.973 0.000 0.0

00973 20 PUERTO RICO .............................................................................................................. 0.794 0.794 0.000 0.0

00900 18 HOUSTON, TX .............................................................................................................. 1.034 1.034 0.000 0.0

00900 20 BEAUMONT, TX ............................................................................................................ 0.973 0.973 0.000 0.0

00836 02 SEATTLE (KING CNTY), WA ........................................................................................ 1.023 1.023 0.000 0.0

00825 21 WYOMING ..................................................................................................................... 0.925 0.925 0.000 0.0

02050 99 REST OF CALIFORNIA* ............................................................................................... 1.007 1.008 ¥0.001 ¥0.1

31140 99 REST OF CALIFORNIA* ............................................................................................... 1.007 1.008 ¥0.001 ¥0.1

00520 13 ARKANSAS ................................................................................................................... 0.886 0.887 ¥0.001 ¥0.1

00832 00 ARIZONA ....................................................................................................................... 0.994 0.995 ¥0.001 ¥0.1

00740 02 METROPOLITAN KANSAS CITY, MO ......................................................................... 0.982 0.983 ¥0.001 ¥0.1

11260 01 METROPOLITAN ST. LOUIS, MO ................................................................................ 0.983 0.984 ¥0.001 ¥0.1

00801 99 REST OF NEW YORK .................................................................................................. 0.973 0.974 ¥0.001 ¥0.1

00901 01 BALTIMORE/SURR. CNTYS, MD ................................................................................. 1.031 1.032 ¥0.001 ¥0.1

00900 15 GALVESTON, TX .......................................................................................................... 1.000 1.001 ¥0.001 ¥0.1

00510 00 ALABAMA ...................................................................................................................... 0.930 0.932 ¥0.002 ¥0.2

02050 26 ANAHEIM/SANTA ANA, CA .......................................................................................... 1.090 1.092 ¥0.002 ¥0.2

00621 15 SUBURBAN CHICAGO, IL ............................................................................................ 1.048 1.050 ¥0.002 ¥0.2

00521 05 NEW MEXICO ............................................................................................................... 0.935 0.937 ¥0.002 ¥0.2

00522 00 OKLAHOMA ................................................................................................................... 0.908 0.910 ¥0.002 ¥0.2

00880 01 SOUTH CAROLINA ....................................................................................................... 0.913 0.915 ¥0.002 ¥0.2

00590 99 REST OF FLORIDA ...................................................................................................... 0.981 0.984 ¥0.003 ¥0.3

31142 99 REST OF MAINE ........................................................................................................... 0.934 0.937 ¥0.003 ¥0.3

00740 99 REST OF MISSOURI* ................................................................................................... 0.908 0.911 ¥0.003 ¥0.3

11260 99 REST OF MISSOURI* ................................................................................................... 0.908 0.911 ¥0.003 ¥0.3

00865 99 REST OF PENNSYLVANIA .......................................................................................... 0.948 0.951 ¥0.003 ¥0.3

10240 00 MINNESOTA .................................................................................................................. 0.957 0.961 ¥0.004 ¥0.4

31140 03 MARIN/NAPA/SOLANO, CA ......................................................................................... 1.058 1.063 ¥0.005 ¥0.5

31142 03 SOUTHERN MAINE ...................................................................................................... 0.987 0.992 ¥0.005 ¥0.5

31140 07 OAKLAND/BERKLEY, CA ............................................................................................. 1.086 1.092 ¥0.006 ¥0.5

10230 00 CONNECTICUT ............................................................................................................. 1.100 1.106 ¥0.006 ¥0.5

00623 01 DETROIT, MI ................................................................................................................. 1.131 1.137 ¥0.006 ¥0.5

00860 99 REST OF NEW JERSEY .............................................................................................. 1.044 1.051 ¥0.007 ¥0.7

00865 01 METROPOLITAN PHILADELPHIA, PA ......................................................................... 1.059 1.066 ¥0.007 ¥0.7

31140 06 SAN MATEO, CA .......................................................................................................... 1.122 1.130 ¥0.008 ¥0.7

00900 28 FORT LAUDERDALE, FL .............................................................................................. 1.046 1.055 ¥0.009 ¥0.9

31140 09 SANTA CLARA, CA ....................................................................................................... 1.125 1.134 ¥0.009 ¥0.8

00590 04 MIAMI, FL ...................................................................................................................... 1.105 1.114 ¥0.009 ¥0.8

31140 05 SAN FRANCISCO, CA .................................................................................................. 1.143 1.153 ¥0.010 ¥0.9

00580 01 DC +MD/VA SUBURBS ................................................................................................. 1.095 1.105 ¥0.010 ¥0.9

31143 99 REST OF MASSACHUSETTS ...................................................................................... 1.030 1.040 ¥0.010 ¥1.0

00860 01 NORTHERN NJ ............................................................................................................. 1.099 1.109 ¥0.010 ¥0.9

00650 00 KANSAS* ....................................................................................................................... 0.933 0.945 ¥0.012 ¥1.3

00740 04 KANSAS* ....................................................................................................................... 0.933 0.945 ¥0.012 ¥1.3

00951 00 WISCONSIN .................................................................................................................. 0.955 0.968 ¥0.013 ¥1.3

00833 01 HAWAII/GUAM .............................................................................................................. 1.072 1.086 ¥0.014 ¥1.3

31143 01 METROPOLITAN BOSTON .......................................................................................... 1.088 1.108 ¥0.020 ¥1.8
Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations 59259

ADDENDUM F.—1999 VERSUS 1997 GEOGRAPHIC ADJUSTMENT FACTOR (GAF) BY 1998 FEE SCHEDULE AREA—

Continued

Carrier

No.

Locality

No. Locality name 1999GAF

1997

GAF Difference Percentdifference

00870 01 RHODE ISLAND ............................................................................................................ 1.047 1.068 ¥0.021 ¥2.0

02050 17 VENTURA, CA ............................................................................................................... 1.055 1.079 ¥0.024 ¥2.2

*Payment locality is serviced by two carriers.

ADDENDUM G.—COUNTIES INCLUDED IN 1998 LOCALITIES

[Alphabetically by State and Locality Name Within State]

Carrier

No.

Locality

No. State Fee schedule area Counties

00510 00 ALABAMA .......................... STATEWIDE ................................................................... ALL COUNTIES.

00831 01 ALASKA ............................. STATEWIDE ................................................................... ALL COUNTIES.

00832 00 ARIZONA ........................... STATEWIDE ................................................................... ALL COUNTIES.

00520 13 ARKANSAS ....................... STATEWIDE ................................................................... ALL COUNTIES.

02050 26 CALIFORNIA ..................... ANAHEIM/SANTA ANA .................................................. ORANGE.

02050 18 ............................................ LOS ANGELES .............................................................. LOS ANGELES.

31140 03 ............................................ MARIN/NAPA/SOLANO ................................................. MARIN, NAPA, AND SOLANO.

31140 07 ............................................ OAKLAND/BERKLEY ..................................................... ALAMEDA AND CONTRA COSTA.

31140 05 ............................................ SAN FRANCISCO .......................................................... SAN FRANCISCO.

31140 06 ............................................ SAN MATEO .................................................................. SAN MATEO.

31140 09 ............................................ SANTA CLARA ............................................................... SANTA CLARA.

02050 17 ............................................ VENTURA ....................................................................... VENTURA.

02050 99 ............................................ REST OF STATE* .......................................................... ALL OTHER COUNTIES.

31140 99 ............................................ REST OF STATE* .......................................................... ALL OTHER COUNTIES.

00824 01 COLORADO ...................... STATEWIDE ................................................................... ALL COUNTIES.

10230 00 CONNECTICUT ................. STATEWIDE ................................................................... ALL COUNTIES.

00570 01 DELAWARE ....................... STATEWIDE ................................................................... ALL COUNTIES.

00580 01 DISTRICT OF COLUMBIA DC + MD/VA SUBURBS ................................................ DISTRICT OF COLUMBIA; ALEXANDRIA CITY, ARLINGTON, FAIRFAX, FAIRFAX CITY, FALLS

CHURCH CITY IN VIRGINIA; MONTGOMERY AND

PRINCE GEORGE’S IN MARYLAND.

00900 03 FLORIDA ........................... FORT LAUDERDALE ..................................................... BROWARD, COLLIER, INDIAN RIVER, LEE, MARTIN,

PALM BEACH, AND ST. LUCIE.

00590 04 ............................................ MIAMI ............................................................................. DADE AND MONROE.

00590 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

00511 01 GEORGIA .......................... ATLANTA ........................................................................ BUTTS, CHEROKEE, CLAYTON, COBB, DEKALB,

DOUGLAS, FAYETTE, FORSYTH, FULTON,

GWINNETT, HENRY, NEWTON, PAULDING,

ROCKDALE AND WALTON.

00511 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

00833 01 HAWAII/GUAM .................. STATEWIDE ................................................................... ALL COUNTIES.

05130 00 IDAHO ................................ STATEWIDE ................................................................... ALL COUNTIES.

00621 16 ILLINOIS ............................ CHICAGO ....................................................................... COOK.

00621 12 ............................................ EAST ST. LOUIS ............................................................ BOND, CALHOUN, CLINTON, JERSEY, MACOUPIN,

MADISON, MONROE, MONTGOMERY, RANDOLPH, ST. CLAIR AND WASHINGTON.

00621 15 ............................................ SUBURBAN CHICAGO .................................................. DUPAGE, KANE, LAKE AND WILL.

00621 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

00630 00 INDIANA ............................ STATEWIDE ................................................................... ALL COUNTIES.

00640 00 IOWA ................................. STATEWIDE ................................................................... ALL COUNTIES.

00650 00 KANSAS ............................ STATEWIDE* ................................................................. ALL COUNTIES.

00740 04 ............................................ STATEWIDE* ................................................................. ALL COUNTIES.

00660 00 KENTUCKY ....................... STATEWIDE ................................................................... ALL COUNTIES.

00528 01 LOUISIANA ........................ NEW ORLEANS ............................................................. JEFFERSON, ORLEANS, PLAQUEMINES AND ST.

BERNARD.

00528 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

31142 03 MAINE ................................ SOUTHERN MAINE ....................................................... CUMBERLAND AND YORK.

31142 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

00901 01 MARYLAND ....................... BALTIMORE/SURR. CNTYS ......................................... ANNE ARUNDEL, BALTIMORE, BALTIMORE CITY,

CARROLL, HARFORD AND HOWARD.

00901 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES EXCEPT MONTGOMERY

AND PRINCE GEORGE’S.

31143 01 MASSACHUSETTS ........... METROPOLITAN BOSTON ........................................... MIDDLESEX, NORFOLK AND SUFFOLK.

31143 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

00623 01 MICHIGAN ......................... DETROIT ........................................................................ MACOMB, OAKLAND, WASHTENAW AND WAYNE.

00623 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

10240 00 MINNESOTA ...................... STATEWIDE ................................................................... ALL COUNTIES.

10250 00 MISSISSIPPI ...................... STATEWIDE ................................................................... ALL COUNTIES.

00740 02 MISSOURI ......................... METROPOLITAN KANSAS CITY .................................. CLAY, JACKSON AND PLATTE.

11260 01 ............................................ METROPOLITAN ST. LOUIS ......................................... JEFFERSON, ST. CHARLES, ST. LOUIS AND ST.

LOUIS CITY.

00740 99 ............................................ REST OF STATE* .......................................................... ALL OTHER COUNTIES.

11260 99 ............................................ REST OF STATE* .......................................................... ALL OTHER COUNTIES.

00751 01 MONTANA ......................... STATEWIDE ................................................................... ALL COUNTIES.
59260 Federal Register / Vol. 62, No. 211 / Friday, October 31, 1997 / Rules and Regulations

ADDENDUM G.—COUNTIES INCLUDED IN 1998 LOCALITIES—Continued

[Alphabetically by State and Locality Name Within State]

Carrier

No.

Locality

No. State Fee schedule area Counties

00655 00 NEBRASKA ....................... STATEWIDE ................................................................... ALL COUNTIES.

00834 00 NEVADA ............................ STATEWIDE ................................................................... ALL COUNTIES.

31144 40 NEW HAMPSHIRE ............ STATEWIDE ................................................................... ALL COUNTIES.

00860 01 NEW JERSEY ................... NORTHERN NJ .............................................................. BERGEN, ESSEX, HUDSON, HUNTERDON, MIDDLESEX, MORRIS, PASSAIC, SOMERSET, SUSSEX,

UNION AND WARREN.

00860 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

00521 05 NEW MEXICO ................... STATEWIDE ................................................................... ALL COUNTIES.

00803 01 NEW YORK ....................... MANHATTAN ................................................................. NEW YORK.

00803 02 ............................................ NYC SUBURBS/LONG ISLAND .................................... BRONX, KINGS, NASSAU, RICHMOND, ROCKLAND,

SUFFOLK AND WESTCHESTER.

00803 03 ............................................ POUGHKPSIE/N NYC SUBURBS ................................. COLUMBIA, DELAWARE, DUTCHESS, GREENE, ORANGE, PUTNAM, SULLIVAN AND ULSTER.

14330 04 ............................................ QUEENS ......................................................................... QUEENS.

00801 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

05535 00 NORTH CAROLINA ........... STATEWIDE ................................................................... ALL COUNTIES.

00820 01 NORTH DAKOTA .............. STATEWIDE ................................................................... ALL COUNTIES.

16360 00 OHIO .................................. STATEWIDE ................................................................... ALL COUNTIES.

00522 00 OKLAHOMA ....................... STATEWIDE ................................................................... ALL COUNTIES.

00835 01 OREGON ........................... PORTLAND .................................................................... CLACKAMAS, MULTNOMAH AND WASHINGTON.

00835 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

00865 01 PENNSYLVANIA ............... METROPOLITAN PHILADELPHIA ................................ BUCKS, CHESTER, DELAWARE, MONTGOMERY

AND PHILADELPHIA.

00865 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

00973 20 PUERTO RICO .................. PUERTO RICO ............................................................... ALL COUNTY EQUIVALENTS.

00870 01 RHODE ISLAND ................ STATEWIDE ................................................................... ALL COUNTIES.

00880 01 SOUTH CAROLINA ........... STATEWIDE ................................................................... ALL COUNTIES.

00820 02 SOUTH DAKOTA .............. STATEWIDE ................................................................... ALL COUNTIES.

05440 35 TENNESSEE ..................... STATEWIDE ................................................................... ALL COUNTIES.

00900 31 TEXAS ............................... AUSTIN ........................................................................... TRAVIS.

00900 20 ............................................ BEAUMONT ................................................................... JEFFERSON.

00900 09 ............................................ BRAZORIA ..................................................................... BRAZORIA.

00900 11 ............................................ DALLAS .......................................................................... DALLAS.

00590 03 ............................................ FORT WORTH ............................................................... TARRANT.

00900 15 ............................................ GALVESTON .................................................................. GALVESTON.

00900 18 ............................................ HOUSTON ...................................................................... HARRIS.

00900 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

00910 09 UTAH ................................. STATEWIDE ................................................................... ALL COUNTIES.

31145 50 VERMONT ......................... STATEWIDE ................................................................... ALL COUNTIES.

00973 50 VIRGIN ISLANDS .............. VIRGIN ISLANDS ........................................................... ALL COUNTY EQUIVALENTS.

10490 00 VIRGINIA ........................... STATEWIDE ................................................................... ALL COUNTIES, EXCEPT ALEXANDRIA CITY, ARLINGTON, FAIRFAX, FAIRFAX CITY, AND FALLS

CHURCH CITY.

00836 02 WASHINGTON .................. SEATTLE (KING CNTY) ................................................ KING.

00836 99 ............................................ REST OF STATE ........................................................... ALL OTHER COUNTIES.

16510 16 WEST VIRGINIA ................ STATEWIDE ................................................................... ALL COUNTIES.

00951 00 WISCONSIN ...................... STATEWIDE ................................................................... ALL COUNTIES.

00825 21 WYOMING ......................... STATEWIDE ................................................................... ALL COUNTIES.

*Payment locality is serviced by two carriers.

[FR Doc. 97–28973 Filed 10–30–97; 8:45 am]

BILLING CODE 4120–03–P